XXIV World Allergy Congress 2015

World Allergy Organization Journal 2016, Volume 9 Suppl 1 DOI 10.1186/s40413-016-0096-1

MEETING ABSTRACTS

Open Access

XXIV World Allergy Congress 2015 Seoul, Korea. 14-17 October 2015 Published: 14 April 2016

A1 Pirfenidone inhibits TGF-b1-induced extracellular matrix production in nasal polyp-derived fibroblasts Heung-Man Lee1, Il-Ho Park2, Jae-Min Shin3 1 Korea University College of Medicine, Guro Hospital; 2College of Medicine, Korea University; 3Korea University Guro Hospital, South Korea Correspondence: Jae-Min Shin – Korea University Guro Hospital, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A1 Purpose: Pirfenidone has been shown to have anti-fibrotic and antiinflammatory effects in the lungs. The purpose of this study was to evaluate the inhibitory effects of pirfenidone on transforming growth factor (TGF)-β1-induced myofibroblast differentiation and extracellular matrix accumulation. We also determined the molecular mechanisms of pirfenidone in nasal polyp-derived fibroblasts (NPDFs). Methods: NPDFs were isolated from nasal polyps from eight patients who had chronic rhinosinusitis with nasal polyp. Pirfenidone was used to treat TGF-β1-induced NPDFs. Cytotoxicity was evaluated using a 3-(4,5- dimethylthiazol-2yl)-2,5-diphenyl-tetrazolium bromide assay. Fibroblast migration was evaluated with scratch assays. Expression levels of α-smooth muscle actin (SMA), fibronectin, and phosphorylated Smad2/3 were determined by western blot and/or reverse transcription-polymerase chain reaction and immunofluorescent staining. Total collagen production was analyzed with the Sircol collagen assay and contractile activity was measured by a collagen gel contraction assay. Results: Pirfenidone (0 – 2 mg/ml) has no significant cytotoxic effects in TGF-β1-induced NPDFs. Migration of NPDFs was significantly inhibited by pirfenidone treatment. The expression levels of α–SMA and fibronectin were significantly reduced in pirfenidonetreated NPDFs. Collagen contraction and production were also significantly decreased by pirfenidone treatment. Finally, pirfenidone significantly inhibited phosphorylation of Smad2/3 pathway in TGFβ1-induced NPDFs. Conclusions: Pirfenidone has an inhibitory effect on TGF-β1-induced migration, myofibroblast differentiation (α-SMA), extracellular matrix accumulation, and collagen contraction by blocking the phosphorylation of Smad2/3 pathways in NPDFs. Thus, pirfenidone may inhibit TGF-β1-induced extracellular matrix by regulating Smad2/3. A2 The efficacy of a 2-week course of oral steroid in the treatment of chronic spontaneous urticaria refractory to antihistamines Hyun-Sun Yoon, Gyeong Yul Park Seoul National University Boramae Hospital, Seoul, South Korea Correspondence: Hyun-Sun Yoon – Seoul National University Boramae Hospital, Seoul, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A2 Even though antihistamines are the mainstay in the treatment of chronic spontaneous urticaria (CSU), some CSU patients have not responded to antihistamines. Many clinicians have accepted the efficacy of steroids in the treatment of CSU. There is, however, little evidence supporting steroid use in antihistamine-resistant CSU. The

purpose of this study was to demonstrate the efficacy of, and suggest a regimen for, oral steroid in the treatment of CSU patients who were refractory to a high dosage of antihistamines. We conducted a retrospective chart review of all patients diagnosed with urticaria between Feburary 1, 2012, and December 31, 2014. A total of 98 patients with CSU were included. Of these, 16 patients (16.3%) were antihistamineresistant and prescribed a 2-week course of steroid. Thirteen patients (81.2%) were successfully controlled with antihistamines only after stopping the first course. Second course of steroid induced remission additionally in two patients (12.5%). No adverse events and complications associated with oral steroid were observed over the study period. This study demonstrated the excellence of a 2-week course of oral corticosteroid in antihistamine-resistant CSU and propose standardized corticosteroid treatment regimen.

A3 The altered distribution of follicular t helper cells may predict a more pronounced clinical course of primary sjögren’s syndrome Margit Zeher Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary, Debrecen, Hungary World Allergy Organization Journal 2016, 9(Suppl 1):A3 Recent studies emphasized the important role of follicular T helper (TFH) cells, which contribute to B-cell differentiation, as well as antibody production. The aim of our study was to investigate the possible role of TFH cells in the pathogenesis of primary Sjögren’s syndrome (pSS). In the first part of the study, we focused on the periphery by analyzing immune-competent cells and serological markers. We enrolled 50 pSS patients and 16 healthy controls in the study. Patients had elevated ratio of peripheral TFH cells, however, when dividing patients into two groups defined by the presence of extraglandular manifestations (EGMs), only patients with EGMs differed from controls significantly. Moreover, TFH cell percentages correlated positively with both activated T cell and Tr1 cell values, but TFH cell percentages showed negative correlation with both IgM and IgG memory B cell proportions. Elevated TFH percentages were observed in the anti-SSA/SSB positive patients. In the second part, we concentrated on the site of the inflammation, and determined the composition of lymphocyte infiltration in labial salivary gland (LSG) biopsies with special emphasis on TFH cells. We selected tissue blocks obtained from 10 patients at the time of disease onset. LSGs were graded based on the organizational level of periductal lymphocytic infiltrates. TFH cell markers occurred predominantly in more organized structures with higher focus scores. The co-expression of CD3 and Bcl-6 markers identified TFH cells close to Bcl-6+B cells with the typical formation of germinal centers. Systemic features were developed later in the disease course only in patients with more structured infiltrates. Our results indicate that the presence of TFH cells in LSGs at the disease onset may predict a more pronounced clinical course of pSS. We expect that the further understanding of the regulation of TFH cells will provide new potential therapeutic targets in the treatment of pSS patients with EGMs.

