488 Egg's allergy: an experience from Brazilian Food AllergyReference Center

C. M. A. Jacob, A. C. Pastorino, D. Munhoz, R. G. Ramos, T. Batelochio,

A. C. Brandao, A. K. F. Gushken, G. H. Yonamine, A. P. B. M. Castro;

Faculty of Medicine of University of Sao Paulo, Sao Paulo, BRAZIL.

RATIONALE: Egg is one of the most important allergen related to food

allergy in children. The authors relate clinical and laboratorial data from

egg allergy patients.

METODOLOGY: Among 154 patients from a Brazilian reference center

to food allergy, were selected patients with clinical manifestations trigged

to egg with specific IgE (prick test and RAST). It wasconsidered as positive

prick test a mean wheal diameter �3 mm and RAST class 3 or 4, and for

ImmunoCAPTM the decision point of 7 kUA/L.

RESULTS: Egg’s allergy was found in 14 (9, 1%) and 8/14 present cow’s

milk allergy (CMA) associated. Associated allergic manifestations were:

atopic dermatitis (11/14) , rhinitis (9/14), asthma (7/14) and conjunctivitis

(2/14). The onset age of clinical manifestations ranged from 4 mo to 13

years (median -11months). Cutaneous findings occurred in all patients, be-

ing in 7 patients the isolated manifestation. Two patients presented anaphy-

laxis with egg as the only one food related. Only two patients developed

tolerance (2 y and 12 y). The prick test was positive to white egg (11/11),

yolk (5/6), ovalbumin (5/5) and ovomucoid (3/3). RAST/ImmunoCAP�to white egg were positive in 9/9 patients.

CONCLUSION: Egg’s allergy represents the most important food allergy

after cow’s milk in this casuistic with predominantly cutaneous manifesta-

tion. Anaphylaxis was present only in patients with isolated egg allergy.

The authors point out the necessity to investigate egg allergy in all patients

with cutaneous manifestations.

Funding: Instituto da Criancxa

489 The Effect of Increasing Study Enrollment on Willingness toAdopt Newly Validated Asthma Therapies

P. Khoury, J. O’Brien, S. K. Aberegg; The Ohio State University, Colum-

bus, OH.

RATIONALE: Understanding reasons for underutilization of novel effec-

tive therapies is essential in healthcare. Because asthma care guidelines are

frequently based on randomized controlled trials, we sought to determine

the influence of increasing RCT enrollment on willingness to adopt new

asthma therapies.

METHODS: Four hundred pulmonologists were randomized to receive

one of two versions of a hypothetical clinical trial abstract describing a

new treatment for asthma called ‘‘A’’. In both versions, treatment with

‘‘A’’ reduced absolute mortality by 5% but was associated with certain

risks. In version #1, the study enrolled 799 patients and treatment with

‘‘A’’ provided a statistically significant mortality benefit at p 5 0.04. In ver-

sion #2, 1799 patients were enrolled and treatment was significant at p 5

0.001. The main outcome variable was respondents’ willingness to utilize

the new therapy for a patient with asthma and respiratory failure.

RESULTS: There were 54 respondents for version #1 and 51 respondents

for version #2. Respondents receiving version #1 were significantly more

willing to use the new therapy (74% versus 55%; p 5 0.0398).

Respondents choosing not to adopt the therapy were significantly more

likely to indicate side effects as a reason for this choice.

CONCLUSIONS: Willingness to adopt new asthma therapies based on

the results of RCTs did not conform to our hypothesis that decision-making

under risk would preference evidence-based therapies according to ex-

pected utility theory. This finding has implications for quality of care

and the development of asthma guidelines. Additional research is war-

ranted to elucidate the mechanism of this effect.

Funding: Ohio State University

490 Adherence To Immunotherapy Protocols, SLIT Vs. SCITR. Garcia-Ibanez, D. M. Pollina; The AllergiGroup, Tampa,

FL.

RATIONALE: In Europe sublingual immunotherapy (SLIT) is widely

used for the treatment of allergic disease. In the U.S. subcutaneous inject

able immunotherapy (SCIT) remains the standard of treatment.

Adherence to SCIT treatment is affected due to time constrains, adverse

events, and inconvenience. SLIT may be an alternative to SCIT, and may

have a better tolerance and adherence.

METHODS: We report a series of 200 multi sensitive patients affected

with Perennial Allergic Rhinitis that entered desensitization protocols.

We did observe adherence to treatment protocol from beginning to main-

tenance levels of immunotherapy treatment.

RESULTS: Two treatment groups consisting of 100 patients each received

either SLITor SCIT treatments. Age average was 34.8 years, 68 female, 32

males for the SLIT group, while age average was 42.1 years, 73 females,

and 27 males in the SCIT group. We did observed a gradual decline in

the adherence to both treatment modalities as the protocols progressed.

The decline was steeper in the SCIT group and at maintenance levels of

treatment, and adherence in SLIT group was 87% compared with 57% in

the SCIT treatment group.

CONCLUSIONS: In a previous report, we have found SLIT a useful ther-

apeutic intervention in the management of patients affected with

Rhinoconjunctivitis and Bronchial Asthma. In this report we found a

greater adherence to SLIT therapy compared to that observed in the stan-

dard SCIT treatment. SLIT protocols have a shorter and a more convenient

schedule compared with that of SCIT.

491 Low Temperature is a Strong Risk Factor for the Onset ofAtopic Dermatitis in Children in Japan

K. Matsumoto, H. Saito; National Research Institute for Child Health and

Development, Tokyo, JAPAN.

RATIONALE: The prevalence of atopic dermatitis (AD) differs among

different countries presumably because of the differences in genetic predis-

positions and environmental factors including, race, customs, foods and

hygiene conditions. In the present study we attempted to clarify the in-

volvement of geometric and meteorological factors associated with the

prevalence of atopic dermatitis in Japan.

METHODS: The results from two independent large-scale nationwide

surveys, the 21 Century Longitudinal Birth Cohort Survey (46,962 chil-

dren, 18 months of age, response rate 93.5%) and National Livelihood

Survey (approximately 70,000 children, 0-14 years of age, response rate

87.3%) were analyzed in the present study. In both surveys, the presence

or absence of physician diagnosed AD was answered in self-writing ques-

tionnaires by the guardians. Empirical Bayes estimate of standardized

disease ratio (EBSDR) and multiple regression analysis between meteoro-

logical factors and the prevalence of AD was determined.

RESULTS: The prevalence of AD in 48 prefectures in Japan from two dis-

tinct surveys showed very high correlation with each other (r 5 0.37, p 5

0.0001). The prevalence was significantly higher in northern prefectures

than southern ones. Among 10 meteorological factors, the average, the

highest and the lowest temperatures showed significant inverse correlation

with the prevalence of AD.

CONCLUSIONS: The significant correlation of the prevalence of AD

from two distinct nationwide surveys suggests the involvement of some

geometric factors in the onset of AD. Multiple regression analysis sug-

gested that low temperature is a strong risk factor for the onset of atopic

dermatitis in children in Japan.

Funding: National Institute of Biomedical Innovation and Japanese

Ministry of Health, Labour and Welfare

J ALLERGY CLIN IMMUNOL

JANUARY 2007

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