J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB288 Abstracts

TUESDAY

992 CD3andCD8CellsProduce IL-9 InPediatricEosinophilicEsophagitisArjun Andrew Anilkumar, BS1, Lisa Beppu, BS2, Richard

Kurten, PhD3, Dr. Robert Newbury, MD4, Ranjan Dohil, MD5, David

Broide, MB ChB6, Seema Sharma Aceves, MD, PhD, FAAAAI7; 1Depart-

ment ofMedicine; Division ofAllergy/Immunology, 2Department of Pediat-

rics University of California San Diego; Division of Allergy and

Immunology, 3University of Arkansas for Medical Sciences, Little Rock,

AR; Department of Physiology and Biophysics, 4Department of Pediatrics;

Division of Pathology, 5Department of Pediatrics, Division of Gastroenter-

ology; Division of Gastroenterology, UCSD, Rady Children’s Hospital,

San Diego, 6University of California San Diego, Department of Medicine,

Division of Allergy and Immunology, 7Pediatrics, University of California

San Diego, La Jolla, CA.

RATIONALE: Eosinophilic esophagitis (EoE) is a chronic allergic

disease of increasing prevalence. IL-9 is elevated in EoE submucosa and

may play a role in its pathogenesis.

METHODS: We used esophageal biopsies and quantitative immunohis-

tochemistry/immunofluorescence from pediatric EoE (n511) and control

subjects (n56) to evaluate IL-9+, CD3+, and CD8+ cells. Double

immunofluorescence demonstrated the cellular subsets that produced IL-

9. The effect of IL-13 on IL-9 receptor expression in cultured esophageal

epithelial cells was analyzed using qPCR.

RESULTS: EoE subjects had significantly more IL-9+ cells (947.5 +/-

60.6 per mm2), CD3+ (1183 +/- 100.2 per mm2), and CD8+ (951.3 +/-

280.8 per mm2) cells than non-diseased controls (IL-9551.1 +/- 11.7,

p<0.0001; CD3+5168.0 +/- 24.2, p<0.0001; and CD8+5126.5 +/- 25.7,

p<0.05). Double immunofluorescence showed that both CD3+ and CD8+

cells produced IL-9. 41.8% of CD3+ and 26.7% of CD8+ cells co-ex-

pressed IL-9. Further, IL-13 treatment of cultured esophageal epithelial

cells increased IL-9 receptor mRNA expression.

CONCLUSIONS: CD3+ and CD8+ cells are sources of IL-9 in EoE and

treatment of esophageal epithelial cells with IL-13 increases the expression

of the IL-9 receptor. As such, a mechanistic pathway whereby T cell

derived IL-9 acts on the esophageal epithelium in the presence of IL-13 to

drive esophageal epithelial abnormalities in EoE.

993 Longitudinal Effect Of Food Allergy Education On EpinephrineAvailability In Public Schools

Dipika Patel, MD1, Gwendolyn Johnson, BSN, RN, MEd2, Danielle

Guffey, MS1, Charles Minard, PhD1, Carla Davis, MD11Baylor College of

Medicine, Houston, TX, 2Houston Independent School District, Houston, TX.

RATIONALE: The effect of school nursing food allergy education is

unknown. We hypothesized that a didactic educational session for nurses

would increase the identification of food allergic children, decrease allergic

reactions, and increase the availability of epinephrine injectors.

METHODS: A survey pre and post a didactic session was administered in

2011 to school nurses addressing causative foods, allergic reactions, and

appropriate treatment. A survey one year later was completed by school

nurses and outcomesmeasured. Statistical analysis was performedwith the

Wilcoxon signed rank test and McNemar’s test. The correlation between

the number of food allergic students and number of epinephrine injectors

was estimated using Spearman’s rank correlation.

RESULTS: A total of 197 school nurses responded to the survey in at least

one year (2010,2012,2013). Sixty-two nurses responded to the survey before

and after education with 39 responding all 3 years. The percent of schools

with allergic reactions decreased (15% in 2010,0% in 2012,p50.0143) and

the decrease was sustained in 2013 (5%,p50.1537). Epinephrine injectors

increased (median:1/school in 2010,2 in 2012,p<0.001). The correlation

between the number of students with food allergies and epinephrine injectors

increased from 2010(r250.43) to 2012(r250.82).

CONCLUSIONS: Education significantly impacted school preparedness

for food allergic reactions, evidenced by increased correlation between the

number of food allergic students and number of epinephrine injectors.

Food allergic reactions significantly decreased after education. This data

showed a longitudinal effect, supporting implementation of standardized

nursing education programs in public schools.

