Allergy Profile Research Articles

Methods for Detecting Pediatric Adverse Drug Reactions From the Electronic Medical Record.

Adverse drug reactions (ADRs) are common yet are often underreported, making them difficult to track and study. Prospective pharmacovigilance programs significantly increase detection and reporting of ADRs. The aim of this pilot study was to apply triggers used by a prospective pharmacovigilance program at a freestanding children's hospital to retrospectively detect ADRs at our institution, therefore determining if these methods could be replicated and provide the basis for implementation of a prospective pharmacovigilance program. In 2019, our institution had 22000 inpatient admissions and 51000 emergency room visits and had 21 ADRs voluntarily reported in an electronic medication safety tracking system. Additional ADRs were identified by methods including new or modified entries to a patient's allergy profile in the electronic medical record (EMR) and International Classification of Disease (ICD) codes. We identified 754 unique patients with changes to allergy profile and 5719 ICD codes in 3966 unique patients to evaluate. These triggers prompted screening of the EMR to validate the ADR, and we identified 280 ADRs occurring in 2019. Eight (2.8%) were identified solely by the electronic medication safety tracking system, 64 (23%) were identified by the allergy list, 110 (39%) were identified only by ICD coding, and the remaining 98 (35%) were identified by multiple methods. The use of triggers followed by review of the EMR identified 13-fold more ADRs than were voluntarily reported, illustrating the need for an active pharmacovigilance service and the successful use of multimodal methods to detect and track ADRs.

Evaluation of Penicillin Allergies and an Allergy Assessment Pilot in the Emergency Department

Penicillin (PCN) allergy is one of the most frequently reported medication allergies, with ~10% of the US population reporting a PCN allergy. However, studies have shown that only 1% of the US population have a true IgE-mediated reaction to PCN. Delabeling and appropriately updating patient allergy profiles could decrease the use of alternative broad-spectrum antibiotics, rates of infectious complications [C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE)], antibiotic resistance, and overall healthcare cost. The emergency department (ED) is an important setting in which to assess PCN allergies and to delabel patients when appropriate because there are >130 million ED visits in the United States each year. We sought to determine the percentage of PCN allergy–labeled patients who could be delabeled through a PCN allergy assessment interview in an ED. Key secondary outcomes included the percentage of interviewed patients who could not be delabeled based on history alone but would be eligible for an amoxicillin oral challenge or a PCN skin test (PST). A prospective PCN allergy assessment pilot was performed for patients aged >18 years presenting to the UNC Medical Center ED between December 1 and December 17, 2020, with a documented PCN allergy. A pharmacist conducted penicillin allergy assessments on a convenience sample of patients presenting to the ED between 8 a.m. and 3 p.m. on weekdays. Based on patients’ reported and documented histories, charts were updated with the most accurate information and allergies were delabeled if appropriate. In total, 95 patients were assessed; 62 (65.3%) were interviewed and 15 (24.2%) were delabeled. In addition, 26 patients (41.9%) were deemed eligible for an oral amoxicillin challenge, 19 (30.6%) qualified for a PST, and 2 (3.2%) patients did not qualify for further assessment due to having a an IgE-mediated reaction in the past 5 years. Of the 15 patients who were delabeled, 6 (40.0%) received antibiotics during their admission: 4 (73.3%) of those patients received a penicillin and 2 (36.7%) received a cephalosporin, all without adverse reactions. Patient assessments took ~20 minutes to complete, including chart review, patient interview, and postinterview chart updating. The results from this pilot study demonstrate the impact of performing PCN allergy assessments in ED. Interdisciplinary opportunities should be explored to develop processes that will improve the efficiency and sustainability of PCN allergy assessments within the ED to allow this important stewardship intervention to continue.Funding: NoDisclosures: None

Clinical profile of limpet allergy: a preliminary report

Clinical profile of limpet allergy: a preliminary report

Successful Use of Aspirin, Apixaban, and Viscoelastography in a Patient with Severe COVID Disease and Allergy to Porcine Products.

