1108
Patterns of food allergen sensitization in urban and rural populations - the EuroPrevall-INCO surveys
Wong, G1; Mahesh, P2; Ogorodova, L3; Leung, TF1; EuroPrevall-INCO Study Group
1Chinese University of Hong Kong, Shatin, Hong Kong, China;2Allergy Associates, Mysore, India;3Siberian State Medical University, Tomsk, Russian Federation
Background: Food allergy is a common condition affecting children and adults in developed countries. Food induced ana-phylaxis has been documented to be increasing in the recent decade. Food allergy has been perceived to be less com-mon in developing countries. There is lim-ited published data outside Europe and North America.
Methods: We used the standardized Euro-Prevall methodology to investigate random samples of school children from Russia, India, and China to evaluate the patterns of food allergen sensitization in primary school children. Children aged 7–10 years were screened for the presences of possible food allergies. Subsamples of subjects with or without possible food allergies were studied by detailed face-to-face question-naires, SPT, and serum specific IgE test-ings.
Results: A total of 35 549 children were recruited, of who 2891 participated in the second clinical stage. Using a cut off 0.35 kU/l as positive, the weight-adjusted prevalence rates of food-specific IgE sensi-tisation to at least one food were 29.7%, in Hong Kong, 14.5% in Guangzhou, 25.8% in rural Shaoguan, 13.2% in Tomsk, and 26.7% in India. The differ-ences in the prevalence were statistically significant (P<0.01). The patterns were very different among the different popula-tions. In Hong Kong, sensitization to milk, hen’s egg, and shrimp were the top three allergens while sensitization to nuts and vegetables were more common in Russia and India. For children recruited from Hong Kong, both sensitisation and food allergy were significantly higher (P<0.01) in children who were born and raised in Hong Kong when compared to those who were born in mainland China and migrated to Hong Kong highlighting the potential importance of early life exposure in
affecting the subsequent development of food sensitisation and allergy.
Conclusions: There are wide variations in the prevalence of food specific IgE sensiti-sation in the three participating countries.
Despite high degree of sensitization in rural areas, food allergies were uncommon highlighting that other factors are impor-tant in the clinical manifestation of food allergies other than just sensitization.
Acknowledgement: Supported by the
HKRGC CUHK477110, NNSFC
81261130023 and EU
1109
Study of patients with positive skin tests to LTP and/or profilin in a Mediterranean area
Fernandez, J1; Jimenez-Rodriguez, T1; Lindo-Gutarra, M1; Canto-Reig, V1; Cueva, B1; Gonzalez, P1; Flores-Pardo, E2; Soriano, V1
1University Hospital Alicante, UMH, Allergy, Alicante, Spain;2University Hospital San Juan de Alicante, Clinical Analysis, San Juan de Alicante, Spain
Background: The use of LTP and other panallergens in skin tests joined to in vitro IgE to molecular components to study fruit allergy patients has been recently intro-duced. Our aim was to study molecular component of positive patients to panaller-gens by skin tests referred to allergy outpa-tient clinics in a highly prevalent Mediterranean area in Spain.
Method: A cross sectional study of patients positive to panallergens (LTP, profilin and/or polcalcin) by skin tests, from the outpatient clinic of Alicante University hospital, between 2012 and 2014 was carried out. Clinical history, skin tests to the major allergens of our area as pollens (olive, chenopods, and grasses), mites, fungi, epithelia and fruits extracts were done. ImmunoCAP ISAC array (Thermo Fisher Scientic, U.K.) were car-ried out in all of them. The ISAC tests were considered positive when they were greater than 0.35 ISU. Descriptive statisti-cal analysis was performed with SPSS 20 MAC.
Results: 219 allergy patients were studied.
The sample has a mean age of young adults (30.3511.8), and predominantly women (59%). Most of them suffered from any allergy disease, such as rhinitis (73%),
food allergy (72%), asthma (28%) or ato-pic Dermatitis (7%). Pollen was responsi-ble for 64% sensitization, presenting symptoms of rhinitis (100%) and asthma (53%). Among the different positive panal-lergens, LTPs were the most important.
