All abstracts are strictly embargoed until the date of presentation at the 2016 Annual Meeting. AB202 Abstracts J ALLERGY CLIN IMMUNOL FEBRUARY 2016 Relationship Between Exhaled Breath Temperature The Asthma Control Test (ACT): Does It Reliably 655 and Ear Temperature in Otherwise Healthy Persons 657 Assess Asthma Control in African American during Febrile Infectious Illness Adolescents with Persistent Asthma? 1 2 3 1 1 Allison J. Burbank, MD , Katherine Mills, BA , Haibo Zhou, PhD , Todor A. Popov, MD, PhD , Tanya Kralimarkova , Lawrence M. 3 4 1 2,3 1 Qingning Zhou , Michelle L. Hernandez, MD ; UNC School of DuBuske, MD, FAAAAI ; Sofia Medical University, Sofia, Bulgaria, 2 2 Medicine, Chapel Hill, NC, University of North Carolina Chapel Hill George Washington University School of Medicine, Washington, DC, 3 3 School of Medicine, Chapel Hill, NC, University of North Carolina at Immunology Research Institute of New England, Gardner, MA. Chapel Hill, School of Public Health, 4University of North Carolina at RATIONALE: Exhaled breath temperature (EBT) is proposed as a Chapel Hill School of Medicine, Chapel Hill, NC. non-invasive marker of inflammation in obstructive airway diseases. RATIONALE: Measurement properties of the Asthma Control Test EBTand core body temperature (CBT) are not identical in normal persons. (ACT) are lacking in adolescent asthmatics, particularly among African This study assesses associations between EBT and CBT during febrile Americans who may under-report asthma symptoms and experience more illnesses. asthma-related morbidity and mortality. METHODS: Six generally healthy subjects, including 5 men, aged 42–64 METHODS: We propose that the accepted ACT scores used to determine years, had daily EBTassessed for 5 months and 2 years. All used hand-held Ò asthma control would have poor agreement with physician assessment of devices specifically engineered for personal use, the X-halo , DMI control in African American adolescents. We conducted an ongoing Singapore. They measured ear temperature (ET) to assess CBT. The prospective study of African American children ages 12-18 with persistent EBT devices had data uploaded automatically on an Internet site. The asthma. After completing the ACT and spirometry, the physician (blinded subjects were instructed to record ET at 8-hour intervals if the o to ACT score) performed a standardized assessment of asthma control. measurement exceeded 37 C. Frequency of EBT measurements were Agreement of an ACT score > 19 with physician assessment of control was increased during febrile illnesses. used to measure sensitivity, specificity, and Cohen k. RESULTS: Six episodes of fever were documented during the study: 2 RESULTS: Data for 22 subjects who completed at least one visit were cases of rhinovirus infections in which EBT rose by 1.2-1.9oC above base- o included in the analysis. Using a cut point of > 19 for asthma control, the line, preceding by 24-72 hours a moderate increase of ET (up to 38 C); 2 5 o ACT and physician’s assessment were somewhat in agreement (k 0.374, cases of influenza in which EBT rose by >2.0 C about 6 hours before ET 5 o p .08). In addition, a cut point of > 19 had a sensitivity of 77.8% and (up to 40 C); and 2 cases of bacterial infections, urinary and GI, in which specificity of 61.5% in this population. z o o EBT rose by 1.0 C simultaneously with ET (up to 39 C). CONCLUSIONS: Our results show only a fair level of agreement between CONCLUSIONS: EBT rises during incipient viral infections earlier than ACT score and physician assessment of asthma control in African American CBTas seen by ET, providing a window of opportunity for early treatment. adolescents with persistent asthma. While not statistically significant, our EBT assessment allows early detection of illness in patients at risk of data suggest that our effect size could be significant, but a larger sample size exacerbation of underlying obstructive airway diseases. is needed in order to reach significance. The cut off score of 19 was less Pulmonary Embolism in a Patient with Factor V specific for determining asthma control in African American teens compared 656 Leiden Mutation, Presenting with Symptoms of to previous studies of ACT accuracy in Caucasian adults. Asthma Exacerbation Characterization of Urge to Cough in Patients with 658 the Common Cold: Results from a US Internet Survey 1,2 3 1 Anil Nanda, MD , Anita N. Wasan, MD ; Asthma and Allergy Center, 1 2 2 3 Peter Dicpinigaitis, MD , Howard M. Druce, MD, FAAAAI , Ron Lewisville, TX, UT-Southwestern Medical Center, Dallas, TX, Allergy Eccles, BSc, PhD, DSc3, Ronald Turner, MD4, Maryann Attah, MPH5, and Asthma Center, Lansdowne, VA. Ashley L. Mann, MS5; 1Albert Einstein College of Medicine, 2Rutgers- RATIONALE: The differential diagnosis