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

World Allergy Organization Journal 2016, Volume 9 Suppl 1

A4 Betamethasone suppresses Th2 cell development induced by langerhans cell like dendritic cells Katsuhiko Matsui, Saki Tamai, Reiko Ikeda Meiji Pharmaceutical University, Kiyose, Tokyo, Japan Correspondence: Katsuhiko Matsui – Meiji Pharmaceutical University, Kiyose, Tokyo, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A4 Objective: It is well known that Langerhans cells (LCs) work as the primary orchestrators in the polarization of immune responses towards T helper type 1 (Th1) or T helper type 2 (Th2) immune responses. In this study, we investigated the effects of tacrolimus and betamethasone on Th2 cell development by LCs. Methods: LC-like dendritic cells (LDCs) were generated from mouse bone marrow cells. Mice were primed with ovalbumin (OVA) peptide-pulsed LDCs, which had been treated with tacrolimus or betamethasone, via the hind footpad. After 5 days, the cytokine response in the draining popliteal lymph nodes was investigated by enzyme-linked immunosorbent assay. The expression of LDC surface molecules was investigated using reverse transcriptase polymerase chain reaction. Results: Administration of OVA peptide-pulsed LDCs, which had been treated with betamethasone, into the hind footpads of mice inhibited Th2 development as represented by down-regulation of interleukin (IL)-4 production as well as Th1 development as represented by downregulation of interferon (IFN)-γ production. However, unlike the LDCs treated with betamethasone, those treated with tacrolimus did not inhibit Th1/Th2 cell development. The inhibition of Th1 cell and Th2 cell development by betamethasone was associated with suppression of CD40 and TIM-4 expression, respectively, in LDCs. Conclusion: These results suggest that topical application of betamethasone to lesional skin would be beneficial for control of atopic dermatitis by acting on epidermal LCs and inhibiting the development of Th2 cells. A5 An evaluation of variousallergens in cases of allergic bronchial asthma at lucknow and neighbouring districts by intradermal skintest Drsushil Suri, Dranu Suri Suri Medical Foundation Hospital, Lucknow district, Uttar Pradesh State, India Correspondence: Drsushil Suri – Suri Medical Foundation Hospital, Lucknow district, Uttar Pradesh State, India World Allergy Organization Journal 2016, 9(Suppl 1):A5 The work of Kasliwas et al. (1959) and Shivpuri et al. (1971) have proved beyond doubt that there is a definite correlation between pollen peaks and symptomatology of the patients of respiratoty allergy. With these factors in mind the present study was conducted with the aims - to clinically evaluate the cases of bronchial asthma, to know the spectrum of allergens by skin testing in these cases(intradermal skin tests) and to find out seasonal and climatic variations in these cases. The patients were prepared for intradermal skin test as per Shivpuri et al (1964). The intradermal skin tests were performed by means of a tuberculin syringe and 26 gauge (1”length) short bevelled needle. A negative control test was done in the similar manner with 0.01ml of buffer saline (the diluent of the antigen) and marked as “C’. A positive control test was done by Histamine phosphate solution(100 microgram/ml) and marked as “H”.Interpretation was done as per Shivpuri’s criteria (Shivpuri1962,1969). The 2 to 4 reactions were taken as “markedly positive”. This study showed that the prevalance of allergic manifestations were higher in first degree relatives (50%) than the second degree relatives (8%) of the patients. In this study the pollen antigens which gave “significant positive reactions” (and there clinical correlation with the patient’s history) in the descending order of significance were as Cassiasiamea, Adhantoda, Morus, Parthenium, Artemesia, Argemonemaxicana, Cannabisoccidentalis, Rumex, Asphodelous, Gynandropsis, Amaranthus, Cenchrusalbum, Ricinuscommunis, Crataeva nurvuala, Melia, Kigelia, Prosopsis, Pennisetum, Dodonaea, Azadirechta, Putranjiva

