Antibiotic Use in Patients With β-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain-Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment.

Background: β-lactam antibiotics with dissimilar R-group side chains are associated with low cross-reactivity. Despite this, patients with β-lactam allergies are often treated with non-β-lactam alternative antibiotics. An institutional β-lactam side chain-based cross-reactivity chart was developed and implemented to guide in antibiotic selection for patients with β-lactam allergies.

Hidradenitis Suppurativa at an Uncommon Site: A Review of Its Clinical Features, Diagnostic Difficulties, and Management.

Hidradenitis suppurativa (HS) is a non-contagious chronic inflammatory and often debilitating skin disease that is characterized by recurrent painful nodules, draining sinus tracts, and abscesses. The disease primarily affects the axillary, perineal, inguinal, intermammary, and inframammary regions with an estimated global prevalence rate of up to 4%. The etiology of HS is still unknown, but our understanding of its pathogenic process has evolved.

Impact of an Antibiotic Side-Chain-Based Cross-reactivity Chart Combined With Enhanced Allergy Assessment Processes for Surgical Prophylaxis Antimicrobials in Patients With β-Lactam Allergies.

Background: β-Lactam antibiotics are first-line therapy for perioperative prophylaxis; however, patient-reported allergies often lead to increased prescribing of alternative antibiotics that may increase the incidence of surgical site infections. The R-group side chain of the β-lactam ring is responsible for allergic cross-reactivity and experts recommend the use of β-lactams that are structurally dissimilar.

Methods: An internally developed, antibiotic side-chain-based cross-reactivity chart was developed and implemented alongside enhanced allergy assessment processes.

Camp Leadership Perspectives on Food Allergy-Related Anaphylaxis Events and Training for Camp Staff: A National Survey of Summer Camps.

Background: Training of camp staff to recognize and treat anaphylaxis is recommended because food allergies are prevalent among summer campers. The frequency of food allergy anaphylaxis events and the extent of anaphylaxis training for camp staff are unknown.

Objective: To estimate the frequency of food-allergic reactions in camps across the United States and to assess the state of food allergy anaphylaxis training for camp staff.

Improving Patient-Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study.

Background: The rapid proliferation of electronic health records (EHRs) in clinics has had mixed impact on patient-centered communication, yet few evaluated interventions exist to train practicing providers in communication practices.

Aims: We extended the evidence-based Physician Asthma Care Education (PACE) program with EHR-specific communication strategies, and tested whether training providers with the extended program (EHR-PACE) would improve provider and patient perceptions of provider communication skills and asthma outcomes of patients.

Method: A pilot randomized design was used to compare EHR-PACE with usual care.

Food Allergy Trends and Epinephrine Autoinjector Presence in Summer Camps.

Background: Pediatric campers with food allergies are at greater risk for exposure and anaphylaxis. A diagnosis of asthma increases risk for anaphylaxis. Epidemiological investigations of food-allergic children at high risk for allergic reactions requiring intervention in camp settings are lacking.

The extent and patterns of multiple chronic conditions in low-income children.

Background And Objectives: Little is known about the magnitude of multiple chronic conditions (MCC) in children. This study describes the prevalence of and patterns of comorbidities in children receiving Medicaid assistance.

Methods: Diagnoses from 5 years of Medicaid claims data were reviewed and identified 128,044 children with chronic conditions.

Asthma outcomes in children and adolescents with multiple morbidities: Findings from the National Health Interview Survey.

Background: More Americans are managing multiple chronic conditions (MCCs), and trends are particularly alarming in youth.

Objective: The purpose of this study was to examine the prevalence and distribution of 9 chronic conditions in children and adolescents with and without asthma, and adverse asthma outcomes associated with having MCCs.

Methods: Cross-sectional interview data from the National Health Interview Survey were analyzed (N = 66,790) between 2007 and 2012 in youth 0 to 17 years of age.

The relationship of season of birth to asthma and allergy in urban African American children from 10 to 13 years of age.

Objectives: To assess the relationship between season of birth and presence of asthma and allergy in preteen, low-income, African American children.

Methods: The study consisted of a self-administered survey followed by telephone interviews of parents of children attending 19 middle schools in Detroit, Michigan. Out of 4194 children, 1292 were identified with asthma and 962 parents of these children provided informed consent and took part in telephone interviews.

Addressing food allergy issues within child care centers.

The prevalence of food allergies in the pediatric population has risen significantly in the past decade. School districts and advocacy groups have made progress in developing systematic approaches to address pediatric food allergies; however, the widespread variance in child care settings, organization, and staff training still presents unique challenges. Addressing these obstacles requires multiple approaches to policy and guideline formulation and dissemination.

Peanut-allergic subjects and their peanut-tolerant siblings have large differences in peanut-specific IgG that are independent of HLA class II.

We enrolled 53 peanut-allergic subjects and 64 peanut-tolerant full siblings, measured peanut-specific IgG and IgE, determined HLA class II at high resolution, and analyzed DRB1 alleles by supertypes. Peanut-specific IgG and IgE were elevated in the peanut-allergic subjects (p<0.0001) but did not stratify with HLA alleles, haplotypes, or supertypes.

A developmental, community, and psychosocial approach to food allergies in children.

Recent estimates show that food allergies affect a substantial proportion of children in the United States and appear to have increased in prevalence. At present, management of food allergies consists of strict avoidance of the responsible allergen and an appropriate response should a reaction occur. Creating safe environments for the growing number of children with food allergies requires a partnership between affected families and members of the caregiving and educational communities.

A novel mutation in NFKBIA/IKBA results in a degradation-resistant N-truncated protein and is associated with ectodermal dysplasia with immunodeficiency.

Alterations in nuclear factor kappa B (NF-kappaB) essential modulator (NEMO; HUGO-approved symbol IKBKG) underlie most cases of ectodermal dysplasia with immune deficiency (EDI), a human disorder characterized by anhidrosis with diminished immunity. EDI has also been associated with a single heterozygous mutation at position Ser32 of the NF-kappaB inhibitor IkappaBalpha, one of two phosphorylation sites that are essential for targeting IkappaBalpha for proteasomal degradation and hence for activation of NF-kappaB. We report a novel heterozygous nonsense mutation in the IKBA (HUGO-approved symbol, NFKBIA) gene of a 1-year-old male child with EDI that introduces a premature termination codon at position Glu14.

Managing children with food allergies in childcare and school.

In the past decade the rise in life-threatening allergic reactions to foods in young children has necessitated increased interaction among personnel in the psychosocial, medical, and educational arenas regarding the multifaceted aspects of this concerning problem. Schools and childcare facilities are vital venues for the continued growth and development of children outside the home. However, these facilities offer unique challenges to caring for the food-allergic child, requiring that the medical, educational, and caretaking communities work in unison to provide the safest environment for all children.

Outcomes associated with spirometry for pediatric asthma in a managed care organization.

Background: The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing "at least every 1 to 2 years to assess the maintenance of airway function."

Objective: The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma.

Methods: We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003).