istics of SC among CIU/CSU patients and their association with other disease measures .... CONCLUSIONS: Registry data regarding pnfC1-INH usage support a.
AB244 Abstracts
795
Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers-Induced Angioedema at the Emergency Department
Sarah Micozzi, MD, Marta Seoane, MD, Dasha Roa Medellin, MD, Maria Elisa Caralli, MD, Ana Rodriguez, MD, Mercedes Saenz de Santa Marıa, MD, Marıa L. Baeza, MD, PhD, Ines Torrado, MD; University General Hospital Gregorio Mara~non. RATIONALE: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) are important causes of angioedema (AE) at the Emergency Department (ED). Many times it becomes overlooked. METHODS: AE caused by ACEIs/ARBs attended at the ED of a 3th level hospital in Madrid, January 2013-March 2015, were reviewed. They were later studied at the Allergy Department. RESULTS: 339151 patients were attended at the ED; 505 (0.15%) referred AE without urticaria. 56 AE (11%) were caused by ACEIs and/or ARBs . Mean age: 67 years (614), 59% males. 17.8% had recurrent AE, none had familiar AE and 39.3% were atopic. 30.5% received daily treatment with nonsteroidal antinflamatory drugs, 42.8% were smokers or ex-smokers. The antihypertensive mean duration was 55 months (676.4; median 24; range 1300). AE localized exclusively on face (44.6%) or oropharyngeal area (throat 39.3%, tongue 51.8%) with respiratory distress in 28.6%. One patient required intubation. . At the ED, ACEIs/ARBs were unrecognized as inducers in 73.2%; 54 received corticoid/antihistamines, 8 icatibant, (6 of them after corticoid failure). Mean stay at ED: 8.8h (613.6); range 25-1.5 h). Thirty eight patients stopped ACEIs or ARBs, 6 of them (15.8%) had new angioedema outbreaks in a follow up of 6-17 months. CONCLUSIONS: The ACEi/ARBs are largely unrecognized but not uncommon causes of AEs at the Emergency Departments. It is mainly not peripheral AE, which very often affects the upper airways. Most of patients are not correctly diagnosed, thus they undergo inefficacious treatments and very often the causal agent is not removed.
796
Frequency and Characteristics of Systemic Complaints Among Chronic Idiopathic/Spontaneous Urticaria Patients
Judy Doong, BS1, Eric Oliver, MD2, Sarbjit S. Saini, MD, FAAAAI2; Johns Hopkins University School of Medicine, Baltimore, MD, 2Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD. RATIONALE: Chronic idiopathic/spontaneous urticaria (CIU/CSU) patients can report systemic complaints (SC) that are also seen in primary mast cell disorders. We sought to determine the frequency and characteristics of SC among CIU/CSU patients and their association with other disease measures, basophil histamine release profiles, and serum tryptase. METHODS: CIU/CSU patients were recruited from allergy clinics. Subjects completed a disease symptom survey and venipuncture. Blood basophils were isolated and histamine release was measured after polyclonal goat anti-human IgE stimulation. In addition, a serum sample was stored for later tryptase analysis. RESULTS: A total of 155 CIU/CSU subjects were surveyed, with 103 reporting SC with concomitant hives as follows: joints pain or swelling (36.8%), headache/fatigue (31.6%), flushing (28.4%), wheezing (20%), gastrointestinal complaints (17.4%), and palpitations (6.5%). Three or more SC were noted by 30.1% of SC subjects. Subjects with SC were compared with subjects lacking systemic complaints (NSC). Both groups had similar demographic profile (average age in 40s, majority female, and Caucasian), use of anti-histamines, and basophil histamine release profiles. The SC group, compared to NSC group, had significantly greater disease duration (53% SC vs 30.8% NSC had >4 years duration), emergency department visits (16.5% vs 0% >3 visits in the last year), CIU-related work absences (23% vs 3.9% >7 days), use of oral corticosteroids (84.5% vs 59.6%), and quality-of-life (QoL) impairment (76 vs 59 SkinDex Score). CONCLUSIONS: Despite similar demographics with NSC subjects, CIU/ CSU patients with SC have features consistent with greater disease burden (work absences, ER visits, and corticosteroid use), and QoL impairment. 1
J ALLERGY CLIN IMMUNOL FEBRUARY 2016
797
Importance of Patch Test in Diagnosing Chronic Spontaneous Urticaria
Maged Refaat, MD, Rasha Shahin, MD, Asmaa Moustafa, MD, Walaa Abu El-Yazeed, MB, BCh; Department of Allergy and Clinical immunology, Ain Shams university, Cairo, Egypt. RATIONALE: Chronic spontaneous urticaria (CSU) is defined as the occurrence of almost daily wheals and itching for at least 6 weeks, with no obvious cause. Specific laboratory tests should be carried out to discover the suspected cause .Our aim was to investigate the possible significance of patch test (PT) which depends on type IV and delayed type I hypersensitivity with common allergens in diagnosis of CSU. METHODS: Fifty patients having CSU were selected from Allergy and Clinical Immunology outpatient clinic of Ain Shams University Hospitals, with 50 healthy controls. Blood and immunological tests were done to exclude known causes of chronic urticaria. (PT) was done using common aeroallergens, food, chemicals, metals and drug allergens. RESULTS: The patch test results were positive in 22(44.0%) of case group with 3(6%) positivity among the control group. The sensitivity to the PT was 44%, the specificity was 94%, the positive predictive value was 88% and the negative predictive value was 63%. Most of patients showed positivity to mixed group of allergens.PT was positive in 42.9% to food allergens, 18.4% to drugs, 26.5% to chemicals and 24.5% to aeroallergens. CONCLUSIONS: Patch test showed satisfactory results to be used in diagnosing chronic spontaneous urticaria as it show high specificity and predictive values in comparison to control.
798
Pediatric Use of a C1 Esterase Inhibitor Concentrate for Hereditary Angioedema: Findings from the International BerinertÒ (C1-INH) Registry
MONDAY
Inmaculada Martinez-Saguer1, James W. Baker, MD, FAAAAI2, Paula J. Busse, MD, FAAAAI3; 1Haemophilia Centre Rhine Main, MoerfeldenWalldorf, Germany, 2Baker Allergy, Asthma, and Dermatology, lake Oswego, OR, 3Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. RATIONALE: The plasma-derived, pasteurized, nanofiltered C1-inhibitor concentrate (pnfC1-INH; BerinertÒ/CSL Behring) is the only on demand treatment of HAE approved for use in patients across all age _12 years of age in the European Union. A large groups, including children < international patient registry collected data on the use of pnfC1-INH in patients of all ages, including children. METHODS: This observational registry, conducted between 2010 and 2014 at 34 US and 7 European sites, gathered data on a total of 318 subjects, including 18 children (5 to