Page 2 of 206

rox-burghii. The extensive botanical and aero-biological surveys with clinical evaluation of a very largre number of cases of alleric bronchial asthma should be carried out in future in order to draw the exact polen calender of this region. A6 Evaluation ferqency of ADHD in childhood asthma Marzieh Heidarzadeh Arani Shahid Beheshti University, Tehran, Iran World Allergy Organization Journal 2016, 9(Suppl 1):A6 Introduction Attention Deficit-Hyperactivity Disorder is one of the most common problems of children and adolescents and is a very common reason for visiting a pediatric psychologist or consultant. This disorder which has a profound effect on the lives of thousands of children and their families manifests in early childhood with symptoms of hyper activity, inattention and impulsivity. In studies conducted in western countries it has been pointed out that there is an association between ADHD symptoms and asthma in asthmatic children, and also the response to asthma treatment in children with ADHD is poor. This study is performed with the aim to evaluate the prevalence of ADHD in children referring to the clinic of Kashan Beheshti hospital. Material and Method In this case- control study 206 children referred to the pediatric clinic of Kashan Beheshti hospital in the second half of 1388 were evaluated. Spirometery or peak flow metery was used for the diagnosis of ADHD. Using the SPSS software version 19, chi- square test and Fisher’s exact test. Result It was found that the prevalence of ADHD in children with asthma is significant higher than control group and increases the risk about five fold more. It was also found that having ADHD does not have a significant correlation with the severity of asthma. Conclusion It was found that asthma is one of the risk factors for developing ADHD, but ADHD is not related to the severity of asthma morbidity. Keywords: Attention Deficit-Hyperactivity Disorder, Asthma A7 Steven johnson syndrome caused by typhoid fever in a child Azwin Lubis, Anang Endaryanto 1 Airlangga University Teaching Hospital, Surabaya, Indonesia Correspondence: Azwin Lubis – Airlangga University Teaching Hospital, Surabaya, Indonesia World Allergy Organization Journal 2016, 9(Suppl 1):A7 Background: Steven-Johnson Syndrome (SJS) in children can caused by infection. Thypoid is one of bacterial etiologies. Case report: A 7 years-old boy with main complaint of blistering all over his body, fever and weak condition. His lips were ulcerated, erythematous, swollen covered with pseudomembran and hemorrhagic crust. There were pruritic hyperpigmented plaques with papilovesicular eruptions at their center (bullous target lesions) covered almost of his whole body. There were also macula erythematous with vesicle and ulceration in his external genital and scrotum. He suffered from blistering since 3 days before admission. The lesion appeared first in the face and mouth, then spreads to the whole body. After that his mucosa of mouth and lips were ulcerated and he had difficulty in swallowing. He had been on medical treatment to a doctor before, but on the 4th day of illness there were red blotches and vesicles appeared on his body, sore throat and oral thrush. So he admitted in hospital for 3 days, but his condition was getting worse and came to our hospital. The O widal test result was 1/320. The assessment were SJS and suspected Typhoid fever. Treatment were supportive, ceftriaxone and corticosteroid. This patient discharged in a good condition. Summary: Thypoid is one of SJS bacterial etiologies in children. Diagnosis established after clinical examination, serological, epidemiologicallyprevalent and probable infections in country area. Antibiotic is required for SJS caused by infections.


Page 3 of 206

A8 Chronic Bronchitis with Radio Contrast Media Hypersensitivity: A Case with Hypothesized GINA Step 1 Asthma Shinichiro Koga Tokyo Metropolitan Police Hospital, Tokyo, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A8

with female, unemployment but not associated with lung function in asthmatics. Conclusion: The present study showed that depression was an important risk factor of the prevalence of asthma in Korean adult. These results warrant future studies to explore the mechanisms responsible for the association between depression and asthma.

Background: Nonimmediate reactions induced by radio contrast media (RCM) are an important health problem because nearly 50 % of patients with a suspected nonimmediate reactions to RCM are confirmed as allergic (Gomez E, et al. Curr Opin Clin Immunol 2013;13:345-53). Case Record: A 60-year-old female was brought to emergency department with chief complaint of hemoptysis one day after transient dry cough. Past medical history included current smoking in 30 pack-per-years, acute hypersensitivity reaction with nicotinic α4β2 receptor partial agonist valenicline, epilepsy on phenytoin and phenobarbiturate, and pollinosis. Body temperature 98.5 F, blood oxygen saturation 95 % in room air; No crackle, stridor, nor wheeze was audible. Contrast chest computed tomography show atelectasis in left lower lobe, but not about carvenous lesion, pulmonary arteriovenous fistula, nor racemose hemangioma. Bronchoscopy detected thrombus in left lower lobe; Mycobacterium avium, intracellulare, and tuberculosis were negative in bronchoalveolar lavage fluid. Specific immunofluorescence in M. tuberculosis was also in negative. Serum test was thoroughly negative in SCC, CYFRA, ProGRP, NSE, IgG4, PR3- and MPO-ANCA, Aspergillus, (1,3→) βD-glucan, ANA, ds-DNA-IgG, anti-RNP, anti-sm, and anti-GBM antibodies. Clinical diagnosis of chronic bronchitis was made with findings described above. Pruritus exanthema in trunk one-and-a-half day after contrast media iomeprol infusion (Dona I, et al. J Investig Allergy Clin Imunol 2014;24:143-53) was disappeared several days after bepotastine besilate administration. Discussions: Global Initiative of Asthma (GINA) step 1 was hypothesized because patients who were treated with GINA step 1 have reported to have over 3-fold-increased risk to develop acute hypersensitivity reaction as compared with patients who did not have asthma (Kobayashi D, et al. Chest 2012;141:1367-8). Conclusions: Pharmacogenetics and/or transcriptomics should be helpful to clarify T-cell mediated mechanisms in development of RCM hypersensitivity reaction (Fernandez TD, et al. Allergy 2014;69:150-8).

