J ALLERGY CLIN IMMUNOL

VOLUME 131, NUMBER 2

Abstracts AB177

MONDAY

627 Incidence of Intraoperative Anaphylaxis in A UniversityGeneral Hospital in Brazil

Laila Sabino Garro, MD1, Maria Jos�e Carvalho Carmona2, Iracy Silvia

Correa Soares2, Marcelo Vivolo Aun, MD1, Marisa Rosimeire

Ribeiro, MD1, Adriana Teixeira Rodrigues1, Jorge Kalil, MD, PhD1, Pe-

dro Giavina-Bianchi, MD, PhD1, Antonio Ab�ılio Motta, MD, PhD1; 1Di-

vision of Clinical Immunology and Allergy, University of S~ao Paulo,

Brazil, 2Anesthesia Division, University of S~ao Paulo, Brazil.

RATIONALE: The epidemiology of intraoperative anaphylaxis is un-

known in Brazil. We aimed to evaluate the incidence and clinical features

of anaphylaxis during anesthesia in a University General Hospital in Sao

Paulo, Brazil.

METHODS: A cross-sectional, observational study analyzing data from

voluntary notification sent by anesthesiologists, about occurrence of

intraoperative anaphylaxis during the period between January and

December 2010. The diagnostic criteria for anaphylaxis were based on

the World Allergy Organization Guidelines. We analyzed the incidence of

intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types

of surgical procedures, classification of anesthetic risk (American Society

of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and

type of treatment provided.

RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000

surgeries. The mean age of patients with anaphylaxis was 36.7 years-old

and 57% were women. The most common procedures associated with

anaphylaxis were the abdominal non-vascular (17.1%) and urologic

(17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and

all patients who presented cardiovascular shock were classified as ASA II

(42.9%) or ASA III (57.1%). Epinephrine was used preferentially in

anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades

1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly

etiologic drugs cited by the anesthesiologists were the neuromuscular

blocking agents (22.9%).

CONCLUSIONS: Our incidence of intraoperative anaphylaxis was

higher than in other studies reported in the literature. These data are a

warning signal to encourage measures to reduce the incidence of these

severe reactions.

628 Knowledge of Food Protein-Induced Enterocolitis (FPIES)Among General Pediatricians

Nikhil Menon, Medical student1, Elizabeth Feuille, MD1, Faith

Huang, MD2, Anna H. Nowak-Wegrzyn, MD, FAAAAI3; 1Mount Sinai

School of Medicine, 2Mount Sinai Hospital, New York, NY, 3Mt. Sinai

School of Medicine, New York, NY.

RATIONALE: FPIES is a non-IgE, presumably T cell-mediated gastro-

intestinal childhood food allergy that manifests within 2-4 hours following

food ingestion with repetitive emesis, ashen-gray appearance and lethargy;

15%progress to hypotension.We sought to determine knowledge of FPIES

among pediatricians.

METHODS: A 22-question anonymous survey was sent via email to

randomly selected physicians who registered with American Medical

Association (AMA) as pediatricians.

RESULTS: Eighty-six surveys were completed; 55% responders were in

practice more that 15 years, 67% in suburban location and 85% in private

office. Twenty percent declared full understanding, 56% limited under-

standing of FPIES; 24% never heard of FPIES. When presented with

clinical vignettes, 73% recognized chronic FPIES, 53% recognized acute

FPIES; 58% misdiagnosed allergic proctocolitis and 15% colic as FPIES.

Recognition of specific FPIES symptoms was as follows: severe diarrhea

57%, severe emesis 48%, failure to thrive 41%, hypotension 11%, cyanosis

9%, and elevatedWBC9%. Seventy-three percent reported having patients

with FPIES in their practice, with most common triggers being cow’s milk,

followed by concomitant milk and soy. Diagnosis was made by a

gastroenterologist in 57% and allergist in 32%. Regarding management

of acute FPIES, 30% recommended oral rehydration at home followed by

emergency room evaluation, 29% prescribed epinephrine autoinjector, and

14% prescribed oral steroids. 39% reported managing FPIES by them-

selves, 68% referred out to a gastroenterologist and 34% to an allergist.

