Volume 6 Supplement 1

4th Pediatric Allergy and Asthma Meeting (PAAM)

Open Access

4th Pediatric Allergy and Asthma Meeting (PAAM)

  • S. Tolga Yavuz1,
  • Ozan Koc2,
  • Ali Gungor2,
  • Faysal Gok2,
  • Jessica Hawley3,
  • Christopher O’Brien4,
  • Matthew Thomas4,
  • Malcolm Brodlie4,
  • Louise Michaelis4, 210,
  • Inês Mota5,
  • Ângela Gaspar5,
  • Susana Piedade5,
  • Graça Sampaio5,
  • José Geraldo Dias5,
  • Miguel Paiva5,
  • Mário Morais-Almeida5,
  • Cristina Madureira6, 251, 375,
  • Tânia Lopes6, 251, 375,
  • Susana Lopes6, 251, 375,
  • Filipa Almeida6, 251, 375,
  • Alexandra Sequeira6,
  • Fernanda Carvalho6, 251, 375,
  • José Oliveira6, 251,
  • Fabienne Gay-Crosier7,
  • Ioana-Valentina Nenciu8, 230, 231,
  • Andreia Florina Nita8, 230, 231,
  • Alexandru Ulmeanu8, 230,
  • Dumitru Oraseanu8, 230, 231,
  • Carmen Zapucioiu8, 230,
  • Adrianna Machinena9, 216,
  • Olga Domínguez Sánchez9, 67,
  • Montserrat Alvaro Lozano9, 67, 216,
  • Rosa Jiménez Feijoo9, 67,
  • Jaime Lozano Blasco9, 67,
  • Mònica Piquer Gibert9, 67,
  • Mª Teresa Giner Muñoz9, 67,
  • Marcia Dias da Costa9, 67,
  • Ana Maria Plaza Martín9, 67,
  • Ebru Arik Yilmaz10,
  • Özlem Cavkaytar10,
  • Betul Buyuktiryaki10, 250,
  • Ozge Soyer10,
  • Cansin Sackesen10,
  • Merryn Netting11,
  • Adaweyah El-Merhibi11,
  • Michael Gold12,
  • Patrick Quinn12,
  • Irmeli Penttila13,
  • Maria Makrides14,
  • Stavroula Giavi15,
  • Antonella Muraro16,
  • Roger Lauener17, 18,
  • Annick Mercenier19,
  • Eugen Bersuch17, 18,
  • Isabella M. Montagner20,
  • Maria Passioti15,
  • Nicolò Celegato16,
  • Selina Summermatter17, 18,
  • Sophie Nutten19,
  • Tristan Bourdeau19,
  • Yvonne M. Vissers19,
  • Nikolaos G. Papadopoulos15, 21, 64, 393,
  • Hanneke van der Kleij22,
  • Hans Warmenhoven22,
  • Ronald van Ree23,
  • Raymond Pieters24,
  • Dirk Jan Opstelten22,
  • Hans van Schijndel22,
  • Joost Smit22,
  • Roisin Fitzsimons25, 333, 419,
  • Victoria Timms25, 333,
  • George Du Toit25, 157, 371,
  • Guven Kaya2,
  • Mustafa Gulec26,
  • Mehmet Saldir2,
  • Osman Sener26,
  • Nagwa Hassan27,
  • Hala Shaaban28,
  • Hazem El-Hariri27,
  • Ahmed Kamel Inas E. Mahfouz27,
  • Papp Gabor29,
  • Biro Gabor29,
  • Kovacs Csaba29,
  • Bo Chawes30, 33,
  • Klaus Bønnelykke30,
  • Jakob Stokholm30,
  • Lene Heickendorff31,
  • Susanne Brix32,
  • Morten Rasmussen30,
  • Hans Bisgaard30, 33,
  • Henrik Wegener Hallas33,
  • Lambang Arianto33,
  • Maike Pincus34,
  • Thomas Keil35, 41, 44, 105, 106, 113, 144,
  • Andreas Reich35, 44,
  • Ulrich Wahn34, 44, 163, 164,
  • Susanne Lau34, 44, 113, 350,
  • Linus Grabenhenrich35, 44,
  • Sara Fagerstedt36,
  • Helena Marell Hesla36,
  • Emelie Johansson36,
  • Helen Rosenlund36,
  • Axel Mie36,
  • Annika Scheynius36,
  • Johan Alm36,
  • Jorge Esparza-Gordillo37, 38, 112, 113,
  • Anja Matanovic37, 38, 112, 113,
  • Ingo Marenholz37, 38, 112, 113,
  • Anja Bauerfeind37, 112,
  • Klaus Rohde37,
  • Katja Nemat39,
  • Min-Ae Lee-Kirsch39,
  • Magnus Nordenskjöld40,
  • Marten C.G. Winge40,
  • Renate Krüger34,
  • Kirsten Beyer34, 44,
  • Birgit Kalb34,
  • Bodo Niggemann34,
  • Norbert Hübner37, 112,
  • Heather J. Cordell42,
  • Maria Bradley40, 43,
  • Young-Ae Lee37, 38, 44,
  • Hannah Gough44,
  • Dirk Schramm44,
  • John Beschorner44,
  • Antje Schuster44, 104, 110,
  • Carl-Peter Bauer44, 101,
  • Johannes Forster44, 102,
  • Fred Zepp44, 103, 109,
  • Renate Bergmann44,
  • Karl Bergmann44,
  • Filipe Benito Garcia5,
  • Natacha Santos5,
  • Helena Pité5,
  • Athina Papadopoulou45, 46, 193,
  • Despina Mermiri46,
  • Elpida Xatziagorou47,
  • Ioannis Tsanakas47,
  • Stavroula Lampidi45, 193,
  • Kostas Priftis48,
  • Elaine Fuertes49,
  • Iana Markevych49, 50,
  • Gayan Bowatte51,
  • Olena Gruzieva52,
  • Ulrike Gehring53,
  • Allan Becker54,
  • Dietrich Berdel55,
  • Michael Brauer56, 57,
  • Chris Carlsten56, 57,
  • Barbara Hoffmann58, 59,
  • Anita Kozyrskyj60, 61,
  • Caroline Lodge51,
  • Göran Pershagen36, 52,
  • Alet Wijga62,
  • Heinrich Joachim49,
  • Zorica Zivkovic63, 268, 320,
  • Ivana Djuric-Filipovic63, 268,
  • Jasmina Jocić-Stevanovic63,
  • Snežana Zivanovic63, 268,
  • Styliani Taka64,
  • Dimitra Kokkinou64,
  • Aliki Papakonstantinou64,
  • Panagiota Stefanopoulou64,
  • Anastasia Georgountzou64,
  • Paraskevi Maggina64,
  • Sofia Stamataki64,
  • Vassiliki Papaevanggelou65,
  • Evangelos Andreakos66,
  • Monica Piquer Gibert67,
  • Adriana Machinena Spera67,
  • Matea Deliu68,
  • Danielle Belgrave68,
  • Angela Simpson68,
  • Adnan Custovic68,
  • João Gaspar Marques69,
  • Pedro Carreiro-Martins69,
  • Joana Belo69,
  • Sara Serranho69,
  • Isabel Peralta69,
  • Nuno Neuparth69,
  • Paula Leiria-Pinto69,
  • Marta Vazquez-Ortiz70,
  • Mariona Pascal71,
  • Ana Maria Plaza70,
  • Manel Juan71,
  • Lorella Paparo72,
  • Rita Nocerino72,
  • Rosita Aitoro72,
  • Ilaria Langella72,
  • Antonio Amoroso72,
  • Alessia Amoroso72,
  • Carmen Di Scala72,
  • Roberto Berni Canani72, 73,
  • Santanu Maity74, 253,
  • Giuseppina Rotiroti74,
  • Minal Gandhi74, 284,
  • Karin Jonsson75,
  • Annika Ljung76,
  • Bill Hesselmar76,
  • Ingegerd Adlerbert76,
  • Hilde Brekke77,
  • Susanne Johansen78,
  • Agnes Wold76, 100,
  • Ann-Sofie Sandberg75,
  • Björn Nordlund36,
  • Cecilia Lundholm36,
  • Villhelmina Ullemar36,
  • Marianne van Hage36,
  • Anne Örtqvist36,
  • Catarina Almqvist36,
  • Anna Selby79,
  • Kate Grimshaw79,
  • Michael Clausen80,
  • Ruta Dubakiene81,
  • Alessandro Fiocchi82,
  • Marek Kowalski83,
  • Nikos Papadopoulos84,
  • Marta Reche85,
  • Sigurveig Sigurdardottir80,
  • Aline Sprikkleman86,
  • Paraskevi Xepapadaki84, 396,
  • Clare Mills68,
  • Graham Roberts79, 95,
  • Herberto Jose Chong Neto87,
  • Gustavo Falbo Wandalsen88,
  • Ana Carolina Dela Bianca89,
  • Carolina Aranda88,
  • Nelson Augusto Rosário87,
  • Dirceu Solé88,
  • Javier Mallol90,
  • Luis García Marcos91,
  • Ivana Banic92,
  • Matija Rijavec93,
  • Davor Plavec92,
  • Peter Korosec93,
  • Mirjana Turkalj92,
  • Alen Bozicevic94,
  • Maria De Mieri94,
  • Matthias Hamburger94,
  • Simone Holley79,
  • Ruth Morris95,
  • Frances Mitchell96,
  • Rebecca Knibb97,
  • Susan Latter79,
  • Christina Liossi79,
  • Mostafa M. M. Hassan98,
  • Malin Barman75,
  • Anna Sandin99,
  • Daniela Posa34,
  • Serena Perna34,
  • Ute Hoffmann101,
  • Kuan-Wei Chen107,
  • Yvonne Resch107,
  • Susanne Vrtala107,
  • Rudolf Valenta107,
  • Paolo Maria Matricardi34, 386,
  • Olympia Tsilochristou34,
  • Alexander Rohrbach34,
  • Antonio Cappella108,
  • Stephanie Hofmaier34,
  • Laura Hatzler34,
  • Raffaele D’Amelio108,
  • Sophia Björkander111,
  • Maria A. Johansson111,
  • Gintare Lasaviciute111,
  • Eva Sverremark-Ekström111,
  • Franz Rüschendorf112,
  • David P. Strachan114,
  • Ben D. Spycher115,
  • Hansjörg Baurecht116,
  • Patricia Margaritte-Jeannin117, 118,
  • Annika Sääf36,
  • Marjan Kerkhof119,
  • Markus Ege120,
  • Svetlana Baltic121,
  • Melanie C. Matheson122,
  • Jin Li123,
  • Sven Michel124,
  • Wei Q. Ang121,
  • Wendy McArdle125,
  • Andreas Arnold148,
  • Georg Homuth126,
  • Florence Demenais117, 118,
  • Emmanuelle Bouzigon117, 118,
  • Cilla Söderhäll36,
  • Johan C. de Jongste127,
  • Dirkje S. Postma119,
  • Charlotte Braun-Fahrländer128,
  • Elisabeth Horak129,
  • Ludmila M. Ogorodova130,
  • Valery P. Puzyrev130, 131,
  • Elena Yu Bragina131,
  • Thomas J. Hudson132,
  • Charles Morin133,
  • David L. Duffy134,
  • Guy B. Marks135,
  • Colin F. Robertson136,
  • Grant W. Montgomery134,
  • Bill Musk137,
  • Philip J. Thompson117,
  • Nicholas G. Martin134,
  • Alan James137,
  • Patrick Sleiman123, 138,
  • Elina Toskala139,
  • Elke Rodriguez116,
  • Regina Fölster-Holst116,
  • Andre Franke140,
  • Wolfgang Lieb140,
  • Christian Gieger141,
  • Andrea Heinzmann142,
  • Ernst Rietschel143,
  • Sven Cichon94, 145, 146,
  • Markus M. Nöthen145,
  • Craig E. Pennell117,
  • Peter D. Sly147,
  • Carsten O. Schmidt148,
  • Valentin Schneider112,
  • Matthias Heinig112, 149,
  • Patrick G. Holt117, 147,
  • Michael Kabesch124,
  • Stefan Weidinger116,
  • Hakon Hakonarson123, 138,
  • Manuel AR Ferreira134,
  • Catherine Laprise150,
  • Maxim B Freidin131,
  • Jon Genuneit151,
  • Gerard H Koppelman119,
  • Erik Melén36, 152,
  • Marie-Hélène Dizier117, 118,
  • A. John Henderson112,
  • Young Ae Lee112, 113,
  • Purificacion González-Delgado153,
  • Esther Caparrós154,
  • Fernando Clemente155,
  • Begoña Cueva153,
  • Victoria M. Moreno154,
  • Jose Luis Carretero156,
  • Javier Fernández153,
  • Kate Swan157,
  • Mudiyur Gopi158,
  • Tim Smith158,
  • Edara Ramesh158,
  • Arun Sadasivam158,
  • Cristina Arêde5,
  • Luís Miguel Borrego5,
  • Graça Pires5,
  • Cristina Santa-Marta5,
  • Stephanie Brand159,
  • Karina Stein160,
  • Holger Heine160,
  • Marion Kauth159,
  • Leif Bjarte Rolfsjord161,
  • Egil Bakkeheim162,
  • Håvard Ove Skjerven163,
  • Kai-Håkon Carlsen162,
  • Jon Olav Hunderi162,
  • Teresa Løvold Berents162,
  • Petter Mowinckel162,
  • Karin C. Lødrup Carlsen162,
  • Ullrich Munzel165,
  • William Berger166,
  • Román Valiente167,
  • the Bilastine Pediatric Safety Study Group,
  • Valvanera Vozmediano169,
  • John C. Lukas168,
  • Mónica Rodríguez168,
  • Sebastiano Guarnaccia169,
  • Luigi Vitale169,
  • Ada Pluda169,
  • Emanuele D’Agata169,
  • Denise Colombo169,
  • Stefano Felici169,
  • Valeria Gretter169,
  • Susanna Facchetti169,
  • Gaia Pecorelli169,
  • Cristina Quecchia169,
  • George Guibas170, 171,
  • Evangelia Spandou172,
  • Spyridon Megremis170,
  • Peter West170,
  • Nikolaos Papadopoulos15, 170, 171,
  • João Cavaleiro Rufo173,
  • Joana Madureira173,
  • Inês Paciência173,
  • Lívia Aguiar174, 175,
  • Patrícia Padrão177,
  • Mariana Pinto176,
  • Luís Delgado176,
  • Pedro Moreira177,
  • João Paulo Teixeira174, 175,
  • Eduardo Oliveira Fernandes173,
  • André Moreira176, 177,
  • Adriana Izquierdo Dominguez178, 179,
  • Antonio Valero178,
  • Joaquim Mullol180,
  • Alfonso Del Cuvillo181,
  • Javier Montoro182,
  • Ignacio Jauregui183,
  • Joan Bartra178,
  • Ignacio Davila184,
  • Marta Ferrer185,
  • Joaquin Sastre186,
  • Catarina Martins187,
  • Jorge Lima188,
  • Maria José Leandro189,
  • Glória Nunes187,
  • Jorge Cunha Branco188,
  • Hélder Trindade190,
  • Luis Miguel Borrego187, 188,
  • Secil Conkar191,
  • Mehtap Kilic191,
  • Canan Aygun192,
  • Recep Sancak191,
  • Eleni Tagalaki46,
  • Lambros Banos46, 395,
  • Anna Vlachou46,
  • Fotini Giannoula46,
  • Marina Pavlakou193,
  • Maria Kryoni193,
  • Kostas Makris194,
  • Snezhina Lazova195, 390,
  • Guergana Petrova195, 390,
  • Dimitrinka Miteva195, 390,
  • Penka Perenovska195, 390,
  • Aliya Klyucharova196,
  • Olesya Skorohodkina196,
  • Dimitra Koumaki197,
  • Alkisti Manousaki197,
  • Maria Agrapidi197,
  • Lida Iatridou197,
  • Omima Eruk198,
  • Konstantinos Myridakis199,
  • Emmanouil Manousakis197,
  • Vasiliki Koumaki200,
  • Maria Dimou201,
  • Maria Ingemansson201,
  • Gunilla Hedlin201, 260,
  • Nitida Pastor202,
  • Delphine de Boissieu203,
  • Jon Vanderhoof204,
  • Nancy Moore202,
  • Kaitlin Maditz202,
  • Adeli Mehdi205,
  • Shaza Elhassan205,
  • Carolin Beck205,
  • Ahmed Al-Hammadi205,
  • Ioana Maris206,
  • Ronan O’Sullivan207,
  • Jonathan Hourihane208, 211,
  • George Raptis209,
  • Audrey DunnGalvin208,
  • Matthew Greenhawt213,
  • Carina Venter212,
  • Evelyn O’Regan208,
  • Duncan Cronin208,
  • Anna O’Reilly208,
  • Foued Abdelaziz213,
  • Dounia Khelifi-Touhami214,
  • Nihad Selim215,
  • Tahar Khelifi-Touhami213,
  • Pablo Merida216,
  • Ana Mª Plaza216,
  • Juan Heber Castellanos216,
  • Jaime Lozano216,
  • Olga Dominguez216,
  • Monica Piquer216,
  • Rosa Jimenez216,
  • Mª Teresa Giner216,
  • Konstantinos Kakleas217,
  • Manohar Joishy217,
  • Wendmu Maskele217,
  • Huw R. Jenkins217,
  • Mercedes Escarrer218,
  • Agustín Madroñero218,
  • Maria Teresa Guerra219,
  • Juan Carlos Julia220,
  • Juan Carlos Cerda220,
  • Javier Contreras221,
  • Eulalia Tauler222,
  • Maria Jesus Vidorreta220,
  • Ana Rojo223,
  • Silvia Del Valle222,
  • Niamh Flynn224,
  • Gary Foley225,
  • Carol Harmon225,
  • John Fitzsimons225,
  • Krasimira Baynova226,
  • Ávila Maria Del Robledo226,
  • Labella Marina226,
  • Aaron Cortes227,
  • Alicia Sciaraffia227,
  • Angela Castillo228,
  • Nanna Juel-Berg229,
  • Kirsten Skamstrup Hansen229,
  • Lars Kærgaard Poulsen229,
  • Adina Lazar230, 231,
  • Rita Aguiar232,
  • Anabela Lopes232,
  • Maria J. Paes232,
  • Amélia S. Santos232,
  • M. A. Pereira-Barbosa232,
  • Hatice Eke Gungor233,
  • Salih Uytun233,
  • Umit Murat Sahiner233,
  • Yasemin Altuner Torun233,
  • Mirjana Zivanovic234,
  • Marina Atanasković-Marković235,
  • Tina Vesel236, 414,
  • Mihaela Nahtigal237,
  • Andreja Obermayer-Temlin238,
  • Eva Šoster Križnik238,
  • Mirjana Maslar238,
  • Ruben Bizjak239,
  • Marjeta Tomšič-Matic240,
  • Sonja Posega-Devetak241,
  • Maja Skerbinjek-Kavalar242,
  • Mateja Predalič243,
  • Tadej Avčin236, 414,
  • Guillaume Pouessel244, 245, 246,
  • Etienne Beaudouin245, 247,
  • Anne M. Moneret-Vautrin245,
  • Antoine Deschildre249,
  • Allergy Vigilance Network2,
  • Marta Viñas249,
  • Bartolomé Borja249,
  • Nora Hernández248,
  • Mª José Castillo248,
  • Adriana Izquierdo248,
  • Marcel Ibero248,
  • Can Naci Kocabas250,
  • Camille Heming252,
  • Emily Garrett252,
  • Adam Blackstock252,
  • Rahul Chodhari253,
  • Simona Belohlavkova254,
  • Eliska Kopelentova255,
  • Petr Visek256,
  • Ivana Setinova257,
  • Ivana Svarcova254,
  • Sigrid Sjölander258,
  • Nora Nilsson259,
  • Malin Berthold260,
  • Helena Ekoff260,
  • Magnus Borres260,
  • Caroline Nilsson260, 373,
  • Loreto González Domínguez261,
  • Cristina Muñoz Archidona262,
  • Ana Moreira Jorge261,
  • Sergio Quevedo Teruel261,
  • Teresa Bracamonte Bermejo261,
  • Miriam Castillo Fernández263,
  • Fernando Pineda de la Losa263,
  • Luis Ángel Echeverría Zudaire263,
  • Olga Vrani264,
  • Antigone Mavroudi264,
  • Maria Fotoulaki265,
  • Maria Emporiadou265,
  • Kleomenis Spiroglou266,
  • Ioannis Xinias264,
  • Helyeh A. Sadreddini267,
  • Mia Warnes267,
  • Donna Traves267,
  • Gordana Kostić268,
  • Đorđe Filipovic268,
  • Sawapon Sittisomwong269,
  • Siripong Sittisomwong270,
  • Zygmunt Podolec271,
  • Marcin Hartel272,
  • Daria Panek271,
  • Magdalena Podolec-Rubiś271,
  • Tomasz Banasik272,
  • Elham Abbasi273,
  • Mozhgan Moghtaderi273,
  • Phani Sanneerappa274, 275,
  • Alina Deliu274,
  • Moosa Kutty274,
  • Nagabathula Ramesh275,
  • Roya Sherkat276,
  • Mohammad Reza Sabri277,
  • Bahar Dehghan277,
  • Hamid Bigdelian278,
  • Nahid Raeesi277,
  • Mino Afshar279,
  • Hamid Rahimi277,
  • Christoph Klein280,
  • Mohemid Al-Jebouri281,
  • Oxana A. Svitich282,
  • Daria O. Zubacheva282,
  • Dmitrii A. Potemkin282,
  • Ludmila V. Gankovskaya283,
  • Vitalii V. Zverev282,
  • Elaine OB Doyle275,
  • Paul Gallagher275,
  • Sherine Dewlett284,
  • Kin Man284,
  • James Pocock284,
  • Anna Gerrardhughes284,
  • Jolanta Wasilewska285,
  • Maciej Kaczmarski285,
  • Dariusz Lebensztejn285,
  • Chandramani Thuraisingham286,
  • Davendralingam Sinniah286,
  • Yue Chen287,
  • Xiaomei Mei287,
  • Sebnem Ozdogan288, 292,
  • Pinar Karadeniz288,
  • Durdugul Ayyildiz-Emecen288,
  • Ummuhan Oncul288,
  • Gizem Sari288,
  • Sabanur Cavdar288,
  • Niloufar Farzan289,
  • Susanne J. Vijverberg289,
  • Colin J. Palmer290,
  • Kelan G. Tantisira291,
  • Anke-Hilse Maitland-van der Zee289,
  • on behalf of the PiCA consortium,
  • Fatma Yavuzyilmaz292,
  • Nafiye Urganci292,
  • Merve Usta292,
  • Mehmet Hoxha293,
  • Maksim Basho293,
  • Gustavo F. Wandalsen88,
  • Fernanda Monteiro88,
  • Blerta Lame294,
  • Eris Mesonjesi294,
  • Arjeta Sherri294,
  • Alkerta Ibranji295,
  • Laert Gjati296,
  • Gjustina Loloci297,
  • Ardii Bardhi298,
  • Behnam Moghtaderi299,
  • Shirin Farjadian299,
  • Dorna Eghtedari299,
  • Manuela Olaya300,
  • Laura Del Mar Vasquez300,
  • Luis Fernando Ramirez300,
  • Carlos Daniel Serrano300,
  • Belgin Usta Guc301,
  • Suna Asilsoy301,
  • Fulya Ozer302, 303,
  • Sylvia Shopova195,
  • Vera Papochieva195,
  • Jessica Loekmanwidjaja88,
  • Márcia Mallozi88,
  • Paul Ratner304,
  • Daniel Soteres305,
  • Zoltán Novák306,
  • Anahí Yáñez307,
  • Kiss Ildikó308,
  • Piotr Kuna309,
  • Miguel Tortajada310,
  • Román Valiente311,
  • Julia Feuerhahn312,
  • Christine Blome312,
  • Meike Hadler313,
  • Efstrathios Karagiannis313, 316,
  • Anna Langenbruch312,
  • Matthias Augustin312,
  • Michel Roux314,
  • Shinji Kakudo315,
  • Robert K. Zeldin314,
  • Anna Sokolova317,
  • Tiago Milheiro Silva318,
  • Snezana S. Zivanovic319,
  • Vesna Cvetkovic319,
  • Ivana Nikolic319,
  • Sonja J. Zivanovic319,
  • Ljiljana Saranac319,
  • Zoia Nesterenko321,
  • Snezana Radic322,
  • Branislava Milenkovic323,
  • Spomenka Smiljanic322,
  • Milka Micic-Stanijevic322,
  • Olivera Calovic322,
  • Anne Marie Bro Hofbauer324,
  • Lone Agertoft324,
  • Lucy Everson325,
  • Jessica Kearney325,
  • Jonny Coppel325,
  • Simon Braithwaite325,
  • Elisabeth S. Christiansen326,
  • Henrik Fomsgaard Kjaer327,
  • Esben Eller326,
  • Charlotte G. Mørtz326,
  • Susanne Halken327,
  • Cristina Román India261,
  • Juana Jiménez Jiménez261,
  • Luis Echeverría Zudaire261,
  • Cathal O’Connor208,
  • Varvara Kanti328,
  • Lena Lünnemann328,
  • Günther Malise328,
  • Laine Ludriksone328,
  • Andrea Stroux328, 329,
  • Wolfgang Henrich330,
  • Michael Abu-Dakn331,
  • Ulrike Blume-Peytavi328,
  • Natalie Garcia Bartels328,
  • Marianne Schario328,
  • Thorsten Stanley332,
  • Nicolien Brandenbarg332,
  • Alia Boardman333,
  • Gary McGreevy333,
  • Emily Rodger333,
  • Katherine Knight333, 419,
  • Trisha Taylor333,
  • Gemma Scanlan333,
  • Grüber Christoph44,
  • Margriet van Stuivenberg334,
  • Fabio Mosca335,
  • Guido Moro336,
  • Gaetano Chirico337,
  • Christian P. Braegger338,
  • Joseph Riedler339,
  • Yalcin Yavuz340,
  • Günther Boehm341,
  • Stefania Arasi342,
  • Giuseppe Crisafulli342,
  • Lucia Caminiti342,
  • Federica Porcaro342,
  • Giovanni Battista Pajno342,
  • Akane Tanaka343,
  • Yaei Togawa344,
  • Kumiko Oida343,
  • Naotomo Kambe344,
  • Peter Arkwright68,
  • Yosuke Amagai343,
  • Naoki Shimojo344,
  • Yasunori Sato345,
  • Hiroyuki Mochizuki346,
  • Hyosun Jang343,
  • Saori Ishizaka343,
  • Hiroshi Matsuda343,
  • Wisnu Barlianto347,
  • Ery Olivianto347,
  • H. M. S. Chandra Kusuma347,
  • Mariapia Mollica348,
  • Giovanna Trinchese348,
  • Elena Alfano348,
  • Francesco Amato72,
  • Claudio Pirozzi349,
  • Antonio Calignano349,
  • Rosaria Meli349,
  • Siri Rossberg350,
  • Kerstin Gerhold350,
  • Kurt Zimmermann351,
  • Mohammad Zaino352,
  • Thomas Geske353,
  • Eckard Hamelmann354, 355,
  • Sarah Bogovic356,
  • Jochem van den Berg356,
  • Chantal Janssen356,
  • Angela Claver357,
  • Mª Flor Martin-Muñoz358,
  • C. Martorell359,
  • M. T. Belver358,
  • E. Alonso Lebrero360,
  • L. Zapatero360,
  • V. Fuentes360,
  • M. Piqué361,
  • A. Plaza361,
  • C. Muñoz362,
  • Cristina Blasco363, 421,
  • B. Villa363,
  • C. Gómez364,
  • S. Nevot364,
  • J. M. García365,
  • L. Echeverria366,
  • Brenda DeWitt367,
  • Judith Holloway79,
  • Donald Hodge367,
  • Sian Ludman368,
  • Merhdad Jafari-Mamaghani369,
  • Rosemary Ebling370,
  • Adam T. Fox371,
  • Gideon Lack371,
  • Sofia Lovén Björkman372,
  • Natalia Ballardini372,
  • Supriyo Basu373,
  • Jenny Hallet373,
  • Jyothi Srinivas373,
  • Hazel Stringer374,
  • Nicola Jay374,
  • Paula Fonseca375,
  • Clara Vieira375,
  • Carla Mastrorilli376,
  • Carlo Caffarelli376,
  • Riccardo Asero377,
  • Salvatore Tripodi378,
  • Arianna Dondi379,
  • Gianpaolo Ricci380,
  • Carlotta Povesi Dascola376,
  • Elisabetta Calamelli380,
  • Francesca Cipriani380,
  • Andrea Di Rienzo Businco381,
  • Annamaria Bianchi382,
  • Paolo Candelotti383,
  • Tullio Frediani384,
  • Carmen Verga385,
  • Paraskevi Korovessi46,
  • Skevi Tiliakou46,
  • Evaggelia Tavoulari46,
  • Kalliopi-Maria Moraiti46,
  • Wan Jean Tee387,
  • Samir Deiratany387,
  • Raymond Seedhoo387,
  • Roisin McNamara387,
  • Ike Okafor387,
  • Ekaterina Khaleva388,
  • Gennady Novic388,
  • Natalia Bychkova389,
  • Amany Abd Al-Aziz27,
  • Amany Fatouh27,
  • Ayat Motawie27,
  • Eman El Bostany27,
  • Amr Ibrahim27,
  • Sylvia Andonova391,
  • Alexey Savov391,
  • Maria Zoto392,
  • Marialena Kyriakakou393,
  • Mariza Vassilopoulou394,
  • Athina Balaska395,
  • Stavroula Kostaridou395,
  • Jorien Wartna396,
  • Arthur M. Bohnen396,
  • Gijs Elshout396,
  • David H. J. Pols396,
  • Patrick J. E. Bindels396,
  • Sven F. Seys397,
  • Ellen Dilissen397,
  • Sarah Van der Eycken397,
  • An-Sofie Schelpe397,
  • Gudrun Marijsse397,
  • Thierry Troosters398,
  • Vincent Vanbelle399,
  • Sven Aertgeerts400,
  • Jan L. Ceuppens397,
  • Lieven J. Dupont398,
  • Koen Peers401,
  • Dominique M. Bullens402,
  • Sandra Bulat Lokas92,
  • Jelena Zivkovic92,
  • Boro Nogalo92,
  • Iva Mrkic Kobal92,
  • Georgeta Oliveira403,
  • Katharine Pike404,
  • Alda Melo405,
  • Tomás Amélia405,
  • José Carlos Cidrais Rodrigues403,
  • Cristina Serrano403,
  • José Manuel Lopes dos Santos403,
  • Carla Lopes406,
  • Uwe Schauer355, 407,
  • Karl-Christian Bergmann408,
  • Luis Moral409,
  • Teresa Toral409,
  • Nuria Marco409,
  • Beléns García Avilés409,
  • Mª Jesús Fuentes409,
  • Jesús Garde409,
  • Cristina Montahud409,
  • Javier Perona409,
  • Mª José Forniés409,
  • Esozia Arroabarren410,
  • Marta Anda410,
  • Maria Luisa Sanz411,
  • Maria Teresa Lizaso410,
  • Candida Arregui410,
  • Sara May412,
  • Martha Hartz412,
  • Avni Joshi412,
  • Miguel A. Park412,
  • Sonja Posega Devetak413,
  • Anja Koren Jeverica414,
  • Leonor Castro415,
  • Carolina Gouveia415,
  • Ana Carvalho Marques415,
  • Antonio Jorge Cabral415,
  • Luis Amaral416,
  • Fabrícia Carolino416,
  • Eunice Castro416,
  • Madalena Passos417,
  • Josefina R. Cernadas416,
  • Luís Amaral416,
  • Eunice Dias de Castro416,
  • Fernando Pineda418,
  • Armanda Gomes417,
  • Helen Brough419,
  • Jobst Röhmel44,
  • Carsten Schwarz44,
  • Anne Mehl44,
  • Philippe Stock44,
  • Doris Staab44,
  • Christine Seib44,
  • Anita Critchlow374,
  • Alyson Barber374,
  • Belen Delavalle420,
  • Teresa Garriga420,
  • Blanca Vilá420,
  • Annalisa Astolfi421,
  • Costanza Di Chiara380,
  • Iria Neri422,
  • Annalisa Patrizi422,
  • Katerina Neskorodova423,
  • Asya Kudryavtseva423,
  • Jorge Alvarez410,
  • Miriam Palacios410,
  • Marta Martinez-Merino410 and
  • Ibone Vaquero410
Clinical and Translational Allergy20166(Suppl 1):42

DOI: 10.1186/s13601-016-0117-8

Published: 21 November 2016

Table of contents

WORKSHOP 4: Challenging clinical scenarios (CS01–CS06)

CS01 Bullous lesions in two children: solitary mastocytoma

S. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal Gok

CS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experience

Jessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise Michaelis

CS03 Cold urticaria in pediatric age: an invisible cause for severe reactions

Inês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-Almeida

CS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosis

Cristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José Oliveira

CS05 A child with unusual multiple organ allergy disease: what is the primer?

Fabienne Gay-Crosier

CS06 A case of uncontrolled asthma in a 6-year-old patient

Ioana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu

ORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06)

OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric Hospital

Adrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza Martín

OP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitis

Ebru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin Sackesen

OP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trial

MerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria Makrides

OP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed egg

Stavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. Papadopoulos

OP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacy

Hanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost Smit

OP06 Administration of the yellow fever vaccine in egg allergic children

Roisin Fitzsimons, Victoria Timms, George Du Toit

ORAL ABSTRACT SESSION 2: Asthma (OP07–OP12)

OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthma

S. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal Gok

OP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalities

Nagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. Mahfouz

OP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadium

Papp Gabor, Biro Gabor, Kovacs Csaba

OP10 Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial

Bo Chawes, Klaus Bønnelykke, Jakob Stokholm, Lene Heickendorff, Susanne Brix, Morten Rasmussen, Hans Bisgaard

OP11 Lung function development in childhood

Henrik Wegener Hallas, Bo Chawes, Lambang Arianto, Hans Bisgaard

OP12 Is the effect of maternal and paternal asthma different in female and male children before puberty?