Coagulation abnormalities are frequently described in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Common thromboprophylaxis and anticoagulation treatment strategies include the use of heparinoid therapy. We describe a 57-year-old woman with an allergy to porcine products that was started on apixaban for anticoagulation therapy given her allergy profile and need for venous thromboembolism prophylaxis. Apixaban and aspirin therapy were optimized with the support of serial viscoelastography and platelet function assays. Our patient experienced respiratory failure requiring intubation for 7 days but was successfully weaned to room air, tolerated a regular diet, and ultimately discharged to home after a 17-day hospital course. Here we report the safe and successful use of aspirin, apixaban, and viscoelastography for COVID-19-associated coagulopathy.

Drug Allergy Profile From a National Drug Allergy Registry

Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consultation in allergy departments and are becoming more common due to increasing prevalence and case complexity. Objective: To describe the most common drugs associated with clinical reactions, diagnostic methods used, and outcomes of allergic evaluations of a national drug allergy registry over a 12-year period were used. Methods: An observational, prospective, patient’s data registry-based study was conducted to analyze all referrals to the drug allergy outpatient clinics at Al-Rashed Allergy Center, Kuwait, between 2007 and 2019. Demographics, description of DHRs, and results of allergy tests to potential causative medications were reviewed. Diagnostic methods were focused mainly on skin tests (STs) and drug provocation test (DPT), when indicated. Results: We evaluated 1,553 patients with reported DHRs. The mean age of the population was 41.52 ± 16.93 years, and the study population consisted of 63.7% female patients. Hypersensitivity was finally confirmed in 645 (41.5%) of patients, probable in 199 (12.8%), and not confirmed/nonallergic in 709 (45.6%) patients. Anti-inflammatory drugs and analgesics contributed to 39.22% of all confirmed drug allergies, followed by antibiotics 38.1% (β-lactam antibiotics (BLs) constituted 73.98% of all antibiotics and 28.21% of all drugs), anesthetics 1.8%, and radio-contrast media 0.31%. The majority of reactions were non-immediate 51.44%. The most commonly presenting symptoms among confirmed patients were urticaria 57.80%, angioedema 42.50%, respiratory symptoms 47.60%, and erythema 33.60%. Symptoms of anaphylaxis/anaphylactic shock were reported by 284 patients (44.00%) among confirmed cases. The most common method of diagnosis was a positive clinical history (54.4% in BLs and 90.45% in nonsteroidal anti-inflammatory drugs (NSAIDs). Among confirmed allergy to BLs, a positive ST was obtained in 31.9% of patients and positive DPT in 13.7%. Conclusion: NSAIDs and antibiotics, mainly BLs, are the most commonly implicated in confirmed allergy. In both confirmed and not confirmed/nonallergic cases, BLs are the most frequently involved DHRs which are mainly immediate, and the most commonly presenting symptoms were urticaria, angioedema, and respiratory symptoms. Diagnosis was confirmed mainly by a positive clinical history and when indicated, by positive STs or a DPT.

Prevalence of common inhaled allergies in Erbil province, Kurdistan Region of Iraq

Nowadays, inhaled allergens are the main causes of allergic diseases, which are derived from different sources such as animal dander, grasses, tree, insects and fungi/molds. Identification and detection of allergens play a critical role in the diagnosis and treatment of many allergic diseases. Aims were to determine the prevalence of most common inhaled allergens in Erbil province and determination the intensity of allergic response among allergic patients against 35 identified inhaled allergens items. A total number of 170 patients suffering from suspected inhalant allergy were checked in the present study. The study was carried out for patients who visited the private clinical sectors between 2018-2020 in Erbil province, Kurdistan Region of Iraq. Determination of specific IgE (sIgE) antibodies was examined for suspected patients. The country-specific inhaled allergy profile “Euroline inhaled Iraq 1” (Catalog no: DP 313816011 E, IVD approved, and CE certified EUROLINE immunoblot), containing strip for 35 different inhalant allergens, has been used in this study. Positive specific IgE to inhaled allergens was detected in 22.35% of our suspected patients. Orchard grass (21.05%) was the most inhaled allergen in our 38 allergic patients, followed by the Meadow foxtail (15.78%), Cockroach German and Sweet vernal grass (13.15%). Based on the present study results, we conclude that the prevalence of inhaled allergy differed between men and women in different age groups. Our study reached that there were no associations between inhaled allergens and sex or age. DOI: http://dx.doi.org/10.5281/zenodo.4395149