CONCLUSIONS: Pediatricians have limited knowledge of manifesta-

tions and management of FPIES. There is a need for education and

establishing a role of allergists in diagnosis and management of FPIES.

629 M. Pneumoniae Is a Potential Trigger for EosinophilicEsophagitis

Maya D. Srivastava, MD, PhD, FAAAAI; SUNY at Buffalo, East Am-

herst, NY.

RATIONALE:Mycoplasma pneumoniae (MP) is suggested as a trigger of

asthma. MP undergoes cyclic epidemics, has increasing macrolide resis-

tance, increases IL-5 and VEGF and contains gene CARDS promoting

TH2 inflammation. It has never before to our knowledge been implicated in

eosinophilic esophagitis (EOE). We recently treated a 10 year old male for

two months of acute onset morning vomiting and cough. He had multiple

similarly ill contacts at school. He had failed reflux therapy. EGD showed

over 50 eosinophils/HFP in all 3 levels, Ph-impedance probe was normal,

MRI of CNS revealed severe pansinusitis. Blood work showed positive

2177 u/ml IgM for MP. Treatment with clarithromycin and topical flovent

rapidly improved symptoms. This suggested to us that MP may have been

the trigger for him and possibly others with EOE.

METHODS: Patients treated for EOE in our (NY) practice over this

spring-summer (2012) were offered standard serology for MP, with the

intention to treat acute cases.

RESULTS: 1/13 was positive for IgM (with eosinophilic gastritis), 10/12

were positive for IgG including the oldest and youngest patient. MP

infection is rare in very young children.

CONCLUSIONS: Patients with EOE had almost universal serologic

evidence of prior MP, but serology can not distinguish past versus active

infection. We plan PCR for MP on esophageal biopsies from EOE and

controls, and will assess MP-TSLP genetic polymorphism interactions, a

proposed mechanism linking infection and atopy.

630 Eosinophilic Esophagitis : Clinical Spectrum of PuertorricanChildren

Vylma Velazquez, MD; Hospital Episcopal San Lucas, Ponce, PR.

RATIONALE: Eosinophilic Esophagitis (EoE) is a chronic inflammatory

condition of the esophagus induced by pro-inflammatory mediators

released by eosinophils. This disease links a gastroenterology condition

with an allergic component. The aim of our study is to describe charac-

teristics, demographic features, endoscopic findings and allergy associa-

tions of EoE children in a Puertorrican population

METHODS: Chart review of children with EoE diagnosed by endoscopic

study (15 ormore eosinophils per high power field) between 2005 and 2012

at Hospital Episcopal San Lucas Pediatric Gastroenterology clinic. Will

evaluate, gender, age, presenting symptoms, family and patient history of

atopy. and endoscopic findings

RESULTS: 68 patients with EoE were identified, 60% were male.

Predominant symptoms were abdominal pain and vomiting in (70%).

Age distribution; 0-4 years 26%, 5 to 9 years 31% and over 10 years of age

43%. 51% of patients have a family history of atopy, 30% were allergic to

food or environmental allergens. Endoscopic findings include chronic

esophagitis, but there were no linear furrows, no narrow esophagus, or

strictures. Pathologic findings include from 16 to 60 eosinophils counted

by high power field.

CONCLUSIONS: EoE is prevalent in the pediatric population of Puerto

Rico and should be suspected in children with chronic abdominal pain and

vomiting even though there are no typical endoscopic findings; diagnosis is

confirmed by the presence of over 15 eosinophils on histologic evaluation

by high power field. Endoscopic findings were not as prevalent in our

patients as adults. The prevalence of atopy is high in patients and family.