J ALLERGY CLIN IMMUNOL

FEBRUARY 2010

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250 Patients with a History of Anaphylaxis to Penicillin CanReceive Pre-Operative Cephalosporins Safely

J. T. Li, K. L. Rossow, M. A. Park; Mayo Clinic, Rochester, MN.

RATIONALE: This study reviewed the penicillin skin test results of pa-

tients with a history of anaphylaxis to penicillin, and the risk of reaction

to cephalosporins in patients with negative skin tests to penicillins.

METHODS: This retrospective study was conducted at an academic med-

ical center with 8 allergists. The penicillin allergy database was queried us-

ing patient reported anaphylaxis as a search term. Out of 15298 patients

with a history of penicillin allergy and evaluated by an allergist, 193 pa-

tients reported a history of anaphylactic reaction to penicillin. Charts

were reviewed for penicillin skin test results, the administration of pre-

operative cephalosporins and for possible adverse drug events.

RESULTS: Out of 193 patients with a history of anaphylaxis to penicillin,

15 (7.8%) patients were not tested due to negative histamine controls. Out

of the 178 patients skin tested, ten patients (5.6%) had equivocal results.

Twelve (6.7%) had positive skin tests to the major and/or minor determi-

nants of penicillin, and one-hundred fifty-six (87.6%) had negative skin

tests to penicillin. This compares with a historical positive skin test rate

of 4% from patients with any history of penicillin allergy (P 5 0.13).

Eighty patients with negative skin tests to penicillin went on to receive a

cephalosporin antibiotic as prophylaxis during surgery. One patient

(1.25%) had an adverse drug reaction to cephalosporins (muscle and joint

pain after a plastic surgery procedure).

CONCLUSIONS: Most patients (98.8%) with a history of anaphylaxis to

penicillin and with negative skin tests are able to tolerate cephalosporins.

251 The Effect of Food Allergen Introduction Whilst Breast-feeding on the Development of Food Hypersensitivity

C. Venter1, J. Grundy1, C. B. Clayton1, B. N. Pereira1, B. Higgins2, T.

Dean2; 1The David Hide Asthma and Allergy Research Centre, Newport,

UNITED KINGDOM, 2University of Portsmouth, Portsmouth, UNITED

KINGDOM.

RATIONALE: Recently, much interest has been evoked by data from

large cohort studies indicating that the introduction of wheat whilst

breast-feeding may prevent the development of celiac disease. This lead

to the hypothesis that weaning and the introduction of allergenic foods

whilst breast-feeding, may prevent the development of FHS.

METHODS: All pregnant women with an estimated delivery time be-

tween 1st September 2001 to 31st August 2002 were approached at antena-

tal clinics on the Isle of Wight to participate in this study. Following

consent, information regarding family history of allergy (parental or sib-

ling), was obtained by means of a standardised questionnaire. At three,

six and nine months, as well as one, two and three years, information re-

garding feeding practices and reported symptoms of atopy were obtained

using a standardised questionnaire administered by telephone. FHS were

diagnosed by means of a food challenge or sensitisation to the food plus

a good clinical history.

RESULTS: 969 families were recruited into the study. 54 of these children

developed a FHS to 67 foods: milk (26), egg (19), fish (1), wheat (5 [of

which 1 child was diagnosed with celiac disease]), peanut (11) and sesame

(5). Of these 67 FHS seen, 32 (47.8%) of the foods were introduced whilst

the mother was still breast feeding: milk (17/26; 65.4%), egg (8/19;

42.1%), wheat (2/5; 40%), fish (1/1; 100%), peanut (2/11; 18%) and ses-

ame (2/5; 40%).

CONCLUSIONS: Our data suggests that introduction of the allergenic

foods during breastfeeding in this small group of children, did not seem

to have a preventative effect.

252 Bacteriostatic Agents and Sterility Requirements for AllergenImmunotherapy

K. L. Rossow1, D. Lowe2, M. Butler2, J. T. Li1; 1Mayo Clinic, Rochester,

MN, 2Olmsted Medical Center, Rochester, MN.

RATIONALE: We studied the effectiveness of bacteriostatic agents used

in current immunotherapy practice and determined the concentrations of

phenol and glycerin necessary to suppress microbial growth.

METHODS: Two sets of experiments were performed in parallel, one set

performed under the vertical hood with sterile technique; the other set on

the bench top. Sterile, 5ml vials were prepared with 5ml of preservative

free diluent with varying concentrations of phenol (from 0 up to 0.25%)

or glycerin (from 0 up to 20%), with or without cat hair allergen extract.

The vials were stored at 4 degrees Celsius for a 1 month period. During

this 1 month period, a total of 10 manipulations (10 punctures of the vials

with syringes) were performed on the bench top to each separate vial. 100

expired immunotherapy vials (prepared in a vertical hood) from 2 medical

centers were collected prospectively. All vials were cultured for bacterial

growth using 1 blood plate, 1 anaerobic plate, and thioglycolate broth.

RESULTS: None of the 100 expired immunotherapy vials showed micro-

bial growth. Out of 3 different concentrations of phenol and 4 different con-

centrations of glycerin tested, prepared under the hood or on the bench top,

none showed microbial growth.

CONCLUSIONS: These studies suggest that current immunotherapy

practice is highly effective at preventing microbial growth, that a sterile

hood may not be necessary to ensure the sterility of allergenic extracts

and that the sterility of immunotherapy extracts are preserved even with

low concentrations of phenol and/or glycerin.

253 Influence of Comorbidities on AsthmaT. S. Estes; Virginia Commonwealth University, Richmond,

VA.

RATIONALE: Since there is a need for further understanding of how co-

morbidities influence asthma, this research examined the relationships be-

tween comorbidities and asthma severity, control, medication adherence,

pulmonary function, and healthcare utilization.

METHODS: The study used a cross-sectional design with self-report

measures and spirometry. Eleven comorbidities were measured (history

of allergic rhinitis, atopic dermatitis, chronic fatigue syndrome, food al-

lergy, gastroesophageal reflux disease, laryngopharyngeal reflux, obesity,

obstructive sleep apnea, sinusitis, and nicotine addiction). Study instru-

ments included the Severity of Asthma Score, Perceived Control of

Asthma Questionnaire, and Adherence Schedule in Asthma. Healthcare

utilization assessed emergency room visits, hospital admissions, and inten-

sive care unit admissions for asthma in the past year. Data analysis included

descriptive, analysis of variance, and multivariate methods.

RESULTS: The selected comorbidities (n 5 225 patients) were significant

predictors of asthma control (F 5 2.9; p 5 0.002) and asthma medication

adherence (F 5 6.6; p < 0.0001) with allergic rhinitis and nicotine addic-

tion being the most important. Of those patients denying comorbidities

(n 5 10), 40% had severe asthma.

CONCLUSIONS: Comorbidities, especially allergic rhinitis and nicotine

addiction may be important influencing factors in asthma control and

asthma medication adherence. In general, comorbidities are pervasive oc-

curring at all levels of asthma severity. However, severe asthma can occur

without comorbidities.