A10 Management of allergic disease exacerbations in pregnancy Yasunobu Tsuzuki Sapporo Tokushukai Hospital, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A10

A9 The association between asthma and depression in Korean adult : An analysis of the fifth Korea national health and nutrition examination survey (2010-2012) Lee Ju Suk Shinichiro Koga – Samsung Changwon Hospital, Seoul, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A9 Purpose: Asthma is a one of the most common allergic disease and depression is an important comorbidity in asthma. However, it is little known about the different prevalence of depression in Korean adult asthmatics than normal adults. This study was performed to find association between asthma and depression and investigate the characteristics in Korean adult asthmatics with depression. Methods: Data were acquired from 18,066 men and women, aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys (KNHANES), which was conducted from 2010 to 2012. The presence of asthma was based on self-reported physician diagnosis of asthma in the Health Interview Surveys. Results: The prevalence of asthma was 3.2 % and depression was 4.2 %. In univariated analysis, adults with asthma were older, single, unemployed, low educated, lower monthly family income, lower household members, obese (p 5 x ULN) was observed more frequently in CTD than controls, there was no statistical significance (7.5% vs. 5.9%, P = 0.451). Conclusion: The frequency of DILI in patients with CTD was not significantly different from non-CTD patients. These findings suggest that CTD is not a significant risk factor for DILI induced by ATD. A254 Ocular Symptoms of Cedar Pollinosis in Otolaryngology Patients Yukiyoshi Hyo Kawasaki Medical School, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A254 Background: Japanese cedar pollinosis is a disease with a variety of symptoms; in particular, ocular and nasal symptoms occur frequently. The incidence of these cedar pollinosis symptoms reportedly differs year by year, and due the large amount of Japanese cedar pollen dispersed in Japan, they are often more severe than the symptoms of seasonal allergic rhinitis in Europe and the United States. Although pollen allergy prevalence symptoms in Europe (Canonica et al. 2007)


and the United States (Schatz 2007) has been reported, the prevalence of ocular symptoms due to cedar pollinosis in Japan has yet to be determined. Methods: We used the Japanese Rhinoconjunctivitis Quality of Life Questionnaire to examine symptoms and quality of life in 633 patients who consulted our hospital or ear, nose, and throat clinic between 2009 and 2014 during the peak cedar pollen season and who had not received any previous treatment. Results: Ocular symptoms were seen in 87% of patients. Itchy eyes were more prevalent than watery eyes, with 84%of patients experiencing itchy eyes and 63% watery eyes, even in a year with low pollen dispersal. Responses for the occurrence of nasal and ocular symptoms indicated that a more severe score for nasal symptoms was correlated with better eye symptoms. Comparison of annual pollen counts revealed a correlation between worsening of itchy eyes and increased pollen counts. However, the severity of watery eye symptoms did not differ significantly between years with small and moderate pollen levels, indicating that watery eyes develop when the amount of pollens is high. Conclusions: This study revealed that ocular symptoms of Japanese cedar pollinosis are prevalent even in years with low cedar pollen dispersal, and that pollinosis patients with ocular symptoms were likely to have more severe nasal symptoms. References Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. Survey of the burden of allergic rhinitis in Europe. Allergy 2007;62 Suppl 85:17-25. Schatz MA. Survey of the burden of allergic rhinitis in the USA. Allergy. 2007;62 Suppl 85:9-16.

A255 The Clinical Characteristics of Adverse Drug Reactions Reported in a Regional University Hospital for 6 Years and the Suggestions for the Reporting System Jaechun Lee1,2, Su Hee Kim1, Eunkyoung Lee1 1 Jeju National University Hospital; 2Jeju National University School of Medicine, South Korea Correspondence: Jaechun Lee – Jeju National University Hospital World Allergy Organization Journal 2016, 9(Suppl 1):A255 Background: Adverse drug reaction (ADR) increases in-hospital stay, cost of care, and even mortality. Prevention of ADRs leads to marked socioeconomic benefits. We performed this study to investigate the incidence, actual reporting status and clinical features of ADRs, for improving ADR reporting system and preventing recurrent ADRs. Methods: A retrospective study was performed in a regional university hospital located in Jeju, Korea. ADR cases were recruited by review of medical records from 2009 to 2013. An ADR event was defined as either of ADR-related diagnosis in a patient or ADRs reported through in-hospital ADR reporting system. The incidence, culprit drug, clinical manifestation, source of reporting, severity, treatment, and recurrence rate were assessed. Results: In 1112 patients, 1375 ADR events were enrolled, estimated as 0.06% of total patient-visit during the study period. Diagnostic contrast agent (46.4%) was most common as culprit drugs, followed by antibiotics (22%), non-steroidal anti-inflammatory drugs (9.9%), and opioids (4.5%). Cutaneous involvement (67.5%) such as rash and hives was the most frequently observed manifestation. In two thirds of ADR cases, additional medical attentions were noted. In severity, 180 (13.1%) were categorized in severe ADRs. Nineteen (1.4%) experienced re-exposure to the culprit drugs, resulting recurrent ADR and 4 (0.3%) died of ADRs. Physicians were the most frequent ADR reporter using in-hospital ADR reporting system. Conclusions: Large proportions of ADR events might be omitted in medical records or in reporting system. ADRs due to re-exposure to the culprit drugs were not rare. To prevent avoidable ADRs, an effective reporting and alerting system is necessary.

