Family History Of Food Allergy Research Articles

Factors influencing age of common allergen introduction in early childhood.

We evaluated factors influencing the timing of allergen introduction in the U.S., including updated peanut introduction guidelines. The Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) study is a prospective observational cohort in suburban Massachusetts. Infants' caregivers enrolled between 2014 and 2017, and they reported when they introduced common allergens to their child. Multivariable linear and survival regression analyses were used to examine factors influencing time of introduction of allergens. By 9 months, children old enough to be potentially affected by NIAID's 2017 peanut introduction guidelines were more often introduced to peanut than children enrolled well before guidelines publication [54% vs. 42%, OR: 1.63, CI: (1.03, 2.57), P = 0.03]. At any given time, Black children were 73% [HR: 0.27, CI: (0.11, 0.69), P = 0.006] less likely to be introduced to peanut as early as White children. Asian children were, respectively, 36% [HR: 0.64, CI: (0.47, 0.86), P = 0.003] and 26% [HR: 0.74, CI: (0.55, 0.97), P = 0.03] less likely to be introduced to peanut and egg as early as White children. A first child was 27% [HR: 1.27, CI: (1.04, 1.56), P = 0.02] more likely to have been introduced to peanut earlier than a non-first child. There was no association between age of introduction and sex, gestational age, family history of food allergy, or other allergic comorbidities. Updated introduction guidelines, race, and birth order all influenced earlier introduction of peanut. Further studies to evaluate current practices for allergen introduction with a focus on potential disparities are needed.

Early infancy dysbiosis in food protein-induced enterocolitis syndrome: A prospective cohort study.

The microbiome associations of food protein-induced enterocolitis syndrome (FPIES) are understudied. We sought to prospectively define the clinical features of FPIES in a birth cohort, and investigate for the evidence of gut dysbiosis. We identified children diagnosed with FPIES in the Gastrointestinal Microbiome and Allergic Proctocolitis Study, a healthy infant cohort. Children were assessed and stools were collected at each well child visit. The clinical features of the children with FPIES were summarized. Stool microbiome was analyzed using 16S rRNA sequencing comparing children with and without FPIES. Of the 874 children followed up for 3 years, 8 FPIES cases (4 male) were identified, yielding a cumulative incidence of 0.92%. The most common triggers were oat and rice (n=3, each) followed by milk (n=2). The children with FPIES were more likely to have family history of food allergy (50% vs. 15.9% among unaffected, p=.03). The average age of disease presentation was 6months old. During the first 6months of life, stool from children with FPIES contained significantly less Bifidobacterium adolescentis, but more pathobionts, including Bacteroides spp. (especially Bacteroides fragilis), Holdemania spp., Lachnobacterium spp., and Acinetobacter lwoffii. The short-chain fatty acid (SCFA)-producing Bifidobacterium shunt was expressed significantly less in the stool from FPIES children. In this cohort, the cumulative incidence over the 3-year study period was 0.92%. During the first 6 months of life, children with FPIES had evidence of dysbiosis and SCFA production pathway was expressed less in their stool, which may play an important role in the pathogenesis of FPIES.

The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children.

While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children. We investigated 1- (n=1108) and 6-year-old (n=675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers. Grass pollen at lag 0-3 (every 20 grains/m3 increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only. Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.

Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

BackgroundAtopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea.MethodsAD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschool-onset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups.ResultsA total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancy-onset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group.ConclusionThis study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

Clinical Documentation of Peanut Allergy Prevention in an Academic Learning Health System

