2023 Conference Presentations

European Association of Allergy & Clinical Immunology 2023 Annual Congress

The Penicillin Allergic Pregnant Population: Comparing History to Challenge to Intrapartum Penicillin Use: An Analysis of Risk

Cohort of Chronic Disease: Identifying Patterns of Allergic, Thyroid and Systemic Inflammation in Persistent CSU

Is Nickel Allergy for Life? An Analysis of Nickel Contact Allergy Over a Decade

The New Kid on the Allergy Block: Tracking Early Sensitization to Allergy of Sesame Seed in the High Risk Pediatric Atopic Dermatitis Population

2022 Conference Presentations

Penicillin Allergy in Pregnancy: A Safe and Opportune Time to Test and Challenge

Is the Hand a Sign for the Heart? Interesting Patterns of Lipid Dysregulation in Patients with Chronic Hand Eczema

Choosing OIT Wisely in Egg Allergy Children (EAC): Characterization of Successful Baked Egg Oral Immunotherapy in EAC

Education Emergency in Epinephrine Autoinjector (EAI) Use: Inconsistencies in Anaphylaxis Management and Comfort in Parental Anaphylaxis Management of their Children

2021 Conference Presentations

American Association of Allergy, Asthma & Immunology 2021 Annual Meeting

Going Beyond Virus Biology: COVID-19’s Impact on the Mental Health of Pediatric Populations in an Allergy Community

American College of Allergy, Asthma & Immunology 2021 Conference

Choosing Wisely: Atopic Profile and Serum IgE in the Prediction of Egg OIT Outcomes

Characterization of allergic infants who FAIL initial peanut oral food challenges, is there a pattern?

Canadian Society of Allergy and Clinical Immunology 2021 Annual Meeting

Evolving EoE Etiology: Characterization of Immediate and Delayed Allergic Profiles

European Association of Allergy & Clinical Immunology 2021 Annual Congress

A Call for Action: Understanding Mental Health Impact of Covid-19 in the Referred Allergic Population

The “Other” Mango Allergy: The Need to Educate Patients With Poison Ivy About the Risks of Mango Allergies

Going Viral: Assssing Etiological Trends in Pediatric Urticaria in the Absence of Immediate Historical Trigger(s)

Urticaria ‘Chronic’led: An Analysis of Pediatric Chronic Urticaria Presentation in the Absence of Immediate Historical Trigger(s)

2020 Conference Presentations

American Association of Allergy, Asthma & Immunology 2020 Annual Meeting

Does Age Matter? Impact of Pediatric Age Groups on Parental Quality of Life. Is Older, Better?

European Association of Allergy & Clinical Immunology 2020 Annual Congress

Going the Distance: Assessing Efficacy of Prolonged Injections Interval in CSU patients receiving monthly Xolair injections

Is it Helpful? Impact of Allergy Assessments in the Management of Pediatric Moderate to Severe Atopic Dermatitis

When Does Age Matter? Impact of Psychosocial Stressors on Parental Quality of Life. Is Younger, Better?

Is It Worth the Effort?: Assessing Tree Nut Uptake and Impact on Quality of Life of Families Following an In-Office Oral Food Challenge.

2019 Conference Presentations

American Association of Allergy, Asthma & Immunology 2019 Annual Meeting

When Milk isnt the problem - Carrageenan as a trigger for adverse reaction to dairy products

Disguised Dairy: Anaphylaxis to Hidden Allergens in Routine Vaccinations with Severe Cow’s Milk

Could Early Peanut Introduction In Atopic Infants Increase The Risk of Peanut Induced FPIES?

Authours: Vince Wu, Stephanie L. Vakaljan, BSc, Sydney A. Scheffler, BSc, Jason A. Ohayon, MD FAAAAI

Presented at: AAAAI Annual Meeting 2019

Published in: The Journal of Allergy and Clinical Immunology

Rationale: The NIAID recommends early introduction to peanut in atopic infants. However, implementation of this recommendation has resulted in some allergic reactions, early and late. Food protein induced enterocolitis syndrome (FPIES) is uncommon (< 1%), especially to peanut. We hypothesize that early peanut introduction in these infants may contribute to peanut induced FPIES.

Methods: From 2017, infants (4-12 months) with atopic dermatitis were challenged with peanut. Infants were given standard peanut updosing to a total of 7.75 g over 90 mins. Parents were then advised to continue with 2 teaspoons of peanut flour or butter in diet twice weekly henceforth. Infants who initially tolerated PN in office were followed at home for any delayed allergic response, suspicious of FPIES. Some infants were invited back to office for FPIES confirmation by standard protocol.

Results: Between January 2017 and July 2018, 4 out of 32 (12.5%) high risk infants challenged with peanut had delayed vomiting 2 to 3 hours post peanut ingestion, after initial tolerance. All four patients were initially tolerant to peanut in office. One patient was confirmed to have FPIES from subsequent repeat challenge as per the protocol above. Peanut has been withheld from all four patients’ diets henceforth.

