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The Multiple Open Food Allergen Challenge Test in Children with Moderate to Severe Atopic Dermatitis
AB100 Abstracts
362
SUNDAY
Differences in Dietary Management of Infant Atopic Dermatitis Among Pediatricians, Allergists, and Dermatologists in the United States Laura Czerkies, MS, RD1, Erica Horodniceanu2, Vardhaman Patel2,3, Marc Botteman, MSc2, Jose Saavedra, MD1; 1Nestle Nutrition, Florham Park, NJ, 2Pharmerit International, Bethesda, MD, 3College of Pharmacy, University of Illinois, Chicago, IL. RATIONALE: Cow milk-based formula use is one etiologic factor of atopic dermatitis (AD), the most common chronic skin disease of infancy. However, data regarding clinical management practices of AD are limited. One study objective was to estimate differences among specialties in the use of formula change for dietary management of AD in non-exclusively breastfed infants <1 year of age. METHODS: A convenience sample of U.S. physicians (101 pediatricians [PED], 26 pediatric dermatologists [DERM], 26 pediatric allergistsimmunologists [ALLER]) completed a web-based survey exploring management of AD. Dietary management results are reported with differences among specialties detected using Kruskal-Wallis for ordinal and Fisher’s exact test for nominal variables. RESULTS: Most physicians (92.8%) had been practicing >5 years, and 80.4% treated >50 AD patients during the past year. Overall, 59.4% PED, 61.5% ALLER, and 26.9% DERM use formula change alone in >5% of infants for AD management. When infants are receiving intact protein formula, 44.0% PED, 45.8% ALLER, and 73.7% DERM recommend change to soy-based formula, and 46.2 % PED, 41.7% ALLER, and 15.8% of DERM recommend extensively hydrolyzed formula (EHF) (p50.06). For infants receiving partially hydrolyzed formula, 61.5% PED, 50.0% ALLER and 36.8% DERM recommend EHF (p50.01). For infants already consuming EHF, amino acid-based formulas are recommended by 62.6% PED, 66.7% ALLER, and 26.3% of DERM (p<0.001). CONCLUSIONS: In non-exclusively breastfed infants with AD, infant formula change is a common management approach, with significant variations among specialties. Despite recommendations to the contrary, soy-based formulas continue to be widely used as an alternative in managing atopic conditions.
363
The Multiple Open Food Allergen Challenge Test in Children with Moderate to Severe Atopic Dermatitis Jae Ho Lee, MD, PhD1, Eun Kyung Lim2, Eun Ae Yang1; 1Department of Pediatrics, Chungnam National University, Taejeon, South Korea, 2 Department of Pediatrics, Cungnam National University, Taejeon, South Korea. RATIONALE: The food allergy is closely related with the moderate to severe atopic dermatitis (AD). The multiple food elimination and challenge test was performed to evaluate clinical relevance of food allergy and identify the accurate diagnosis of multiple food allergy with moderate to severe AD in children. METHODS: The multiple food allergic patients with moderate to severe AD aged 2 to 14 years (n 520) had hypoallergenic diet for 1 to 4 weeks and underwent open food challenges (OFC) to milk, egg, wheat, soy. And the food specific IgE was also checked. RESULTS: The total of 64 OFCs were performed in 20 patients and the mean number of challenges per patient was 3.2. In 64 positive challenges to food allergens, 23% showed early reactions within two hours of challenge. The milk was the most frequent. Late-onset reaction occurred from 3 hours after challenge in 77%. 56% of positive OFC were negative for specific IgE. The 9 of 12 early reactions (75%) and 9 of 31 late reactions (29.0%) were IgE-mediated. The sensitization of specific food was not correlated with positive OFCs. Only the egg showed significance between specific IgE and reaction type. (P50.02) CONCLUSIONS: Our results indicated that a large part of the positive OFCs seemed to occur in non specific IgE-sensitized patients. Serial food challenges after strict food restriction in children with moderate to severe AD can play significant role in the diagnosis of undisclosed food allergy and treatment of AD.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