Consensus guidelines recommend early peanut introduction (EPI) as an effective strategy for preventing peanut allergy. Real-world practice patterns of EPI guidance are poorly understood. We aimed to described EPI practice patterns within an academic learning health system. We queried the health system’s central data repository to identify individuals eligible to receive EPI guidance from 1/6/2017 - 03/30/2020: persons less than 12 months of age at the time of a clinical encounter for either a health supervision visit or a problem-based visit related to eczema. We used the Electronic Medical Record Search Engine (EMERSE) to search clinical notes for the word “peanut.” These were manually reviewed for EPI documentation and other practice pattern characteristics. Of a total of 18,149 individuals, 152 (0.8%, mean age 6.4 months) had clinical documentation of EPI guidance (72% clinical note, 20% patient instructions, 5% both, 3% telephone note). EPI guidance was performed by 61 providers among 6 specialties (43% pediatrics, 40% family medicine, 15% allergy/immunology, 2% other) in 24 unique practices. Of those who received EPI guidance, the following comorbid diagnoses and/or characteristics were documented: 35% eczema, 11% egg allergy, 21% family history of food allergy, 31% topical corticosteroid use. Twenty percent were referred to an allergist for peanut allergy risk assessment and 12% had a peanut IgE obtained. Clinical documentation of EPI counseling is low. Further dissemination and implementation efforts are needed to encourage providers to prioritize EPI and increase standard utilization of consensus guidelines.

Caregiver and Expecting Caregiver Support for Early Peanut Introduction Guidelines

To assess current opinions and preferences of new and expecting caregivers regarding early allergenic solid food introduction and how such introduction may be accomplished by surveying a sample of expecting and recently delivered caregivers.The population included US residents 18 to 55 years of age that identified as expecting caregivers or caregivers of newborns 12 months or younger.One thousand expecting caregivers and 1000 caregivers of infants <12 months of age were surveyed during a 3-week period in April 2017 (3 months after the release of the National Institute of Allergy and Infectious Diseases guidelines on early peanut introduction and 26 months after publication of the LEAP Study). The survey contained 32 questions on knowledge, attitude, and preference regarding timing of solid food introduction, concern and knowledge for the potential development of food allergy, attitudes regarding office-based recommendations for the introduction of potentially allergenic solids, and in-office procedures for assessment of food allergies.Two thousand of 2196 respondents completed the survey. A family history of food allergy was significantly associated with a better awareness of the guidelines (odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.02–1.49; P = .03, nonsignificant after adjustment for multiple comparisons), concern for their child developing a food allergy (OR: 2.5; 95% CI: 1.8–3.5; P < .001), and belief in the timing of introduction in developing food allergy (OR: 1.2; 95% CI: 1.03–1.46; P = .02, nonsignificant after adjustment for multiple comparisons). Only 31% of respondents reported willingness to introduce peanut before or around 6 months of age, with nearly 40% willing to introduce only after 11 months of age. An exception was egg, in which 60% reported willingness to introduce before 8 months of age. Fifty-one percent were unwilling to allow skin testing before 11 months of age, and 56.8% were unwilling to allow an oral food challenge before 11 months of age. Overall, 58% of the combined sample indicated that they would support medicalization of early introduction of potentially allergenic solids foods with in-office risk assessment, 28.1% would not support, and 13.6% reported they would do what their physician recommended. The preference for early introduction and willingness to allow in-office assessment was greater among expecting caregivers than those recently delivered.Recently delivered and expecting caregivers surveyed in this study expressed considerable hesitancy regarding readiness to introduce peanut and other potentially allergenic solid foods early and hesitancy regarding in-office assessments to help mitigate potential risk of such introduction.There have been many efforts to disseminate LEAP Study results and subsequent updated National Institute of Allergy and Infectious Diseases guidelines. Implementation of the new guidelines is equally important and requires that health care providers have discussions with parents and identify barriers to change. This study sheds light on the hesitancy that expecting and recently delivered caregivers may have regarding these guidelines.