Maike Pincus, Thomas Keil, Andreas Reich, Ulrich Wahn, Susanne Lau, Linus Grabenhenrich

ORAL ABSTRACT SESSION 3: Epidemiology—genetics (OP13–OP18)

OP13 Lifestyle is associated with incidence and category of allergen sensitisation: the ALADDIN birth cohort

Sara Fagerstedt, Helena Marell Hesla, Emelie Johansson, Helen Rosenlund, Axel Mie, Annika Scheynius, Johan Alm

OP15 Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance

Jorge Esparza-Gordillo, Anja Matanovic, Ingo Marenholz, Anja Bauerfeind, Klaus Rohde, Katja Nemat, Min-Ae Lee-Kirsch, Magnus Nordenskjöld, Marten C. G. Winge, Thomas Keil, Renate Krüger, Susanne Lau, Kirsten Beyer, Birgit Kalb, Bodo Niggemann, Norbert Hübner, Heather J. Cordell, Maria Bradley, Young-Ae Lee

OP16 Allergic multimorbidity of asthma, rhinitis and eczema in the first 2 decades of the German MAS birth cohort

Thomas Keil, Hannah Gough, Linus Grabenhenrich, Dirk Schramm, Andreas Reich, John Beschorner, Antje Schuster, Carl-Peter Bauer, Johannes Forster, Fred Zepp, Young-Ae Lee, Renate Bergmann, Karl Bergmann, Ulrich Wahn, Susanne Lau

OP17 Childhood anaphylaxis: a growing concern

Filipe Benito Garcia, Inês Mota, Susana Piedade, Ângela Gaspar, Natacha Santos, Helena Pité, Mário Morais-Almeida

OP18 Indoor exposure to molds and dampness in infancy and its association to persistent atopic dermatitis in school age. Results from the Greek ISAAC II study

Athina Papadopoulou, Despina Mermiri, Elpida Xatziagorou, Ioannis Tsanakas, Stavroula Lampidi, Kostas Priftis

ORAL ABSTRACT SESSION 4: Pediatric rhinitis—immunotherapy (OP19–OP24)

OP19 Associations between residential greenness and childhood allergic rhinitis and aeroallergen sensitisation in seven birth cohorts

Elaine Fuertes, Iana Markevych, Gayan Bowatte, Olena Gruzieva, Ulrike Gehring, Allan Becker, Dietrich Berdel, Michael Brauer, Chris Carlsten, Barbara Hoffmann, Anita Kozyrskyj, Caroline Lodge, Göran Pershagen, Alet Wijga, Heinrich Joachim

OP20 Full symptom control in pediatric patients with allergic rhinitis and asthma: results of a 2-year sublingual allergen immunotherapy study

Zorica Zivkovic, Ivana Djuric-Filipovic, Jasmina Jocić-Stevanovic, Snežana Zivanovic

OP21 Nasal epithelium of different ages of atopic subjects present increased levels of oxidative stress and increased cell cytotoxicity upon rhinovirus infection

Styliani Taka, Dimitra Kokkinou, Aliki Papakonstantinou, Panagiota Stefanopoulou, Anastasia Georgountzou, Paraskevi Maggina, Sofia Stamataki, Vassiliki Papaevanggelou, Evangelos Andreakos, Nikolaos G. Papadopoulos

OP22 Cluster subcutaneous immunotherapy schedule: tolerability profile in children

Monica Piquer Gibert, Montserrat Alvaro Lozano, Jaime Lozano Blasco, Olga Domínguez Sánchez, Rosa Jiménez Feijoo, Marcia Dias da Costa, Mª Teresa Giner Muñoz, Adriana Machinena Spera, Ana Maria Plaza Martín

OP23 Rhinitis as a risk factor for asthma severity in 11-year old children: population-based cohort study

Matea Deliu, Danielle Belgrave, Angela Simpson, Adnan Custovic

OP24 The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children

João Gaspar Marques, Pedro Carreiro-Martins, Joana Belo, Sara Serranho, Isabel Peralta, Nuno Neuparth, Paula Leiria-Pinto

POSTER DISCUSSION SESSION 1: Food allergy (PD01–PD05)

PD01 Allergen-specific humoral and cellular responses in children who fail egg oral immunotherapy due to allergic reactions

Marta Vazquez-Ortiz, Mariona Pascal, Ana Maria Plaza, Manel Juan

PD02 FoxP3 epigenetic features in children with cow milk allergy

Lorella Paparo, Rita Nocerino, Rosita Aitoro, Ilaria Langella, Antonio Amoroso, Alessia Amoroso, Carmen Di Scala, Roberto Berni Canani

PD04 Combined milk and egg allergy in early childhood: let them eat cake?

Santanu Maity, Giuseppina Rotiroti, Minal Gandhi

PD05 Introduction of complementary foods in relation to allergy and gut microbiota in farm and non-farm children

Karin Jonsson, Annika Ljung, Bill Hesselmar, Ingegerd Adlerbert, Hilde Brekke, Susanne Johansen, Agnes Wold, Ann-Sofie Sandberg

POSTER DISCUSSION SESSION 2: Asthma and wheeze (PD06–PD16)

PD06 The association between asthma and exhaled nitric oxide is influenced by genetics and sensitisation

Björn Nordlund, Cecilia Lundholm, Villhelmina Ullemar, Marianne van Hage, Anne Örtqvist, Catarina Almqvist

PD09 Prevalence patterns of infant wheeze across Europe

Anna Selby, Kate Grimshaw, Thomas Keil, Linus Grabenhenrich, Michael Clausen, Ruta Dubakiene, Alessandro Fiocchi, Marek Kowalski, Nikos Papadopoulos, Marta Reche, Sigurveig Sigurdardottir, Aline Sprikkleman, Paraskevi Xepapadaki, Clare Mills, Kirsten Beyer, Graham Roberts

PD10 Epidemiologic changes in recurrent wheezing infants

Herberto Jose Chong Neto, Gustavo Falbo Wandalsen, Ana Carolina Dela Bianca, Carolina Aranda, Nelson Augusto Rosário, Dirceu Solé, Javier Mallol, Luis García Marcos

PD13 A single nucleotide polymorphism in the GLCCI1 gene is associated with response to asthma treatment in children

IvanaBanic, Matija Rijavec, Davor Plavec, Peter Korosec, Mirjana Turkalj

PD14 Pollen induced asthma: Could small molecules in pollen exacerbate the protein-mediated allergic response?

Alen Bozicevic, Maria De Mieri, Matthias Hamburger

PD15 A qualitative study to understand how we can empower teenagers to better self-manage their asthma

Simone Holley, Ruth Morris, Frances Mitchell, Rebecca Knibb, Susan Latter, Christina Liossi, Graham Roberts

PD16 Polymorphism of endothelial nitric oxide synthase (eNOS) gene among Egyptian children with bronchial asthma

Mostafa M. M. Hassan

POSTER DISCUSSION SESSION 3: Mechanisms—Epidemiology (PD17–PD21)

PD17 Pregnancy outcomes in relation to development of allergy in a Swedish birth cohort

Malin Barman, Anna Sandin, Agnes Wold, Ann-Sofie Sandberg

PD18 Evolution of the IgE response to house dust mite molecules in childhood

Daniela Posa, Serena Perna, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Ulrich Wahn, Thomas Keil, Susanne Lau, Kuan-Wei Chen, Yvonne Resch, Susanne Vrtala, Rudolf Valenta, Paolo Maria Matricardi

PD19 Antibody recognition of nsLTP-molecules as antigens but not as allergens in the German-MAS birth cohort

Olympia Tsilochristou, Alexander Rohrbach, Antonio Cappella, Stephanie Hofmaier, Laura Hatzler, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, RaffaeleD’Amelio, Ulrich Wahn, Thomas Keil, Susanne Lau, Paolo Maria Matricardi

PD20 Early life colonization with Lactobacilli and Staphylococcus aureus oppositely associates with the maturation and activation of FOXP3+ CD4 T-cells

Sophia Björkander, Maria A. Johansson, Gintare Lasaviciute, Eva Sverremark-Ekström

PD21 Genome-wide meta-analysis identifies 7 susceptibility loci involved in the atopic march

Ingo Marenholz, Jorge Esparza-Gordillo, Franz Rüschendorf, Anja Bauerfeind, David P. Strachan, Ben D. Spycher, Hansjörg Baurecht, Patricia Margaritte-Jeannin, Annika Sääf, Marjan Kerkhof, Markus Ege, Svetlana Baltic, Melanie C Matheson, Jin Li, Sven Michel, Wei Q. Ang, Wendy McArdle, Andreas Arnold, Georg Homuth, Florence Demenais, Emmanuelle Bouzigon, Cilla Söderhäll, Göran Pershagen, Johan C. de Jongste, Dirkje S Postma, Charlotte Braun-Fahrländer, Elisabeth Horak, Ludmila M. Ogorodova, Valery P. Puzyrev, Elena Yu Bragina, Thomas J Hudson, Charles Morin, David L Duffy, Guy B Marks, Colin F Robertson, Grant W Montgomery, Bill Musk, Philip J Thompson, Nicholas G. Martin, Alan James, Patrick Sleiman, Elina Toskala, Elke Rodriguez, Regina Fölster-Holst, Andre Franke, Wolfgang Lieb, Christian Gieger, Andrea Heinzmann, Ernst Rietschel, Thomas Keil, Sven Cichon, Markus M Nöthen, Craig E Pennell, Peter D Sly, Carsten O Schmidt, Anja Matanovic, Valentin Schneider, Matthias Heinig, Norbert Hübner, Patrick G. Holt, Susanne Lau, Michael Kabesch, Stefan Weidinger, Hakon Hakonarson, Manuel AR Ferreira, Catherine Laprise, Maxim B. Freidin, Jon Genuneit, Gerard H Koppelman, Erik Melén, Marie-Hélène Dizier, A. John Henderson, Young Ae Lee

POSTER DISCUSSION SESSION 4: Food allergy—Anaphylaxis (PD22–PD26)

PD22 Atopy patch test in food protein induced enterocolitis caused by solid food

Purificacion González-Delgado, Esther Caparrós, Fernando Clemente, Begoña Cueva, Victoria M. Moreno, Jose Luis Carretero, Javier Fernández

PD23 Watermelon allergy: a novel presentation

Kate Swan, George Du Toit

PD24 A pilot study evaluating the usefulness of a guideline template for managing milk allergy in primary care

Mudiyur Gopi, Tim Smith, Edara Ramesh, Arun Sadasivam

PD26 Efficacy and safety of cow’s milk oral immunotherapy protocol

Inês Mota, Filipe Benito Garcia, Susana Piedade, Angela Gaspar, Graça Sampaio, Cristina Arêde, Luís Miguel Borrego, Graça Pires, Cristina Santa-Marta, Mário Morais-Almeida

POSTER DISCUSSION SESSION 5: Prevention and treatment—Allergy (PD27–PD36)

PD27 Allergy-protection by the lactic acid bacterium Lactococcus lactis G121: mode-of-action as revealed in a murine model of experimental allergy

Stephanie Brand, Karina Stein, Holger Heine, Marion Kauth

PD29 The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy

Leif Bjarte Rolfsjord, Egil Bakkeheim, Johan Alm, Håvard Ove Skjerven, Kai-Håkon Carlsen, Jon Olav Hunderi, Teresa Løvold Berents, Petter Mowinckel, Karin C. Lødrup Carlsen

PD30 Randomised trial of the efficacy of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥6 years to <12 years with allergic rhinitis

Ulrich Wahn, Ullrich Munzel, William Berger

PD31 10 mg of oral bilastine in 2 to 11 years old children has similar exposure to the adult therapeutic dose (20 mg)

Ulrich Wahn, Román Valiente, Valvanera Vozmediano, John C. Lukas, Mónica Rodríguez

PD33 Daily symptoms, nocturnal symptoms, activity limitations and reliever therapies during the three steps of IOEASMA programme: a comparison

Sebastiano Guarnaccia, Luigi Vitale, Ada Pluda, Emanuele D’Agata, Denise Colombo, Stefano Felici, Valeria Gretter, Susanna Facchetti, Gaia Pecorelli, Cristina Quecchia

PD34 Sensitisation to an inert aeroallergen in weaning rats and longstanding disease, in a sensitisation-tolerant and easily tolerisable rodent strain

George Guibas, Evangelia Spandou, Spyridon Megremis, Peter West, Nikolaos Papadopoulos

PD35 Bacterial and fungi exposure in school and allergic sensitisation in children

João Cavaleiro Rufo, Joana Madureira, Inês Paciência, Lívia Aguiar, Patrícia Padrão, Mariana Pinto, Luís Delgado, Pedro Moreira, João Paulo Teixeira, Eduardo Oliveira Fernandes, André Moreira

PD36 Comparative study of allergy rhinitis between two populations: children vs. adults

Adriana Izquierdo Dominguez, Antonio Valero, Joaquim Mullol, Alfonso Del Cuvillo, Javier Montoro, Ignacio Jauregui, Joan Bartra, Ignacio Davila, Marta Ferrer, Joaquin Sastre

POSTER VIEWING SESSION 1: Inflammation—Genetics—Immunology—Dermatology (PP01–PP09)

PP01 Immune profile in late pregnancy: immunological markers in atopic asthmaticwomen as risk factors for atopy in the progeny

Catarina Martins, Jorge Lima, Maria José Leandro, Glória Nunes, Jorge Cunha Branco, Hélder Trindade, Luis Miguel Borrego

PP02 The impact of neonatal sepsis on development of allergic diseases

Secil Conkar, Mehtap Kilic, Canan Aygun, Recep Sancak

PP03 Clinical overview of selective IgE deficiency in childhood

Athina Papadopoulou, Eleni Tagalaki, Lambros Banos, Anna Vlachou, Fotini Giannoula, Despina Mermiri

PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence

Athina Papadopoulou, Stavroula Lampidi, Marina Pavlakou, Maria Kryoni, Kostas Makris

PP05

PP06

PP07 Asthma control questionnaire and specific IgE in children

Snezhina Lazova, Guergana Petrova, Dimitrinka Miteva, Penka Perenovska

PP08 Features of chronic urticaria of adolescents

Aliya Klyucharova, Olesya Skorohodkina

PP09 Cutaneous mastocytosis in children: a clinical analysis of 8 cases in Greece

Dimitra Koumaki, Alkisti Manousaki, Maria Agrapidi, Lida Iatridou, Omima Eruk, Konstantinos Myridakis, Emmanouil Manousakis, Vasiliki Koumaki

POSTER VIEWING SESSION 2: Food allergy—Anaphylaxis (PP10–PP47)

PP10 Prognostic factors in egg allergy

Maria Dimou, Maria Ingemansson, Gunilla Hedlin

PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula

Nitida Pastor, Delphine de Boissieu, Jon Vanderhoof, Nancy Moore, Kaitlin Maditz

PP12 Anaphylaxis and epinephrine auto-injector use: a survey of pediatric trainees

Adeli Mehdi, Shaza Elhassan, Carolin Beck, Ahmed Al-Hammadi

PP13 Anaphylaxis in children: acute management in the Emergency Department

Ioana Maris, Ronan O’Sullivan, Jonathan Hourihane,

PP14 Understanding Cumbrian schools preparedness in managing children at risk of anaphylaxis in order to provide training and support which will create healthy and safe environments for children with allergies

George Raptis, Louise Michaelis

PP15 A new valid and reliable parent and child questionnaire to measure the impact of food protein enterocolitis syndrome on children: the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form

Audrey DunnGalvin, Matthew Greenhawt, Carina Venter, Jonathan Hourihane

PP16 An in-depth case study investigation of the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity

Evelyn O’Regan, Duncan Cronin, Jonathan Hourihane, Anna O’Reilly, Audrey DunnGalvin

PP17 Cow’s milk protein allergy in Constantine. A retrospective study of 62 cases between 1996 and 2013

Foued Abdelaziz, Dounia Khelifi-Touhami, Nihad Selim, Tahar Khelifi-Touhami

PP18

PP19 Cow’s milk and egg oral immunotherapy in children older than 5 years

Pablo Merida, Ana Mª Plaza, Juan Heber Castellanos, Adrianna Machinena, Montserrat Alvaro Lozano, Jaime Lozano, Olga Dominguez, Monica Piquer, Rosa Jimenez, Mª Teresa Giner

PP20 Professionals’ awareness of management of Cow’s Milk Protein Allergy (CMPA) in North Wales Hospitals

Konstantinos Kakleas, Manohar Joishy, Wendmu Maskele, Huw R. Jenkins

PP21

PP22 Anaphylaxis: the great unknown for teachers. Presentation of a protocol for schools

Mercedes Escarrer, Agustín Madroñero, Maria Teresa Guerra, Juan Carlos Julia, Juan Carlos Cerda, Javier Contreras, Eulalia Tauler, Maria Jesus Vidorreta, Ana Rojo, Silvia Del Valle

PP23 Challenges facing children with food allergies and their parents in out of school activity sectors

Niamh Flynn

PP24 A review of food challenges at a Regional Irish Centre

Gary Foley, Carol Harmon, John Fitzsimons

PP25 The use of epinephrine in infants with anaphylaxis

Krasimira Baynova, Ávila Maria Del Robledo, Labella Marina

PP26

PP27

PP28 Mother’s psychological state predicts the expression of symptoms in food allergic children

Aaron Cortes, Alicia Sciaraffia, Angela Castillo

PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic

Nanna Juel-Berg, Kirsten Skamstrup Hansen, Lars Kærgaard Poulsen

PP30 Food allergy in children: evaluation of parents’ use of online social media

Andreia Florina Nita, Ioana Valentina Nenciu, Adina Lazar, Dumitru Oraseanu

PP31 The impact of food allergy on quality of life: FAQLQ questionnaire

Rita Aguiar, Anabela Lopes, Maria J. Paes, Amélia S. Santos, M. A. Pereira-Barbosa

PP32 An unexpected cause of anaphylaxis: potato

Hatice Eke Gungor, Salih Uytun, Umit Murat Sahiner, Yasemin Altuner Torun

PP33 Is it clinical phenotype of allergic diseases determined by sensitisation to food?

Mirjana Zivanovic, Marina Atanasković-Marković

PP34

PP35 Prescribing adrenaline auto-injectors in children in 2014: the data from regional pediatricians

Tina Vesel, Mihaela Nahtigal, Andreja Obermayer-Temlin, Eva Šoster Križnik, Mirjana Maslar, Ruben Bizjak, Marjeta Tomšič-Matic, Sonja Posega-Devetak, Maja Skerbinjek-Kavalar, Mateja Predalič, Tadej Avčin

PP36 Who should have an adrenaline autoinjector? Adherence to the European and French guidelines among 121 allergists from the Allergy Vigilance Network

Guillaume Pouessel, Etienne Beaudouin, Anne M. Moneret-Vautrin, Antoine Deschildre, Allergy Vigilance Network

PP37 Anaphylaxis by Anacardium Occidentale

Marta Viñas, Bartolomé Borja, Nora Hernández, Mª José Castillo, Adriana Izquierdo, Marcel Ibero

PP38 Anaphylaxis with honey in a child

S. Tolga Yavuz, Ali Gungor, Betul Buyuktiryaki, Ozan Koc, Can Naci Kocabas, Faysal Gok

PP39 Evaluation of courses adopted to children on prevention, recognition and management of anaphylaxis

Tina Vesel, Mihaela Nahtigal

PP40 Symptomatic dust mites and shrimp allergy: three pediatric case reports

Filipa Almeida, Susana Lopes, Cristina Madureira, Tânia Lopes, Fernanda Carvalho

PP41 Poor identification rates of nuts by high risk individuals: a call for improved education and support for families

Camille Heming, Emily Garrett, Adam Blackstock, Santanu Maity, Rahul Chodhari

PP42 DAFALL: database of food allergies in the Czech Republic

Simona Belohlavkova, Eliska Kopelentova, Petr Visek, Ivana Setinova, Ivana Svarcova

PP43 Serological cross-reactivity between grass and wheat is not only caused by profilins and CCDs

Sigrid Sjölander, Nora Nilsson, Malin Berthold, Helena Ekoff, Gunilla Hedlin, Magnus Borres, Caroline Nilsson

PP44 Oil body associated proteins in children with nuts allergy. Allergens to consider in IgE-mediated nuts allergy

Loreto González Domínguez, Cristina Muñoz Archidona, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire

PP45

PP46 Protective effect of helicobacter pylori infection against food allergy in children

Olga Vrani, Antigone Mavroudi, Maria Fotoulaki, Maria Emporiadou, Kleomenis Spiroglou, Ioannis Xinias

PP47 Anaphylaxis pathway: A road tryp-tase to success?

Helyeh A. Sadreddini, Mia Warnes, Donna Traves

POSTER VIEWING SESSION 3: Miscellaneous (PP48–PP58)

PP48 Surveillance study on safety of SLIT in pediatric population

Ivana Djuric-Filipovic, Zorica Zivkovic, Snežana Zivanovic, Gordana Kostić, Đorđe Filipovic

PP49 Efficacy and safety of mixed mite subcutaneous immunotherapy among allergic rhinitis patients in the Northeastern Thailand

Sawapon Sittisomwong, Siripong Sittisomwong

PP50 Effect of inhaled beclomethasone or placebo on brain stem activity in a patient chronically treated with steroids: preliminary report

Zygmunt Podolec, Marcin Hartel, Daria Panek, Magdalena Podolec-Rubiś, Tomasz Banasik

PP51 Sensitisation to aeroallergens in patients with allergic rhinitis, asthma and atopic dermatitis in Shiraz, Southwestern Iran

Elham Abbasi, Mozhgan Moghtaderi

PP52 Referring a child for allergy test: how appropriate are we?

Phani Sanneerappa, Alina Deliu, Moosa Kutty, Nagabathula Ramesh

PP53 EBV lymphoproliferative disease and cardiac lymphoma in a STK4 deficient patient

Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Raeesi, Mino Afshar, Hamid Rahimi, Christoph Klein

PP54 A case study: the effect of massive honeybees attack on various body parameters atopic girl including allergy

Mohemid Al-Jebouri

PP55 The role of TLR9, NLRP3 and proIL-1β in activation of antiviral innate immunity

Oxana A. Svitich, Daria O. Zubacheva, Dmitrii A. Potemkin, Ludmila V. Gankovskaya, Vitalii V. Zverev

PP56 Overnight pulse oximetry, as a screening tool to diagnose obstructive sleep apnoea. How effective is it?

Phani Sanneerappa, Elaine OB Doyle, Paul Gallagher, Nagabathula Ramesh

PP57 The presentation and management of acute urticaria and allergic reactions in children in a multi-ethnic, inner city Emergency Department (ED)

Sherine Dewlett, Kin Man, Minal Gandhi, James Pocock, Anna Gerrardhughes

PP58 Food allergens responsible for delayed-type sensitisation in atopy patch test in children diagnosed with autism spectrum disorder

Jolanta Wasilewska, Maciej Kaczmarski, Dariusz Lebensztejn

POSTER VIEWING SESSION 4: Asthma—Rhinitis (PP59–PP87)

PP59 Systematic review of incense as a trigger factor for asthma

Chandramani Thuraisingham, Davendralingam Sinniah

PP60 Increased risks of mood and anxiety disorders in children with asthma

Yue Chen, Xiaomei Mei

PP61

PP62 Asthma Control Test (ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) association in children

Sebnem Ozdogan, Pinar Karadeniz, Durdugul Ayyildiz-Emecen, Ummuhan Oncul

PP63 Seasonal and gender variations in vitamin D levels in children with asthma and its association with pulmonary function tests

Sebnem Ozdogan, Gizem Sari, Sabanur Cavdar

PP64 Defining treatment response in childhood asthma: rationale and design of the Pharmacogenomics in the Childhood Asthma (PiCA) consortium

Niloufar Farzan, Susanne J. Vijverberg, Colin J. Palmer, Kelan G. Tantisira, Anke-Hilseon Maitland-van der Zee behalf of the PiCA consortium

PP65 Prevalence of asthma and allergic disease in patients with inflammatory disease compared to celiac disease

Fatma Yavuzyilmaz, Sebnem Ozdogan, Nafiye Urganci, Merve Usta

PP66 A severe case with cystic fibrosis (CF) asthma

Mehmet Hoxha, Maksim Basho

PP67 Severe asthma exacerbation complicated with pneumothorax in a child with uncontrolled asthma due to poor treatment compliance

Ioana Valentina Nenciu, Andreia Florina Nita, Adina Lazar, Alexandru Ulmeanu, Carmen Zapucioiu, Dumitru Oraseanu

PP68 Evaluation of the Pediatric Quality of Life inventory (PedsQL) asthma module among low income asthmatic children and adolescents in Sao Paolo, Brazil

Gustavo F. Wandalsen, Fernanda Monteiro, Dirceu Solé

PP69 Early initiation of specific immunotherapy in asthma patients leads to higher benefits

Blerta Lame, Eris Mesonjesi, Arjeta Sherri

PP70 Treatment resistant asthma and rhinosinusitis with recurrent pulmonary infections. Is it primary ciliary dyskinesia?

Alkerta Ibranji, Laert Gjati, Gjustina Loloci, Ardii Bardhi

PP71 The comparison of sensitisation to animal allergens in children- and adult- onset patients with asthma

Behnam Moghtaderi, Shirin Farjadian, Dorna Eghtedari

PP72 Characterisation of children less than five years with wheezing episodes in Cali, Colombia

Manuela Olaya, Laura Del Mar Vasquez, Luis Fernando Ramirez, Carlos Daniel Serrano

PP73 Evaluation of the patients with recurrent croup

Belgin Usta Guc, Suna Asilsoy, Fulya Ozer

PP74 Obesity in adolescence compromising the asthma control

Guergana Petrova, Sylvia Shopova, Vera Papochieva, Snezhina Lazova, Dimitrinka Miteva, Penka Perenovska

PP75 Sleep behavior in children with persistent allergic rhinitis

Gustavo F. Wandalsen, Jessica Loekmanwidjaja, Márcia Mallozi, Dirceu Solé

PP76 Randomised trial of the safety of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥4 years to <12 years with allergic rhinitis

William Berger, Ulrich Wahn, Paul Ratner, Daniel Soteres

PP77 Safety and tolerability evaluation of bilastine 10 mg in children from 2 to 11 years of age with allergic rhinoconjunctivitis or urticaria

Zoltán Novák, Anahí Yáñez, Kiss Ildikó, Piotr Kuna, Miguel Tortajada, Román Valiente, the Bilastine Pediatric Safety Study Group

PP78 Sensitisation to Alternaria alternata: Is it a risk factor for severe rhinitis?

Susana Lopes, Filipa Almeida, Tânia Lopes, Cristina Madureira, José Oliveira, Fernanda Carvalho

PP79 Validation of the Patient Benefit Index (PBI) for the assessment of patient-related outcomes in allergic rhinitis in children

Julia Feuerhahn, Christine Blome, Meike Hadler, Efstrathios Karagiannis, Anna Langenbruch, Matthias Augustin

PP80 Efficacy of sublingual tablet of house dust mite allergen extracts in adolescents with house dust mite-associated allergic rhinitis

Michel Roux, Shinji Kakudo, Efstrathios Karagiannis, Robert K. Zeldin

PP81 Lung function improvement in a child treated with omalizumab for bronchial asthma

Anna Sokolova, Tiago Milheiro Silva

PP82 How to treat a child suffering from asthma, allergic rhinitis, allergy to peanuts and diabetes at the same time?

Snezana S. Zivanovic, Vesna Cvetkovic, Ivana Nikolic, Sonja J. Zivanovic

PP83 Nitric oxide in exhaled air in the relationship of the degree of sensitisation to aeroallergens

Snezana S. Zivanovic, Ljiljana Saranac, Ivana Nikolic, Sonja J. Zivanovic, Zorica Zivkovic

PP84 Clinical basis of diagnostic errors in pediatric asthma

Zoia Nesterenko

PP85

PP86 Childhood asthma control in Serbia and organised Asthma Educational Intervention (AEI)

Snezana Radic, Branislava Milenkovic, Spomenka Smiljanic, Milka Micic-Stanijevic, Olivera Calovic

PP87 Experience from a group of adolescents with severe allergic asthma treated with Omalizumab

Anne Marie Bro Hofbauer, Lone Agertoft

THEMATIC POSTER SESSION 1: Prevention and Treatment—Epidemiology (TP01–TP18)

TP01 A cost effective primary school asthma education program: pilot study from inner London schools

Lucy Everson, Jessica Kearney, Jonny Coppel, Simon Braithwaite, Rahul Chodhari

TP02 The prevalence of allergic diseases among 14–15 years old adolescents in two Danish birth cohorts 14 years apart

Elisabeth S. Christiansen, Henrik Fomsgaard Kjaer, Esben Eller, Charlotte G. Mørtz, Susanne Halken

TP03 Does pattern of sensitisation to phleum pratense change with age? Is it different in children with allergic rhinitis or asthma?

Cristina Román India, Ana Moreira Jorge, Loreto González Domínguez, Cristina Muñoz Archidona, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Juana Jiménez Jiménez, Luis Echeverría Zudaire

TP04 Practicalities of prevention of peanut allergy: modelling a national response to LEAP

Cathal O’Connor, Jonathan Hourihane

TP05 Comparison of the influence of sunflower seed oil and skin care lotion on the skin barrier function of newborns: a randomised controlled trial

Varvara Kanti, Lena Lünnemann, Günther Malise, Laine Ludriksone, Andrea Stroux, Wolfgang Henrich, Michael Abu-Dakn, Ulrike Blume-Peytavi, Natalie Garcia Bartels

TP06 The effect of daily skin care on skin barrier properties in infants with dry skin and risk for atopic dermatitis

Varvara Kanti, Lena Lünnemann, Laine Ludriksone, Marianne Schario, Andrea Stroux, Ulrike Blume-Peytavi, Natalie Garcia Bartels

TP07 Change in sum total aeroallergen skin prick test wheal diameters at 6 months predicts which children will respond to subcutaneous immunotherapy by three years

Thorsten Stanley, Nicolien Brandenbarg

TP08 Are mobile apps regarding adrenaline auto-injectors accessed by adolescents for support and education in the community?

Alia Boardman, Gary McGreevy, Emily Rodger, Katherine Knight, Victoria Timms, Trisha Taylor, Gemma Scanlan, Roisin Fitzsimons

TP09

TP10 Prevention of early atopic dermatitis among low-atopy-risk infants by immunoactive prebiotics is not sustained after the first year of life

Grüber Christoph, Ulrich Wahn, Margriet van Stuivenberg, Fabio Mosca, Guido Moro, Gaetano Chirico, Christian P. Braegger, Joseph Riedler, Yalcin Yavuz, Günther Boehm

TP11

TP12

TP13 Treatment with Omalizumab in a 16-year-old Caucasian girl with refractory solar urticaria

Stefania Arasi, Giuseppe Crisafulli, Lucia Caminiti, Federica Porcaro, Giovanni Battista Pajno

TP14 Ultra-pure soft water ameliorates skin conditions of adult and child patients with atopic dermatitis

Akane Tanaka, Yaei Togawa, Kumiko Oida, Naotomo Kambe, Peter Arkwright, Yosuke Amagai, Naoki Shimojo, Yasunori Sato, Hiroyuki Mochizuki, Hyosun Jang, Saori Ishizaka, Hiroshi Matsuda

TP15 Potential adjuvant effect of immunomodulator to improve specific immunotherapy in asthmatic child

Wisnu Barlianto, Ery Olivianto, H. M. S. Chandra Kusuma

TP16 How can Component Resolved Diagnosis (CRD) influence in Specific Immunotherapy (SIT) prescription, in a Spanish children population

Ana Moreira Jorge, Cristina Román India, Loreto González Domínguez, Cristina Muñoz Archidona, Juana Jiménez Jiménez, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Luis Echeverría Zudaire

TP17 Mitochondrial dysfunction in food allergy: effects of L. rhamnosus GG in a mice model of peanut allergy

Rosita Aitoro, Mariapia Mollica, Roberto Berni Canani, Giovanna Trinchese, Elena Alfano, Antonio Amoroso, Lorella Paparo, Francesco Amato, Claudio Pirozzi, Antonio Calignano, Rosaria Meli

TP18 Prediction of atopic diseases in childhood: elevated blood eosinophils in infancy in a high risk birth cohort

Siri Rossberg, Kerstin Gerhold, Kurt Zimmermann, Mohammad Zaino, Thomas Geske, Eckard Hamelmann, Susanne Lau

THEMATIC POSTER SESSION 2: Food allergy—Anaphylaxis (TP19–TP38)

TP19

TP20

TP21 Double-blind provocation tests in non-IgE mediated cow’s milk allergy and the occurrence of placebo reactions

Sarah Bogovic, Jochem van den Berg, Chantal Janssen

TP22 Gradual introduction of baked egg (BE) in egg allergic patients under 2 years old

Angela Claver

TP23 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy I: safety and efficacy of daily vs. weekly protocols of induction

Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria

TP24 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy II: a randomised controlled trial to study a safer, more effective and easy to perform maintenance (daily vs. every two days) pattern of egg SOTI

Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria

TP25 Determining the safety of baked egg home reintroduction for children with mild egg allergy

Brenda DeWitt, Judith Holloway, Donald Hodge

TP26 Demographics, investigations and patterns of sensitisation in children with oral allergy syndrome in a London Teaching Hospital

Sian Ludman, Merhdad Jafari-Mamaghani, Rosemary Ebling, Adam T. Fox, Gideon Lack, George Du Toit

TP27 Airborne peanut challenge in children: allergic reactions are rare

Sofia Lovén Björkman, Caroline Nilsson, Natalia Ballardini

TP28 The nutty question on Pediatric Wards: to be or “nut” to be?