Plasma metabolomic profiles associated with infant food allergy with further consideration of other early life factors

BackgroundFatty acids have been implicated in early life immune development. Food allergy provides a clear phenotype of early allergic disease. Fish oil and vitamin D have immune-modulating properties. We aimed to identify the metabolomic profile of (i) infant food allergy and (ii) factors linked to food allergy in past studies such as fish oil supplementation and serum 25OHD3 levels in early life. MethodsNMR was used to quantify 73 metabolites in plasma of 1 year old infants from the Barwon Infant Study (n=485). Logistic regression models were used to examine associations between infant metabolome and food allergy in infants. Linear regression models were used to describe associations between maternal fish oil supplementation and 25OHD3 levels with infant metabolites. ResultsA higher linoleic acid: total fatty acid (FA) ratio and phenylalanine level were associated with higher odds of food allergy. Antenatal fish oil supplementation was positively associated with docosahexaenoic acid (DHA) and omega-3 related metabolite levels. Postnatal 25OHD3 levels at 1 year of age were positively associated with several FA measures and creatinine and inversely with the saturated FA: total FA ratio. Only the postnatal 25OHD3 patterns persisted after adjustment for multiple comparisons. ConclusionsInfants with food allergy had altered fatty acid profiles at one year. Fish oil supplementation in pregnancy was associated with higher DHA and omega-3 related metabolites at 1 year of age. Associations were modest and the most robustly altered metabolomic profiles were with postnatal 25OHD3 levels.

Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

Allergy to β-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic- and region-specific sensitization patterns of skin testing for β-lactam antibiotic allergy are also unknown. To identify the prevalence, 1-year incidence, and sensitization patterns of β-lactam antibiotic allergy in patients in Hong Kong. This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (Hong Kong East, Hong Kong West, Kowloon Central, Kowloon East, Kowloon West, New Territories East, and New Territories West). All referrals to Queen Mary Hospital for β-lactam antibiotic allergy testing from January 1, 2018, to December 31, 2019, were also analyzed for sensitization patterns. Prevalence and cumulative incidence of β-lactam antibiotic allergy reported in Hong Kong, and sensitization patterns according to β-lactam antibiotic allergy skin testing. Complete records of 7 184 271 unique patients were analyzed, with a men to women ratio of 1:1.2 and with a median age of 44 years. The prevalence of physician-reported β-lactam antibiotic allergy was 2.0%, and the cumulative incidence was 107 per 100 000 population. Of the 34 402 new drug allergies reported in 2018, 8032 (23.3%) were β-lactam antibiotic allergies. Three hundred fifty-five patients with reactions suggestive of β-lactam antibiotic allergy underwent skin testing, and only 49 (13.8%; 95% CI, 10.64%-17.90%) of them had positive test results. Of these 49 patients, 14 (28.6%; 95% CI, 18.35%-44.49%) had selective reaction and 35 (71.4%; 95% CI, 59.84%-85.27%) had nonselective reaction. The sensitization rate to either benzylpenicilloyl polylysine or a minor determinant (benzylpenicilloate) was 47.0% (n = 23; 95% CI, 34.85%-63.21%), with 10 patients monosensitized to benzylpenicilloyl polylysine only (20.4%; 95% CI, 11.74%-35.48%) and 5 to benzylpenicilloate only (10.2%; 95% CI, 4.45%-23.42%). Results of this study suggest that patients in Hong Kong with β-lactam antibiotic allergy had much higher rates of monosensitization to benzylpenicilloyl polylysine and benzylpenicilloate, making these reagents essential in β-lactam antibiotic skin tests. Such a finding warrants future studies into whether this sensitization is specific to ethnicity or region.

Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population

BackgroundPatients with pollinosis are often multi-sensitized to diverse pollen allergens. However, little is known about pollen allergy types among Chinese pollinosis patients. This study is aimed to characterize clinical manifestations of food allergy among patients with different types of pollen allergy. MethodsWe retrospectively analyzed 402 pollinosis patients from an outpatient allergy department of the Peking Union Medical College Hospital who had been diagnosed by experienced allergists. All included patients who answered a questionnaire regarding seasonal pollinosis and clinical symptoms after ingestion of food and underwent intradermal skin tests. Total IgE and specific IgE levels were quantified by ImmunoCAP, using 0.35 kUA/L as a threshold for positivity. ResultsThe patients were divided into 3 groups, based on the season during which they experienced symptoms and the 2 peaks of Chinese airborne pollen: spring-tree pollen symptoms group (SG), autumn-weed pollen symptoms group (AG), and a combined spring and autumn pollen symptoms group (CG). Birch pollen (83%) and ash pollen (74%) were common allergens among patients with spring symptoms, while mugwort pollen (87%) was a common allergen among patients with autumn symptoms. In total, 30% of the study population experienced pollen-related food allergy. Pollen-related food allergies were more prevalent among the single-season symptom groups (68% and 50% for the SG and AG, respectively) than among the CG (20%). All patients with pollen-related food-induced anaphylaxis exhibited autumn weed pollen symptoms. Except for 2 patients, all patients with food-induced anaphylaxis were allergic to mugwort pollen. In the SG, all patients with food allergy were sensitive to birch pollen, with birch and Bet v 1-specific IgE levels higher in this group than in the group without food allergy (p < 0.001). In the AG, Art v 3 was more prevalent among patients with pollen-related food allergy than without food allergy (79% vs. 33%, p < 0.001), a proportion similar to the one in the CG (67% vs. 48%, p = 0.01). Meanwhile, the Art v 3-specific IgE levels among patients with pollen-related food allergy were higher than among tolerant patients in the AG (p < 0.001) and CG (p = 0.02). Unexpectedly, the Art v 3-specific IgE levels were higher in patients with food-induced anaphylaxis than with oral allergy syndrome only in the CG. ConclusionsBet v 1 (a Pathogenesis-related 10 protein) and Art v 3 (a non-specific lipid transfer protein; nsLTP) are candidate molecular biomarkers for the diagnosis of food allergies in patients with season-specific pollen-related allergies. Measuring pollen allergen component-specific IgE levels might be an effective tool for the management of pollinosis in clinical practice in China.

Exploratory analysis of plasma cytokine/chemokine levels in 6-year-old children from a birth cohort study

This study aimed to reveal a new dimension of allergy profiles in the general population by using machine learning to explore complex relationships among various cytokines/chemokines and allergic diseases (asthma and atopic dermatitis; AD). We examined the symptoms related to asthma and AD and the plasma levels of 72 cytokines/chemokines obtained from a general population of 161 children at 6 years of age who participated in a pilot birth cohort study of the Japan Environment and Children’s Study (JECS). The children whose signs and symptoms fulfilled the criteria of AD, which are mostly based on questionnaire including past symptoms, tended to have higher levels of the two chemokine ligands, CCL17 and CCL27, which are used for diagnosis of AD. On the other hand, another AD-related chemokine CCL22 level in plasma was higher only in children with visible flexural eczema, which is one of AD diagnostic criteria but was judged on the same day of blood examination unlike other criteria. Here, we also developed an innovative method of machine learning for elucidating the complex cytokine/chemokine milieu related to symptoms of allergic diseases by using clustering analysis based on the random forest dissimilarity measure that relies on artificial intelligence (AI) technique. To our surprise, the majority of children showing at least any asthma-related symptoms during the last month were divided by AI into the two clusters, either cluster-2 having elevated levels of IL-33 (related to eosinophil activation) or cluster-3 having elevated levels of CXCL7/NAP2 (related to neutrophil activation), among the total three clusters. Future studies will clarify better approach for allergic diseases by endotype classification.

