Yumi Koike

Clinical studies in oral allergen-specific immunotherapy: differences among allergens.

Oral immunotherapy (OIT) is a significant focus of treatment of food allergy. OIT appears to be effective in inducing desensitization, however, patients receiving OIT frequently developmild/moderate symptoms during the therapy. It has not been clearly established whether the clinical tolerance induced by OIT resembles natural tolerance. According to our data, the efficacy of OIT is different among food antigens, and it is comparatively difficult to achieve the clinical tolerance in milk OIT. Moreover, the definitive evidence of efficacy and safety with long-term therapy is limited. Further studies need to be offered to patients in clinical practice. Recently, novel treatments for food allergy, sublingual and epicutaneous immunotherapy, and combination treatment with an anti-IgE monoclonal antibody (omalizumab), have been examined in some studies. OIT combined with omalizumab increased the threshold doses of food without adverse reactions and may be of benefit in food allergy treatment. More studies are needed to demonstrate long-term safety and treatment benefits in a larger patient cohort.

Wheat oral immunotherapy for wheat-induced anaphylaxis.

FIG 1. Comparison of outcome between OIT and control group in 2 years. The tolerance rate of the OIT group and the control group was determined as follows: tolerant (subject passed the final OFC), allergic (subject did not pass the final OFC in the OIT group or had an allergic reaction at the OFC or did not ingest the target amount of wheat in the control group). The gray bar represents the rate of tolerant subjects. The white bar represents the rate of allergic subjects.

A review of biomarkers for predicting clinical reactivity to foods with a focus on specific immunoglobulin E antibodies.

Purpose of reviewThe purpose of this study is to assess the latest studies that focus on specific immunoglobulin (Ig)E antibodies for predicting clinical reactivity to foods. Recent findingsPersistent hens egg and cows milk allergy patients have higher antigen-specific IgE levels at all ages than those who have outgrown these allergies. Recent studies on the natural histories of hens egg and cows milk allergies suggested that baseline antigen-specific IgEs are the most important predictors of tolerance. Oral immunotherapy (OIT), which is a novel therapeutic approach for food allergy, requires biomarkers for predicting outcomes after therapy. Several studies indicate that the initial antigen-specific IgE level may be a useful biomarker for the prognosis of OIT. Recently, component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Current studies have suggested that Ara h 2, omega-5 gliadin and ovomucoid are good diagnostic markers for peanut, wheat and egg allergies, respectively. SummaryAntigen-specific IgE can be a useful biomarker for predicting clinical reactivity to food allergies. Monitoring hens egg and cows milk-specific IgE is useful for predicting prognosis, and baseline specific IgE levels may be associated with the outcome of OIT. The use of CRD provides us with a better tool for diagnosing food allergy.

Asthma diagnosis and treatment – 1005. Optimization for the withdrawal of inhaled corticosteroid treatment by monitoring fractional exhaled nitric oxide (feno) and lung functions

Results Subjects in recurrent asthma symptom group were 28 cases and those of non-recurrent asthma symptom group 27 cases (relapse rate: 50.9%). Any significant factors in background patients’ profiles, such as FeNO and pulmonary functions, were not associated with the recurrence of asthma. In recurrent asthma symptom group, FeNO was significantly increased by 3 months after withdrawal of ICS (from 31.8 ppb to 49.2 ppb). Among recurrent asthma symptom group, pulmonary functions were significantly decreased within 1 months (FVC: from 2.11L to 2.02L, FEV1.0: from 1.93L to 1.85L and %FEV1.0: from 98.1% of to 93.8%). Conclusions Although these factors at the time of ICS withdrawal could not predict asthmatic revival, it is highly recommended to follow asthmatic patients who quit ICS therapy by measuring pulmonary function and FeNO periodically.

Four Sporadic Pediatric Cases of Yersinia enterocolitica O:8 Infection in a Rural Area of Japan

In the spring of 2015, we experienced a cluster of 4 sporadic cases of yersiniosis in children in Nagano prefecture, a rural area of Japan. Two patients developed appendicitis-like episodes; one had acute gastroenteritis, and the other had bacteremia associated with liver abscess. The causative agent of these infections was Yersinia enterocolitica serogroup O:8. None of the patients had an underlying illness, and all have recovered completely. The patients were neither socially nor geographically related to each other. These 4 consecutive cases suggest that Y. enterocolitica O:8 has spread substantially in the middle part of Japan, and that this virulent strain might be more common than previously reported in our country.

