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The Hygiene Hypothesis : Aeroallergen Sensitization in Allergic Rhinitis Patients Living in Rural and Urban Areas of Lebanon
AB36 Abstracts
SATURDAY
131
The Hygiene Hypothesis : Aeroallergen Sensitization in Allergic Rhinitis Patients Living in Rural and Urban Areas of Lebanon Carla Irani, MD, FAAAAI1,2, Maya Mouzannar1; 1Hotel Dieu de France hospital, Beirut, Lebanon, 2University of Alberta, Edmonton, Canada. RATIONALE: The hygiene hypothesis suggests that in some rural areas,overcrowding, unhygienic conditions and larger family size were associated with a lower prevalence of allergic rhinitis and asthma. The primary objective of this study is to compare aeroallergen sensitization in patients with allergic rhinitis living in urban Beirut, and rural South of Lebanon. METHODS: It is a retrospective study observational, multivarite of allergic rhinitis patients treated between 2002 and 2010 in Beirut and the South of Lebanon. One hundred patients of each area were included in the study. RESULTS: 200 patients divided in two equal groups were evaluated with a sex-ratio 1-1. Mean age of allergic rhinitis patients was 14,2 years in the South of Lebanon, and 23.4 years in Beirut. The 2 groups were statistically equivalent concerning tobacco exposure, exposure to dust mites and antibiotic intake in childhood. Patients with allergic rhinitis living in Beirut were more sensitized to pollen with a significant p50.036. There was no significant difference regarding sensitization to dust mites although the number was higher for those living in Beirut. CONCLUSIONS: Differences in the prevalence of allergic disease between urban and rural areas have been observed in many parts of the world. Our study, the first of its kind in Lebanon, showed pollen sensitization to be higher in urban than rural areas. There was no significant difference regarding dust mites sensitization in both groups, maybe due to environmental factors or lower age. Asthma prevalence was similar in both groups.
132
The Immunoglobulin Diagnosis, Evaluation, and Key Learnings (IDEaL) Patient Registry: An Initial Two-Year Data Survey From a Longitudinal Registry of Patients On Immunoglobulin Replacement Therapy in an Alternate Care Setting Sean Kearns, PhD1, Keith Crawford1, Loretta Kristofek, RN1, Robbyn Kirylo1, Luqman Seidu, MD2; 1Coram Clinical Trials, Denver, CO, 2 Allergy and Asthma of Atlanta, LLC, Atlanta, GA. RATIONALE: The IDEaL Patient Registry collects longitudinal information on patients receiving immunoglobulin (Ig) replacement therapy from Coram Specialty Infusion Services in an alternate care setting. This survey reveals the results of an initial two-year data collection focused on outcomes and effectiveness. METHODS: Patients from our 133 investigators are eligible. With patient consent acquired, patient information from July 2010 onward that had been collected by Coram providers was entered into the IDEaL database. Additionally, patients were asked to complete an SF-36 questionnaire and a Life Quality Index survey every 6 months. RESULTS: As of summer 2012, 207 patients were enrolled, with 91% (191 patients) being referred for primary immune deficiency. At the time they started treatment with Coram, 90% of the patients were over the age of 18, with 32% aged 65 or older. Sixty-five percent of the patients received subcutaneous Ig. Baseline IgG levels averaged 536 mg/dL. For immune deficiencies, the average, intravenous dose was 458 mg/kg; the average subcutaneous dose was 129 mg/kg. Twelve percent reported headaches, and 18% reported skin reactions. For patients on service at least one year, average infection incidence was reported at 2.52 infections per year. CONCLUSIONS: These results from the IDEaL Registry create an overall profile of patients receiving Ig. Key findings include that a significant majority receives their dose via subcutaneous administration, and that overall infection incidence appears to be low. Registry data will contribute to existing research by filling in gaps and contributing information on ‘‘real world usage’’ of Ig across multiple conditions, products, and doses.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
133
Epinephrine Preparedness in a Food-Allergic Pediatric Patient Population Casey Curtis, MD1, David R. Stukus, MD, FAAAAI2, Rebecca Scherzer, MD, FAAAAI3, Kara Simonson, MD1; 1Nationwide Children’s Hospital, 2Nationwide Children’s Hospital, New Albany, OH, 3Nationwide Children’s Hospital, Columbus, OH. RATIONALE: Early administration of epinephrine is known to decrease the risk of death secondary to anaphylaxis. Our goal was to assess access to self-injectable epinephrine in a population at risk for anaphylaxis. METHODS: A questionnaire was provided to all patients with a diagnosis of food allergy over a four-week period who presented to the outpatient allergy clinic at a tertiary care referral center. RESULTS: Thirty-five surveys were collected; 20% of respondents reported a prior allergic reaction to food requiring self-administered epinephrine. Of these, 29% had self-injectable epinephrine present when the survey was administered. 60% of all patients endorsed carrying selfinjectable epinephrine at all times, but only 40% could produce the medication at that time. Of those with self-injectable epinephrine available at the time of survey, nearly 50% were expired, and 86% had the appropriate dose. Peanut allergy was reported in 86% of respondents, with 43% of these patients having self-injectable epinephrine available. Of the 60% of the subjects also diagnosed with asthma, 38% had selfinjectable epinephrine available. 29% of patients reported an accidental exposure to food allergen in the past year, but only 30% of those had epinephrine available. Reasons given for not having self-injectable epinephrine available included: availability in other places such as home or school, expiration of the previous prescription, and lack of awareness that it was supposed to be carried at all times. CONCLUSIONS: Despite the known efficacy of epinephrine in treatment of anaphylaxis, the availability of self-injectable epinephrine is low in a population of pediatric patients at risk for anaphylaxis.