46: Impact of reported allergies in treatment of women with recurrent urinary tract infection

Recurrent UTI (rUTI) is a common, costly condition often requiring Female Pelvic Medicine and Reconstructive Surgery care. Identifying appropriate treatment begins with knowledge of patients' reported allergies, which may be inaccurate. This is problematic as inappropriate antibiotic use is linked to multi-drug resistant organisms, a public health threat affecting quality of life and healthcare cost. This study aims to evaluate the impact of reported antibiotic allergies on antibiotic selection and cost in treatment of rUTI. We queried our institution’s electronic medical record to identify female patients aged 25-85 with a documented allergy history from 2007 to 2017. Patients were grouped into allergy profiles, sorted by prevalence. Eight rUTI scenarios were developed using the most prevalent organisms and sensitivities from our institution’s 2018 antibiogram. Treatment of a patient in each allergy profile was driven by AUGS Best Practice guidelines for each rUTI scenarios. Differential costs of rUTI treatment for an individual in each allergy profile were computed by adding the price of 3 courses of acute treatment and 6 months of prophylaxis compared to an individual with no reported antibiotic allergies. Differential total costs of treatment for all reported antibiotic allergies were computed by summating the cost differences in treating individuals, multiplied by 19% (rUTI prevalence) across all rUTI scenarios. 969,679 patients were identified and sorted into 11 allergy profile categories. 75.04% of patients reported allergy to no antibiotics, 10.3% to β-Lactams, 4.18% to sulfa, and 3.24% to β-Lactams and sulfa. A first-line treatment and prophylactic therapy for each rUTI scenario was available regardless of reported allergy. Fosfomycin, the most expensive at $97.74 per packet, was the only first-line option for rUTI with P. mirabilis resistant to sulfa. Otherwise fosfomycin was only necessary for acute infection if the allergy profile included sulfa or nitrofurantoin. For 6 months of prophylaxis, nitrofurantoin and fosfomycin were the most expensive at $208.01 and $1,632.00, respectively. These were the only options available for patients with reported allergies to both β-Lactams and sulfa for any rUTI scenario. Allergy to β-Lactams and sulfa incurred a $1.1-11.3 million cost difference compared to a population without antibiotic allergies in all scenarios except an ESBL E. coli UTI resistant to trimethoprim/sulfamethoxazole (Table 1). Total differential cost for all reported antibiotic allergies ranged from $1.9-48.2 million. Accurate allergy reporting is crucial to fighting the antibiotic resistance crisis. Treatment costs for rUTI are negatively impacted by reported allergies to β-Lactams, sulfa, and nitrofurantoin. Efforts to de-label inaccurate reported allergies should be considered to help prevent multi-drug resistance and reduce healthcare costs.

Implementation of a Pharmacist-Driven Detailed Penicillin Allergy Interview.

Background: Self-reported penicillin allergies may be outdated or inaccurate, leading to the use of alternative antimicrobials that may be less effective, more toxic, and/or more expensive. Although penicillin skin tests can provide accurate assessments of penicillin allergies, these procedures are not feasible at all institutions. Another solution is to conduct a detailed penicillin allergy interview (DPAI), which can potentially lead to optimization of antimicrobial therapy. Objective: The purpose of this study was to assess the impact of a pharmacist-driven DPAI protocol. The primary objective was to measure the number of patients requiring a change to their allergy profile following DPAI. Secondary objectives included characterizing allergy profile updates and measuring the number of recommendations to switch to a β-lactam agent, provider acceptance rate, and patient tolerance. Methods: Standardized pharmacist-driven DPAIs were conducted prospectively on adult patients admitted with a documented penicillin allergy. The allergy profile within the electronic health record (EHR) was updated and a recommendation to switch to noncarbapenem β-lactam therapy was made when indicated by a decision algorithm. Results: A total of 175 (37.5%) patients received a DPAI. Of these, 133 (76.0%) required a change to their allergy profile. Additionally, 135 (77.1%) patients interviewed were on antimicrobial therapy, with 42 (31.1%) meeting criteria to switch to noncarbapenem β-lactam therapy; of which 31 (73.8%) patients were successfully transitioned, with no signs or symptoms of intolerance. Conclusions and Relevance: Implementation of pharmacist-driven DPAIs can provide updated and corrected allergy information within the EHR, allowing for de-escalation and/or optimization of antimicrobial therapy.