Supriyo Basu, Jenny Hallet, Jyothi Srinivas

TP29

TP30

TP31 Allergy education in nursery schools

Hazel Stringer, Nicola Jay

TP32 Food allergy in the first year of life

Tânia Lopes, Cristina Madureira, Filipa Almeida, Susana Lopes, Paula Fonseca, Clara Vieira, Fernanda Carvalho

TP33 Prevalence and geographic distribution of oral allergy syndrome in Italian children: a multicenter study

Carla Mastrorilli, Carlo Caffarelli, Riccardo Asero, Salvatore Tripodi, Arianna Dondi, Gianpaolo Ricci, Carlotta Povesi Dascola, Elisabetta Calamelli, Francesca Cipriani, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Tullio Frediani, Carmen Verga, Paolo Maria Matricardi

TP34 Are common standardised allergen extracts used in skin test enough in the diagnosis of nuts allergy?

Cristina Muñoz Archidona, Loreto González Domínguez, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire

TP35 Evaluation of IgE sensitisation in children with allergic proctocolitis and its relationship to atopic dermatitis

Despina Mermiri, Paraskevi Korovessi, Skevi Tiliakou, Evaggelia Tavoulari, Kalliopi-Maria Moraiti, Fotini Giannoula, Athina Papadopoulou

TP36 Food allergy in children: are we managing them appropriately in the Emergency Department?

Wan Jean Tee, Samir Deiratany, Raymond Seedhoo, Roisin McNamara, Ike Okafor

TP37 Importance of oil body associated allergenic proteins in nuts suspected allergy children

Loreto González Domínguez, Ana Moreira Jorge, Cristina Muñoz Archidona, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Fernando Pineda de la Losa, Miriam Castillo Fernández, Luis Ángel Echeverría Zudaire

TP38 Practical application of basophil activation test in children with food allergy

Ekaterina Khaleva, Gennady Novic, Natalia Bychkova

THEMATIC POSTER SESSION 3: Asthma (TP39–TP57)

TP39 Effect of corticosteroid therapy upon serum magnesium level in chronic asthmatic children

Amany Abd Al-Aziz, Amany Fatouh, Ayat Motawie, Eman El Bostany, Amr Ibrahim

TP40 ADAM33 in Bulgarian children with asthma

Guergana Petrova, Dimitrinka Miteva, Snezhina Lazova, Penka Perenovska, Sylvia Andonova, Alexey Savov

TP41

TP42 The impact of vitamin D serum levels in asthma and allergic rhinitis

Maria Zoto, Marialena Kyriakakou, Paraskevi Xepapadaki, Nikolaos G. Papadopoulos

TP43 Life-threatening, first reported, paradoxical bronchospasm after nebulised Salbutamol in a 10 year old child

Paraskevi Korovessi, Mariza Vassilopoulou, Athina Balaska, Lambros Banos, Stavroula Kostaridou, Despina Mermiri

TP44

TP45 Asthma symptoms in children with treatment for allergic rhinoconjunctivitis

Jorien Wartna, Arthur M. Bohnen, Gijs Elshout, David H. J. Pols, Patrick J. E. Bindels

Erasmus MC, Rotterdam, The Netherlands

TP46 Atopy increased the risk of developing exercise-induced bronchoconstriction in young athletes

Sven F. Seys; Ellen Dilissen, Sarah Van der Eycken, An-Sofie Schelpe, Gudrun Marijsse, Thierry Troosters, Vincent Vanbelle, Sven Aertgeerts, Jan L. Ceuppens, Lieven J. Dupont, Koen Peers, Dominique M. Bullens

TP47 The effect of higher BMI on risk for asthma and treatment outcome in overweight and obese children

Ivana Banic, Sandra Bulat Lokas, Jelena Zivkovic, Boro Nogalo, Iva Mrkic Kobal, Davor Plavec, Mirjana Turkalj

TP48

TP49

TP50

TP51

TP52 The impact of a multidisciplinary project intended to change the culture of nebulisers towards pressurised metered dose inhalers

Georgeta Oliveira, Katharine Pike, Alda Melo, Tomás Amélia, José Carlos Cidrais Rodrigues, Cristina Serrano, José Manuel Lopes dos Santos, Carla Lopes

TP53

TP54

TP55

TP56 Increased asthma control in patients with severe persistent allergic asthma after 12 month of nightly temperature controlled laminar airflow (TLA)

Eckard Hamelmann, Uwe Schauer, Karl-Christian Bergmann

TP57

THEMATIC POSTER SESSION 4: Drug allergy—Dermatology (TP58–TP77)

TP58 Should we proceed directly to provocation challenges to diagnose drug allergy? Our experience says yes

Luis Moral, Teresa Toral, Nuria Marco, Beléns García Avilés, Mª Jesús Fuentes, Jesús Garde, Cristina Montahud, Javier Perona, Mª José Forniés

TP59 Anaphylaxis to 13-valent pneumococcal vaccine

Esozia Arroabarren, Marta Anda, Maria Luisa Sanz, Maria Teresa Lizaso, Candida Arregui

TP60 Intrapartum antibiotic exposure for treatment of group B streptococcus was not associated with the development of penicillin allergy in children

Sara May, Martha Hartz, Avni Joshi, Miguel A. Park

TP61 Evaluation of suspected drug hypersensitivity reactions in 169 children referred to the General Hospital

Sonja Posega Devetak, Tina Vesel, Anja Koren Jeverica, Tadej Avčin

TP62 Drug provocation testing: experience of a tertiary hospital

Leonor Castro, Carolina Gouveia, Ana Carvalho Marques, Antonio Jorge Cabral

TP63 Perioperative anaphylaxis: a growing concern in pediatric population

Luis Amaral, Fabrícia Carolino, Eunice Castro, Madalena Passos, Josefina R. Cernadas

TP64 Raising awareness of hypersensitivity to non-steroidal anti-inflammatory drugs in the pediatric age

Fabrícia Carolino, Luís Amaral, Eunice Dias de Castro, Josefina R. Cernadas

TP65 Perioperative anaphylaxis in young children: how to confirm the suspicion

Josefina R. Cernadas, Fabrícia Carolino, Luís Amaral, Fernando Pineda, Armanda Gomes

TP66 A case study of a child suspected to be penicillin allergic-digging deeper

Katherine Knight, Roisin Fitzsimons, Helen Brough

TP67 Prevalence, characteristics and risk factors of hypersensitivity reactions to antibiotics in patients with cystic fibrosis

Jobst Röhmel, Carsten Schwarz, Anne Mehl, Philippe Stock, Doris Staab

TP68 Antibiotic drug hypersensitivity in cystic fibrosis: A pilot study using cellular allergy tests for diagnostics

Jobst Röhmel, Carsten Schwarz, Christine Seib, Doris Staab, Philippe Stock

TP69 Oral antibiotics challenges in children

Anita Critchlow, Alyson Barber, Nicola Jay

TP70 Hypersensitivity reaction to vancomycin: a new successful desensitization protocol

Belen Delavalle, Teresa Garriga, Blanca Vilá, Cristina Blasco

TP71

TP72 Clinical phenotypes according to FLG gene loss of function mutations in children with atopic dermatitis

Francesca Cipriani, Annalisa Astolfi, Costanza Di Chiara, Elisabetta Calamelli, Iria Neri, Annalisa Patrizi, Gianpaolo Ricci

TP73

TP74 Urticaria in children: clinical and epidemiological features

Katerina Neskorodova, Asya Kudryavtseva

TP75

TP76 Acute urticaria at the Pediatrics Emergency Department: is it allergy?

Esozia Arroabarren, Jorge Alvarez, Marta Anda, Miriam Palacios, Marta Martinez-Merino, Ibone Vaquero

TP77

WORKSHOP 4: Challenging clinical scenarios (CS01–CS06)

CS01 Bullous lesions in two children: solitary mastocytoma

S. Tolga Yavuz1, Ozan Koc2, Ali Gungor2, Faysal Gok2

1Department of Pediatric Allergy, GATA School of Medicine, Ankara, Turkey; 2Department of Pediatrics, GATA School of Medicine, Ankara, Turkey
Correspondence: S. Tolga Yavuz

Clinical and Translational Allergy 2016, 6(Suppl 1):CS01

Introduction: Bullous lesions are common skin lesions particularly in childhood. Drug reactions, burns, insect bites, mosquito bites, skin diseases, autoimmune bullous dermatoses and bacterial infections are the most common etiologies. Herein, we report two children who have solitary mastocytoma presented with variable bullous lesions.

Case 1: A 3-year old boy admitted to our outpatient department suffering from red, periodically vesicular and bullous lesions on his back of neck since birth. His medical history revealed that he had four attacks characterized by flushing, perioral paleness, and hypotension. The lesion became swollen and itchy when it was rubbed vigorously (positive Darier’s sign). Physical examination revealed a bullous lesion (2 × 3 cm) in his dorsal neck region. Laboratory investigations including CBC, liver and kidney function tests and serum electrolytes were within normal limits. Histopathologic examination of a punch biopsy specimen revealed solitary mastocytoma and the patient is under regular antihistamine treatment.

Case 2: A 3-month old boy admitted with complaints of oval, erythematous and periodically changing bullous lesions in his proximal of right ankle since birth. His medical history revealed that the lesion became bullous and itchy when his mother rubbed it vigorously. Physical examination revealed a bullous lesion (1 × 1 cm) in his left foot. Laboratory investigations for possible etiologic factors were within normal limits. Histopathologic examination of a punch biopsy specimen revealed solitary mastocytoma. The patient is uneventfully under regular follow up.

Conclusion: Solitary mastocytomas should be considered in the differential diagnosis of periodically varying bullous reactions in children.

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CS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experience

Jessica Hawley1, Christopher O’Brien2, Matthew Thomas2, Malcolm Brodlie2, Louise Michaelis2

1Newcastle University, Newcastle, UK; 2Royal Victoria Infirmary, Great North Children’s Hospital, Newcastle, UK
Correspondence: Jessica Hawley

Clinical and Translational Allergy 2016, 6(Suppl 1):CS02

The published version of this abstract can be found at [1].

Reference
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    Clin Exp Allergy. 2015;45(12):1876–913. http://onlinelibrary.wiley.com/doi/10.1111/cea.12656/abstract.

     

CS03 Cold urticaria in pediatric age: an invisible cause for severe reactions

Inês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-Almeida

Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
Correspondence: Inês Mota

Clinical and Translational Allergy 2016, 6(Suppl 1):CS03

Background: Cold urticaria (CU) is a subtype of inducible urticaria, which can be responsible for severe reactions namely during aquatic activities and winter season. The prevalence and clinical course in pediatric age is barely known. The authors describe the clinical features and the evolution of CU in pediatric patients.

Methods: Retrospective characterization of 15 pediatric patients with CU followed at our Immunoallergy Department, including clinical presentation, ice cube challenge test (ICCT) result, laboratory testing, allergen sensitization and outcome.

Results: The mean age of onset was 8.9 ± 4.2 years old, 73 % were female. Most patients had other allergic diseases (87 %), 40 % were atopic, two had also cholinergic urticaria and one case had family history of CU. Five patients (33 %) had systemic reactions with hemodynamic collapse after cold exposure. Symptoms occurred few minutes after skin exposure to cold (median of 7 min; ranging from immediate reactions to 20 min later); 73 % had several episodes (>5). Found one case secondary to cryoglobulinemia and the remaining cases were considered idiopathic. Aquatic activities (swimming, sea bathing) and cold air exposure were the main triggers. Some children developed reactions when touching cold objects (3), with cold beverages (1) and intraoperative (1). Positive ICCT with ≤3 min of stimulation in 5 patients (3 of 5 who had type III reactions), 5 min in 1, 10 min in 5 and 20 min in 3 of them. Patients were successfully controlled with prophylactic antihistamines and avoidance measures; adrenaline was prescribed when indicated. Five patients (33 %) overcame the symptoms in less than 5 years (mean: 3.6 years). Those who remain susceptible have so far a follow-up period of 1–13 years.

Conclusions: In pediatric age, CU seems to be a persistent disorder. ICCT is a convenient tool to confirm the diagnosis, to assess the risk for severe reactions and follow-up. Severe reactions can be prevented with prophylactic treatment and cold exposure avoidance.

CS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosis

Cristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José Oliveira

CHMA, Famalicão, Portugal
Correspondence: Cristina Madureira

Clinical and Translational Allergy 2016, 6(Suppl 1):CS04

Introduction: Angioedema is defined as localised and self-limiting nonpitting recurrent edema of the skin and mucous membranes caused by the release of several vasoactive mediators.

Seven forms of angioedema were identified based on specific characteristics and are classified as non-hereditary and hereditary forms.

Only Hereditary Angioedema with C1 inhibitor (C1-INH) deficiency had approved treatment.

The authors present a case of angioedema with C1 deficiency without family history of angioedema.

Clinical case: Five years old girl attended in emergency unit with angioedema of the face (Fig. 1) after left periorbital trauma. There was improvement of the clinical picture after administration of epinephrine, corticosteroids and antihistamine. She had a history of two previous similar episodes both triggered by trauma. Edema disappears completely after 5 days. Family history of angioedema is unknown.
Fig. 1

Angioedema of the face

The study carried out in outpatient pediatric allergy revealed: C4 very low (<5 mg/dl) and low esterase C1-INH (30 mg/L) with decreased function (10 %). She waits for genetic study of C1-INH gene (SERPING1).

Currently the child is medicated with an antihistamine without new episodes of angioedema.

Conclusion: Angioedema without urticaria in children is an infrequent condition and requires an exhaustive diagnostic investigation. Dosing C4 and C1-INH esterase becomes fundamental when no etiologic factor is identified. Deficit of C1-INH esterase with a decrease in C4 points to an acquired or a hereditary form of angioedema. Hereditary angioedema with C1-INH deficiency is a rare disease with an estimated prevalence of 1/10,000–1/100,000 inhabitants and is due to a mutation in one of the two alleles of the C1-INH gene (SERPING1). In the absence of family history, the genetic study becomes important to define possible prophylaxis.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

CS05 A child with unusual multiple organ allergy disease: what is the primer?

Fabienne Gay-Crosier

Clinical Allergy and Clinical Immunology, Internal Medicine, Federal Specialist, Geneva, Switzerland
Correspondence: Fabienne Gay-Crosier

Clinical and Translational Allergy 2016, 6(Suppl 1):CS05

Introduction: An immediate contact urticaria to food rich in palm date oil was developed by Julia at 2 years old. At 6 years old, she developed rhinoconjunctivitis and a severe onset of asthma on the 15th April 2014.

Method and results: SPT for panallergens profilin and polcalcin were positive which led to conduct to multiple false positive result for usual pollens’ SPT extracts [1].

Pollen calendar issued from the Swiss centre for meteorology gave this year for betulaceae like birch, a highest pollen count of 798 grains/m3 on the 2.04.2014. No pollen count was really pertinent on the 15 April 2014, date of the asthma crisis. Three days before, the highest pollen count of plane tree (400 grains/m3) and oak (360 grains/m3) were recorded. The ash highest pollen count was 62 grains/m3 on the 1st of April; the cupressaceae highest pollen count was 182 grains/m3 on the 17th of March.

Conclusion: According to SPT and biology, profilin is probably the primer to explain contact food urticaria to palm oil pastries, Phod2 [2] being the major allergen contained in palm oil in accordance to SPT profilin.

According to molecular biology [1,3], the pathogenesis of accumulated panallergens [4] due to multiple pollen expositions before the 15th April might explain the severe pollinosis [5].

To my knowledge, this is the first case report of profilin contact dermatitis in childhood. Recently, panallergens have been related to severe clinical pollinosis [6] and the role of enzyme activity of particular allergenic pollens has been described [7,8]. These mechanisms are probably involved predominantly in the delayed phase reaction of allergic asthma [9,10].

This observation should lead clinicians to improve their diagnosis and understanding of different panallergen and/or enzyme activity implications in allergy disease’ clinical onset and severity [11], particularly in multiple pollens exposed area and multi-ethnic areas [11,12].

Consent to publish

Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

References
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    Barber D, de la Torre F, Lombardero M, Antépara I, Colas C, Dávila I, Tabar AI, Vidal C, Villalba M, Salcedo G, Rodríguez R. Component-resolved diagnosis of pollen allergy based on skin testing with profilin, polcalcin and lipid transfer protein pan-allergens. Clin Exp Allergy. 2009;39(11):1764–73.

     
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    Asturias JA, Ibarrola I, Fernández J, Arilla MC, González-Rioja R, Martínez A. Pho d 2, a major allergen from date palm pollen is a profilin: cloning, sequencing and immunoglobulin E cross-reactivity with other profilins. Clin Exp Allergy. 2005;35:374–81.

     
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    Barber D, de la Torre F, Feo F, Florido F, Guardia P, et al. Understanding patient sensitization profiles in complex pollens areas: a molecular epidemiological study. Allergy. 2008;63:1550–1558.

     
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    Hauser M, Roulias A, Ferreira F, Egger M: Panallergens and their impact on the allergic patient. Allergy Asthma Clin Immunol 2010;6:1–14.

     
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    Ribeiro H, Abreu I, et al. Pollen allergenic potential nature of some trees species: a multidisciplinary approach using aerobiological, immunochemical and hospital admissions data. Environ Res. 2009;109(3):328–33.

     
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    Patelis A, et al. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness. J Allergy Clin Immunol 2011;130(2):397–402.

     
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    Barderas R, Villalba M, Pascual CY, Batanero E, Rodríguez R. Profilin (Che a 2) and polcalcin (Che a 3) are relevant allergens of Chenopodium album pollen: isolation, amino acid sequences and immunologic properties. J Allergy Clin Immunol. 2004;113:1192–8.

     
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    Mas S, Garrido-Arandia M, Batanero E, Purohit A, Pauli G. Characterization of profilin and polcalcin panallergens from ash pollen. J Investig Allergol Clin Immunol. 2014;24(4):257–66.

     
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    Smole U, Balazs N, Hoffmann-Sommergruber K, Radauer C, Hafner C, Wallner M, Ferreira F, Grossinger R, De Jong EC, Wagner S, Breiteneder H. Differential T cell responses and allergen uptake after exposure of dendritic cells to the birch pollen allergens Bet v 1.0101, Bet v 1.0401 and Bet v 1.1001. Immunobiology 2010;215(11):903–9.

     
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    Schulten V, Sette A, Peters B, et al. Previously undescribed grass pollen antigens are the major inducers of T helper 2 cytokine-producing T cells in allergic individuals. Proc Natl Acad Sci USA 2013;110(issue 9):3459–64.

     
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    Barber D, Díaz-Perales A, Villalba M, Chivato T. Challenges for allergy diagnosis in regions with complex pollen exposures in press. In: Current Allergy and Asthma Reports, vol. 15, 2015. p. 496.

     
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    Gay-Crosier F, Barber D, Bienvenu J. Allergy diagnosis in Geneva area: a complex multi-ethnic community with high pan-allergen prevalence. Clin Transl Allergy. 2014;4(Suppl 2):P49.

     

CS06 A case of uncontrolled asthma in a 6-year-old patient

Ioana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu

“Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania
Correspondence: Ioana-Valentina Nenciu

Clinical and Translational Allergy 2016, 6(Suppl 1):CS06

Introduction: Poorly controlled asthma involves higher costs related to emergency department visits, hospitalizations and scholar absenteeism. A survey of pediatric patients visiting their primary care providers revealed a 46 % prevalence of uncontrolled asthma (Liu AH et al. 2010).

Case report: We report a case of a 6-year-old male patient with uncontrolled asthma, receiving treatment with fluticasone and montelukast, who referred to our hospital for chronic cough and repeated asthma exacerbations. The patient was diagnosed with asthma at 4 years and with gastro-esophageal reflux at 5 years. He was also diagnosed with hypogammaglobulinemia and immunoglobulin A deficiency. The child’s mother is smoker. The parents were advised about the therapy and the measures they should take in order to improve their child’s outcome. Giving the repeated asthma exacerbations despite the indication of correct treatment, differential diagnosis and comorbidities were taken into account. The spirometry revealed obstructive syndrome reversible after 200 μg salbutamol administration. Thoracic CT scan showed bronchiectasis located in the middle lobe and lingula. Bronchoscopy revealed severe inflammation of traheobronhic mucosa and bronchial dyskinesia. FENO was 1 ppb and the sweat test was normal. Chest X-ray revealed increased interstitial markings and the X-ray for the sinuses was normal. Allergy testing and diamine oxidase activity were normal. All the tests revealed lack of control both for the asthma and for the gastro-esophageal reflux, despite the treatment, leading to important complications such as bronchiectasis. Repeated history revealed that the child did not receive the treatment correctly, daily, ant the mother continued to smoke close to the child.

Acknowledgements: This paper was co-financed from the European Social Fund, through the Sectorial Operational Programme Human Resources Development 2007–2013, contract POSDRU/187/1.5/S/155463 “Supporting excellence in scientific interdisciplinary doctoral research in the economic, medical and social fields”, coordinator The Bucharest University of Economic Studies.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

ORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06)

OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric Hospital

Adrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Ma Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza Martín

Pediatric Allergy Department, Hospital Sant Joan de Déu, Barcelona, Spain
Correspondence: Adrianna Machinena

Clinical and Translational Allergy 2016, 6(Suppl 1):OP01

Aim: To report clinical features, food allergens, reaction threshold doses and age of tolerance within a pediatric population with food protein-induced enterocolitis syndrome (FPIES).

Methods: Retrospective study of children with suspected FPIES who have undergone an oral food challenge (OFC) for tolerance evaluation from June 2008 to December 2013. Variables registered: age at OFC, gender, family and personal atopic history, symptoms, food involved, skin prick test (SPT), total and specific IgE and OFC outcomes.

Results: 82 patients with FPIES were included, 52.4 % boys, 42.7 % with atopic family history and 18.3 % had atopic dermatitis. Vomiting, lethargy, pallor and diarrhea were reported in 95.1, 67.1, 48.8 and 41.5 %, respectively, with an average time of reaction of 2 h post-ingestion (1.5–6). Food allergens implicated: fish (53.7 %), cow’s milk (25.6 %), egg (11 %), rice and corn (9.8 %). Mean age at OFC: 38.7 months (6–106 months) and 58.5 % (n 48) resulted tolerant.

The mean age at which tolerance was achieved differed according to the trigger food with statistical significance: 51.2 months for fish, 29.9 months for cow’s milk, 45.1 months for egg and 33.4 months for cereals. Of the 20 children (n 44) who tolerated one fish at OFC, 16 also tested negative with other fish families.

The reaction threshold doses were: 1.6 g for cow’s milk, about 2 g for egg and 0.5 g of protein for rice. Regarding fish, the reaction threshold dose was different depending on the fish family involved: half of the positive OFC had tested hake (n 13) and 69 % (n 9) reacted with 3.6 g of protein.

Conclusion: This study shows high prevalence of FPIES for fish in our environment. Fish tolerance resolves later than other foods and the outcome can usually be applied to other fish families. We detect low reaction threshold doses especially for cereals and fish.

OP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitis

Ebru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin Sackesen

Division of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey
Correspondence: Ebru Arik Yilmaz

Clinical and Translational Allergy 2016, 6(Suppl 1):OP02

Background: Food protein-induced enterocolitis syndrome (FPIES) and allergic proctocolitis (AP) are rare non-IgE-mediated food allergies in early childhood. We aimed to determine the clinical and laboratory features of FPIES and AP in infants.

Method: FPIES was diagnosed in the presence of gastrointestinal symptoms within 24 h after the ingestion of incriminated foods, without any other cause for the symptoms; or a positive open food challenge result with causative food or removal of causative food from the diet resulting in the resolution of symptoms in infants. AP was diagnosed in the presence of bloody stool after ingesting incriminated food and disappearance of blood with elimination of incriminated food or with positive challenge test.

Results: We analyzed 52 patients (23 FPIES and 29 AP) between 2010 and 2014. The age at admission was significantly lower in patients with AP than FPIES [4.2 (3.1–7.2) vs. 8.9 (4.4–12.7) month, p = 0.008] and age of initial symptoms was slightly lower in AP than FPIES [2 (1–3 vs. 4.5 (1–6) month, p > 0.05]. Cow’s milk was determined as the most frequent trigger with 90.4 %. The other incriminated foods are hen’s egg (n = 7), rice (n = 2), fish (n = 2), potato (n = 1), lentil (n = 1), wheat (n = 1), soy (n = 1) and banana (n = 1). Three patients had positive skin prick test with the suspected food, 7 (13.5 %) had concomitant IgE-mediated food allergy (egg, milk walnut), and 15 (28.8 %) had atopic dermatitis. Oral food challenge test was performed in 40 patients and 13 of those (32.5 %) resulted positive. The age of recovery of diseases was similar in FPIES and AP [12 (10.5–15.3) and 13 (12–20.3) months, respectively].

Conclusion: Our results denoted that cow’s milk is the most common trigger of FPIES and AP. Although the age of onset for initial symptoms seems to be earlier in AP compared with FPIES, resolution age was similar.

OP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trial

Merryn Netting1, Adaweyah El-Merhibi1, Michael Gold2, Patrick Quinn2, Irmeli Penttila3, Maria Makrides4

1Women’s and Children’s Health Research Institute, Adelaide, Australia; 2School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia; 3School of Medicine, The University of Adelaide, Adelaide, Australia; 4South Australian Health Medical Research Institute, Adelaide, Australia
Correspondence: Merryn Netting

Clinical and Translational Allergy 2016, 6(Suppl 1):OP03

Background: This RCT aimed to compare clinical and immunological outcomes after 6 months consumption of baked egg (BE) with an egg free diet in 1–5 year old BE tolerant, but raw egg allergic children.

Methods: Children were recruited at the Women’s and Children’s Hospital, Adelaide, Australia Allergy Clinic and randomised into two groups according to a protocol approved by the Institutional Human Research Ethics Committee, (REC2400/9/14; ACTRN 12612000173897). The intervention group consumed 10 g BE per serve of the provided muffins, biscuits or cake, two to three times per week for 6 months. The control group consumed identical egg free products. Both groups maintained egg free diets during the trial. The final assessment was a medically supervised raw egg oral food challenge (OFC) at 7 months. Immune markers, including skin prick testing (SPT), egg specific IgE and IgG4, Th1/Th2 cytokines and T cell phenotype were assessed at baseline and 7 months.

Results: 43 children were randomised into the study (intervention group n = 21; control group n = 22). The final analysis included 35 children (intervention group n = 17; control group n = 18) who had raw egg OFCs. Ten children (4/17 intervention group and 6/18 control group) tolerated raw egg at the end of the intervention. Tolerance was independent of age and amount of BE consumed. Both groups demonstrated decreased SPT weal sizes and whole egg, egg white, ovalbumin specific serum IgE titre and increased whole egg IgG4. No difference between the groups was observed in the percentage of naive (CD4+ CD45RA+), central (CCR7CD45RA) or effector (CCR7+CD45RA) memory T-cells or cytokine excretion after culture of cells with egg allergens.

Conclusion: The results suggest that BE tolerant 1–5 year old egg allergic children are evolving tolerance to raw egg which is not hastened by short term, regular inclusion of BE. Further trials of larger sample size, including children of different age groups are required.

OP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed egg

Stavroula Giavi1, Antonella Muraro2, Roger Lauener3,4, Annick Mercenier5, Eugen Bersuch3,4, Isabella M. Montagner6, Maria Passioti1, Nicolò Celegato2, Selina Summermatter3,4, Sophie Nutten5, Tristan Bourdeau5, Yvonne M. Vissers5, Nikolaos G. Papadopoulos1,7

1Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; 2 Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Department of Women and Child Health, Padua University Hospital, Padua, Italy; 3Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland; 4CK-CARE, Davos, Switzerland; 5Nestlé Research Center, Lausanne, Switzerland; 6 Department of Surgery, Oncology and Gastroenterology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; 7Centre for Pediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
Correspondence: Yvonne M. Vissers

Clinical and Translational Allergy 2016, 6(Suppl 1):OP04

Background: There is considerable interest in oral immunotherapy (OIT) to treat food allergy. Because the major drawback of OIT is severe side effects, we designed a low allergenic hydrolysed egg (HE) product and tested its efficacy for desensitisation.

Method: In a double-blind placebo control multicentre pilot study (Athens, Davos, Padua), 29 patients (aged 1–5.5 years), diagnosed with IgE-mediated egg allergy were included. A tolerance assessment was performed at day 1 and afterwards 9 ± 1 g HE (n = 15) or placebo (n = 14) was administered daily for 6 months. Primary outcome was the result for OFC to boiled egg performed at the end of the study. Basophil activation and specific IgE and IgG4 were assessed at the start and end of the study.

Results: All egg allergic patients randomized to HE (n = 15) tolerated the full dose at day 1. No significant difference was observed on the primary outcome (36 % and 21 % had a negative OFC in the treatment and placebo group, respectively). While no significant difference was observed regarding egg specific IgE levels, IgG4 to egg white, egg yolk and ovalbumin increased significantly more over time in the treatment than in the placebo group (p = 0.07, p = 0.01 and p = 0.04, respectively). A higher increase over time in the treatment group compared to the placebo group was also observed for specific IgG4/specific IgE. In the basophil activation test, a significant decrease in both CD203c+ (p = 0.04) and CD63+ (p = 0.07) was observed after stimulation with 0.01 µg/ml ovalbumin in the treatment group, as compared to an increase over time in the placebo group.

Conclusion: HE given for 6 months did not change significantly the proportion of patients becoming tolerant to egg. However, HE induced a modulation of the immune response towards better tolerance. A larger study considering a longer treatment period and/or a higher dose could improve the clinical outcome.

Conflicts of interest AM, SN, TB and YMV are employees of Nestec Ltd. The study was sponsored by Nestec Ltd.

OP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacy

Hanneke van der Kleij1, Hans Warmenhoven1, Ronald van Ree2, Raymond Pieters3, Dirk Jan Opstelten1, Hans van Schijndel1, Joost Smit1

1HAL Allergy B.V., Haarlem, The Netherlands; 2Experimental Immunology, Academic Medical Centre, Amsterdam, The Netherlands; 3Institute for Risk Assessment Sciences, Immunotoxicology, Utrecht University, Utrecht, The Netherlands
Correspondence: Hanneke van der Kleij

Clinical and Translational Allergy 2016, 6(Suppl 1):OP05

Background: Peanuts are responsible for the induction of the majority of food related anaphylactic reactions. A curative treatment is not yet available for peanut-allergic patients. A chemically modified peanut extract is being investigated for its potential use in immunotherapy.

Methods: Peanut extract (PE) was reduced and subsequent alkylated resulting in modified PE (MPE) followed by adsorption to aluminium hydroxide (AlOH3). IgE-binding assays using a set of sera from peanut-allergic patients and mediator release assays (MRA) using human basophils were performed. The immunogenicity of PE and MPE was evaluated by the induction of PE-specific IgG after i.p. injections of PE and MPE in mice. In addition, mice were sensitized intra-gastrically for PE and either (1) s.c. challenged with (M) PE ± Al(OH)3 to assess safety, or (2) de-sensitized by s.c. injections of PE or MPE ± Al(OH)3 for 3–6 weeks, followed by oral and i.p. challenges to assess efficacy. Body temperature was measured after challenge as an objective parameter for an anaphylactic shock response. During the course of immunotherapy, blood samples were taken for analysis of antibody responses.

Results: The IgE-binding of MPE was decreased (mean remaining potency: 7.2 ± 5 %) when tested in all patient sera. The potency of MPE in MRA was also reduced for all patients (mean reduction: 10- to 100-fold, range 3- to >10,000-fold). PE and MPE were equally potent in inducing PE-specific IgG antibodies in mice. Mice sensitized for PE experienced severe anaphylactic symptoms upon s.c. challenge with PE. These effects were aborted after modification of PE or after complete binding of PE to Al(OH)3. Immunotherapy with both PE and MPE (±alum) resulted in a dose-dependent reduction of the anaphylactic response upon systemic challenge. In addition, both PE and MPE (±alum) were able to induce strong increases in the levels of PE-specific IgG1 and IgG2a compared to non-desensitized mice.

Conclusions: Various in vitro and in vivo model systems have shown that MPE adsorbed to Al(OH)3 has a significantly improved safety profile compared to PE while retaining its efficacy profile.

OP06 Administration of the yellow fever vaccine in egg allergic children

Roisin Fitzsimons, Victoria Timms, George Du Toit

Guys and St Thomas’ NHS Trust, London, UK
Correspondence: Roisin Fitzsimons

Clinical and Translational Allergy 2016, 6(Suppl 1):OP06

Objectives: Yellow Fever Vaccine (YFV) was developed in the 1930s for the prevention of YF. In the UK it is administered to those travelling to countries where there is a risk of contracting the disease. Adverse reactions are possible following administration of YFV: mild localised erythema, malaise or more severe, but rare, neurotropic or viscerotropic disease. YFV is propagated on hen’s egg and as such poses a risk of allergic reaction to those children with an egg allergy.

Children in the UK with an egg allergy were unable to receive the YFV until GSTT Children’s Allergy Service was awarded a licence to be an YFV centre in 2013. There are few studies looking at the administration of YFV in patients with an egg allergy, suggesting this can be administered in divided doses and protective immunity achieved following intradermal administration 1/5 of the dose.

Methods: A prospective evaluation of patients receiving the YFV between 2013 and 2015 was performed. The administration protocol includes: counselling regarding geographical area to which travel is planned, risks and benefits of receiving the YFV, SPT, and YFV administered as a subcutaneous injection in divided doses—1/10 dose and 30 min later 9/10 dose. The patient is observed for one hour post administration.