Page 79 of 206

A256 Changes in Skin Prick Test Results over 3 Years in School-Aged Children Hahn Jin Jung1, Jaehyun Lim1, Seung-No Hong1, Doo Hee Han1, Chae-Seo Rhee2 1 Seoul National University Hospital, South Korea; 2Seoul National University Bundang Hospital Correspondence: Hahn Jin Jung – Seoul National University Hospital, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A256 Objectives: Determining the allergen is important for the diagnosis and management of allergic diseases. The skin prick test (SPT) has been widely used to identify allergens. Skin sensitivity to allergens can change due to changes in lifestyle and outdoor environments. Little is known about the changes of allergen sensitivity in young children. Methods: In this Allergic Rhinitis Cohort Study for Kids (ARCOkids), consecutive pediatric patients with rhinitis symptoms underwent skin prick tests (SPTs). 1689 children were assessed for allergen sensitivity from 2009 to 2011. SPTs were performed with inhalant allergens at initial survey and re-performed at 3-year follow-up survey. Results: 280 children fulfilled the follow-up SPT. Initially 72 children were negative for SPT and 25 (34.7%) developed skin sensitivity during the 3-year study. Among 25 children, 20 (80%) were newly sensitized to house dust mites (HDM). 194 (69.3%) were sensitized to HDM at initial survey and 213 (76.1%) were sensitized to HDM at follow-up survey. Skin sensitivity to cat, dog, tree, grass, fungus also increased during the study. 102 children were sensitized only to HDM. After 3-year follow up, 41 (40.2%) were newly sensitized to other antigens such as cat, dog, trees. Conclusion: Our study showed the changes in skin sensitivity to inhalant allergens over 3 years in school-aged children. Skin sensitivity was increased in both non-sensitizer and mono-sensitizer to HDM. A257 The Analysis of Risk Factors and Features of Food Allergy in Korean Children: Nationwide Cross-Sectional Survey Kun Song Lee Dankook University Hospital, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A257 Background: To analyze related risk factors and features of food allergy in Korea children through a cross sectional survey. Methods: We used a stratified cluster sampling design and chosen from a random sample of 45 primary and 40 middle schools in South Korea between October and November 2010. Total 7,725 children aged 6-7 years and 13-14 years were involved. We acquired that the information of food allergy from the questionnaires and analyzed the mean value of continuous variable (Total Ig E and Eosinophil count) and the risk factors which were associated with food allergy using multivariate logistic regression. Results: The prevalence of food allergy in this study was 13.4% and the mean age at the beginning of the first allergic symptoms was 58.4 ± 41.9 months (1-168). The most common food, cause of allergic symptoms, was egg (21%) and following order common cause for food allergies symptoms were fruits, shellfish, and milk in the sequence. The mean total Ig E level and eosinophil count was higher in food allergy group (362.1 ± 555.0 IU/mL, 4.1 ± 3.2%) than no food allergy group (241.6 ± 414.4, 3.5 ± 2.9; P < 0.001) The risk factors of food allergy in multivariate logistic regression were asthma history (OR, 1.465; 95% CI, 1.078-1.991), atopic dermatitis history (2.841; 2.334-3.458), father and mother food allergy history (1.764; 1.1892.617 and 2.009;1.342-3.009), and breast milk feeding for more than 7 months (1.359; 1.110-1.663). Conclusion: The prevalence of food allergy in Korean children was 13.4% and the risk factors of food allergy were the present of asthma history, atopic dermatitis, and parent food allergy and breast milk feeding for more than 7 months.


Page 80 of 206

A258 A Sequential Indirect-Direct Bronchial Provocation Test for Diagnosis of Asthma: A Pilot Study Jaechun Lee3, Sun Young Yang1, Mi Young Ahn1, Jong Hoo Lee1, Jasmina Golez2 1 Jeju National University Hospital, South Korea; 2Ambulanta Meznar, Slovenia; 3Jeju National University School of Medicine, South Korea Correspondence: Jaechun Lee – Jeju National University School of Medicine, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A258

adjusted OR = 0.43, 95% CI = 0.21-0.89; AG/GG: adjusted OR = 0.46, 95% CI = 0.23-0.94) of PER in the female subgroup. Analysis of the locus-locus interactions of VDR and CYP2R1 revealed two models were statistically significant (P < 0.05). D) Conclusions: Age and gender may have an impact on the association of three SNPs (rs2228570, rs731236, and rs2060793) in genes of the vitamin D pathway with the risk of mite-sensitized PER in this Han Chinese population. The VDR and CYP2R1 polymorphisms may be involved in genetic interactions in the pathogenesis of allergic rhinitis.