364
Parental Survey Concerning Pediatric Atopic Dermatitis and Bathing Frequency Recommendations by Providers: An Area of Uncertainty and Frustration Erin Kempe1, Ivan D. Cardona, MD1,2, Neal Jain, MD FAAAAI3; 1Maine Medical Center, Portland, ME, 2Allergy and Asthma Associates of Maine, Portland, ME, 3San Tan Allergy, Gilbert, AZ. RATIONALE: Studies evaluating bathing frequency in pediatric atopic dermatitis (AD) are lacking. Advice given by providers and received by parents concerning bathing frequency in AD remains unclear. METHODS: A web-based survey was conducted among parents of children with AD who are members of the National Eczema Association (NEA). The survey examined which type of physician managed the patients’ AD and what they recommended concerning bathing frequency. Families reporting seeing more than one provider were asked if conflicting advice on bathing frequency was received and if this was a source of frustration. RESULTS: A total of 354 NEA parents participated. For AD management, 68.9% (95% CI 63.8-73.6) versus 31.1% (95% CI 26.4-36.2) reported seeing a specialist (i.e. allergist or dermatologist) versus their PCP. Of those managed by a specialist, 55% were advised to bathe daily (95% CI 49.5-60.4), 27.2% to bathe less than daily (95% CI 22.6-32.3), and 17.8% (95% CI 14-22.4) did not receive advice regarding bathing frequency. For those managed by their PCP, 42.3% were told to bathe daily (95% CI 37.1-47.6), 33% less than daily (95% CI 28.2-38.2), and a quarter did not receive any advice (95% CI 20.4-29.6). For those who saw more than one provider and received conflicting advice (45.6%; CI 40.2-52.1), 76.4% (95% CI 68.8-82.6) reported a feeling of confusion or frustration. CONCLUSIONS: There is no consensus among allergists, dermatologists, or PCPs concerning bathing frequency in pediatric AD. This conflicting advice is a source of frustration for families dealing with an already difficult to control chronic skin condition.
365
Allergen-Specific Immunotherapy (ASIT) Effect On Quality of Life (QOL) in Children with Moderate (MAD) and Severe (SAD) Atopic Dermatitis Tatiana Slavyanskaya, MD, PhD1,2, Vladislava Derkach, PhD2,3; 1 University of Russia, Moscow, Russia, 2Institute of Immunophysiology, Moscow, Russia, 3Vladivostok State Medical University, Vladivostok, Russia. RATIONALE: The effect of ASIT with house dust mite allergens (HDMA) on QOL in AD Ch was assessed. METHODS: The study has included 64 children from 7-18 years old with MAD and SAD. At baseline specific IgE to domestic and epidermal allergens was identified. ASIT was performed by subcutaneous injecting of HDMA 3 times in dilutions from 1:1000000 to 1:1000 with minimum 2 hours intervals. The 1:100 and 1:10 diluted allergens were introduced once a week. Initial course duration was 1 month. Supporting course (1–2 subcutaneous injections a month depending on tolerability) lasted for 2 years 11 months. QOL in AD children was estimated by points using Dermatology specific quality of life questionnaire at baseline and after 3 years of ASIT. RESULTS: There was significant negative disease effect on QOL observed in MAD and SAD patients. The most distressing symptoms were pruritus (3.6960.22), xerodermia (3.3460.23), physical discomfort (3.1360.14), sleep disorders. Cumulative value according ‘‘Activities of Daily Living Scale’’ was 3.1860.23. Mean value according ‘‘Self-perception Scale’’ was 3.2260.24. Social activity was reduced one-half. Teenagers were mostly limited in school advances. The major effect on mental status was made by mental anguish, confusion due to skin view, annoyance due to appearance. Three years after ASIT beginning negative disease effect on QOL (p<0.05) and confusion due to skin view (p<0,05) decreased, the AD severity improved, daily living and social activity increased. The most significant symptom was xerodermia. CONCLUSIONS: ASIT provides AD control, significant severity reduction and thus QOL improvement.
