J ALLERGY CLIN IMMUNOL

VOLUME 125, NUMBER 2

Abstracts AB167

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654 Frequency of Dosing for Hereditary Angioedema AttackProphylaxis with C1 Esterase Inhibitor

E. Banta, C. Mende, C. Rhoads, T. Craig; Penn State Milton S. Hershey

Medical Center, Hershey, PA.

RATIONALE: Hereditary angioedema (HAE) is a debilitating, life-

threatening disease characterized by unpredictable attacks of swelling.

Few treatment options exist for HAE. C1 esterase inhibitor is now ap-

proved for intravenous administration for prophylaxis against angioedema

attacks every 3-4 days, but individual requirements for treatment may vary.

METHODS: Four male and three female subjects with HAE (ages 14-71)

received C1 esterase inhibitor prophylaxis through our practice. Five pa-

tients were started on once weekly C1 esterase inhibitor 1000U while 2

were dosed every 3-4 days. Patients were followed for efficacy and safety.

Treatment frequency was increased for breakthrough attacks after receiv-

ing a rescue dose for exacerbations.

RESULTS: Three out of the five subjects started on weekly therapy (two

female, one male) continued to have breakthrough symptoms and were

changed to twice weekly dosing. One female patient continued to have

breakthrough attacks on twice weekly dosing and was increased to every

60 hour dosing. She continues to have occasional breakthrough 50-60

hours after dosing. The female subject who was started on q3-4 day had

breakthroughs and required frequent rescue dosing. The male who started

on q3-4 day dosing failed therapy as his hepatocellular carcinoma pro-

gressed. One male subject suffered a DVT and had treatment stopped.

One subject continues on weekly dosing of C1 esterase inhibitor without

attacks of HAE.

CONCLUSIONS: Individual requirements for C1 esterase inhibitor treat-

ment may vary. C1 esterase inhibitor treatment goals should include defin-

ing the lowest dose required to completely control symptoms of HAE.

655 Screening of Untreated Schoolchildren with AllergicSymptoms - How many are left untreated?

K. Mukaida1,2, T. Kusunoki1,3, T. Morimoto4, T. Yasumi3, R. Nishiko-

mori3, T. Heike3, T. Fujii1, T. Nakahata3; 1Shiga Medical Center for Chil-

dren, Moriyama, Shiga, JAPAN, 2Kumiko Allergy Clinic, Kyoto, JAPAN,3Department of Pediatrics, Graduate School of Medicine, Kyoto Univer-

sity, Kyoto, JAPAN, 4Center for Medical Education, Graduate School of

Medicine, Kyoto University, Kyoto, JAPAN.

RATIONALE: Allergic diseases continue to increase among children.

However, it is unclear as to how many of these children are under appropri-

ate medical care. To establish the number of schoolchildren being treated

for their allergic symptoms and determine if their symptoms and treatment

status are associated with their total and allergen-specific IgE levels.

METHODS: A total of 618 out of the 627 (94.5%) 11-year-old schoolchil-

dren living in Shiga, Japan answered a questionnaire designed to determine

the presence of allergic symptoms and treatment status. Levels of total IgE,

mite-specific IgE and three pollen-specific IgEs were measured at the same

time the questionnaire was filled out and used to analyze relationships be-

tween the questionnaire data and IgE levels.

RESULTS: The rates of diagnosis and treatment were 100% and 81%

among those with bronchial asthma (BA) symptom. However, the rates

for other allergic symptoms (atopic dermatitis, allergic rhinitis and allergic

conjunctivitis) were significantly lower (ranging from 44 to 88% for diag-

nosis and 28 to 52% for treatment). When subjects were screened for a total

IgE of 300 or more and/or a mite-specific IgE class 3 or more, 70% of those

with untreated moderate or severe allergic symptoms were detected.

CONCLUSIONS: Subjects with allergic symptoms other than BA ex-

hibited significantly poorer treatment rates. Total and allergen-specific

IgE screening at schools might be useful in determining untreated sympto-

matic children and helping advise them on appropriate medical care.

