2024 Conference Presentations

The American Association of Asthma, Allergy and Immunology (AAAAI) Annual Meeting 2024

Case Study Presentation

Two Hands are Better Than One: Epinephrine Use Recommendations in the Allergic Toddler Population

When Does Lightning Strike Twice? Assessment of “Repeat” Infant FPIES, the Risks and Characteristics of Sibling FPIES

Diagnosis and Treatment of IgE Mediated Food Allergies

Characterization of peanut sensitization and outcome of oral food challenge increase of AD in patients 1-year-old or younger

pH Matters: Identifying Trends in Control of Childhood Atopic Dermatitis Based on pH of Common Over-The-Counter Products

Authors: Maxwell Librach. MSc, Caitlin Schuetz, Jason Ohayon Ohayon MD

Rationale: Atopic dermatitis (AD) is associated with increased transepidermal waterloos; impaired barrier function impacted by altered skin pH, with a healthy skin pH ranging 4.5, 5.5. This study examines the pH of common personal care products purchased by infant caregivers and investigates the relationship between pH of products used by parents and AD severity.

Methods: Children (aged 0-3), both currently or previously diagnosed with AD, and controls with otherwise healthy skin were consented for evaluation in a community-based Allergy clinic. Parents presented their child’s primary soap, moisturizing lotion, and sunscreen at the time of consultation. Products were analyzed for pH using standardized strips (Hydrion®), and compared to a list of recommended products.

Results: Twenty-six caregivers of AD children were consulted. All patients used ≥ 1 non ideal pH product (>4.5); ~65% used ≥ 1 in a harmful range (>6). ~58% of AD and ~71% of controls used harmful range products. Only one patient used a harmful range soap, whereas the majority used harmful range lotion (~68%) and sunscreen (~53%). Approximately one quarter of patients used products within the recommended range (<4.5). There was a significantly lower average pH of lotions used by AD patients vs. control (p<0.05).

Conclusions: Most parents tend to use skin products available in stores, without necessarily considering pH and how this may affect AD symptoms in children. Parents of children with AD may specifically be using preferable lotions as they are recommended for AD. This study highlights the importance of medical education in treating AD.

Does Distraction Do Anything? Assessing the Effectiveness of Introducing a Distraction Task During Skin Testing to Pediatric Patients to Decrease Distress

Authors: Nandini Kohli, Jason Ohayon MD, Stephanie Raptis, Vaidehi Bhatt; University of Waterloo, Hamilton Allergy

Rationale: Pediatric allergy skin prick testing (SPT) is a stressful encounter. Introducing tactile distraction (TD) during SPT may reduce its stress by way of visual and autonomic outcome measures. Outcomes were collected in a single clinic.

Methods: Pediatric patients (4-14 years) were randomly assigned to either one of 2 TD, (fidget spinner vs. squeezable toy) vs control. Single observer rated a five-point Anxiety Assessment Tool (AAT) using a 4 point scale describing facial expressions, body movements, verbalisations, breathing pattern and autonomic changes. Tabulated scores represented levels of anxiety; ie. 0 - 5 “No/Mild”, 6 - 10 “Moderate”, 11 - 15, “Severe”, 16 - 20 “Extreme”. Heart Rate (HR) and Mean Arterial Pressure (MAP) values were collected at pre and post SPT. T-test scores and two-way ANOVA were used for statistical analysis.

Results: Forty-four patients with 22 in each group (mean age 2.7 years, SD 3.1 yrs) were assessed. No statistical significance was observed in the mean AAT score t(42) = 0.25, p = 0.80. No statistically significant interaction between the effects of introducing TD and time (F(1, 84) = 0.28, p = 0.6) on HR was seen. Paradoxically, a statistically significant interaction between distraction task and time (F(1, 84) = 17.74, p = 0.00006) was found in TD groups with higher MAP (p = 0.003).

Conclusions: TD was not associated with improved anxiety scores or lowered HR. Paradoxically, elevated MAP was confirmed in the TD group. TD was a little help in decreasing SPT induced pediatric stress of allergy evaluation.

Do Numbers Matter? Assessing Influence Of Number Of Food Allergies (FA) In Patients’ Long Term Management Of Their Eating Practices and Allergy Treatment

Authors: Gurnidhi Binner, Jason Ohayon; University of Waterloo, Hamilton Allergy

Rationale: The impact of food allergies is associated with increased anxiety. Assessment of eating practices and allergy treatment between patients with single (SFA) vs multiple food allergies (MFA) may benefit their counseling.

Methods: A prospective 15 point questionnaire was collected in a community allergy clinic to evaluate the above. A 5-point scale was used. Results were obtained to compare patients with SFA and MFA.

Results: Results were obtained from 42 respondents. Thirty patients were female (71%). SFA was found in 13/42 (31%) and MFA in 29/42 (69%). Previous epinephrine use was found in 55% (23/42), higher in MFA 17/29, (59%). Still, MFA 13/29 (45%) used antihistamines first in case of early anaphylaxis. Despite patient meticulous ingredient review, more MFA remained hesitant to eat screened foods (17/23, 74%) compared to SFA 6/13 (46%). There was no difference in avoiding “May Contain” labels. Concern for airborne FA and FA contact with public surfaces affected only the MFA group 8/29, (28%), and 5/29 (17%) respectively. Concern for eating in the presence of others consuming their FA was higher in MFA 14/29 (48%) vs SFA 5/13 (38%). MFA patients preferred bringing their own food to social events, avoiding restaurants, both (9/29, 28%). There were no similar concerns in the SFA patients.

Conclusions: MFA are at higher risk of altered eating practices and social isolation compared to SFA. Early epinephrine remains suboptimal in both SFA/MFA.