362
SUNDAY
Differences in Dietary Management of Infant Atopic Dermatitis Among Pediatricians, Allergists, and Dermatologists in the United States Laura Czerkies, MS, RD1, Erica Horodniceanu2, Vardhaman Patel2,3, Marc Botteman, MSc2, Jose Saavedra, MD1; 1Nestle Nutrition, Florham Park, NJ, 2Pharmerit International, Bethesda, MD, 3College of Pharmacy, University of Illinois, Chicago, IL. RATIONALE: Cow milk-based formula use is one etiologic factor of atopic dermatitis (AD), the most common chronic skin disease of infancy. However, data regarding clinical management practices of AD are limited. One study objective was to estimate differences among specialties in the use of formula change for dietary management of AD in non-exclusively breastfed infants <1 year of age. METHODS: A convenience sample of U.S. physicians (101 pediatricians [PED], 26 pediatric dermatologists [DERM], 26 pediatric allergistsimmunologists [ALLER]) completed a web-based survey exploring management of AD. Dietary management results are reported with differences among specialties detected using Kruskal-Wallis for ordinal and Fisher’s exact test for nominal variables. RESULTS: Most physicians (92.8%) had been practicing >5 years, and 80.4% treated >50 AD patients during the past year. Overall, 59.4% PED, 61.5% ALLER, and 26.9% DERM use formula change alone in >5% of infants for AD management. When infants are receiving intact protein formula, 44.0% PED, 45.8% ALLER, and 73.7% DERM recommend change to soy-based formula, and 46.2 % PED, 41.7% ALLER, and 15.8% of DERM recommend extensively hydrolyzed formula (EHF) (p50.06). For infants receiving partially hydrolyzed formula, 61.5% PED, 50.0% ALLER and 36.8% DERM recommend EHF (p50.01). For infants already consuming EHF, amino acid-based formulas are recommended by 62.6% PED, 66.7% ALLER, and 26.3% of DERM (p<0.001). CONCLUSIONS: In non-exclusively breastfed infants with AD, infant formula change is a common management approach, with significant variations among specialties. Despite recommendations to the contrary, soy-based formulas continue to be widely used as an alternative in managing atopic conditions.
363
The Multiple Open Food Allergen Challenge Test in Children with Moderate to Severe Atopic Dermatitis Jae Ho Lee, MD, PhD1, Eun Kyung Lim2, Eun Ae Yang1; 1Department of Pediatrics, Chungnam National University, Taejeon, South Korea, 2 Department of Pediatrics, Cungnam National University, Taejeon, South Korea. RATIONALE: The food allergy is closely related with the moderate to severe atopic dermatitis (AD). The multiple food elimination and challenge test was performed to evaluate clinical relevance of food allergy and identify the accurate diagnosis of multiple food allergy with moderate to severe AD in children. METHODS: The multiple food allergic patients with moderate to severe AD aged 2 to 14 years (n 520) had hypoallergenic diet for 1 to 4 weeks and underwent open food challenges (OFC) to milk, egg, wheat, soy. And the food specific IgE was also checked. RESULTS: The total of 64 OFCs were performed in 20 patients and the mean number of challenges per patient was 3.2. In 64 positive challenges to food allergens, 23% showed early reactions within two hours of challenge. The milk was the most frequent. Late-onset reaction occurred from 3 hours after challenge in 77%. 56% of positive OFC were negative for specific IgE. The 9 of 12 early reactions (75%) and 9 of 31 late reactions (29.0%) were IgE-mediated. The sensitization of specific food was not correlated with positive OFCs. Only the egg showed significance between specific IgE and reaction type. (P50.02) CONCLUSIONS: Our results indicated that a large part of the positive OFCs seemed to occur in non specific IgE-sensitized patients. Serial food challenges after strict food restriction in children with moderate to severe AD can play significant role in the diagnosis of undisclosed food allergy and treatment of AD.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