Pru p 3 was found positive in 84.7% of the sample, followed by Jur g 3(74.6%), Pla a 3(61.9%), Ara h 9 (55.8%), Art v 3 (51.6%), Cor a 8 (47%) y Ole e 7 (22.8%).
Mostly they featured multiple sensitization (49% gave positive to 5 LTPs, 31%
between 2 and 4, and only 18% to one).
This multiple sensitization was related with food allergy symptoms (4.6 LTPs) vs asymptomatic (2.6 LTPs, P<0.001).
Although there was not a clear relationship between Ole e 1 and Ole e 7, there was a good correlation (OR 19.3, P<0.01) between them. Profilin represented less than 10% of sensitizations.
Conclusion: LTP was found the most important panallergen in our Mediter-ranean area. The profile of different LTPs may vary from place to place depending on food habits or pollen count.
1110
Sensitization to profilin in Greek adults and correlation to oral allergy syndrome:
results of a prospective study
Iliopoulou, A1,2; Pitsios, C2; Petrodimopoulou, M1; Konstantakopoulou, M1; Papadopoulou, E1; Passioti, M1; Mikos, N1; Kontogianni, M2; Kompoti, E1
1Allergy, Laikon General Hospital of Athens, Athens, Greece;2Nutrition and Dietetics, Harokopion University, Athens, Greece
Background: Profilin is a panallergen often responsible for cross-reactivity between pollen and plant food. Oral allergy syn-drome is a clinical expression of this cross-reactivity. The aim of our study was to determine the prevalence of sensitization to profilin and the correlation between its sen-sitization and manifestation of OAS.
Method: 264 adult atopic patients were included in our study. They had a history of respiratory (allergic rhinitis and/or asthma) or food allergy and presented at least one positive SPT out of the relative panel used in our Clinic. SPTs with an extra panel were conducted for the study including one profilin extract, four plant food extracts (peach skin and pulp, walnut
and apple), and three pollen (Olea europea, Parietaria judaica, Phleum pratense).
Results: 29/264 of our atopic patients (11%) resulted positive to profilin. 79/264 patients (30%) referred symptoms of OAS.
The foods of plant origin most implicated in OAS were peach, walnut, kiwi, banana, hazelnut, peanut, apricot, eggplant and melon. No statistically significant correla-tion was found between sensitizacorrela-tion to profilin and OAS, or between pollen extracts and OAS. A significant trend of profilin-sensitization was found in patients with allergic rhinitis (P=0.054), but not in asthmatics. OAS was connected to peach pulp’s sensitivity (P<0.0001), but also to other plant foods. Cases with positive SPT to peach pulp extract had the highest cor-relation to OAS [OR=5.77, 95%CI:
(2.754–12.102)], in comparison to other food extracts.
Conclusion: Our results show a low preva-lence of sensitization to profilin, in Greece.
The in vivo sensitization to profilin’s extract was not correlated to OAS, maybe due to the limited number of patients, or due to the fact that OAS in our country might be caused by other allergens.
1111
A retrospective study on clinical manifestations of fruits and vegetable allergy between adults and pediatric patients
Yasunobu, T
Sapporo Tokushukai Hospital, Sapporo, Japan
Background: The prevalence of allergy to fruits and vegetables has increased and has become important in children and adults.
The aim of study aim is to clinical manifes-tations of fruits and vegetable allergy between adults and pediatric patients.
Methods: We retrospectively analyzed clin-ical manifestations in 148 patients (70 chil-dren and 78 adults) with allergy to fruits and vegetables.
Results: The patients showed allergy to 52 kinds of fruits and vegetables. Children were allergy to a total of 196 kinds, and adults were allergy to a total of 352 kinds, of fruits and vegetables. Eight of the 10 leading allergens were the same in children and adults; apple, peach, cherry, melon, kiwi, pear, banana, strawberry. Apple and peach were the most frequently implicated foods. The allergic symptoms appeared form at 8.1 years old on average in chil-dren and at 24.1 years old on average in adults. Allergic symptoms (children/adults) were oral itchiness (75.7%/91%), skin symptoms (17.1%/32.1%), gastrointestinal symptoms (12.9%/16.7%), and respiratory symptoms (12.9%/21.8%). Only adults
patients reported headache in 2, and fati-gue in 1. Twelve children and 16 adults experienced anaphylaxis to fruits and veg-etable allergy. Five children were allergic to melon and 4 adults were allergic to apple, which are the most causal anaphy-laxis fruits. A hundred twenty patients (54 children and adults 66 adults) had polli-nosis as the most frequently complicated allergy and of whose patients were allergic to birch (35 children and adults 40 adults).
