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To Bee or Not to Bee - Bee Pollen Sensitive
Abstracts AB239
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
To Bee or Not to Bee - Bee Pollen Sensitive P. Hemmers, Z. Li, J. Santilli; St. Vincent’s Medical Center, Bridgeport, CT. RATIONALE: Bee pollen (BP) and honey are common alternative therapies used in the treatment of allergic rhinitis. The proposed mechanism of action is oral desensitization. The treatment preparations contain highly variable type and quantity of pollen. The majority are likely to be entomophilous and therefore non-allergenic. We hypothesize that the cross-reactivity rate between BP and allergenic pollens is low. METHODS: Twenty five consecutive rhinitis patients underwent skin puncture testing during August 2010. The testing panel included manufactured extracts of tree, grass and weed pollens. Additionally, we included locally purchased BP. RESULTS: Twenty four patients were included in the analysis; one patient did not react to histamine and was excluded. The prevalence of BP sensitivity was 17% (4/24). Of the 4 patients testing positive to bee pollen, 3 tested positive to one or more of the manufactured pollen extracts; p50.295 (Fisher’s exact test). CONCLUSIONS: In this small group of patients, there was no association between pollen (tree, grass, weed) and BP sensitivity. Using the results of this pilot study, a sample size of 334 patients would be needed to prove our hypothesis (with > 80% statistical power). Additional studies may address efficacy, pollen type and quantity.
901
Are Pseudopods On Skin Prick Testing Reproducible? M. Serota, J. Portnoy, Z. Jacobs; Children’s Mercy Hospital, Kansas City, MO. RATIONALE: Pseudopod development on skin prick testing is used widely by allergists to denote severe sensitivity to a given allergen. We attempted to evaluate if a patient will consistently develop a pseudopod to a particular allergen. METHODS: Patients aged 2-17 were enrolled in our outpatient hospital based allergy clinic. Any patient who developed a pseudopod during their skin prick testing associated with their visit were enrolled. For the purpose of objectivity a pseudopod was defined as an asymmetric foot like projection on the wheel of a skin prick test that projects > 5 mm away from the natural contour of the wheel and with no other identifiable cause for the asymmetry. 2 subsequent pricks to the allergen were applied to a neutral central area of their back. Skin tests were measured, documented with tape tracings, and photographed. RESULTS: A total of 42 skin prick tests were applied to 22 patients. All initial skin pricks met the definition of a pseudopod. Of the subsequent pricks there were 27% (95% CI: 30-48) of patients that had both follow up skin pricks being positive for a pseudopod. 55% (95% CI: 40-69) of the total follow up skin prick tests were positive for a pseudopod. CONCLUSIONS: Pseudopod development on skin prick testing is not a reliably reproducible phenomenon even when using an objective measure of what a pseudopod is. Based on these findings we suggest using caution when interpreting pseuodopod development as a marker for severity of allergic disease.
902
Optimal Concentration Of Dermatophagoides Pteronyssinus allergen Extract (Dp) For Skin Prick Testing (SPT) In Thai Population With Allergic Rhinitis (AR) P. Prottasan1,2, C. Bunnag1,3, P. Tantilipikorn1,3, T. Suwanwech1,3, N. Visitsunthorn1,2, O. Jirapongsananuruk1,2, P. Pacharn1,2, P. Vichyanond1,2; 1 Siriraj Hospital, Bangkok, THAILAND, 2Department of Pediatrics, Faculty of Medicine, Bangkok, THAILAND, 3Department of Otorhinolaryngology, Faculty of Medicine, Bangkok, THAILAND. RATIONALE: It is noted that sizes of SPT to Dp in some allergic Thai patients are large. We hypothesize that lower concentration of Dp may be used for the Thais. METHODS: Forty AR patients with positive SPT to Dp and 69 healthy _ 15 years) were recruited. SPT with Dp at concentration of volunteers (all > 30, 100, 300, 1000, 3000 and 10,000 AU/ml were performed in duplicates, in all. SPT sizes were recorded. Nasal challenge test with Dp allergen extract (50 AU/side) were performed to accurately verify Dp-induced AR. Sensitivities, specificities, accuracies and receptive operative curve (ROC) were analyzed at various Dp concentrations. RESULTS: 35 patients had positive nasal challenges to Dp. 10 subjects in healthy group had positive challenge and were excluded. By ROC, areas under the curve (AUCs) of Dp at 30 and 100 AU/ml were significantly smaller than that of 10,000 AU/ml (p < 0.001) while AUCs of 300, 1000, 3000 and 10,000 AU/ml were similar (p > 0.05). Further analysis at cutpoint of 3 mm wheal size, the accuracies of 300, 1000, 3000, 10,000 AU/ml were 72.5%, 79.8%, 82.6% and 85.3%. The accuracies of 1000, 3000, and 10,000 AU/ml were not significant different from one another (p > 0.05). Sensitivities and specificities of 1000, 3000, 10,000 AU/ml were 53.3/ 98.4%, 64.4/95.3% and 80/89.1%. CONCLUSIONS: Despite the fact that the best sensitivity was noted at Dp 10,000 AU/ml, similar accuracies between 3000 and 10,000 AU/ml was observed. Concentration of between 3000 and 10,000 AU/ml should be further investigated.