994 Population Response To Change In Infant Feeding GuidelinesFor Allergy Prevention

Dr. Dean Tey, MD1,2, Prof. Katrina Jane Allen, MD, PhD, FAAAAI1,2,

Ms. Rachel Peters, MPH2, Dr. Jennifer Koplin, PhD2, Prof. Mimi L. K.

Tang, MD, PhD, FAAAAI3, Prof. Lyle Gurrin, PhD2,4, Prof. Anne-Louise

Ponsonby, PhD2, Dr. Adrian Lowe, PhD2,4, Prof. Melissa Wake, MD,

PhD1,2, Prof. Shyamali Dharmage, MD, PhD2,4; 1Royal Children’s Hospi-

tal, Victoria, Australia, 2Murdoch Childrens Research Institute, Victoria,

Australia, 3The University of Melbourne, Melbourne, Australia, 4Univer-

sity of Melbourne, Victoria, Australia.

RATIONALE: It is unclear if population infant feeding practices have

changed since Australian allergy guidelines were revised to no longer

delay introduction of dietary allergenic solids.

METHODS: In a population-based, cross-sectional study (HealthNuts) of

5,276 infants recruited between 2007-2011, parents reported on infant

feeding in the first year of life. Multinomial logistic regression was used to

investigate the associations between recruitment year and feeding practices.

RESULTS: Participants recruited after national allergy guidelines were

updated in 2008 were more likely to introduce solids at age 4 months

(adjustedmultinomial odds ratio (aMOR)1.2195%CI [1.02-1.45], p50.032)

and less likely to introduce solids at age 6months (aMOR0.80, 95%CI [0.69-

0.92], p50.002), egg after 6 months (aMOR 0.82, 95%CI [0.71-0.94],

p50.004), and peanut after 12 months (aMOR 0.70, 95%CI [0.49-0.98],

p50.037). While parents recruited after changed guidelines were less likely

toutilize an infant formula (aMOR0.84, 95%CI [0.72-0.98], p50.023), there

was an increased use of partially hydrolyzed formulas (aMOR 1.37, 95%CI

[1.12-1.70], p50.003) amongst formula-fed infants. These changes were

modified by socio-demographic factors, with families with a higher socio-

economic status and those without a family history of allergies being less

likely to delay allergenic solids; families with a history of food allergy were

more likely to choose a partially hydrolyzed formula.

CONCLUSIONS: Updated national allergy guidelines have been asso-

ciated with reduced delay in introduction of solids, egg and peanut, and an

increase in partially hydrolyzed formula use among formula-fed infants.

Higher socioeconomic status and absence of family history of allergies

were associated with improved uptake of feeding guidelines.

995 Teasing and Bullying Among Adolescents With Food AllergyDr. Adora Lin, MD, PhD1, Dr. Hemant P. Sharma, MD, MHS,

FAAAAI2; 1National Institute of Allergy and Infectious Diseases, Be-

thesda, MD, 2Children’s National Medical Center, Division of Allergy

and Immunology, Washington, DC.

RATIONALE: Prior studies have found children with food allergy often

experience teasing and bullying, but its prevalence and impact specifically

among adolescents is less well understood.

METHODS: An online questionnaire was administered to 115 adoles-

cents with food allergy. The questionnaire assessed food allergy clinical

history, behaviors, beliefs, and social factors. Responses were analyzed to

examine the prevalence and characteristics of teasing and bullying.

RESULTS: Eighty four adolescents, from over 25 U.S. states and Canada,

completed all parts of the questionnaire. The ages of subjects were 11 to 13

years (30%), 14 to 16 (33%), 17 to 19 (18%), and 20 to 22 (19%). Two-thirds

had previously experienced anaphylaxis. Including all ages, 71% of re-

spondents reportedhaving been teasedbyother children because of their food

allergy. Regarding frequency, 55% reported having been teased once or a few

times, 8% less than once a week, and 8% more than once a week. Physical

bullying was also prevalent, with 45% reporting episodes in which other

children tried to make them eat a food allergen. In 8% of respondents, such

physical events were repetitive (more than a few times). Adolescents who

reported teasing were significantly more likely to feel annoyed by their food

allergy (87%versus 67%, p50.03), embarrassed (55%versus 25%, p50.01),

different (75% versus 29%, p<0.001), left out (60% versus 29%, p50.01),

and wanting to be able to eat like everyone else (87% versus 54%, p<0.01).

CONCLUSIONS: Teasing and bullying is prevalent among adolescents

with food allergy, and also has a significant emotional impact.