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001 Penicillin Allergy Evaluation in Pregnancy J ALLERGY CLIN IMMUNOL Abstracts AB1 VOLUME 147, NUMBER 2 Penicillin Allergy Evaluation in Pregnancy poly(I:C) challenged mice with acute and chronic nebulization. No 001 Impacts Antibiotic Utilization and Neonatal respiratory or CNS toxicities were demonstrated at 50x the therapeutic Clinical Outcomes nebulized dose. CONCLUSIONS: MIDD0301 is a promising NCE that, following Jamie Waldron, MD1, Nerlyne Desravines, MD2, Kim Boggess, MD3, nebulized administration, safely reduces AHR and inflammation in allergic Mildred Kwan, MD PhD FAAAAI4; 1University of North Carolina Chapel murine asthma models and is further efficacious in reducing inflammatory Hill, 2University of North Carolina at Chapel Hill, 3UNC, 4University of sequelae of bacterial and viral lung infections. North Carolina. RATIONALE: Penicillin (PCN) allergy is commonly reported, but many Significant Hypogammaglobulinemia in Patients are erroneously labeled. Pregnancy is associated with high antibiotic 003 Receiving CAR T-cell therapy usage, with indications including prophylaxis for surgical Caesarean 1 1 1 section delivery and group B streptococcus (GBS) colonization, a leading Sara Barmettler, MD , Nancy Yang , Jocelyn Farmer, MD PhD , Aidan 2 1 cause of neonatal sepsis. PCN allergy evaluation has the potential to Long, MD FAAAAI , Marcela Maus, MD/PhD , Carlos Camargo, MD 1 1 2 significantly impact both maternal and neonatal clinical outcomes, how- DrPH ; Massachusetts General Hospital, Mass General Hospital. ever, proactive drug allergy evaluations during pregnancy remain RATIONALE: Chimeric antigen receptor T- (CAR T) cell therapy has underutilized. revolutionized the treatment of relapsed and refractory hematologic METHODS: Pregnant women with listed PCN allergy underwent PCN malignancies. The two first FDA-approved CAR T-cell therapies, skin testing and graded Amoxicillin challenge in outpatient Allergy clinic tisagenlecleucel and axicabtagene ciloleucel, target the CD19+ receptor between 13-38 weeks gestation (n546). Patients who passed the on B-cells, and have potential adverse effects including B-cell aplasia and Amoxicillin challenge were de-labeled in the electronic medical record hypogammaglobulinemia. There are sparse data on immunologic and continued routine obstetric care. Retrospective chart review of women outcomes in these patients. who maintained PCN allergy status served as controls (n5105). METHODS: We performed a retrospective evaluation of patients RESULTS: Of the women tested, 94% had their PCN allergy de-labeled. receiving CAR T-cell therapy in a large healthcare system. We evaluated Of those in the tested group who required antibiotics, 59% received a demographics, indication for CAR T-cell therapy, frequency of penicillin and 96% a beta-lactam (compared to 7% and 40% of controls, immunologic evaluation, and hypogammaglobulinemia pre- and respectively). The majority of peripartum indications were for infection post-CAR T-cell therapy. Hypogammaglobulinemia was stratified as prophylaxis (GBS and surgical); peripartum antibiotic use, maternal length mild (Immunoglobulin G [IgG] <650mg/dL), moderate (IgG of stay, and postpartum complications were not significantly different <400mg/dL) or severe (IgG <200mg/dL). between the two groups. Infants of tested mothers had significantly shorter RESULTS: We identified 101 patients who received tisagenlecleucel or 5 lengths of stay and decreased neonatal sepsis scores despite similar rates of axicabtagene ciloleucel for diffuse large B-cell lymphoma (n 88), 5 5 NICU admissions and neonatal complications compared to controls. follicular lymphoma (n 11), and CNS lymphoma (n 2). Of 59/101 CONCLUSIONS: Our results suggest that proactive penicillin allergy patients with immunoglobulins evaluated prior to therapy, 35 (35%) had evaluation during pregnancy is efficacious, can enhance narrow-spectrum hypogammaglobulinemia: 27/35 (77%) mild, 6/35 (17%) moderate, and penicillin and beta-lactam antibiotic use and can impact the duration of 2/35 (6%) severe. Following CAR T-cells, 72/81(89%) patients with hospitalization and neonatal sepsis scores. We encourage broader utiliza- immunoglobulins evaluated had hypogammaglobulinemia: 22/72 (31%) tion of prenatal PCN allergy testing. mild, 41/72 (57%) moderate, and 9/72 (13%) severe. The median time to nadir IgG levels was 2 months (interquartile range 1-6 months) post-CAR Nebulized MIDD0301 is Efficacious in Allergic T-cell therapy. In the 46 patients who had both pre- and post-CAR T-cell 002 and Microbial Lung Inflammation Models therapy immunoglobulins evaluated, immunoglobulin levels decreased significantly post therapy (692mg/dL pre- vs. 392mg/dL post-; p <0.0001). Leggy Arnold1, Brandon Mikulsky, BS2, M. S. Rashid Roni, MS, RA1, CONCLUSIONS: