Showing papers by "Stacie M. Jones published in 2012"

Oral immunotherapy for treatment of egg allergy in children.

Abstract: BACKGROUND For egg allergy, dietary avoidance is the only currently approved treatment. We evaluated oral immunotherapy using egg-white powder for the treatment of children with egg allergy. METHODS In this double-blind, randomized, placebo-controlled study, 55 children, 5 to 11 years of age, with egg allergy received oral immunotherapy (40 children) or placebo (15). Initial dose-escalation, build-up, and maintenance phases were followed by an oral food challenge with egg-white powder at 10 months and at 22 months. Children who successfully passed the challenge at 22 months discontinued oral immunotherapy and avoided all egg consumption for 4 to 6 weeks. At 24 months, these children underwent an oral food challenge with egg-white powder and a cooked egg to test for sustained unresponsiveness. Children who passed this challenge at 24 months were placed on a diet with ad libitum egg consumption and were evaluated for continuation of sustained unresponsiveness at 30 months and 36 months. RESULTS After 10 months of therapy, none of the children who received placebo and 55% of those who received oral immunotherapy passed the oral food challenge and were considered to be desensitized; after 22 months, 75% of children in the oral-immunotherapy group were desensitized. In the oral-immunotherapy group, 28% (11 of 40 children) passed the oral food challenge at 24 months and were considered to have sustained unresponsiveness. At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg. Of the immune markers measured, small wheal diameters on skin-prick testing and increases in eggspecific IgG4 antibody levels were associated with passing the oral food challenge at 24 months. CONCLUSIONS These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00461097.)

ICON: Food allergy

Abstract: Food allergies can result in life-threatening reactions and diminish quality of life. In the last several decades, the prevalence of food allergies has increased in several regions throughout the world. Although more than 170 foods have been identified as being potentially allergenic, a minority of these foods cause the majority of reactions, and common food allergens vary between geographic regions. Treatment of food allergy involves strict avoidance of the trigger food. Medications manage symptoms of disease, but currently, there is no cure for food allergy. In light of the increasing burden of allergic diseases, the American Academy of Allergy, Asthma & Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and American College of Allergy, Asthma & Immunology have come together to increase the communication of information about allergies and asthma at a global level. Within the framework of this collaboration, termed the International Collaboration in Asthma, Allergy and Immunology, a series of consensus documents called International Consensus ON (ICON) are being developed to serve as an important resource and support physicians in managing different allergic diseases. An author group was formed to describe the natural history, prevalence, diagnosis, and treatment of food allergies in the context of the global community.

Sublingual immunotherapy for peanut allergy: A randomized, double-blind, placebo-controlled multicenter trial

Abstract: Background There are presently no available therapeutic options for patients with peanut allergy. Objective We sought to investigate the safety, efficacy, and immunologic effects of peanut sublingual immunotherapy (SLIT). Methods After a baseline oral food challenge (OFC) of up to 2 g of peanut powder (approximately 50% protein; median successfully consumed dose [SCD], 46 mg), 40 subjects, aged 12 to 37 years (median, 15 years), were randomized 1:1 across 5 sites to daily peanut or placebo SLIT. A 5-g OFC was performed after 44 weeks, followed by unblinding; placebo-treated subjects then crossed over to higher dose peanut SLIT, followed by a subsequent crossover Week 44 5-g OFC. Week 44 OFCs from both groups were compared with baseline OFCs; subjects successfully consuming 5 g or at least 10-fold more peanut powder than the baseline OFC threshold were considered responders. Results After 44 weeks of SLIT, 14 (70%) of 20 subjects receiving peanut SLIT were responders compared with 3 (15%) of 20 subjects receiving placebo ( P P = .05). The median SCD at the Week 44 Crossover OFC was significantly higher than baseline (603 vs 71 mg, P = .02). Seven (44%) of 16 crossover subjects were responders; median SCD increased from 21 to 496 mg among responders. Of 10,855 peanut doses through the Week 44 OFCs, 63.1% were symptom free; excluding oral-pharyngeal symptoms, 95.2% were symptom free. Conclusions Peanut SLIT safely induced a modest level of desensitization in a majority of subjects compared with placebo. Longer duration of therapy showed statistically significant increases in the SCD.