Results: Fifteen patients attended the service for administration of the YFV with an age range of 10 months–20 years. Two (13 %) children had positive SPT and did not receive the vaccine. Two (13 %) children had previously had anaphylaxis to egg, both tolerated the YFV. Three (20 %) children tolerated baked egg in their diet—they all tolerated administration of the vaccine, which was administered in divided doses.

Conclusions: YFV can be safely administered to children who are allergic to egg. We should explore the possibility of administering 1/5 of the dose intradermally to those children who are positive on SPT.

ORAL ABSTRACT SESSION 2: Asthma (OP07–OP12)

OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthma

S. Tolga Yavuz1, Guven Kaya2, Mustafa Gulec3, Mehmet Saldir2, Osman Sener3, Faysal Gok2

1Department of Pediatric Allergy, Gata School of Medicine, Ankara, Turkey; 2Department of Pediatrics, Gata School of Medicine, Ankara, Turkey; 3Department of Adult Immunology and Allergic Diseases, Gata School of Medicine, Ankara, Turkey
Correspondence: S. Tolga Yavuz

Clinical and Translational Allergy 2016, 6(Suppl 1):OP07

Background: Acute asthma exacerbation is one of the most frequent emergencies in childhood. We aimed to investigate the risk factors associated with exacerbations in school-age children with asthma.

Method: Children who attended to a tertiary outpatient pediatric allergy and asthma department and diagnosed with asthma were enrolled in the study. A questionnaire including demographic features and parameters to determine socioeconomic status along with previous disease history were applied in the admission visit. Recent GINA guidelines were used to determine the asthma control status of patients and for the diagnosis of asthma exacerbation. Laboratory investigations including complete blood counts with differential, total IgE levels, skin prick tests and pulmonary function tests were also performed.

Results: A total of 431 children (288 male (66.8 %); with a median age [interquartile range] of 8.1 [6.3–11.2] years were included. Asthma was controlled in 154 children (35.7 %), whereas partially controlled and uncontrolled in 53 (12.3 %) and 143 (33.2 %) patients, respectively. 81 patients (18.8 %) presented with an asthma exacerbation. Multivariate logistic regression analysis revealed that history of asthma exacerbation in the last year (Odds Ratio [Confidence Interval]) (16.51 [6.97–39.11]; p < 0.001), lack of previous asthma diagnosis (3.02 [1.53–5.96]; p = 0.001), history of ER admission in the last year (2.34 [1.18–4.66]; p = 0.015) and lack of regular controller therapy (2.80 [1.03–7.61]; p = 0.044) were related with asthma exacerbation whereas presence of rhinitis emerged as a “protective” factor (0.43 [0.24–0.79]; p = 0.006) in school-age children with asthma.

Conclusion: Awareness of risk factors related with asthma exacerbation may alert physicians who deal with school-age children with asthma and may help prompt and rational interventions in order to prevent asthma exacerbations.

OP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalities

Nagwa Hassan1, Hala Shaaban2, Hazem El-Hariri1, Ahmed Kamel Inas E. Mahfouz1

1National Research Centre, Cairo, Egypt; 2Faculty of Medicine, Cairo University, Cairo, Egypt
Correspondence: Ahmed Kamel Inas E. Mahfouz

Clinical and Translational Allergy 2016, 6(Suppl 1):OP08

Background: Asthma is a chronic airway inflammation characterized by being a heterogenous disease. Acupuncture is one of traditional Chinese medicine (TCM) modalities and it is considered the backbone of complementary and alternative medicine Laser acupuncture specially low-level laser therapy (LLLT) is a noninvasive form of phototherapy which being acceptable for treating children instead of needle acupuncture.

Methodology: Our study formed on sixty asthmatic children under ordinary medical treatment for bronchial asthma and they were divided randomly into 3 groups. Group A: Twenty children were given laser Acupuncture session three times per week for 1 month group B: twenty patients given needle acupuncture sessions by a rate same as laser group and group C (control group) under their asthmatic medications only. Assessing of the clinical condition of the patient (frequency of attack and severity of asthma) and laboratory (IgE level and Eosinophil count) before and after the study.

Results: Frequency of asthmatic attack diminished in group A (p < 0.001) more than in group B (p = 0.002) and least in group C (p = 0.147) at the end of the study, Clinical severity of group A significantly improved (p < 0.001) than group B and C, IgE level were significantly improved in both groups A and B (p < 0.001) better than changes occurred in group C (p = 0.057). Eosinophilic count showed more significantly improvement in group A (p < 0.001) than group B (p = 0.206) and group C (p = 0.784).

Conclusions: Application of laser acupuncture sessions beside medical treatment results in more significantly improvement of the asthma frequency of attack, the degree of asthma severity, IgE level and eosinophilic count in asthmatic children than the use of needle acupuncture or medications used only.

OP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadium

Papp Gabor, Biro Gabor, Kovacs Csaba

Szigetvar Hospital, Szigetvar, Hungary
Correspondence: Papp Gabor

Clinical and Translational Allergy 2016, 6(Suppl 1):OP09

Introduction: The exhaled carbon monoxide is an important biomarker of the oxidative stress and the airways inflammation. Most scientific publications account of increase values in asthma. However our known literature does not have data on the relationship between different stadiums of asthma control and the exhaled carbon monoxide values. The aim of this study was to access this correlation.

Method: Our patients are well controlled, partly and uncontrolled asthma bronchial children, who are treated in outpatient clinic. Each of them has treatment according to GINA protocol. Before spirometry, patients were made deep inhalation, then they were made slow exhalation to the carbon monoxide measure equipment. (PiCO + Smokerlyzer) The exhaled carbon monoxide values were only known by the assistant, so that these values wouldn’t influence when putting in a category. We made the statistic by InStat softver. We used non-parametric procedures.

Results: We found significant differences between the groups of well controlled and group of partly or uncontrolled in concentration of exhaled carbon monoxide, but significant difference was not demonstrable between the group of partly controlled and group of uncontrolled (Table 1).
Table 1

Summary

 

Well controlled

Partly controlled

Uncontrolled

Significance

Number of patients

99 (37 %)

102 (38 %)

68 (25 %)

 

eCO (ppm)

3.21 (SD: 1.15)

4.88 (SD: 2.60)

5.55 (SD: 2.49)

P < 0.0001

Conclusion: According to our investigation/examinations the exhaled carbon monoxide is significantly higher in partly or uncontrolled stadium of asthma bronchial than in well controlled stadium of asthma. This higher amount of exhaled carbon monoxide values show the raising of airways inflammation and the finish of well controlled stadium. The exhaled carbon monoxide suggests the inflammation aspect of asthma bronchial. Detailed analysis of our results shows that the eCO can be used to estimate the compliance of patients (Table 2).
Table 2

Summary

 

Controlled

Partly controlled

Uncontrolled

Significant relation

Patients number (male/female)

99 (37 %) (51/48)

102 (38 %) (62/40)

68 (25 %) (36/32)

Age

11.13

11.23

10.97

p > 0.05

FVC%

94.53

94.06

94.74

p > 0.05

FEV1%

95.29

92.24

91.57

p > 0.05

FEV1/FVC

88.24

85.68

85.41

P < 0.05 (p = 0.0186)

FEF25–75 %

94.82

85.95

86.65

P < 0.05 (p = 0.0163)

eCO/ppm/

3.21

4.88

5.55

P < 0.05 (p < 0.0001)

OP10 Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial

Bo Chawes1, Klaus Bønnelykke1, Jakob Stokholm1, Lene Heickendorff2, Susanne Brix3, Morten Rasmussen1, Hans Bisgaard1

1Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark; 2Department of Clinical Biochemistry, Århus University Hospital, Århus, Denmark; 3Department of Systems Biology, Center for Biological Sequence Analysis, Technical University, Lyngby, Denmark
Correspondence: Bo Chawes

Clinical and Translational Allergy 2016, 6(Suppl 1):OP10

Importance: Observational studies have suggested that increased dietary Vitamin D intake during pregnancy may protect the offspring against preschool wheezing, which is the most common disorder in young children.

Objective: To determine whether supplementation of Vitamin D3 during third trimester of pregnancy reduces the risk of persistent wheeze in the offspring.

Design, setting and participants: The study was a double-blinded, single-center, randomized controlled trial conducted within the Copenhagen Prospective Study on Asthma in Childhood (COPSAC2010) unselected mother–child cohort. A total of 627 women were recruited for the Vitamin D trial at 24 weeks of pregnancy, between March 4th 2009 and November 17th 2010. Clinical follow-up of the children (n = 581) was completed when the youngest child turned 3 years and unblinded on March 28th 2014.

Intervention: Vitamin D3 (2400 IU/day) supplementation or matching placebo tablets from pregnancy week 24 to 1 week postpartum.

Main outcome measure: Persistent wheeze at age 0–5 years diagnosed solely by the intervention-blinded study pediatricians strictly adherent to a predefined algorithm based on 11 scheduled and additional acute clinic visits and a day-to-day symptom diary filled by the parents from birth. Secondary outcomes were number of wheezy episodes, asthma, neonatal airway immunology, respiratory infections, allergic sensitization and eczema.

Results: Occurrence of persistent wheeze did not differ between the Vitamin D3 supplement and control group (incidence, 18 % vs. 21 %; hazard ratio, 0.79; 95 % CI, 0.54–1.14, P = 0.21). The number of wheezy episodes was reduced by the Vitamin D3 intervention (mean 5.9 vs. 7.2 episodes; incidence risk ratio, 0.83; 95 % CI, 0.71–0.97, P = 0.02) and the airway immune profile at age one month was up-regulated (principle component analysis, P = 0.04). There was no effect on additional end-points.

Conclusion: The use of Vitamin D3 supplementation during pregnancy did not reduce the risk of persistent wheeze in the offspring.

OP11 Lung function development in childhood

Henrik Wegener Hallas, Bo Chawes, Lambang Arianto, Hans Bisgaard

Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital, Gentofte, Denmark
Correspondence: Henrik Wegener Hallas

Clinical and Translational Allergy 2016, 6(Suppl 1):OP11

Background: We have previously shown that children who develop asthma in childhood have reduced lung function already at birth. The objective of this study was to examine if the inborn lung function deficit in asthmatic children is sustained until adolescence, even if symptoms cease.

Methods: This study included 366 children of the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2000) high-risk birth cohort. Lung function was measured repetitively from 0 to 13 years by spirometry (FEVx) and plethysmography (sRaw). Asthma was diagnosed solely by the COPSAC pediatricians according to a strict predefined algorithm based on symptom load and response to treatment. Age at onset and remission was monitored by daily diary cards.

Association analysis was performed using generalized estimating equation models.

Results: Children developing asthma during childhood compared to children never experiencing asthma symptoms had reduced forced expiratory flow: FEVx (z-score): −0.31 [−0.47; −0.16], p < 0.0001, and increased airway resistance: sRaw (z-score): 0.41 [0.24;0.59], p < 0.0001. The lung function was reduced in the asthmatics already before onset of symptoms (FEVx (z-score): −0.32 [−0.49; −0.14], p = 0.0004 and sRaw (z-score): 0.47 [0.21;0.72], p = 0.0003) and not improving after remission of symptoms (FEVx (z-score): 0.03 [−0.03;0.07], p = 0.31 and sRaw (z-score): 0.02 [−0.03;0.07], p = 0.39).

The level of lung function was not correlated with the duration of symptoms (FEVx (z-score): −0.03 [−0.10;0.04], p = 0.44 and sRaw (z-score): 0.01 [−0.05;0.07], p = 0.68).

Conclusion: The reduced lung function characterizing newborn children developing asthma later in childhood is sustained till adolescence independent of remission of symptoms and not further deteriorated by increased disease duration. This suggests that the lung function deficit accompanying asthma propensity is primarily an inherited trait.

OP12 Is the effect of maternal and paternal asthma different in female and male children before puberty?

Maike Pincus1, Thomas Keil2, Andreas Reich2, Ulrich Wahn1, Susanne Lau1, Linus Grabenhenrich2

1Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; 2Institute of Social Medicine, Epidemiology and Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
Correspondence: Maike Pincus

Clinical and Translational Allergy 2016, 6(Suppl 1):OP12

Background: Parental allergy is one of the strongest risk factors for asthma during childhood, but data on sex/gender-specific effects by maternal and paternal asthma separately are lacking. Our aim was to evaluate the prevalence of asthma in males and females before puberty by maternal and paternal asthma separately.

Methods: We analysed the prospective follow-up data from two decades of the urban multicenter birth cohort study MAS which recruited 1314 children in 5 German cities in 1990. Definition of current asthma was based on the presence of at least 2 of the following criteria: (i) wheeze in the last 12 months; (ii) asthma medication last 12 months; (iii) parent-/self-reported doctor diagnoses asthma ever.

Results: Among girls at age 9, 22 % (n = 11, 95 % CI 11–35 %) with an asthmatic mother had asthma themselves compared to 18 % (n = 6, 95 % CI 7–35 %) with an asthmatic father and 67 % (n = 4, 95 % CI 22–96 %) where both parents had asthma. The corresponding results in boys aged 9 were 17 % (n = 6, 95 % CI 7–33 %), 22 % (n = 8, 95 % CI 10–38 %) and none. In children without an asthmatic parent 4 % (n = 12, 95 % CI 2–6 %) of girls and 8 % (n = 30, 95 % CI 6–11 %) of boys had asthma at 9 years of age. Analyses of assessments in puberty and adolescence are currently ongoing.

Conclusion: The tendency of different sex-specific paternal and maternal effects on asthma at age 9 needs to be interpreted with caution (wide confidence intervals). More information will be gained by considering the MAS data from puberty and during adolescence up to age 20.

ORAL ABSTRACT SESSION 3: Epidemiology—genetics (OP13–OP18)

OP13 Lifestyle is associated with incidence and category of allergen sensitisation: the ALADDIN birth cohort

Sara Fagerstedt, Helena Marell Hesla, Emelie Johansson, Helen Rosenlund, Axel Mie, Annika Scheynius, Johan Alm

Karolinska Institutet, Stockholm, Sweden
Correspondence: Sara Fagerstedt

Clinical and Translational Allergy 2016, 6(Suppl 1):OP13

Background: Environmental and lifestyle factors are considered to contribute to the global increase in allergen sensitization. Pre- and post-natal periods are important time windows for immune system development. Lifestyle is associated with lower prevalence of allergic sensitization. We aimed to determine if the age at onset, and category of allergic sensitization, is associated with lifestyle.

Methods: Children (n = 474) from the prospective cohort study ALADDIN were followed from birth to 5 years. Families were divided into 3 lifestyle groups: anthroposophic (n = 100), partly anthroposophic (n = 209) and non-anthroposophic (n = 165). IgE-sensitization to food- (hen’s egg, cow’s milk and peanut), animal- (cat and dog) and pollen allergen (birch and timothy) was analyzed in blood samples from the children at 6, 12, 24 and 60 months of age.

Results: 118 developed an allergen sensitization up to 5 years of age. Out of these, 18 were from the anthroposophic-, 44 from the partly- and 56 from the non-anthroposophic group. The incidence rate in the children from families with an anthroposophic and partly anthroposophic lifestyle was significantly lower compared to the non-anthroposophic group up to 6 months. Up to 12 months, the incidence rate remained significantly lower in the anthroposophic group compared to the non-anthroposophic group. The differences were explained by the sensitization to food allergens in early infancy.

Conclusions: Anthroposophic lifestyle is associated with reduced risk of allergic sensitization in early childhood. This seems largely explained by the absence of food sensitization before one year of age. We propose that this lifestyle affects the pattern of the allergic march.

OP15 Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance

Jorge Esparza-Gordillo1,2, Anja Matanovic1,2, Ingo Marenholz1,2, Anja Bauerfeind1, Klaus Rohde1, Katja Nemat3, Min-Ae Lee-Kirsch3, Magnus Nordenskjöld4, Marten C.G. Winge4, Thomas Keil5, Renate Krüger6, Susanne Lau6, Kirsten Beyer6, Birgit Kalb6, Bodo Niggemann6, Norbert Hübner1, Heather J. Cordell7, Maria Bradley4,8, Young-Ae Lee1,2

1Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany; 2Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany; 3Klinik fur Kinder- und Jugendmedizin, Technical University Dresden, Dresden, Germany; 4Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 5Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany; 6Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; 7Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK; 8Dermatology Unit, Department of Medicine, Solna Karolinska University Hospital, Stockholm, Solna, Sweden
Correspondence: Jorge Esparza-Gordillo

Clinical and Translational Allergy 2016, 6(Suppl 1):OP15

Epidemiological studies have shown that maternal allergy is a stronger risk factor for the offspring than paternal allergy, suggesting a preferential maternal transmission of disease risk. However, the molecular mechanism underlying this observation is currently unknown. Loss-of-function mutations in the filaggrin gene (FLG) cause skin barrier deficiency and strongly predispose to atopic dermatitis (AD). We analyzed the 4 most prevalent European FLG mutations (c.2282del4, p.R501X, p.R2447X, and p.S3247X) in two family-based samples (759 and 450 AD families) and applied the PREMIM/EMIM tool to test for parent-of-origin effects. As expected from the known role of these mutations on AD, children carrying a FLG mutation had a 2.4 fold increased disease risk (R1meta-analysis = 2.4, P = 1.0 × 10−36). Strikingly, we also observed a strong maternal FLG genotype effect indicating that children of FLG-carrier mothers had a 1.5-fold increased AD risk (S1 = 1.50, Pmeta-analysis = 8.4 × 10−8). This maternal effect that was consistent in both sets of families and for all 4 mutations analyzed. Our results point to two independent scenarios where FLG mutations increase AD risk: (i) carrying a mutation and (ii) having a mutation carrier mother. This maternal effect was independent of mutation inheritance and can be seen as a non-genetic transmission of a genetic effect. Interestingly, the FLG maternal effect was observed only when mothers had allergic sensitization, suggesting that FLG-induced changes in the maternal immune response shape the child’s immune system through feto-maternal cross-talk and increase the child’s risk for AD. Overall, our study indicates that maternal FLG mutations act as strong environmental risk factors for the child and highlights the potential of family-based studies in uncovering novel disease mechanisms in the field of allergy susceptibility.

OP16 Allergic multimorbidity of asthma, rhinitis and eczema in the first 2 decades of the German MAS birth cohort

Thomas Keil, Hannah Gough, Linus Grabenhenrich, Dirk Schramm, Andreas Reich, John Beschorner, Antje Schuster, Carl-Peter Bauer, Johannes Forster, Fred Zepp, Young-Ae Lee, Renate Bergmann, Karl Bergmann, Ulrich Wahn, Susanne Lau

Charité-Universitätsmedizin Berlin, Berlin, Germany
Correspondence: Thomas Keil

Clinical and Translational Allergy 2016, 6(Suppl 1):OP16

The published version of this abstract can be found at [1].

Reference
  1. 1.

    Pediatr Allergy Immunol. 2015;26(5):431–7. http://onlinelibrary.wiley.com/doi/10.1111/pai.12410/abstract.

     

OP17 Childhood anaphylaxis: a growing concern

Filipe Benito Garcia, Inês Mota, Susana Piedade, Ângela Gaspar, Natacha Santos, Helena Pité, Mário Morais-Almeida

Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
Correspondence: Filipe Benito Garcia

Clinical and Translational Allergy 2016, 6(Suppl 1):OP17

Background: Anaphylaxis is a severe life-threatening condition, frequently underdiagnosed and undertreated. The incidence of anaphylaxis is increasing, especially among children. We aimed to examine the changes in anaphylaxis frequency and characteristics over a 5 year period.

Methods: Comparative analysis report on data from two cross-sectional independent samples of children with anaphylaxis, collected 5 years apart in 2006 (sample A) and 2011 (sample B). In both samples, we included patients <18 years with history of anaphylaxis, observed in an Immunoallergy Department in Lisbon, Portugal, during 12 months.

Results: The frequency of anaphylaxis was 0.98 % (A, n = 56/5734) and 1.76 % (B, n = 64/3646), respectively (p = 0.001). Median age was 7 years (A, 1–17 years; B, 18 days–17 years); 71 % (A) and 61 % (B) male. Median age of first anaphylactic episode was 2 years (A, 29 days–16 years) and 3 years (B, 4 days–17 years); 57 % (A) and 44 % (B) had history of asthma. Food-induced anaphylaxis occurred in 70 % (A) and 84 % (B) of children and drug-induced anaphylaxis was reported in 9 % (A) and 8 % (B). Less common triggers were cold exposure, latex and insect sting. Most children had no previous etiologic diagnosis [70 % (A); 73 % (B)]; anaphylaxis triggers were identified in all patients after proper clinical investigation. Clinical manifestations of anaphylaxis were similar in both samples: mucocutaneous [100 % (A); 94 % (B)] and respiratory [75 % (A); 84 % (B)] symptoms were more common than gastrointestinal [39 % (A); 42 % (B)] and cardiovascular [21 % (A); 25 % (B)] manifestations. In 89 % (A) and 88 % (B), the anaphylactic reaction occurred in the first 30 min after trigger exposure. Only about one-third of children with anaphylaxis had been treated with adrenaline [32 % (A); 33 % (B)].

Conclusions: The frequency of anaphylaxis was significantly higher in 2011; food allergy was the leading cause. The percentages of children with anaphylaxis with previous unknown etiologic diagnosis and treated with adrenaline were fairly similar in both time points. This data suggests the need for improved awareness and educational programs for the recognition and management of children with anaphylaxis.

OP18 Indoor exposure to molds and dampness in infancy and its association to persistent atopic dermatitis in school age. Results from the Greek ISAAC II study

Athina Papadopoulou1, Despina Mermiri2, Elpida Xatziagorou3, Ioannis Tsanakas3, Stavroula Lampidi1, Kostas Priftis4

1Allergy Pediatric Unit, KAT General Hospital, Athens, Greece; 2Allergology and Respiratory Unit, Penteli’s Children Hospital, Athens, Greece; 33rd Pediatric Department, Aristoleleio University, Thessaloniki, Greece; 4Pediatric Allergy and Pulmonology Units, 3rd Department of Pediatrics, University of Athens General Hospital “Attikon”, Athens, Greece
Correspondence: Athina Papadopoulou

Clinical and Translational Allergy 2016, 6(Suppl 1):OP18

The presence of molds as a source of perennial allergens and multiple bacteria has been related to the appearance of respiratory symptoms in several studies. Yet, its role in eczema has not been elucidated.

Aim: The aim of this study was to investigate the association between exposure to indoor visible molds/dampness and the manifestation of eczema in children.

Materials and methods: The study is part of the Greek contribution to ISAAC IΙ that includes 2023 students of randomly selected public primary schools in Athens and Thessaloniki, aged 9–10 years. The children represented a general population sample and were evaluated according to ISAAC II questionnaire, validated for Greek language. Additionally, skin prick tests (SPT), to aero-allergens were performed and children were examined for active lesions.

Results: 13 % had suffered from eczema in the past, 9 % had current and 2 % atopic eczema (positive SPT). Out of the children examined, half reported that eczema first appeared after the age of 5 years whereas 68 % mentioned persistence of eczema since infancy. 10.8 and 6.4 % of children were currently exposed to indoor dampness and visible mold respectively, while 77, 5 % of them confirmed exposure since birth. 10 % of the sensitized children were positive to house dust mites and Alternaria. In logistic regression analysis evaluating 20 environmental risk factors, a significant association was noted between the presence of indoor visible mold and dampness in infancy, and the presence of current eczema OR 1, 89 (95 % CI 1.25–2.85). This association remained significant irrespective of the family history of atopy.

Conclusions: Frequently eczema first appears at early school age. The presence of visible mold and dampness at home during infancy appears to be an initial enhancing risk factor for the development but also for the persistence of the disease throughout school age.

ORAL ABSTRACT SESSION 4: Pediatric rhinitis—immunotherapy (OP19–OP24)

OP19 Associations between residential greenness and childhood allergic rhinitis and aeroallergen sensitisation in seven birth cohorts

Elaine Fuertes1, Iana Markevych1,2, Gayan Bowatte3, Olena Gruzieva4, Ulrike Gehring5, Allan Becker6, Dietrich Berdel7, Michael Brauer8,9, Chris Carlsten8,9, Barbara Hoffmann10,11, Anita Kozyrskyj12,13, Caroline Lodge3, Göran Pershagen4, Alet Wijga14, Heinrich Joachim1

1Institute of Epidemiology I, Helmholtz Zentrum München – German Research Center for Environmental Health, Munich, Germany; 2Division of Metabolic and Nutritional Medicine, Ludwig Maximilians University of Munich, Dr. von Hauner Children’s Hospital, Munich, Germany; 3Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; 4Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 5Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; 6Department of Pediatrics and Child Health, University of Manitoba, Winnipeg MB, Canada; 7Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany; 8School of Population and Public Health, University of British Columbia, Vancouver BC, Canada; 9Department of Medicine, University of British Columbia, Vancouver BC, Canada; 10IUF – Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; 11Heinrich-Heine University of Düsseldorf, Medical Faculty, Deanery of Medicine, Düsseldorf, Germany; 12Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, Edmonton AB, Canada; 13School of Public Health, University of Alberta, Edmonton AB, Canada; 14Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
Correspondence: Iana Markevych

Clinical and Translational Allergy 2016, 6(Suppl 1):OP19

Introduction: Inconsistent associations have been reported between the green environment and childhood asthma and allergic health outcomes. We conducted a meta-analysis on residential greenness and allergic rhinitis and aeroallergen sensitization based on data from Swedish (BAMSE), Australian (MACS), Dutch (PIAMA), Canadian (CAPPS and SAGE) and German (GINIplus and LISAplus) birth cohorts (N = 13,016).

Methods: Allergic rhinitis (doctor diagnosis or symptoms) and aeroallergen sensitization were assessed in children aged 6–8 years in six cohorts and 10–12 years in five cohorts. Residential greenness was defined as the mean Normalized Difference Vegetation Index (NDVI) in 500 m and 1000 m buffers around the home address at the time of health assessment. Cohort-specific associations between NDVI (per 0.2 unit increase) and allergic rhinitis and aeroallergen sensitization were assessed using logistic regression models adjusted for host and environmental confounders. The findings were combined in a random-effects meta-analysis.

Results: Heterogeneous associations for a range of outcomes were observed across cohorts. Greenness in a 500 buffer was positively associated with allergic rhinitis at 6–8 years in BAMSE (odds ratio = 1.42, 95 % confidence interval [1.13, 1.79]) and GINI/LISA South (1.69, [1.19, 2.41]) but negatively associated in GINI/LISA North (0.61 [0.36, 1.01]) and PIAMA (0.67 [0.47, 0.95]). The direction of the effect estimates in the Canadian cohorts were also conflicting but not significant (0.63 [0.32, 1.23] and 1.22 [0.76, 1.95] for CAPPS and SAGE, respectively). All meta-analytic estimates were null. Results were similar for aeroallergen sensitization at 6–8 years and both outcomes at 10–12 years, and were independent of buffer size. Stratification by four urbanization markers (particulate matter smaller than 2.5 µm concentrations, nitrogen dioxide concentrations, population density and urban versus rural surroundings) did not reveal consistent trends within subgroups.

Conclusions: Although residential greenness appears to be associated with childhood allergic rhinitis and aeroallergen sensitization, the direction of the effect varies by location.

OP20 Full symptom control in pediatric patients with allergic rhinitis and asthma: results of a 2-year sublingual allergen immunotherapy study

Zorica Zivkovic, Ivana Djuric-Filipovic, Jasmina Jocić-Stevanovic, Snežana Zivanovic

Children Hospital for Pulmonary Diseases and Tuberculosis, Belgrade, Serbia
Correspondence: Ivana Djuric-Filipovic

Clinical and Translational Allergy 2016, 6(Suppl 1):OP20

Introduction: Our study was designed to assess the efficacy of SLIT in allergic rhinitis and asthma in pediatric population. Here we report interim analysis done after 2 years. The aim of this study was to document the clinical implication of allergen specific drops on symptom severity and medication in children with allergic rhinitis and asthma.

Methods: In this observational case control study we have collected information from 59 children with AR or/and asthma. 34 children received SLIT drops plus symptomatic treatment whereas 25 of patients received only symptomatic therapy. During the follow up period the patients rate their symptoms (rhinitis, conjunctivitis, asthma and atopic dermatitis) as combined score of severity—traditional symptom score assessment (graded from 0 to 3) plus recording of doses of symptomatic medications. The beneficial effects of SLIT on asthma and rhinitis scores and medication use have been observed for two consecutive years of treatment.

Results: Both asthma and rhinitis scores were decreased during the first year of treatment, with the tendency of further decrease in the second year of follow up period. The most important effects of SLIT were observed for the symptom of wheezing and night cough (Χ2 = 56,790; p < 0.001, Χ2 = 56,142; p < 0.001) only in the experimental group. On the other side the biggest success of SLIT for rhinitis symptoms were detected for nasal congestion and rhinorrhea (Χ2 = 43,607; p < 0.001, Χ2 = 41,809; p < 0.001), without any significant changes in the control group. No differences have been detected for ocular and symptoms of atopic dermatitis. Additional significant improvements were also observed for symptomatic medication: antihistaminic: Χ2 = 32,774; p < 0.001, inhalation corticosteroids: Χ2 = 30,022; p < 0.001, intranasal corticosteroids: Χ2 = 30,785; p < 0.001, beta2agonist Q = 28,783; p < 0.001, LTRA: Q = 12,000; p = 0.002, but only in the experimental group.

Conclusion: The results of this study indicate favorable clinical efficacy of SLIT drops in children with asthma and allergic rhinitis. These findings also suggest that SLIT drops may have potential to alter the natural history of atopic disease with the convenience of home administration and the benefit of oral rather than subcutaneous administration.

OP21 Nasal epithelium of different ages of atopic subjects present increased levels of oxidative stress and increased cell cytotoxicity upon rhinovirus infection

Styliani Taka1, Dimitra Kokkinou1, Aliki Papakonstantinou1, Panagiota Stefanopoulou1, Anastasia Georgountzou1, Paraskevi Maggina1, Sofia Stamataki1, Vassiliki Papaevanggelou2, Evangelos Andreakos3, Nikolaos G. Papadopoulos1,4

12nd Pediatric Clinic, University of Athens, Athens, Greece; 23rd Pediatric Clinic, University of Athens, Attikon University Hospital, Athens, Greece; 3Biomedical Research Foundation, Academy of Athens, Athens, Greece; 4Centre for Pediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
Correspondence: Styliani Taka

Clinical and Translational Allergy 2016, 6(Suppl 1):OP21

Background: The respiratory epithelium is critical both for the clearance of infections and the development of adaptive responses. There is still a significant gap of knowledge on the interplay between maturation of innate immunity, exposure and vulnerability to infections in the development of allergic responses. The aim of the present study was to determine the role of viral infections in the maturation of the immune response in relation to age.

Method: Primary nasal epithelial cells (PNECs) were derived from non atopic (n = 17) and atopic (n = 13) individuals (1–48 years). The existence of atopy was assessed by skin prick testing to common aeroallergens or/and egg white. PNECs were cultured and infected with Human Rhinovirus A1B (HRVA1B). Doubling time of PNECs was assessed using Least Squares Fitting. Reactive oxygen species (ROS) were measured at 1 h, 3 h, 24 h post infection with flow cytometry. Virus replication evaluated using titration method at 8 h, 24 h, 48 h and 72 h. CCL5 release was examined at 48 h using ELISA. Cytotoxicity levels were evaluated at 24 h, 48 h and 72 h with crystal violet staining. Statistic analysis was performed using Linear regression analysis and oneway ANOVA.

Results: Epithelial cell growth rate was affected by age and specifically atopic children have higher doubling time than atopic adults. Also atopic individuals seem to have increased production of ROS at baseline and CCL5 production. PNECs from atopic individuals have increased induction of ROS at 3 h and 24 h (p < 0.05) post infection and higher virus replication at 72 h (p < 0.1). Age is a factor that influence ROS production, CCL5 release and cytotoxicity after HRA1VB infection (p < 0.05). Males produce higher levels of ROS in combination with increased cytotoxicity (p < 0.05).

Conclusion: This is the first study investigating the development of cell growth and ROS generation comparing atopic and non-atopic individuals. Age, atopy and gender are important factors to rhinovirus infection in PNECs.

OP22 Cluster subcutaneous immunotherapy schedule: tolerability profile in children

Monica Piquer Gibert, Montserrat Alvaro Lozano, Jaime Lozano Blasco, Olga Domínguez Sánchez, Rosa Jiménez Feijoo, Marcia Dias da Costa, Ma Teresa Giner Muñoz, Adriana Machinena Spera, Ana Maria Plaza Martín

Sant Joan de Déu Hospital, Barcelona, Spain
Correspondence: Monica Piquer Gibert

Clinical and Translational Allergy 2016, 6(Suppl 1):OP22

Background: Subcutaneous immunotherapy (SCIT) treatment begins with an allergen dose increase phase over a period of several weeks, followed by a maintenance phase. The aim of our study was to test the tolerance of a cluster schedule.

Methods: We recruited pediatric patients diagnosed with asthma and/or rhinoconjunctivitis due to mites or alternaria in which immunotherapy was indicated. A SCIT with non-modified allergens with aluminium hydroxide as adjuvant was chosen. On the 1st day patients received two injections (6000 and 9000SQ+) within 30 min. Spirometry was performed baseline and 30 min after the second dose or/and at any time if respiratory symptoms appeared. A maintenance dose of 15000SQ+ was administered after 28 days, spirometry was performed baseline and if respiratory symptoms appeared. Adverse events were recorded. Demographic data were collected.

