J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB260 Abstracts

TUESDAY

896 Eosinophilic Esophagitis In The Puerto Rican PediatricPopulation

Dr. Carmen M. Pimentel, MD, Dr. Angel M. Rivera, MD, Dr. Iona K.

Malinow, MD, Dr. Cristina J. Ramos, MD, Dr. Anardi Agosto-

Mujica, MD, Dr. Rita Diaz, MD, Dr. Sylvette Nazario, MD; University

of Puerto Rico School of Medicine, San Juan, PR.

RATIONALE: Eosinophilic esophagitis (EoE) has been rarely recognized

in Hispanics. Our goal is to describe the clinical characteristics, skin prick

test (SPT) and food atopy patch test (APT) results in a Puerto Rican

pediatric population with EoE.

METHODS: A retrospective analysis of all pediatric patients with EoE

seen at the Allergy/Immunology Clinics of the University of Puerto Rico

School of Medicine between July 2012 and June 2013.

RESULTS: Thirty six patients (age 0.8-18 years) with biopsied-confirmed

EoE were identified. Seventy one percent were males. Most were atopic

(91.4%). Allergic rhinitis was the most frequent diagnosis (83.3%) and

dust mite was the most common sensitivity (83.3%). EoE symptoms

included abdominal pain, emesis, dysphagia, and nauseas (56.3%, 56.3%,

46.8%, and 43.7% respectively). Food SPTwas positive in 88.9% of cases.

Egg, milk, oat, and corn (44.4%, 29.6%, 25.9%, and 25.9% respectively)

were the most prevalent positives. APTs were positive in 88.9%. Wheat,

beef, and chicken (41.7%, 36.1%, and 36.1% respectively) were the most

prevalent positives. Therewas an association between SPToat (RR5 0.43)

with eosinophil counts in esophageal biopsy, unlike APT wheat (RR 5-0.28), chicken (RR 5 -0.19) and beef (RR 5 -0.10).

CONCLUSIONS: This is the first study to describe results of both food

SPTand APT in a Hispanic EoE pediatric population. APT results differed

from other published cohorts. Dietary, gut microbial flora and host immune

factors may explain these differences. Prospective studies are needed to

evaluate efficiency of combining these testing methods in directing

successful dietary elimination.

897 Challenges With Measurement Of IgE Antibodies To MinorComponents In Food Allergy: Eosinophilic Esophagitis, PeanutAllergy, and Delayed Anaphylaxis To Mammalian Meat

Anubha Tripathi, MD1, Lisa J. Workman, BA1, Scott Commins, MD,

PhD1, Barrett Barnes, MD2, Prof. Robert G. Hamilton, PhD, D. Abmli,

FAAAAI3, Thomas A. E. Platts-Mills, MD, PhD, FAAAAI1, Elizabeth

Erwin, MD4; 1Division of Asthma, Allergy & Immunology, University

of Virginia Health System, Charlottesville, VA, 2Division of Pediatric

Gastroenterology, University of Virginia Health System, Charlottesville,

VA, 3Johns Hopkins University School of Medicine, Baltimore, MD,4Nationwide Children’s Hospital, Columbus, OH.

RATIONALE: No one diagnostic modality currently identifies the foods

responsible for development of Eosinophilic Esophagitis (EoE): skin

testing (prick, patch) is sometimes positive and serum IgE titers are often

low-level positive.

METHODS: IgE to food and inhalant allergens was measured in sera of

adults and children with biopsy-diagnosed EoE by: ImmunoCAP (CAP),

and for component specificity, by ISAC (112-component biochip assay),

serial (1:2 to 1:8) dilution CAP assays, and component CAP assays (milk,

wheat). Results were compared to those for subjects with anaphylaxis after

ingestion of peanut, milk, and mammalian meat.

RESULTS: ISAC component analysis of EoE sera for aeroallergens

correlated well with analysis by CAP, however, for foods, was largely

negative. For dilution assays, no change (undiluted value vs. calculated

titer) was noted for: aeroallergens (mite, cat) in EoE sera or peanut and

milk in anaphylaxis sera; in contrast, calculated titers up to six times the

undiluted value were noted for foods in EoE sera (milk, wheat, peanut) and

in mammalian meat allergy sera (beef, pork). CAP assays for 5 milk

components revealed positivity to minor components in greater than 50%

of EoE sera.

