AB188 Abstracts
FEBRUARY 2011
719 DOHaD and Allergic Diseases in Schoolchildren: Does IUGR
Affect Risk of Allergic Diseases?
K. Mukaida1,2, T. Kusunoki1,3, T. Morimoto4, M. Sakuma4, N. Mito1, T.
Yasumi3, T. Fujii1, R. Nishikomori3, T. Heike3; 1Department of Pediatrics,
Shiga Medical Center for Children, Shiga, JAPAN, 2Kumiko Allergy
clinic, Kyoto, JAPAN, 3Department of Pediatrics, Graduate School of
Medicine, Kyoto University, Kyoto, JAPAN, 4Center for Medical Educa-
tion, Graduate School of Medicine, Kyoto University, Kyoto, JAPAN.
RATIONALE: Developmental Origins of Health and Disease (DOHaD) is
the hypothesis that states that the change in fetal programming in response
to preterm birth or intrauterine growth restriction (IUGR) is associated
with metabolic diseases later in life. It is not clear whether it is also
associated with allergic diseases. Our aim was to determine whether the
prevalence of allergic diseases in schoolchildren was affected by
DOHaD-related prenatal factors, such as being born late preterm (34-36
weeks) or light for dates (LFD).
METHODS: A questionnaire-based survey on the prevalence of allergic
diseases, such as bronchial asthma (BA), atopic dermatitis (AD), allergic
rhinitis (AR), allergic conjunctivitis (AC), and food allergy (FA), as well
as birth weight and gestational age, was administered to more than
13,000 schoolchildren. Multivariate analysis was performed to test the dif-
ferences in the prevalence of allergic diseases between those with or with-
out DOHaD-related factors.
RESULTS: The prevalence of any allergic disease did not differ signifi-
cantly between those born late preterm and term. On the other hand, the
prevalence of those with any allergic diseases was significantly lower
among LFD children than among non-LFD children (p50.03).
Specifically, the prevalence of FA was significantly lower in LFD children
than in non-LFD children (1.9% vs. 3.9%, p50.004). Although not statis-
tically significant, the prevalence of other allergic diseases was also lower
in LFD children.
CONCLUSIONS: The present data suggest that the change in fetal pro-
gramming due to IUGR might suppress allergic diseases, especially food
allergy, in schoolchildren. Possible mechanisms are discussed.
720 Goat and Sheep's Milk Allergy With Cow's Milk Tolerance. A
MONDAY
Case Report
M. Cabanillas Platero1, M. Pi~nero Saavedra2; 1Department of Pediatric
AllergyVirgen del Rocio Hospital, Sevilla, SPAIN, 2Department of Al-
lergy, Virgen del Rocio Hospital, Sevilla, SPAIN.
RATIONALE: Cow’s milk allergy (CMA) is one of the most important
food allergy in infants. The existence of a high degree of cross-reactivity
between milk caseins from different animals has been reported. Allergy
to goat and sheep’s milk (GSM) without CMA is rare. Here we present a
10 year-old boy with several anaphylaxis episodes after eating goat and
sheep’s cheeses with good tolerance to cow’s milk.
METHODS: Skin prick tests (SPT) were carried out using whey fractions
of cow’s milk (casein, alfa-lactoglobuline and beta-lactoglobuline),whole
cow’s milk and GSM allergenic extracts. Total serum IgE and specific
IgE to cow’s milk proteins (casein, alfa-lactoglobuline and beta-lactoglo-
buline), whole cow and goat’s milk extracts were determined (IgE to
sheep’s milk not available).
RESULTS: SPT were positive to GSM allergenic extracts and were nega-
tive to cow’s milk proteins and whole cow’s milk extract. Total serum IgE:
84’5 KU/L. Every specific IgE were negative with the only exception of
IgE to goat’s milk allergenic extract (34’7 KU/L.)
CONCLUSIONS: We report a patient with allergy to goat and sheep’s
milk proteins whithout any previous or current history of CMA.
J ALLERGY CLIN IMMUNOL
721 Systemic Mastocytosis Presenting as Prinzmetal (Variant)
Angina
B. R. Ward, L. B. Schwartz; Virginia Commonwealth University Health
System, Richmond, VA.