Backgrounds: Asthma is a chronic inflammatory disorder in the airways, which subsequently leads characteristic airway hyperresponsivenss (AHR). Measuring or proving the existence of AHR is the mainstay in its diagnosis. In Korea, airway provocation test with methacholine (direct test) had been used in clinical practices until the recent official objection of KFDA. Instead, airway provocation test with mannitol is used (indirect test), which shows lower sensitivity and consumes longer test-time compared with those in methacholine, despite higher specificity in the diagnosis of asthma. To overcome its demerits, a sequential indirect-direct provocation test was designed. Methods: A prospective observational study was conducted in asthma-suspicious subjects. Indirect test was performed with skipped doses but up to 640 mg in accumulation. Methacholine inhalation (8mg/mL) by 2-min tidal breathing method was applied thereafter in the subjects who showed negative (PD15 > 640 mg of mannitol). Regardless of the results, at the end of the tests, bronchodilator was applied. AHR positive were defined as either PD15 < 640 mg of mannitol, PC20 < 8mg/mL of methacholine, or 20% increment of FEV1 in bronchodilator. Results: Twenty four asthma-suspicious subjects (median age of 54, 11 males, 45.8%) were enrolled. The test-time test was theoretically shortened at least 10 min compared with that of suggested indirect test. In AHR, two subjects (8.3%) showed positive in mannitol provocation. Five (20.8%) showed positive in methacholine provocation compared with baseline FEV1 and 2 (8.3%) compared with FEV1 after 640mg of mannitol. Four (16.7%) showed positive in bronchodilator. Overall, 5 subjects (22.7%) showed AHR positive among 22 negatives in indirect test. No adverse reaction except for coughing during inhalation of mannitol was identified. Conclusions: The sequential indirect-direct provocation facilitates to detect AHR in higher sensitivity and shorter test-time. As a confirmative test of asthma in clinical practice, it can be applied effectively after modification and verification.

A260 Associations of Metabolic Syndrome with Asthma and Atopy in Korean Adults Ji-Yong Moon, Sang-Heon Kim, Tae Hyung Kim, Ji Young Yhi, Ho Joo Yoon, Jang Won Sohn, Dong Ho Shin, Dong Won Park Hanyang University College of Medicine, South Korea Correspondence: Ji-Yong Moon – Hanyang University College of Medicine, South Korea World Allergy Organization Journal 2016, 9(Suppl 1):A260

A259 Association of VDR and CYP2R1 Polymorphisms with Persistent Allergic Rhinitis in a Han Chinese Population Hui-Qin Tian, Lei Cheng, Xin-Yuan Chen The First Affiliated Hospital of Nanjing Medical University, China Correspondence: Hui-Qin Tian – The First Affiliated Hospital of Nanjing Medical University China World Allergy Organization Journal 2016, 9(Suppl 1):A259 A) Background: As recent studies have described an association between vitamin D and allergic rhinitis, we hypothesized that genes encoding components of the vitamin D pathway may be candidate genes for susceptibility to allergic rhinitis. This study sought to evaluate whether genetic variants in the vitamin D pathway-related genes are associated with allergic rhinitis in a Han Chinese population. B) Methods: A hospital-based case-control study consisting of 519 patients with mite-sensitized persistent allergic rhinitis (PER) and 447 healthy controls was conducted. Five single nucleotide polymorphisms (SNPs) in VDR and CYP2R1 were selected for genotyping. C) Results: The CT genotype of rs2228570 in VDR exhibited a significantly decreased risk (adjusted OR = 0.63, 95% CI = 0.41-0.96), while the AA genotype of rs2060793 in CYP2R1 exhibited a significantly increased risk (adjusted OR = 1.80, 95% CI = 1.02-3.16) of PER in the juvenile subgroup (0.05). 2, 53.5% (31/58) bermuda sIgE-positive patients were sensitized to Cyn d 1. The concentration of sIgE of bermuda in Cyn d 1 positive patients were significantly higher than Cyn d 1 negative levels (Z=3.103, P=3.103). 3, In the 58 bermuda sIgE-positive patients, 35 patients were timothy sIgE-positive. The concentration of sIgE of bermuda in timothy positive patients were significantly higher than timothy negative (Z=4.735, P=4.735). 4, 100% (35/35) timothy-positive patients were sensitized to Phl p 4 , but only 17.1% (6/35) were positive to Phl p 1. 5, 56.90% (33/58) bermuda-positive patients with were sensitized to peanut. Ara h 1 were positive in 6 patients with peanut-sIgE higher than 17.5kU/L. 3 of them were sensitized to Ara h 8. 32.76% (19/18) were sensitized to birch. 6 cases of birch-positive were sensitized to Bet v 4, which sensitized to Ara h8 simultaneously. 6, 39.66% (23/58) bermuda-positive patients with CCD sensitization, and CCD sIgE levels had good correlation with bermuda, Cyn d 1, peanut, birch, timothy and Phl p 4 (P 60.500 data sets from >1.600 PHD users the mean TSS for 2009 to 2011 in Germany was calculated with 3.0 to 5.4 for birch seasons and 3.9 to 4.4 for grass seasons. The SLI (TSS) was calculated on a total of 293,098 data entries ranging for birch season from 4.5 to 5.6 and for grass season from 3.4 to 4.7 points. The repeated exposures with birch and grass pollen with 4000 – 8000 grains/m3 elicited reproducible symptoms on all 3 organs and significant differences between placebo and verum pollen exposure. Generally, the symptoms started to occur after 10 min and reached a plateau following 70 - 90 min of continuous exposure. The TSS for birch pollen reached an average of 5.8 and for grass 6.5 points. Conclusions: Exposures with birch and grass pollen in the mobile exposure chamber allow to induce clinical symptoms in the same kind and severity in patients with allergic rhinitis due to pollen experience in real-life. Therefore, they are an alternative to natural allergen exposure.