Results: Ninety-five children (31 females) between age 5 and 18 years were evaluated. History of allergic disease: drug allergy 1 %, food allergy 7 %, atopic dermatitis 27 %, and no other allergic diseases 65 %. 49/95 were monosensitised. 69 patients had asthma, 59 of them also rhinoconjunctivitis, and 26 only rhinoconjunctivitis. Patients were treated with a SCIT formulation with alternaria in 12, D. pteronyssinus in 18, and a mix of mites in 65. Local and systemic reactions were reported by 2.1 % (2/95) of the patients. Both local reactions were delayed reactions (injection site swelling and erythema). Systemic reactions occurred within 30 min after the second dose on the first day. One patient had a mild asthma reaction, resolved with inhaled salbutamol, and tolerated subsequent doses. The second patient had a moderated asthma reaction, treated with inhaled salbutamol and oral corticosteroids, SCIT was withdrawn as any dose above 6000SQ+ produced asthma.

Conclusions: This cluster schedule has a good safety profile in children. SCIT fast protocols improve compliance by reducing injections, appointments, and school/work absences.

OP23 Rhinitis as a risk factor for asthma severity in 11-year old children: population-based cohort study

Matea Deliu, Danielle Belgrave, Angela Simpson, Adnan Custovic

University of Manchester, Manchester, UK
Correspondence: Matea Deliu

Clinical and Translational Allergy 2016, 6(Suppl 1):OP23

The published version of this abstract can be found at [1].

OP24 The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children

João Gaspar Marques, Pedro Carreiro-Martins, Joana Belo, Sara Serranho, Isabel Peralta, Nuno Neuparth, Paula Leiria-Pinto

Immunoallergy Department, Hospital de Dona Estefânia CHLC EPE, Lisbon, Portugal
Correspondence: João Gaspar Marques

Clinical and Translational Allergy 2016, 6(Suppl 1):OP24

Methods: A retrospective analysis of the children (6–18 years-old) with a medical diagnosis of asthma that performed spirometry during 2014 in our lung function laboratory was made. GLI and Zapletal equations agreement was compared in three different obstruction criteria: FEV1 < 80 % predicted, FEV1 < LLN (lower limit of normal) and FEV1/FVC < LLN. All the agreement analyses were performed using Cohen’s kappa test.

Results: 391 children were evaluated (61 % boys) with a mean age of 12.4 years (standard-deviation ±3.1 years). Considering Zapletal equations the percentages of children classified as obstructed according to the different analyzed parameters were: 7.7 % for FEV1 < 80 % predicted, 8.7 % for FEV1 < LLN and 26.3 % for FEV1/FVC < LLN. Assuming GLI 2012 equations the correspondent percentages were 12.0 % for FEV1 < 80 % predicted, 11.8 % for FEV1 < LLN and 29.2 % for FEV1/FVC < LLN. Using the FEV1/FVC < 0.70 ratio criteria 10.2 % of the patients were classified as obstructed. Cohen’s kappa coefficients for agreement between Zapletal and GLI 2012 equations to the analyzed parameters were: 0.67 for FEV1 < 80 % predicted, 0.64 for FEV1 < LLN and 0.85 for FEV1/FVC < LLN.

Conclusions: In our study there was a good agreement between the commonly used prediction equations (Zapletal equations) and GLI 2012 equations. GLI 2012 equations adoption is a reasonable option in asthmatic children lung function evaluation, although maybe the changes in nowadays clinical practice will not be considerable.

POSTER DISCUSSION SESSION 1: Food allergy (PD01–PD05)

PD01 Allergen-specific humoral and cellular responses in children who fail egg oral immunotherapy due to allergic reactions

Marta Vazquez-Ortiz1, Mariona Pascal2, Ana Maria Plaza1, Manel Juan2

1Pediatric Allergy Section, Sant Joan de Deu Hospital, Barcelona, Spain; 2Immunology Department, Hospital Clinic, Barcelona, Spain
Correspondence: Marta Vazquez-Ortiz

Clinical and Translational Allergy 2016, 6(Suppl 1):PD01

Introduction: Oral immunotherapy (OIT) may trigger significant allergic reactions. Our ability to identify children who are unable to undergo OIT safely is limited.

Aim: To characterize allergen-specific humoral and cellular responses in children who required “Early Discontinuation” (named “ED group”) due to allergic reactions, versus those who successfully completed egg-OIT (“non ED group”).

Methods: Children aged 5–16 years with DBPCFC-confirmed IgE-mediated egg allergy were recruited for egg-OIT. Ovalbumin (OVA) and ovomucoid (OVM)- specific serum IgE, IgG4 and IgA were determined by ImmunoCAP (Thermofisher Scientific, Sweden) at baseline. In a subset of patients, PBMCs (2 × 105) were isolated and cultured (in duplicate) for 7 days at 37 °C in 5 % CO2 with OVA and OVM (both at 100 ug/ml, Sigma Aldrich, Germany) with phytohaemaglutinin and medium alone as positive and negative controls respectively. After centrifugation, supernatants were collected and analyzed for presence of IL-2, IL-4, IL-5, IL-13, IFNg, IL-10, IL-9, IL-17, IL-6 and TNFa by multiplex magnetic bead assay (Luminex, Invitrogen, Life technologies, USA). Comparative analysis between ED and non ED groups was performed using U-Mann-Withney test. A two-tailed p value <0.05 was considered significant.

Results: 50 children underwent egg-OIT, 9 of whom required “Early Discontinuation” (ED group). Specific IgE, IgG4 and IgA to OVA and OVM were higher in ED vs. non ED group (p < 0.005). IL-9 production by PBMC following OVM stimulation was higher in ED (n = 6) vs. non ED group (n = 10, p < 0.006) and a similar trend was detected after OVA. IL-5 and IL-13 responses to OVM also tended to be higher in ED vs. non ED children. No differences were observed in other cytokines.

Conclusion: An IL-9 predominant cellular response as well as a strong allergen-specific poly-isotypic antibody response characterizes egg-allergic children who fail OIT at early stages due to significant allergic reactions.

PD02 FoxP3 epigenetic features in children with cow milk allergy

Lorella Paparo1, Rita Nocerino1, Rosita Aitoro1, Ilaria Langella1, Antonio Amoroso1, Alessia Amoroso1, Carmen Di Scala1, Roberto Berni Canani1,2

1Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy; 2CEINGE Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
Correspondence: Lorella Paparo

Clinical and Translational Allergy 2016, 6(Suppl 1): PD02

Background and aim: Epigenetic changes in DNA methylation have been recently demonstrated during cow milk allergy (CMA) disease course (Berni Canani R et al. Clin Epigenet, 2015). The suppressive phenotype of regulatory T (Treg) cells, characterized by stable expression of transcription factor Forkhead box Protein 3 (FoxP3), is involved in oral tolerance acquisition. We aimed to assess whether tolerance acquisition in children with IgE-mediated CMA involves a different DNA methylation profile of FoxP3.

Methods: DNA methylation of CpGs in the promoter regions and respective mRNA levels of FoxP3 from peripheral blood mononuclear cells (PBMCs), were assessed in children with active IgE-mediated CMA (Group 1), CMA subjects with recent evidence of oral tolerance acquisition (Group 2) and in healthy controls (Group 3).

Results: 37 children (18 male, aged 3–18 months) were enrolled: 16 in Group 1, 10 in Group 2 and 11 Group 3. DNA methylation profiles of FoxP3 clearly separated active CMA patients from healthy controls. Active IgE-mediated CMA patients showed significantly higher rate of DNA methylation in FoxP3 promoter region compared to healthy controls (52 vs. 80 %; p < 0.0001). DNA methylation analysis of this transcription factor clearly separated CMA patients by disease-state: tolerant subjects presented a significant different DNA methylation profile compared with active CMA patients (42 vs. 80 %, p < 0.0001). This profile was similar but not identical to that observed in healthy controls. A strong correlation between gene promoter DNA methylation rates and respective mRNA levels was also demonstrated (R2 = 0.946; p < 0.0001).

Conclusion: Tolerance acquisition in children with IgE-mediated CMA involves demethylation of promoter region of Foxp3 gene leading to an increased expression in Tregs. This feature could be a new epigenetic biomarker to follow the CMA disease course.

PD04 Combined milk and egg allergy in early childhood: let them eat cake?

Santanu Maity, Giuseppina Rotiroti, Minal Gandhi

Royal Free London NHS Trust, London, UK
Correspondence: Santanu Maity

Clinical and Translational Allergy 2016, 6(Suppl 1):PD04

Background: Milk and egg allergies are the commonest food allergies in early childhood. Over 75 % may tolerate baked products avoiding unnecessary dietary restrictions and accelerating tolerance.

Objective: To audit our use of casein and ovomucoid recombinants in patients with combined milk and egg allergy to aid early dietary introduction of baked products.

Method: Caesin and ovomucoid recombinant testing on combined milk and egg allergic children, not previously exposed to baked products. Challenge selections included consideration of current published predictive data for SPT and recombinant tests.

Results: 67 children, aged 5–74 months (median 9.5) were tested.

Milk allergy: 18/19 (94.7 %) children passed the baked milk challenge. The SPT milk solution was 0–10 mm (median 3.0 mm), SPT raw milk 0–23 mm (median 10 mm), casein 0–14.2 KU/l (median 0.59 KU/l, mean 2.54 KU/l). 2/18 children who passed had a milk solution SPT of 6 mm or above but with a casein of 1.46 and 2.13. GG allergy: 18/21 (85.7 %) children passed the baked egg challenge. The SPT egg solution was 2–18 mm (median 8.0 mm), SPT raw egg 7–22 mm (median 10 mm), ovomucoid 0–4.56 KU/l (median 0.24, mean 0.59). 14/18 children had an egg solution SPT of 5 mm or above. These children’s’ ovomucoid was 0–4.56 KU/l (median 0.36, mean 0.65). 3 children failed their baked egg challenge (SPT egg solution 11 mm, 6 mm & 4 mm, ovomucoid 28.8 KU/l, 0.0 KU/l, 0.79 KU/l). Two of these children are now tolerating baked egg. 33 children were not challenged. Their median SPT to milk solution was higher (median 6.0) as was the caesin (median 16.6). The egg solution SPT was similar (median 10) with higher ovomucoid levels (median 12).

Conclusion: Caesin and Ovomucoid recombinants are useful additional predictive tools to aid patient selection for early introduction of dietary baked milk and egg.

PD05 Introduction of complementary foods in relation to allergy and gut microbiota in farm and non-farm children

Karin Jonsson1, Annika Ljung2, Bill Hesselmar2, Ingegerd Adlerbert2, Hilde Brekke3, Susanne Johansen4, Agnes Wold2, Ann-Sofie Sandberg1

1Chalmers University of Technology, Gothenburg, Sweden; 2University of Gothenburg, Gothenburg, Sweden; 3University of Oslo, Oslo, Norway; 4Skaraborg Hospital, Lidköping, Sweden
Correspondence: Karin Jonsson

Clinical and Translational Allergy 2016, 6(Suppl 1):PD05

Background and aim: Evidence is emerging that postponed introduction of complementary foods might increase the risk of allergy. Likewise, low “food diversity” in early age has been associated with allergy development. Interestingly, also low diversity of the early gut microbiota has been linked to increased allergy risk. The incidence of allergy is markedly low in farm children; our aims are to investigate introduction practices in relation to: (1) farm environment, (2) allergy development, and (3) gut microbiota.

Methods: Subjects from the FARMFLORA birth-cohort, including 28 farm and 37 non-farm parent-children pairs, were investigated. Practices of breastfeeding, formula and complementary feeding were recorded; month of introduction was registered for potatoes, vegetables, fruits, berries, nuts, peanuts, legumes, eggs, fish, meat, milk and flour. Allergies were diagnosed by doctors. Timing of introduction of complementary foods was analyzed in farm and non-farm infants and related to allergy development. Additionally, prevalence of microbes commonly found in the infant gut microbiota was analyzed on a genus level up to 18 months of age and will be related to formula and food introduction practices.

Preliminary results: Nuts were introduced earlier to farm children than non-farm children and flour was more frequent introduced to farm children at 7 months. In contrast, peanuts were less frequent introduced to farm children at 17 months. When allergic (1 farmer, 10 non-farmers) and healthy children were compared, fish was more frequent introduced to healthy infants at 10 months; the association was strengthened in children of non-allergic mothers but weakened when the analysis was confined to non-farm children. Legumes were more frequent introduced to healthy infants at 8 months, although non-significantly when maternal heredity was considered. Eggs were less frequent introduced to healthy infants at 11 months; the significance disappeared when considering maternal heredity. No differences in food diversity were observed at 6 months, or in total up to 18 months, between farm and non-farm children or between healthy and allergic children. Microbial analyses are ongoing.

POSTER DISCUSSION SESSION 2: Asthma and wheeze (PD06–PD16)

PD06 The association between asthma and exhaled nitric oxide is influenced by genetics and sensitisation

Björn Nordlund, Cecilia Lundholm, Villhelmina Ullemar, Marianne van Hage, Anne Örtqvist, Catarina Almqvist

Karolinska Institutet, Stockholm, Sweden
Correspondence: Björn Nordlund

Clinical and Translational Allergy 2016, 6(Suppl 1):PD06

Background: Rationale was to enhance knowledge about fraction of exhaled nitric oxide (FeNO) as a biomarker. The aim was to analyze the association between asthma and FeNO, and to take genetics, inhaled corticosteroids (ICS), and sensitization into account.

Methods: The population based STOPPA study of 681 twins (53 % monozygotic (MZ) and 47 % dizygotic (DZ), average age 12.6; SD 1.5) was used. Measurements were FeNO (parts per billion), parental report of current asthma with and without ICS and airborne sensitization (allergen-specific immunoglobulin E ≥ 0.35 kUA/l). The association between FeNO and asthma was analyzed between and within twin pairs (DZ and MZ) in regression models, the latter giving adjustment for shared environmental and genetic factors. Regression coefficients (β) and 95 % confidence interval (CI) per unit increase of log-transformed FeNO were presented.

Results demonstrated an association between current asthma and FeNO in between pairs analysis; β 0.31 (0.13–0.50), which was significantly stronger within DZ; β 0.41 (0.17–0.64), compared to MZ; β 0.07 (−0.18–0.31), and DZ vs. MZ, (p = 0.049). This indication of genetic confounding remained in twins without regular treatment with ICS (p = 0.022), but not in those with regular ICS. There was no increase in FeNO in children with asthma but without sensitization in between pairs analysis; β −0.01 (−0.27–0.24), compared to children with neither asthma nor sensitization. However, sensitization only, β 0.33 (0.14–0.53), and together with asthma, β 0.62 (0.32–0.92) were associated with increased FeNO.

Conclusions: This study shows that genetics and sensitization are strong influences for the association between asthma and FeNO.

PD09 Prevalence patterns of infant wheeze across Europe

Anna Selby1, Kate Grimshaw1, Thomas Keil2, Linus Grabenhenrich2, Michael Clausen3, Ruta Dubakiene4, Alessandro Fiocchi5, Marek Kowalski6, Nikos Papadopoulos7, Marta Reche8, Sigurveig Sigurdardottir3, Aline Sprikkleman9, Paraskevi Xepapadaki7, Clare Mills10, Kirsten Beyer2, Graham Roberts1

1University of Southampton, Southampton, UK; 2Charité Universitätsmedizin, Berlin, Germany; 3Landspitali University Hospital, Reykjavik, Iceland; 4Vilnius University, Vilnius, Lithuania; 5Pediatric Hospital Bambino Gesu, Rome, Italy; 6Medical University of Lodz, Lodz, Poland; 7University of Athens, Athens, Greece; 8Sofia Children’s University Hospital, Madrid, Spain; 9Emma Children’s Hospital, Amsterdam, the Netherlands; 10University of Manchester, Manchester, UK
Correspondence: Anna Selby

Clinical and Translational Allergy 2016, 6(Suppl 1):PD09

Aim: Pre-school wheeze is a significant health problem worldwide. This analysis aimed to assess prevalence patterns of wheeze in the first 2 years of life and identify how risk factors for this vary across Europe focusing on food allergy, breastfeeding and smoke exposure.

Methods: Children from nine European countries were recruited into the EuroPrevall birth cohort between 2005 and 2010. At recruitment, data were collected on birth details, familial allergies, socio-demographic status and environmental exposures, including cigarette smoke. At 12 and 24 months, data on feeding, symptoms and signs of allergic disease, wheeze, cigarette smoke exposure, infections and day care attendance were collected. The primary outcome for this study was wheeze in the second year of life using Poisson regression to identify risk factors (STATA SE 13).

Results: The EuroPrevall birth cohort included 12049 infants. Data on wheeze in the second year of life was available in 8775 (72.8 %). Prevalence rates varied across Europe with a broadly north-western to south-eastern gradient (Table 3). In multivariate analysis of the whole cohort, male gender, maternal asthma, maternal smoking, day care attendance and frequent respiratory tract infections were identified as risk factors for wheeze in the second year of life. Analysis of individual country data revealed different risk factor patterns. Food allergy was only associated with wheeze in univariate analysis. Breastfeeding did not appear to protect against wheeze.
Table 3

Prevalence of wheeze in the second year of life by country

Nordic

Maritime

Central European

Mediterranean

All

Iceland

UK

Netherlands

Germany

Poland

Lithuania

Spain

Italy

Greece

17.2 %

13.1 %

10.8 %

11.8 %

1.7 %

1.9 %

3.0 %

9.5 %

2.8 %

7.8 %

Conclusions: In this study, the prevalence of wheeze in the second year of life varied considerably across Europe. A priori risk factors for preschool wheeze did not explain this variation. Other factors may be operating within countries.

PD10 Epidemiologic changes in recurrent wheezing infants

Herberto Jose Chong Neto1, Gustavo Falbo Wandalsen2, Ana Carolina Dela Bianca3, Carolina Aranda2, Nelson Augusto Rosário1, Dirceu Solé2, Javier Mallol4, Luis García Marcos5

1Federal University of Paraná, Curitiba, Brazil;; 2Federal University of São Paulo, São Paulo, Brazil; 3Federal University of Pernambuco, Recife, Brazil; 4University of Santiago de Chile, Santiago, Chile; 5University of Murcia, Murcia, Spain
Correspondence: Herberto Jose Chong Neto

Clinical and Translational Allergy 2016, 6(Suppl 1):PD10

The published version of this abstract can be found at [1].

PD13 A single nucleotide polymorphism in the GLCCI1 gene is associated with response to asthma treatment in children

Ivana Banic1, Matija Rijavec2, Davor Plavec1, Peter Korosec2, Mirjana Turkalj1

1Children’s Hospital Srebrnjak, Zagreb, Croatia; 2University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
Correspondence: Ivana Banic

Clinical and Translational Allergy 2016, 6(Suppl 1):PD13

The published version of this abstract can be found at [1].

Reference
  1. 1.

    Allergy. 2015;70(Suppl S101):113–279. http://onlinelibrary.wiley.com/doi/10.1111/all.12717/abstract.

     

PD14 Pollen induced asthma: Could small molecules in pollen exacerbate the protein-mediated allergic response?

Alen Bozicevic, Maria De Mieri, Matthias Hamburger

University of Basel, Basel, Switzerland
Correspondence: Alen Bozicevic

Clinical and Translational Allergy 2016, 6(Suppl 1):PD14

Background: Plant pollen are known to be strong airborne elicitors of asthma in humans, and the role of allergenic proteins in the allergic response is well established. To better understand the exacerbation episodes of asthma in patients, other pathophysiologic mechanisms based on airways mechanics need to be considered. Both mechanisms regulated by cation channels such as TRPA1 and by the lipid kinase PIP5Kγ, regulate the intracellular Ca2+ concentration, having as an effect the smooth muscle contractionand consequent airways constriction. To explore a possible contribution of non-allergenic small molecules in pollen to the clinical outcome of asthma, we analyzed and compared the phytochemical profiles of pollen originating from Ambrosia artemisiifolia and other 29 plant species causing pollen allergenicity of varying severity.

Methods: Profiling was performed with high performance liquid chromatography (HPLC) coupled with electrospray ionization mass spectrometry (ESIMS), photodiode array (PDA) and evaporative light scattering (ELSD) detectors, and supported by microprobe nuclear magnetic resonance (NMR) spectroscopy and spectrophotometric analysis.

Results: The presence of conjugated polyamineswas a characteristic feature of pollen from the family of Asteraceae (Ambrosia and Artemisia ssp.). Compounds with Michael acceptor properties, such as sesquiterpene lactones (STLs) were present in pollen of different families.

Conclusion: Polyamines, such as spermine and spermidine, activate the lipid kinase PIP5Kγ. Sesquiterpene lactones activate cation channel TRPA1. Thus, the possible contribution of these small molecules in the exacerbation of airway constriction after exposure to plant aeroallergenes should be explored in more detail. The immunologic modulation through allergens might not be the only responsible for the asthma exacerbation episodes.

PD15 A qualitative study to understand how we can empower teenagers to better self-manage their asthma

Simone Holley1, Ruth Morris2, Frances Mitchell3, Rebecca Knibb4, Susan Latter1, Christina Liossi1, Graham Roberts1,2

1University of Southampton, Southampton, UK; 2University Hospital Southampton NHS Foundation Trust, Southampton, UK; 3St Mary’s Hospital, Newport, UK; 4University of Aston, Birmingham, UK
Correspondence: Simone Holley

Clinical and Translational Allergy 2016, 6(Suppl 1):PD15

Background: Teenagers with asthma often find it difficult to manage their asthma and there is little robust evidence on how health care professionals can facilitate teenagers’ efforts.

Aim: To understand the facilitators and barriers to asthma self-management in teenagers.

Methods: We recruited teenagers aged 12–18 years with asthma to take part in either a focus group or one-to-one interview as preferred by the participants. Separate focus groups and interviews were also conducted with their parents and healthcare professionals (HCP-pediatrician, nurse, family doctor). A thematic data analysis was undertaken.

Findings: 28 teenagers (1 focus group; 22 1:1 interviews), 12 parents (2 focus groups; 4 interviews) and 13 health professionals (2 focus groups, 3 interviews) were recruited. Themes included: 1) medication: forgetting, being prepared, need for routines or reminders, device issues, insufficient time; 2) symptom management: breathing techniques, keeping calm, recognising symptoms; 3) trigger avoidance: avoiding triggers, preparing for unavoidable triggers; 4) beliefs about medication and asthma: effectiveness of medication, need for medication, lack of control, outgrowing asthma; 5) attitudes to asthma: motivation, acceptance, seriousness, embarrassment, confidence, taking responsibility; 6) knowledge: consequences of not taking medication, understanding of condition and understanding of treatment, others not understanding asthma; 7) parents: reminders, education and information, monitoring, communication with HCP, providing support, help with treatments; 8) HCP: providing treatment, education and information, support, communication, conflicting and inaccurate information, honesty, lack of action, clinic setup; 9) others: friends, schools/teachers. In general, similar issues were voiced by the adolescents, parents and HCP.

Discussion: The potential facilitators and barriers to asthma self-management were similar to themes that were identified in our recent narrative systematic review of the literature (Holley et al., submitted). These could be targeted to support teenagers to become empowered to self-manage their asthma through a self-efficacy model of self-management.

Funding: Asthma UK.

PD16 Polymorphism of endothelial nitric oxide synthase (eNOS) gene among Egyptian children with bronchial asthma

Mostafa M. M. Hassan

Medical Biochemistry, Faculty of Medicine, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
Correspondence: Mostafa M. M. Hassan

Clinical and Translational Allergy 2016, 6(Suppl 1):PD16

Introduction: Bronchial asthma is a pulmonary disease characterized by chronic inflammation of the airways and bronchial hyperresponsiveness. Asthma is a multifactorial disease influenced by genetic and environmental factors. Nitric oxide (NO) has recently attracted attention in the pathophysiology of bronchial asthma. NO has protective effects on airways such as muscle relaxation & attenuation of airway hyper-responsiveness to bronchoconstrictor stimuli. In contrast, adverse effects of NO include vasodilation of the bronchial circulation & increased airway secretions. NO is synthesized by the enzyme NO synthase (NOS), which exists in three distinct isoforms: neural (nNOS), inducible (iNOS) and endothelial (eNOS).

Purpose: To investigate the association between Glu298Asp polymorphism of eNOS gene (rs1799983) and development of bronchial asthma in children from Egypt.

Methods: 93 asthmatic children who were able to perform pulmonary function tests efficiently & had a history of mild persistent asthma were included in this study. In addition, ninety healthy age matched subjects who had neither clinical evidence nor personal or familial history of asthma, served as control group. All participants were subjected to thorough medical history taking, clinical examination, pulmonary function testing, and estimation of eNOS (Glu298Asp) gene polymorphism using conventional PCR.

Results: A statistically significant difference was observed as regards genotype distribution of the Glu298Asp polymorphism between children with and without bronchial asthma. The prevalence of the T allele was significantly higher in asthmatic groups in comparison to control group.

Conclusion: This study showed the presence of a strong association between Glu298Asp polymorphism of the eNOS gene and the risk of development of bronchial asthma among Egyptian children. Genetic associations are often inconsistent across ethnic barriers. The results of this study provide the rationale for further studies with larger sample sizes.

POSTER DISCUSSION SESSION 3: Mechanisms—Epidemiology (PD17–PD21)

PD17 Pregnancy outcomes in relation to development of allergy in a Swedish birth cohort

Malin Barman1, Anna Sandin2, Agnes Wold3, Ann-Sofie Sandberg1

1Chalmers University of Technology, Gothenburg, Sweden; 2Umeå University, Umeå, Sweden; 3Gothenburg University, Gothenburg, Sweden
Correspondence: Malin Barman

Clinical and Translational Allergy 2016, 6(Suppl 1):PD17

Background: It is suggested that the infantile period is crucial for immune modulation. Pregnancy outcomes, such as gestational age and birth weight, have been associated with risk for developing allergic disease later in life.

Aim: To analyze the influence of gestational age, birth weight, birth length and head circumference at birth on later allergy development in children born at term in a Swedish birth-cohort (BAS).

Method: All 1231 children born during a 1-year period from February 1996 to January 1997 at the Östersund Hospital in Jämtland, Sweden, were included in the BAS cohort and were followed from pregnancy until 13 years of age, with regular assessments of allergic sensitisation by skin prick tests and allergic symptoms by questionnaires. Data regarding gestational age, birth weight, birth length, and head circumference at birth, were derived from the Swedish Medical Birth Register, and related to atopic eczema and respiratory allergy at 13 years of age in children born at term (gestational week 37–42, n = 1052).

Results: Higher gestational age was a risk factor for developing respiratory allergy at 13 years of age (OR = 1.20, P = 0.041). No association was found for gestational age and prevalence of atopic eczema at 13 years of age. No association was found for birth weight, birth length or head circumference at birth and risk of developing respiratory allergy or atopic eczema at 13 years of age.

Conclusion: Higher gestational age was a risk factor for respiratory allergy at 13 years of age for children born at term.

PD18 Evolution of the IgE response to house dust mite molecules in childhood

Daniela Posa1, Serena Perna1, Carl-Peter Bauer2, Ute Hoffmann2, Johannes Forster3, Fred Zepp4, Antje Schuster5, Ulrich Wahn1, Thomas Keil6,7, Susanne Lau1, Kuan-Wei Chen8, Yvonne Resch8, Susanne Vrtala8, Rudolf Valenta8, Paolo Maria Matricardi1

1Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; 2Department of Pediatrics, Technical University of Munich, Munich, Germany; 3Department of Pediatrics St. Hedwig, St. Josef’s Hospital, Freiburg, Germany; 4Department of Pediatrics and Adolescent Medicine, Johannes Gutenberg University Medical Centre, Mainz, Germany; 5Department of Pediatrics, Heinrich-Heine-University, Düsseldorf, Germany; 6Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany; 7Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; 8Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
Correspondence: Daniela Posa

Clinical and Translational Allergy 2016, 6(Suppl 1):PD18

Background: The allergic IgE response to grass pollen starts as a weak monosensitisation or oligosensitisation phenomenon and increase through a “molecular spreading” process. We aimed this study to investigate the development of the IgE response to house dust mite.

Materials and methods: The Multicenter Allergy Study (MAS), a birth cohort study, started in 1990 and recruiting 1314 infants in 5 German cities. Blood samples were collected at 1, 2, 3, 5, 6, 7, 10, 13 and 20 years of age. Sera with IgE antibodies to an extract of Dermatophagoides pteronyssinus (D.pt) (ImmunoCAP, TFS) were further tested for the presence of IgE to Der p1, Der p2, Der p4, Der p5, Der p7, Der p11, Der p14, Der p15, Der p18, Der p21, Der p23, Clone 16 (in the context of a MeDALL chip). The concentration of Der p1 was measured in house dust samples collected at 6–18 months of age.

Results: Overall, 168 subjects produced serum-IgE to D.pt. and its molecules. Der p2, Der p1 and Der p23 were the molecules most frequently recognized by IgE, working as “initiators molecules” in 98 % of the children. IgE to Der p4, 5, 7, 11, and 21 were frequently observed (20–37 %) while those to Der p 14, 15, 18 and to clone 16 were less frequent (11–18 %). This ranking of prevalence was stable during the first two decades of life. The IgE sensitization profiles to the 12 molecules were extremely heterogeneous in the population at all ages. Twenty-one subjects remained prospectively sensitized to only one molecule (stable”monomolecular” sensitization). The remaining 147 subjects developed a molecularly complex sensitization. The complexity of the IgE response to D.pt molecules was higher in the children most exposed to Der p1 at 6–18 months of age than in the least exposed ones (highest vs. lowest exposure quartile).

Conclusions: In the MAS birth cohort, Der p1, Der p2 and Der p23 are the “initiators” of the IgE response to D. pt. High exposure to Der p1 in early childhood is associated with a stronger “molecular spreading” of the IgE response to D.pt.

PD19 Antibody recognition of nsLTP-molecules as antigens but not as allergens in the German-MAS birth cohort

Olympia Tsilochristou1, Alexander Rohrbach1, Antonio Cappella2, Stephanie Hofmaier1, Laura Hatzler1, Carl-Peter Bauer3, Ute Hoffmann3, Johannes Forster4, Fred Zepp5, Antje Schuster6, Raffaele D’Amelio2, Ulrich Wahn1, Thomas Keil7,8, Susanne Lau1, Paolo Maria Matricardi1

1Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; 2Department of Clinical and Molecular Medicine, Sapienza University of Rome, S. Andrea University Hospital, Rome, Italy; 3Department of Pediatrics, Technical University of Munich, Munich, Germany; 4Department of Pediatrics St. Hedwig, St. Josef’s Hospital, Freiburg, Germany; 5Department of Pediatrics and Adolescent Medicine, University Medicine Mainz, Germany; 6Department of Pediatrics, University of Düsseldorf, Düsseldorf, Germany; 7Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany; 8Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
Correspondence: Olympia Tsilochristou

Clinical and Translational Allergy 2016, 6(Suppl 1):PD19

Background: IgE sensitization to non-specific lipid transfer proteins (nsLTP) molecules is very frequent in Southern Europe, but not in Northern and Central Europe. Information on the geographical distribution of IgG responses to nsLTP in Europe is limited.

Aim: To evaluate the longitudinal development of IgE and IgG responses to nsLTP molecules in a population of German children.

Methods: Children of the German Multicenter Allergy Study (MAS) were included in the present analysis if they had provided: (1) ≥1 serum sample at age 1–3 years, (2) ≥2 serum samples at ages 5–7 years, (3) a serum sample at age 10 years. IgG (cut-off ≥0.1 ISU/L) and IgE (cut-off ≥0.3 ISU/L) to four nsLTP molecules (rPar j2, nArt v3, nPru p3, rCor a8) were tested by microarray (ISAC, TFS). Sera with undetectable IgE (<0.35 kU/l) against a panel of nine common foodborne and airborne allergenic extracts (ImmunoCAP, TFS) were considered negative for IgE against the four nsLTPs and were tested only for IgG.

Results: Overall, 586 sera from 104 children were examined. Of these, 389 (66 %) were negative for IgE to extracts and not tested for IgE to nsLTP. Only 1/104 (1 %) child had IgE to a nsLTP (only once, to nArt v3). By contrast, all 104 children but one (99 %) developed IgG to at least one of the examined nsLTPs. IgG responses to all the nsLTPs were frequent: nPru p3 = 72 % (419/586 sera), rCor a8 = 67 %, nPar j2 = 63 %, rArt v3 = 16 %. IgG to rCor a8 showed the highest concentration [geometric mean value: 1.62 (ISU/L)], followed by nPru p3 [1.40 (ISU/L)], nArt v3 [0.92 (ISU/L)], and rPar j2 [0.87 (ISU/L)]. The prevalence of IgG responses to rPar j2, nPru p3, and rCor a8 rapidly increased until age 5 and plateaued thereafter. The average concentration of IgG antibodies against all four nsLTP molecules remained quite stable at population level until age 10 years.

Conclusions: Our results confirm that IgE responses to nsLTPs are rare among children living in Central-Northern Europe. On the contrary, IgG responses to nsLTPs are very frequent in our German-MAS birth cohort. The biological and clinical implications of our observations require further investigation.

PD20 Early life colonization with Lactobacilli and Staphylococcus aureus oppositely associates with the maturation and activation of FOXP3+ CD4 T-cells

Sophia Björkander, Maria A. Johansson, Gintare Lasaviciute, Eva Sverremark-Ekström

Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Sweden
Correspondence: Sophia Björkander

Clinical and Translational Allergy 2016, 6(Suppl 1):PD20

Introduction: The human gut microbiota influences immune maturation during early life and associates with the development of immune mediated diseases. Several studies support the idea that the gut microbiota influences the FOXP3+ T-regulatory cells, which are important for immune homeostasis and tolerance. Lactobacilli are present in the early infant gut and correlated with a lower risk of allergy later in life. In addition, lactobacilli dampen in vitro immune activation induced by Staphylococcus (S.) aureus, a gut bacteria associated with an increased risk for allergy.