364
Parental Survey Concerning Pediatric Atopic Dermatitis and Bathing Frequency Recommendations by Providers: An Area of Uncertainty and Frustration Erin Kempe1, Ivan D. Cardona, MD1,2, Neal Jain, MD FAAAAI3; 1Maine Medical Center, Portland, ME, 2Allergy and Asthma Associates of Maine, Portland, ME, 3San Tan Allergy, Gilbert, AZ. RATIONALE: Studies evaluating bathing frequency in pediatric atopic dermatitis (AD) are lacking. Advice given by providers and received by parents concerning bathing frequency in AD remains unclear. METHODS: A web-based survey was conducted among parents of children with AD who are members of the National Eczema Association (NEA). The survey examined which type of physician managed the patients’ AD and what they recommended concerning bathing frequency. Families reporting seeing more than one provider were asked if conflicting advice on bathing frequency was received and if this was a source of frustration. RESULTS: A total of 354 NEA parents participated. For AD management, 68.9% (95% CI 63.8-73.6) versus 31.1% (95% CI 26.4-36.2) reported seeing a specialist (i.e. allergist or dermatologist) versus their PCP. Of those managed by a specialist, 55% were advised to bathe daily (95% CI 49.5-60.4), 27.2% to bathe less than daily (95% CI 22.6-32.3), and 17.8% (95% CI 14-22.4) did not receive advice regarding bathing frequency. For those managed by their PCP, 42.3% were told to bathe daily (95% CI 37.1-47.6), 33% less than daily (95% CI 28.2-38.2), and a quarter did not receive any advice (95% CI 20.4-29.6). For those who saw more than one provider and received conflicting advice (45.6%; CI 40.2-52.1), 76.4% (95% CI 68.8-82.6) reported a feeling of confusion or frustration. CONCLUSIONS: There is no consensus among allergists, dermatologists, or PCPs concerning bathing frequency in pediatric AD. This conflicting advice is a source of frustration for families dealing with an already difficult to control chronic skin condition.
365
Allergen-Specific Immunotherapy (ASIT) Effect On Quality of Life (QOL) in Children with Moderate (MAD) and Severe (SAD) Atopic Dermatitis Tatiana Slavyanskaya, MD, PhD1,2, Vladislava Derkach, PhD2,3; 1 University of Russia, Moscow, Russia, 2Institute of Immunophysiology, Moscow, Russia, 3Vladivostok State Medical University, Vladivostok, Russia. RATIONALE: The effect of ASIT with house dust mite allergens (HDMA) on QOL in AD Ch was assessed. METHODS: The study has included 64 children from 7-18 years old with MAD and SAD. At baseline specific IgE to domestic and epidermal allergens was identified. ASIT was performed by subcutaneous injecting of HDMA 3 times in dilutions from 1:1000000 to 1:1000 with minimum 2 hours intervals. The 1:100 and 1:10 diluted allergens were introduced once a week. Initial course duration was 1 month. Supporting course (1–2 subcutaneous injections a month depending on tolerability) lasted for 2 years 11 months. QOL in AD children was estimated by points using Dermatology specific quality of life questionnaire at baseline and after 3 years of ASIT. RESULTS: There was significant negative disease effect on QOL observed in MAD and SAD patients. The most distressing symptoms were pruritus (3.6960.22), xerodermia (3.3460.23), physical discomfort (3.1360.14), sleep disorders. Cumulative value according ‘‘Activities of Daily Living Scale’’ was 3.1860.23. Mean value according ‘‘Self-perception Scale’’ was 3.2260.24. Social activity was reduced one-half. Teenagers were mostly limited in school advances. The major effect on mental status was made by mental anguish, confusion due to skin view, annoyance due to appearance. Three years after ASIT beginning negative disease effect on QOL (p<0.05) and confusion due to skin view (p<0,05) decreased, the AD severity improved, daily living and social activity increased. The most significant symptom was xerodermia. CONCLUSIONS: ASIT provides AD control, significant severity reduction and thus QOL improvement.