656 Anaphylaxis to Hymenoptera Venom Stings: Are WeEffectively Meeting the Gold Standard?

S. Kapoor1, A. Wolff2; 1UMDNJ-New Jersey Medical School, Newark,

NJ, 2VA Healthcare System of New Jersey, East Orange, NJ.

RATIONALE: To examine the management of anaphylaxis to hymenop-

tera stings by primary care providers within our hospital.

METHODS: We performed a search of all outpatient encounters at a New

Jersey VA hospital from 2007-2008 for the diagnosis of Toxic effect of

venom (ICD code 989.5). We reviewed the charts with this diagnosis to de-

termine if an anaphylactic reaction occurred, and if so, whether an Epi-pen

was prescribed and/or an allergist was consulted.

RESULTS: Of the 21 cases of insect stings identified, 7 resulted in anaphy-

laxis. Of the six patients known by the primary care/ER physicians to have

anaphylaxis to hymenoptera stings, 83%(5/6) were prescribed an Epi-pen.

Of the total cases of venom sting anaphylaxis, 29%(2/7) were appropriately

referred to an allergist for evaluation of this problem, while 57%(4/7) were

never referred despite the primary care provider being aware of the history

of venom anaphylaxis (the history of anaphylaxis was an incidental finding

by the Allergist in one case while evaluating the patient for an unrelated

problem).

CONCLUSIONS: Based on the high percent of patients prescribed an

Epi-pen (83%), the primary care physicians in our hospital seem to under-

stand the importance of preventing future anaphylactic episodes in patients

with a history of a systemic reaction after a hymenoptera sting. A large per-

cent (57%) were not offered an evaluation by an allergist which prevented

venom immunotherapy from being considered as a treatment option. This

suggests the important role of the allergist in treating and preventing hyme-

noptera anaphylaxis is not well recognized in our hospital.

657 Patients On Multiple Medications Who Need Allergy SkinTests: Which Medications Should Be Held?

K. M. Shah, M. A. Rank, J. Krogman, C. L. Oslie, J. H. Butterfield; Mayo

Clinic, Rochester, MN.

RATIONALE: A multivariate model examining patients taking multiple

medications may clarify whether specific medication classes interfere

with allergy skin tests.

METHODS: A retrospective study from January 2008 to March 2009

evaluated patients taking any of the following medications within 7 days

of allergy skin testing: TCAs, SSRIs, SNRIs, benzodiazepines, atypical an-

tidepressants/sedatives, PPIs, H2blockers and H1 blockers. The study was

approved by the IRB and consent was obtained from all patients. The ef-

fects of multiple medications were determined using multi-variate logistic

regression and were reported as the odds ratio (OR) of a negative histamine

skin test with 95% confidence intervals.

RESULTS: There were 580 patients that met inclusion criteria. Forty-nine

percent of the patients were taking 2 or more of these medications and 89%

discontinued the medication <48 hours prior to skin testing. The odds of a

negative histamine test for patients taking TCAs was 6.33 (2.11-20.5), H1

blockers was 4.95 (1.78-15.1), benzodiazepines was 5.01 (1.72-15.80),

atypical antidepressants/sedatives was 3.11 (1.09-9.61), and H2 blockers

was 2.91 (0.97-9.37). The odds of a negative histamine test for SSRIs,

SNRIs, or PPIs were not significantly increased. The odds of a negative

skin test decreased for each day off of medication by 0.67 (0.50-0.87).

The total number of medications did not increase the odds of a negative

skin test (OR50.81, 0.32-1.87).

CONCLUSIONS: SSRIs, SNRIs, and PPIs are unlikely to interfere with

skin testing while TCAs, H1 blockers, benzodiazepines, atypical antide-

pressants/sedatives, and perhaps H2 blockers should be discontinued prior

to skin testing if clinically able.