RATIONALE: Systemic mastocytosis is a rare condition characterized by
increased mast cell burden in the bone marrow and other tissues, with
symptoms that result in part from secretion of mast cell mediators. Signs
and symptoms frequently include hypotensive spells, flushing, gastrointes-
tinal complaints, and bone remodeling. Here we report a patient presenting
with recurrent episodes of syncope and Prinzmetal (variant) angina as a
manifestation of systemic mastocytosis.
METHODS: Evaluation of syncope and angina prior to referral to an im-
munologist included electrocardiography (ECG), coronary angiography,
electroencephalogram, tilt-table testing, and blood/urine catecholamine
testing. Evaluation for systemic mastocytosis included bone marrow bi-
opsy and serum total tryptase measurements.
RESULTS: A 45 year-old male presented with a history of flushing and sub-
sternal chest pain preceding episodes of syncope and was initially referred for
cardiologic and neurologic evaluations. During one such episode, ECG trac-
ings showed marked ST-segment elevations, prompting additional cardiac
work-up. No evidence of coronary artery disease was discovered, and he
was diagnosed with Prinzmetal angina. Resistance to standard treatment
and increasingly frequent syncopal episodes prompted further assessment,
including bone marrow biopsy and measurement of baseline serum tryptase
level (57 ng/ml). The diagnosis of systemic mastocytosis was made, and
treatment with antihistamines and a leukotriene inhibitor was initiated,
with gradual improvement and control of his symptoms.
CONCLUSIONS: Mast cell mediators have been implicated in coronary va-
sospasm and may have been involved in this case. Though cardiac manifesta-
tions of systemic mastocytosis are rare, this case teaches us that mastocytosis
should be considered in patients with recurrent episodes of cardiac instability.
722 Skin Test Predictive Value On The Proton Pump Inhibitors
Allergy
P. Bonadonna1, M. Pagani2, A. Bircher3, K. Scherer3, B. Caruso4, C. Cocco5,
M. Schiappoli1, G. Senna1, C. Lombardo1; 1Allergy Unit Verona General
Hospital, Verona, ITALY, 2Allergy and Oncology Department, Mantova,
ITALY, 3Allergy Unit, Department of Dermatology University Hospital
Basel, Basel, SWITZERLAND, 4Laboratory of Clinical Chemistry and Hae-
matology Verona General Hospital, Verona, ITALY, 5Laboratory of Clinical
Chemistry and Haematology Verona General Hospital, Verona, ITALY.
RATIONALE: The incidence of the skin rashes induced by PPI is less then
0.5%.The aim of our prospective study was to verify sensitivity (Se) and
specificity (Sp) of skin prick test (PT) and intradermal test (ID) in the di-
agnosis of PPI allergy
METHODS: Our study was performed in 44 patients (37 female/7 male),
with history of adverse reactions to PPI; mean age: 60 years.
PT with omeprazole, esomeprazole, pantoprazole and rabeprazole (40 mg/
ml) and lansoprazole (30 mg/ml), and ID (0.04-0.4 mg/ml) for esomepra-
zole, omeprazole and pantoprazole were performed in all patients.
Thirty-five patients underwent to single-blind placebo-controlled chal-
lenge test (CT) with the culprit PPI.
RESULTS: 29.5% of patients reacted to esomeprazole, 16% to omeprazole,
22.7% to pantoprazole, 27.3% to lansoprazole and 4.5% to rabeprazole.
The symptoms reported were urticaria (50%), angioedema (13.6%), erythema
(11.3%), dyspnea (6.9%) hypotension (6.9%) and anaphylaxis (11.3%).
PT were positive in 3 patients and ID were positive in 5 patients for the
culprit drug. CT were positive in 6 cases (3 to esomeprazole, 2 to
lansoprazole and 1 to rabeprazole) but only in 3 cases PT and/or ID were
positive.We found a low Se (50%) but an high Sp (96.5%). The positive
predictive value (PPV) and the negative predictive value (NPV) were
respectively 75% and 90.3%.
CONCLUSIONS: Our results suggest a low predictive capacity of a pos-
itive skin test, that confirm the need to perform CT. Furthermore we didn’t
find cross-reactivity within PPI, in fact the 4 allergic patient tolerated
others PPI