Aims: Here we investigated if early life colonization with lactobacilli and S. aureus influences the maturation and functional responses of FOXP3+ T-cells later in life. Further, we studied how soluble products from these bacteria affect FOXP3+ T-cells in vitro.

Materials and methods: RT PCR was used to detect and quantify bacterial DNA in faeces from infants and associated with immune data at age two. Peripheral blood mononuclear cells from children at age two and adults were analysed basally or after stimulation with cell free supernatants (CFS) from Lactobacillus (L.) reuteri DSM 17938 or/and S. aureus 161:2. The cells were stained with antibodies and analysed by flow cytometry.

Results: Children colonized with S. aureus had a higher percentage of FOXP3+ cells that produced IL-10 and expressed CD161, a T-cell marker connected to high cytokine-producing capacity. Further, in vitro stimulation with S. aureus-CFS induced CD161-expression and production of IL-10 and IFN-γ in FOXP3+ cells. In opposite, lactobacilli-colonization associated with a lower percentage of IL-10-producing FOXP3+ cells after stimulation. L. reuteri-CFS also dampened S. aureus-induced activation of FOXP3+ cells in vitro.

Conclusions: We conclude that species in the early gut microbiota are differentially linked to the development and function of FOXP3+ cells later in life, perhaps by modulation of CD161-expression and cytokine responses.

PD21 Genome-wide meta-analysis identifies 7 susceptibility loci involved in the atopic march

Ingo Marenholz1,2, Jorge Esparza-Gordillo1,2, Franz Rüschendorf1, Anja Bauerfeind1, David P. Strachan3, Ben D. Spycher4, Hansjörg Baurecht5, Patricia Margaritte-Jeannin6,7, Annika Sääf8, Marjan Kerkhof9, Markus Ege10, Svetlana Baltic11, Melanie C. Matheson12, Jin Li13, Sven Michel14, Wei Q. Ang11, Wendy McArdle15, Andreas Arnold16, Georg Homuth17, Florence Demenais6,7, Emmanuelle Bouzigon6,7, Cilla Söderhäll8, Göran Pershagen8, Johan C. de Jongste18, Dirkje S. Postma9, Charlotte Braun-Fahrländer19, Elisabeth Horak20, Ludmila M. Ogorodova21, Valery P. Puzyrev21,22, Elena Yu Bragina22, Thomas J. Hudson23, Charles Morin24, David L. Duffy25, Guy B. Marks26, Colin F. Robertson27, Grant W. Montgomery25, Bill Musk28, Philip J. Thompson11, Nicholas G. Martin25, Alan James28, Patrick Sleiman13,29, Elina Toskala30, Elke Rodriguez5, Regina Fölster-Holst5, Andre Franke31, Wolfgang Lieb31, Christian Gieger32, Andrea Heinzmann33, Ernst Rietschel34, Thomas Keil2,35, Sven Cichon36,37,38, Markus M Nöthen36, Craig E. Pennell11, Peter D. Sly39, Carsten O. Schmidt16, Anja Matanovic1,2, Valentin Schneider1, Matthias Heinig1,40, Norbert Hübner1, Patrick G. Holt11,39, Susanne Lau2, Michael Kabesch14, Stefan Weidinger5, Hakon Hakonarson13,29, Manuel A. R. Ferreira25, Catherine Laprise41, Maxim B. Freidin22, Jon Genuneit42, Gerard H Koppelman9, Erik Melén8,43, Marie-Hélène Dizier6,7, A. John Henderson15, Young Ae Lee1,2

1Max-Delbrück-Center for Molecular Medicine, Berlin, Germany, 2Charité University Medical Center, Berlin, Germany; 3 St George’s, University of London, UK; 4 University of Bern, Switzerland; 5 University Hospital Schleswig–Holstein, Kiel, Germany; 6 Inserm, Paris, France; 7 Université Paris Diderot, France; 8 Karolinska Institutet, Stockholm, Sweden; 9 University of Groningen, The Netherlands; 10 Ludwig Maximilians University, Munich, Germany; 11 University of Western Australia, Perth, Australia; 12 University of Melbourne, Australia; 13 The Children’s Hospital of Philadelphia, USA; 14 University Children’s Hospital Regensburg, Germany; 15 University of Bristol, UK; 16University Medicine Greifswald, Germany; 17 University Medicine and Ernst-Moritz-Arndt-University Greifswald, Germany; 18 Erasmus University Medical Center, Rotterdam, The Netherlands; 19 Swiss Tropical and Public Health Institute and the University of Basel, Switzerland; 20 Medical University, Innsbruck, Austria; 21 Siberian State Medical University, Tomsk, Russia; 22 Research Institute of Medical Genetics, Tomsk, Russia; 23 Ontario Institute for Cancer Research, Toronto, Canada; 24 Centre de santé et de services sociaux de Chicoutimi, Saguenay, Canada; 25 QIMR Berghofer Medical Research Institute, Brisbane, Australia; 26 University of Sydney, Australia; 27 Murdoch Children’s Research Institute, Melbourne, Australia; 28 Sir Charles Gairdner Hospital, Perth, Australia; 29 University of Pennsylvania, Philadelphia, USA; 30 Temple University, Philadelphia, USA; 31 Christian-Albrechts-University, Kiel, Germany; 32 Helmholtz Zentrum München, Germany; 33 Albert Ludwigs University, Freiburg, Germany; 34 University of Cologne, Germany35 University of Würzburg, Germany; 36 University of Bonn, Germany; 37 University of Basel, Switzerland; 38 Research Centre Jülich, Germany; 39 University of Queensland, Brisbane, Australia; 40 Max Planck Institute for Molecular Genetics, Berlin, Germany; 41 Université du Québec à Chicoutimi, Saguenay, Canada; 42 Ulm University, Germany; 43 Sachs’ Children’s Hospital, Stockholm, Sweden
Correspondence: Ingo Marenholz

Clinical and Translational Allergy 2016, 6(Suppl 1):PD21

Introduction: The atopic march refers to the sequential development of allergic conditions in childhood and is associated with severe and persistent disease manifestations. Up to 30 % of infants with eczema develop asthma in childhood which is the most common pattern of the atopic march.

Aim of the study: We conducted a multi-stage genome-wide association study (GWAS) for infantile eczema followed by childhood asthma to unravel the genes underlying this characteristic pattern of allergic disease.

Methods: GWASs were performed in 6 study populations (discovery phase). Selected SNPs were replicated in another 6 study populations (replication phase). Our study included 2428 cases and 17,034 controls of European descent. Association was calculated by logistic regression using an additive allele-dosage model. Meta-analyses were carried out with METAL using the inverse variance fixed effects model.

Results: We identified 7 loci associated with the atopic march at genome-wide significance. Two chromosomal loci at 6p12.3 and 12q21.3 were specific for the combined eczema plus asthma phenotype and associated with allergic disease for the first time. Four additional loci at 1q21.3, 5q31.1, 11q13.1, and 11q13.5 were previously identified in GWASs on eczema while, at 17q21, a single asthma-specific locus was detected. By inspecting all known GWAS loci for eczema or asthma in the discovery set, we found that eczema loci were significantly more likely to be associated with the atopic march than asthma loci.

Conclusion: The two novel loci provide genetic support for a specific atopic march phenotype. In addition, we demonstrate that eczema loci were the main genetic determinants of the atopic march which may point to the development of eczema as a key event initiating this unfavorable disease course. We suggest that the prevention or early treatment of infantile eczema could be a promising approach in order to reduce the burden of allergic diseases associated with the atopic march.

POSTER DISCUSSION SESSION 4: Food allergy—Anaphylaxis (PD22–PD26)

PD22 Atopy patch test in food protein induced enterocolitis caused by solid food

Purificacion González-Delgado1, Esther Caparrós2, Fernando Clemente3, Begoña Cueva1, Victoria M. Moreno2, Jose Luis Carretero4, Javier Fernández1

1Allergy Section, Hospital General Universitario Alicante, Alicante, Spain; 2Universidad Miguel Hernández, Alicante, Spain; 3Pediatrics Service, Hospital General Universitario Alicante, Alicante, Spain; 4Preventive Service, Hospital General Universitario Alicante, Alicante, Spain
Correspondence: Purificacion González-Delgado

Clinical and Translational Allergy 2016, 6(Suppl 1):PD22

Background: Atopy patch test (APT) has been proposed as a valuable tool in children with non-IgE mediated cow’s milk allergy, although studies are small and limited. We aimed to investigate the value of APT in solid food protein induced enterocolitis (FPIES).

Methods: We studied 22 children diagnosed as having FPIES caused by solid foods. Oral food challenge was performed to confirm the diagnosis, except in severe recent reactions. All children had negative skin prick test (SPT) to the offending food.

Patch tests were performed to a battery of foods implicated with the same extracts used for SPT (ALK, Abello, Denmark). They were applied into Finn chambers, placed on the back and removed after 48 h. Reactions were scored at 72 h. Positive reactions included erythema with infiltration (+), with few papules (++) several papules (+++) and vesicles (++++) following the EAACI GA2LEN position paper.

APT were carried out in the first and in follow up visits.

A control group of 10 non atopic children with good tolerance to foods were also tested.

Results: 22 patients with FPIES to solid foods were studied. Mean age at diagnosis was 19 months (range 12–28 months). Eighteen patients were diagnosed by OFC, 4 with clinical history and OFC was not performed because of a recent severe reaction.

Skin prick tests were negative in all.

At the first visit, 8 children showed positivity APT to the offending food, 14 were negative (sensitivity: 0.36, 36 %, specificity: 100 %). Children in control group showed negative APT.

In the series of positive APT children, only 4 showed persistence of positivity when they were tested 24 months later. Patients in whom APT became negative (4), underwent OFC that confirmed persistence of symptoms.

Conclusions: APT in FPIES induced by solid foods has some diagnostic value, but OFC remains as the gold standard.

Although in some patients APT become negative, clinical symptoms persisted, so the age of diagnosis may be important, with loss of sensitivity in older children.

PD23 Watermelon allergy: a novel presentation

Kate Swan, George Du Toit

Pediatric Allergy Department, St Thomas’ Hospital, London, UK
Correspondence: Kate Swan

Clinical and Translational Allergy 2016, 6(Suppl 1):PD23

Background: Recently, there has been an increased recognition of patients who are allergic to the seeds but not the pulp of citrus fruit. A study of 100 patients with nut allergy demonstrated high rates of co-sensitisation between cashew and orange seed but the clinical relevance of this state was not investigated by challenge. Watermelon (Citrullus lanatus), of the Cucurbitaceae family, has a high protein content in the seeds. Watermelon allergy predominantly presents as oral allergy syndrome but we describe a different manifestation.

Case history: 2 patients have presented to our pediatric allergy service, both with a history of uneventfully enjoying consumption of watermelon on multiple occasions. A 6 years old boy, on one occasion of eating watermelon had swelling of his lips and widespread urticaria which resolved with anti-histamine and another young man of 7 years had anaphylaxis requiring an adrenaline autoinjector when he ate watermelon.

Investigations: Both tested negative to the watermelon pulp (0 mm) but had positive skin prick test to the seeds (4 mm and 25 mm). Interestingly, both were also sensitised to cashew nut (3 mm and 6 mm). Neither has ever eaten cashew nut.

Discussion: Watermelon seeds are often swallowed whole or removed before eating, hence patients may appear to tolerate watermelon. When the seed contents are consumed the reaction occurs. Watermelon seeds contain high levels of vicilin-like glycoprotein (seed storage protein). In cashew nuts Ana o 1, a vicilin-like protein, is a major food allergen hence the possibility of cross-reactivity. Other vicilin-like proteins such as peanut (Ara h1), soya (gly m5) and sesame (Ses i3) may also need consideration.

Conclusions: Allergy to fruit seeds may be common and under-recognised. One should consider seed allergy despite previous or ongoing apparent tolerance to the fruit pulp. Clinical significance of the co-sensitisation to the cashew nut is uncertain and needs further investigation.

PD24 A pilot study evaluating the usefulness of a guideline template for managing milk allergy in primary care

Mudiyur Gopi, Tim Smith, Edara Ramesh, Arun Sadasivam

Macclesfield District General Hospital, NHS England, Altrincham, UK
Correspondence: Mudiyur Gopi

Clinical and Translational Allergy 2016, 6(Suppl 1):PD24

Background: With the increasing prevalence of allergic disease, the number of children presenting with cow’s milk protein allergy (CMPA) to primary care has also increased. They have little resource or access to allergy testing and may be unfamiliar with the interpretation of results. Many guidelines have surfaced in the past few years but it is felt that the knowledge, uptake and application of these guidelines have been suboptimal. This project attempted to assess if an electronic version of a modified CMPA guideline can increase the confidence of primary care clinicians in the management of children with possible CMPA. This was done by developing a template which was adapted and modified from a national guideline and was introduced into individual primary care computer systems.

Aim: To evaluate the usefulness of a guideline template for “managing cow’s milk allergy in primary care” based on confidence scoring from primary care clinicians.

Methodology: An electronic guideline template for managing CMPA was introduced for a period of two months in primary care electronic record keeping computer system. Confidence scoring was compared in GPs before and after this period to see whether use of the template resulted in changes in confidence scores.

Results: Nine clinicians participated in this study from five surgeries across North of England. Awareness of national guidelines was very low in this group (11 %) before the template was introduced. Following the introduction of an electronic template to manage CMAP, a significant increase in confidence scores was noted from all participants GPs (p = 0.038). When asked if the template improved their confidence levels, a significant number of respondents answered in the affirmative (p = 0.020). A significant number of respondents felt that using the templates helped them consider the diagnosis if CMPA in cases where such a diagnosis would not have been considered previously (p = 0.003). An additional finding was noted in this survey that the GPs did not refer the patients to dieticians (p = 0.007), which is a MAP guideline recommendation.

Conclusion: Our study, like many previous studies, has demonstrated that the uptake and use of national guidelines remains poor. Our study demonstrates that confidence levels in managing CMPA improved significantly by following an electronic template. We recommend that national and international bodies take note of the significance of these findings as these may guide future CMPA and other guideline implementation in primary care.

PD26 Efficacy and safety of cow’s milk oral immunotherapy protocol

Inês Mota, Filipe Benito Garcia, Susana Piedade, Angela Gaspar, Graça Sampaio, Cristina Arêde, Luís Miguel Borrego, Graça Pires, Cristina Santa-Marta, Mário Morais-Almeida

Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
Correspondence: Inês Mota

Clinical and Translational Allergy 2016, 6(Suppl 1):PD26

Background: Cow’s milk (CM) is one of the major causes of food allergy in childhood. Oral immunotherapy (OIT), a novel strategy, has been recognized as promising treatment for severe and long-lasting CM allergy. The authors describe the efficacy and safety of the CM-OIT protocol used in our Immunoallergy Department.

Methods: Systematic review of all children and adolescents, who underwent CM-OIT until March 2015. The protocol involves the introduction of increasing amounts of non-diluted CM, beginning with sublingual drops and gradual increases of the threshold dose at predetermined intervals. The doses increments and establishment of the dose for daily ingestion at home were always performed in hospital sessions.

Results: A consecutive sample of 49 children and adolescents was included: mean age at initiation of the protocol was 7 years-old, 59 % male and 96 % IgE-mediated reactions (20 % anaphylaxis). Most patients had other allergic diseases (69 % allergic rhinitis, 51 % asthma, 33 % atopic dermatitis) and 24 % multiple food allergy. The target dose (200 mL/day) was reached in 92 % of children, after a mean period of time of 5.2 months (ranging from 1.5 to 15 months). There were 4 failures: 2 due to gastrointestinal symptoms and 2 by poor adherence. During the protocol occurred mild to moderate reactions in 86 % and severe in 3 cases: milk-dependent exercise-induced anaphylaxis, accidental exposure and due to poor adherence to the recommended protocol. All reactions were controlled with rescue treatment.

Conclusions: CM-OIT is a safe and effective treatment for severe and long-lasting CM allergy. The protocol used allowed to achieve tolerance within a short period of time. Maintenance of 200 mL daily ingestion enables a diet without restrictions, with a clear positive impact on quality of life.

POSTER DISCUSSION SESSION 5: Prevention and treatment—Allergy (PD27–PD36)

PD27 Allergy-protection by the lactic acid bacterium Lactococcus lactis G121: mode-of-action as revealed in a murine model of experimental allergy

Stephanie Brand1, Karina Stein2, Holger Heine2, Marion Kauth1

1Protectimmun GmbH, Gelsenkirchen, Germany; 2Division of Innate Immunity, Research Center Borstel, Borstel, Airway Research Center North, Member of the German Center for Lung Research (DZL), Germany
Correspondence: Marion Kauth

Clinical and Translational Allergy 2016, 6(Suppl 1):PD27

Introduction: Numerous epidemiological studies provide strong evidence that frequent contact to a traditional farm environment in early life protects children from the development of allergic airway diseases like hay fever and asthma. We have previously demonstrated that intranasal application of the cowshed-derived lactic acid bacterium Lactococcus lactis G121 (LL) resulted in protection from allergic disease in different murine asthma models. However, details of the underlying mode-of-action of this protective immune response are largely unknown.

Materials and methods: Cellular mechanisms involved in cytokine induction upon LL exposure were analysed in human monocyte derived dendritic cells (moDCs) and murine bone marrow-derived dendritic cells (BMDCs) by use of specific inhibitors for uptake and endosomal acidification. Functional relevance was assessed in vivo in a murine model of allergic airway inflammation with sensitisation via intranasal transfer of ovalbumin (OVA)-pulsed BMDCs to naïve mice.

Results: LL exposure of moDCs and BMDCs led to release of several cytokines including IL-12p70 and IL-10. Preincubation with the inhibitors Cytochalasin D or Bafilomycin A1 (Baf) strongly decreased the cytokine production indicating the importance of both uptake of the bacteria and endosomal acidification. In vivo, sensitisation of mice could be achieved by intranasal administration of OVA-pulsed BMDC. Administration of BMDC which were exposed to LL prior to pulsing with allergen (G121/OVA group) protected mice from the development of allergic airway inflammation upon allergen challenge. However, treatment of BMDC with Baf prior to LL exposure significantly reduced the protective effect resulting in a restored allergic phenotype.

Conclusion: We revealed uptake of LL in dendritic cells and subsequent endosomal acidification as key elements of the mode-of-action of allergy protection mediated by the cowshed-derived bacterium. These findings will greatly support the further development of a Lactococcus-based primary prophylaxis against hay fever and asthma for protection of children early in life.

Funding: KS and HH were supported by DFG, SFB/TR22, project A2.

PD29 The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy

Leif Bjarte Rolfsjord1, Egil Bakkeheim2, Johan Alm3, Håvard Ove Skjerven4, Kai-Håkon Carlsen 2, Jon Olav Hunderi2, Teresa Løvold Berents2, Petter Mowinckel2, Karin C. Lødrup Carlsen2

1Innlandet Hospital Trust, Elverum, Norway; 2Oslo University Hospital, Oslo, Norway; 3Karolinska Institutet, Stockholm, Sweden; 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Correspondence: Leif Bjarte Rolfsjord

Clinical and Translational Allergy 2016, 6(Suppl 1):PD29

Introduction: Hospitalisation with bronchiolitis in infancy is associated with increased asthma risk and reduced quality of life (QoL). Stress may negatively impact morning cortisol and possibly asthma development. We aimed to investigate the association between cortisol and QoL in young children and the potential modifying effect of having been hospitalised for bronchiolitis.

Method: In children recruited during hospitalisation in their first year of life for moderate to severe bronchiolitis (n = 207), and controls (n = 152), with mean ages at follow-up 23.5 and 24.0 months, morning salivary cortisol and parentally completed QoL questionnaires, ITQOL™, were collected. 10.5 % of controls and 32.4 % of bronchiolitis children had asthma diagnosis or inhaled steroids daily. Cortisol was analysed at Karolinska Institutet by RIA. By robust regression, cortisol results were analysed as dependent of QoL quartiles, adjusting for age and gender, and subsequently also for asthma severity, graded depending of follow-up plans or daily steroid inhalations.

Results: Cortisol did not differ significantly between the groups, but was lower the more severe the asthma. Mean QoL scores were higher in the control group for Overall health and General Health, but higher in the bronchiolitis group for Change in health (compared to 1 year ago). Increasing QoL for 11 of 13 domains was associated with increasing morning cortisol in the bronchiolitis group but not in controls except for two domains. Controls had results for one domain pointing the opposite way. After adjustment for asthma severity, the associations remained significant for 9 of 13 domains in the bronchiolitis group. We found interaction between hospitalisation for bronchiolitis and QoL quartiles.

Conclusion: Increasing QoL at 2 years of age was associated with increasing morning cortisol only in the bronchiolitis group. The group differences are possibly due to different asthma frequencies and severities, but not explainable only by our measured asthma severity.

PD30 Randomised trial of the efficacy of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥6 to <12 years with allergic rhinitis

Ulrich Wahn1, Ullrich Munzel2, William Berger3

1Department of Pediatrics, Division of Pneumonology, Immunology and Intensive Care Medicine incl. Rescue Center, Charité University Hospital, Berlin, Germany; 2Meda, Bad Homburg, Germany; 3Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
Correspondence: Ulrich Wahn

Clinical and Translational Allergy 2016, 6(Suppl 1):PD30

Background: MP29-02* (a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP)) is approved for use in patients aged 12 years or older with moderate/severe allergic rhinitis (AR). Superior efficacy of MP29-02* over FP has already been established in seasonal AR patients (aged ≥12 years) [1,2] and in perennial AR patients (aged 12–80 years) [3]. The objective of this analysis was to evaluate the efficacy of MP29-02* compared to FP, administered as 1 spray per nostril twice daily, in pediatric AR subjects aged ≥6 to <12 years.

Methods: This was a randomized, open-label, 3-month safety study in patients (≥4 to 12 years). Qualified subjects had a history of AR, were in good health, and had no evidence of nasal mucosal erosion, nasal ulceration, nasal septum perforation, or any significant nasal disease. Subjects were randomized in a 3:1 ratio to MP29-02* (n = 304) or FP (n = 101). Efficacy was also assessed by subject-reported assessment of overall allergy symptom severity, in a subset of patients (aged 6–12 years; MP29-02*: n = 264; FP: n = 89). Symptom severity was rated daily on a 4 point scale from 0 to 3 (0 = no symptoms; 1 = mild symptoms; 2 = moderate symptoms; 3 = severe symptoms).

Results: The total symptom score at baseline was 1.73 for patients in the MP29-02* group and 1.80 for patients in the FP group (max score: 3). Over the entire study period patients treated with MP29-02* experienced a −0.68 pt reduction in overall symptom score (corresponding to a −5.44 change from baseline in AM + PM reflective total nasal symptom score (rTNSS; max = 24), significantly greater relief than that afforded by FP (−0.54 pt reduction; Diff: −0.14; 95 % CI: −0.28, −0.01; p = 0.04).

Conclusion: MP29-02* provides significantly greater AR symptom relief than FP in a pediatric population (aged ≥6–12 years) and has been granted approval for use in this age group by the FDA.

*Dymista

References
  1. 1.

    Meltzer E, et al. Int Arch Allergy Immunol. 2013;161(4):369–77

     
  2. 2.

    Carr W, et al. J Allergy Clin Immunol. 2012;129(5):1282–9

     
  3. 3.

    Price D, et al. J Investig Allergol Clin Immunol. 2013;23(7):495–503

     

PD31 10 mg of oral bilastine in 2 to 11 years old children has similar exposure to the adult therapeutic dose (20 mg)

Ulrich Wahn1, Román Valiente2, Valvanera Vozmediano3, John C. Lukas3, Mónica Rodríguez3

1Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; 2Clinical Research Department, FAES FARMA SA, Leioa, Bizkaia, Spain; 3Drug Modeling and Consulting, Dynakin SL, Bilbao, Spain
Correspondence: Mónica Rodríguez

Clinical and Translational Allergy 2016, 6(Suppl 1):PD31

Background: The H1 antihistamine Bilastine is approved in adults for seasonal and perennial allergic rhinoconjunctivitis (SAR/PAR) and urticaria. A model based drug development strategy, supported by a set of prior data from adults (N = 310) receiving bilastine, permitted extrapolation of the PK to children, selection of the appropriate dose for the pediatric subset, and then design of an adaptive limited sampling trial to confirm the adequacy of the proposed regimen.

Objective: A clinical trial was performed in children (2–11 years) with SAR/PAR or urticaria to ascertain whether the proposed dose (10 mg/day) matched the systemic exposure in adults (20 mg/day), via pharmacokinetic (PK) assessment.

Methods: Blood samples were drawn from each child after multiple administrations of 10 mg of bilastine as oral dispersible tablet. The PK schedule was optimally designed to minimize the number of samples and the total volume per child. Dataset (N = 31) analysis was with NONMEM® VI. Final model establishment and validation was done using standard statistical and diagnostic criteria for parametric non-linear mixed effects models. Individual PK parameters were used to calculate the exposure (AUC0→∞), which was then applied in the statistical assessment of the suitability of the proposed dose.

Results: The population parameters in children, expressed as mean (SEE%) were the following: Ka 1.29 (22.2) h−1, CL/F 12.5 (5.90) L/h, Vc/F 19.7 (12.8) L, Q/F 2.01 (34.0) L/h, Vp/F 17.4 (14.8) L. Interindividual variability was estimated for CL and Ka15 % and 67 %, respectively and also a proportional error variance (35 (22) %). The model served to characterize the PK in children and to confirm the universal validity of the proposed 10 mg dose for the whole pediatric range.

Conclusion: A daily dose of 10 mg bilastine in children adequately produces similar exposure (1265 ng h/mL) to that observed in adults (1105 ng h/mL) after the therapeutic dose of 20 mg.

PD33 Daily symptoms, nocturnal symptoms, activity limitations and reliever therapies during the three steps of IOEASMA programme: a comparison

Sebastiano Guarnaccia, Luigi Vitale, Ada Pluda, Emanuele D’Agata, Denise Colombo, Stefano Felici, Valeria Gretter, Susanna Facchetti, Gaia Pecorelli, Cristina Quecchia

Centro “Io e l’Asma”, Spedali Civili, Brescia, Italy
Correspondence: Sebastiano Guarnaccia

Clinical and Translational Allergy 2016, 6(Suppl 1):PD33

Introduction: Asthma is a major cause of chronic morbidity and mortality throughout the world in terms of access to emergency services, number of hospitalization days, school absence.

IOEASMA program used an integrative care model, implemented international asthma guidelines, to address pediatric asthma with a multidisciplinary approach.

Methods: Since 2007 the center “Io e l’Asma” implemented the programme as follows:
  • 2007–2009, Path Diagnostic Therapeutic (PDT): 3 visits every 4/6 weeks, with follow-up after 6 months. During the protocol, skin prick tests and spirometry were administered.

    The family physician and/or the patient’s parents communicated to specialists any symptoms and treatments used.

  • 2010–2011: Path Diagnostic Therapeutic Educational (PDTE): 3 visits every 8 weeks, followed by semiannual or annual visit. After the first visit, children and parents undertook an individual therapeutic education course, conducted by the health personnel, about: environmental prevention, asthma attacks management, daily therapy use, proper use of devices, self-management disease control.

  • 2012–2013, Path Diagnostic Therapeutic Educational (PDTE) reissued as ECCM, extended to lifestyles above 6 years of age. The ECCM, after the first visit, addressed the following health adversity: social interaction, diet, physical activity, smoking.

Results: A percentage decrease (Δ%), in “activity limitations”: −37.5 % (PDT); −39.4 % (PDTE); −40.4 % (PTDE + ECCM). “Nocturnal symptoms”: −32.1 % (PDT); −33.8 % (PDTE); −34.3 % (PTDE + ECCM); reaching the highest value in the (PDTE + ECCM). A significant percentage decrease of “daily symptoms” in each group (Δ −37.5 %); −31.7 (PDTE); −23.7 % (PTDE + ECCM). The “relievers therapies” decreased in each group with a more significant percentage change in the first period (Δ −17.3 %) compared to PDTE (Δ −9 %) and to PDTE + ECCM (Δ −14 %); initial number of patients were really different in the three groups at the beginning, so the gap is explained.

Conclusions: An integrated and structured diagnostic and therapeutic pathway can significantly reduce the impact of asthma and its comorbidities and improve children’s quality of life.

PD34 Sensitisation to an inert aeroallergen in weaning rats and longstanding disease, in a sensitisation-tolerant and easily tolerisable rodent strain

George Guibas1,2, Evangelia Spandou3, Spyridon Megremis1, Peter West1, Nikolaos Papadopoulos1,2,4

1Center of Pediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; 2Department of Pediatric Immunology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Trust, Manchester, UK; 3Laboratory of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
Correspondence: George Guibas

Clinical and Translational Allergy 2016, 6(Suppl 1):PD34

Background: The difficulty to sensitize most strains of laboratory rodents to ovalbumin (OVA) -and especially through the airways-, without the addition of adjuvant is well-known. It is also well-known that even if sensitization does occur, it is difficult to model longstanding disease, as the rodents gradually develop tolerance to OVA and usually only one or two exposures are carried out before sacrifice.

Aim: We opted to design a rodent model of allergic rhinitis/asthma in which we could both sensitize the rodents to the innocuous aeroallergen OVA through the airways, but also manage to sustain longstanding disease even after several exposures.

Methods: Three week-old ether-anesthetized male Wistar rats (n = 20) were given ovalbumin (OVA) in saline vehicle, intranasally (i.n). Fifteen days later, awake rats were re-challenged i.n with OVA (n = 10-active group) or saline (n = 10-control group) and subsequent sneezes were counted. The rodents were re-exposed every third day for a total of 13 exposures. They were sacrificed 54 days from the start of the experiment. Inflammation of the nasal mucosa was semi-quantitatively assessed with Haematoxylin & Eosin stain.

Results: OVA-challenged rats demonstrated signs of allergic rhinitis as evidenced by a statistically significant increase in the number of sneezes and presence of marked nasal mucosal inflammation, as opposed to the control group.

Conclusions: We present an experimental model whereby we managed to sensitize to OVA, rats of a sensitization-tolerant strain. These rats were of weaning age upon first exposure and sensitization. Furthermore, these weaning rats were sensitized via the airways without the addition of adjuvant, and multiple exposures to OVA failed to tolerise them to this innocuous aeroallergen. It is likely that exposure to inert aeroallergens at a very early age and in the context of in irritant (ether), rendered these rats susceptible to sensitization and longstanding disease.

PD35 Bacterial and fungi exposure in school and allergic sensitisation in children

João Cavaleiro Rufo1, Joana Madureira1, Inês Paciência1, Lívia Aguiar2–3, Patrícia Padrão5, Mariana Pinto4, Luís Delgado4, Pedro Moreira5, João Paulo Teixeira 2,3, Eduardo Oliveira Fernandes1, André Moreira4,5

1INEGI-Institute of Science and Innovation in Mechanical Engineering and Industrial Management, Porto, Portugal; 2National Institute of Health, Porto, Portugal; 3Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal; 4Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal; 5Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
Correspondence: João Cavaleiro Rufo

Clinical and Translational Allergy 2016, 6(Suppl 1):PD35

Background: Development of allergic sensitization may be regulated by microbial exposure. Children spend a lot of their time in school, under an extensive diversity of biological aerosols, such as bacteria and fungi. We aimed characterize indoor air microbiological exposure as a predictor of allergic sensitization.

Methods: A total of 858 children, aged 8–10 years, attending 71 classrooms in 20 primary schools were submitted to skin-prick tests (SPT) to house-dust mites, mixed weed, mixed grasses, cat, dog and Alternaria alternata. Atopy was defined by a positive SPT to at least one of the allergens. Air samples were collected in all the participating classrooms and respective outdoor locations using a single-stage microbiological air impactor through TSA and MEA plates at a 100 L/min rate. Quantification was performed by naked eye count. Endotoxins were collected using a 2 L/min flow control pump for 4 h and analysed by limulus amebocyte lysate assay. Mann–Whitney tests and logistic regression models were used to statistically analyse the data.

Results: Prevalence of atopy was 34.1 %. The risk of sensitization to inhalant allergens increased with increasing endotoxin exposure in classrooms (p = 0.015). Similarly, higher concentrations of Penicillium spp. showed higher risk of having a positive SPT (1.682 [95 % CI 1.180–2.398]) while children in classrooms with higher concentrations of Aspergilus fumigatus, Aspergilus niger and Chaetomium spp. had lower risk of sensitization (0.64 [95 % CI: 0.47–0.87], 0.62 [95 % CI: 0.45–0.87] and 0.61 [95 % CI: 0.39–0.96], respectively).

Conclusion: Although the cross sectional nature of our study does not allow to establish causal relationships, our results further suggest that current exposure to higher levels of endotoxin is associated with increasing odds of allergic sensitization in children. However, some fungi species, such as Aspergilus fumigatus, Aspergilus niger and Chaetomium spp., but not Penicillium spp., may also have effect in protecting from allergic sensitization.

PD36 Comparative study of allergy rhinitis between two populations: children vs. adults

Adriana Izquierdo Dominguez1,2, Antonio Valero1, Joaquim Mullol3, Alfonso Del Cuvillo4, Javier Montoro5, Ignacio Jauregui6, Joan Bartra1, Ignacio Davila7, Marta Ferrer8, Joaquin Sastre9

1Hospital Clínic de Barcelona, Barcelona, Spain; 2Hospital Quirón, Barcelona, Spain; 3Unitat de Rinologia i Clinica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic de Barcelona, Barcelona, Spain; 4Sección de Rinología, UGC ORL, Hospital de Jerez, Cadiz, Spain; 5Hospital Universitario Arnau de Vilanova, Valencia, Spain; 6Hospital de Basurto, Bilbao, Spain; 7Hospital Clínico de Salamanca, Salamanca, Spain; 8Clínica Universitaria de Navarra, Pamplona, Spain; 9Fundación Jimenez Díaz, Madrid, Spain
Correspondence: Adriana Izquierdo Dominguez

Clinical and Translational Allergy 2016, 6(Suppl 1):PD36

Introduction: Allergic rhinitis (AR) is a highly prevalent disease among the worldwide population, with significant impact on quality of life and healthcare costs that affects both pediatric and adults. Numerous studies describe the characteristics of AR in adult and pediatric patients, but do not compare the characteristics between both populations.

