J ALLERGY CLIN IMMUNOL

VOLUME 131, NUMBER 2

Abstracts AB215

UESDAY

766 Characterization of the Causative Allergens for Wheat-Dependent Exercise-Induced Anaphylaxis Sensitized withHydrolyzed Wheat Proteins in Facial Soap

Tomoharu Yokooji1, Saki Kurihara1, Tomoko Murakami1, Yuko Chi-

nuki2, Susumu Harada3, Hitoshi Takahashi2, Eishin Morita2, Kaori Ishii4,

Makiko Hiragun4, Michihiro Hide4, Hiroaki Matsuo1; 1Department of

Pathophysiology and Therapeutics, Graduate School of Biomedical and

Health Sciences, Hiroshima University, Hiroshima, Japan, 2Department

of Dermatology, Shimane University, Izumo, Japan, 3Harada Skin Clinic,

Nishinomiya, Japan, 4Department of Dermatology, Graduate School of

Biomedical and Health Sciences, Hiroshima University, Hiroshima,

Japan.

RATIONALE: Hydrolyzed wheat proteins (HWP) were reported to cause

wheat-dependent exercise-induced anaphylaxis (WDEIA) by transcutane-

ous sensitization through the use of HWP-containing soap in Japan. These

patients developed the allergic reactions not only with the use of soap, but

also on exercise after the intake of wheat protein (WP). In this study, we

identified the allergens and its IgE-binding primary epitopes in WP for

HWP-WDEIA patients.

METHODS: Sera were obtained from 13 patients with native WP-

sensitized WDEIA and 23 patients with HWP-sensitized WDEIA. The

allergenic activities of HWP and 6 recombinant wheat proteins, including

a/b-, g-, v1,2- and v5-gliadins and low- and high molecular weight

(HMW)-glutenins, were characterized by immuno-blot analysis and

histamine releasing test. The IgE-binding epitopes were identified using

arrays of overlapping peptides synthesized on SPOTs membrane.

RESULTS: The higher IgE-bindings to v5-gliadins and HMW-glutenins

were detected inWP-WDEIA patients, whereas the IgE-binding toa/b-, g-

and v1,2-gliadins were preferential in HWP-WDEIA patients. g-Gliadin

strongly induced the histamine releases from basophils of the patients with

HWP-WDEIA. In the inhibition study, the HWP significantly inhibited the

IgE-binding to a/b-, g- and v1,2-gliadins, indicating that HWP-specific

IgE cross-reacts with those proteins. An epitope ‘‘QFLQPQQPFPQQPQ’’

was identified within primary sequence of g-gliadin.

CONCLUSIONS: The specific-IgE to HWP cross-reacted with g-gliadin

in WP most strongly, and the major IgE-binding epitope was

QFLQPQQPFPQQPQ. Thus, HWP-WDEIA symptoms after wheat inges-

tion could be induced by g-gliadin at least partly.

767 Streptomycin in a Blueberry Pie? Risk of AllergicSensitization and Reaction to Antibiotics Contained in Foods

Francois Graham, MD, MSc1, Philippe Begin, MD, MSc1, Louis P.

Paradis, MD, FAAAAI1, Yves Babin, PhD2, Anne M. Des Roches, MD,

FAAAAI3; 1CHUM, Hopital Notre-Dame, Montreal, QC, Canada, 2Min-

ist�ere de l’Agriculture, des Pecheries et de l’Alimentation du Qu�ebec,

Quebec, QC, Canada, 3CHU Sainte-Justine, Montreal, QC, Canada.

RATIONALE: Widespread use of antibiotics in the agri-food industry is

highly controversial, mostly in light of the emergence of bacterial

resistances. Antibiotic sensitization is another potential risk that has

been described with reports of anaphylaxis to antibiotics contained in

meats. At our center, we investigated an 11-year-old girl with known milk

allergy who presented with anaphylaxis requiring ICU admission follow-

ing the ingestion of a blueberry pie, which was presumed to be contam-

inated with streptomycin.

METHODS: Skin prick tests to the pie ingredients were performed on the

subject with intradermal skin tests to streptomycin, as this was an antibiotic

used in orchards at the time. Contents of the pie were analyzed at the

Quebec Ministry of Agriculture, Fisheries and Food laboratory for

detection of milk and sulfites. Bacterial growth inhibition testing was

also performed.

RESULTS: Pie sample analyses showed milk and sulfites below

detection limit. However, samples inhibited bacterial growth. Skin tests

for ingredients other than milk, including blueberry, were negative.

Intradermal skin testing with 0.0008 mg and 0.008 mg of streptomycin

were strongly positive. A control subject had negative tests at these

concentrations. In the minutes following skin tests, the patient developed

an urticarial neck rash and was kept under observation and given an anti-

histaminic. She was discharged but was admitted for a late phase reaction

with stridor and urticaria. She had never been in contact with strepto-

mycin in the past.

CONCLUSIONS: To our knowledge, this is the first documented report of

an anaphylactic reaction likely caused by the ingestion of antibiotic

contaminated fruits.

768 Severe Marijuana Allergy Controlled with OmalizumabDavid B. Engler, MD, FAAAAI1, Alnoor A. Malick, MD,

FAAAAI2, Sunil K. Saraf, MD3, Lisa Adams Dargel, PA-C4; 1Houston Al-

lergy & Asthma Clinic, Houston, TX, 2The Allergy Clinic, Pasadena, TX,3The Allergy Clinic, The Woodlands, TX, 4The Allergy Clinic, Manvel,

TX.

RATIONALE: To see if omalizumab could decrease the frequency and

severity of anaphylaxis in a police detective.

METHODS: The patient has moderate asthma. She received treatment

with 375 mg omalizumab q 2 weeks.

RESULTS: Episodes of anaphylaxis decreased from 3 per month to 0 per

month after 4 months of omalizumab.

CONCLUSIONS: Omalizumab may be of benefit in patients with

anaphylaxis when they cannot avoid the allergen. A 29 y.o. police detective

began experiencing anaphylaxis from casual exposure to marijuana after

her daughter was born. Although she did not interact directly with the

marijuana as her specialty is battered women, casual exposure tomarijuana

plants, marijuana smoke, or even a person who had recently smoked

marijuana caused dyspnea, throat closing, generalized urticaria that

progressed to hypotension with loss of consciousness if she did not use

two epinephrine auto-injectors (each 0.3 mg). Reasonable accommoda-

tions for her to avoid marijuana could not be achieved as she works for a

county whose sheriff’s office is one small building. She continued to

experience anaphylaxis in spite of daily use of fexofenadine, cetirizine,

ranitidine, formoterol, mometasone, and montelukast. She was started on

omalizumab 300mg SQ q 4 weeks. Four months after starting therapy with

omalizumab, she could be exposed to large amounts of marijuana without

experiencing anaphylaxis, although she continues to feel her harbinger

symptoms of tingling of the skin. Omalizumab may be effective in

reducing the frequency and/or severity of anaphylaxis when a patient

cannot avoid the offending allergen.

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