CONCLUSIONS: ISAC results suggest that the components of foods

currently recognized as important allergens may not be relevant in EoE.

Differences in dilution assay results among EoE and anaphylaxis sera, in

addition to predominance of positive titers for minor milk components in

EoE sera, elucidate that assaying undiluted serum can significantly

underestimate IgE levels and that comprehensive component analysis

may be the key to understanding food sensitivity in EoE.

898 Serum IgE To Allergen Components In Patients WithEosinophilic Esophagitis

Maria Slack, MD1, Princess U. Ogbogu, MD, FAAAAI2, Anubha

Tripathi, MD3, Lisa J. Workman, BA3, Thomas A. E. Platts-Mills, MD,

PhD, FAAAAI3, Elizabeth Erwin, MD4; 1Nationwide Children’s Hospital,

Columbus, OH, 2Wexner Medical Center at the Ohio State University, Co-

lumbus, OH, 3Division of Asthma, Allergy & Immunology, University of

Virginia Health System, Charlottesville, VA, 4Nationwide Children’s

Hospital.

RATIONALE: Milk, wheat, egg, soy, and peanut are common problem

foods for adults and children with eosinophilic esophagitis (EoE). Current

recommended diets for treatment are challenging to maintain long term.

We examined specific IgE to allergen components among patients with

EoE.

METHODS: In a cohort of adults (n524) and children (n530) with EoE,

we measured levels of specific IgE to common foods (ImmunoCAP). IgE

antibodies to milk and peanut component proteins were also measured.

RESULTS: In the whole cohort, milk and/or peanut sensitization was

identified in 44.4% and 33.3% respectively. In 82% of patients who had

sensitization to milk, we found detectable specific IgE to at least one

component. No single component was dominant; 58.8% had specific IgE to

Bos d 4, 52.9% to Bos d 5, 41.2% to Bos d 8, and 23.5% to Bos d 9. The

geometric mean titer of specific IgE to milk was higher in patients with IgE

to two or more components (p50.01). Specific IgE to at least one

component for peanut allergen was detected in 71.4% of patients. In

contrast with milk, specific IgE to Ara h 8 or Ara h 9 was most frequently

identified in patients with EoE (42.9% for each component). Specific IgE to

Ara h 1 and Ara h 2 was found in only 14.3%.

CONCLUSIONS: Sensitization to distinct milk components may differ-

entially influence inflammation and symptoms. The negative results for

Ara h 1, 2, and 6 in most EoE patients suggest that some individuals with

EoE may not need to avoid peanut.

899 Eosinophilic Gastroenteritis Due To Egg Allergy PresentingAs Acute Pancreatitis

Dr. Kevin Tse, MD, UCSD, Dr. Sandra C. Christiansen, MD, FAAAAI;

Southern CA Permanente Med Grp, San Diego, CA.

RATIONALE: Eosinophilic gastroenteritis (EGE) is a disease character-

ized by eosinophilic infiltration of the gastrointestinal tract. Most patients

present with nonspecific symptoms of gastrointestinal pain, bloating,

nausea, vomiting, diarrhea, malabsorption and ascites. Here we present a

case of acute pancreatitis in a 25 year-old female within 1 hour after

ingestion of an egg-containing product.

METHODS: Serologic testing by Immunocap performed to commonly

allergic foods. Endoscopy performed during admission for acute

pancreatitis.

RESULTS: During one of these attacks, her lipasewas elevated to 2400U/

L. Endoscopic biopsies revealed increased eosinophils in the duodenum

without villous blunting or acute inflammation. Charcot Leyden crystals

were also noted on a stool sample. In vitro allergy testing demonstrated a

level III sensitization to egg, all other tested foods were negative. Removal

of egg from this patient’s diet has lead to complete resolution of her

symptoms.

CONCLUSIONS: One previous case report discussed a patient with milk

allergy resulting in EGE with acute pancreatitis. A possible mechanism by

which food-hypersensitivity related EGE may cause acute pancreatitis is

due to obstruction of the pancreatic duct from local duodenal inflamma-

tion. When unexplainable gastrointestinal symptoms are observed in

patients with positive food allergy testing, EGE triggered by food allergies

should be included in the diagnosis.