of asthma is extensive. NJ Medical School, 3Cardiff University Cardiff, 4University of Virginia, Pulmonary embolism may present with similar symptoms to asthma. We Charlottesville, VA, 5Pfizer Consumer Healthcare. present a case of pulmonary embolism in a patient with moderate persistent RATIONALE: Cough is typically thought to be a reflex, requiring primary asthma and Factor V Leiden mutation who presented with symptoms of an afferent input to the brainstem, leading to reflex changes in respiration. Urge asthma exacerbation. to cough represents an additional dimension, involving complex sensory and METHODS: Our patient was referred for evaluation and treatment of cognitive processes in higher brain centers. Individual experiences, moderate persistent asthma. perspectives, and management options for urge to cough were investigated. RESULTS: A 52 year old woman with a Factor V Leiden mutation METHODS: An Internet survey exploring cough attributes in respondents presented with a history of moderate persistent asthma. Symptoms who had contracted the common cold within the last 3 months was fielded in included cough, wheezing, and shortness of breath. She had been April 2015. Those with chronic cough were excluded. Demographics, urge previously treated with montelukast with no significant benefit. She could to cough attributes and impact, and management choices were elicited. not tolerate medications with long-acting beta agonists due to anxiety side RESULTS: Of 19,530 screened, 2,708 met inclusion/exclusion criteria; 58% effects. She was placed on fluticasone proprionate 220 mcg two puffs twice female; 85% white; 19% smoked tobacco; 8% used e-cigarettes. Urge to cough daily with benefit. However, after two months, she developed worsening was experienced by 97.8% of respondents and was uncontrollable in 64%. shortness of breath symptoms with wheezing. On exam, she had normal MONDAY Uncontrollability of urge to cough (62%), throat clearing (40.4%), and sore heart rate (80), respiratory rate (12), and blood pressure (110/70). Lung throat (35.6%) were the most bothersome aspects. Common triggers included exam was clear to auscultation without any wheezes, rhonchi, or rales. talking, cold air, or changing position. Attempts to prevent/treat urge to cough Fluticasone dose was increased with some benefit in two days, however, occurred in 74.3%; over-the-counter (OTC) drugs/syrups or lozenges were at mild symptoms still occurred. She then developed chest discomfort, which least somewhat effective in 83% and 78%, respectively. Prescriptions were used was exacerbated by arm movement. She was referred to emergency by 12.9%, and 89% felt they were ‘‘somewhat’’or ‘‘very’’effective. Healthcare department for further evaluation, and CT pulmonary angiography provider (HCP) advice was elicited by 16% and received by 86%. Advice revealed a pulmonary embolism. She was successfully treated with included prescription medications (66.5%), OTC medications (45.7%), herbal anticoagulant therapy. remedies (15.1%), and home remedies (12.6%); 96% followed HCP advice. CONCLUSIONS: This case demonstrates the importance of considering CONCLUSIONS: Urge to cough frequently accompanies the common pulmonary embolism in the differential diagnosis of an asthma cold. This Internet survey provided characterization of urge to cough exacerbation, especially in a patient with a hypercoagulable state, such attributes. Enhanced understanding of cough perception may lead to as Factor V Leiden. insights relevant to novel therapy. All abstracts are strictly embargoed until the date of presentation at the 2016 Annual Meeting. J ALLERGY CLIN IMMUNOL Abstracts AB203 VOLUME 137, NUMBER 2 Sterility Practices in Bronchodilator Administration Total Serum IgE Levels in Asthmatic Children 659 in Allergy Office Settings 661 1 2 Kabir S. Chhabra1, Johanna Wickemeyer1,2, Sudhir Sekhsaria, MD1, Cristine S. Rosario, MD , Nelson A. Rosario, MD, PhD,FAAAAI ,Her- 3 4 Naba A. Sharif, MD1; 1Asthma, Allergy & Sinus Center, Waldorf, MD, berto J. Chong Neto, MD, PhD, FAAAAI , Carlos Antonio Riedi, MD, PhD , 3 1 2Georgetown University School of Medicine, Washington, DC. Monica Lima ; Hospital de Clınicas, Federal University of Parana - Brazil, 2 3 RATIONALE: Due to the need for asthma diagnosis and surveillance, the curitiba, Brazil, Federal University of Parana, Curitiba, Brazil, Federal Uni- 4 bronchodilator reversibility test is commonly used. Yet, there are no versity of Parana, Brazil, Federal University of Parana, Curitiba, Brazil. complete, standardized guidelines for bronchodilator administration. RATIONALE: Total serum IgE levels (sIgE) are elevated in allergic Various methods are used to clean the Metered Dose Inhalers (MDIs), diseases and correlate with asthma severity in children.