Conclusion: Symptoms of fruits and veg-etable allergy were similar both children and adults. More investigations toward the prognosis and management, which includ-ing the risk of anaphylaxis, are necessary.
1113
Egg allergy: onset in adult age
Roa-Medellin, D1; Navarro, J2; Morales-Cabeza, C1; Rodrıguez-Gamboa, A1; Rojas, P1; Baeza, ML1
1Department of Allergy, Hospital General Universitario Gregorio Maran~on, Madrid, Spain; 2Department of Immunology, Hospital General Universitario Gregorio Mara~non, Madrid, Spain
Background: The onset of egg allergy in adulthood is unusual. It frequently occurs as bird-egg (BES) or occupational egg-egg syndrome. However it may also manifest as a rare selective immediate food egg allergy (FEA).
Methods: A retrospective-descriptive study from Jan 2008 to Dec 2014 of patients with late-onset egg allergy (after 18 years old) in a third-level hospital was con-ducted. It was aimed to study and compare the specific characteristics of FEA and BES.
Results: Only 17 patients were found to have late onset-immediate egg reactions.
Ten had been diagnosed with FEA and 7 patients with BES. At the onset of the dis-ease the mean age was 30 years (SD=10), 60% women, in FEA and 44 years (SD16), 100% women in BES (n.s.).
Seventy percent, and 100% had previous atopic diseases respectively (n.s). The delay on diagnosis was 9 years (median) in FEA and 5 years in BES. The main symptoms upon egg ingestion were: 80% cutaneous, 20% respiratory, 20% gastrointestinal in FEA and 57%, 42.85%, 57% in BES, respectively. Two patients presented with anaphylaxis in each group.
In FEA skin prick tests were positive in 100% of the patients to white egg, 50% to yolk, 70% ovomucoid (OVM) and 50%
ovalbumin (OVA). In BES it was positive in 100% of the patients to white egg, 100% to yolk, and 71.4% to OVA. Prick test to OVM was negative in all of them.
Specific IgE (sIgE) were present in 100%
of patients to white egg (median: 2.14 KU/
l, range: 0.37–100), in 50% to yolk (0.6,
0.39–22.9), 60% to OVM (3.04, 1.69–65) and 70% to OVA (0.98, 0.65–100) in FEA.
It was present in 100% of patients to white egg (median: 11.1 kU/l, range: 0.65–39.3), in 100% to yolk (11.29, 0.51–100), 43% to OVM (27.2, 0.69–100) and 71.4% to OVA (2.9, 0.35–46) in BEA patients.
In the FEA all tolerated chicken meet and 40% had tried and tolerate eggs from different species (ostrich, quail).
In BES only 42% did not tolerate chicken meat. The median sIgE to chicken meat was 18.9 kU/l (range: 7.09–33.6. All of them avoided all eggs.
Conclusions: FEA and BES have a similar incidence in the adult age, being both of them rare pathologies, with a considerable delay in the diagnosis. The clinical pattern of both entities look dissimilar, being cuta-neous symptoms the main clinical presenta-tion in FEA, whereas in BES patients, cutaneous and gastrointestinal and respira-tory symptoms are developed at the same rate. Anaphylaxis may occur in both groups.
1114
Food allergy in a pediatric food allergy unit at Centro Hospitalar Porto, Portugal:
2 years of experience
Vieira, L1; Rezende, I2; Cunha, L2; Falc~ao, H2
1Centro Hospitalar Vila Nova de Gaia, Immunoallergology, Vila Nova de Gaia, Portugal;
2Centro Hospitalar do Porto, Immunoallergology, Porto, Portugal
Background: The prevalence of food allergy (FA) in childhood increased in the last decades, affecting almost 10% of the pediatric population and being, across Eur-ope, the leading cause of anaphylaxis in children aged 0–14 years. The aim of our study was to investigate the prevalence and characteristics of the principal foods impli-cated in a Pediatric population with sus-pected FA.
