J ALLERGY CLIN IMMUNOL

VOLUME 129, NUMBER 2

Abstracts AB125

SUNDAY

474 Maternal IgE Levels Are Associated With IgE Levels At Ages10 And 18 In Girls But Not In Boys, Isle Of Wight Birth Cohort

A. Sadeghnejad1, W. Karmaus2, S. H. Arshad3; 1Department of Medi-

cine, Capital Health System, Trenton, NJ, 2University of South Carolina,

Columbia, SC, 3The Asthma and Allergy Centre, Isle of Wight and

University of Southampton, UNITED KINGDOM.

RATIONALE: We have previously shown that parental history of asthma

exerts a higher risk on asthma in the same gender offspring, ‘‘parent of

origin effect’’. To investigate this concept, IgE was utilized as an objective

measure of atopy. We conducted gender-specific analyses for the relation-

ships between maternal IgE and IgE levels at ages 10 and 18.

METHODS: Of 1456 subjects in this birth cohort, maternal IgE was

available for 1057 (73%). IgE levels were available for 954 (66%) at 10

years and for 560 (38%) at 18 years. To evaluate the associations between

maternal and adolescence IgE we used linear and logistic regressions. IgE

levels were either logransformed (linear regression) or dichotomized

(logistic regression). We adjusted the effect of maternal IgE for pet

exposure, smoking and birth weight. Raised IgE levels were defined as

levels above median.

RESULTS: In linear regressions, maternal IgE was associated with IgE

levels at ages 10 (p50.0005) and 18 (p50.02) in girls but not in boys. In

logistic regressions, the odds ratios (OR) for the association of raised

maternal IgE levels on raised IgE levels at ages 10 and 18 were larger in

girls (OR52.07, p50.001 and OR51.72, p50.07) compared to boys (OR

1.93, p50.004 and OR51.04, p50.90).

CONCLUSIONS: This is the first study investigating the association of

maternal IgE and adolescence IgE. Maternal serum IgE seems to have

stronger relationship with IgE levels at ages 10 and 18 years in girls

compared to boys. These findings suggest that there is a gender-specific

imprinting of the maternal atopy status.

475 An Unusual Case of Mast Cell Activation SyndromeR. Patel1, J. Celestin2, M. Frieri1; 1Nassau University Medical

Center, East Meadow, NY, 2Albany Medical College, Albany, NY.

RATIONALE: Mast Cell Activation Syndrome (MCAS) can be difficult

to diagnose. This is due in part to commonmultiple organ involvement and

overlap with other disorders. Most recently, criteria to diagnose this entity

have been published. It can be primary, secondary due to chronic

autoimmune urticaria (CAU), or idiopathic.

CASE PRESENTATION:Wedescribe a 74 year old Caucasianmalewho

is being treated for Neuroendocrine Antral Carcinoid since 2008, with

Sandostatin. Since 2003, he has been having intermittent episodes of

urticaria, sometimes associated with flushing and diarrhea. His current

medications are H1 and H2 blockers, ketotifen, and opioids for spinal

stenosis. Physical examination shows dermatographia, without urticaria or

Darier’s sign.

METHODS: CBC and differential, 24 hr urine 5-HIAA, and serum

gastrin, serotonin, and chromogranin A were normal. He had elevated

levels of alkaline phosphatase (157 U/ml), serum tryptase (17 ng/mL),

plasma histamine (8.44 ng/ml), and anti-IgE receptor antibody (10.7%).

Skin biopsy revealed lichenoid keratosis, patchy mononuclear cells, and

papillary dermal fibrosis, but no visible mast cells. Gastric biopsy showed

small neuroendocrine tumor cells (positive for chromogranin A) and

synaptophysin without mitosis.

CONCLUSION: This patient’s MCAS is secondary and probably due to

his neuroendocrine antral tumor or hyperactive mast cells that may have

degranulated. However, his CAU may have been triggered by neurohor-

mones, histamine release, or intermittent opioid analgesics for spinal

stenosis. Incubation in vitro of his mast cells along with his tumor cells

would confirm that hypothesis.