1025. Inappropriate Aztreonam Usage – Antimicrobial Stewardship Strikes Back

BackgroundSeveral studies have demonstrated that patients with reportedly β-lactam allergies (BLA) receive less efficacious and more toxic alternative antibiotics. A previous study at our institution utilizing aztreonam as a surrogate marker for BLA demonstrated nearly 50% of patients receiving aztreonam had previously tolerated an alternative β-lactam (BL). In response to those results, our Antimicrobial Stewardship Program (ASP) provided dedicated hospitalist, medical resident and pharmacist education on appropriate utilization of aztreonam and BLA. Additionally, members of the ASP team began receiving real-time clinical surveillance alerts for all aztreonam orders.MethodsA retrospective chart review of inpatients >18 years old who received at least one dose of aztreonam between July 1, 2018 – December 31, 2018. Patients were excluded if they did not have a documented BLA or if they received aztreonam as de-escalation therapy. Cost of aztreonam therapy was compared with the cost of alternative BL agents based on prior and subsequently tolerated classes of BLs. Comparator agents included: piperacillin/tazobactam (penicillin), cefepime (cephalosporin) and meropenem (carbapenem). Comparisons of total number of aztreonam patients and doses, cost of aztreonam, and cost of alternative therapy were compared with the index population from 2017ResultsSimilar to our prior study, 43.7% (48.5% in 2017) had prior BL tolerance with an additional 31.3% (19.4% in 2017) demonstrated subsequent BL tolerance following aztreonam administration. Following the ASP interventions, orders, doses and cost of aztreonam was reduced. Forty-eight patients during the 6-month period received aztreonam, a 26.7% reduction. There was a 38.5% reduction in the number of aztreonam doses (P = 0.001), which yielded a cost savings of $14,067.67 (extrapolated to 1 year). Median aztreonam cost in 2017 $382.40 vs. $191.20 in 2018 (P = 0.004). In 2018, 41.7% of patient’s allergy profiles were appropriately updated compared with 3.3% in 2017.ConclusionOur study demonstrates that ASP interventions including increased education, allergy documentation and clinical surveillance alerts targeted at reducing aztreonam utilization can reduce pharmaceutical expenditures. Disclosures All authors: No reported disclosures.

1048. A Randomized Controlled Trial of an Electronic Tool for Empiric Antibiotic Prescription: Results from the ANti-infective Stewardship using the WISCA tool in the Electronic Medical Record (AnSWER) Study

BackgroundThe Weighted-Incidence Syndromic Combination Antibiogram (WISCA) is a computer-based, clinical tool for improving initial antibiotic selection in the management of pneumonia, cellulitis, urinary tract infection (UTI) and intraabdominal infection (IAB). WISCA predicts the likelihood that an antibiotic regimen will be active against the expected organisms causing the infection for each of these syndromes.MethodsWe performed a crossover randomized controlled trial of the WISCA tool between July 1, 2015 and June 30, 2018 at 4 hospitals. WISCA suggests an empiric antibiotic regimen based on individual patients’ comorbidities, severity of illness, allergy profile, history of multidrug-resistant organisms (MDRO), and prior antibiotics. Within 24 hours of admission an ID physician-reviewed patient charts to determine whether one of the clinical syndromes was present. At intervention hospitals, patients’ providers were notified when a change in empiric therapy was suggested or antibiotics were recommended to be stopped (if no bacterial infection was present). Outcomes included readmission, mortality, C. difficile infection (CDI), MDRO infection, length of stay (LOS), and cost of antibiotics.Results10,202 patients enrolled in the study with 4,451 (57% female, mean age 72) in the intervention arm and 5,751 (55% female, mean age 71) in the control arm. There were no significant differences in clinical outcomes for any of the syndromes. Among 2,146 patients determined to have no bacterial infection, WISCA intervention resulted in lower antibiotic cost during the hospital stay ($714.46 vs. $927.56, P < 0.01). When providers accepted the recommendation to stop antibiotics, there were fewer antibiotic days (mean 296 antibiotic days/1000 patient-days vs. mean 378 antibiotic days/1000 patient-days, P = 0.038) and no significant difference in mortality or readmission rates. No bacterial infection patients also experienced a nearly 3-fold lower rate of CDI vs. patients with infection (0.8% vs. 2.3%, P < 0.001).ConclusionAlthough the use of the WISCA tool was not associated with a reduction in mortality, readmissions, or LOS, intervention to stop antibiotics for those with no bacterial infection was associated with reduced antibiotic use and cost savings.Disclosures All authors: No reported disclosures.

