765 Dioscorea batatas (Sanyak) Allergy, Identification of an IgE-binding Component

G. Hur1, S. Shin2, H. Park1, H. Kim1, Y. Ye1, S. Kim3, D. Nahm1,

H. Park1; 1Ajou University School of Medicine, Suwon, REPUBLIC OF

KOREA, 2KyungHee University College of Medicine, Seoul, REPUBLIC

OF KOREA, 3Yonsei University Wonju College of Medicine, Wonju,

REPUBLIC OF KOREA.

RATIONALE: Dioscorea batatas, Sanyak is widely used in Asia as

a herbal medicine or food product with potential health benefit. There

have been several reports of occupational asthma caused by inhalation of

Sanyak dust. But, there have been no reports of systemic allergic reactions

after oral administration of Dioscorea batatas’ roots. The objective of this

study was to compare IgE binding components among the patients sensi-

tized through oral or inhalation route.

METHODS: Two patients with Dioscorea batatas allergy were enrolled.

One was a merchant of herbal materials, had been exposed to dust of

Dioscorea batatas for 26 months, and diagnosed as having occupational

asthma through the positive inhalation challenge test result. The other

had experienced severe urticaria and angioedema after the indigestion of

fresh Dioscorea batatas. For detecting serum specific IgE and IgG4 anti-

bodies to Dioscorea batatas, ELISA was done followed by IgE immuno-

blot to identify IgE binding components.

RESULTS: Both patients had strong positive responses to extracts of

Dioscorea batatas, and high serum specific IgE and IgG4 antibodies to

Dioscorea batatas were detectable by ELISA. IgE immunoblot analysis

demonstrated one identical IgE binding component with 27 kD bound to

both sera.

CONCLUSIONS: Dioscorea batatas exposure could induce IgE-medi-

ated allergic responses by oral sensitization as well as inhalation route.

The IgE binding component was identical in both sensitization routes.

Funding: The Korean Health 21 R&D Project, Ministry of Health &

Welfare, Republic of Korea (A050571)

766 Severe Peripheral Eosinophilia and Failure to Thrive withComplete Resolution of Symptoms with Milk Elmination

H. Ahluwalia, L. Bernstein, J. Shliozberg; Albert Einstein The Children’s

Hospital at Montefiore, Bronx, NY.

RATIONALE: Patients with gastrointestinal symptoms, peripheraleosi-

nophilia, and nondiagnostic biopsies may benefit from elimination diets

based on allergy testing.

METHODS: This is a case review of a 2 year old patientwho had been

seen by an allergist for atopic dermatitis and placed on a milk elimination

diet because of a positive RAST to milk. Her diet had been liberalized to

include milk containing products a month prior to presenting to the emer-

gency room with peripheral edema, diarrhea, and failure to thrive.

RESULTS: She presented with protein losing enteropathy (stoolalpha-

1 antitrypsin 5 115 mg/Dl) and hypoalbuminemia.Stool studies and renal

and abdominal ultrasounds were within normal limits. Bone marrow bi-

opsy was consistent with eosinophilia and negative for lymphoproliferative

malignancy. Esophageal, duodenal, gastric, and colon biopsies (total 11)

were notconsistent with eosinophilic gastroenteritis with only few scat-

tered eosinophils. Peripheral eosinophil count was 14,469 cells/mcL.

Total IgE was 267. Due to a positive RAST the patient was placed on strict

milk elimination. Peripheral eosinophilia and symptoms completely

resolved.

CONCLUSIONS: The diagnosis of eosinophilic gastroenteritis requires

abnormal GI symptoms, 20 or more eosinophils perhigh-power field in

multiple areas of the GI tract, absence of an identified cause of

eosinophilia.Our patient presented with classic features of atopic subtype

of eosinophilic gastroenteritis with peripheral edema, high peripheral

eosinophil counts,an elevated IgE, and elevated RAST to foods but with

nondiagnostic biopsies. In patients with an atopic background, peripheral

eosinophilia and gastrointestinal symptoms with positive food allergy test-

ing may be enough to initiate a trial of food elimination diet.