Method: A retrospective review was per-formed on children with suspected FA referred to our Pediatric Food Allergy Unit from Jan/2014 to Dec/2015. The eval-uation involved skin prick test (SPT);
Prick-to-prick test (PPT); specific IgE (sIgE); component-resolved diagnostics (CRD); Basophil Activation Test (BAT) and Oral Food Challenges (OFC).
Results: 109 children aged 10 months to 18 years (median 6) were analysed, most of them males (57%) and referred by general Allergist (35%), followed by primary care Physicians (32.7%) and Pediatrician (21%). Most frequent causes and clinical signs were: FA screening in high risk infants (18%); symptons involved the skin (urticaria and/or angioedema (42%),
followed by gastrointestinal (17%), ana-phylaxis (10%), food sensitization (8.3%), oral allergy syndrome (4.6%) and respira-tory symptoms (1.8%).
A total of 190 food allergens were found in result of positive SPT (88%), PPT (63%), sIgE (56%) and CRD (12%). We performed 4 BAT, in patients with persi-tent Cow0s milk allergy (CMA), which were all positive. One of these patients underwent oral immunotherapy to CM, being fully desensitized.
A total of 67 OFCs were performed. 57 to confirm suspicion of FA. Of these, 27 (47%) were positive: 10 to Cow0s milk (CM), 6 to hen’s egg (HE), 6 to fish and crustaceans, 2 to peanut, 2 to wheat and 1 to vegetable.
Twelve (18%) OFC were performed to evaluate the acquisition of tolerance to CM and HE, and they were all negative.
Diagnosis of IgE-mediated FA was established in 77 patients. Of these, 65 are on elimination diet and 12 acquired toler-ance. In 21 patients FA was excluded. 5 patients droup out the follow-up evalua-tion and 6 are in investigaevalua-tion. Most patients with FA reacted to one or two foods (89%). Only 11% of patients reacted to 3 or more foods, mostly to fish and crustaceans.
Conclusion: CMA was the most frequent FA. The most frequent symptoms involved the skin. Anaphylaxis was reported in 10%
of patients. The SPT were the most used diagnostic tests and OFC was used asgold standard to confirm the diagnosis or the acquisition of tolerance.
1115
Early associations with asthma in young children with cow’s milk allergy
Petrus, NCM1; Jansen van der Weide, MC2; van Aalderen, WMC1; Sprikkelman, AB1,3
1Emma Children’s Hospital AMC, Pediatric Respiratory Medicine and Allergy, Amsterdam, the Netherlands;
2Pediatric Research Center, Emma Children’s Hospital AMC, Amsterdam, the Netherlands;3Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Groningen, the Netherlands
Background: Cow’s milk allergy (CMA) is a common disease in infancy. It is hypoth-esized that these children have an increased risk for developing other allergic diseases, such as asthma, later in childhood. How-ever, it is not clear how many will develop asthma. We hypothesized that children with CMA more likely had an aero-aller-gen sensitization, asthma-like symptoms and inhalation medication use compared to controls in the first 2.5 years of life.
Method: All children, aged 0–2.5 years, with challenge proven CMA participating in the Dutch EuroPrevall birth cohort
study were investigated. They were age-matched and age-matched for age at aero-aller-gen sensitization sampling with healthy controls. Aero-allergen sensitization was defined according to Phadiatop reference values. Asthma-like symptoms were defined as having doctors diagnosed wheeze, and/
or coughing at night without common colds, and/or doctors diagnosed asthma.
Inhalation medication included use of pre-scribed inhalation medication. A logistic regression model was created for aero-allergen sensitization, asthma-like symp-toms and inhalation medication use, sepa-rately.
Results: In total 45 children with CMA were included. The crude model regarding asthma-like symptoms was significantly dif-ferent between children with CMA and matched controls (P=0.01). This effect just disappeared after correction for con-founders (P =0.05). None of the other models showed significant results.
