- Email: [email protected]
The Role of Oral Food Challenge in Peanut-Sensitized Individuals
AB134 Abstracts
442
Results of a 16-Year Oral Food Challenges (OFC) Performed at a Major Teaching Hospital in Thailand
Pakit Vichyanond, MD, FAAAAI1, Witchaya Srisuwatchari, MD2; 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Limited information on challenge-proven food allergy (FA) is available from Asia. We herein report our 16-year experience in OFCs performed at Siriraj hospital – the largest teaching hospital in Thailand. METHODS: From 1996-2012, 206 children had OFCs performed (total 306 OFCs). Their ages ranged from 4 months to 17 years (mean + SD 5.8 + 4.6 years). Standard OFC protocol as described Bock et al (JACI 1998) was followed with modifications made over time. 297 challenges were open with 9 being double-blinded. Clinical data, results of OFC, skin prick test (SPT) and specific IgE to foods (SpIgE) were reviewed. Descriptive statistics were used. RESULTS: 84 of 306 challenges were positive (27.5%) among 60 of 206 children (29%), with no preference observed among the two genders. Foods yielding positive challenges among children less than 3 years of age were wheat (30%) cow’s milk (26%), egg white (17%), and egg yolk (17%) while for those 3 years or older, shellfish was the most common food (48%) followed by wheat (20%), cow’s milk (13%), egg white (6%) and egg yolk (5%). Cutaneous reactions were most commonly observed (71%). 11.9% had multisystem involvement with anaphylaxis encountered only once. SPTs and SpIgEs were positive in 98.4% and 58% among those with positive OFCs. CONCLUSIONS: Aside from cow’s milk and egg, wheat and shellfish are common foods giving positive challenges in this study. Only 1/3 of children studied had positive challenges emphasizing the need of OFC for a proper diagnosis of FA in Asia.
443
Outcomes of 109 Consecutive Open Food Challenges to Extensively-Heated (baked) Milk
SUNDAY
Jeanifer Poon1, Elizabeth Feuille, MD2, Zara Atal3, Hugh A. Sampson, MD, FAAAAI4,5, Anna H. Nowak-Wegrzyn, MD, FAAAAI2; 1 Icahn School of Medicine at Mount Sinai, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Icahn School of Medicine at Mt. Sinai, 4 Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA, 5Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. RATIONALE: Cow milk (CM) is one of the most common food allergens among children. Majority of milk-allergic children tolerate baked-milk. In a process of acquiring tolerance to unheated milk, higher doses of less extensively baked foods with milk are being tolerated. Additionally, regular ingestion of baked-milk may accelerate development of tolerance to unheated milk products. METHODS: Open OFCs to muffin and pizza conducted at a food allergy referral center were reviewed. OFCs were undertaken based on allergists’ interpretation of history, results of allergy testing and family preference. OFC to pizza was offered to those already tolerating muffins. RESULTS: Of 85 children challenged to muffin, 16 (18.8%) developed allergic symptoms; 1 (6.3%) received epinephrine. Average serum CMspecific IgE levels [kIU/L] of those who passed and failed muffin were 4.24 (95% CI, 3.01 – 5.47) and 8.14 (95% CI, 4.66 – 11.61), p <0.05. Average CM-skin prick test wheal diameters of those who passed and failed muffin were 7.3 mm (95% CI 6.7 – 8.1) and 8.1 mm (95% CI 6.1 – 10.1), p > 0.40. Of 23 children challenged to pizza, 2 (8.7%) developed allergic symptoms; none received epinephrine. Average serum CM-specific IgE levels for those who passed and failed were 6 and 4.1 kIU/L. Average CM-skin prick test wheal diameters of those who passed and failed were 9.9 mm and 8.5 mm. CONCLUSIONS: The majority of milk-allergic children tolerate bakedmilk in a form of a muffin and many tolerate pizza. Physician-supervised, office-based baked-milk challenges are safe and generally well tolerated by milk-allergic children.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
444
Severity of Reactions to Oral Peanut Challenges in Children and Adults