476 Effects of Omalizumab on Two Patients with Short Stature andAtopic Disease

N. B. Richards, S. McGeady, C. Chang, D. Doyle; Thomas Jefferson Hos-

pital, Philadelphia, PA.

RATIONALE: Up to 6% of children/adolescents with atopic diseases

have heights that are below the third percentile. While this high prevalence

of growth delay has been attributed to the impact of atopy on normal

development, the mechanism of this interaction is unknown. Decreased

prostaglandin E2 (PGE2) production may result in delayed skeletal

maturation and growth retardation. PGE2 synthesis in osteoblasts is

decreased by platelet activating factor (PAF). We describe 2 male

adolescents with longstanding linear growth retardation who experienced

growth spurts immediately following omalizumab therapy.

METHODS: Patient A is a 14 year old with severe asthma, allergic

rhinitis, and atopic dermatitis. Patient B is a 15 year old with severe atopic

dermatitis, asthma, and allergic rhinitis. Both required frequent oral

corticosteroids and had heights less than the third percentile.

RESULTS: Despite markedly elevated IgE levels, both were treated with

omalizumab and within 4 months following initiation of treatment had

rapid increases in linear growth. Patient A is now at the fifth percentile for

age and patient B is at the fifteenth percentile for height.

CONCLUSION: Omalizumab is thought to decrease the release of mast

cell mediators, which may reduce the amount of PAF released, enhancing

PGE2 production and allow accelerated linear skeletal growth to occur, as

was observed. While decreased therapeutic need for oral glucocorticoids

and/or serendipitous growth spurts in these patients cannot be ruled out, the

rapid growth observed pursuant to omalizumab therapy suggests that

clinical trials of omalizumab in severely atopic children with short stature

are indicated

477 Impact of Asthma Counseling by Pharmacist on AsthmaControl and Medication Adherence in Asia

T. Lim1, S. Kowalski2, K. Tan3; 1Department of Pharmacy, Singapore

General Hospital, Singapore, SINGAPORE, 2School of Pharmacy, Uni-

versity of South Australia, Adelaide, AUSTRALIA, 3Department of Res-

piratory and Critical Care Medicine, Singapore General Hospital,

Singapore, SINGAPORE.

RATIONALE: Published overseas studies demonstrated that asthma

counselling by pharmacists improved medication adherence and clinical

outcomes. We conducted a retrospective study to assess the impact of

asthma counseling by pharmacist on asthma control and medication

adherence in patients attended the pharmacist managed asthma counseling

clinic in Asia.

METHODS: Patients who attended the asthma counseling clinic and

received asthma counseling between September 2008 and March 2009

were recruited. The patients’ asthma control was assessed by comparing

the mean number of emergency department visits, hospitalizations and

Asthma Control Test (ACT) scores prior to counselling with the results 6

and 12 months after asthma counseling. Medication adherence was

assessed by medication refills during 6-months and 12 months after the

first clinic visit. Paired t-test and chi-squared test were used for comparing

mean values and categorical variables, respectively. The level of signifi-

cance was set at <0.05.

RESULTS: Total of 120 patients were recruited. The mean no of

hospitalization or emergency department visits due to asthma was reduced

from 0.61 60.71 and 0.74 60.77, 6 and 12 months before counseling, to

0.09 60.36 and 0.20 60.69, 6 and 12 months after counseling (p<0.01).

Mean ACT improved from 20 to 22.2(p<0.05). The proportion of patientswith medication adherence rates of more than 70%were 76.7% and 71.7%

respectively during 6 and 12 months after the first clinic visit.

CONCLUSIONS: Asthma counseling by pharmacists significantly re-

duces the hospitalization or emergency department visit; improves the

asthma control and maintains good medication adherence in Asia asthma

patients.