Objectives: The aim was to compare the characteristic of AR between child and adults.

Methods: Two observational, cross-sectional, multicenter studies were performed with data collection consecutively in two phases, the study in children and study in adults. The AR was classified according to the criteria original Allergic Rhinitis and Its Impact on Asthma (o-ARIA) and a modification of this classification (m-ARIA), and comorbidities were also assessed. We compared both databases, and we was performed a database in common, for analysis by SPSS 15.0

Results: 5405 patients (children: 1275; adults: 4130) were included, mean age 37.5 (±13.4) years in adults and 9.05 (±1.93) years children. Distribution by gender was 41 % girls and 52 % female. According to their duration, was intermittent in 59.5 % children and 51.5 % adults (p < 0.001). According o-ARIA classification adults was 26 % mild, 74 % moderate and severe. Children was 10.3 % mild, 90 % moderate-severe (p < 0.001). Depending on m-ARIA classification, AR adults was moderate 56.7 and 14.5 % severe. In children was moderate 68.3 and 18.2 % severe (p < 0.0001). Adults T4SS (6.50 ± 2.8) were higher than children (6.25 ± 2.8; p < 0.01). Moreover, adults VAS (39.78 ± 23.60) were higher than children (36.99 ± 25.47; p < 0.0001). According classification allergen implicated adults was perennial 35 % of them and, children 39 % (p < 0.001). Regarding comorbidities, 49.5 % children had asthma and 20 % adults; 54 % children had conjunctivitis and 28 % adults (p < 0.0001).

Conclusion: We found significant differences between the characteristics of AR between children and adults. Rhinitis is more intermittent and severe in children, being also more prevalent comorbidities.

POSTER VIEWING SESSION 1: Inflammation—Genetics—Immunology—Dermatology (PP01–PP09)

PP01 Immune profile in late pregnancy: immunological markers in atopic asthmaticwomen as risk factors for atopy in the progeny

Catarina Martins1, Jorge Lima2, Maria José Leandro3, Glória Nunes1, Jorge Cunha Branco2, Hélder Trindade4, Luis Miguel Borrego1,2

1CEDOC, NOVA Medical School, UNL, Lisboa, Portugal; 2CUF Descobertas Hospital, Lisboa, Portugal; 3UniversityCollege London, Center for Rheumatology, London, United Kingdom; 4Instituto Português do Sangue e da Transplantação, Lisboa, Portugal
Correspondence: Luis Miguel Borrego

Clinical and Translational Allergy 2016, 6(Suppl 1):PP01

Background: Asthma and rhinitis are the commonest chronic diseases in pregnancy, with possible outgrowth in progeny.

Objective: This study aimed to characterize the immune profile of atopic asthmatic women in late pregnancy, and to further evaluate its relation with the development of atopic signs and symptoms in newborns.

Methods: Third trimester asthmatic pregnant women (n = 15) were recruited between the 31st and 36th weeks of gestation. At this time point, peripheral blood samples from each woman were collected and analyzed by Flow Cytometry, in order to characterize T and B cell subsets. Six months after birth, the babies were clinically assessed and atopic manifestations were investigated (atopic dermatitis, recurrent wheeze). Statistical analysis was done using GraphPadPrism6 (statistical significance: p-value <0.05).

Results achieved: After separating the mothers in two groups (BW-babies with complications, n = 6, and BWO-babies without complications, n = 9), differences were observed, with BW mothers presenting increased circulating activated CD4+CD25+ T cells and decreased effector memory CD8+ T cells (p < 0.05) in late pregnancy. Within B cells, BW mothers had a significantly higher percentage of transitional CD38++IgM++ B cells (p < 0.001).

Conclusion: BW mothers do have distinguishing immune features in late pregnancy, with a more activated T cell compartment and loss of circulating effector memory CD8+ T cells. Interestingly, effector memory CD8+ T cells, highly activated, are the most important subset of T cells at the fetal–maternal interface.[1] We speculate that BW mothers have a higher migration of effector memory CD8+ T cells into the fetal-maternal interface, and this activation status may alter the immune response of the child. Transitional B cells point towards a more effective B cell output in BW mothers. These are preliminary data that need further confirmation, but can be useful in the future development of atopy risk markers in children from atopic mothers.

Reference
  1. 1.

    Tilburgs T, Strominger JL. CD8+ effector T cells at the fetal–maternal interface, balancing fetal tolerance and antiviral immunity. Am J ReprodImmunol. 2013;69(4). doi:10.1111/aji.12094.

     

PP02 The impact of neonatal sepsis on development of allergic diseases

Secil Conkar1, Mehtap Kilic1, Canan Aygun2, Recep Sancak1

1Department of Pediatric Allergy, Mayıs Unıversity, Samsun, Turkey; 2Department of Neonatology, Mayıs Unıversity, Samsun, Turkey
Correspondence: Mehtap Kilic

Clinical and Translational Allergy 2016, 6(Suppl 1):PP02

Background: It was suggested that bacterial infections in children at early ages can protect allergic reactions in future. Nevertheless, contact to bacterial products such as endotoxins in early childhood may protect development of allergic diseases later in childhood is still a dilemma.

Aim: The aim of the study is to assess the impact of neonatal sepsis on development of asthma, allergic rhinitis and atopic dermatitis in children.

Methods: 126 children were divided into two groups. Group 1 was consists of 63 subjects (mean age 67.2 ± 8.4 months) who have been hospitalized or have had sepsis in neonatal period. Another 63 children (mean age 91.4 ± 24.2 months) were in group 2 who were chosen among the siblings of group 1 to minimize genetical and environmental factors which affect developing allergic diseases. The prevalence of asthma, atopic dermatitis and allergic rhinitis were compared between two groups. Comprehensive examination was performed for all subjects by the same pediatric allergist. The Turkish version of International Study of Asthma and Allergies in Children (ISAAC) questionnaires were utilized for each subject. Face to face methodology was used to complete all ISAAC questionnaires. In addition, total blood count for eosinophilia, total IgE levels were measured and skin prick tests were performed for each subjects.

Results: Total IgE levels and sensitivity of dermatophagoides pteronyssinus, dermatophagoides farinea were significantly lower (p < 0.05) in group 1. In addition, prevalence of allergic symptoms and diagnosed asthma were also found significantly lower (p < 0.05) in group 1. However, we found no significant difference between two groups in terms of prevalence of allergic rhinitis and atopic dermatitis.

Conclusion: Our study has highlighted that severe infections such as sepsis in neonatal period can protect from sensitization to environmental allergens and developing asthma in later childhood.

PP03 Clinical overview of selective IgE deficiency in childhood

Athina Papadopoulou, Eleni Tagalaki, Lambros Banos, Anna Vlachou, Fotini Giannoula, Despina Mermiri

Allergology and Respiratory Unit, Penteli’s Children Hospital, Athens, Greece
Correspondence: Athina Papadopoulou

Clinical and Translational Allergy 2016, 6(Suppl 1):PP03

Selective IgE deficiency was recently associated with immune system dysregulation leading to lung diseases, autoimmunity and chronic urticaria in adults and children. Seventy-six children with selective IgE deficiency have been studied since 2005 (44.7 % boys, mean age 55.7 ± 34, ranging from 11 to 120 months). Clinical history was taken, SPT, nasal as well as sputum cultures, lung function test and chest x-ray were performed.

Results: Recurrent upper and lower airway infections were reported in 54 % whereas 23 % were admitted to hospital due to serious infection or respiratory distress. Abnormal CXR was detected in 26.3 % of cases. Family atopic history was positive in 33 % whereas 58 % of cases were passive smokers. 15.7 % had active asthma and 14 % sensitization to aeroallergens but no relation was detected between asthma symptoms and allergy sensitization or parental atopic history. Six cases (8 %) suffered from chronic rhinosinusitis and one child had chronic urticaria and Hashimoto disease. 17 % had reported atopic dermatitis.

Conclusions: Selective IgE deficiency seems to be related to increased prevalence of lung diseases and non atopic asthma. Low serum total IgE may be used as a marker of immune dysregulation.

PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence

Athina Papadopoulou1, Stavroula Lampidi1, Marina Pavlakou1, Maria Kryoni1, Kostas Makris2

1Allergic Pediatric Unit, KAT General Hospital, Athens, Greece; 2Clinical Biochemistry Department, KAT General Hospital, Athens, Greece
Correspondence: Athina Papadopoulou

Clinical and Translational Allergy 2016, 6(Suppl 1):PP04

Non skeletal effects of vitamin D have been discussed in recent studies and many reports refer to its role in health and disease. There is also evidence that vitamin D deficiency can impair immune function, resulting in both, overactivity or suppression. However, there are no studies relating Vitamin D levels to total IgE, a basic marker of allergic diseases. The main aim of this study was to relate levels of 25(ΟΗ) Vitamin D3 to total IgE in general population. Clinical and laboratory data from 223 children and adolescence (54.3 % boys, mean age 10.8 years, 4.5–18 years) who proceeded to the pediatric unit for vaccination, were analyzed. Serums were collected during winter 17.4 %, spring 43 %, summer 19.7 % and autumn 19.7 %.

Results: Mean levels of 25(ΟΗ) Vitamin D3 was 25.66 ± 10.02 pg/ml whereas deficiency (<20 pg/ml) was detected in 35 % of the cases. Mean level of IgE was 203 ± 70 KU/L whereas 30, 20.5 and 5 % reported active asthma, allergic rhinitis and eczema respectively. Levels of 25(ΟΗ) Vitamin D3 showed a negative association with total IgE (p = 0.001). This association was constant when total IgE was >60 IU/ml and independent of season, sex and age.

Conclusion: Total IgE was inversely related to 25 (ΟΗ) Vitamin D3 in serums. Allergic diseases might influence vitamin D synthesis or vice versa, low levels of vitamin D might increase allergic markers. More studies are needed to clarify this relation and to evaluate any clinical role.

PP05

WITHDRAWN

Clinical and Translational Allergy 2016, 6(Suppl 1):PP05

PP06

WITHDRAWN

Clinical and Translational Allergy 2016, 6(Suppl 1):PP06

PP07 Asthma control questionnaire and specific IgE in children

Snezhina Lazova, Guergana Petrova, Dimitrinka Miteva, Penka Perenovska

Pediatric Clinic, University Hospital “Alexandrovska”, Sofia, Bulgaria
Correspondence: Snezhina Lazova

Clinical and Translational Allergy 2016, 6(Suppl 1):PP07

Background: Atopy and allergy have long been associated with asthma. Usually the presence of atopy or any allergic diseases could interfere and obstacle the control of asthma.

Method: For a period of 6 months we evaluated medical history data of 113 children with asthma aged 3–17 years. For all children we drew blood for IgE against inhalation and food allergies antibodies detection and asked them to fill ACQ. IgE were detected with the predesigned kit EurolinePediatric.

Results: We found that the children claiming to have more limited physical activities to have inadequate asthma control (ACQ ≥ 1.5) Elevated titer against specific IgE (especially birch, D. pteronyssinus and D. farinae) are correlated with worse asthma control (p < 0.05).

Conclusion: Closer monitoring for patients sensitive to birch, D. pteronyssinus and D. farinae is needed in order to prevent bad asthma control.

Acknowledgements: This work was supported by a grant from the Medical University of Sofia (Council of Medical Science, project no. 23-D/2013, grant no. 35-D/2013)

PP08 Features of chronic urticaria of adolescents

Aliya Klyucharova, Olesya Skorohodkina

Kazan State Medical University, Kazan, Russia
Correspondence: Aliya Klyucharova

Clinical and Translational Allergy 2016, 6(Suppl 1):PP08

Objective: To study the clinical features of the current chronic urticaria (CU) of adolescents.

Materials and methods: The study involved 28 patients aged 17–19 years. A comparison group was presented of 34 patients middle-aged (30–50 years) with CU. All patients had a comprehensive examination, including clinical history, physical examination, laboratory and instrumental examination, specific allergy tests.

Results: Among adolescents with CU dominated male (79 %), among the middle-aged patients were predominantly female (85 %). The most common form of CU of adolescents was inducible (63.8 %): dermographic (39 %), and the combination of cold contact and cholinergic forms (14.3 %). The inducible CU met among young men 2 times more often (72.1 %) than girls (32 %). Spontaneous CU prevailed among the middle-aged patients (75 %), this form met with the same frequency among men and women. It should be noted that spontaneous urticaria of adolescents was predominantly moderate. Middle-aged patients had not only moderate disease, but mild (19.6 %) and severe (9.8 %) CU also. Urticaria in half of boys and girls was observed more than a year. 70 % of men over 30 years had symptoms of CU less than 6 months, while 55.2 % of women with CU had urticaria more than 1 year. Most common comorbidities of adolescents were a disease of gastrointestinal system (57.1 %) and helminth infections and parasitosis (21.4 %). Patients of middle age had also pathology gastrointestinal system (48.4 %), parasitosis with helminths occurred in 2 times less, and 16 % of patients diagnosed with autoimmune thyroiditis.

Conclusions: CU of adolescents had certain features. Urticaria observed among young men mainly. The symptoms of urticaria induced mainly by physical factors. The most common forms of urticaria is inducible: dermographic and combination cold contact with cholinergic. Idiopathic CU usually has moderate forms. The most common comorbidities are diseases of the gastrointestinal system, helminth infections and parasitosis.

PP09 Cutaneous mastocytosis in children: a clinical analysis of 8 cases in Greece

Dimitra Koumaki1, Alkisti Manousaki1, Maria Agrapidi1, Lida Iatridou1, Omima Eruk2, Konstantinos Myridakis3, Emmanouil Manousakis1, Vasiliki Koumaki4

1Second Pediatric Clinic, Aglaia Kyriakou Children’s Hospital, Athens, Greece; 2Department of Dermatology, Salford Royal Hospital, Salford, United Kingdom; 3Department of Dermatology, Agia Sophia, Children’s Hospital, Athens, Greece; 4Department of Medical Microbiology, Medical School of Athens, Athens, Greece
Correspondence: Dimitra Koumaki

Clinical and Translational Allergy 2016, 6(Suppl 1):PP09

Objectives: To characterize the clinical features, response to therapy, evolution and prognosis of pediatric cutaneous mastocytosis in a children hospital in Athens, Greece.

Methods: We conducted a file review of children diagnosed with cutaneous mastocytosis at Children’s Hospital in Athens, Greece, over the last year. We evaluated gender, age at onset, character and distribution of lesions, associated symptoms and course of the disease.

Results: In total 8 children were diagnosed with mastocytosis based on clinical presentation and on histological examination of the skin using special stains. There were 62.5 % cases of urticaria pigmentosa, 12.5 % of cases of mastocytoma and 25 % of diffuse cutaneous mastocytosis. In 100 % of cases disease onset was in the first year of life. There was a male predominance 2:1. There was a male predominance 2:1. The majority of lesions were distributed over the trunk and limbs. Different kinds of associated symptoms were noticed. None of the cases was familial. Treatment did not modify the disease evolution.

Conclusion: Pediatric onset mastocytosis is an unusual disease with an often benign course. Most cases of pediatric mastocytosis appeared within the first year of life, especially on the trunk. The most common clinical form of mastocytosis was urticaria pigmentosa followed by diffuse cutaneous mastocytosis and mastocytoma. The disease in childhood is less likely to have a systemic component. The prognosis of pediatric mastocytosis in general is good.

POSTER VIEWING SESSION 2: Food allergy—Anaphylaxis (PP10–PP47)

PP10 Prognostic factors in egg allergy

Maria Dimou, Maria Ingemansson, Gunilla Hedlin

Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
Correspondence: Maria Dimou

Clinical and Translational Allergy 2016, 6(Suppl 1):PP10

Introduction: Egg allergy is one of the most common food allergies in children. Even if tolerance has developed in 70 % of the children by the age of 16, there is evidence that children outgrow their allergy at older age now compared to past decades. There is a variety of symptoms from eczema to anaphylaxis. Comorbidity with other allergic diseases is common. The aim of this study was to evaluate if specific symptoms, comorbidities or biochemical markers could be used as prognostic factors in the development of tolerance.

Methods: 52 children (28 boys and 24 girls) with a mean age of 7.8 (±4.1) years underwent oral egg challenge in 2012–2013. Their histories included comorbidities like atopic eczema (40 %) and peanut allergy (40 %). 17 % of the participants had no comorbidities. When exposed to egg 79 % of children had a history of skin symptoms, 46 % gastrointestinal tract symptoms, 11 % airway symptoms and 4 % anaphylaxis. Using logistic regression, we have searched for associations between age, gender as well as specific clinical characteristics and biochemical markers (IgE to egg and ovomucoid) and the oral egg challenge result.

Results: 33 children had a positive egg challenge. Preliminary analysis not including any covariates showed nominally significant associations between IgE to egg ≥0.35 kU/l and IgE to the egg component ovomucoid ≥0.35 kU/l and positive oral egg challenge result (p-values 0.028 and 0.028 respectively). However, adjusting for age at provocation, only the association between IgE to egg and the oral challenge result remained nominally significant. There was no association between comorbidities or a specific symptom and the oral egg challenge result.

Conclusions: Positive IgE to egg was the only factor that could be used as a prognostic factor for the result of an oral egg challenge in children with a history of egg allergy.

PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula

Nitida Pastor1, Delphine de Boissieu2, Jon Vanderhoof3, Nancy Moore1, Kaitlin Maditz1

1Mead Johnson Pediatric Nutrition Institute, Evansville IN, USA; 2Private Practice, Boulogne, France; 3Boston Children’s Hospital, Boston MA, USA
Correspondence: Nitida Pastor

Clinical and Translational Allergy 2016, 6(Suppl 1):PP11

Background: Nearly 2.2–2.5 % of infants and children under 3 years of age are diagnosed with cow’s milk protein allergy (CMPA), resulting in atopic dermatitis, diarrhea, urticaria, vomiting, and gastroesophageal reflux (GER) [1,2]. Current management for infants and children with CMPA includes complete avoidance of cow’s milk protein and initiation of extensively hydrolyzed protein (EHP) formula. However, in infants and children unable to tolerate EHP formulas, amino acid-based formulas are often recommended.

Objective: To evaluate the efficacy of an amino acid-based formula in infants between the ages of 1–12 months with CMPA who had history of weight loss of >0.5 WHO reference z-score while on an EHP formula.

Methods: This was an observational, prospective, multi-center study conducted in France. Infants were put on an amino acid-based formula for 12 weeks. The primary outcome for this study was infant z-score change over the 12 weeks of feeding. Formula efficacy was evaluated by body weight gain and evaluation of allergic manifestations (atopic dermatitis (AD), bloody stools, GER score, chronic diarrhea, and urticaria).

Results: Thirty (30) of 32 infants completed the 12-week feeding period. Mean weight gain over the 12 week feeding period was +0.43 ± 0.28 (mean ± SD). Improvement was observed for all allergic manifestations, both in terms of the number of infants presenting symptoms and the intensity of symptoms. For AD, 13 presented and 7 continued at end of study (SCORAD improvement p = 0.02). Over the 12 week feeding period, an improvement of the overall GER score was observed, −10.5 ± 1.8 (mean ± standard error, p < 0.01).

Conclusions: The amino acid formula supported healthy weight gain and improvement in allergic manifestations in CMPA infants who had a history of intolerance to EHP formulas.

References
  1. 1.

    Crittenden RG, Bennett LE. J Am Coll Nutr 2005;24(6 Suppl):582S–91S.

     
  2. 2.

    Vandenplas Y, et al. Acta Paediatr 2012;101(11):1105–9.

     

PP12 Anaphylaxis and epinephrine auto-injector use: a survey of pediatric trainees

Adeli Mehdi, Shaza Elhassan, Carolin Beck, Ahmed Al-Hammadi

Pediatric Department, Hamad Hospital, Doha, Qatar
Correspondence: Ahmed Al-Hammadi

Clinical and Translational Allergy 2016, 6(Suppl 1):PP12

Background: Anaphylactic shock is a life-threatening circumstance which requires urgent and proper medical management. The delay in making an accurate diagnosis, initiating appropriate treatment and inappropriate use of epinephrine can lead to death.

Objectives: This study is designed to evaluate and emphasize the paramount importance of the trainee knowledge about anaphylaxis, the treatment methods, life-saving medications, the route of administration and the dosage.

Method: This is a cross-sectional two phase questionnaire based survey at Hamad General Hospital’s Pediatrics department, in Doha-Qatar.

Results: In phase 1, the questionnaires were distributed to 96 trainees. The response was 98 % (94 responses). 84 trainees (89.3 %) reported knowing how to treat and a total of 44 (50 %) claimed not being trained at all. Epinephrine was selected as a life saving drug by 89 (94 %). Correct Epinephrine concentration was known by 77 (83 %). For phase 2, questionnaires were distributed to 94 trainees who responded to the stage 1 and the response rate was 89 % (84). 84 % claimed they heard about Epinephrine Auto injector, 72 % claimed knowing when to use it .23 (27 %) did not know. Anaphylaxis was the case of using it in 71 %. Only 43 responders (51 %) know the right location and the method of injection.

Conclusion: Although prompt treatment with epinephrine is deemed to be critically important for survival in anaphylaxis, we have huge gap between theoretical knowledge about epinephrine concentration and site of administration of epinephrine and fundamental practice among pediatrics trainees. Analysis of these data necessitates the urgent need of a concrete program for teaching the trainees, especially the pediatrics fellows to solidify their knowledge about anaphylaxis. More important practical guidelines about the site of administration, what concentration and how to act fast when faced with anaphylaxis is needed to be taught to current and future trainees.

PP13 Anaphylaxis in children: acute management in the Emergency Department

Ioana Maris1, Ronan O’Sullivan2, Jonathan Hourihane3

1Cork University Hospital, Cork, Ireland; 2Bon Secours Hospital, Cork, Ireland; 3University College Cork, Cork, Ireland
Correspondence: Ioana Maris

Clinical and Translational Allergy 2016, 6(Suppl 1):PP13

Hypothesis: Several studies suggest an increase in both the prevalence of food allergy and in the frequency of emergency department (ED) visits for food-related allergic reactions, including anaphylaxis.

Aim: To describe the key features of anaphylactic reactions in children and their management when presenting to the Emergency Department.

Study design and method: Patients aged 0–16 years who presented to a large academic ED, and met diagnostic criteria for anaphylaxis, were consecutively included from July 2013 to February 2015. We collected data on patient characteristics, suspected triggers, signs and symptoms, ED management, and discharge recommendations.

Results: 48 cases presented to the ED with anaphylaxis, either directly (77 %) or referred by a General Practitioner (23 %). Anaphylaxis was the first allergic event in 81 % of the cases. Food caused 73 % of events, with egg (25 %) and cashew nut (17 %) being the most common eliciting foods. Skin (92 %) and airway (89 %) symptoms predominated, with gastro-intestinal (48 %) and cardio-vascular symptoms (46 %) also frequent. Emergency medication was given by lay person before presenting to ED in 33 % of cases. Adrenaline i.m. was given in 50 % of the cases: in ED in 8/24 cases (33 %), self administered in 5/24 cases (21 %), by GP prior to ED attendance in 9/24 cases (37 %), and in 2 cases by paramedics. 65 % were hospitalized. None of the 7 new patients (18 %) discharged directly from ED, were given adrenaline auto injectors prescription and training, but they were all referred to a specialist clinic.

Conclusions: Food allergens are the main triggers for anaphylaxis in Irish children. The rate of Adrenaline use in emergency setting clearly needs to improve in Ireland, and barriers to Adrenaline use must be addressed.

PP14 Understanding Cumbrian schools preparedness in managing children at risk of anaphylaxis in order to provide training and support which will create healthy and safe environments for children with allergies

George Raptis1, Louise Michaelis2

1North Cumbria University Hospitals, Whitehaven, United Kingdom; 2Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
Correspondence: George Raptis

Clinical and Translational Allergy 2016, 6(Suppl 1):PP14

Background: Allergic diseases can have detrimental effects on physical, emotional and social life especially in childhood and they can affect significantly children’s ability to flourish.

Aim: To develop an effective model of care for allergic children at school and ensure all staff are familiar with and able to implement it.

Methods: A self-completed postal questionnaire was sent to all Cumbrian schools (n = 312) to assess three primary areas of concern: existing protocols for anaphylaxis management, training offered by and to schools and preventative measures. Subsequently, training on how to deal with anaphylaxis was offered to 10 % (n = 18) of all participating schools. A follow-up questionnaire was sent to measure the preparedness and confidence by staff following the training.

Results: Prior to training 47 % of all participating schools felt completely confident dealing with anaphylaxis while 55 % felt prepared for anaphylaxis in children without a prior history of allergies. 78 % of the schools felt that further training in anaphylaxis would be beneficial. 82 % believed that a national school policy in managing anaphylaxis is needed and 96 % agreed with the genetic provision of adrenaline auto-injectors along with individual anaphylaxis plans to be kept at school.

45 % of the schools have a no-nut policy while 56 % have one on no food-sharing. However, only 38 % have a no eating-utensil sharing policy and 34 % one on no eating-on-transport to and from school.

The confidence level in dealing with anaphylaxis increased to 95 % post training while 100 % of them are updating their no-nut, no food and no eating-utensil sharing and no eating-on- transport to and from school policies.

Conclusions: Adopting a county-wide, age appropriate school protocol including training in anaphylaxis led by the school and supported by all the stake holders will ensure that all school staff can prevent, recognise and initiate safe treatment of anaphylaxis.

PP15 A new valid and reliable parent and child questionnaire to measure the impact of food protein enterocolitis syndrome on children: the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form

Audrey DunnGalvin1, Matthew Greenhawt2, Carina Venter3, Jonathan Hourihane2

1University College Cork, Cork, Ireland; 2University of Michigan, Ann Arbor MI, USA; 3University of Portsmouth, Portsmouth, United Kingdom
Correspondence: Audrey DunnGalvin

Clinical and Translational Allergy 2016, 6(Suppl 1):PP15

Rationale: No tool currently exists to measure health related quality of life (HRQL) in Food Protein Enterocolitis Syndrome (FPIES). We investigated the ability of the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form to accurately assess the impact of FPIES on the HRQL of children, aged 0+ years. FPIES are similar to severe forms of food allergy where there is the risk of death, but due to hypovolemic shock rather than anaphylaxis. FPIES are also different from classic IgE mediated food allergy, as the foods involved are often atypical foods and not validated tests exists.

Methods: Following initial validation with 148 Irish, UK, and US caregivers of children with FPIES of the protocol instrument, 68 Irish and UK parents completed the short online version of the questionnaire on the impact of FPIES on their child (10 items) and on the parent themselves (10 items). The measure underwent further psychometric analysis including factor analysis and reliability analysis.

Results: Parents of children (58 % male) aged between 6 months and 8 years completed the questionnaires. Analyses demonstrated high reliability (α = .92). Bartlett’s test of sphericity, Χ2(45) = 257.3, p ≤ .001, showed good correlation between items. Two components had eigenvalues over the KMO criterion of 1 and explained 70 % of the variance in the impact of FPIES on HRQL, demonstrating construct validity. There was a high positive correlation between independent clinical items and scores on the questionnaire.

Conclusions: The new questionnaire allows for a disease specific analysis of the impact of FPIES on HRQL in both parents and children. It will provide a powerful disease specific outcome and tracking measure in both research and clinical contexts.

PP16 An in-depth case study investigation of the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity

Evelyn O’Regan, Duncan Cronin, Jonathan Hourihane, Anna O’Reilly, Audrey DunnGalvin

University College Cork, Cork, Ireland
Correspondence: Audrey DunnGalvin

Clinical and Translational Allergy 2016, 6(Suppl 1):PP16

Rationale: There is limited research into coping and management strategies of teenagers and young adults living with food allergy, particularly with a strong developmental focus using either qualitative or quantitative methods.

Aim: The current study qualitatively investigates the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity.

Method: In-depth case study interviews were conducted with participants aged 18–24, and analysed following the method of Interpretative Phenomenological Analysis.

Results: The analysis yielded five super-ordinate themes: “change as a process”, “being consumed by panic”, “using mechanisms to cope with fear”, “creating internal and external stability”, and “compromising safety for normality”, with the overarching theme “gaining control”. Findings show that coping and management in food-allergic young adults is a journey. This journey is similar for all young adults in that they all are striving for control, though their experiences are unique. All are challenged by the developmental juncture with which they are faced as young adults and are informed by previous developmental transition experience. While they move towards developing independence, young people rely on external support for their safety and to cope with the fear and anxiety around reactions.

Conclusions: The findings from this study add complexity to our existing knowledge of coping and management in food allergy from a developmental perspective, and can be used as a basis for interventions or further qualitative and quantitative research in the field.

PP17 Cow’s milk protein allergy in Constantine. A retrospective study of 62 cases between 1996 and 2013

Foued Abdelaziz1, Dounia Khelifi-Touhami2, Nihad Selim3, Tahar Khelifi-Touhami1

1Pediatric Pulmonology and Allergy, Annaba, Algeria; 2Pharmacy Department, Constantine, Algeria; 3University Hospital, Annaba, Algeria
Correspondence: Foued Abdelaziz

Clinical and Translational Allergy 2016, 6(Suppl 1):PP17

Background: The epidemiology of cow’s milk protein allergy (CMPA) remains poorly defined in North Africa. The aim of this study is to report the epidemiological, clinical and evolutionary characteristics of CMPA in children living in Constantine.

Method: This is a retrospective study that included all children with CMPA seen in a pediatric allergy clinic from 1996 to 2013 and all available data were used.

Results: 62 cases were gathered (32 boys and 30 girls). The average age when the reaction to cow’s milk formula took place was 4 months (3 days–14 months) and 43 % received some cow’s milk supplement during the lactation period; a first degree family history of atopy was revealed in 54 % of cases. The clinical signs were in 54 % of cases cutaneous. Prick-tests were performed on 87 % of the children and CMP-specific IgE in 45 % of them. 32 % had a Diagnostic elimination diet.

All patients adhered to strict avoidance of CMP and received an eHF with a good tolerance in 86 % of cases, goat’s milk used without medical advice induced urticaria or anaphylaxis and Camel’s milk was not tolerated. Reintroduction of CMP was conducted in hospital in 75 % of cases, the age of reintroduction varied from 12 months to 3 years. In 10 % of cases reintroduction was done at home by parents. CMPA remains persistent in 9 % of cases and 48 % of the patients in this study developed asthma and or allergic rhinitis.

Conclusion: CMPA is probably the most common food allergy in infants under 12 month in Algeria, CMPA testing should include other food allergens and aeroallergens. Home reintroduction of CMP and use of goat’s milk are not permitted. More studies on camel’s milk should be done. An early identification of, and intervention for, CMPA is essential to avoid vital complications.

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Clinical and Translational Allergy 2016, 6(Suppl 1):PP18

PP19 Cow’s milk and egg oral immunotherapy in children older than 5 years

Pablo Merida, Ana Ma Plaza, Juan Heber Castellanos, Adrianna Machinena, Montserrat Alvaro Lozano, Jaime Lozano, Olga Dominguez, Monica Piquer, Rosa Jimenez, Ma Teresa Giner

Pediatric Allergy Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
Correspondence: Adrianna Machinena

Clinical and Translational Allergy 2016, 6(Suppl 1):PP19

Aim: To report clinical features and outcomes of oral immunotherapy (OIT) in children with cow’s milk (CM) and egg allergy (EA).

Methods: Retrospective study of children with CM and EA who have undergone OIT with CM or raw egg from January 2011. Variables: age at oral food challenge (OFC), gender, atopic history, skin prick test (SPT), total and specific IgE (s-IgE) and OIT outcomes.

Results: 87 patients included, 39 with CMA and 48 with EA. 58.6 % boys, 67 % with atopic family history, 45 % had atopic dermatitis and 55.2 % had one or more food allergies.

CM allergic children: 69.2 % (27) had anaphylaxis at OFC before OIT, needing epinephrine 30.8 % (12). Mean CM and casein SPT and s-IgE were: 10.11 mm (3.5–19), 8.9 mm (3.5–17.5), 80.5 KU/L (1.34–688), and 80 KU/L (1–694), respectively. Mean time at build-up phase 8.7 months (2–33), with statistical significance for those with casein s-IgE >50 KU/L. At the maintenance phase only 1 child withdrew due to adverse events. The achieved dose range was 75–200 ml.

EA children: 39.6 % (19) had anaphylaxis at OFC before OIT, needing epinephrine 47.3 % (9). Mean egg-white, ovoalbumin, ovomucoid SPT and s-IgE were: 8.3 mm (0–13.5), 8.3 mm (0–14.5), 7.4 mm (0–13.5), 17.6 KU/L (0.35–101), 10.6 KU/L (0.35–101) and 12 KU/L (0.35–101), respectively. Mean time at the build-up phase 7.2 months (2–25). 5 children withdrew due to adverse events, 3 at build-up and 2 at maintenance phase. The achieved dose range was 15–30 ml of raw egg-white.

Conclusion: Most of the children (93 %) completed our OIT protocol for CMA and EA. The time to complete the build-up period was longer for children with casein s-IgE >50 KU/L. In EA, drop-outs due to adverse events were more frequent.