Conclusion: Children with CMA seem to have a higher probability of asthma-like symptoms in the first 2.5 years of life, compared to controls. Since this is the first study including young children with chal-lenge proven CMA, investigating early signs of asthma, we consider our results, although with limited power, relevant.
1118
Tolerance to cow0s milk protein development in children with IgE mediated cow0s milk allergy
Barzylovych, V1; Barzylovych, A2; Pochinok, T1; Gudsij, M2
1Bogomolets National Medical University, Kiev, Ukraine;2Clinic Oberig, Kiev, Ukraine
Background: Cow0s milk is a major aller-gen and one of the main nutrient in first years children. Development of tolerance to cow0s milk is important task up to date allergology.
Method: Under our supervision were 143 1-st year children with cow milk allergy (skin and/or gastrointestinal symptoms approved with increased levels of specific IgE to cow milk fractions) 12 children had severe oral allergy syndrome to cows milk.
(n=7 rash, angioedema; n=3 angioe-dema, vomiting; n=2 vomiting). All chil-dren had high IgE level to cows milk (n=6-a,b lactoglobulin and casein; 4=a, b lactoglobulin, 1=casein) and negative IgG levels to cows milk. To all children straight avoiding diet were recommended.
At the age of three in the case of necessity oral immunotherapy were suspected. Dur-ing supervision time control should be pro-vided by oral provocation with cows milk
and measuring IgE and IgG to cow milk proteins.
Results: At the age of three we found sig-nificant decrease of specific IgE and signifi-cant increase of specific IgG in 9 children.
The tolerance development in these chil-dren approved with negative oral provoca-tion. After diet analyses were found that in ratio of this children small doses of such products as beef, bred and other bakery were present.
3 other children had no violations in the diet and significant decrease of specific IgE and still negative IgG. 2 children had posi-tive oral provocation result and 1 negaposi-tive.
Conclusion:
1 Avoidance of cow0s milk significantly reduces the risk of development oral allergy syndrome in children allergic with cow0s milk allergy.
2 Including in diet products with small quantities of cows milk can lead to food tolerance development
3 Provocative tests to products with small quantities of cows milk can be reason-able and used for diet widening and food tolerance formation
1119
Rare case of late onset of allergy to chicken egg white
Novakova, S1; Iliev, Y2; Novakova, PI3; Bozhilov, V2
1University Hospital ‘Sv. Georgi’, Allergy Unit, Plovdiv, Bulgaria;2University Hospital ‘Sv. Georgi’, Clinic of Toxicology, Plovdiv, Bulgaria;3Medical University, Plovdiv, Bulgaria
Background: Food allergy is most com-monly acquired during the first year of life.
The onset of disease, in most cases, is clo-sely related to the time of introduction, predominantly before the second year.
Allergy to egg is among the eight most common food allergies across different age groups and regions in Europe. Most chil-dren outgrow allergy to egg. The onset in adolescent and adults is very rare.
Aim: The aim of this presentation is to demonstrate a rare case of late onset allergy to chicken egg white.
Method: Seventeen year old boy was referred to evaluate the reason for urticaria and angioedema, appeared for the first time 1 month ago and repeated twice. In order to diagnose the reason, a thorough history was acquired. Skin prick test with milk, whole egg, egg yolk, egg white, wheat was performed evaluated according to European Academy of Allergy and Clinical Immunology.
Results: From the detailed history of the disease it was clarified the urticaria and angioedema appeared within 20 min after raw egg shake was taken and repeated
once again after pancake was eaten. No adverse reactions had appeared when eat-ing either pancakes or boiled eggs up to that time. There was no history of accompanying allergic disease and no family history of allergy. Sensitization to egg white was demonstrated by skin prick test.
Conclusion: The presented case is interest-ing because it demonstrates the onset of allergy to egg white in 17 year old boy who consumed eggs before that. Although rare, food allergy can begin at any time throughout life. It should be evaluated in cases of adverse reactions to food not only
Conclusion: The presented case is interest-ing because it demonstrates the onset of allergy to egg white in 17 year old boy who consumed eggs before that. Although rare, food allergy can begin at any time throughout life. It should be evaluated in cases of adverse reactions to food not only