Double-blinded, placebo-controlled food challenges (DBPCFCs) remain the gold standard for diagnos... more Double-blinded, placebo-controlled food challenges (DBPCFCs) remain the gold standard for diagnosing food allergies. Skin prick tests (SPTs) and allergen-specific IgE (sIgE) are routinely used in medical practice but are not sufficient to predict severity of clinical reactivity. To compare the utility of SPT wheal diameter, sIgE, allergen-specific IgG4 (sIgG4), total IgE (tIgE), sIgE/sIgG4 and sIgE/tIgE ratios, peanut component-specific IgE, and basophil activation in predicting outcome and severity of reactions at DBPCFCs. Sixty-seven subjects (12-45 years old) underwent DBPCFCs for peanut, tree nut, fish, shrimp, and/or sesame as part of screening for enrollment in a clinical trial. The SPT, sIgE, tIgE, sIgG4, and peanut component-specific IgE (if applicable) levels were measured. CD63 upregulation on basophils in response to in vitro allergen challenge was analyzed by flow cytometry. Correlations between these measurements and DBPCFC severity scores were analyzed. The SPT and sIgE showed a weak correlation with DBPCFC severity scores, but tIgE and sIgG4 did not. The sIgE/sIgG4 ratio differentiated between positive and negative reactions but did not correlate with DBPCFC severity scores. A low positive correlation was seen between DBPCFC severity score and Ara h 2 IgE, whereas a low negative correlation with Ara h 8 IgE was observed. Basophil activation was positively correlated with DBPCFC severity scores. Receiver operating characteristic curves showed basophil reactivity had the largest area under the curve at 0.904 and sIgE at 0.870. These results indicate that basophil activation testing can enhance discrimination between allergic and nonallergic individuals and could serve as an additional tool to predict clinical severity.
The journal of allergy and clinical immunology. In practice
Food allergies are commonly seen by the practitioner, and managing these patients is often challe... more Food allergies are commonly seen by the practitioner, and managing these patients is often challenging. Recent epidemiologic studies report that as many as 1 in 13 children in the United States may have a food allergy, which makes this an important disease process to appropriately diagnose and manage for primary care physicians and specialists alike. Having a understanding of the basic immunologic processes that underlie varying presentations of food-induced allergic diseases will guide the clinician in the initial workup. This review will cover the basic approach to understanding the immune response of an individual with food allergy after ingestion and will guide the clinician in applying appropriate testing modalities when needed by conducting food challenges if indicated and by educating the patient and his or her guardian to minimize the risk of accidental ingestion.
The Journal of Allergy and Clinical Immunology: In Practice, 2013
What is already known about this topic? High-fidelity mannequins and standardized patients provid... more What is already known about this topic? High-fidelity mannequins and standardized patients provide an innovative and interactive method of education that has been shown to be an effective means of teaching in general medical education and some subspecialties.
The Journal of Allergy and Clinical Immunology: In Practice, 2013
Cite this article as: Dilley MA, Jones SM, Perry TT, Scurlock AM, Brodie-Fowler M, Bufford JD, et... more Cite this article as: Dilley MA, Jones SM, Perry TT, Scurlock AM, Brodie-Fowler M, Bufford JD, et al. Pneumococcal meningitis in a patient with IL-1 receptore associated kinase-4 deficiency: A case of failed prophylaxis. J Allergy Clin Immunol Pract 2013;1:700-3. http://dx.
Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it... more Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy. Our primary objective was to determine whether peanut OIT can induce sustained unresponsiveness after withdrawal of OIT. We conducted a pilot clinical trial of peanut OIT at 2 US centers. Subjects age 1 to 16 years were recruited and treated for up to 5 years with peanut OIT. The protocol was modified over time to permit dose increases to a maximum of 4000 mg/d peanut protein. Blood was collected at multiple time points. Clinical end points were measured with 5000-mg double-blinded, placebo-controlled food challenges once specific criteria were met. Of the 39 subjects originally enrolled, 24 completed the protocol and had evaluable outcomes. Twelve (50%) of 24 successfully passed a challenge 1 month after stopping OIT and achieved sustained unresponsiveness. Peanut was added to the diet. At baseline and the time of challenge, such subjects had smaller skin test results, as well as lower IgE levels specific for peanut, Ara h 1, and Ara h 2 and lower ratios of peanut-specific IgE/total IgE compared with subjects not passing. There were no differences in peanut IgG₄ levels or functional activity at the end of the study. This is the first demonstration of sustained unresponsiveness after peanut OIT, occurring in half of subjects treated for up to 5 years. OIT favorably modified the peanut-specific immune response in all subjects completing the protocol. Smaller skin test results and lower allergen-specific IgE levels were predictive of successful outcome.
RATIONALE: Contact urticaria syndrome (CUS) due to Lettuce and chicory, belonging to the Composit... more RATIONALE: Contact urticaria syndrome (CUS) due to Lettuce and chicory, belonging to the Compositae family, has rarely been reported. METHODS: A 30-year-old man, who had been a cook for the past 11 years, was referred to our hospital due to several anaphylactic reactions during cooking. He started developing urticaria on his hands, accompanied by generalized urticaria, abdominal pain, vomiting, and dyspnea,when he washed lettuce at the age of 27. He also began to feel itching on his lips and oral cavity after ingestion of lettuce. Thereafter, he limited his exposure to lettuce by using gloves and avoiding ingestion. Two years later, he experienced generalized urticaria and dyspnea when he handled chicory for the first time. The patient underwent prick-prick tests with lettuce and chicory and skin prick tests (SPTs) with pollen extracts. Furthermore, specific IgE against pollens and the allergens of lettuce and chicory were detected by CAP-FEIA and IgE-immunoblotting, respectively. RESULTS: The prick-prick tests with lettuce and chicory were positive, whereas SPTs with ragweed and mugwort were negative. Serum total IgE was 1,587 IU/ml. CAP-RAST revealed positivity to ragweed. The patient's serum bound to proteins at 32-kDa and 32;34 kDa in the lettuce and chicory extracts, respectively,in IgE-immunoblotting. CONCLUSIONS: We reported a rare case of occupational CUS caused by handling lettuce and chicory. Our study showed that 32;34-kDa proteins of lettuce and chicory were responsible for CUS in our case, indicating that CUS after first handling of chicory might be caused by cross-reactivity with lettuce. Funding:
RATIONALE: A simple and effective method for reducing exposure to mites is the encasing of mattre... more RATIONALE: A simple and effective method for reducing exposure to mites is the encasing of mattress, pillows and quilt with allergen-proof covers. Several studies have shown that encasing reduces the levels of mite allergens on the bed up to 98-100%. Reduced exposure improves allergic symptoms and lung function, as well as decreases the need of rescue medication, especially among children. The aim of this study was to evaluate how parents of mite allergic children perceive the effect of encasing. This has not been investigated earlier.
Oral food challenges are essential to the diagnosis of food allergy; however, little has been rep... more Oral food challenges are essential to the diagnosis of food allergy; however, little has been reported regarding the risks of performing food challenges in children with suspected food allergy. To examine the risk and reaction severity of failed oral food challenges. A retrospective chart review was performed on children who underwent food challenges to milk, egg, peanut, soy, and/or wheat in a university-based pediatric allergy clinic over a 7-year period. Of the 584 challenges completed, 253 (43%) resulted in an allergic reaction. There were 90 milk, 56 egg, 71 peanut, 21 soy, and 15 wheat failed challenges. Of patients who failed, there were 197 (78%) cutaneous, 108 (43%) gastrointestinal, 66 (26%) oral, 67 (26%) lower respiratory, and 62 (25%) upper respiratory reactions. No patients had cardiovascular symptoms. There was no difference between foods in the severity of failed challenges or the type of treatment required to reverse symptoms. All reactions were reversible with short-acting antihistamines +/- epinephrine, beta-agonists, and/or corticosteroids. No children required hospitalization, and there were no deaths. There are risks associated with food challenges, and the risks are similar for each of the foods studied. Given the benefits that result from a negative challenge, these risks are reasonable when challenges are performed under the guidance of an experienced practitioner in a properly equipped setting.
