had no known allergy, and 51.3% (1026/2000) had no known history of asthma. Conclusion: These results demonstrate the unpredictability of anaphylaxis and emphasize the importance of preparedness training and implementation of allergy policies to help manage anaphylaxis in schools. O046 INTRAOPERATIVE ANAPHYLAXIS SECONDARY TO BACITRACIN IRRIGATION K. Sacco*, S. Baumann, T. Pongdee, Jacksonville, FL. Introduction: Allergic reactions to topical bacitracin are well documented, however anaphylaxis is rare. We report a case of intraoperative anaphylaxis secondary to bacitracin. While intra- operative hypotension is common, hypotension secondary to anaphylaxis accounts for less than 0.02% of cases. Methods: Case report (exempt from IRB approval) and literature review. Case report: A 67-year-old male with a history of prostate adenocarcinoma underwent a urologic procedure for removal of an infected penile prosthesis. He reported allergies to penicillin, sulfa drugs and hydroxychloroquine. Prior surgeries were uneventful. The patient developed hypotension (BP 80/40mmHg) eighty minutes into the surgical procedure associated with hypoxemia and hyper- carbia. Initial concerns for pulmonary embolism or myocardial infarction were ruled out. The possibility for distributive shock secondary to anaphylaxis was then considered. Serum tryptase and urine N-methylhistamine levels were ordered, and he was resusci- tated intraoperatively with vasopressors, albumin, hydrocortisone and diphenhydramine. The patient was extubated and admitted to the intensive care unit with an uneventful stay thereafter. Serum tryptase was found to be elevated at 28.5ng/mL (ref <11.4 ng/mL) with urine N-methylhistamine 1036mcg/g Cr (30-200 mcg/g Cr). Chart review was indicative of bacitracin/polymyxin irrigation pre- ceding deranged vital signs by fifteen minutes. No other medication was administered within this interval. Allergy skin testing four weeks following the incident was positive for bacitracin and nega- tive for other perioperative medications that had been administered. He underwent subsequent surgeries without adverse reactions. Conclusion: Bacitracin is a rare cause for intraoperative anaphy- laxis. History is of utmost importance in identifying etiologic agents in perioperative anaphylaxis. O047 SUCCESSFUL INDUCTION OF TOLERANCE IN PATIENTS WITH PLATINUM-BASED CHEMOTHERAPY HYPERSENSITIVITY REACTIONS S. Mawhirt* 1 , S. Sani 2 , L. Fonacier 1 , R. Calixte 1 , M. Davis-Lorton 1 , M. Aquino 1 , 1. Mineola, NY; 2. Flushing, NY. Introduction: Platinum hypersensitivity reactions are relatively common among oncology patients. Induction of tolerance (IOT) procedures may provide life-saving chemotherapy and predicting successful IOTs would be a useful tool. Methods: We conducted an IRB approved, seven year retrospective chart review of patients evaluated for platinum-based hypersen- sitivity reactions. Data gathered for analysis included patient clin- ical characteristics, index reaction details, and IOT outcomes. Results: Platinum infusion reactions were identified in 42 patients. Of these, 36 (88.9% female; age63.6 +/- 10.1 years) underwent 146 total IOTs (1d12 per patient; n¼34 carboplatin, n¼2 oxaliplatin). Most index reactions involved one organ system (72.2%), occurring after the 5th cycle (80.6%). Standard 12-step protocols were utilized in 99 IOTs (8d22 steps). No differences were detected in demo- graphics, atopic/drug allergy history, or reaction cycle between patients with any IOT reaction (n¼21) and completely IOT-tolerant patients (n¼15). The IOT-tolerant group comprised a greater proportion of patients with index anaphylaxis (p¼0.028). Fifty IOT reactions occurred: 62%-cutaneous limited, 32%-pulmonary or gastrointestinal involvement, 6%-anaphylaxis (epinephrine administered). The index reaction severity demonstrated no cor- relation to IOT reaction severity (kappa¼-0.03d0.19). Ten patients (55.6%) with IOT reactions subsequently tolerated IOTs with pro- tocol revision (additional pre-medication and/or increased steps). In patients with index anaphylaxis or respiratory arrest, 78.3% of IOTs were tolerated. Overall, the IOT completion rate was 96.6%. Conclusion: In our population, even patients with life-threatening platinum reaction history tolerated standard IOTs. Patient charac- teristics and index reaction severity did not predict IOT outcomes. Our data affirms that the vast majority of patients with platinum hypersensitivity can receive additional platinum courses. O048 AN UNUSUAL CAUSE OF PERSISTENT ABDOMINAL PAIN S. Arakali*, M. Fajt, Pittsburgh, PA. Silicone allergy is a rare entity primarily described in neurosur- gical literature in patients with ventriculoperitoneal (VP) shunts. A 62-year-old female with history of pseudotumor cerebri status-post VP shunt placement was hospitalized with dizziness and diffuse abdominal pain. Seizure activity was seen on EEG and she was placed on levetiracetam. CT imaging showed small bowel thickening and mesenteric stranding consistent with peritonitis for which she underwent VP shunt repositioning. She developed fevers and fluc- tuating elevated peripheral eosinophil counts, ranging from 700/L to 2130/L. Due to concerns of drug allergy, several recently started medications were discontinued. However, eosinophilia, fevers and abdominal pain persisted. No rashes were present. Total IgE was elevated at 375 IU/mL. Parasitic workup was negative. Hepatic/renal studies were normal. Repeat abdominal imaging showed resolution of initial peritonitis. Due to concern for silicone allergy, the decision was made to replace the VP shunt-catheter with an extracted sili- cone catheter. CSF culture was negative and cell count was normal. Fevers, abdominal pain and nausea completely resolved within 48 hours of the procedure, and her eosinophil count decreased to 500/L. Reports of silicone allergy in patients with VP shunts show diverse presentations ranging from headache to abdominal pain/ distention. There is no diagnostic testing for this delayed type of reaction. In this case, suspicion for silicone allergy arose only after several medications were discontinued and eosinophilia and symptoms persisted. Silicone allergy should be on differential diagnosis in cases involving silicone-containing-devices, persistent eosinophilia and fevers, especially when infection has been ruled out and commonly implicated drugs have been discontinued. O049 SYSTEMIC REACTION TO SUBLINGUAL IMMUNOTHERAPY IN PATIENT WITH PRIOR LOCAL REACTIONS TO SUBCUTANEOUS IMMUNOTHERAPY F. Jiang* 1 , N. Sikka 2 , S. Gupta 2 , J. Yusin 3 , 1. Los Angeles, CA; 2. Plano, TX; 3. Stevenson Ranch, CA. Introduction: Sublingual immunotherapy (SLIT) has predomi- nantly local oral mucosal symptoms with a lower risk for systemic reactions than subcutaneous therapy (SCIT). Here we present a patient with a systemic reaction to her first dose of sublingual Timothy grass related extract. Methods: Patient received one tablet of sublingual Timothy grass related extract. Results: The patient is a 48-year-old woman with allergic rhino- conjunctivitis with severe seasonal exacerbations, skin test positive to dust mites, trees, weeds and grass with normal spirometry. SCIT was attempted twice (rush in 2012, cluster in 2015) but Abstracts: Oral Concurrent Sessions / Ann Allergy Asthma Immunol 117 (2016) S1eS21 S16