S342 Abstracts J ALLERGY CLIN IMMUNOL JANUARY 2000 1006 Local Anesthetic (LA) Use Following LA Skin Testing S Knowles. J Haber; E Weber Sunnybrook and Women’s College Health Sciences Centre, Toronto, Canada True allergic reactions to LAS are extremely rare. Many indi- viduals labelied as “allergic” often experience vasovagal reac- tions, toxic reactions, side effects from epinephrine or psychomo- tor responses and are denied the use of LA agents. At the Drug Safety Clinic, patients presenting with a history of an “allergic” reaction to a LA undergo skin testing to a battery of LAS at vari- ous concentrations. If the skin tests are negative, a graded subcu- taneous LA challenge is performed. Even though most patients complete testing without any adverse reaction, it is unknown whether patients feel confident enough in the testing results to subsequently receive LAS. 214 patients (mean age=43 yrs; FA4=180/34) completed LA testing between 1992-98. There were 5 positive reactions (2.3%): 2 immediate at the intradermal site, 2 delayed at the intradermal site, and 1 immediate following subcutaneous challenge. A tele- phone interview was conducted in 79 patients who completed test- ing. Patients were asked whether they had received a LA since the testing. If not, patients were asked whether they felt “comfort- able” receiving a LA in the future. 17 patients (21.5%) stated they were not comfortable to receive a LA and 62 patients either had already received (N=41) or were comfortable to receive (N=21) a LA. Although test results were negative in one patient, the dentist continued to withhold LA. There was no significant difference between patients who would or would not receive a LA except for type of reaction. 42% of patients who would receive a LA reported an allergic-type or skin reaction during the initial exposure. No patient in the group who did not feel comfortable to receive LAS had developed an allergic-type or skin reaction (p<O.Ol). but rather had symptoms consistent with a vasovagal, panic-type or other non-allergic-type reaction. Although not statistically significant, all patients who would not receive a LA were female, as compared to 5 1 (82%) in the group who would receive a LA. Approximately 20% of patients who undergo LA testing do not feel confident in receiving subsequent LAS, despite negative skin and challenge testing. Most of these patients had experienced a vasovagal reaction, panic-type reaction or other non-allergic type of reaction. These results may help to identify those patients in whom LA testing does not alter perception of risk or avoidance behaviour. These patients may need more than objective testing to feel confident in using LAS in the future. 1007 Systemic Symptoms with Anthrax Vaccine (AVA) Doses 1 & 2 M Metrich*, HG Oak+. C Costellof. KJ Hoffman f. RJM Engler* *Walter Reed Army Medical Center. Washington. DC tSeou1, South Korea Anthrax vaccine for the protection of U.S. military service members from the potentially lethal consequences of inhalation anthrax utilizes an approved vaccine schedule of 6 SQ doses over 18 months (at 0,2.4 weeks; 6, 12, 18 months) with yearly boost- ers. METHODS: As part of the clinical screening program, AVA recipients completed, prior to the next dose, a questionnaire regarding adverse reactions to prior AVA doses. Soldiers were sta- tioned in Korea or attached to a Walter Reed reserve unit (ResU). The questionnaires included details regarding fever (FEV), malaise or “flu-like” (FLU) illness. and other systemic symptoms (SYS) such as pruritis and fatigue, as well as large local reactions (LLR) exceeding I2 cm in diameter. RESULTS: There were no prolonged reactions resulting in chronic illness. The 1st dose of AVA in women was associated with LLR in >5% and FLU in ~10% for both survey groups. For the second dose of AVA, the table below summarizes the frequen- cies (S) of systemic symptoms (FEV, FLU, SYS) as well as LLR for the Korea survey and the Reservist Unit for total and gender- specific groups (Fem=female). 2ND AVA FEV % SYS % FLU % LLR % N= KOREA TOTAL 2.3 4.0 8.7 2.6 2427 KOREA MALE 1.7 3.5 7. I 2.0 1953 KOREA FEM 4.8** 6.1;’ 5.4” 5.8** 474 RESU TOTAL 4.7 10.5 7.0 2.3 86 RESU MALE 3.0 9.0 3.5 1.5 67 RESU FEM 10.5 15.8 15.8 5.3 I9 Male-Female differences significant at p < O.Ol(**). Systemic side effects (lasting more than 24 hours) associated with the first 3 doses of AVA in the ResU occurred in 15% of patients (21% Fem. 13.4% Male) for one or more shots. However, not all patients experienced these effects with all doses. CONCLUSION: The first 2 doses of Anthrax vaccination are associated with a high frequency of LLR at the injection site as well as systemic symptoms such as fever, pruritis, fatigue, and generalized “flu-like” illness. Similar reactions have been observed with the adjuvant aluminum hydroxide (also present in AVA), when included in vaccine studies as a component of the placebo. It is noteworthy that no other vaccine with this adjuvant is given by the SQ route. The higher the frequency of LLR and systemic symptoms with anthrax vaccine in women compared to men needs further study and may reflect differences in immune response related to gender. 1008 Allergic Disease in Pediatric Heart ‘bansplant Recipients D Nash, R Sutton. G Friday, JI; S Kocoshis. S Webber University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh The use of non-specific immunosuppression with either Tacrolimus or Cyclosporine in childhood recipients of solid organ transplantation has been associated with anecdotal reports of aller- gic hypersensitivity. We propose to describe, in a large cohort of pediatric cardiac transplantation patients, both the risk factors and nature of atopic disease in this population. We used a retrospective review of cardiology, allergy and gastroenterology charts to iden- tify and describe 73 heart transplant recipients less than 16 years old and having survived at least 6 months post transplantation. An allergy questionnaire was performed prospectively by either tele- phone interview or during follow-up visits in cardiology clinic to determine if, when and how atopy had been diagnosed, the fami- ly history of atopy, and the clinical severity of the atopic condi- tion. Our results demonstrate a remarkable incidence of atopic dis- ease in children transplanted in the first year of life. A total of 25 patients were transplanted in the first year of life and 22 have had a physician diagnosis of asthma, eczema or food allergy. Only I3 of the 48 patients who were transplanted after I year of age have been diagnosed with atopic disease. In children less than I year of age eczema was the most common diagnosis 14/22, followed by food allergy 9/22, and S/22 had a diagnosis of either asthma or reactive airway disease. Older transplant recipients were more likely to have nasal disease 6/13, food allergy 5/13, or asthma 5/13. A surprising number of patients 5/73 have been diagnosed with eosinophilic gastroenteritis (EG). A diagnosis of EG did not appear to be related to either patient age or alleric hypersensitivi- ty to foods. Only l/5 patients with EG had either a positive skin test or RAST test to foods. Our data demonstrate a significant risk for the development of