J ALLERGY CLIN IMMUNOL

FEBRUARY 2013

AB24 AbstractsSATURDAY

86 Prevalence of Milk, Peanut and Egg Allergies in ASocioeconomically Diverse Cohort of Infants: Identifying Casesof Food Allergy for Field Studies Using an Expert Panel

Jerel M. Ezell, MPH1, Suzanne Havstad, MA1, Haejin Kim, MD2, Ga-

nesa Wegienka, PhD1, Dennis Ownby, MD, FAAAAI3, Edward M.

Zoratti, MD, FAAAAI2, Christine Cole Johnson, PhD, MPH, FAAAAI1,

Christine L. M. Joseph, PhD1; 1Department of Public Health Sciences,

Henry Ford Hospital, Detroit, MI, 2Division of Allergy and Clinical Im-

munology, Henry Ford Hospital, Detroit, MI, 3Division of Allergy-Immu-

nology and Rheumatology, Georgia Health Sciences University, Augusta,

GA.RATIONALE: Double-blind, placebo-controlled oral food challenges

remain the gold standard for identifying cases of food allergy, but are

seldom feasible for large, epidemiologic studies. We used an expert panel

to ascertain food allergy in a birth cohort.METHODS: Determination of Immunoglobulin-E-mediated food allergy

(FA) to milk, peanut and egg in infants age 24 months was made by two

board-certified allergists who categorized cases as highly probable, likely

and unlikely. A third allergist was consulted for discordant reviews.

Panelists reviewed1 cord blood IgEmeasures;2 parent interviews at 1, 6, 12,

and 24 months, including family history of allergy/asthma;3 a 36-month

parent interview including items on food avoidance, gastrointestinal symp-

toms, onset and duration of reactions to food;4 infant medical records; and5

serum-specific IgE and skin prick test results at 24 months.

RESULTS: Of the 587 infants analyzed, the panel reviewed 280 cases and

agreed on 220 (78.6%). The remaining 60 cases (21.4%) were decided by a

third allergist. Overall, 52 infants (8.9%) had highly probable/likely cases of

FA based on panel consensus. Prevalence of milk, peanut, and egg allergies

was 1.7% (0.8-3.1), 5.3% (3.6-7.4) and 6.1% (4.3-8.4), respectively. In

comparison, prevalence of sensitization to these food allergens was 31.6%,

11.6%, and 24.5%, respectively. Prevalence was highest for African

Americans. Panelists took 1.7 minutes, on average, to review each case.CONCLUSIONS: As expected, not all sensitized infants were found to

have a corresponding FA. Usage of an expert panel provides a systematic

approach to identifying cases of FA in epidemiologic studies.

87 African American Race Is a Robust Risk Factor for Food, but NotAeroallergen Sensitization

Haejin Kim, MD1, Suzanne Havstad, MA2, Jerel M. Ezell, MPH2, Ga-

nesa Wegienka, PhD2, Edward M. Zoratti, MD, FAAAAI1, Christine

Cole Johnson, PhD, MPH, FAAAAI2; 1Division of Allergy and Clinical

Immunology, Henry Ford Hospital, Detroit, MI, 2Department of Public

Health Sciences, Henry Ford Hospital, Detroit, MI.RATIONALE: The role of self-reported race in the development of

sensitization to aeroallergens and food allergens has been explored

previously with conflicting resultsMETHODS: Parents and their children (n5543) enrolled in a longitudinal

general birth cohort were interviewed and examined at a clinical visit

occurring at age two years of the child. Interviews addressed parents’

allergic history (doctor’s diagnosis of hayfever, nasal allergies, and allergic

rhinitis), and childrenwere skin tested to a panel of seven aeroallergens and

three food allergens. Race was self-reported as African American (AA) or

white (non-Hispanic). Odds ratios (OR) for sensitization to any aeroaller-

gen or any food allergen were calculated using logistic regression

RESULTS: Overall, AA children (n5388) were more likely to be sensi-

tized to at least one food allergen (OR 3.65, [95%CI 1.84-7.25]) than white

children (n5153). Gender, birth order, and parental history did not modify

this association. In contrast, overall odds of sensitization to an aeroallergen

was similar between AA and white children (OR 1.31, [95% CI 0.74-

2.34]), but AA children with an atopic parent were more likely to be sen-

sitized (OR 2.45, 95% CI [0.87-6.87]) than AA children without an atopic

parent (OR 0.79, [95% CI 0.38-1.64]).

CONCLUSIONS: In the general population, AA race was significantly

associated with the development of food sensitization but not aeroallergen

sensitization. Parental history did not modify the association between race

and food sensitization but appears to modify the association with

aeroallergen sensitization.