Background: Rat allergen has proved to be an important cause of IgE-mediated hypersensitivity in ... more Background: Rat allergen has proved to be an important cause of IgE-mediated hypersensitivity in the occupational setting. The prevalence and significance of rat allergen in homes has not been studied. Objective: The purpose of this study was to determine the prevalence of rat allergen in the homes of inner-city children with asthma and to examine the relationship between rat allergen exposure, sensitization, and asthma morbidity. Methods: We developed a new monoclonal-based ELISA to determine the prevalence of rat allergen in dust samples from inner-city homes of the National Cooperative Inner-City Asthma Study population. Home characteristics were evaluated to detect variables that were associated with the presence of rat allergen. Data were also analyzed to assess the relationship between the presence of rat allergen, sensitization, and asthma morbidity. Results: Thirty-three percent of inner-city homes had detectable rat allergen (Rat n 1). The presence of rat allergen was associated with reported rat and mouse infestation, as well as evidence of mouse infestation on home inspection. Twentyone percent of the participants were sensitized to rat allergen; however, sensitization was not more common when rat allergen was found in the home. The number of hospitalizations, unscheduled medical visits, and days with slowed activity because of asthma were significantly increased in those individuals who were both sensitized and exposed to rat allergen. Conclusions: Rat allergen sensitization and exposure are associated with increased asthma morbidity in inner-city children. (J Allergy Clin Immunol 2003;112:346-52.)
Oral food challenges remain the gold standard for the diagnosis of food allergy. However, clear c... more Oral food challenges remain the gold standard for the diagnosis of food allergy. However, clear clinical and laboratory guidelines have not been firmly established to determine when oral challenges should be performed. We sought to determine the value of food-specific IgE levels in predicting challenge outcome. A retrospective chart review of 604 food challenges in 391 children was performed. All children had food-specific IgE levels measured by means of CAP-RAST before challenge. Data were analyzed to determine the relationship between food-specific IgE levels and challenge outcome, as well as the relationship between other clinical parameters and challenge outcome. Forty-five percent of milk challenges were passed compared with 57% for egg, 59% for peanut, 67% for wheat, and 72% for soy. Specific IgE levels were higher among patients who failed challenges than among those who passed (P </=.03 for each food). When seeking a specific IgE level at which a 50% pass rate could be expected, a cutoff level of 2 kUA/L was determined for milk, egg, and peanut. Data were less clear for wheat and soy. Coexistent eczema or asthma was associated with failed egg challenges, but other atopic disease was otherwise not associated with challenge outcome. Allergen-specific IgE concentrations to milk, egg, and peanut and, to a lesser extent, wheat and soy serve as useful predictors of challenge outcome and should be considered when selecting patients for oral challenge to these foods.
Background: Asthma disproportionately affects minority and low-income children. Investigations th... more Background: Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited.
Challenge with short-term exposure to airborne cat allergen in sensitized patients produces pulmo... more Challenge with short-term exposure to airborne cat allergen in sensitized patients produces pulmonary function changes and rhinitis symptoms. To determine the benefit of montelukast, 10 mg, for patients with concomitant asthma and allergic rhinitis as demonstrated by protection against both lower and upper airway responses to cat allergen challenge. This randomized, crossover study treated patients with montelukast vs placebo during two 2-week, double-blind treatment periods, separated by a 1-week washout period. After each treatment period, patients underwent a 60-minute or less exposure to high levels of airborne cat allergen. Lower and upper airway responses were measured by spirometry and symptom scores. Of 52 patients with data from both treatment arms, 79% of patients taking montelukast and 67% taking placebo were exposed to the full 60-minute allergen challenge. Montelukast provided significant (P < or = .001) protection against allergen challenge in the lower airway coprimary end point of area under the curve during challenge (AUC0-60min) for percentage decrease in forced expiratory volume in 1 second: mean of 10.5% per hour and 14.7% per hour for montelukast and placebo, respectively. Although the effect on the overall nasal symptoms score (NSS) coprimary end point of AUC0-60min was not statistically significance (P = .12), nasal congestion during the challenge and NSS during recovery showed statistically significant (P = .048) protection by montelukast. Additional analyses of simultaneous lower and upper airway responses showed that more patients taking montelukast (22, 43%) vs placebo (13, 26%) were protected from both asthma and rhinitis (P = .02), with an odds ratio of 2.24 (95% CI, 1.16-4.32) in favor of montelukast. Montelukast has a protective effect against both lower and upper airway responses during exposure to high levels of cat allergen.
RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibili... more RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibility of results obtained by different laboratories. We evaluated reproducibility and inter-laboratory variability of a Multiplex Array for Indoor Allergens (MARIA), including Der p 1, Der f 1, Mite Group 2, Fel d 1, Can f 1, Rat n 1, Mus m 1 and Bla g 2. METHODS: For evaluation of the 8-plex MARIA, we used a multi-center ring trial. Ten laboratories across the US and Europe were recruited and trained to use the technology. All reagents required for the trial, as well as aliquots of an identical set of 151 dust extract samples, were sent to each of the 10 participating centers and analyzed by each laboratory on three separate occasions at three dilutions. A hierarchical model was applied to the nested data structure (repeat nested within laboratories, laboratories nested within samples). RESULTS: Complete results for 3 of the 10 participating laboratories were available at time of submission. The current results are based on more than 10,000 individual allergen measurements. More than 36,000 tests will eventually be completed. Allergens levels covered a wide range from below detection limit to greater than 100ug/g (Mus m 1 < 35ug/g). Results were highly reproducible within as well as between the three laboratories, with correlation coefficients generally greater than 0.95. CONCLUSIONS: The data indicate that the MARIA produces results that are reproducible within and between laboratories, which will improve standardization of allergen exposure assessment.
Double-blinded, placebo-controlled food challenges (DBPCFCs) remain the gold standard for diagnos... more Double-blinded, placebo-controlled food challenges (DBPCFCs) remain the gold standard for diagnosing food allergies. Skin prick tests (SPTs) and allergen-specific IgE (sIgE) are routinely used in medical practice but are not sufficient to predict severity of clinical reactivity. To compare the utility of SPT wheal diameter, sIgE, allergen-specific IgG4 (sIgG4), total IgE (tIgE), sIgE/sIgG4 and sIgE/tIgE ratios, peanut component-specific IgE, and basophil activation in predicting outcome and severity of reactions at DBPCFCs. Sixty-seven subjects (12-45 years old) underwent DBPCFCs for peanut, tree nut, fish, shrimp, and/or sesame as part of screening for enrollment in a clinical trial. The SPT, sIgE, tIgE, sIgG4, and peanut component-specific IgE (if applicable) levels were measured. CD63 upregulation on basophils in response to in vitro allergen challenge was analyzed by flow cytometry. Correlations between these measurements and DBPCFC severity scores were analyzed. The SPT and sIgE showed a weak correlation with DBPCFC severity scores, but tIgE and sIgG4 did not. The sIgE/sIgG4 ratio differentiated between positive and negative reactions but did not correlate with DBPCFC severity scores. A low positive correlation was seen between DBPCFC severity score and Ara h 2 IgE, whereas a low negative correlation with Ara h 8 IgE was observed. Basophil activation was positively correlated with DBPCFC severity scores. Receiver operating characteristic curves showed basophil reactivity had the largest area under the curve at 0.904 and sIgE at 0.870. These results indicate that basophil activation testing can enhance discrimination between allergic and nonallergic individuals and could serve as an additional tool to predict clinical severity.