R. Sharon Chinthrajah, MD1, Jaime S. Rosa, MD, PhD2, Dana Tupa3, Bridget Smith, PhD4, Ruchi S. Gupta, MD, MPH5, Stephen J. Galli, MD2, Kari C. Nadeau, MD, PhD, FAAAAI6; 1Medcine, Division of Pulmonary and Critical Care, Stanford University, Stanford, CA, 2Stanford University School of Medicine, Stanford, CA, 3Stanford University, Stanford, CA, 4Northwestern University Feinberg School of Medicine, Chicago, IL, 5Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg school of Medicine, Chicago, IL, 6Stanford University, Medicine, Division of Pulmonary and Critical Care, Stanford, CA. RATIONALE: To understand differences in oral food challenges to peanut in children and adults. METHODS: Children and adults underwent double-blind, placebocontrolled food challenges (DBPCFCs) to peanut as part of screening for an oral immunotherapy clinical trial at Stanford University. Challenges were performed up to 500mg of peanut allergen and graded for severity of reaction using the modified Bock’s grading system, and then rated as low for grade 1 and moderate to severe for grades 2-3. History of asthma, allergic rhinitis, and/or atopic dermatitis, total IgE, peanut sIgE and peanut SPT were assessed. Fisher’s exact tests and Mann-Whitney tests were used to test differences between adults and children. RESULTS: 99 children and 14 adults underwent DBPCFCs to peanut. More children experienced moderate to severe reactions than adults (50.5% vs 21.4%, p50.049). There were significant differences between children and adults in cumulative tolerated dose (median, 25mg vs 5mg, p50.0221), history of atopic dermatitis (77% vs 36%, p50.003), total IgE (median, 1481 ng/L vs 420 ng/L, p50.0013), and peanut sIgE (median, 254 ng/L vs 15 ng/L, p<0.001). There were no significant differences in the history of asthma or allergic rhinitis, or peanut SPT size in these subjects. CONCLUSIONS: Our site’s current preliminary data show that the children participating in OIT trials for peanut have higher total IgE, peanut sIgE, history of atopic dermatitis, and more moderate to severe reactions compared to adults.
445
The Role of Oral Food Challenge in PeanutSensitized Individuals
Michael B. Levy, MD, FAAAAI1, Liat Nachshon, MD1, Michael R. Goldberg, MD, PhD1, Hadas Yechiam-Caspi1, Keren Golobov, BScNutr, RD1, Arnon Elizur, MD1,2, Yitzhak Katz, MD, FAAAAI1,2; 1Assaf Harofeh Medical Center, Zerifin, Israel, 2Department of Pediatrics, Sackler School of Medicine, Tel Aviv, Israel. RATIONALE: Peanut allergy is considered to be of high risk and persists in 80% of cases. There is a tendency, therefore, to avoid evaluation by oral food challenge (OFC) in the presence of evidence for sensitization. METHODS: Patients (n573, 65.8% male) ranging from 1.6-39.9 years (median, 4.5) with a history suggestive of an allergic reaction to peanut (Group A538) or a dietary avoidance to peanuts from a variety of reasons including atopic dermatitis (Group B535) underwent skin prick test (SPT, _2) and oral food challenge (OFC) to positive response wheal diameter > peanuts and tree nuts. Twenty additional patients were excluded because of a history of a definitive reaction within the past year, a severe anaphylactic reaction or unstable asthma. RESULTS: Regarding peanuts, 54/73 (73.9%) of patients were SPT+, while only 26/73 (35.6%) were OFC+. 29/38 (76.3%) and 25/35 (71.4%) of Group A and Group B, respectively, were SPT+. Surprisingly, however, only 15/29 (51.7%) of Group A, SPT+ patients were positive on OFC. Furthermore, 11/25 of Group B SPT+ patients were positive on OFC. While 18/21 patients (10 from group A and 11 from group B) with a history of atopic dermatitis were SPT+ to peanut, only 9 (42.9%) were OFC+. Regarding sensitization to tree nuts, 22/34 patients were SPT+ to at least one tree nut, and 6/16 (37.5%) confirmed allergy to one of those nuts on OFC. CONCLUSIONS: Unless clinically contraindicated, patients sensitized to peanuts that either avoided or have a suggestive history of an allergic reaction to peanut should be evaluated by OFC.
