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Understanding Predictors for the Development of Tolerance to Allergies in Pediatric Food Allergy Natural History Registry
AB140 Abstracts
446
Prebiotic Prevents Allergic Diseases and IgE Sensitization in Infants
SUNDAY
Herberto J. Chong Neto, MD, PhD, FAAAAI1, Priscilla N. Moura, PhD2, Carlos A. Riedi, MD, PhD1, and Nelson A. Rosario, MD, PhD, FAAAAI3; 1 Federal University of Parana, Curitiba, Brazil, 2UNICENTRO, Guarapuava, Brazil, 3Federal University of Parana, Curitiba, Brazil. RATIONALE: The aim of this study was to assess the effect of a prebiotic to prevent IgE sensitization and allergic diseases. METHODS: DBPC RCT was conducted in a birth cohort. Mother’s had at least one allergic disease identified by ISAAC written questionnaire (IWQ). Infants were daily supplemented with fructo-oligosaccharide (FOS) at 8g/L after breastfeed, added to a regular milk formula. Serum total IgE and specific IgE antibodies to cow’s milk (CM), egg white, D. pteronyssinus (Dp), dog, cat and grass have been determined by ImmunoCAPÒin samples of umbilical cord and in children’s blood one year by the time IWQ was again applied to. RESULTS: 1000 pregnant women had been screened, and 115 completed the evaluation, 50.4% in the FOS Group. Ninety nine (86%) had asthma and/or rhinitis, and 67 (58%) had been considered atopic. Wheezing was reported in 15 infants of placebo group (PLA) (26.3%) but in none of FOS group (p<0.001). Eight (14%) had rhinitis in PLA but none in FOS group, (p 50.009). Positive specific IgE to Dp was more frequent in wheezing children of PLA 6 (10.5%) than of FOS group (p50.02). Atopic dermatitis (AD) and elevated total serum IgE were identified in one in placebo group but none in FOS (p50.02). Positive specific IgE to Dp 6 (10.5%) and to CM 4 (7%) was observed in PLA group whereas undetectable in FOS group. CONCLUSIONS: Prebiotic supplementation in risk infants prevents allergic sensitization, as well as reduces wheezing and AD.
447
Characterization of multifood allergic children based on clinical and serological data
Sandra Andorf, PhD1, Magnus Borres, MD, PhD2,3, Whitney Block, MSN, NP1, Jonas Lidholm, PhD3, Joseph E. Jones, MS4, Stephen J. Galli, MD1, R. Sharon Chinthrajah, MD5, and Kari C. Nadeau, MD, PhD, FAAAAI5; 1Stanford University, Stanford, 2Uppsala University, Uppsala, Sweden, 3Thermo Fisher Scientific, Uppsala, Sweden, 4Thermo Fisher Scientific, Portage, 5Stanford University, Stanford, CA. RATIONALE: Multiple food allergies in children are of great concern to families, schools, healthcare providers, and other parts of the society. Improved management of these children requires a better understanding of underlying disease mechanisms, clinical characteristics, and risk factors. We report the characterization of multifood allergic children based on comprehensive screening tests, including double-blind, placebo-controlled food challenge (DBPCFC) data. METHODS: We recruited 60 pediatric multifood allergic participants for an NIH-funded pilot clinical trial for which we are reporting the baseline data. The clinically-relevant food allergies to between 2 and 7 foods were determined by DBPCFC and IgE antibody levels to whole foods and food allergen components were quantified. We used Spearman’s rhos and Jaccard similarities in combination with a resampling, bootstrapping approach to determine significant co-occurrences of allergies. RESULTS: Clinical (Jaccard index based on positive DBPCFC) and serological (Spearman’s rhos of IgE levels) results demonstrated significant (q-value < 0.05) association (co-occurrence/positive correlation) between cashew and pistachio allergies as well as between walnut, pecan and hazelnut allergies. After adjusting the data for age, we also observed an association of gastrointestinal reactions in DBPCFC with being male (p < 0.05) as well as with IgE to 2S albumins (q < 0.05). CONCLUSIONS: Cashew/pistachio and walnut/pecan/hazelnut allergies show clinical associations, suggesting further consideration when giving avoidance advice. Our results suggest the need for further investigation on whether sensitization against 2S albumins might serve as predictor for increased probability of gastrointestinal reactions during food challenges.
