J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB210 Abstracts

MONDAY

728 Banana Allergy In Children Evaluated Using Double BlindPlacebo Controlled Food Challenge

Aysen Bingol1, Dilara Kocacik Uygun2, Dr. Serkan Filiz3, Olcay Yegin4;1TURPEDAS, Turkey, 2Akdeniz University Medical Faculty Dept of Pe-

diatric Allergy Immmunology, 3Akdeniz University Medical Faculty

Dept of Pediatric Allergy Immunology, Antalya, Turkey, 4Akdeniz Uni-

versity Medical Faculty Dept of Pediatric Allergy Immunology, Antalya,

Turkey.

RATIONALE: Food allergy is defined as an abnormal or an exaggerated

immune response against food proteins. The diagnosis should be made by

skin prick test and double-blind placebo controlled food challenge

(DBPCFC) is required for definitive diagnosis. In our study, we aimed to

study DBPCFC in the children who have history of reaction with banana

and have high level of banana specific IgE .

METHODS: 47 children who have high banana specific IgE levels were

subjected to skin prick, prick to prick and DBPCFC tests.

RESULTS: 66% (31/47) of the children were male and 34% of themwere

(16/47) girls. We determined positive DBPCFC reaction in 13% of the

children. Statistical analysis showed that, banana specific IgE cut-off value

was 0,66 kU/L and sensitivity and specificity was 83% and 51%,

respectively. For banana spesific IgE, positive predictive value was 20%

and negative predictive value was 96%. Sensitivity and specificity for

banana prick to prick test were 33% and 93%, respectively. Positive and

negative predictive value for prick to prick test was 40% and 91%

respevtively.

CONCLUSIONS: This is the firs study using the DBPCFC test to

diagnose the banana allergy in comparison with other diagnostic tests

in children. Up to now, positive predictive value was not defined for

banana specific IgE. Our study showed that, specific IgE or skin prick

tests (both commercial and fresh material) alone are not adequate for

the diagnosis of food allergy. DBPCFC test should be done for

definitive diagnosis.

729 Risk Of Oral Food Challenges In Children - a ProspectiveMulticenter Study -

Dr. Toshiko Itazawa, MD, PhD1, Dr. Motokazu Nakabayashi, MD,

PhD1, Dr. Yasunori Ito, MD, PhD1, Dr. Yoshie Okabe, MD, PhD1,

Dr. Yoko S. Adachi, MD, PhD1, Dr. Yuichi Adachi, MD, PhD1,

Dr. Komei Ito, MD, PhD2, Motohiro Ebisawa, MD, PhD, FAAAAI3;1Department of Pediatrics, University of Toyama, Toyama, Japan, 2Aichi

Children’s Health and Medical Center, Obu, Aichi, Japan, 3Clinical

Research Center for Allergy and Rheumatology, Sagamihara National

Hospital, Kanagawa, Japan.

RATIONALE: Oral food challenges (OFCs) are essential to the diagnosis

of food allergy or tolerance to a food. However, there are few multicenter

studies about risk of OFC.

METHODS: A prospective multicenter study was performed to

evaluate provoked symptoms in OFC. Each center was asked to

register all OFCs or a maximum of 100 consecutive OFCs during 6

months.

RESULTS: Data of 5,270 OFCs were enrolled. Data of OFC for rush

immunotherapy, patients older than 19 years old and insufficient

questionnaire information were excluded. A total of 5,063 OFCs

(median: 3.7 years old, male: 65.0%) from 113 hospitals and 6 clinics

were analyzed. Most frequently tested foods were egg (n52,462), milk

(n51,094), and wheat (n5609), with the following positive rate for

each food; egg 43.3% (1,067), milk 54.5% (596), and wheat 54.2%

(330). Among children with positive response to egg, cutaneous

reactions were most common (69.5%), followed by gastrointestinal

(51.6%) and respiratory (32.6%) symptoms. Similarly, cutaneous

reactions were most common (79.2%), followed by respiratory

(42.6%) and gastrointestinal (29.6%) symptoms in milk challenge. In

wheat challenge, cutaneous reactions were also common (82.7%),

followed by respiratory (52.1%) and gastrointestinal (17.3%)

symptoms.

CONCLUSIONS: OFCs can result in not only mild allergic reactions but

also systemic or severe reaction. OFC should be carried out only under the

close supervision by trained physicians. This study was performed by Oral

Food Challenge Survey Group.

730 A Double-Blind Randomized Controlled Trial Of A ThickenedAmino-Acid-Based Formula In Children Allergic To Cow'sMilk and To Protein Hydrolyzates

Prof. Nicolas Kalach, MD, PhD1, Dr. Elena Bradatan2, Prof. Alain

Lachaux3, Dr. Francois Payot3, Prof. Frederic de BLAY4, Dr. Lydie

Gu�enard-Bilbault5,6, Dr. Riad Hatahet7, Dr. Sandra Mulier8,

Prof. Christophe Dupont, MD, PhD9; 1Hopital Saint Vincent de Paul,

Groupement des Hospitaux de l’Institut Catholique de Lille (GH-ICL),

Lille, France, 2Department of Pediatrics, Regional Hospital, Namur,

Belgium, 3Gastroenterology, Hepatology and Nutrition Unit, University

and Pediatric Hospital of Lyon, France, 4CHRU Strasbourg, France,5Regional University Hospital, Strasbourg, Strasbourg, France, 6Aller-

gologist, Illkirch-Graffenstaden, France, 7Pediatrician Allergologist,

Forbach, France, 8Queen Fabiola Children’s, University Hospital, Brus-

sels, Brussels, Belgium, 9Hopital Necker Enfants Malades, Paris,

France.

RATIONALE: Children with cow’s milk allergy (CMA) may also be

allergic to extensively hydrolyzed protein formulas (eHF). Amino acid-

based formulas (AAFs) are recommended in such cases, though no AAF

has been clinically tested in infants allergic to eHF.

METHODS: 86 infants were randomized in a double-blind controlled

trial comparing a ‘‘thickened" AAF (Elementa, United

Pharmaceuticals) and a commercially available ‘‘reference’’ AAF.

Only patients whose symptoms did not improve with an eHF were

included. CMA was confirmed through a double blind placebo

controlled food challenge. Digestive, cutaneous and respiratory symp-

toms as well as growth parameters were assessed at 1, 3 and 6

months.

RESULTS: Data at 1 month show that both formulas were tolerated

(100% of children for ‘‘thickened’’ AAF and 95% for ‘‘reference’’

AAF). CMA and eHF allergy were confirmed in 75 children: all of

them tolerated the tested formulas. The main allergic symptom

disappeared completely within 1 month in 26/42 (61.9%) and 17/33

(51.5%) respectively with the ‘‘thickened’’ and the ‘‘reference’’ AAF

(ns). Infants had significantly more normal stools (90.5% vs 66.7%,

p50.011) with the ‘‘thickened" AAF versus the ‘‘reference’’ AAF.

Regurgitations disappeared completely in 65.4% vs 42.3% (ns)

respectively. Weight-for-age z-score increased by 0.160.3

(mean6SD) for the ‘‘thickened’’ AAF and 0.260.4 for the ‘‘reference’’

AAF’’ (ns). BMI z-scores increased respectively by 0.260.6 and

060.7 (ns).

CONCLUSIONS: This is the first demonstration of AAF efficacy in CMA

associated with eHF allergy. The ‘‘thickened" AAF was tolerated by all

infants and growth parameters were appropriate.