PP20 Professionals’ awareness of management of Cow’s Milk Protein Allergy (CMPA) in North Wales Hospitals

Konstantinos Kakleas, Manohar Joishy, Wendmu Maskele, Huw R. Jenkins,

Ysbyty Gwynedd, Bangor and University Hospital of Wales, Cardiff, United Kingdom
Correspondence: Konstantinos Kakleas

Clinical and Translational Allergy 2016, 6(Suppl 1):PP20

Background/Aims: In the UK it is estimated that 2–2.5 % of infants suffer from CMPA, but the diagnosis can be easily missed and it is important to recognise this condition promptly and treat effectively. Our aim was to investigate whether pediatric doctors, working in Betsi Cadwaladr University Health Board (BCUHB) comprising of North Wales Hospitals, were aware of the CMPA guidelines and if they implemented these guidelines appropriately in clinical practice.

Methods: All pediatric doctors working in pediatric departments of BCUHB were asked to complete a specific questionnaire in order to determine their awareness on diagnosis and management of CMPA. Of the 50 distributed questionnaires, 40 were completed and returned to us.

Results: About 25 % of doctors were unaware of CMPA guidelines and 30 % stated they were not confident in managing this condition. Nearly 80 % of medical staff provided the right advice for CMPA in breast fed infants including duration of treatment and appropriately selected the hydrolysed formula for bottle fed infants. A good proportion of medical staff deviated from the guidelines regarding the management of CMPA in cases of anaphylaxis (52.5 %) and failure to thrive (FTT) (85 %).

Conclusions: Overall medical staff had a good understanding of CMPA guidelines. However nearly a quarter of staff was not aware of the existence of guidelines and another third stated they had not read them. In addition the majority deviated from guidelines in terms of FTT and anaphylaxis in CMPA. Therefore it is important to educate staff regarding the presence of guidelines and management of CMPA, as prompt and correct diagnosis of this condition will reduce the parental anxiety and will decrease the financial burden on the Health System.

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PP22 Anaphylaxis: the great unknown for teachers. Presentation of a protocol for schools

Mercedes Escarrer1, Agustín Madroñero1, Maria Teresa Guerra2, Juan Carlos Julia3, Juan Carlos Cerda3, Javier Contreras4, Eulalia Tauler5, Maria Jesus Vidorreta3, Ana Rojo6, Silvia Del Valle5

1Clínica Juaneda, Palma de Mallorca, Spain; 2Cadiz, Spain; 3Valencia, Spain; 4Madrid, Spain; 5Barcelona, Spain; 6Granada, Spain
Correspondence: Mercedes Escarrer

Clinical and Translational Allergy 2016, 6(Suppl 1):PP22

Background: The cases of food allergies have doubled in the last 10 years and the number of hospitalisations caused by severe allergic reactions has increased seven fold in the same period.

Objective: To emphasise the importance of reaching an early diagnosis and appropriate treatment in order to prevent such serious incidents and improve patients’ quality of life.

Methods: In 2014 we made a questionnaire on 2481 Spanish teachers between November 2013 and January 2014, with the following questions:
  1. (a)

    Do you know what anaphylaxis is?

     
  2. (b)

    Are there any students in your class who have ever had an anaphylactic reaction?

     
  3. (c)

    Would you know what to do if a student had an anaphylactic reaction in your school?

     
  4. (d)

    Would you know how to administer the medication if a student had an anaphylactic reaction in your school?

     
Results: In the survey it became evident that knowledge about anaphylaxis was scarce, only 40.5 % reported knew what anaphylaxis was and only 11 % said they would know how to administer the auto-injector adrenaline (Fig. 2).
Fig. 2

Protocol

Conclusion: We present a protocol for teachers in case of anaphylaxis, where we explain simply the steps and how to use the auto-injector adrenaline with drawings.

PP23 Challenges facing children with food allergies and their parents in out of school activity sectors

Niamh Flynn

University of Southampton, Dublin, Ireland
Correspondence: Niamh Flynn

Clinical and Translational Allergy 2016, 6(Suppl 1):PP23

Background: Food allergy (FA) affects up to 4–7 % of primary school children in Europe. Despite the rise in diagnosis, many community members are unaware that a severe allergic reaction, such as anaphylaxis, could result in death. Food allergy can often be confused with food intolerances leading to misunderstandings regarding severe allergic reactions. It can also have a significant effect on the quality of life (QoL) of the FA child and their parents in social interactions.

Objective: The focus of this research is in the area of extra-curricular activities that FA children participate in. No previous FA studies have looked at this before. Such a study is of significance in order to understand parental concerns and if necessary improve supports within the community.

Methods: A qualitative approach was used by conducting semi structured telephone interviews and analysed using thematic analysis.

Results: The interviews produced a number of key findings: food was regularly provided at one or more of the activities which the child engaged in, although primarily in team sports; parents tended to stay at the activity partly due to trust and also due to a sense of responsibility.

Conclusion: The main conclusion drawn from this study was that there is a lack of awareness and understanding of FA indicating that there is also no risk perceived by some coaches or instructors. Some sporting bodies were more proactive with regards training than others, but central to the risk of food allergen exposure is the education of the coaches and instructors in all activities where there is a potential for food to be provided. This research proffers engagement with coaches and instructors at community level to recognise that this is a real concern for parents of FA children and also to get governing sports bodies involved in developing FA and anaphylaxis policies.

PP24 A review of food challenges at a Regional Irish Centre

Gary Foley, Carol Harmon, John Fitzsimons

Pediatric Assessment Unit, Our Lady of Lourdes Hospital, Drogheda, Ireland
Correspondence: Gary Foley

Clinical and Translational Allergy 2016, 6(Suppl 1):PP24

Introduction: Parents often overestimate the likelihood of their child having a food allergy.[1] Food challenges allow the health care professional to determine if a true food allergy exists. Food challenge audits such as this will help tailor the decision whether or not a food challenge is required in this subpopulation.

Aims:
  1. 1)

    To review the activity of food allergen challenges.

     
  2. 2)

    To determine food challenge results verses international standards.

     

Methods: Data of food challenges that occurred from 2012–2014 were reviewed and placed into the following categories; suspect allergen, type of challenge performed, IgE sample obtained, skin prick testing (SPT) performed, passed challenge, failed challenge, type of reaction if failed, treatment given if failed and follow up at 24 h.

Exclusion Criteria: Drug allergy challenges and food challenges with incomplete information were excluded.

Results: A total of 164 challenges were performed over the time period. 161 of these were food related. The main food allergens challenged were milk (N = 54), peanut (N = 47) and egg (N = 40). There was one case of a food challenge (wheat) with exercise. A total of 45 patients underwent SPT prior to the food challenge, 119 underwent IgE testing and 35 had both investigations. There were 119 (73 %) passed and 42 (27 %) failed food challenges. There was one case of anaphylaxis. The most common post challenge reaction noted was urticaria (N = 22). There were two incidents of respiratory reactions requiring Beta-2 agonists. One case of eczema flare at 18 h was documented.

Conclusion: A significant number of food challenges occurred without any prior investigation. There was a large discrepancy between the number of those who passed verses failed the food challenges. In time, the international standard of a near 50 % pass verses 50 % fail rate should be reached with more stringent criteria.[2] Until then limited resources will lend to higher than averages pass rates.

References
  1. 1.

    Venter C, et al. Prevalence of sensitization reported and objectivity assessed food hypersensitivity amongst 6-year old children: a population based study. Pediatr Allergy Immunol. 2006;17(5):356–63.

     
  2. 2.

    Food allergy in children and young people. NICE Guidelines 2011.

     

PP25 The use of epinephrine in infants with anaphylaxis

Krasimira Baynova, Ávila Maria Del Robledo, Labella Marina

Department of Allergy, University Hospital “Virgen del Rocío”, Seville, Spain
Correspondence: Krasimira Baynova

Clinical and Translational Allergy 2016, 6(Suppl 1):PP25

Background: Anaphylaxis is a potentially life-threatening systemic hypersensitivity reaction and its first-choice treatment is Epinephrine given intramuscularly (IM). On discharge, all patients should be prescribed epinephrine auto injectors, and referred to an allergist. But do we use the epinephrine appropriately in case of anaphylaxis or do we skip it?

Methods: We studied retrospectively 41 children who performed anaphylactic reaction and who were admitted to the emergency department or were attended by emergency mobile units during a 9-years period (2006–2015) in a 700,000 population. We determined the prevalence of use of epinephrine as a first-choice treatment and the percentage of patients in whom epinephrine auto injector was prescribed when they were discharged.

Results: Only 22 % of the patients were treated with epinephrine IM when anaphylaxis was presented. Just 4.8 % of the patients received prescription of epinephrine auto injector when hospital/ED discharge. All patients were referred to an allergist.

Conclusions: The use of epinephrine as a first choice treatment is still not solid. The prescription of epinephrine auto injectors when patients are discharged from emergency departments is still an issue.

Keywords: anaphylaxis; emergency; infant; epinephrine.

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Clinical and Translational Allergy 2016, 6(Suppl 1):PP26

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PP28 Mother’s psychological state predicts the expression of symptoms in food allergic children

Aaron Cortes1, Alicia Sciaraffia1, Angela Castillo2

1Hospital Clinico Universidad de Chile, Santiago, Chile; 2Hospital Carlos Van Buren, Valparaiso, Chile
Correspondence: Aaron Cortes

Clinical and Translational Allergy 2016, 6(Suppl 1):PP28

Background: It has been established that child allergies, such as asthma and rhinitis, have a direct impact on carers (usually the mother), increasing their likelihood of psychological disorders and social network deterioration. It is hypothesised a significant interaction between mother’s psychological state and child’s food allergy (FA) symptoms; however, there is very little information on FA regarding this topic. Therefore, this study compared the relative odds of the occurrence of gastric symptoms in the food allergic child given exposure to maternal psychosocial factors.

Methods: Mother’s psychological state was evaluated and analysed against the occurrence of FA gastric symptoms in their children in a cross-sectional study involving 206 participants (mothers and children). Logistic regressions were used to determine whether mother’s psychological state is a risk factor for child’s gastric symptoms and to compare the magnitude of different psychological variables as risk factors for a specific gastric symptom occurrence.

Results: High levels of anxiety were found in 44 % of the participants, depressive symptoms on the 21.4 and 68 % had moderate or high psychosocial impact due to CFA. Low perceived social support was found in 21.4 % of the mothers. Higher CFA-Related Impact (CFA-RI) and CFA-Related Social Impact (CFA-R SI) in the mother increase the possibility for abdominal pain (OR = 2.04; p < .001) and diarrhoea (OR = 1.32; p = .05) in the child. The possibility for abdominal bloating in the child increases when the mother suffer from higher anxiety (OR = 4.45; p < .001), lower perceived social support (PSS) (OR = 3.17; p = .002) and CFA-RI (OR = 1.32; p < .05).

Conclusions: The psychological impact of caring a food allergic child and the perceived social support can predicts the occurrence of allergic symptoms in children. CFA is propounded as a process where biological, psychological and social variables have a relationship of mutual influence. Therefore, a comprehensive care strategy that considers the family perspective is proposed to achieve a more inclusive and integrative care of CFA focused on “families living with food allergy”.

PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic

Nanna Juel-Berg, Kirsten Skamstrup Hansen, Lars Kærgaard Poulsen

Allergy Clinic, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
Correspondence: Nanna Juel-Berg

Clinical and Translational Allergy 2016, 6(Suppl 1):PP29

Background: Tree nut allergy is a frequent medical problem. Some are allergic to tree nuts due to birch pollen cross reactivity whereas others have a primary tree nut allergy. There can be great regional variance in the serological profile and hence in clinical allergy. A pilot study suggested that hazelnuts, walnuts, pistachio nuts and cashew nuts were the most common nuts involved in allergic reactions in a Danish Pediatric population.

Aim: To investigate the correlation between sIgE towards four common tree nuts and the correlation between sIgE towards hazelnuts and birch pollen amongst patients in a Danish outpatient allergy clinic.

Method: Specific IgE in all patients born after January 1st 1991 with sensitization to tree nuts and birch pollen were sought in our sIgE (ImmunoCAP®) database.

GraphPad Prism 6 software was used for statistical analysis.

The interrelationship between sIgE was pictured in XY-plots and Spearman correlation was calculated for sIgE towards hazelnut and birch pollen and for sIgE towards hazelnut, walnut, pistachio and cashew measured in the same patients.

Results: The number of patients with sIgE >0.35 kU/l and median sIgE values:
  • Hazelnut: n = 560, median 10.75 kU/l

  • Cashew: n = 163, median 2.77 kU/l

  • Pistachio: n = 182, median 2.55 kU/l

  • Walnut: n = 164, median 3.85 kU/l

  • Spearman correlation coefficient between:

  • Hazelnut and birch: rs = 0.7947

  • Cashew and hazelnut: rs = 0.2172

  • Pistachio and hazelnut: rs = 0.2854

  • Walnut and hazelnut: rs = 0.3132

  • Walnut and cashew nut: rs = 0.4696

  • Pistachio nut and cashew nut: rs = 0.8313

  • Walnut and pistachio nut: rs = 0.4648

Conclusions: Our findings show a strong relationship between sensitization towards cashew nut and pistachio nut, and hazelnut and birch pollen and a moderate relationship towards walnut and cashew nut, and walnut and pistachio nut. Results from the same population are underway to determine the clinical association of these findings.

PP30 Food allergy in children: evaluation of parents’ use of online social media

Andreia Florina Nita1,2, Ioana Valentina Nenciu1,2, Adina Lazar2, Dumitru Oraseanu1,2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
Correspondence: Andreia Florina Nita

Clinical and Translational Allergy 2016, 6(Suppl 1):PP30

Introduction: Worldwide, 8 % of the children are diagnosed with food allergy, which means 2 children in every classroom. In the last 10 years food allergies among children have increased by 50 % (CDC). In light of this concerning facts, more and more parents have to cope with an allergic child, being responsible for risk assessment and management of their child’s condition. Nowadays, social media is a powerful tool that parents use to get informed. Despite this, little has been published about social media role in health issues.

Objective: To evaluate the content of communication in parents dedicated websites regarding topics on food allergy in children.

Design: We searched for non-medical online networking websites dedicated to parents, with topics and talks regarding food allergy in children and identified 19 online sites which we further evaluated in respect to content form (personal experience, information) and correctitude of information from a medical point of view.

Results: The number of answers to a topic was variable according to the popularity of the website, ranging from 8 to 215. However, the number of unique visualizations was exponentially higher, ranging from 3302 to 25.123.

Parents of children with food allergy either medically confirmed or suspected use social media tools to ask for information and share personal experiences. The hierarchy of most common reasons to use the online media is the following: (1) to describe an acute reaction and ask for opinions on management and causes (2) to get informed about food diet and treatment and find out others experience with specific treatment, including different brands, 3. Ask other parents to recommend a physician and/or a medical laboratory. Other important concerns raised by parents were the difficulties encountered regarding collectivity attendance due to impossibility of providing food specific diet. There were some medically inaccurate recommendations such as use of homeopathic treatment or inadequate definition of medical terms.

Conclusions: Online social media provides a place to share personal experiences, receive emotional support and get information on medical management, suggesting that this tool should be better managed for greater efficiency.

Funding: This paper was co-financed from the European Social Fund, through the Sectorial Operational Programme Human Resources Development 2007–2013, contract POSDRU/187/1.5/S/155463 “Supporting excellence in scientific interdisciplinary doctoral research in the economic, medical and social fields”, coordinator The Bucharest University of Economic Studies”.

PP31 The impact of food allergy on quality of life: FAQLQ questionnaire

Rita Aguiar, Anabela Lopes, Maria J. Paes, Amélia S. Santos, M. A. Pereira-Barbosa

Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal
Correspondence: Rita Aguiar

Clinical and Translational Allergy 2016, 6(Suppl 1):PP31

Introduction: Food allergy (FA) affects 8.5 % percent of children in Portugal. This study evaluates the impact of on quality of life (QoL).

Methods: We performed a study using the Food Allergy Quality of Life Questionnaire FAQLQ. The appropriate questionnaire will depend on the age of the patient. FAQLQ-PF (0–12 years) as perceived by the parent. FAQLQ-CF and FAQLQ-TF are self-administered tools that measure the impact of FA on children (8–12 years) and teenagers (13–17 years). We applied the questionnaire to patients under 18 years diagnosed with FA in the last 2 months.

Information on food allergens and demographic data was collected for all children.

Results: The questionnaire FAQLP-PF was applied to 13 parents of children under 12 years. The questionnaires FAQLP-CF and FAQLQ-TF were applied to 7 children and 9 teenagers, respectively.

The mean age of the food allergy population was 9 ± 5.2 (1–17 years). 16 patients (55.2 %) were male; 34.5 % had rhinitis, 27.6 % had atopic dermatitis and 13.8 % had asthma. 17 (58.6 %) were allergic to 1 or 2 foods; 12 (41.4 %) were allergic to 3 or more foods. The egg is the most common food allergen implicated in children (37.9 %), followed by milk proteins (31.09 %), shrimp (31.09 %), and fresh fruits (27.6 %).

The median score of the questionnaires were: FAQLQ-PF = 5.2; FAQLQ-CF = 4.9; FAQLQ-TF = 4.

The correlation between the severity of the reaction (Mueller classification) and the FAQLQ is 0.3 (p = 0.05). The correlation between the number of food and impairment in the QoL was not found.

Conclusions: The parents were the group most affected about the impact on quality of life (FAQLQ-PF 5.2) as they indicated that FA significantly impact meal preparation, impact on their level of stress, affected family social activities and affected their child’s school attendance. We found a positive but weak correlation between the severity of the reaction and the impairment in the quality of life (FAQLQ).

The results show that FA impairs the children’s quality of life in all age groups and also the quality of life of their families. We suggest the regular evaluation of the quality of life in the clinical management of children with FA.

PP32 An unexpected cause of anaphylaxis: potato

Hatice Eke Gungor, Salih Uytun, Umit Murat Sahiner, Yasemin Altuner Torun

Kayseri Education and Research Hospital, Department of Pediatrics, Pediatric Allergy-Immunology Unit, Kayseri, Turkey
Correspondence: Hatice Eke Gungor

Clinical and Translational Allergy 2016, 6(Suppl 1):32

Background: Immediate reactions against contact to raw potato has been reported in adults with generally being in the form of an oral contact dermatitis or contact urticaria, but it may also manifest as rhinitis symptoms, wheezing or even anaphylaxis. Cooked or raw potato allergy has been rarely reported in children as some is being immediate and others being late reactions, and it usually results from ingestion.

Objective: We report two cases with a background of allergic diseases developed anaphylaxis one with cooked potato and the other one with raw potato.

Methods: We measured serum potato specific IgE and applied a skin prik test (SPT) with aeroallergens, food allergens and prick-to-prick test using raw and cooked potato.

Results: We found serum potato specific IgE 4.92 and 125 kU/L case 1 and case 2 respectively. We also demonstrated SPT positivity aganist raw potato and cooked potato case 1 and case 2 respectively.

Conclusion: We aimed to emphasize potato allergy, a rare entity, and to remind potential disorders that could develop with or after potato allergy.

PP33 Is it clinical phenotype of allergic diseases determined by sensitisation to food?

Mirjana Zivanovic1, Marina Atanasković-Marković2

1Special Hospital Sokobanja, Sokobanja, Serbia; 2University Children Hospital, Faculty of Medicine, Belgrade, Serbia
Correspondence: Mirjana Zivanovic

Clinical and Translational Allergy 2016, 6(Suppl 1):33

Background: Food allergy results from an atypical response of the mucosal immune system to orally consumed allergens. Relationship between the offending food and natural course of the disease is a little known and controversial.

Aim: To determine the relationship between the causative food and the clinical presentation of food allergy and other associated allergic diseases.

Methods: This is a review of patients who underwent skin prick testing, prick to prick testing, presence of food specific IgE and positive oral provocation test, in small number of patients.

Results: We were analysed 226 patients. There are ranged between 4 months and 7 years. The implicated food were as follows: CMP (24.79 %), egg (17.70 %), peanut (12.83 %), wheat (11.50 %), soy (10.18 %), tree nuts (7.96 %), fish (7.96 %), kiwi fruit (7.08 %). The median age of the children was 28 months, 52 % were boys and 48 % were girls. The frequency of atopic dermatitis was higher in children with egg allergy (72 %), compared to those with milk (28 %), or wheat (24 %), or peanut (49 %), (p < 0.001). Asthma was more frequently in children with isolated peanut allergy (65 %) than children with milk (26.2 %) and egg allergy (24.4 %), (p = 0.001). Allergic rhinitis was more frequent in children with isolated peanut allergy (41 %) compared to children with milk (4.2 %) and egg allergy (3.8 %), (p < 0.001). The frequency of pollen sensitization was higher in children with peanut allergy (64.4 %) compared to children with egg allergy (4.7 %), or milk allergy (4 %), (p < 0.001).

Conclusion: The type of culprit food may be important factor of clinical presentation and prognosis of food allergy and may be reason for expression other allergic conditions.

Keywords: allergy; children; food.

PP34

WITHDRAWN

Clinical and Translational Allergy 2016, 6(Suppl 1):PP34

PP35 Prescribing adrenaline auto-injectors in children in 2014: the data from regional pediatricians

Tina Vesel1, Mihaela Nahtigal2, Andreja Obermayer-Temlin3, Eva Šoster Križnik3, Mirjana Maslar3, Ruben Bizjak4, Marjeta Tomšič-Matic5, Sonja Posega-Devetak6, Maja Skerbinjek-Kavalar7, Mateja Predalič8, Tadej Avčin1

1Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center, Ljubljana, Slovenia; 2General Hospital in Slovenj Gradec, Slovenj Gradec, Slovenia; 3General Hospital in Celje, Celje, Slovenia; 4General Hospital in Šempeter, Šempeter, Slovenia; 5General Hospital in Trbovlje, Trbovlje, Slovenia; 6General Hospital in Izola, Izola, Slovenia; 7Allergologic Pediatric Ambulance, Maribor, Slovenia; 8General Hospital in Novo Mesto, Novo Mesto, Slovenia
Correspondence: Tina Vesel

Clinical and Translational Allergy 2016, 6(Suppl 1):PP35

Introduction: Previous data from the University Children’s Hospital in Ljubljana, Slovenia, showed that adrenaline auto-injector was prescribed to Slovenian children most frequently because of allergy to peanuts.

Methods: We prospectively collected data on interventions of immediate reactions and allergic follow-up of children which had adrenaline auto-injectors prescribed in year 2014 and were followed-up exclusively by regional paediatricians’ with special interest in paediatric allergy.

Results: 76 children (52 boys, 24 girls) were followed-up exclusively by regional pediatricians with special interest in paediatric allergy. 10.5 % were babies, 27.6 % 1 to 5 years old, 55.3 % 6 to 14 years old and 6.5 % 15 to 18 years old. Adrenaline auto-injector was prescribed in 63.1 % because of anaphylaxis and in 31.6 % because of urticaria and/or angioedema. In 92.1 % of children adrenaline auto-injector was prescribed because of food allergy, most frequently because of allergy to peanuts (44 children). 93.2 % of peanut allergic children had specific IgE antibodies to rArah h 2. Among food allergic children 7.2 % had multiple food allergies, 38.6 % asthma and 7.2 % suffered more than one immediate reaction. Other confirmed reasons for prescribing adrenaline auto-injector were insect sting (4 children) and inhalant allergens (1 child). In 5 % of children the cause of immediate reaction was unknown. 29.1 % of anaphylaxis was treated with adrenaline 43.7 % of children were admitted to hospital after anaphylaxis. For comparison, during 2014 adrenaline auto-injector was prescribed in 291 children during 2014 in Slovenia.

Conclusions: Demographic and clinical characteristics of children with prescribed adrenaline auto-injectors reported by regional paediatricians with special interest in pediatric allergy were similar to our previous data though children had fewer different food allergies.

PP36 Who should have an adrenaline autoinjector? Adherence to the European and French guidelines among 121 allergists from the Allergy Vigilance Network

Guillaume Pouessel1, 2, 3, Etienne Beaudouin2,4, Anne M. Moneret-Vautrin2,4, Antoine Deschildre2,3, Allergy Vigilance Network2

1Department of Pediatrics, Children’s Hospital, Roubaix, France; 2Allergy Vigilance Network, Vandoeuvre les Nancy, France; 3Pediatric Pulmonology and Allergy Department, Pôle Enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France; 4Department of Internal Medicine, Immunology and Allergology, Jean Monnet Hospital, Epinal, France
Correspondence: Guillaume Pouessel

Clinical and Translational Allergy 2016, 6(Suppl 1):PP36

Background: According to the French[1] and the EAACI[2] anaphylaxis guidelines, patients with a previous anaphylaxis (apart drug allergy) or at particular risk of anaphylaxis should require prescription of adrenaline auto-injector (AAI). Our aim was to assess prescription practices of AAI by the French allergists from the Allergy Vigilance Network[3] (AVN) and to confront these to the European and French guidelines.

Methods: In January 2015, an electronic questionnaire was sent to the 299 allergists of the AVN.

Results: 121 questionnaires (40 %) were analyzed. According to the European guidelines, 77 % of the allergists were used to prescribe AAI for at least 5 of the 6 absolute indications in children, 90 % of them in adults, and about 50 % of them in all absolute indications in children and adults. According to the French guidelines, 81 % of the allergists were used to prescribe AAI for at least 4 of the 5 absolute indications in children and 90 % in adults, but only 33 % validated all the absolute indications in children, 28 % in adults. History of isolated generalized hive was not considered as an indication by a third of the allergists. 77 % of the allergists were used to prescribe AAI in children with co-existing unstable or moderate-to-severe asthma, 66 % in adults, even if it was not initially considered as an absolute indication in the French guidelines. Food allergy due to traces was an indication for 78 % of the allergists, and adolescence for 16 % of them. In all, there was no significant difference between children and adults. A second AAI was systematically prescribed by the allergists in 34 % of the patients and half of them were used to prescribe a second adrenaline auto-injector for at least one of the 6 suggested indications of the European guidelines. The main criteria for choosing the AAI device were: availability (56 %), ergonomics (38 %), availability of trainers (33 %), needle’s length (22 %).

Conclusions: Our findings may be useful to improve knowledge and adherence to the guidelines and to update French guidelines for prescribing AAI.

References
  1. 1.

    Commision tripartite de la SFA. Rev Fr Allergol Immunol Clin 2003.

     
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    Muraro, et al. Allergy 2014.

     
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PP37 Anaphylaxis by Anacardium Occidentale

Marta Viñas1, Bartolomé Borja2, Nora Hernández1, Mª José Castillo1, Adriana Izquierdo1, Marcel Ibero1

1Hospital de Terrassa, Terrassa, Spain; 2Bial Arístegui, Bilbao, Spain
Correspondence: Marta Viñas

Clinical and Translational Allergy 2016, 6(Suppl 1):PP37

Introduction: According to our casuistry, nuts are the leading cause of anaphylaxis in children aged from 0 to 14 years.

Case report: A 7 year old boy diagnosed in 2011 of extrinsic bronchial asthma due to sensitisation to dog dander/epithelium. In May 2014, after 5–10 min of eating 3 cashews, he presented dyspnea, dysphagia, sweating, and generalized urticaria. We performed him skin prick tests to panallergens (lipid transfer protein, polcalcina and profilin), to commercial extracts of nuts (peanut, hazelnut, almond, walnut, pistachio, pine nuts, sunflower seeds and chestnut) and natural extracts of fried and raw cashew and roasted and raw hazelnut, both degreased and without degreasing and prick by prick with cashew. Analytics with basal tryptase, total IgE and specific IgE by ImmunoCAP to peanut, hazelnut, walnut, cashew and pistachio, and component resolved diagnostics (CRD) with recombinant allergens. Finally, an oral challenge with hazelnuts was performed with good tolerance and SDS-PAGE immunoblotting with cashew. The results of all tests were completely negative. Tryptase baseline: 4.03 mg/L. Total IgE: 339.5 U/l. Specific IgE: hazelnut, peanut, walnut, cashew and pistachio <0.10 kU/L. CRD: rJug r 3, rAra h 2, rAra h 9 and rAra h 8 < 0.10 kU/L. The patient tolerated 20 g of hazelnuts and in the Immunoblotting SDS-PAGE one band corresponding to a protein of about 33 kDa was detected.

Conclusions: Basing on the results of the SDS-PAGE Immunoblotting, our patient was diagnosed of anaphylaxis by cashew nuts. The protein detected corresponds to an allergen described of cashew: Ana o 2, which is an 11S globulin reservation. In our patient we have forbidden eating cashew and pistachio, being of the same family (Anacardiaceae) and they have cross-reactivity, but we have allowed the intake of other nuts.

Consent to publish

Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

PP38 Anaphylaxis with honey in a child

S. Tolga Yavuz1, Ali Gungor2, Betul Buyuktiryaki3, Ozan Koc2, Can Naci Kocabas3, Faysal Gok2

1Department of Pediatric Allergy, GATA School of Medicine, Ankara, Turkey; 2Department of Pediatrics, GATA School of Medicine, Ankara, Turkey; 3Department of Pediatric Allergy and Immunology, Ankara Child Health and Diseases Hematology-Oncology Training and Research Hospital, Ankara, Turkey
Correspondence: S. Tolga Yavuz

Clinical and Translational Allergy 2016, 6(Suppl 1):PP38

Introduction: Honey is a mixture of flower nectar, pollens, and components from bees. Honey allergy is a rare entity, however it may cause serious reactions in allergic individuals.

Case report: A 10-year-old boy admitted to our outpatient department suffering from allergic reactions after consumption of honey. He was under regular follow-up due to asthma and pollen-induced allergic rhinitis for 4 years. At different times, he presented with wheezing, swelling of the lips and eyelids within 5 min after ingestion of honey. His skin prick test with common aeroallergens revealed grass pollen and mold mix sensitivity and prick-to-prick tests with four different types of honey were found to be positive. Specific IgE to honey was also positive. Dietary elimination of honey was suggested and adrenaline auto-injectors were provided.

Conclusion: Along with the leading causes of food allergy in childhood such as cow’s milk, egg and peanuts, rare foods such as honey may cause allergic reactions in children. Increase of the awareness by the physicians and the families may help better identification of rare food allergies.

Consent to publish

Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

PP39 Evaluation of courses adopted to children on prevention, recognition and management of anaphylaxis

Tina Vesel1, Mihaela Nahtigal2

1Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center, Ljubljana, Slovenia; 2General Hospital in Slovenj Gradec, Slovenj Gradec, Slovenia
Correspondence: Tina Vesel

Clinical and Translational Allergy 2016, 6(Suppl 1):PP39

Background: Training children and teenagers to avoid, recognise and manage anaphylaxis is essential.

Methods: 95 food allergic children with prescribed adrenaline auto injectors were invited with their relatives and friends to attenuate courses on anaphylaxis management and families of 21 among them responded invitation. We have applied the questionnaire on avoiding, recognition and management of anaphylaxis to children before and after the 1.5 h long courses on anaphylaxis management.

Results: There were 26 participants (20 boys, 6 girls; age 10–18). 20 children had prescribed adrenaline auto injectors because of food allergy, four children were relatives of food allergic child and two children were colleagues of food allergic child. 96 % of children recognised correctly signs of anaphylaxis before and 100 % after the course. Regarding preventive measures of anaphylaxis, the correct position during anaphylaxis and the correct order of management during the anaphylaxis all children answered correctly. 88 % of children would give adrenaline by auto injector during anaphylaxis before the course and all of them after the course.

Conclusions: The course enhanced theoretical ability and the willingness of appropriate first-line management of anaphylaxis in children though children were already previously well prepared and motivated to act during anaphylaxis. Other modes of passing knowledge on anaphylaxis management beside courses during schooldays should be sought in order to educate more children.

PP40 Symptomatic dust mites and shrimp allergy: three pediatric case reports

Filipa Almeida, Susana Lopes, Cristina Madureira, Tânia Lopes, Fernanda Carvalho

Centro Hospitalar do Médio Ave, Vila Nova de Fa, Portugal
Correspondence: Filipa Almeida

Clinical and Translational Allergy 2016, 6(Suppl 1):PP40

Introduction: It has been reported that many patients sensitized to inhaled dust mites are also sensitized to shellfish, due largely to the cross-reacting anti-tropomyosin (r Pen a1) IgE. That co-sensitization can also occur in the absence of cross-reactivity and clinical relevance may be different.

Purpose and methods: To characterize cases of allergy to shellfish and inhaled dust mites in children followed in outpatient Level II Hospital evaluating their sensitization profile and occurrence of any cross-reaction. Data were collected on shrimp, inhaled dust mites (dermatophagoides pteronyssinus and dermatophagoides farinae) and tropomyosin sensitization based on clinical history, skin prick tests (SPTs) (Leti®) or specific serum IgE (ImmunoCap®).

Results: Three cases were selected, all male. There was a family history of allergy in 2 cases. In those the allergy to shrimp was the first manifestation of atopic disease. The age of diagnosis of shrimp allergy varied between 8 and 10 years, and clinical presentations were: anaphylaxis, urticaria, angioedema and pharyngeal itching. All cases had allergic rhinitis to inhaled dust mites. One case also had asthma and co-sensitization to grass. All cases had co-sensitization with other food allergen (crustacean and mollusk). The specific serum IgE to shrimp and tropomyosin (r Pen a1) was positive in two cases (one case with a positive skin prick test to shrimp is waiting for the result). In 2 cases there was previous history of persistent rhinitis but the symptoms were not valued.

Conclusion: The authors present 3 cases of allergy to shrimp and inhaled dust mites with different clinical presentations. In all cases the rhinitis was the main atopic disease though often neglected. The presence of other food allergies to shellfish group is in favor of cross-reactivity obtained by the panallergen tropomyosin.

PP41 Poor identification rates of nuts by high risk individuals: a call for improved education and support for families

Camille Heming1*, Emily Garrett1*, Adam Blackstock1*, Santanu Maity2