749 The Impact of Cleaning Practices on Antigen Levels andSpirometry in an Asthmatic Population

C. S. Barnes, F. Pacheco, L. Gard, E. Forrest, L. Johnson, J. Portnoy;

Childrens Mercy Hospital, Kansas City, MO.

RATIONALE: Specific household cleaning practices have potential to re-

duce allergen asthma triggers. To test the impact of cleaning practices and

products on dust allergen levels and spyrometry in an asthmatic population

we conducted the following studies.

METHODS: Families with at least one asthmatic adult and one asthmatic

child were recruited from the Kansas City area. Families were supplied

with an off the shelf cleaning product containing mild hypochlorite.

Families used the product 2 - 3 times a week spraying all surfaces in the

home lightly. The home was visited four times at two week intervals to

collect house dust from four areas. Dust samples were analyzed for Alt

a1, Fel d1, Can f1, Der p1 and whole Aspergillus and Alternaria antigens.

RESULTS: There were 30 homes enrolled and 25 completed the four

visits. There was no significant difference in spyrometry values taken im-

mediately before spraying the product and those taken immediately after

spraying the product. Spyrometry results over the six weeks of the study

showed steady improvement. Household surface bacteria counts showed

a 2 to 10 fold reduction. The sum of measured allergenic material at

each visit decreased a mean of 10% throughout the study. Mean reduction

in allergenic material measured before and after allergen reduction treat-

ment was 21%.

CONCLUSIONS: Specific products designed to reduce allergen levels ap-

plied over an extended period of time resulted in a reduction of allergen

content in house dust. Such allergen treatment measures have the potential

to improve spyrometry values.

Funding: Clorox Corporation

750 Sensitization to Cor a 8, a Lipid Transfer Protein, in Childrenwith Objective Reactions to Hazelnut from a Birch EndemicCountry

A. E. Flinterman1, J. H. Akkerdaas2,1, C. F. den Hartog Jager1, M. O.

Hoekstra1, A. C. Knulst1, R. van Ree2, S. G. M. A. Pasmans1; 1University

Medical Center, Utrecht, THE NETHERLANDS, 2Academic Medical

Center, Amsterdam, THE NETHERLANDS.

RATIONALE: Although hazelnut allergy is usually related to birch pollen

allergy and limited to mild oral allergy, in particular children also report

more serious reactions. In areas without birches, sensitization to lipid trans-

fer protein (LTP) in hazelnut, Cor a 8, has been observed in subjects with

severe reactions. Children from a birch-endemic area might develop sensi-

tization to LTP at a young age independent from birch pollen.

METHODS: Specific IgE to purified Cor a 1, Cor a 8, and Bet v 1 was

determined in sera of 217 Dutch children aged 0-17 years. Twenty-six

of these children also underwent a DBPCFC.

RESULTS: In 217 hazelnut-sensitized children, sensitization to Cor a

1 was observed in 62.7%, to Cor a 8 in 31.3%, and to Bet v 1 in 55.0%.

Sensitization to Cor a 8 was predominantly present at early ages, whereas

sensitization to Cor a 1 and Bet v 1 was correlated with increasing age

(r50.630 and r50.503, respectively).Children with objective reactions

during DBPCFC (n58) were all sensitized to Cor a 8 (0.51 - 23.3 kU/l),

compared to only one child (1/18) without objective reactions (0.90 kU/l).

Levels of IgE to Cor a 8 and Cor a 1, but not to Bet v 1, were significantly

higher in the group with objective reactions.

CONCLUSIONS: This is the first report of a substantial presence of LTP

sensitization in children from a birch-endemic area, associated with serious

reactions to hazelnut. The route of sensitization to LTP remains to be elu-

cidated, but seems independent from birch pollen.

Funding: University Medical Center Utrecht

751 Omega-5-Gliadin Specific IgE as a Predictor of Wheat Allergyin Children

K. Ito1, Y. Takaoka1, M. Futamura1, T. Sakamoto2, K. Kohno3, E. Morita3,

H. Matsuo4, A. Tanaka5; 1Aichi Children’s Health and Medical Center,

Obu, JAPAN, 2Department of Pediatrics, Nagoya University Graduate

School of Medicine, Nagoya, JAPAN, 3Department of Dermatology, Shi-

mane University School of Medicine, Shimane, JAPAN, 4Graduate School

of Biomedical Sciences, Hiroshima University, Hiroshima, JAPAN,5Phadia KK., Tokyo, JAPAN.