The journal of allergy and clinical immunology. In practice
Food allergies are commonly seen by the practitioner, and managing these patients is often challe... more Food allergies are commonly seen by the practitioner, and managing these patients is often challenging. Recent epidemiologic studies report that as many as 1 in 13 children in the United States may have a food allergy, which makes this an important disease process to appropriately diagnose and manage for primary care physicians and specialists alike. Having a understanding of the basic immunologic processes that underlie varying presentations of food-induced allergic diseases will guide the clinician in the initial workup. This review will cover the basic approach to understanding the immune response of an individual with food allergy after ingestion and will guide the clinician in applying appropriate testing modalities when needed by conducting food challenges if indicated and by educating the patient and his or her guardian to minimize the risk of accidental ingestion.
The Journal of Allergy and Clinical Immunology: In Practice, 2013
What is already known about this topic? High-fidelity mannequins and standardized patients provid... more What is already known about this topic? High-fidelity mannequins and standardized patients provide an innovative and interactive method of education that has been shown to be an effective means of teaching in general medical education and some subspecialties.
The Journal of Allergy and Clinical Immunology: In Practice, 2013
Cite this article as: Dilley MA, Jones SM, Perry TT, Scurlock AM, Brodie-Fowler M, Bufford JD, et... more Cite this article as: Dilley MA, Jones SM, Perry TT, Scurlock AM, Brodie-Fowler M, Bufford JD, et al. Pneumococcal meningitis in a patient with IL-1 receptore associated kinase-4 deficiency: A case of failed prophylaxis. J Allergy Clin Immunol Pract 2013;1:700-3. http://dx.
Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it... more Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy. Our primary objective was to determine whether peanut OIT can induce sustained unresponsiveness after withdrawal of OIT. We conducted a pilot clinical trial of peanut OIT at 2 US centers. Subjects age 1 to 16 years were recruited and treated for up to 5 years with peanut OIT. The protocol was modified over time to permit dose increases to a maximum of 4000 mg/d peanut protein. Blood was collected at multiple time points. Clinical end points were measured with 5000-mg double-blinded, placebo-controlled food challenges once specific criteria were met. Of the 39 subjects originally enrolled, 24 completed the protocol and had evaluable outcomes. Twelve (50%) of 24 successfully passed a challenge 1 month after stopping OIT and achieved sustained unresponsiveness. Peanut was added to the diet. At baseline and the time of challenge, such subjects had smaller skin test results, as well as lower IgE levels specific for peanut, Ara h 1, and Ara h 2 and lower ratios of peanut-specific IgE/total IgE compared with subjects not passing. There were no differences in peanut IgG₄ levels or functional activity at the end of the study. This is the first demonstration of sustained unresponsiveness after peanut OIT, occurring in half of subjects treated for up to 5 years. OIT favorably modified the peanut-specific immune response in all subjects completing the protocol. Smaller skin test results and lower allergen-specific IgE levels were predictive of successful outcome.
RATIONALE: Contact urticaria syndrome (CUS) due to Lettuce and chicory, belonging to the Composit... more RATIONALE: Contact urticaria syndrome (CUS) due to Lettuce and chicory, belonging to the Compositae family, has rarely been reported. METHODS: A 30-year-old man, who had been a cook for the past 11 years, was referred to our hospital due to several anaphylactic reactions during cooking. He started developing urticaria on his hands, accompanied by generalized urticaria, abdominal pain, vomiting, and dyspnea,when he washed lettuce at the age of 27. He also began to feel itching on his lips and oral cavity after ingestion of lettuce. Thereafter, he limited his exposure to lettuce by using gloves and avoiding ingestion. Two years later, he experienced generalized urticaria and dyspnea when he handled chicory for the first time. The patient underwent prick-prick tests with lettuce and chicory and skin prick tests (SPTs) with pollen extracts. Furthermore, specific IgE against pollens and the allergens of lettuce and chicory were detected by CAP-FEIA and IgE-immunoblotting, respectively. RESULTS: The prick-prick tests with lettuce and chicory were positive, whereas SPTs with ragweed and mugwort were negative. Serum total IgE was 1,587 IU/ml. CAP-RAST revealed positivity to ragweed. The patient's serum bound to proteins at 32-kDa and 32;34 kDa in the lettuce and chicory extracts, respectively,in IgE-immunoblotting. CONCLUSIONS: We reported a rare case of occupational CUS caused by handling lettuce and chicory. Our study showed that 32;34-kDa proteins of lettuce and chicory were responsible for CUS in our case, indicating that CUS after first handling of chicory might be caused by cross-reactivity with lettuce. Funding:
RATIONALE: A simple and effective method for reducing exposure to mites is the encasing of mattre... more RATIONALE: A simple and effective method for reducing exposure to mites is the encasing of mattress, pillows and quilt with allergen-proof covers. Several studies have shown that encasing reduces the levels of mite allergens on the bed up to 98-100%. Reduced exposure improves allergic symptoms and lung function, as well as decreases the need of rescue medication, especially among children. The aim of this study was to evaluate how parents of mite allergic children perceive the effect of encasing. This has not been investigated earlier.