A Retrospective Study On High Risk Factors For The Development of Peanut Allergy

The Learning Early about Peanut Allergy (LEAP) trial demonstrated that early introduction of peanut products in high risk infants decreases the risk of peanut allergy by 5 years of age. High risk patients were defined as infants with severe eczema, and or egg allergy. In our study, we aimed to identify other high risk factors associated with the development of peanut allergy and thereby additional patient populations who may benefit from early introduction of peanut products. A retrospective chart review was performed on 103 patients ages 0-3 years old with either positive (≥3mm) skin test to peanuts or serum peanut immunoglobulin E (IgE) level greater than or equal to 1.0 kU/L. Clinical data from this subset of patients was analyzed for additional risk factors (i.e. other food allergies, family history of food allergy, parental asthma, etc.) that could lead to the development of peanut allergy using logistic regression analysis. Parental asthma was found to be significantly associated with an increased risk of peanut allergy in the child (p=0.0359, OR 2.743). Other concurrent food allergy to soy was also associated with a propensity for peanut allergy (p-value 0.0150, OR 6.344). Patients with food allergy to soy or parental asthma should be further investigated as potential identifiers of patients at high risk of developing a peanut allergy.

Prevalence, Characteristics, and Outcome of Cow's Milk Protein Allergy in Chinese Infants: A Population-Based Survey.

Cow's milk protein allergy (CMPA) is commonly seen in children. There have been no reports of the true prevalence of CMPA in Chinese infants. The aim of this population-based study is to determine the prevalence, clinical characteristics, and outcome of CMPA in Chinese infants. We carried out a prospective survey in 7 participating hospitals throughout southern China. We included infants ≤12 months of age during the survey. For those suspected of CMPA, oral food challenge with cow's milk protein (CMP) was performed. A follow-up telephone interview was conducted at 12 months after the diagnosis to assess the clinical outcome of CMPA. A total of 9910 questionnaire surveys were distributed and 7364 (74.3%) were returned. The eligible survey number of surveys was 6768 (91.9%). A total of 182 infants was confirmed with CMPA, including 13 with anaphylactic reactions, 28 with clinical symptoms and serum immunoglobulin E (sIgE) >3.5 IU/mL, and 141 with positive CMP challenge test. The prevalence of CMPA was 2.69%. Infants with confirmed CMPA had significantly stronger family history of either 1 or both parents with food allergy, higher Cesarean section rate, and lower rate of breastfeeding, compared with those without CMPA. At 12-month telephone follow-up of 176 CMPA infants, 136 infants (77.3%) had become tolerant to CMP. The prevalence of CMPA was 2.69%. CMPA infants had a strong family history of food allergy and atopy. Both Cesarean delivery and formula feeding were risk factors for CMPA. At 12-month follow-up, the majority of CMPA infants had become tolerant to CMP.

Pollen-food allergy syndrome is a common allergic comorbidity in adults with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is associated with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis; however, limited data exist on the correlation between pollen-food allergy syndrome (PFAS) and EoE. We analyzed 346 adults with EoE treated at a single center between 2002 and 2016. Demographic and EoE-specific data including clinical features and measures of EoE disease severity and treatments were collected. The presence of other atopic diseases, family history, prevalence of peripheral eosinophilia and elevated IgE, and details of PFAS triggers were collected. Twenty six percent of the 346 subjects in our cohort had both EoE and PFAS (EoE-PFAS). Compared to subjects with EoE alone, subjects with EoE-PFAS had an increased frequency of allergic rhinitis (86.7% vs. 64.2%, P<0.001) and family history of allergies (71.1% vs. 53.3%, P=0.003), and comprised a higher proportion of EoE diagnoses made in the spring (Χ2<0.001). 43.3% of subjects with concurrent EoE and PFAS opted for treatment with elimination diet, and these measures failed to induce remission in 46.2% of cases. In most cases, elimination diet failed despite strict avoidance of PFAS trigger foods in addition to common EoE triggers including dairy, wheat, and eggs. EoE-PFAS was also associated with higher serum IgE at the time of EoE diagnosis (460.6 vs. 289.9, P<0.019). Allergic rhinitis and a family history of food allergy were independently associated with having EoE-PFAS. The most common triggers of PFAS in adults with EoE are apples (21.1%), carrots (15.5%), and peaches (15.5%). Along with asthma, allergic rhinitis and atopic dermatitis, PFAS is a common allergic comorbidity that is highly associated with EoE. Further studies aimed at understanding mechanistic similarities and differences of PFAS and EoE may shed light on the pathogenesis of these closely related food allergy syndromes.