88 Comparison of Allergy to Multiple Versus Single Foods in aPediatric Urban Population

Jennifer M. Camacho, MD, Sarah A. Taylor-Black, MD, Julie Wang,

MD, FAAAAI; Mt. Sinai School of Medicine, New York, NY.RATIONALE: Given limited data on food allergies in the pediatric urban

population, we examined the comorbidities associatedwithmultiple versus

single food allergy in this group.METHODS: A retrospective review of electronic medical records from

July 1, 2008 to July 1, 2010 was performed of children from the Mount

Sinai Pediatric clinic that serves East Harlem, NY. Charts for review were

selected based on ICD-9 codes for food allergy and/or epinephrine auto

injector prescriptions.RESULTS: A total of 313 children (3.4%) of the general pediatric

population had a physician-diagnosed food allergy. 42% had multiple food

allergies (MFA) and 58% had a single food allergy (SFA). There were no

racial or gender differences. Children with MFAwere on average younger

than children with SFA (7.76 years (yrs), range 1-21 yrs vs. 9.09 yrs, range

1.4-21 yrs, p50.035). Children with MFA compared to children with SFA

had higher rates of asthma (58% vs. 49%, p<0.029) and atopic dermatitis

(66% vs. 43%, p<0.0001) while the rates of allergic rhinitis were similar.

Children with MFA were more likely to be referred to and seen by an

allergist compared to children with SFA (83% vs. 56%, p<0.0001; 62% vs.

32%, P<0.0001 respectively). Children withMFA had comparable rates of

anaphylactic events compared to children with SFA (15% vs. 11%).CONCLUSIONS: Children with MFA are more likely to have comor-

bidities that include asthma and atopic dermatitis and also to be referred to

and seen by an allergist compared to children with SFA.

89 The Anti-Inflammatory Pro-Resolution Lipoxin A4 IncreasesDuring Ultra-Rush Venom Immunotherapy

Vincenzo Patella1,2, Mario Romano3, Eleonora Cianci4, Salvatore Saitta5,

Stefano Lattanzio4, Giovanni Florio2, Sebastiano Gangemi5,6; 1School of

Allergy and Clinical Immunology, University of Naples Federico II, Naples,

Italy, 2Division of Allergy and Clinical Immunology, Agropoli General

Hospital, ASL Salerno, Salerno, Italy, 3Department of Experimental and

Clinical Sciences, Center of Excellence on Aging, G. D’Annunzio Univer-

sity Foundation, Chieti, Italy, 4Department of Medicine and Aging Sci-

ences, Center of Excellence on Aging, G. D’Annunzio University

Foundation, Chieti, Italy, 5School and Division of Allergy and Clinical Im-

munology, Department of Human Pathology, University of Messina, 6IBIM

(Istituto di Biomedicina e Immunologia Molecolare ‘‘Alberto Monroy’’),

CNR (Consiglio Nazionale delle Ricerche), Palermo, Italy.RATIONALE: Venom immunotherapy (VIT) is largely used for allergic

reactions triggered by hymenoptera. Despite of these achievements, our

knowledge of mechanisms of VIT-induced tolerance still remains incom-

plete. Lipoxins (LX), lipid mediators generated by the lipoxygenase

pathway, exert potent bioactions which stop inflammation and promote

resolution. To determine whether the beneficial actions are also connected

to changes in LXA4 production, we measured immunoreactive urinary

LXA4 (iLXA4) levels in VIT treated patients.METHODS: 13 patients (4F, 9M; 39.5611.2 yrs) were treated with

Hymnox (Roxall, Italy), an aqueous preparation of Vespula Species or Apis

Mellifera, according to an ultra-rush VIT protocol. Blood and urine

sampleswere collected before and after build-up phase of VIT, and assayed

for iLXA4according to a validated method.

RESULTS: A significant increase in iLXA4 post ultrarush VIT (0.008860.003 vs 0.013 6 0.006 ng/mg creatinine; P50.046) was observed.

Comparing two groups (groupA: 7 patients with sIgE/tIgE< 0.05 vs group

B: 6 patients with sIgE/tIgE > 0.05) the basal iLXA4 levels were higher in

group A patients (0.01036 0.0022 vs 0.00716 0.0033 ng/mg creatinine;

P50.032). All patients fromgroupB displayed a significant increase in uri-

nary iLXA4 post ultrarush VIT (0.0071 6 0.0033 vs 0.016 6 0.0056 ng/

mg creatinine; P50.028; P50.031).

CONCLUSIONS: Ultrarush VIT induces a rapid increase in iLXA4 uri-

nary levels. These data uncover the involvement of LXA4 in ultrarush

VIT-induced tolerance, which may open new avenues to treat patients

with allergy to Hymenoptera venom.