S10 Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21 low-molecular-weight proteome (< 30 KDa) mass fingerprinting profile in breastmilk, commercial starting formulae and mammal’s milks to assess the proteome profile similarities. Methods: Breastmilk samples were collected from 20 mothers at 2 (colostrum; HC), 30, 60 and 90 days (HM30, HM60 and HM90). Commercial starting formula samples were collected from four commercially available brands [Aptamil (A), Humana (H), Formulat (F), Nidina (N)]. Donkey (DM), cow’s (CM), buffalo’s (BM) goat (GM) and ewe’s milk (EM) were collected from Italian farms. Camel milk (CAM) was collected from Libyan desert farms. Raw milk samples were analyzed by linear MALDI-TOF MS for the generation of proteomic phenotyping profiles. Results: At hierarchical clustering (Figure), three groups are clearly distinguishable: formula, animal and human milk. A,H,F, and N display an homogeneous clustering, suggesting quite common spectral characteristics, but are clearly distinguishable each other. HM clustered near HC, whereas the animal milk group is pretty well separated. CAM displayed a very poor correlation with all of the considered milks. Conclusions: These results can have importance on the use of specific milks for infant feeding. In particular in CMA, camel milk might have a different protein profile compared to other animal milks. The specific profile of different eHFs remain to be assessed. Hierarchical clustering tree (bootstrap n¼1000) of all spectral replica from animal milk (BM, CAM, CM, DM, EM and GM), human colostrum (HC), mature milk at 30, 60 and 90 days (HM30, HM60 and HM90) and formula milk (A, F, H, N). O027 IS TIMING IMPORTANT FOR EGG ORAL FOOD CHALLENGE OUTCOME? A. Devonshire*1, K. Barbon2, C. Szychlinski1, A. Singh1, 1. Chicago, IL; 2. Fontana, WI. Introduction: Few studies have examined characteristics of children that have failed oral food challenges (OFC) once a low specific IgE has been obtained. Methods: Three-hundred seventy three egg OFC and 129 baked egg oral food challenges were retrospectively reviewed. Time between OFC and first and last reaction to the implicated food was determined. Data was compared between individuals who passed and failed OFC using chi-squared testing and Mann-Whitney U testing. This study was IRB exempt. Results: Patients that failed OFC to whole egg were more likely to have additional food allergies (83% versus 69%, p¼0.037) and atopic dermatitis (83% versus 67.5%, p¼0.023). These differences were not found with baked egg. Individuals that failed OFC to whole egg had higher egg white specific IgE at the time of challenge compared to individuals that passed (1.66 versus 0.94, p<0.001). Similarly, individuals that failed an OFC to baked egg had higher egg white specific IgE at the time of challenge (14.7 versus 5.99, p¼0.002). Individuals that failed OFC to whole egg had larger skin prick testing wheal and flare at diagnosis compared to those who passed (8.92 versus 6.67, p¼0.002; 18.5 versus 14.5, p¼0.009). Demographic factors, reaction severity and timing between OFC and first and last reaction did not differ between individuals who passed and failed whole and baked egg challenges. Conclusion: Neither severity of reaction, nor timing of last reaction distinguished OFC outcome. This suggests that OFCs can be considered at 6 months or less from the last exposure or with recent severe reaction, independent of outcome. O028 RECOGNITION AND TREATMENT OF FOOD-INDUCED ANAPHYLAXIS BY SCHOOL STAFF MEMBERS A. Tsuang*1, H. Demain2, K. Patrick3, M. Pistiner4, J. Wang1, 1. New York, NY; 2. Lakewood, CO; 3. Denver, CO; 4. Newton, MA. Introduction: With food allergies becoming more prevalent, school staff members, including those without a nursing background, are increasingly the first to respond to allergic reactions. This study aims to assess knowledge of treating food-induced anaphylaxis among non-nursing school staff. Methods: An anonymous questionnaire was distributed to nonnursing school staff at Colorado schools from August 2015 until January 2016. Results: 143 surveys were completed by non-nursing school staff, which included teachers (67%), office staff (14%), school administrators (7%), custodial staff (1%) and other (18%). 54% of staff members were from rural schools, 33% were from suburban schools, and 13% were from urban schools. 41% of those surveyed had worked in the school system for 5 years or less; while 16% had been present for more than 20 years. 66% reported that the staff received food allergy training from the school with a reported average training time of 29 minutes. The majority of the food allergy training was provided by school nurses (71%). Among those surveyed, a low percentage felt very confident in their ability to recognize the symptoms of anaphylaxis (18%) or their ability to treat anaphylaxis (19%). Of 12 knowledge-based questions in the survey, an average of 72% of these questions were answered correctly. The majority (87%) were able to identify the correct sequence of actions to take if a child is experiencing anaphylaxis. Conclusion: Non-nursing school staff members have some knowledge to recognize and treat anaphylaxis. Education and training should include non-nursing staff to increase confidence in their skills. O029 VITAMIN D DEFICIENCY AND ITS ASSOCIATION WITH FOOD ALLERGIES IN CHILDREN: SYSTEMATIC REVIEW AND META-ANALYSIS E. Willits*1, A. Joshi1, M. Motosue2, B. Patel3, J. Jin1, S. Kumar1, A. Bhagia1, 1. Rochester, MN; 2. Honolulu, HI; 3. Madison, WI. Introduction: Vitamin-D deficiency has been associated with immune dysfunction and linked to the epidemic of atopic diseases in the western hemisphere. Different studies have