173 Risk-taking and Coping Strategies of Food Allergic Adoles-cents and Young Adults

M. Sampson1, A. Munoz-Furlong2, S. H. Sicherer1; 1Pediatrics, Mt Sinai

School Of Medicine, New York, NY, 2Food Allergy & Anaphylaxis

Network, Fairfax, VA.

RATIONALE: To identify factors to explain why adolescents and young

adults are at high risk for fatal food anaphylaxis.

METHODS: Web-based questionnaire based upon focus groups.

RESULTS: Participants (174 subjects; 49% male) were 13-21 yrs of age

(mean, 16 yrs) and reported: peanut allergy (75%), milk allergy (20%), >2

food allergies (75%), anaphylaxis (82%) and >3 lifetime reactions (52%).

Regarding risk-taking, 74% report always carrying epinephrine, but fre-

quencies varied during certain activities: traveling (94%), restaurants

(81%), friends’ homes (67%), school dance (61%), wearing tight clothes

(53%) and sports (43%). While 75% “always” read labels, 42% would eat

a food labeled “may contain” an allergen. We designated 29 participants

as “High Risk” (HR) because they do not always carry epinephrine and

ate foods that “may contain” allergens. The HR group, compared to the

rest of the group (p<.05), was less concerned with their allergy, less like-

ly to consider “may contain” labels a risk, had more recent reactions, and

felt “different” because of their allergy. The HR group was not distin-

guishable (p=ns) by age, gender, number of lifetime reactions, or severity

of symptoms. Teens variably (60%) tell their friends about their allergy

and 68% feel education of their friends would make living with food

allergy easier.

CONCLUSIONS: A sizeable number of food-allergic teens admit to

risk-taking that varies by social circumstances and perceived risks. The

results imply that educations of teens, and importantly those around them

during social activities, may reduce risk-taking and its consequences.

Funding: Food Allergy & Anaphylaxis Network, Food Allergy Initiative

174 Continuing Avoidance Diets after Negative Food Challenges

P. A. Eigenmann, J. C. Caubet, S. A. Zamora; Children’s University Hos-

pital, Geneva, SWITZERLAND.

RATIONALE: Patients with a negative food challenge do not always

reintroduce the food at home after the challenge. This study aimed to eval-

uate why the food is not later eaten, and which families have to be con-

vinced that the food is safe.

METHODS: Patients/families with a negative food challenge between

1999 and 2003 were contacted my mail and were invited to fill out a ques-

tionnaire comprising items on the reaction at diagnosis, the fear of an

accidental reaction, and the consumption of the food after the negative

food challenge. Informed consent was obtained, and the study was

approved by the IRB.

RESULTS: A total of 74 questionnaires from 55 patients were collected.

Mostly egg and milk (21 each), and peanuts (13) were tested negative.

The food was not reintroduced into the patient’s diet after one third of the

negative challenges. Ten patients reported allergic symptoms, but investi-

gation of the reported reactions suggested unspecific flares of atopic der-

matitis or reactions suggestive of intolerance. The length of the eviction

diet, the severity of the initial reaction, or the food tested did not influence

the decision to reintroduce the food.

CONCLUSIONS: Recent studies suggest, that patients should regularly

eat the food tested negative in order to avoid reoccurrence of food allergy.

In this study we did not identify a specific risk group, which avoids rein-

troduction. After a negative food challenge, the importance of reintroduc-

ing the food should be emphasized in all patients.

175 IgE from Some Green Kiwifruit Allergic Individuals Binds toProteins in Hardy Kiwifruit, a Third Cultivated Species of theGenus Actinidia

R. E. Goodman1, L. Chen1, J. Lucas2, J. O. Hourihane2, S. L. Taylor1;1Food Science & Technology, University of Nebraska, Lincoln, NE,

2Allergy and Inflammation Sciences, University of Southampton,

Southampton, UNITED KINGDOM.

RATIONALE: Since hardy kiwifruit (Acintinidia arguta) is now culti-

vated in western North America, we tested protein extracts of hardy, green

(Actinidia deliciosa) and gold (Actinidia chinensis) kiwifruit for IgE bind-

ing using sera from individuals with clinically diagnosed food allergies to

green kiwifruit, to evaluate potential cross-reactivity.

METHODS: Sera from twelve green kiwifruit-allergic subjects (eight

were positive by DBPCFC, four severe reactors were not challenged but

had positive ImmunoCAP) and control subjects were assayed for IgE

binding to soluble proteins in green, gold and hardy kiwifruits using

reducing and non-reducing SDS-PAGE immunoblots and direct enzyme

linked immunosorbent assays (ELISA).

RESULTS: IgE-ELISA results of all kiwi-allergic subjects were positive

compared to controls for one or more kiwifruit extracts. Immunoblot

results demonstrated individual patient and species variability. Two sera

with strong ELISA positive results to both hardy and green, but not gold

kiwifruit did not show marked IgE binding to kiwifruit proteins on

immunoblots with reduced, heat denatured extracts, but clearly bound two

or more proteins from non-reduced, unheated extracts of hardy, but not

green kiwifruit. One kiwifruit-allergic individual had marked binding to

non-reduced, unheated gold kiwifruit proteins. Only one kiwifruit-allergic

individual had marked binding to proteins of all species on the reduced gel

blot. Some control sera showed marked IgE binding to high molecular

weight proteins on immunblots.

CONCLUSIONS: These results suggest some kiwifruit-allergic individ-

uals may suffer allergic cross-reactions if they consume hardy kiwifruit.

They also demonstrate the difficulty in developing in vitro reagents for

accurate diagnosis of kiwifruit allergy and for correctly identifying major

allergens.

Funding: Efficas, Inc.

176 Establishing a Milk Specific IgE Decision Point in IgE Medi-ated Cow’S Milk Allergy (CMA) Patients from a Tertiary Pedi-atric Brazilian Center

A. K. F. Gushken, A. P. M. Castro, A. C. Pastorino, E. Ciccone, R. F. F.

Gonçalves, C. M. A. Jacob; Department of Pediatrics, University of Sao

Paulo, Sao Paulo, BRAZIL.

RATIONALE: An optimal milk specific IgE decision point had been

establish for CMA diagnosis but this cut off should be evaluated in dif-

ferent populations.

METHODS: We evaluated 23 patients (14male, mean age 4y 2mo, rang-

ing from 11mo to 14y) with cow milk IgE mediated allergy confirmed by

anaphylaxis or positive double blind placebo controlled food challenge

(DBPCFC) . All of them performed Pharmacia ImmunoCAP® system to

milk IgE. A group of 23 equivalent healthy children was considered as

control. Sensitivity (Se), specificity (Sp), PPV, NPV for all levels from

0,35 to 15 kU/L were determined. As the objective of this analysis was to

consider the diagnosis and not only a screening test, PPV and NPV were

the main valorized measures.

RESULTS: Levels under 11kU/L did not show adequate PPV neither

NPV. The best values were obtained with ImmunoCap levels from 11 to

13 kU/L (Se =78,2%, Sp= 100%, PPV = 100%, NPV= 82,1%). Immuno-

Cap level 14 showed : Se =69,5%, Sp= 100%, PPV = 100%, NPV= 76,6%

and level 15 showed Se =65,2%, Sp= 100, PPV = 100%, NPV= 74,1%.

CONCLUSIONS: In this study, the most adequate concentration of

whole milk IgE was 11 suggesting that these levels vary from different

population, but it is necessary more studies to evaluate these findings.

Funding: University of Sao Paulo

S44 Abstracts J ALLERGY CLIN IMMUNOL

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