Performance of basophil activation test and specific IgG4 as diagnostic tools in nonspecific lipid transfer protein allergy: Antwerp‐Barcelona comparison

Recent studies show that nsLTP sensitization is not limited to the Mediterranean basin and can present diverse clinical phenotypes. It remains challenging to predict clinical outcome when specific IgE antibodies (sIgE) to nsLTPs are present. This study compares both clinical and in vitro allergy characteristics but also diagnostic performance of a basophil activation test (BAT) and sIgG4 in nsLTP-sensitized patients from Antwerp (ANT, Belgium) and Barcelona (BCN, Spain). Adult subjects with positive sIgE rPru p 3 and/or rMal d 3≥0.10kUA /L (n=182) and healthy controls (n=37) were included. NsLTP-sensitized individuals were stratified according to clinical symptoms with peach/apple, respectively. BAT rPru p 3 and rMal d 3 were performed and sIgG4 antibodies to both components quantified. In BCN, only ratios of sIgG4/sIgE rMal d 3 and BAT rMal d 3 (0.001µg/mL) can identify clinically relevant Mal d 3 sensitization (sensitivity of 60%-63% and a specificity of 75%-67%, respectively). In ANT, only the sIgE/total IgE rPru p 3 ratio shows added value (sensitivity 60% and specificity 83%). Finally, it appears that symptomatic patients in BCN are more sensitive to lower allergen concentrations compared to ANT. In addition, it was shown that ANT patients were more often sensitized to pollen and that specific pollen sources differed between regions. NsLTP-related allergy profiles and diagnostic performance differ significantly between regions and are component-specific, which makes extrapolation of data difficult to do. In addition, it seems that basophil sensitivity might show geographical differences. Additional research is needed to confirm these findings.

Monoclonal antibody utilization characteristics in patients with multiple myeloma.

This study analyzed 91 multiple myeloma patients who received two monoclonal antibodies, Daratumumab and Elotuzumab, over a year and report the adverse event profile, infusion practices and utilization of these drugs in the real world. All current reported data on monoclonal antibodies is from clinical trials, without any real-world experience. Patients from Mayo Clinic Florida or Arizona diagnosed with relapsed or refractory multiple myeloma who were treated with Daratumumab or Elotuzumab alone or in combination between 1 January 2016 and 31 December 2016 were included in the analysis. Daratumumab-treated patients (n = 78) were more heavily pre-treated than that in published clinical trials, whereas the elotuzumab patient (n = 13) profile was similar to that published before. Infusion time was on average 2 hours less than the prescribing guidelines and premedication use varied noticeably after the initial monoclonal antibody infusion, with an overall decrease over time. We noted higher than reported haematologic adverse events, especially neutropenia and fewer non-haematologic adverse events. 91.7% infusion-related reactions were observed during the first monoclonal antibody infusion, with a subsequent decrease. All infusion-related reactions were grade 2 or less, and none of the patients discontinued treatment due to infusion-related reactions. Baseline allergy profile or laboratory tests were not associated with the likelihood of developing monoclonal antibody-related infusion-related reactions. The real-world safety profile of monoclonal antibodies showed varying adverse event patterns than those reported in previous clinical trials. The infusion-related reaction patterns were similar to previous reports. Despite changes in premedication regimens safety was maintained in succeeding infusions. Such treatment utilization data is vital to broaden our knowledge of approved therapeutic agents and maximize their benefits for patients.