Tu1126 - Pollen-Food Allergy Syndrome is a Common Allergic Comorbidity in Adults with Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is associated with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis; however, limited data exist on the correlation between pollen-food allergy syndrome (PFAS) and EoE. We analyzed 346 adults with EoE treated at a single center between 2002 and 2016. Demographic and EoE-specific data including clinical features and measures of EoE disease severity and treatments were collected. The presence of other atopic diseases, family history, prevalence of peripheral eosinophilia and elevated IgE, and details of PFAS triggers were collected. Twenty six percent of the 346 subjects in our cohort had both EoE and PFAS (EoE-PFAS). Compared to subjects with EoE alone, subjects with EoE-PFAS had an increased frequency of allergic rhinitis (86.7% vs. 64.2%, P < 0.001) and family history of allergies (71.1% vs. 53.3%, P = 0.003), and comprised a higher proportion of EoE diagnoses made in the spring (Χ2 < 0.001). 43.3% of subjects with concurrent EoE and PFAS opted for treatment with elimination diet, and these measures failed to induce remission in 46.2% of cases. In most cases, elimination diet failed despite strict avoidance of PFAS trigger foods in addition to common EoE triggers including dairy, wheat, and eggs. EoE-PFAS was also associated with higher serum IgE at the time of EoE diagnosis (460.6 vs. 289.9, P < 0.019). Allergic rhinitis and a family history of food allergy were independently associated with having EoE-PFAS. The most common triggers of PFAS in adults with EoE are apples (21.1%), carrots (15.5%), and peaches (15.5%). Along with asthma, allergic rhinitis and atopic dermatitis, PFAS is a common allergic comorbidity that is highly associated with EoE. Further studies aimed at understanding mechanistic similarities and differences of PFAS and EoE may shed light on the pathogenesis of these closely related food allergy syndromes.

Prognostic accuracy of clinical signs and diagnostic tests in cow's milk allergy in newborns

The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period. The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1-11years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies. There was a positive correlation between exanthema and confirmed CMA in the neonatal period (R=0.184; p=<0.001; n=361), and hematochezia and confirmed CMA in the neonatal (R=0.203; p<0.001; n=361) and postneonatal period (R=0.215; p=0.042; n=90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA (R=0.275; p=0.009; n=90). No correlation was found between a positive family history of food allergies and CMA in the neonatal (R=-0.66; p=0.398; n=165) and postneonatal periods (R=0.00; p=1.000; n=116). Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.

MON-PP170: Family History of Food Allergies Might Limit Food Choice of Portuguese University Students

MON-PP170: Family History of Food Allergies Might Limit Food Choice of Portuguese University Students

Oral food challenges in a specialised allergy outpatient clinic in Sao Paolo, Brazil

Methods A retrospective study of chart analysis of 171 patients undergone to 220 OFC, between June/2007 and Feb/ 2014. Food tests comprised CM, egg, soy, peanuts, nuts, seafood, meat, chicken, tartrazine, chocolate, wheat and coconut. Patients were evaluated according to the type of CM’s challenge (open or double-blind placebocontrolled), aim of the procedure (diagnosis or follow up tolerance), symptoms, body mass index, time of breastfeeding, age at first reaction, family history of food allergy, presence of other atopic diseases (asthma, allergic rhinitis and atopic dermatitis) and skin prick test.