Following CAR T-cell therapy, most patients were Daniel Knutson1, Md Yeunus Mian1, Gene Yocum3, Charles found to have hypogammaglobulinemia. Future studies are needed to Emala, MD3, Nicolas Zahn1, Daniel Webb1, James Cook4, Douglas Staf- evaluate if hypogammaglobulinemia is associated with worse clinical ford1; 1UW Milwaukee, 2Pantherics Inc., 3Columbia University, 4UW- outcomes including excess infections and mortality. Milwaukee. RATIONALE: MIDD0301 is a novel new chemical entity (NCE) drug that targets GABAA receptors in the lung. This unique mechanism of drug action for asthma avoids common therapeutic targets, such as glucocorti- coid and b-adrenergic receptors that are subject to tolerance and adverse effects. MIDD0301 is expected to have broader clinical utility compared to current inhaled and oral treatments due to alleviation of Th1 and Th2 mediated lung inflammation, in addition to the relief of airway hyperres- ponsiveness (AHR). METHODS: Three discrete models of murine lung inflammation were used to evaluate the efficacy of nebulized MIDD0301 in reducing inflammation and AHR: 1) allergic asthma resulting from ovalbumin and house dust mite challenge; 2) steroid resistant lung inflammation induced with intranasal challenge of LPS and INFg, and; 3) a viral lung infection model induced with intranasal challenge of poly(I:C). Lung and blood levels of MIDD0301 were assessed following nebulized administration. Respiratory and CNS toxicity were evaluated by plethysmography and rotarod. RESULTS: MIDD0301 has excellent water solubility that enabled nebulized dosing. Reduction of AHR in ovalbumin and house mite dust challenged mice was observed at doses comparable to albuterol. MIDD0301 improved inflammation and lung function in LPS/INFg and AB2 Abstracts J ALLERGY CLIN IMMUNOL FEBRUARY 2021 SARS-CoV-2 entry factors are expressed in ICAM-1, and ICAM-5), replication of RV1A, and increased expression of 004 nasal, ocular, and oral tissues: implications for a virus and interferon-related gene (IFIT1). These findings provide COVID-19 prophylaxes/therapeutics evidence that a viral process may be contributing to the inflammation associated with EoE in some individuals. Ivan Lee1, Tsuguhisa Nakayama1, Sizun Jiang1, Yury Goltsev1, Christian Schurch€ 1, Bokai Zhu1, David McIlwain1, Pauline Chu1, Han Chen1, Food Reintroduction after Passing an Oral Food Alexandar Tzankov2, Matthias Matter2, Jayakar Nayak1, Garry Nolan1; 006 Challenge: A Cross-Sectional Structured 1Stanford University School of Medicine, 2Institute of Medical Genetics Interview-Based Assessment of Barriers, and Pathology, University of Basel, Switzerland. Challenges, and Impact on Quality of Life RATIONALE: Tissue tropism is one key to understanding the pathogen- Christina Ditlof1, Roxanne Hummel1, Samantha Wong, MSc, RD1, Mara esis of SARS-CoV-2, the causative agent of the ongoing severe acute 1 1 1 respiratory disease pandemic COVID-19. We characterized the protein Alexanian-Farr, MSc, RD , Slavka Zahrebelny , Jennifer Hoang , Lisa Hung1, Julia Upton, MD1, A. D. E. L. L. E. ATKINSON, MD, FRCP1, expression of the essential SARS-CoV-2 receptor, angiotensin-converting 1 1 1 1 enzyme 2 (ACE2), and the critical SARS-CoV-2 entry factor, trans- Maria Asper, MD , David Hummel, MD , Thomas Eiwegger, MD ; Hos- membrane protease, serine 2 (TMPRSS2), in human aerodigestive and pital for Sick Children. ocular tissues to gain insights into initial SARS-CoV-2-host interactions. RATIONALE: Asymptomatic sensitization and equivocal history often results in long periods of avoidance. In the case of a negative OFC METHODS: Immunofluorescent staining was simultaneously performed neg on tissue microarrays consisting of normal human head & neck tissues. (OFC ), the patient must reintroduce the previously avoided food on a Tissues from SARS-CoV-2-infected patients were collected during regular basis. This population allows for the evaluation of the impact of autopsy. Imaging was performed using confocal microscopy, and quanti- food allergy delabelling and investigation of challenges linked to food fication of fluorescent intensity was done using a custom open-source introduction. software in ImageJ. METHODS: The validated Food Allergy Quality of Life Questionnaire – RESULTS: ACE2 and TMPRSS2 protein expression localize to a variety Parent Form, Child Form, and Teenager Form (FAQLQ-PF, CF, TF), and motivators and barriers for food reintroduction were assessed in a Canadian of human airway, ocular, and oral epithelial surfaces, suggesting that neg SARS-CoV-2 has the capability to enter through all mucosal surfaces of the cohort of 96 parents, children and adolescents with an OFC via a struc- face. Notably, ACE2 and TMPRSS2 are both very highly expressed in the tured interview. Using the FAQLQs, quality of life
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