Oral food challenges are essential to the diagnosis of food allergy; however, little has been rep... more Oral food challenges are essential to the diagnosis of food allergy; however, little has been reported regarding the risks of performing food challenges in children with suspected food allergy. To examine the risk and reaction severity of failed oral food challenges. A retrospective chart review was performed on children who underwent food challenges to milk, egg, peanut, soy, and/or wheat in a university-based pediatric allergy clinic over a 7-year period. Of the 584 challenges completed, 253 (43%) resulted in an allergic reaction. There were 90 milk, 56 egg, 71 peanut, 21 soy, and 15 wheat failed challenges. Of patients who failed, there were 197 (78%) cutaneous, 108 (43%) gastrointestinal, 66 (26%) oral, 67 (26%) lower respiratory, and 62 (25%) upper respiratory reactions. No patients had cardiovascular symptoms. There was no difference between foods in the severity of failed challenges or the type of treatment required to reverse symptoms. All reactions were reversible with short-acting antihistamines +/- epinephrine, beta-agonists, and/or corticosteroids. No children required hospitalization, and there were no deaths. There are risks associated with food challenges, and the risks are similar for each of the foods studied. Given the benefits that result from a negative challenge, these risks are reasonable when challenges are performed under the guidance of an experienced practitioner in a properly equipped setting.
Background: Rat allergen has proved to be an important cause of IgE-mediated hypersensitivity in ... more Background: Rat allergen has proved to be an important cause of IgE-mediated hypersensitivity in the occupational setting. The prevalence and significance of rat allergen in homes has not been studied. Objective: The purpose of this study was to determine the prevalence of rat allergen in the homes of inner-city children with asthma and to examine the relationship between rat allergen exposure, sensitization, and asthma morbidity. Methods: We developed a new monoclonal-based ELISA to determine the prevalence of rat allergen in dust samples from inner-city homes of the National Cooperative Inner-City Asthma Study population. Home characteristics were evaluated to detect variables that were associated with the presence of rat allergen. Data were also analyzed to assess the relationship between the presence of rat allergen, sensitization, and asthma morbidity. Results: Thirty-three percent of inner-city homes had detectable rat allergen (Rat n 1). The presence of rat allergen was associated with reported rat and mouse infestation, as well as evidence of mouse infestation on home inspection. Twentyone percent of the participants were sensitized to rat allergen; however, sensitization was not more common when rat allergen was found in the home. The number of hospitalizations, unscheduled medical visits, and days with slowed activity because of asthma were significantly increased in those individuals who were both sensitized and exposed to rat allergen. Conclusions: Rat allergen sensitization and exposure are associated with increased asthma morbidity in inner-city children. (J Allergy Clin Immunol 2003;112:346-52.)
