Presentation: Easy-to-Use Severity Grading System for Treatment of Symptoms Induced by Oral Food Challenge (WAO International Scientific Conference 2012)

Saturday, 8 December 2012

Hall 4 (HICC)

Noriyuki Yanagida, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Yuu Okada, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Hasegawa Yukiko, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Taro Miura, MD , Department of Allergy, Sagamihara National Hospital, Kanagawa, Japan

Ishida Wako, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Yumi Koike, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Kiyotake Ogura, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Katsuhito Iikura, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Sakura Sato, MD , Department of Allergy, Sagamihara National Hospital, Clinical Research Center, Kanagawa, Japan

Takatsugu Komata, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Takanori Imai, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Morimitsu Tomikawa, MD , Sagamihara National Hospital, Japan

Akinori Shukuya, MD , Department of Pediatrics, National Sagamihara Hospital, Kanagawa, Japan

Motohiro Ebisawa, MD, PhD , Department of Allergy, Sagamihara National Hospital, Clinical Research Center, Japan

Background:

The purpose of this study is to establish grading system for the evaluation of systemic reactions (SR) at oral food challenge and to investigate relationship between severity of SR using the grading system and the treatment.

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.

Results:

Average age of patient’s was 9.1+/-2.7y. Induced symptoms at each organ system were as follows; respiratory tract: 73%, mucosa: 68%, skin: 62%, gastrointestinal tract: 62%, neurological system: 15%, and cardiovascular system: 8%. The number of patients who showed G1, G2, and G3 was 70, 190 and 82, respectively.

Percentages of patients who used antihistamine, corticosteroid, b2 stimulant inhalation, intramuscular adrenaline were as follows; 16% (Grade1), 77% (Grade2) and 94% (Grade 3), 0% 34% 81%, 1% 62% 85% and 0% 0% 89%.

Scores over G2 was significantly increase the frequency of therapeutic intervention (> G2:93% vs. G1:17%, p<0.001, bonferroni test). G3 scores significantly related to intramuscular adrenaline administration compared to that lower than G2 sores (G3:89% vs. lower than G2:0%, p<0.001, bonferroni test).

Conclusions:

Most cases of G2 symptoms required medications and G3 symptoms did adrenaline administration. The easy-to-use grading systems according to severity of symptoms proposed here was useful to select the best approach to treat SR at OFC.

2054 Easy-to-Use Severity Grading System for Treatment of Symptoms Induced by Oral Food Challenge