903
Histamine Skin Prick Test (SPT) Titration Following Antihistamine Administration: Wheal Comparison of Histamine Strength Using Different Devices G. Plunkett, J. Young, R. Erskine, S. Young; ALK-Abello, Inc., Round Rock, TX. RATIONALE: Histamine positive control establishes patient skin reactivity in order to validate skin test results and reveal impairment due to antihistamines or other factors. In the US, different histamine concentrations and devices are used for SPT. The purpose of this study is to evaluate histamine concentrations and SPT devices for positive and negative wheal responses in subjects under antihistamine-induced inhibition. METHODS: SPT was performed simultaneously with 1, 3 and 6mg/mL histamine base using devices from 3 manufacturers; Lincoln Diagnostics, Greer, and Hollister-Stier. A 50% glycero-saline negative control was included. Some subjects were also tested with Standardized Bermuda allergen extracts at 3,000-10,000BAU/mL. SPT was first done after withholding antihistamine for at least 5 days. A single dose of an OTC antihistamine was taken and SPT completed again after 12, 36 and 42hr. Wheal sizes were recorded 10-15 minutes after skin testing. Results were _3mm scored as either positive or negative based on a wheal size of either > _5mm. or > RESULTS: The wheal size increased as histamine concentration increased,. Depending on the device and cutoff criteria used, diagnostic results varied, with low histamine concentrations appearing negative under antihistamine inhibition while high histamine concentrations sometimes appeared positive. This effect was also seen with different Bermuda concentrations. CONCLUSIONS: Due to differences in the wheal size produced with different devices and histamine, proper cutoff ranges must be established for each system. Determining positive reactions under various conditions is especially important for individuals under the influence of antihistamines or other factors that reduce skin responses.
TUESDAY
900
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
To Bee or Not to Bee - Bee Pollen Sensitive P. Hemmers, Z. Li, J. Santilli; St. Vincent’s Medical Center, Bridgeport, CT. RATIONALE: Bee pollen (BP) and honey are common alternative therapies used in the treatment of allergic rhinitis. The proposed mechanism of action is oral desensitization. The treatment preparations contain highly variable type and quantity of pollen. The majority are likely to be entomophilous and therefore non-allergenic. We hypothesize that the cross-reactivity rate between BP and allergenic pollens is low. METHODS: Twenty five consecutive rhinitis patients underwent skin puncture testing during August 2010. The testing panel included manufactured extracts of tree, grass and weed pollens. Additionally, we included locally purchased BP. RESULTS: Twenty four patients were included in the analysis; one patient did not react to histamine and was excluded. The prevalence of BP sensitivity was 17% (4/24). Of the 4 patients testing positive to bee pollen, 3 tested positive to one or more of the manufactured pollen extracts; p50.295 (Fisher’s exact test). CONCLUSIONS: In this small group of patients, there was no association between pollen (tree, grass, weed) and BP sensitivity. Using the results of this pilot study, a sample size of 334 patients would be needed to prove our hypothesis (with > 80% statistical power). Additional studies may address efficacy, pollen type and quantity.
901
Are Pseudopods On Skin Prick Testing Reproducible? M. Serota, J. Portnoy, Z. Jacobs; Children’s Mercy Hospital, Kansas City, MO. RATIONALE: Pseudopod development on skin prick testing is used widely by allergists to denote severe sensitivity to a given allergen. We attempted to evaluate if a patient will consistently develop a pseudopod to a particular allergen. METHODS: Patients aged 2-17 were enrolled in our outpatient hospital based allergy clinic. Any patient who developed a pseudopod during their skin prick testing associated with their visit were enrolled. For the purpose of objectivity a pseudopod was defined as an asymmetric foot like projection on the wheel of a skin prick test that projects > 5 mm away from the natural contour of the wheel and with no other identifiable cause for the asymmetry. 2 subsequent pricks to the allergen were applied to a neutral central area of their back. Skin tests were measured, documented with tape tracings, and photographed. RESULTS: A total of 42 skin prick tests were applied to 22 patients. All initial skin pricks met the definition of a pseudopod. Of the subsequent pricks there were 27% (95% CI: 30-48) of patients that had both follow up skin pricks being positive for a pseudopod. 55% (95% CI: 40-69) of the total follow up skin prick tests were positive for a pseudopod. CONCLUSIONS: Pseudopod development on skin prick testing is not a reliably reproducible phenomenon even when using an objective measure of what a pseudopod is. Based on these findings we suggest using caution when interpreting pseuodopod development as a marker for severity of allergic disease.