Page 82 of 206

A266 Retrospective Analysis of the Incidence of Allergy in Patients with Contact Eczema Joanna Kolodziejczyk, Milena Wojciechowska, Anna HnatyszynDzikowska, Micha Chojnacki, Zbigniew Bartuzi Nicolaus Copernicus University in Toruñ, Ludwik Rydygier Medical College in Bydgoszcz, Poland Correspondence: Joanna Kolodziejczyk – Nicolaus Copernicus University in Toruñ, Ludwik Rydygier Medical College in Bydgoszcz, Poland World Allergy Organization Journal 2016, 9(Suppl 1):A266 Background Contact eczema is a complex polymorphic skin eruptions disease formed on inflammatory, which arises from skin contact with irritants or allergens. In a substantial proportion of patients exist also a contact allergy, however no less is sensitization to inhalant and food allergens. The aim of this study was epidemiological analysis to determine the frequency of contact, inhaled and food allergy in patients with contact eczema. Methods The main research method in the study was a retrospective analysis of medical records of patients who from January 2012 to December 2013 were registered to allergy clinic to diagnosed skin changes characterized of contact eczema. The analysis included only patients who underwent patch testing. Results The study analyzed the histories of 79 patients with contact eczema: 61 women in age 18-83 years (mean age 46.5 years) and 18 men in age 22-80 years (mean age 54.3 years). The most common locations of contact eczema were hands (n = 28; 35.4%) and faces (n = 22; 27.8%). Positive patch tests results were obtained in 29 (36.7%) patients, the majority in patients with hands (n = 12; 42.8%) and faces (n = 6; 27.2%) contact eczema. The most common sensitizing haptens were nickel sulfate (n = 16, 55.1%), para-phenylenediamine (n = 13; 44.8%) and potassium dichromate (n = 12; 41.3%). Prick tests with inhalant allergens were performed in 65 patients and with food allergens were performed in 29 patients. In 27 (41.5%) patients were registered positive skin prick tests results to inhaled allergens, in the majority of patients with hands (n = 13; 20%), faces (n = 7; 10.7%) and the upper limb (n = 4; 6.1%) contact eczema. Food allergy was diagnosed in 6 (20.6%) patients, 2 (33%) of patients were with hands, faces and feet contact eczema. Among the inhaled allergens, the most sensitizing were D. Farinae, D. Pteronyssimus and grass, while the most sensitizing food allergens were celery, pepper and flour. Conclusions The hands and faces are the most common location of contact eczema. In a large proportion of patients with contact eczema occurs contact allergy, especially to metals and para-phenylenediamine. A significant problem for patients with contact eczema are coexist inhalable and food allergies. Because of a high incidence allergies in patients with contact eczema, diagnosis of disease is complicated. Fact of that and various clinical and chronic profiles of disease may decreased quality of life of patients. A267 Effect of Fungal Sensitization in Patients with Severe Asthma Katsunori Masaki1, Koichi Fukunaga1, Takashi Kamatani1, Kengo Ohtsuka1, Takae Tanosaki1, Masako Matsusaka1, Takao Mochimaru1, Hiroki Kabata1, Soichiro Ueda1, Yusuke Suzuki1, Katsuhiko Kamei2, Koichiro Asano3, Tomoko Betsuyaku1 1 Keio University Hospital, Japan; 2Chiba University; 3Tokai University School of Medicine Correspondence: Katsunori Masaki – Keio University Hospital, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A267 Rationale: Fungal exposure triggers asthma exacerbation, and some reports suggest that fungal sensitization and asthma severity are associated. Objective: To investigate the effect of fungal sensitization in severe asthmatic patients.