Value of skin testing children with a family history of food allergy before ingestion of suspect food allergens

A family history of food allergy can cause anxiety in parents. This may prevent food introduction in their children. Current guidelines recommend skin testing only when there is a reaction to a food in that specific patient. When there is a family history of food allergy, parents frequently ask their physicians for food testing of their children prior to introduction of specific foods. We conducted this study to determine whether allergy skin testing reduces anxiety levels in parents thereby leading to food introduction. Methods The parents of 50 children with a family history of food allergy completed a Visual Analog Score (VAS) to estimate their anxiety to give their children the specific food of concern. Previously, the children had not eaten the food. The VAS scores were recorded pre- and post-skin testing on a scale from 0 to 10. The likelihood of food introduction pre- and post-skin testing was estimated. Results The mean age of the children was 3.6 years; the majority were males (62%). Approximately 58% of patients’ parents, 38% siblings and 4% other relatives had food allergy. Most children (78%) had family history of a single food allergen and 60% had a family history of allergy to peanuts. All children tested negative for the food allergen of concern. Mean VAS was statistically different pre- and post-skin testing (pre VAS mean= 7.83 vs post VAS mean = 2.15; p=<0.0001). The likelihood of food

Infant feeding practices and reported food allergies at 6 years of age.

The goal of this study was to identify the frequency of physician-diagnosed food allergies among 6-year-old US children and study the impact of exclusive breastfeeding and complementary food introduction on this frequency. Data were analyzed from children who participated in the Infant Feeding Practices Study II Year 6 Follow-Up Study (Y6FU). Children with probable food allergy (pFA) were defined as children with report of physician-diagnosed food allergy at age 6 years. Subgroups of pFA included children who were not diagnosed before 1 year of age (new pFA) and those with atopic risk factors (high risk). Prevalence of total pFA in the Y6FU was 6.34%. The majority of these children had new pFA and high-risk factors. Higher maternal education, higher family income, family history of food allergy, and reported eczema before 1 year of age were significantly associated with higher odds of total or new pFA. Exclusive breastfeeding duration and timing of complementary food introduction were not significantly associated with total pFA. However, exclusive breastfeeding of ≥4 months compared with no breastfeeding was marginally associated with lower odds of new pFA (adjusted odds ratio: 0.51; P = .07); this effect was not observed with high-risk children. Analysis of infant and maternal variables in the Y6FU cohort of US children revealed that socioeconomic and atopic factors were the main predictors of pFA at age 6 years. Exclusive breastfeeding of ≥4 months may have a preventive effect on development of pFA after 1 year of age in non high-risk children.

Intestinal permeability in children with food allergy on specific elimination diets

Children with food allergy have been shown to have increased small intestinal permeability (IP) following ingestion of the offending food as well as during elimination diets. We investigated IP in asymptomatic food allergic children during an elimination diet to identify clinical characteristics associated with altered IP. Urinary recovery ratios of lactulose and mannitol (L/M) were determined 5 h following ingestion of 7.5 g of lactulose and 2 g of mannitol in 131 cow's milk and egg allergic children. An L/M ratio of ≥0.025 was considered abnormal based upon previously established laboratory internal references. A chart review was conducted to assess the clinical characteristics of these patients. A total of 50 (38%) of the 131 children (median 6.7, range 4.8-8.9 yr; 66.2% male) with food allergy had elevated IP while asymptomatic on strict elimination diets. Age and height negatively correlated with IP. However, in the regression model analysis, abnormal IP was associated with shorter stature independently of age. Otherwise, food allergic patients with increased IP were comparable in gender, nutritional status, age of onset of food allergy, history of reactions, atopic diseases, and family history of food allergies to those with normal IP. Elevated IP was found in about one-third of asymptomatic food allergic children on elimination diets and was associated with shorter stature. Our results suggest that increased IP may be an intrinsic trait in a subset of food allergic children. However, large, prospective studies are necessary to determine the role of impaired intestinal barrier in food allergy.