J ALLERGY CLIN IMMUNOL FEBRUARY 2017
448
Understanding Predictors for the Development of Tolerance to Allergies in Pediatric Food Allergy Natural History Registry
Ruixuan Zhou1, Serena Chan, PhD2, Jesse Blumenstock, MS (c)3, Marjorie Yarbrough, MPH3, Ruchi S. Gupta, MD, MPH3,4, Anne Marie Singh, MD5,6, and Paul J. Bryce, PhD7; 1University of Illinois, Champaign, IL, 2Univeristy of Illinois, Champaign, IL, 3Northwestern University, Chicago, IL, 4Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 5Division of Allergy & Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Division of Allergy-Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 7 Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Despite affecting up to 6 million children nationwide, the natural history of food allergy is not well understood. To learn more about the natural course of food allergy, we developed a prospective registry of children with food allergy. The goal of this study was to investigate what predictors are associated with development of tolerance to peanut, tree nut, and egg allergies. METHODS: By collaborating with allergy clinics across Chicago, we recruited families with at least one child with a food allergy into a registry. Data from children’s medical records and caregiver surveys was analyzed. Logistic regression analyses were conducted to investigate the relationship between tolerance and predictors, such as the child’s demographic characteristics, child’s comorbidities, previous reactions to allergen, current epinephrine usage, current food allergy, and parental morbidities. RESULTS: Children of respondents (N5158) were mostly male (65.2%), white (76.6%), with an average age of 6.4 years (SD53.7). 41.1% of children reported outgrowing at least one of their food allergies. The percentages of children who outgrew their allergies were: 5.1% for peanut, 13.9% for tree nuts, and 19.6% for egg. The average age of outgrown peanut allergy was 6.0 (SD51.7), for tree nut allergy was 7.0 (SD52.9), and for egg was 6.8 (SD53.7). No child or parental factors were found to be significantly associated with the development of tolerance to food allergy. CONCLUSIONS: For all three allergens, none of the predictors showed statistical significance at predicting development of tolerance to food allergies. Further investigation will be conducted when more data becomes available.
446
Prebiotic Prevents Allergic Diseases and IgE Sensitization in Infants
SUNDAY
Herberto J. Chong Neto, MD, PhD, FAAAAI1, Priscilla N. Moura, PhD2, Carlos A. Riedi, MD, PhD1, and Nelson A. Rosario, MD, PhD, FAAAAI3; 1 Federal University of Parana, Curitiba, Brazil, 2UNICENTRO, Guarapuava, Brazil, 3Federal University of Parana, Curitiba, Brazil. RATIONALE: The aim of this study was to assess the effect of a prebiotic to prevent IgE sensitization and allergic diseases. METHODS: DBPC RCT was conducted in a birth cohort. Mother’s had at least one allergic disease identified by ISAAC written questionnaire (IWQ). Infants were daily supplemented with fructo-oligosaccharide (FOS) at 8g/L after breastfeed, added to a regular milk formula. Serum total IgE and specific IgE antibodies to cow’s milk (CM), egg white, D. pteronyssinus (Dp), dog, cat and grass have been determined by ImmunoCAPÒin samples of umbilical cord and in children’s blood one year by the time IWQ was again applied to. RESULTS: 1000 pregnant women had been screened, and 115 completed the evaluation, 50.4% in the FOS Group. Ninety nine (86%) had asthma and/or rhinitis, and 67 (58%) had been considered atopic. Wheezing was reported in 15 infants of placebo group (PLA) (26.3%) but in none of FOS group (p<0.001). Eight (14%) had rhinitis in PLA but none in FOS group, (p 50.009). Positive specific IgE to Dp was more frequent in wheezing children of PLA 6 (10.5%) than of FOS group (p50.02). Atopic dermatitis (AD) and elevated total serum IgE were identified in one in placebo group but none in FOS (p50.02). Positive specific IgE to Dp 6 (10.5%) and to CM 4 (7%) was observed in PLA group whereas undetectable in FOS group. CONCLUSIONS: Prebiotic supplementation in risk infants prevents allergic sensitization, as well as reduces wheezing and AD.