Methods: We collected data from 146 patients with severe asthma for analysis of the following variables: asthma control test (ACT) score, pulmonary function, fractional exhaled nitric oxide (FeNO), and sensitization to fungi (Aspergillus, Alternaria, Cladosporium, Penicillium, Trichophyton, and Schizophyllum commune) and non-fungal antigen sources (house dust mites, dogs, cats, cockroaches, moths, and chironomids). Fungal sensitization was diagnosed when an increase in the serum IgE levels specific to these allergens was detected. Results: Eighty-seven patients (60%) were sensitized to one or more antigens; 37 (25%) were sensitized to fungal allergens, the most common of which were Aspergillus (22 patients, 15%) and Trichophyton(19 patients, 13%). Of the 87 patients, six were only sensitized to fungus (Group F), 50 only to non-fungal allergens (Group N), and 31 to both fungal and non-fungal antigens (Group F + N). The sex distribution, pulmonary function, and dose of inhaled corticosteroid were not significantly different between the three groups; however, the ACT score was significantly lower for Group F + N than for the other groups. The FeNO and the ratio of subjects dependent on oral steroid therapy were higher in Group F + N than in Group N. Conclusion: Fungal sensitization, in addition to non-fungal sensitization, is associated with poor control of asthma in patients with severe asthma. A268 SCIg Patient Preference Pump Versus Push Karlee Trafford Toronto Allerrgy Immunology Clinic, Canada World Allergy Organization Journal 2016, 9(Suppl 1):A268 Background The administration of subcutaneous Immunoglobulin (SCIg) is a safe and convenient alternative to intravenous immunoglobulin (IVIg) therapy. Administration of SCIg can occur via an infusion pump or rapid push technique. Based on patients at a Canadian site where patients are presented with both decisions and the direct cost differences to patients explained. Ourexperience has shown that the pump has an overwhelming higher preference amongst patients. Methods This is a chart review of immune deficient patients at a private clinic who initiated treatment with SCIg therapy between January 2014 and April 2015. Patients were given the option to choose which method they desired after being shown both techniques and determining the difference in cost for each method. Their dosage amounts were confirmed, and they were each shown the amount of time it would take for them to infuse via the pump versus rapid push. Results Charts for the first 25 patients (12 male, 13 female, ranging in age from 40 to 80) were reviewed. Fifteen patients chose the pump and 5 patients chose the push method. Out of the 15 patients, only 2 patients were not covered by insurance. Out of the 5 patients who chose the push method, 3 had to pay out of pocket. The 5 remaining patients were either lost to follow up or switched back to IVIg. Dosage amounts varied in both methods of delivery. Conclusion The results clearly show that immune deficient patients did have a higher preference for administering SCIg through the pump rather than pushing by hand, and it wasn’t in relation to the time spent, but the overall cost and freedom it granted the patient. This may be a result of more immune deficient patients being diagnosed within the aging population particularly for secondary immune deficiencies. A269 Fixed Drug Eruption Induced By Ornidazole and Diclofenac Ismet Bulut, Zeynep Ferhan Ozseker Süreyyapasa Chest Disease and Chest Surgery Training and Research Hospital, Turkey Correspondence: Ismet Bulut – Süreyyapasa Chest Disease and Chest Surgery Training and Research Hospital, Turkey World Allergy Organization Journal 2016, 9(Suppl 1):A269

Page 83 of 206

Introduction Fixed drug eruption (FDE) is a drug reaction characterized by erythema, edema and sometimes bullae appearing in the same skin or mucosal region due to repeated intake of a drug. Most commonly causative drugs are sulfonamides, barbiturates and nonsteroid antiinflamatory drugs. Hereby a FDE developing due to intake of ornidazole for the treatment of vaginitis case is presented. Case 27 years old woman applied to our clinic with complaint of purpleviolet coloured symmetrical, regular bordered, itchy macular erythematous lesions of 5x3 cm in diameter on dorsum of both hands; and oral lesions. Medical history revealed intake of mixovul (ornidazole) one day prior to onset of complaints. He patient had also experienced similar lezions on skin and oral mucosa 6 months ago, 24 hours after taking ornidazole. The patient had similar symptoms on skin and oral mucosa also after intake of diclofenac. Method Ornidazole skin prick test was found to be negative. Ornidazole patch test was similarly negative. Prick test and patch test for diclofenac were found to be negative as well. Amoxicillin- Claculonic acid prick test was done in order to determine an alternative safe antibiotic and it was found as negative too. Oral provocation test did not reveal any early or late onset allergic reaction either. Prick test and oral provocation test with meloxicam was done in order to find an alternative analgesic and these were negative too. Result With this case, we wanted to point out that ornidazole, a commonly used anti-infection agent, can be the cause of fixed drug eruption in some cases. Also, it should be noted that fixed drug eruptions can occur for multiple drugs in the same patient. A270 Transepidermal Water Loss Measurement during Infancy Can Predict the Subsequent Development of Atopic Dermatitis Kenta Horimukai1, Hideaki Morita2, Masami Narita2, Hironori Niizeki2, Kenji Matsumoto3, Yukihiro Ohya2, Hirohisa Saito3, Shigenori Kabashima2, Mai Kondo2, Eisuke Inoue2 1 Jikei University Katsushika Medical Center, Japan; 2National Center for Child Health and Development; 3National Research Institute for Child Health & Development Correspondence: Kenta Horimukai – Jikei University Katsushika Medical Center, Japan World Allergy Organization Journal 2016, 9(Suppl 1):A270 Background: Atopic dermatitis (AD) is characterized by skin barrier dysfunction. Few studies have used non-invasive skin measurement techniques to measure epidermis function in asymptomatic neonates. We therefore conducted a post-hoc analysis to determine whether skin barrier function in the first week of life predicted AD development and allergen sensitizationby age 32 weeks. Methods: Data of 116 infants collected during our previous randomized controlled study were analyzed. Skin barrier function was measured through transepidermal water loss (TEWL), stratum corneum hydration (SCH), and pH. Study participants were divided into 2 groups based on the results of Cox regression analyses of skin measurement values and cumulative AD incidence by 32 weeks of age. A Kaplan–Meier analysis and log–rank test were used to analyze skin barrier function and cumulative AD incidence. Allergic sensitization based on IgE levels to egg white and ovomucoid at 32 weeks of age was assessed by a Chi–squared test. Results: TEWL (with an optimal cut-off level of 6.5 g/m2/h) measured on the forehead within the first week of life showed a lower p-value than TEWL measured on the lower leg, SCH, and pH measurements. We found a significant difference in cumulative AD incidence between the high and low TEWL groups (p