examined the association of Vitamin-D deficiency with food allergies. Results have been conflicting and the risk has not been quantified uniformly across studies. We performed a systematic review and metaanalysis to investigate the possible association between Vitamin-D deficiency and food allergy. Methods: In this systematic review, we included only studies evaluating children with food allergy and documented blood 25(OH)D levels. Random effect models were used to combine the outcomes of interest, including persistence or outgrowth of food allergy from the included studies. Results: A total of 368 citations were identified and included 5,105 children with an average age of 86 months (range:13-159 months). We did not find significant association between 25(OH)D levels and risk of food allergy in children (OR¼1.35,95%CI:0.79,2.29, p¼0.27,I2¼58.3%). We conducted a subgroup analyses for different Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21 S11 cutoffs of 25(OH)D levels (20ng/ml vs. 30ng/ml). Only one study used 30ng/ml for a cut off and found children with 25(OH)D less than 30ng/ ml were more likely to report food allergy than children with 25(OH)D levels of 30ng/ml or more (OR¼2.04,95%CI:1.02,4.04,p¼0.04). Four studies compared children with 25(OH)D levels less than 20ng/ml to children with 25(OH)D levels of 20ng/ml or more and found no significant differences (OR¼1.18,95%CI:0.62,2.27,p¼0.62,I2¼62.7%). Conclusion: There was no association between Vitamin-D deficiency or insufficiency in children with established food allergy. Longitudinal studies are warranted to further assess for the potential role of vitamin-D deficiency in the development of food allergy. Pooled Odds Ratios from included studies Table 1. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Expected number of anaphylaxis episodes, described by potential contributing factors (unadjusted). Examined in 75 peanut anaphylaxis patients. Average follow-up (child age) of 7.8 years. O030 CORRELATING RAST, COMPONENT LEVELS, SKIN TESTING, AND EPINEPHRINE REQUIREMENTS IN PATIENTS WITH ANAPHYLAXIS TO PEANUT I. Randhawa*, C. Caperton, Long Beach, CA. Introduction: Peanut allergen exposure resulting in epinephrinerequiring anaphylaxis is a major health concern. Peanut IgE and components are increasingly ordered, yet research-guided directives regarding clinical correlation and utilization of peanut component diagnostic testing is lacking. In patients with WAO Grade II or higher peanut anaphylaxis, we investigated the correlation between serum-specific peanut IgE (sIgE), component levels, skin prick testing (SPT) and number of anaphylactic episodes and epinephrine use. Methods: The Gallegos Food Allergy Center performed peanut IgE, comprehensive component-resolved diagnostics (Ara h1, Ara h2, Ara h3, Ara h8, Ara h9), and SPT in 74 patients with known peanut anaphylaxis (SPT >3mm and clinical history of anaphylaxis requiring epinephrine). Number of anaphylactic episodes and requirement for epinephrine were recorded for average follow-up (child age) of 7.8 years. The correlation of individual diagnostics was assessed with continuous and dichotomous scales. Results: Patients with Ara h9 >0.2 kUA/L had 67% more anaphylactic episodes (IRR¼1.67,p¼0.002). Higher values of Ara h8 correlated with increased number of anaphylactic episodes (IRR¼1.012, p¼0.004). Neither SPT nor sIgE values corresponded to increased anaphylaxis; sIgE >0.35 was associated with reduced number of epinephrine uses (IRR¼0.40,p¼0.009). Conclusions: In our subset of patients with history of anaphylaxis to peanut, we demonstrated positive correlations between Ara h8 and Ara h9 levels and increasing number of anaphylactic episodes. Interestingly, findings did not support a strong influence of SPT results on number of anaphylactic episodes or epinephrine usage. This information aids in ascertaining the clinical utility of component diagnostics in assessing risk for anaphylaxis in peanut-allergic patients. O031 EVALUATING ANXIETY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS J. Jose*1, A. Horwitz1, P. Jhaveri2, 1. Hershey, PA; 2. Hummelstown, PA. Introduction: Anxiety disorders have a lifetime prevalence of 31.9% with a median age of onset of 6 years. One recent study found that children with food allergies did not have increased anxiety but mothers reported more symptoms of panic disorder in their children. Assessing anxiety in children with eosinophilic esophagitis (EoE) has not been studied. We hypothesize that this population may be at greater risk for anxiety and depression than those without EoE, and assessment for these disorders should be part of the overall evaluation in EoE. Methods: After Institutional Review Board (IRB) approval, all parents of children with EoE who presented to our outpatient clinic were requested to complete the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. SCARED is a 41-item standardized screen for anxiety validated for use in children aged 8 to 16 years. Data were entered into REDCap. Results: To date, eight questionnaires have been completed with majority (88%) (n¼7) male and a mean age of 12.3 years. Three patients (38%) met the criteria for anxiety and of that group, two met at least one subscale cutoff score indicating the presence of specific anxiety related disorders. One out of eight parents reported some bullying secondary to EoE. Conclusion: Children with EoE are potentially at increased risk for anxiety. Screening and referral to mental health services may be warranted in some individuals. Future direction will involve comparing anxiety disorders of EoE patients to those with a diagnosis of food allergies, anxiety disorder, and a healthy control group.