134
Multi-Grass Pollen Immunotherapy Confers Quality Broad Spectrum Treatment Alan D. Bullimore, Murray Skinner; Allergy Therapeutics. RATIONALE: An immunotherapeutic composed solely of one grass species will target a limited patient population compared with a grass mix therapeutic. METHODS: We investigated the 13 common grasses used within the largest placebo-controlled allergy vaccine study ever conducted to assess key parameters relating to grass similarity and difference. Each grass was analysed for major allergen, IgG & IgE reactivity by inhibition ELISA and total protein content. Furthermore, using sera from grass sensitive patients we experimentally blocked reactivity to all Timothy grass allergens. This allowed us to distinguish whether there are any allergens in other grasses which are not cross-reactive with Timothy grass allergens. RESULTS: Each grass species is distinct in having a unique allergen finger-print and biochemical profile. This suggests therapy composed of a mix of grasses potentially contributes protection to a more diverse grass sensitive population. A sera pool composed of as few as 8 patients demonstrated reactivity to allergens not present in a Timothy grass extract for all of the other 12 common grasses. Therefore it can be inferred that patients sensitive to the unique, non-cross reactive allergens of a specific grass species may additionally benefit from the approach of multiple pollen inclusion. The presence of major allergens in each grass pollen species demonstrates that the inclusion of more than one species does not dilute the major allergen content and thus patients sensitised to major allergens are not disadvantaged, however patients solely sensitised to minor allergens still benefit. CONCLUSIONS: Propensity to treat broad-spectrum grass allergy is limited with an exemplar-based grass product.
SATURDAY
131
The Hygiene Hypothesis : Aeroallergen Sensitization in Allergic Rhinitis Patients Living in Rural and Urban Areas of Lebanon Carla Irani, MD, FAAAAI1,2, Maya Mouzannar1; 1Hotel Dieu de France hospital, Beirut, Lebanon, 2University of Alberta, Edmonton, Canada. RATIONALE: The hygiene hypothesis suggests that in some rural areas,overcrowding, unhygienic conditions and larger family size were associated with a lower prevalence of allergic rhinitis and asthma. The primary objective of this study is to compare aeroallergen sensitization in patients with allergic rhinitis living in urban Beirut, and rural South of Lebanon. METHODS: It is a retrospective study observational, multivarite of allergic rhinitis patients treated between 2002 and 2010 in Beirut and the South of Lebanon. One hundred patients of each area were included in the study. RESULTS: 200 patients divided in two equal groups were evaluated with a sex-ratio 1-1. Mean age of allergic rhinitis patients was 14,2 years in the South of Lebanon, and 23.4 years in Beirut. The 2 groups were statistically equivalent concerning tobacco exposure, exposure to dust mites and antibiotic intake in childhood. Patients with allergic rhinitis living in Beirut were more sensitized to pollen with a significant p50.036. There was no significant difference regarding sensitization to dust mites although the number was higher for those living in Beirut. CONCLUSIONS: Differences in the prevalence of allergic disease between urban and rural areas have been observed in many parts of the world. Our study, the first of its kind in Lebanon, showed pollen sensitization to be higher in urban than rural areas. There was no significant difference regarding dust mites sensitization in both groups, maybe due to environmental factors or lower age. Asthma prevalence was similar in both groups.