Oral food challenges remain the gold standard for the diagnosis of food allergy. However, clear c... more Oral food challenges remain the gold standard for the diagnosis of food allergy. However, clear clinical and laboratory guidelines have not been firmly established to determine when oral challenges should be performed. We sought to determine the value of food-specific IgE levels in predicting challenge outcome. A retrospective chart review of 604 food challenges in 391 children was performed. All children had food-specific IgE levels measured by means of CAP-RAST before challenge. Data were analyzed to determine the relationship between food-specific IgE levels and challenge outcome, as well as the relationship between other clinical parameters and challenge outcome. Forty-five percent of milk challenges were passed compared with 57% for egg, 59% for peanut, 67% for wheat, and 72% for soy. Specific IgE levels were higher among patients who failed challenges than among those who passed (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=.03 for each food). When seeking a specific IgE level at which a 50% pass rate could be expected, a cutoff level of 2 kUA/L was determined for milk, egg, and peanut. Data were less clear for wheat and soy. Coexistent eczema or asthma was associated with failed egg challenges, but other atopic disease was otherwise not associated with challenge outcome. Allergen-specific IgE concentrations to milk, egg, and peanut and, to a lesser extent, wheat and soy serve as useful predictors of challenge outcome and should be considered when selecting patients for oral challenge to these foods.
Background: Asthma disproportionately affects minority and low-income children. Investigations th... more Background: Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited.
Challenge with short-term exposure to airborne cat allergen in sensitized patients produces pulmo... more Challenge with short-term exposure to airborne cat allergen in sensitized patients produces pulmonary function changes and rhinitis symptoms. To determine the benefit of montelukast, 10 mg, for patients with concomitant asthma and allergic rhinitis as demonstrated by protection against both lower and upper airway responses to cat allergen challenge. This randomized, crossover study treated patients with montelukast vs placebo during two 2-week, double-blind treatment periods, separated by a 1-week washout period. After each treatment period, patients underwent a 60-minute or less exposure to high levels of airborne cat allergen. Lower and upper airway responses were measured by spirometry and symptom scores. Of 52 patients with data from both treatment arms, 79% of patients taking montelukast and 67% taking placebo were exposed to the full 60-minute allergen challenge. Montelukast provided significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = .001) protection against allergen challenge in the lower airway coprimary end point of area under the curve during challenge (AUC0-60min) for percentage decrease in forced expiratory volume in 1 second: mean of 10.5% per hour and 14.7% per hour for montelukast and placebo, respectively. Although the effect on the overall nasal symptoms score (NSS) coprimary end point of AUC0-60min was not statistically significance (P = .12), nasal congestion during the challenge and NSS during recovery showed statistically significant (P = .048) protection by montelukast. Additional analyses of simultaneous lower and upper airway responses showed that more patients taking montelukast (22, 43%) vs placebo (13, 26%) were protected from both asthma and rhinitis (P = .02), with an odds ratio of 2.24 (95% CI, 1.16-4.32) in favor of montelukast. Montelukast has a protective effect against both lower and upper airway responses during exposure to high levels of cat allergen.
RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibili... more RATIONALE: Standardization of allergen exposure measurements is important to ensure reproducibility of results obtained by different laboratories. We evaluated reproducibility and inter-laboratory variability of a Multiplex Array for Indoor Allergens (MARIA), including Der p 1, Der f 1, Mite Group 2, Fel d 1, Can f 1, Rat n 1, Mus m 1 and Bla g 2. METHODS: For evaluation of the 8-plex MARIA, we used a multi-center ring trial. Ten laboratories across the US and Europe were recruited and trained to use the technology. All reagents required for the trial, as well as aliquots of an identical set of 151 dust extract samples, were sent to each of the 10 participating centers and analyzed by each laboratory on three separate occasions at three dilutions. A hierarchical model was applied to the nested data structure (repeat nested within laboratories, laboratories nested within samples). RESULTS: Complete results for 3 of the 10 participating laboratories were available at time of submission. The current results are based on more than 10,000 individual allergen measurements. More than 36,000 tests will eventually be completed. Allergens levels covered a wide range from below detection limit to greater than 100ug/g (Mus m 1 < 35ug/g). Results were highly reproducible within as well as between the three laboratories, with correlation coefficients generally greater than 0.95. CONCLUSIONS: The data indicate that the MARIA produces results that are reproducible within and between laboratories, which will improve standardization of allergen exposure assessment.
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Papers by Tamara Perry