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Abstract: OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. METHODS: We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions. RESULTS: Over a median follow-up of 36 months (range: 0–48.4), the annualized reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions [95% confidence interval: 0.76–0.85]). Overall, 269/512 (52.5%) reported >1 reaction. The majority of reactions (71.2%) were triggered by milk (495 [42.3%]), egg (246 [21.0%]), and peanut (93 [7.9%]), with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies ( P P n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration. CONCLUSIONS: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers.

Evidence of pathway‐specific basophil anergy induced by peanut oral immunotherapy in peanut‐allergic children

Abstract: Background In Westernized countries, over 1% of the population is allergic to peanuts or tree nuts, which carries a risk of severe allergic reactions. Several studies support the efficacy of peanut oral immunotherapy (OIT) for reducing the clinical sensitivity of affected individuals; however, the mechanisms of this effect are still being characterized. One mechanism that may contribute is the suppression of effector cells, such as basophils. Basophil anergy has been characterized in vitro as a pathway-specific hyporesponsiveness; however, this has not been demonstrated to occur in vivo.

Adherence to Inhaled Corticosteroids: An Ancillary Study of the Childhood Asthma Management Program Clinical Trial

Abstract: JA Krishnan, BG Bender, FS Wamboldt. J Allergy Clin Immunol. 2012;129(1):112–118 To compare subjective and objective measurements of adherence to inhaled corticosteroids versus placebo and to determine if adherence to study medications modified treatment-related outcomes. One hundred forty children aged 5 to 12 years who were diagnosed with mild or moderate asthma were enrolled from 3 of 8 sites from the Childhood Asthma Management Program (CAMP) study. This was a prospective study over a 4-year study period. …

Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment

Abstract: Background Asthma disproportionately affects children living in impoverished communities; however, factors related to asthma morbidity among impoverished rural children have not been adequately described. Objective To examine factors associated with asthma morbidity among rural children living in the Arkansas Delta region. Methods We performed a cross-sectional investigation of 109 rural children with asthma enrolled in public schools in the Arkansas Delta region. A questionnaire format and home inspection were used to examine participant, caregiver, and home characteristics. Results The median age of the study participants was 9 years, 83% were African American, and 71% had an annual household income of $20,000 or less. Ninety-eight percent of participants were insured, and most fit the criteria for uncontrolled asthma, yet only 23% reported taking inhaled corticosteroids. Transportation problems were cited by 20%. In the past 4 weeks, more than 50% reported rescue medication use or exercise limitations of 2 or more days per week or nocturnal symptoms of more than 2 nights per month. Emergency department visits in the past 6 months were reported by 28%, and 43% reported an unscheduled physician's visits for asthma in the past 3 months. Sixty-four percent had 1 or more positive allergen skin test results, and allergic sensitization was associated with exposure to dust mite, dog, mouse, and cockroach allergens in the home. Conclusion Asthma morbidity was high among this cohort of atopic asthmatic children in the Arkansas Delta. Overuse of rescue medications and underuse of inhaled corticosteroids were prevalent even though the population was highly insured and had frequent health care use. Future asthma health initiatives should focus on the unique challenges associated with translating national guidelines–based care to rural pediatric populations. Trial Registration clinicaltrials.gov Identifier: NCT00590304

Natural Course and Comorbidities of Allergic and Nonallergic Rhinitis in Children

Abstract: M Westman, P Stjarne, A Asarnoj. J Allergy Clin Immunol. 2012;129(1):403–408 To evaluate phenotypic variation of rhinitis in relation to natural course and comorbid allergic diseases in preschool and early school age children. Subgroup of a Swedish population-based birth cohort ( N = 4089) born from 1994 through 1996 in Stockholm, Sweden; 2024 children were included based on available questionnaire data and blood analysis at 0, 4, and 8 years of age. This is a prospective, population-based study that analyzed data collected longitudinally from a birth to age 8 years. Baseline data were collected at enrollment with further assessment via questionnaires mailed to subjects at …

Tree nut- and sesame-specific IgE do not decrease from baseline with peanut oral immunotherapy (OIT).