What Determines the Type and Dose of Antibiotic That Is Needed to Be Added to the Cement Spacer in Patients With Infected Total Ankle Arthroplasty (TAA)?

We recommend tailoring the antibiotic in cement spacers to the infecting organism if it has been identified, as is typically done in total knee and hip arthroplasty. Otherwise, broad-spectrum antibiotics may be utilized. Medical comorbidities should always be considered, especially with regard to renal function and allergy profile. A thermostable antibiotic should be added to cement. Consensus. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Factors Affecting the Food Allergy Profile of Children From Schools in Hortaleza District, Madrid, Spain.

Factors Affecting the Food Allergy Profile of Children From Schools in Hortaleza District, Madrid, Spain.

Seasonal variation of allergy profile of patients visiting a tertiary care hospital in hilly areas of Himachal Pradesh

Background: Allergic diseases are very common and are caused by allergen whose role varies according to climate changes. Not many studies are available regarding the same in our region. Skin prick test is a diagnostic procedure for allergy testing. The aim of the present study was to find out the seasonal variation of different allergies in our region.Methods: A total of 686 patients with allergic complaints were assessed for age and sex distribution, seasonal variation of number of allergy patients and seasonal variation of patient symptoms. 608 patients who gave consent and were found fit for skin prick tests underwent the tests and were analysed for allergy profile of the patients in different seasons.Results: The majority of patients were females and of younger age group. The majority of the patients had nasal symptoms and these symptoms were more in summer and rainy season during which pine mix and grass pollen were common allergens. Pulmonary symptoms were maximum in winters with dust mite and moulds being the common allergens. Dust mite was overall the most common allergen involved. Sensitization to allergens was less in winter months.Conclusions: This study focussed on seasonal variation of allergies and found pine mix and grass pollens to be major cause of nasal allergy and dust mite and mould mix to mainly cause pulmonary symptoms.

1794. Impact of a Pharmacist-Driven Detailed Penicillin Allergy Interview

BackgroundIn the United States, 10% of patients report a penicillin (PCN) allergy. These self-reported allergies may be outdated or inaccurate, which may lead to usage of alternate antimicrobials that may be less effective, more toxic, and/or more expensive. While PCN skin tests (PST) can provide an accurate assessment and de-labeling of PCN allergies, they are not feasible at all institutions. An alternative solution is to conduct a detailed penicillin allergy interview (DPAI), which can potentially lead to de-escalation and/or optimization of antimicrobial therapy.MethodsPharmacist-driven DPAIs were conducted between December 26, 2017 and March 26, 2018. Adult patients admitted with a documented PCN allergy were interviewed according to a standardized questionnaire. The allergy profile within the EHR was updated and a recommendation to switch to non-carbapenem β-lactam therapy was made to the prescriber based on a decision algorithm. Objectives of this study include characterization of changes made to the allergy profile within the EHR after DPAI and measuring the number of patients successfully switched to β-lactam therapy.ResultsA total of 466 patients were admitted with a documented PCN allergy, of which 175 (37.5%) received DPAI. Of these patients, 133 (76%) required a change to their allergy profile (Table 1). One-hundred thirty-five (77.1%) patients interviewed were on an antimicrobial agent (Figure 1). Forty-two patients (31.1%) met criteria to switch to non-carbapenem β-lactam therapy, and 31 (73.8%) patients were successfully switched with no adverse events noted.Table 1:Changes to Allergy ProfileType of Change N = 175No changes42 (24)Addition of tolerance history58 (33.1)Modification of reaction details32 (18.3)Addition of tolerance history AND modification of reaction details41 (23.4)Deletion of allergy2 (1.1)Figure 1.Initial antimicrobial therapy.ConclusionA large number of admitted patients with a documented PCN allergy received a DPAI. Implementation of pharmacist-driven DPAIs led to updated, more accurate allergy information within the EHR, as well as de-escalation and/or optimization of antimicrobial therapy. Provider acceptance rate to switch to non-carbapenem β-lactam therapy was high.Disclosures All authors: No reported disclosures.