Prevalence of food allergies (FA) and asthma and associated risk factors in the STRONG Kids Program (SKP)

FA are most prevalent in children under age five and are linked to family history, ethnicity, early‐life feeding practices, absence of breastfeeding (BF) and presence of other atopic diseases, including asthma. Chi‐squaredtests were used to compare risk factors in children (ages 3–5) with and without FA enrolled in SKP, a longitudinal study of childhood obesity and health within an ecological framework. In the SKP cohort (n=423), 12% of kids had FA or sensitivity and 8.5% were diagnosed with asthma. Gender, BMI percentile and ethnicity were not associated with risk of allergy. Children with FA were three‐times more likely to have asthma (95% CI 1.48–7.29, p=0.003) and other chronic diseases (95% CI 1.95–6.81, p&lt;0.0001). Peanut, fruit and cow's milk allergies were most common in the SKP cohort (4.3%, 3.0%, and 2.8% respectively). Family history of FA was associated with allergy occurrence in children (p&lt;0.0001). BF longer than six months was associated with a lower occurrence of soy (p=0.02) and fruit (p=0.03) allergies, but no protective effect against other FA was observed (p=0.18). Family history, lack of BF and other chronic conditions were risk factors for FA in SKP participants.Grant Funding Source: Supported by USDA 2011–67001‐30101

Food allergy and anaphylaxis – 2053. New diagnostic algorithms that will reduce the need for oral food challenges

allergy, (B) early-onset eczema in the absence of reaction history, and (C) family history of food allergy in the absence of reaction history. Clinical decision points for egg sIgE testing reduced the need for oral food challenges in pathway A by 89% (95% CI 82-95), pathway B by 82% (95% CI 75-87%) and pathway C by 65% (95% CI 52-76%). Clinical decision points for peanut sIgE testing reduced the need for oral food challenges in pathway A by 81% (95% CI 58-95%), pathway B by 47% (95% CI 39-55%) and pathway C by 71% (95% CI 5892%). Infants who fell into the indeterminate category (sIgE result between the two thresholds), would still require assessment by specialist allergy services. Conclusions

Skin Prick Test to Egg White Provides Additional Diagnostic Utility to Serum Egg White-Specific IgE Antibody Concentration in Children

Knight AK, Shreffler WG, Sampson HA, et al. J Allergy Clin Immunol. 2006;117:842–847 PURPOSE OF THE STUDY. To determine if skin-prick tests (SPTs) can differentiate children with low egg white–specific immunoglobulin E (IgE) levels who pass an oral egg challenge from those who fail. STUDY POPULATION. The study was a retrospective analysis of oral egg challenges (N = 74) in children with egg allergy and low egg white–specific IgE antibody levels (&amp;lt;2.5 kIU/L). METHODS. A retrospective analysis of serum egg white–specific IgE levels, SPT results, and egg oral food challenge (OFC) outcomes and clinical history in children with egg allergy were performed. Children were typically selected for OFC on the basis of low egg white–specific IgE levels (≤2.5 kIU/L). Sixty eight of the challenges were double-blind, placebo-controlled OFCs conducted in the Mount Sinai General Clinical Research Center (New York, NY), and 12 OFCs were open challenges conducted in outpatient clinics between April 2001 and April 2005. Children who passed their OFC were compared with those who failed for differences in age, gender, history of egg reaction, asthma, eczema, allergic rhinitis, oral allergy syndrome, family history of food allergy, and family history of any allergy. RESULTS. Children who passed the egg OFC (n = 29) had a median wheal size of 3 mm (range: 0–9 mm) and a median egg/histamine index of 0.71 (range: 0.00–2.30), whereas those who failed (n = 45) had a median wheal size of 5 mm (range: 0–8 mm) and a mean egg/histamine index of 1.0 (range: 0.0–2.7), which demonstrated significance of P = .003 for SPT and P = .0009 for index. In patients with egg white–specific IgE levels of &amp;lt;2.5 kIU/L, an SPT wheal of 3 mm or an egg/histamine wheal-size index of 0.65 was associated with a 50% chance of passing an egg OFC. Children who passed their OFC did not differ from those who failed with regard to egg white–specific IgE levels, age, gender, or clinical history, except for allergic rhinitis, which was found in 82% of those who failed versus 55% of those who passed (P = .02). CONCLUSIONS. In egg-allergic children, those with low egg white–specific IgE levels, a small SPT response, and a low egg/histamine index are more likely to pass egg OFCs. The size of the egg SPT wheal response may be used to predict the outcome of the egg OFC, thus aiding clinicians in timing of OFCs in egg-allergic patients. REVIEWER COMMENTS. With the increasing prevalence of food allergy in young children, diet restriction is becoming an increasing burden for families of food-allergic children, which makes it important to test for tolerance as early as possible. The current study population represented more severely affected patients with comorbidities and demonstrated a high OFC failure rate of 62%. Although these findings provide new and useful information for clinicians who treat children with egg allergy, additional studies are needed to validate these findings prospectively and in different populations.