442
Results of a 16-Year Oral Food Challenges (OFC) Performed at a Major Teaching Hospital in Thailand
Pakit Vichyanond, MD, FAAAAI1, Witchaya Srisuwatchari, MD2; 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Limited information on challenge-proven food allergy (FA) is available from Asia. We herein report our 16-year experience in OFCs performed at Siriraj hospital – the largest teaching hospital in Thailand. METHODS: From 1996-2012, 206 children had OFCs performed (total 306 OFCs). Their ages ranged from 4 months to 17 years (mean + SD 5.8 + 4.6 years). Standard OFC protocol as described Bock et al (JACI 1998) was followed with modifications made over time. 297 challenges were open with 9 being double-blinded. Clinical data, results of OFC, skin prick test (SPT) and specific IgE to foods (SpIgE) were reviewed. Descriptive statistics were used. RESULTS: 84 of 306 challenges were positive (27.5%) among 60 of 206 children (29%), with no preference observed among the two genders. Foods yielding positive challenges among children less than 3 years of age were wheat (30%) cow’s milk (26%), egg white (17%), and egg yolk (17%) while for those 3 years or older, shellfish was the most common food (48%) followed by wheat (20%), cow’s milk (13%), egg white (6%) and egg yolk (5%). Cutaneous reactions were most commonly observed (71%). 11.9% had multisystem involvement with anaphylaxis encountered only once. SPTs and SpIgEs were positive in 98.4% and 58% among those with positive OFCs. CONCLUSIONS: Aside from cow’s milk and egg, wheat and shellfish are common foods giving positive challenges in this study. Only 1/3 of children studied had positive challenges emphasizing the need of OFC for a proper diagnosis of FA in Asia.
443
Outcomes of 109 Consecutive Open Food Challenges to Extensively-Heated (baked) Milk
SUNDAY
Jeanifer Poon1, Elizabeth Feuille, MD2, Zara Atal3, Hugh A. Sampson, MD, FAAAAI4,5, Anna H. Nowak-Wegrzyn, MD, FAAAAI2; 1 Icahn School of Medicine at Mount Sinai, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Icahn School of Medicine at Mt. Sinai, 4 Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA, 5Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. RATIONALE: Cow milk (CM) is one of the most common food allergens among children. Majority of milk-allergic children tolerate baked-milk. In a process of acquiring tolerance to unheated milk, higher doses of less extensively baked foods with milk are being tolerated. Additionally, regular ingestion of baked-milk may accelerate development of tolerance to unheated milk products. METHODS: Open OFCs to muffin and pizza conducted at a food allergy referral center were reviewed. OFCs were undertaken based on allergists’ interpretation of history, results of allergy testing and family preference. OFC to pizza was offered to those already tolerating muffins. RESULTS: Of 85 children challenged to muffin, 16 (18.8%) developed allergic symptoms; 1 (6.3%) received epinephrine. Average serum CMspecific IgE levels [kIU/L] of those who passed and failed muffin were 4.24 (95% CI, 3.01 – 5.47) and 8.14 (95% CI, 4.66 – 11.61), p <0.05. Average CM-skin prick test wheal diameters of those who passed and failed muffin were 7.3 mm (95% CI 6.7 – 8.1) and 8.1 mm (95% CI 6.1 – 10.1), p > 0.40. Of 23 children challenged to pizza, 2 (8.7%) developed allergic symptoms; none received epinephrine. Average serum CM-specific IgE levels for those who passed and failed were 6 and 4.1 kIU/L. Average CM-skin prick test wheal diameters of those who passed and failed were 9.9 mm and 8.5 mm. CONCLUSIONS: The majority of milk-allergic children tolerate bakedmilk in a form of a muffin and many tolerate pizza. Physician-supervised, office-based baked-milk challenges are safe and generally well tolerated by milk-allergic children.