RATIONALE: Wheat is the third-most common food allergen in Japanese

children, but detection of wheat-specific IgE antibody is insufficient to di-

agnose wheat allergy because of low clinical specificity. Omega-5-gliadin

is known to represent a major allergen in wheat-dependent exercise-

induced anaphylaxis, but levels in immediate-type wheat allergy in chil-

dren remain unclear.

METHODS: IgE antibody to omega-5-gliadin was detected by

ImmunmoCAP in sera from patients with wheat allergy (n544; mean

age, 3.4 years) diagnosed according to positive wheat challenge or apparent

clinical history. Control patients (n544; mean age, 4.9 years) with positive

IgE for wheat (>53.5 UA/ml) but without clinical symptoms after inges-

tion of wheat products were also recruited.

RESULTS: Levels of wheat-specific IgE (mean 6SD) were 44.52 636.37

UA/ml in patients and 12.57 611.81 UA/ml in controls. Omega-5-gliadin-

specific IgE was positive (>0.34 UA/ml) in 37 patients with wheat allergy

(84.1%) and 12 controls(27.3%). Mean IgE titer in positive sera was 7.25

UA/ml in patients (range, 0.40-81.0 UA/ml) and 1.08 UA/ml in controls

(0.35-4.80 UA/ml). Although only 1 control patient showed a level of

4.80 UA/ml (all others were <1.30 UA/ml), 100% positive predictive value

was obtained using a cutoff of >5.0 UA/ml. Patients with high IgE titer to

omega-5-gliadin tended to display severe reactions including respiratory

symptoms or anaphylaxis.

CONCLUSIONS: Detection of omega-5-gliadin-specific IgE is useful for

the diagnosis of immediate-type wheat allergy in children comparing to

that of wheat.

Funding: Phadia KK.

752 Impact of an Inpatient Program to Improve Safety of FoodAllergic Patients During Hospitalization

A. R. Auerbach1, M. E. Bollinger1, E. Loreck2, M. Simke2, C. Vibbert1,

J. Gladstein1, A. Kewalramani1; 1Univ. of Maryland School of Medicine,

Baltimore, MD, 2Univ. of Maryland Medical System, Baltimore, MD.

RATIONALE: To evaluate the prevalence of food allergy in hospitalized

patients in an urban hospital and determine the impact of an allergy alert

system and computerized ordering protocol to accommodate hospitalized

food allergy patients.

METHODS: FY06 data were provided by the University of Maryland

Medical System (UMMS) for all ICD9 codes related to food allergy and

anaphylaxis. Charts were reviewed for patients with reported anaphylaxis

during hospitalization. Additional data without patient identifiers was pro-

vided by Risk Management for incident reports related to food prior to and

after the implementation of an updated food allergy management program.

RESULTS: During FY06, 1.2% (n5440) of the 34,448 hospitalizations

had documented food allergy (7% milk, 8% peanut, 10% egg, 53% seafood

and 26% other). Co-morbid conditions documented in this population in-

cluded stinging insect allergy (0.7%), latex allergy (5%), radiocontrast sen-

sitivity (9%), cardiac disease (11%) and asthma (32%). In the 8 months

prior to implementation of the food allergy program, there were 6 food al-

lergy related incidents reported to risk management and only 1 report in the

6 months following. Implicated foods included fruit (3 cases), seafood (2),

egg (1) and milk (1). One exposure resulted in injury (angioedema in

patient with citrus allergy).

CONCLUSION: Given the high prevalence of food allergy and potential

risk of reactions, it is important for hospitals to review their accommoda-

tion practices for food allergy patients. To date, the UMMS program for ac-

commodating food allergy patients has led to a decrease in the incidence of

food reactions in hospitalized patients.

J ALLERGY CLIN IMMUNOL

VOLUME 119, NUMBER 1

Abstracts S191

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