132
The Immunoglobulin Diagnosis, Evaluation, and Key Learnings (IDEaL) Patient Registry: An Initial Two-Year Data Survey From a Longitudinal Registry of Patients On Immunoglobulin Replacement Therapy in an Alternate Care Setting Sean Kearns, PhD1, Keith Crawford1, Loretta Kristofek, RN1, Robbyn Kirylo1, Luqman Seidu, MD2; 1Coram Clinical Trials, Denver, CO, 2 Allergy and Asthma of Atlanta, LLC, Atlanta, GA. RATIONALE: The IDEaL Patient Registry collects longitudinal information on patients receiving immunoglobulin (Ig) replacement therapy from Coram Specialty Infusion Services in an alternate care setting. This survey reveals the results of an initial two-year data collection focused on outcomes and effectiveness. METHODS: Patients from our 133 investigators are eligible. With patient consent acquired, patient information from July 2010 onward that had been collected by Coram providers was entered into the IDEaL database. Additionally, patients were asked to complete an SF-36 questionnaire and a Life Quality Index survey every 6 months. RESULTS: As of summer 2012, 207 patients were enrolled, with 91% (191 patients) being referred for primary immune deficiency. At the time they started treatment with Coram, 90% of the patients were over the age of 18, with 32% aged 65 or older. Sixty-five percent of the patients received subcutaneous Ig. Baseline IgG levels averaged 536 mg/dL. For immune deficiencies, the average, intravenous dose was 458 mg/kg; the average subcutaneous dose was 129 mg/kg. Twelve percent reported headaches, and 18% reported skin reactions. For patients on service at least one year, average infection incidence was reported at 2.52 infections per year. CONCLUSIONS: These results from the IDEaL Registry create an overall profile of patients receiving Ig. Key findings include that a significant majority receives their dose via subcutaneous administration, and that overall infection incidence appears to be low. Registry data will contribute to existing research by filling in gaps and contributing information on ‘‘real world usage’’ of Ig across multiple conditions, products, and doses.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
133
Epinephrine Preparedness in a Food-Allergic Pediatric Patient Population Casey Curtis, MD1, David R. Stukus, MD, FAAAAI2, Rebecca Scherzer, MD, FAAAAI3, Kara Simonson, MD1; 1Nationwide Children’s Hospital, 2Nationwide Children’s Hospital, New Albany, OH, 3Nationwide Children’s Hospital, Columbus, OH. RATIONALE: Early administration of epinephrine is known to decrease the risk of death secondary to anaphylaxis. Our goal was to assess access to self-injectable epinephrine in a population at risk for anaphylaxis. METHODS: A questionnaire was provided to all patients with a diagnosis of food allergy over a four-week period who presented to the outpatient allergy clinic at a tertiary care referral center. RESULTS: Thirty-five surveys were collected; 20% of respondents reported a prior allergic reaction to food requiring self-administered epinephrine. Of these, 29% had self-injectable epinephrine present when the survey was administered. 60% of all patients endorsed carrying selfinjectable epinephrine at all times, but only 40% could produce the medication at that time. Of those with self-injectable epinephrine available at the time of survey, nearly 50% were expired, and 86% had the appropriate dose. Peanut allergy was reported in 86% of respondents, with 43% of these patients having self-injectable epinephrine available. Of the 60% of the subjects also diagnosed with asthma, 38% had selfinjectable epinephrine available. 29% of patients reported an accidental exposure to food allergen in the past year, but only 30% of those had epinephrine available. Reasons given for not having self-injectable epinephrine available included: availability in other places such as home or school, expiration of the previous prescription, and lack of awareness that it was supposed to be carried at all times. CONCLUSIONS: Despite the known efficacy of epinephrine in treatment of anaphylaxis, the availability of self-injectable epinephrine is low in a population of pediatric patients at risk for anaphylaxis.
134
Multi-Grass Pollen Immunotherapy Confers Quality Broad Spectrum Treatment Alan D. Bullimore, Murray Skinner; Allergy Therapeutics. RATIONALE: An immunotherapeutic composed solely of one grass species will target a limited patient population compared with a grass mix therapeutic. METHODS: We investigated the 13 common grasses used within the largest placebo-controlled allergy vaccine study ever conducted to assess key parameters relating to grass similarity and difference. Each grass was analysed for major allergen, IgG & IgE reactivity by inhibition ELISA and total protein content. Furthermore, using sera from grass sensitive patients we experimentally blocked reactivity to all Timothy grass allergens. This allowed us to distinguish whether there are any allergens in other grasses which are not cross-reactive with Timothy grass allergens. RESULTS: Each grass species is distinct in having a unique allergen finger-print and biochemical profile. This suggests therapy composed of a mix of grasses potentially contributes protection to a more diverse grass sensitive population. A sera pool composed of as few as 8 patients demonstrated reactivity to allergens not present in a Timothy grass extract for all of the other 12 common grasses. Therefore it can be inferred that patients sensitive to the unique, non-cross reactive allergens of a specific grass species may additionally benefit from the approach of multiple pollen inclusion. The presence of major allergens in each grass pollen species demonstrates that the inclusion of more than one species does not dilute the major allergen content and thus patients sensitised to major allergens are not disadvantaged, however patients solely sensitised to minor allergens still benefit. CONCLUSIONS: Propensity to treat broad-spectrum grass allergy is limited with an exemplar-based grass product.