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
444
Severity of Reactions to Oral Peanut Challenges in Children and Adults
R. Sharon Chinthrajah, MD1, Jaime S. Rosa, MD, PhD2, Dana Tupa3, Bridget Smith, PhD4, Ruchi S. Gupta, MD, MPH5, Stephen J. Galli, MD2, Kari C. Nadeau, MD, PhD, FAAAAI6; 1Medcine, Division of Pulmonary and Critical Care, Stanford University, Stanford, CA, 2Stanford University School of Medicine, Stanford, CA, 3Stanford University, Stanford, CA, 4Northwestern University Feinberg School of Medicine, Chicago, IL, 5Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg school of Medicine, Chicago, IL, 6Stanford University, Medicine, Division of Pulmonary and Critical Care, Stanford, CA. RATIONALE: To understand differences in oral food challenges to peanut in children and adults. METHODS: Children and adults underwent double-blind, placebocontrolled food challenges (DBPCFCs) to peanut as part of screening for an oral immunotherapy clinical trial at Stanford University. Challenges were performed up to 500mg of peanut allergen and graded for severity of reaction using the modified Bock’s grading system, and then rated as low for grade 1 and moderate to severe for grades 2-3. History of asthma, allergic rhinitis, and/or atopic dermatitis, total IgE, peanut sIgE and peanut SPT were assessed. Fisher’s exact tests and Mann-Whitney tests were used to test differences between adults and children. RESULTS: 99 children and 14 adults underwent DBPCFCs to peanut. More children experienced moderate to severe reactions than adults (50.5% vs 21.4%, p50.049). There were significant differences between children and adults in cumulative tolerated dose (median, 25mg vs 5mg, p50.0221), history of atopic dermatitis (77% vs 36%, p50.003), total IgE (median, 1481 ng/L vs 420 ng/L, p50.0013), and peanut sIgE (median, 254 ng/L vs 15 ng/L, p<0.001). There were no significant differences in the history of asthma or allergic rhinitis, or peanut SPT size in these subjects. CONCLUSIONS: Our site’s current preliminary data show that the children participating in OIT trials for peanut have higher total IgE, peanut sIgE, history of atopic dermatitis, and more moderate to severe reactions compared to adults.
445
The Role of Oral Food Challenge in PeanutSensitized Individuals
Michael B. Levy, MD, FAAAAI1, Liat Nachshon, MD1, Michael R. Goldberg, MD, PhD1, Hadas Yechiam-Caspi1, Keren Golobov, BScNutr, RD1, Arnon Elizur, MD1,2, Yitzhak Katz, MD, FAAAAI1,2; 1Assaf Harofeh Medical Center, Zerifin, Israel, 2Department of Pediatrics, Sackler School of Medicine, Tel Aviv, Israel. RATIONALE: Peanut allergy is considered to be of high risk and persists in 80% of cases. There is a tendency, therefore, to avoid evaluation by oral food challenge (OFC) in the presence of evidence for sensitization. METHODS: Patients (n573, 65.8% male) ranging from 1.6-39.9 years (median, 4.5) with a history suggestive of an allergic reaction to peanut (Group A538) or a dietary avoidance to peanuts from a variety of reasons including atopic dermatitis (Group B535) underwent skin prick test (SPT, _2) and oral food challenge (OFC) to positive response wheal diameter > peanuts and tree nuts. Twenty additional patients were excluded because of a history of a definitive reaction within the past year, a severe anaphylactic reaction or unstable asthma. RESULTS: Regarding peanuts, 54/73 (73.9%) of patients were SPT+, while only 26/73 (35.6%) were OFC+. 29/38 (76.3%) and 25/35 (71.4%) of Group A and Group B, respectively, were SPT+. Surprisingly, however, only 15/29 (51.7%) of Group A, SPT+ patients were positive on OFC. Furthermore, 11/25 of Group B SPT+ patients were positive on OFC. While 18/21 patients (10 from group A and 11 from group B) with a history of atopic dermatitis were SPT+ to peanut, only 9 (42.9%) were OFC+. Regarding sensitization to tree nuts, 22/34 patients were SPT+ to at least one tree nut, and 6/16 (37.5%) confirmed allergy to one of those nuts on OFC. CONCLUSIONS: Unless clinically contraindicated, patients sensitized to peanuts that either avoided or have a suggestive history of an allergic reaction to peanut should be evaluated by OFC.