767 Clinical And Laboratorial Findings From Ige Mediated Cow'sMilk Allergy (CMA) In Brazilian Pediatric Patients

A. K. F. Gushken, D. L. A. Pitarello, G. H. Yonamine, E. Ciccone, A. C.

Brandao, A. P. B. M. Castro, A. C. Pastorino, C. M. A. Jacob; DEPTO. OF

PEDIATRICS, Sao Paulo, BRAZIL.

RATIONALE: Cow’s milk is the most important allergen in pediatric pa-

tients with food allergy. It’s important to characterize clinical, epidemio-

logical and laboratorial findings from different countries populations.

METHODS: It was evaluated 136 patients (1,1M:1F), average age (6,22

y), with IgE CMA. They were submitted to clinical and laboratorial proto-

col that included PRICK TEST, RAST/ ImmunoCAP� and DBPCFC.

RESULTS: The average of symptoms onset was 120 days (median 5

135,6 d). The symptoms were: cutaneous (86%), respiratory (64,7%), an-

aphylaxis (43,4%) and gastrointestinal (42%). Allergic familial history

was present in 93/130 (71,5%). Laboratorial findings showed: total IgE

elevated in 76,1%, high blood eosinophils count in 32,8%, presence of spe-

cific IgE to whole milk in 67,4% (58/86) by SPT and 63,3% (76/120) when

considering ImmunoCAP� > 3,5kUA/L and 24,9% (30/120) considering

> 15 kUA/L as decision point. Among cow milk proteins, SPT showed

beta-lactoglobulin as the most frequent 70,7% (70/99) while casein was

elevated in 44,6% (42/94) using ImmunoCAP� (cut off > 3,5 kUA/L).

13 patients presented specific IgE to all tested milk proteins. DBCPFC

was positive in 19/31. Six patients (RAST/ ImmunoCAP�) and 21 patients

(PRICK) presented negative IgE to whole milk with positivity to one or

more cow milk protein.

CONCLUSIONS: In this study cutaneous symptoms was the main man-

ifestation and total IgE elevated was more common than high blood eosin-

ophils count. The authors point out that anaphylaxis is an important clinical

finding that contraindicates the DBPCFC. SPT and ImmunoCAP� to

whole and milk proteins contributed to the diagnosis of CMA.

768 Isolated Food Pollen Syndrome in Response to FreshPineapple

E. S. Lavine1, A. R. Atkinson1, A. K. Ellis2; 1University of Toronto and

Division of Immunology and Allergy, The Hospital for Sick Children,

Toronto, ON, CANADA, 2Division of Clinical Immunology and Allergy,

McMaster University, Hamilton, ON, CANADA.

RATIONALE: We report a case of isolated food pollen allergy syndrome,

a recognized form of IgE mediated food hypersensitivity, to pineapple.

METHODS: Case report and literature review.

RESULTS: A healthy 29 year old woman presented with a ten year history

of oral parasthesia, dyspepsia, abdominal cramping, and vomiting after

consumption of mixed fresh fruit salad. Ingestion of plain fresh pineapple

produced the identical symptoms. Canned pineapple and all other fresh

fruits were eaten without causing symptoms. After five years of complete

dietary exclusion of fresh pineapple, an accidental ingestion of fresh pine-

apple juice caused oral parasthesias followed by severe abdominal cramp-

ing, nausea, and presyncope within thirty minutes. While walking to seek

medical attention, syncope occurred. The patient was confirmed to be

hypotensive and bradycardic by medical staff. Conservative management

yielded resolution of symptoms within two hours. Subsequent skin testing

demonstrated a wheal (6 x 10 mm) in response to fresh pineapple, a nega-

tive test to commercial pineapple extract, and a positive test to birch tree

(10 x 15 mm) along with positive tests to mixed tree, mixed grass, short

ragweed, cat, dog, and dust mite species.

CONCLUSIONS: While pineapple is among several fruits implicated in

the food pollen allergy syndrome, review of the literature suggests that iso-

lated reactivity to pineapple would be considered an uncommon entity.

J ALLERGY CLIN IMMUNOL

VOLUME 119, NUMBER 1

Abstracts S195

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