O0005 EOSINOPHILIC ESOPHAGITIS: AN 8 YEAR EXPERIENCE

Introduction: Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus with symptoms similar to gastroesophageal reflux disease or dysphagia. EoE is unresponsive to aggressive acid blockade but instead responds to the removal of food antigen(s). Methods: Between 1/1/94 and 1/1/03, 309 patients diagnosed with EoE were reviewed. EoE was diagnosed if a patient had symptoms of reflux or dysphagia and an upper endoscopy demonstrating > 20 eosinophils/HPF (in the most densely involved field) isolated to the esophagus. We describe the demographic and clinical data as well as dietary/medical therapy of patients with EoE. We compare this group to a subgroup of pts with reflux esophagitis (GERD). Results: Of all EoE patients, 250 pts (159 males, age 8.1±2.9) with 34.9±10.2 eos/HPF had symptoms of reflux; 59 pts (45 males, age 12.8±3.2) with 56.2±18.7 eos/HPF presented with dysphagia; 102 GERD pts (55 male, age 7.5±2.4) had 2.3±0.6 eos/HPF. Of the pts with EoE, 52% had bronchospasm, eczema or rhinitis and 43% had a family history of food allergy. The number of pts diagnosed with EoE per year increased from 2 in ’94 to 63 in ’02; 34% of EoE pts were 5–10 years old at time of diagnosis while 72% were greater than 5 years of age. Between 1/1/00 and 12/31/02, 5.7% of all pts presenting with reflux symptoms and 66% of all patients with dysphagia were diagnosed with EoE. Endoscopically, when comparing EoE pts to those with GERD, EoE pts had significantly more histologic eosinophilic abscesses, visual white plaques, and esophageal “trachealization” or furrowing. In contrast, GERD pts had more visual erosions. The following therapies were instituted with the results reported as the number of eos/HPF before (pre-), during and post-therapy. Oral solumedrol (32 pts;1.5mg/kg/d; max 48 mg): pre-31.3±8.5, during 0.8±0.5, post-27.9±6.2, p<0.0001. Ingested aerosolized steroids (12 pts;110–220ìg bid): pre-29.4±6.4, during 10.7±2.9, i post-24.8±3.7, p<0.0001. Oral cromolyn (14 pts;100 mg qid): pre-28.3±6.4, during 25.4±4.3, post-27.6±4.4, p<0.2. Diet therapy (amino acid based formula) 137 patients (108 NG tube, 6 non-compliant, 2 failed): pre-39.8±9.6, during 1.0±0.6, post-1.1±0.5, p<0.0001. There was no significant difference in serum IgE or total eosinophil levels between patients with EoE or GERD. Conclusion: The incidence of EoE has been increasing over the past decade and makes up approximately 6% of all patients presenting with GER. While some medical therapy may prove effective, only strict avoidance of allergenic foods prevents reoccurrence of disease. Currently, endoscopy remains the only effective laboratory tool for diagnosis.