Conclusions: FPIES to peanut is uncommon, accounting for 1.9% of all FPIES cases. We report a significantly higher incidence of peanut induced FPIES reactions (12.5%) in atopic infants with early peanut introduction. Physicians should be conscious of FPIES reactions that may occur at home as a consequence of early peanut introduction.

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Being ''SCIT'' Careful in the Spring: Analyzing Patterns of Immunotherapy-Induced Anaphylaxis Over the Years

Authours: Jason A. Ohayon, MD FAAAAI, Stephanie L. Vakaljan, BSc., VinceWu, and Sydney A. Scheffler, BSc

Presented at: AAAAI Annual Meeting 2019

Published in: The Journal of Allergy and Clinical Immunology

Rationale: Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic individuals. Despite SCIT success, anaphylaxis remains a risk, albeit in less than 1% of injections. We aimed to characterize patterns of anaphylaxis in a community clinic administering SCIT, to help identify patterns of increased risk.

Methods: A retrospective chart review was carried out over a 15-year period (January 1, 2004 to August 15, 2018). Data was collected on patients who had sustained SCIT-induced anaphylaxis. Demographic profiles, timing and reaction details were analyzed. A 5-year subset (2012-2017) was used to calculate total average injection rates in May and November.

Results: Sixty patients were identified with 64 total reactions. Thirty four of 64 (53%) were female. One female patient sustained 3 anaphylactic reactions and 2 males sustained 2 reactions. Forty-one (68%) patients were polysensitized (2, 3, 4, or 5 IT allergens) and 19 were monosensitized. April (10/64) and May (15/64) were the most active months for anaphylaxis, totaling 39% of yearly reactions. Fifty-six of 64 (88%) reactions occurred in the afternoon. The mean afternoon injections in May were 317/378 (84%). The mean afternoon injections in November were 35/ 150 (77%). Twenty-five (42%) patients discontinued SCIT following anaphylaxis; 35 (58%) remained on immunotherapy.

Conclusions: SCIT induced anaphylactic reactions were most common in the Spring season (April-May). More anaphylactic reactions occurred in the PM, although consistent with the ratio of PM/total daily injections. Anaphylaxis induced a high drop-out rate, yet the majority continued on SCIT. Polysensitized patients receiving SCIT in Spring afternoons may benefit from closer monitoring for anaphylaxis.

Canadian Society of Allergy & Clinical Immunology 2019 Annual Meeting

Playing with Fire: The Risks Associated with Intradermal Cephlasporin Testing

Skin prick testing infants with atopic dermatitis may lead to sensitization to food allergens

Authors: Vince Wu, Sydney A. Scheffler, Wardha Wardha, Tarin T. Moni, Kristiina E. Frechette, Jason A. Ohayon MD

Presented at: CSACI Annual Scientific Meeting 2019

Published in: Allergy Asthma and Clinical Immunology

Background: Skin prick testing (SPT)is commonly performed to assess for allergen sensitization, but SPT infants with atopic dermatitis who have an impaired skin barrier may sensitize them to tested allergens.

Methods: A retrospective chart review was conducted at a community clinic identifying infants with atopic dermatitis who have had two or more skin prick tests. Infants with AD referred for allergy testing undergo SPT to common foods including milk (1:10 w/v), egg white (1:100 w/v), egg yolk (1:100 w/v), soy (1:10 w/v), wheat (1:10 w/v), tree nut mix (1:10 w/v), and peanuts (1:10 w/v). Infants with a wheal size 3 mm or greater, than histamine control are considered sensitized to these foods and are advised to avoid them until repeat SPT and oral challenge can be arranged to confirm tolerance. The wheal size of the most recent skin test minus the histamine control was compared to the corresponding food allergen wheal size of the initial skin test minus the histamine control.

Results: The wheal size of 30% (7/23) of milk, 28% (7/25) of egg white, 25% (6/24) of egg yolk,0% (0/9) of soy, 10% (1 of 10) of wheat, 37.5% (3/8) of tree nut mix, and 31.3% (5/16) of peanut skin tests increased by 3 mm or more in the most recent skin test compared to initial testing. Seventy one percent (5/7), 85.7% (6/7), 83.3% (5/6), 0% (0/9), 100% (1/1), 66.7% (2/3), and 60% (3/5) of these infants had an initial wheal size of 0 mm.

Conclusions: The dual exposure to allergen hypothesis states that sensitization to foods is a result of cutaneous exposure to potential allergens. Consequently, SPT infants with AD may increase their risk for sensitization to tested allergens due to increased cutaneous exposure through impaired skin barrier.

