food allergy and increased asthma morbidity in a school inner-city asthma study

J ALLERGY CLIN IMMUNOL

FEBRUARY 2012

AB132 Abstracts

SUNDAY

501 Anaphylaxis in America - Results from a National TelephoneSurvey

J. Boyle1, C. A. Camargo2, P. Lieberman3, H. Sampson4, L. B. Schwartz5,

F. E. R. Simons6, M. Zitt7, M. Wilkinson1, C. Collins8, M. Tringale8, R.

Wood9; 1Abt SRBI, Silver Spring, MD, 2Massachusetts General Hospital,

Boston, MA, 3University of Tennessee College of Medicine, Germantown,

TN, 4Mount Sinai School of Medicine, New York, NY, 5Virginia Com-

monwealth University, Richmond, VA, 6University of Manitoba, Winni-

peg, MB, CANADA, 7State University of NY Stony Brook, Stony

Brook, NY, 8Asthma and Allergy Foundation of America, Landover,

MD, 9Johns Hopkins University School of Medicine, Baltimore, MD.

RATIONALE: To delineate triggers of anaphylaxis and compare aware-

ness, knowledge and behaviors among patients at-risk for anaphylaxis.

METHODS: A nationwide, cross-sectional random-digit-dial telephone

survey was conducted using a standardized questionnaire. Household

members were screened for allergic reactions to foods, insect stings, latex,

medications, and other allergens, and for idiopathic reactions. When

multiple householdmembers had allergies, the person with the most severe

allergic reaction was chosen for the interview. Participants were asked over

100 questions about anaphylaxis awareness, triggers, symptoms, treat-

ments, knowledge, perceptions, behaviors, and quality of life.

RESULTS: Over 20,000 phone calls weremade to identify and interview a

nationally representative sample of 1,000 persons who had experienced

allergic reactions within the past ten years. The survey found that 18% of

persons with these types of allergies had experienced at least one likely

anaphylactic reaction. Among those reporting anaphylactic reactions, 42%

occurred within 15 minutes of exposure and the most common triggers

were medications (33%), followed by foods (28%), insect stings (21%),

other (15%), unknown (7%), and latex (3%). Also among those reporting

anaphylaxis, 38% sought emergency room care, 28% self-treated with

antihistamines, 13% went to a doctor’s office, and 13% self-administered

epinephrine. Although 57% reported two or more lifetime episodes, only

18% of the individuals reporting anaphylaxis currently carry epinephrine.

CONCLUSIONS: Severe allergic reactions consistent with anaphylaxis

are common among persons reporting allergic reactions in the general

population. This comprehensive national survey on anaphylaxis, including

its triggers and treatment, supports the need for public health initiatives to

improve anaphylaxis practices and education.

502 Food Allergy and Increased Asthma Morbidity in a SchoolInner-city Asthma Study

J. Friedlander1, W. Sheehan1, E. Hoffman2, C. Fu2, D. Gold3, W. Phipa-

tanakul1; 1Children’s Hospital Boston, Boston, MA, 2Division of Respira-

tory Epidemiology, Channing Laboratory, Brigham and Women’s

Hospital, Boston, MA, 3Department of Biostatistics, Harvard School of

Public Health, Boston, MA.

RATIONALE: Children with asthma have increased prevalence of

coexisting food allergies. While food allergy has been shown to be an

independent risk factor for increased asthma morbidity, this has not been

examined within an urban inner-city asthma school-aged cohort. The

School Inner-City Asthma (SICAS) is an NIH-funded prospective study

evaluating specific risk factors and asthma morbidity among urban

children. We aimed to determine the relationship between food allergy

and asthma morbidity.

METHODS: We prospectively surveyed children from 20 urban, inner-

city schools with a diagnosis of asthma, followed by full clinical evaluation

and pulmonary function testing. Food allergy symptoms were reported

including symptoms experienced within one hour of food ingestion.

Asthma morbidity, pulmonary function, and resource utilization were

compared between children with food allergies and without. Significance

was tested using Wilcoxon rank-sum tests.

RESULTS: Fifty-five (24%) of the 228 asthmatic children surveyed had

food allergies. Asthmatic children with food allergies had significantly

more hospitalizations than thosewithout food allergies (OR: 2.15, 95%CI:

1.16-4.00, p50.01). Percent-predicted FEV1 scores were significantly

lower in the food allergy group (median: 93.8, IQR 82.9-111.5) compared

to the non-allergic group (median 101.5, IQR: 91.4-112.9, p50.04).

Children with food allergies were more likely to have been prescribed an

asthma controller medication (OR: 1.73, 95% CI 0.90-3.34, p50.10) and

have escalated asthma therapy in the last 12 months (p50.07).

CONCLUSIONS: School-aged children with asthma and coexisting food

allergies have increased asthma morbidity, decreased lung function, and

increased healthcare utilization.

503 Outcome Rather Than the Type of Diagnostic InterventionPredicts Improvement in Health-Related Quality of Life ScoreAmong Children With Food Allergy Between 0-12 Years

L. Kirste1, T. K. Takaro1, B. Kuzeljevic2, T. Wong3, E. S. Chan3; 1Simon

Fraser University, Burnaby, BC, CANADA, 2Child and Family Research

Institute, Vancouver, BC, CANADA, 3Department of Pediatrics, Division

of Allergy, University of British Columbia, Vancouver, BC, CANADA.

RATIONALE: Access to diagnostic care may attenuate the negative

impact of food allergy on health-related quality of life (HRQL). We sought

to determine if improved HRQL could be demonstrated among children, 0-

12 years, who received food allergy diagnostic care in a Canadian allergy

clinic setting, utilizing the Food Allergy Quality of Life Questionnaire-

Parent Form (FAQLQ-PF).

METHODS: Parents attending the clinic with their child completed the

questionnaire at the beginning and 2 months after the visit. Parents of

children on the clinic waitlist served as controls. Scores were grouped in 2

ways for analysis: according to type of diagnostic intervention- clinic visit

with or without oral food challenge (OFC or N-OFC, respectively); and

according to diagnostic outcome- fewer or same number of food allergies.

The General Linear Model for Repeated Measures was used to compare

changes in score over time between interventions and between outcomes,

and to test for possible interaction between the variables.

RESULTS:Mean pre-/post-visit scores by intervention were 2.20/2.14 for

OFC (n5 45), 2.00/1.75 for N-OFC (n5 55), and 1.70/1.79 for controls (n

5 59). Therewas no interaction between score change and interventions (F

2.938, p5 0.056). Mean pre-/post-visit scores by outcome were 1.93/1.68

for fewer (n5 64), 2.37/2.37 for same (n5 36), and 1.70/1.79 for controls

(n5 59). Only interaction between score change and fewer food allergies

was significant (F 3.355, p 5 0.037).

CONCLUSIONS: Diagnosis of fewer food allergies predicts improve-

ment in HRQL score among children, regardless of diagnostic

intervention.