902
Optimal Concentration Of Dermatophagoides Pteronyssinus allergen Extract (Dp) For Skin Prick Testing (SPT) In Thai Population With Allergic Rhinitis (AR) P. Prottasan1,2, C. Bunnag1,3, P. Tantilipikorn1,3, T. Suwanwech1,3, N. Visitsunthorn1,2, O. Jirapongsananuruk1,2, P. Pacharn1,2, P. Vichyanond1,2; 1 Siriraj Hospital, Bangkok, THAILAND, 2Department of Pediatrics, Faculty of Medicine, Bangkok, THAILAND, 3Department of Otorhinolaryngology, Faculty of Medicine, Bangkok, THAILAND. RATIONALE: It is noted that sizes of SPT to Dp in some allergic Thai patients are large. We hypothesize that lower concentration of Dp may be used for the Thais. METHODS: Forty AR patients with positive SPT to Dp and 69 healthy _ 15 years) were recruited. SPT with Dp at concentration of volunteers (all > 30, 100, 300, 1000, 3000 and 10,000 AU/ml were performed in duplicates, in all. SPT sizes were recorded. Nasal challenge test with Dp allergen extract (50 AU/side) were performed to accurately verify Dp-induced AR. Sensitivities, specificities, accuracies and receptive operative curve (ROC) were analyzed at various Dp concentrations. RESULTS: 35 patients had positive nasal challenges to Dp. 10 subjects in healthy group had positive challenge and were excluded. By ROC, areas under the curve (AUCs) of Dp at 30 and 100 AU/ml were significantly smaller than that of 10,000 AU/ml (p < 0.001) while AUCs of 300, 1000, 3000 and 10,000 AU/ml were similar (p > 0.05). Further analysis at cutpoint of 3 mm wheal size, the accuracies of 300, 1000, 3000, 10,000 AU/ml were 72.5%, 79.8%, 82.6% and 85.3%. The accuracies of 1000, 3000, and 10,000 AU/ml were not significant different from one another (p > 0.05). Sensitivities and specificities of 1000, 3000, 10,000 AU/ml were 53.3/ 98.4%, 64.4/95.3% and 80/89.1%. CONCLUSIONS: Despite the fact that the best sensitivity was noted at Dp 10,000 AU/ml, similar accuracies between 3000 and 10,000 AU/ml was observed. Concentration of between 3000 and 10,000 AU/ml should be further investigated.
903
Histamine Skin Prick Test (SPT) Titration Following Antihistamine Administration: Wheal Comparison of Histamine Strength Using Different Devices G. Plunkett, J. Young, R. Erskine, S. Young; ALK-Abello, Inc., Round Rock, TX. RATIONALE: Histamine positive control establishes patient skin reactivity in order to validate skin test results and reveal impairment due to antihistamines or other factors. In the US, different histamine concentrations and devices are used for SPT. The purpose of this study is to evaluate histamine concentrations and SPT devices for positive and negative wheal responses in subjects under antihistamine-induced inhibition. METHODS: SPT was performed simultaneously with 1, 3 and 6mg/mL histamine base using devices from 3 manufacturers; Lincoln Diagnostics, Greer, and Hollister-Stier. A 50% glycero-saline negative control was included. Some subjects were also tested with Standardized Bermuda allergen extracts at 3,000-10,000BAU/mL. SPT was first done after withholding antihistamine for at least 5 days. A single dose of an OTC antihistamine was taken and SPT completed again after 12, 36 and 42hr. Wheal sizes were recorded 10-15 minutes after skin testing. Results were _3mm scored as either positive or negative based on a wheal size of either > _5mm. or > RESULTS: The wheal size increased as histamine concentration increased,. Depending on the device and cutoff criteria used, diagnostic results varied, with low histamine concentrations appearing negative under antihistamine inhibition while high histamine concentrations sometimes appeared positive. This effect was also seen with different Bermuda concentrations. CONCLUSIONS: Due to differences in the wheal size produced with different devices and histamine, proper cutoff ranges must be established for each system. Determining positive reactions under various conditions is especially important for individuals under the influence of antihistamines or other factors that reduce skin responses.
TUESDAY
900