Abstract: Figure 1. Peanut-specific IgE decreased significantly between all measured time points (0e12 months, P 1⁄4 .019; 0e24 months, P 1⁄4 .0005, 12e24 months, P 1⁄4 .0005, denoted by *). Serum levels of sesameand almond-specific IgE are significantly increased during the first 12 months of peanut OIT (P1⁄4 .03 and P1⁄4 .01, respectively) and almond-specific IgE decreases significantly between 12 and 24months (P1⁄4 .03). Significant changes in cashewand walnut-specific IgE were not measured at any time point. Median values are represented by black horizontal lineswithin the scatter plot. peanut-specific immunoglobulin E (IgE) in peanut-allergic subjects, and most peanut-allergic individuals completing therapy safely ingest approximately 20 peanuts.1,2 Approximately one third of peanut-allergic individuals are allergic to tree nuts,3 and the effect of peanut OIT on other allergen-specific IgE is unknown. Because cross-reactivity exists between seed storage proteins in peanut and allergens present in almond4 and sesame,5 we hypothesized that peanut OIT would induce a significant decrease in almondand sesame-specific IgE but would not affect cashewand walnutspecific IgE. Serum samples from our original peanut OIT cohort1 were retrospectively analyzed for almond-, sesame-, cashew-, and walnut-specific IgE. Sixteen subjects (ages 26 to 112 months at enrollment, mean age 67 months 24.7 months, 10 male, all white) with convincing clinical history of peanut allergy1 were included in the analysis based on specific IgE greater than 0.01 kU/ L to almond, sesame, cashew, and walnut at the beginning of treatment. Serum was collected at 0, 12, and 24 months on OIT. Skin testing and oral food challenges to tree nuts and sesame were not performed, and only one subject had a history of reacting after tree nut ingestion. Data regarding tree nut and sesame consumption throughout the study were not recorded. Specific IgE was quantified using ImmunoCAP 100 (Phadia AB, Uppsala, Sweden) according to the manufacturer’s instructions. Analysis was performed using the 2-tailed Wilcoxon signed rank test to compare IgE values at 0 and 12 months, 0 and 24 months, and 12 and 24 months. Peanut-specific IgE significantly decreased between all time points (Fig 1), and all subjects were desensitized to peanut. Sesameand almond-specific IgE increased significantly between 0 and 12 months, and almond-specific IgE decreased significantly between 12 and 24 months (Fig 1). There were no significant changes between the other measured time points. Significant changes in cashewand walnut-specific IgE were not detected (Fig 1). Our data show that, in contrast to its effect on peanut IgE, peanut OIT does not significantly decrease IgE to almond, cashew, sesame, or walnut compared with baseline values, despite the known crossreactivity between peanut and sesame and peanut and almond. The clinical significance and changes observed between 0 and 12 or 12 and 24 months on treatment is uncertain. The small sample size,

Addressing Antimicrobial Resistance to Treat Children With Atopic Dermatitis in a Tertiary Pediatric Allergy Clinic

Abstract: Background. Secondary skin infection with Staphylococcus aureus is a significant problem in atopic dermatitis (AD) patients. Objective. This study evaluated antimicrobial resistance patterns of S aureus isolates from skin lesions in AD patients and empiric antimicrobial prescribing patterns. Methods. Resistance patterns from positive skin cultures obtained from AD patients in the Allergy/Immunology clinic from May 1, 2006, to December 31, 2008, were compared with all outpatient wound cultures over the same period. Results. Fifty-nine cultures were obtained from 38 AD patients. S aureus was the most common pathogen cultured from AD patients (53/59 cultures). S aureus resistance to clindamycin and methicillin differed significantly between the study group and the outpatient reference population (37.7% vs 9.4% and 45.3% vs 76.4%). Clindamycin was the most commonly prescribed antimicrobial (59%). Overall, 31.4% of organisms showed resistance to the antimicrobial prescribed. Conclusions. Susceptibility profile...

We are grateful to Rong Huang, MS, Children's Medical Center,

Abstract: cians must be mindful of the implications of each treatment for the multi-food-allergic person. The data from this report do not support the notion that cross-reactive allergens may be treated with peanut OIT. Regardless of the modality of therapy used, if the therapy is only allergen-specific, the benefit of protection against 1 allergen while remaining allergic to other allergens must be considered. Tree nuteallergic individuals receiving peanut OIT should continue strict avoidance of tree nuts and should carry selfinjectable epinephrine in case of accidental ingestion.