Transient Deformation of Neutrophils in Kawasaki Disease.

In the treatment of Kawasaki disease, resistance to high-dose immunoglobulin intravenous (IGIV) can occur. The neutrophil morphology analyses in 17 patients revealed that transient pseudo-Pelger-Huët anomaly was more frequently detected in the IGIV-resistant group. This finding may aid the prediction of IGIV resistance.

A PEDIATRIC CASE OF BACTEREMIA AND POSSIBLE CHOLECYSTITIS, DUE TO MORAXELLA OSLOENSIS

We encountered a pediatric case of bacteremia and possible cholecystitis due to Moraxella osloensis that was treated successfully. We confirmed the diagnosis with the presence of a high serum titer of the antibody to the organism. Furthermore, 16S rRNA sequencing was performed to identify the bacteria.

Food allergy and anaphylaxis – 2054. Easy-to-use severity grading system for treatment of symptoms induced by oral food challenge

Methods From June 2008 to June 2012, the severity of SR was assessed at double-blind placebo-controlled food challenge test (DBPCFC) to evaluate if they were candidates for rush oral immunotherapy or not. The medical records of 342 patients who showed positive reaction at DBPCFC were analyzed. A hundred and forty-one were allergic to hen’s egg, 156 to milk and 45 to wheat. We modified the grading system proposed by Sampson HA in 2003 to enhance the convenience at clinical practice. It was proposed to indicate “severity of SR for each organ system, i.e., skin, mucosa, gastrointestinal tract, respiratory tract, cardiovascular, and neurological system. Systemic reactions for each organ were classified as Grade (G) 1 (mild), G2 (moderate), and G3 (severe). The severity score was based on the organ system mostly affected. We examined relationship between the severity score and its treatment during DBPCFC.

Predictors of Persistent Milk Allergy in Children: A Retrospective Cohort Study

Background: Cow’s milk (CM) allergy is the second most common food allergy developed during infancy in Japan. To identify predictors of persistent CM allergy, we investigated the tolerance acquisition rate based on an oral food challenge in children under 6 years of age, diagnosed with immediate-type CM allergy. Methods: This retrospective cohort study included 131 children born in 2005 with a history of immediate allergic reaction to CM, of whom 39 were excluded because of ongoing oral immunotherapy (n = 18) or a lack of follow-up data (n = 21). The 92 remaining participants were followed for 6 years. Tolerance was defined as no adverse reaction to 200 mL of CM and regular intake of milk at home. Subjects were divided into 3 groups based on age at tolerance acquisition: group I (<3 years; n = 31), group II (3–6 years; n = 42), and group III (persistent allergic group; n = 19). Results: Tolerance acquisition rates by 3, 5, and 6 years of age were 32.6% (30/92), 64.1% (59/92), and 84.8% (70/92), respectively. Age at first hospital visit was significantly higher in groups II and III than in group I (p < 0.001). The incidence of anaphylaxis to other foods was also higher in group III than in group I (p = 0.04), as was CM-induced anaphylaxis (p = 0.03). Furthermore, milk and casein-specific immunoglobulin E (IgE) levels were significantly higher in group III than in group II after birth and remained high thereafter (p < 0.05). Conclusions: The history of anaphylaxis and high milk-specific IgE levels were associated with persistent CM allergy.

Food allergy and anaphylaxis – 2059. Mild symptoms induced by oral food challenge are not always associated with failed challenge results

Methods 4574 patients (average age 4.0 ± 2.6 years old, male-female ratio 1.89), who had received open-OFC to heated-egg or cow’s milk or wheat from 2005 to 2012, were enrolled to this study. Patients were divided into following 3 categories according to symptoms induced by OFC (primary diagnosis of FA). The “positive” group was patients who showed objective symptoms and “negative” group was patients who had not any symptoms. The third group was defined as “uncertain” who only showed subjective or weak objective symptoms such as slight erythema, mild abdominal pain or isolated cough. Patients with “negative” and “uncertain” group were asked to ingest causative foods or those products at home to confirm whether to induce any symptoms by the intake or not. In several weeks after OFC, we made the final diagnosis based on the information obtained from patients (final diagnosis of FA).