Canadian Pediatric Society Conference 2019

Utilization and Safety of “In-Clinic” Amoxicillin Challenge in Ruling Out Penicillin Allergy in Children

Authours: Vince Wu, Jason Ohayon MD

Presented at: Canadian Pediatric Society Annual Conference 2019

Published in: Paediatrics & Child Health

Background: Ten percent of the population self-report an allergy to penicillin, however, less than 10% of these patients are confirmed so (Patterson and Stankewicz 2018). Nonetheless, only the minority (10%) of this population is referred for testing (Jain et al. 2014). Alternative broad spectrum antibiotics are ordered, often expensive and increasing the risk of antibiotic resistance (Jain et al. 2014).

Objectives: To demonstrate the practicality, safety, and importance of “in-clinic” amoxicillin oral challenges (OCs) in suspected penicillin allergic population

Methods: A retrospective chart review was conducted at a community allergy clinic over a period of 2 ½ years. Children referred for penicillin allergy assessment were skin tested to the allergen components of penicillin and aminopenicillin as per standard protocol. Children with positive skin testing were diagnosed as penicillin allergic. Children with negative skin testing were challenged with amoxicillin at home or in-clinic. Families were requested to communicate results of home challenge. In-clinic amoxicillin OC entailed administering 25 mg of amoxicillin followed by a 30 min monitoring period, and if no reaction occurred, a second dose of 225 mg of amoxicillin was given followed by another 30 min monitoring period. Children were diagnosed allergic if a rash or other signs of allergic reaction developed.

Results: Two hundred and three children (mean age 6.3 years) were skin tested; 188/203 (92.6%) were negative and 15/203 (7.4%) were positive. OCs were performed in 181/188 (96.3%). Home challenges were carried out in 110/181 (60.8%) and in-clinic challenges in 71/181 (39.2%).Only 41/110 (37.3%) families communicated outcome of home OCs, resulting in an incomplete diagnosis in the remainder 69/110 (62.7%) children. Thirty nine of 41 (95.1%) home OCs were tolerated, 2/41 (4.9%) had delayed allergic reactions (rashes). Sixty nine of 71 (97.2%) in-clinic OCs were tolerated, 2/71 (2.8%) had delayed allergic reactions (rashes). All in-clinic OCs were safe and resulted in complete diagnosis of tolerance to penicillin during visit. Twenty two of 203 (10.8%) did not proceed onto OC because of positive skin test (15) or previous diagnosis of serum sickness (7).

Conclusion: Penicillin allergy remains over-diagnosed in the community. Skin testing, where available, helps identify patients for amoxicillin challenge. In-clinic OC to amoxicillin assists in confirming tolerance quickly and more effectively than home challenges. Publications for in-clinic amoxicillin OCs, even without skin testing, have been equally effective in ruling out penicillin allergy (Confino-Cohen et al. 2017). Reintroduction of penicillin in pediatrics can occur safely and simplify future antibiotic use.

European Association of Allergy & Clinical Immunology 2019 Annual Congress

Seizing the moment: Benefits of immediate in-office penicillin oral challenge in the management of suspected penicillin allergy

2018 Conference Presentations

Canadian Society of Allergy & Clinical Immunology 2018 Conference

Does time matter? Challenging infants with atopic dermatitis and/ or egg allergy to peanut less than a week after initial assessment may decrease their risk of peanut allergy

Authors: Vince Wu, Claire Wilmer, Jason A. Ohayon MD

Presented at: CSACI Annual Scientific Meeting 2018

Published in: Allergy Asthma and Clinical Immunology

Background: In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) issued a recommendation of early peanut (PN) introduction to infants with severe atopic dermatitis (AD) and/or egg allergy. The outcome of early PN introduction has identified some infants unable to tolerate PN, the reasons of which may not be fully known.

Methods: A retrospective trial was carried out in a community clinic, identifying above infants with no history of PN exposure. Infants were ofered PN in clinic and monitored. The protocol provided increasing amounts of PN four to a final dose of 3.8 g of protein. Infants were monitored for allergic symptoms.

Results: Twenty-eight infants 4 to 12 months (median 7 months) were identified and challenged over an 18 month period. Twenty-three of 28 infants were tolerant (82.1%) to PN and 5/28 were allergic (17.9%). Allergic reactions included urticaria (1), vomiting (3), and anaphylaxis (1). Skin prick test was positive for 43% of tolerant patients with an average size of 4.3 mm, and positive for 40% of allergic patients with an average size of 4.5 mm. Seventeen infants were seen and challenged less than 1 week from their initial assessment, 15/17 (88.2%) infants were tolerant and 2/17 (11.8%) infants were allergic. Eleven infants were seen and challenged greater than 1 week from initial assessment, 8/11 (72.7%) infants were tolerant and 3/11 infants (27.3%) were allergic. Three infants initially tolerant to PN in office subsequently developed FPIES to PN.

Conclusions: Early PN introduction in atopic infants was safe in the majority of high risk infants as per NIAID. Time from assessment to challenge appears to influence outcome of PN tolerance. Challenging infants less than a week from their initial assessment decreased the risk of allergic response. Skin test size did not appear to differentiate between allergic and tolerant infants.