AB150 Abstracts
FEBRUARY 2018
475 Household Dust Endotoxin Level and Food
Allergen Sensitization in the National Health and
Nutrition Examination Survey (NHANES)
Angela Tsuang, MD, MSc1, Ginger L. Chew, ScD2, Joanne
Sordillo, ScD3, and Supinda Bunyavanich, MD, MPH, FAAAAI4; 1Icahn
School of Medicine at Mount Sinai, New York, NY, 2Department of Envi-
ronmental Health Sciences, Mailman School of Public Health, Columbia
University, New York, NY, 3Harvard Medical School, Boston, MA, 4Divi-
sion of Allergy & Immunology, Department of Pediatrics, Icahn School of
Medicine at Mount Sinai, New York, NY; Department of Genetics and
Genomic Sciences and Institute of Genomics and Multiscale Biology,
Icahn School of Medicine at Mount Sinai, New York, NY.
RATIONALE: Household endotoxin levels have been variably linked to
asthma and atopy. We sought to determine the association between
household endotoxin levels and food allergen sensitization in a large
national cohort.
METHODS: We studied 6,963 participants from the 2005-2006 National
Health and Nutrition Examination Survey (NHANES). House dust
endotoxin was collected from the bedroom, and serum-specific IgE for
milk, egg, and peanut were measured. Log-transformed endotoxin level
and specific food allergen sensitization (sIgE>50.35 kU/L) were fitted
into logistic regression models using STATA11.
RESULTS: The geometric mean of household endotoxin in this large US
cohort was 15.5 EU/mg (standard error 0.5 EU/mg). The prevalence of
food allergen sensitization varied by specific food: milk 5.7%, egg 4.0%,
and peanut 7.9%. The unadjusted model revealed that a 10-fold increment
in endotoxin was associated with sensitization to milk (OR 1.8, 95%CI 1.3-
2.3) and egg (OR 1.4, 95%CI 1.04-1.8) but not peanut (OR 1.1, 95%CI 0.9-
1.4). Multivariable logistic regression models controlled for identified
confounders including age, country of birth, total people in household,
race, history of wheezing, and US region demonstrated that household
endotoxin levels remained positively associated with sensitization to milk
(OR 1.7, 95%CI 1.2-2.1) and egg (OR 1.4, 95%CI 1.01-1.9) but not peanut
(OR 0.98, 95%CI 0.8-1.2).
CONCLUSIONS: Increasing household endotoxin levels is associated
SUNDAY
with higher odds of milk and egg sensitization. Participants with allergies
likely have an altered responsiveness to microbial components leading to
allergic disease. This effect of endotoxin is beneficial for understanding
how environmental factors play a role in food allergies.
476 Surfing is a risk factor of sensitization to
poly(gamma-glutamic acid) in
soybean-induced late-onset anaphylaxis
fermented
Naoko Inomata, Mami Miyakawa, and Michiko Aihara; Yokohama City
University School of Medicine, Yokohama.
RATIONALE: Poly(g-glutamic acid) (PGA) is the allergen of fermented
soybeans, natto, that causes late-onset anaphylaxis. We speculated that
jellyfish stings sensitize adults to PGA because a surfer had allergies to
both natto and jellyfish, which produce PGA while stinging someone. The
aim of the study was to identify demographic and behavior factors, such as
marine sports, associated with PGA sensitization.
METHODS: Outpatients diagnosed with food allergies based on relevant
clinical history, positive skin test and/or food challenge test were asked to
answer a questionnaire during a regular visit in 2016.
RESULTS: Questionnaire data from 140 outpatients were analyzed.
These patients were divided into two groups: natto allergy group (13
patients, M:F510:3, mean age 40.6 yrs) and non-natto allergy group (127
patients, M:F546:81, mean age 44.5 yrs). All 13 patients with natto allergy
had positive results in both skin prick test and basophil activation test with
PGA. 92.3% of them had a hobby in marine sports, especially surfing
J ALLERGY CLIN IMMUNOL
(84.6%). PGA sensitization was independently associated with marine
sports (odds ratio, 278.0, 95 percent confidential interval, 36.9-6315.9,
p<0.001) adjusted for male sex and bathing, but not with male sex nor bath-
ing. In addition, although there is no significant difference of experience in
marine sports between natto and non-natto allergy groups, natto allergy
group significantly had participated more frequently in marine sports
than non-natto allergy group (p<0.001).
CONCLUSIONS: Surfing is a risk factor of PGA sensitization, resulting
in subsequent natto allergy. PGA sensitization may occur via inflamed skin
in patients by cnidarian stings while floating in the sea.
477 Persistent Cows Milk Allergy is Associated with
Decreased Growth: A Longitudinal Study
Karen A. Robbins, MD1, Robert A. Wood, MD, FAAAAI2, and Corinne
Keet, MD, MS, PhD3; 1Children’s National Medical Center, Washington,
DC, 2Johns Hopkins University School Medicine, Baltimore, MD, 3Johns
Hopkins School of Medicine, Baltimore, MD.
RATIONALE: Data on the effects of food allergy on growth are limited,
with most studies providing only cross-sectional information in early
childhood. Here we describe longitudinal data on growth in children with
persistent food allergy to cow’s milk or peanut/tree nuts.
METHODS: A retrospective chart review was conducted for 191 children
strictly avoiding cow’s milk (n5111) or peanut/tree nuts (n580) due to
IgE-mediated allergy, who had at least one clinic visit between the ages of
2-4 years, 5-8 years, and 9-12 years. Differences in height, weight, and
BMI z-scores were analyzed by generalized estimating equation regression
models.
RESULTS: In measurements from 1098 clinic visits, children with milk
allergy had lower weight-(mean z difference 0.39,95%CI: 0.13– 0.66
,p50.004) and height-(mean z difference 0.39,95%CI: 0.11–
0.67,p50.006), but not BMI-for-age (p50.11) z-scores compared to
peanut/tree nut allergic children. These differences were larger in the 5-8
yo (mean z difference 0.43,95%CI: 0.13–0.73,p50.004) and 9-12 yo
(mean z difference 0.52,95%CI: 0.21–0.84,p50.001) age groups than the
<5 yo age group for weight but not height (p<0.05 for interaction with
age), and were unaffected by other atopic conditions, early-onset eczema,
or inhaled corticosteroid use. Correspondingly, persistent milk allergy was
associated with a greater decline in weight and also BMI z-scores from
baseline visit (2-4 yo) (weight: mean z-difference 0.25, 95%CI: 0.06– 0.43,
p50.008, BMI: mean z-difference 0.34,95%CI: 0.09- 0.59,p50.007).
CONCLUSIONS: Persistent cow’s milk allergy may negatively influence
growth through pre-adolescence. Further study is needed to better under-
stand the complex relationship between food allergy and childhood growth
patterns.