447
Characterization of multifood allergic children based on clinical and serological data
Sandra Andorf, PhD1, Magnus Borres, MD, PhD2,3, Whitney Block, MSN, NP1, Jonas Lidholm, PhD3, Joseph E. Jones, MS4, Stephen J. Galli, MD1, R. Sharon Chinthrajah, MD5, and Kari C. Nadeau, MD, PhD, FAAAAI5; 1Stanford University, Stanford, 2Uppsala University, Uppsala, Sweden, 3Thermo Fisher Scientific, Uppsala, Sweden, 4Thermo Fisher Scientific, Portage, 5Stanford University, Stanford, CA. RATIONALE: Multiple food allergies in children are of great concern to families, schools, healthcare providers, and other parts of the society. Improved management of these children requires a better understanding of underlying disease mechanisms, clinical characteristics, and risk factors. We report the characterization of multifood allergic children based on comprehensive screening tests, including double-blind, placebo-controlled food challenge (DBPCFC) data. METHODS: We recruited 60 pediatric multifood allergic participants for an NIH-funded pilot clinical trial for which we are reporting the baseline data. The clinically-relevant food allergies to between 2 and 7 foods were determined by DBPCFC and IgE antibody levels to whole foods and food allergen components were quantified. We used Spearman’s rhos and Jaccard similarities in combination with a resampling, bootstrapping approach to determine significant co-occurrences of allergies. RESULTS: Clinical (Jaccard index based on positive DBPCFC) and serological (Spearman’s rhos of IgE levels) results demonstrated significant (q-value < 0.05) association (co-occurrence/positive correlation) between cashew and pistachio allergies as well as between walnut, pecan and hazelnut allergies. After adjusting the data for age, we also observed an association of gastrointestinal reactions in DBPCFC with being male (p < 0.05) as well as with IgE to 2S albumins (q < 0.05). CONCLUSIONS: Cashew/pistachio and walnut/pecan/hazelnut allergies show clinical associations, suggesting further consideration when giving avoidance advice. Our results suggest the need for further investigation on whether sensitization against 2S albumins might serve as predictor for increased probability of gastrointestinal reactions during food challenges.
J ALLERGY CLIN IMMUNOL FEBRUARY 2017
448
Understanding Predictors for the Development of Tolerance to Allergies in Pediatric Food Allergy Natural History Registry
Ruixuan Zhou1, Serena Chan, PhD2, Jesse Blumenstock, MS (c)3, Marjorie Yarbrough, MPH3, Ruchi S. Gupta, MD, MPH3,4, Anne Marie Singh, MD5,6, and Paul J. Bryce, PhD7; 1University of Illinois, Champaign, IL, 2Univeristy of Illinois, Champaign, IL, 3Northwestern University, Chicago, IL, 4Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 5Division of Allergy & Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Division of Allergy-Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 7 Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Despite affecting up to 6 million children nationwide, the natural history of food allergy is not well understood. To learn more about the natural course of food allergy, we developed a prospective registry of children with food allergy. The goal of this study was to investigate what predictors are associated with development of tolerance to peanut, tree nut, and egg allergies. METHODS: By collaborating with allergy clinics across Chicago, we recruited families with at least one child with a food allergy into a registry. Data from children’s medical records and caregiver surveys was analyzed. Logistic regression analyses were conducted to investigate the relationship between tolerance and predictors, such as the child’s demographic characteristics, child’s comorbidities, previous reactions to allergen, current epinephrine usage, current food allergy, and parental morbidities. RESULTS: Children of respondents (N5158) were mostly male (65.2%), white (76.6%), with an average age of 6.4 years (SD53.7). 41.1% of children reported outgrowing at least one of their food allergies. The percentages of children who outgrew their allergies were: 5.1% for peanut, 13.9% for tree nuts, and 19.6% for egg. The average age of outgrown peanut allergy was 6.0 (SD51.7), for tree nut allergy was 7.0 (SD52.9), and for egg was 6.8 (SD53.7). No child or parental factors were found to be significantly associated with the development of tolerance to food allergy. CONCLUSIONS: For all three allergens, none of the predictors showed statistical significance at predicting development of tolerance to food allergies. Further investigation will be conducted when more data becomes available.