Friends, Family, and Food: Development of a Food Allergy Intervention, F3-App, for Children.

Objective: Despite a marked increase in the prevalence of pediatric IgE-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA.

Methods: Development of the "Friends, Family and Food Application (F3-App)" employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts.

Early Introduction of Food Allergens and Risk of Developing Food Allergy.

There is increasing evidence that early introduction of allergenic foods may decrease the risk of developing IgE-mediated food allergy. Patterns of food introduction before the 2015 publication of the Learning Early about Peanut Allergy (LEAP) trial are not well-studied, but are important as a baseline for evaluating subsequent changes in infant feeding practices and potentially food allergy. We performed a retrospective longitudinal study using data from a multicenter cohort of infants hospitalized with bronchiolitis between 2011-2014.

Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions.

Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR).

Emerging Therapies in Anaphylaxis: Alternatives to Intramuscular Administration of Epinephrine.

Purpose Of Review: Anaphylaxis is a severe, life-threatening, systemic allergic reaction that should be recognized and treated promptly. Intramuscular (IM) epinephrine is the first-line treatment for anaphylaxis and there are no absolute contraindications to its use. Despite its established track record of efficacy and safety, physicians and patients face barriers in the recognition and treatment of anaphylaxis, including the maintenance and appropriate use of epinephrine auto-injectors.

Trends in US Emergency Department Visits for Anaphylaxis Among Infants and Toddlers: 2006-2015.

Background: Anaphylaxis is a potentially life-threatening allergic reaction. The overall prevalence of anaphylaxis appears to be rising in children, but temporal trends among infants and toddlers are not well studied.

Objective: To characterize the trends in US emergency department (ED) visits and hospitalizations among infants and toddlers with anaphylaxis from 2006 to 2015.

Severity grading system for acute allergic reactions: A multidisciplinary Delphi study.

Background: There is no widely adopted severity grading system for acute allergic reactions, including anaphylactic and nonanaphylactic reactions, thus limiting the ability to optimize and standardize management practices and advance research.

Objective: The aim of this study was to develop a severity grading system for acute allergic reactions for use in clinical care and research.

Methods: From May to September 2020, we convened a 21-member multidisciplinary panel of allergy and emergency care experts; 9 members formed a writing group to critically appraise and assess the strengths and limitations of prior severity grading systems and develop the structure and content for an optimal severity grading system.

Trends in US hospitalizations for anaphylaxis among infants and toddlers: 2006 to 2015.

Background: Anaphylaxis is a potentially fatal acute allergic reaction. Its overall prevalence appears to be rising, but little is known about US hospitalization trends among infants and toddlers.

Objective: To identify the trends and predictors of hospitalization for anaphylaxis among infants and toddlers.

Persistent, refractory, and biphasic anaphylaxis: A multidisciplinary Delphi study.

Background: The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts.

Objective: Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis.

Methods: Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls.

Epinephrine in the Management of Anaphylaxis.

Epinephrine is life-saving and the only first-line medication in the management of anaphylaxis. At therapeutic doses, it acts rapidly to reverse nearly all symptoms of anaphylaxis, and stabilize mast cells. The standard approved doses administered intramuscularly in the lateral thigh have a long track record for safe and effective use, but more information is needed on epinephrine pharmacokinetics and pharmacodynamics to ensure that current dosing strategies are optimal.

Utility of ICD-9-CM Codes for Identification of Allergic Drug Reactions.

Background: The epidemiology of allergic drug reactions is poorly understood due, in large part, to difficulty in identifying true cases in population data sets. Use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes is a potentially valuable approach that requires formal evaluation.

Objective: To better understand the utility of ICD-9-CM codes for identification of allergic drug reactions, including the validation of specific codes by chart review.

Sunlight, vitamin D and food allergy.

Purpose Of Review: The role of vitamin D in the development of food allergy is unclear. We summarize recent data on the epidemiologic link between sunlight (UVB) and food allergy, and evidence for and against a specific role for vitamin D status.

Recent Findings: Since 2007, most epidemiologic studies have supported low sunlight (as measured by season of birth and latitude) as a risk factor for food allergy.

Topical Review: Pediatric Food Allergies Among Diverse Children.

Objective: To present a brief review of the literature regarding potential racial/ethnic disparities in pediatric food allergy (FA).

Methods: Topical review considering data regarding FA prevalence, asthma comorbidity, epinephrine access/use, and psychosocial impact (e.g.

Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization.

Background: Food-induced anaphylaxis (FIA) is potentially life threatening. Prompt administration of epinephrine is universally recommended by current treatment guidelines.

Objective: To identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.

Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals.

Background: Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology.

Objective: To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis.

Methods: Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm.

Retrospective study of drug-induced anaphylaxis treated in the emergency department or hospital: patient characteristics, management, and 1-year follow-up.

Background: Drugs are a common cause of anaphylaxis, which is potentially life threatening.

Objective: We sought to describe US patients with an emergency department (ED) visit or hospitalization for drug-induced anaphylaxis (DIA), including postdischarge follow-up care.

Methods: By using International Classification of Diseases, Ninth Revision codes in the MarketScan Database, we identified all patients with an ED visit and/or hospitalization for DIA between 2002 and 2008 (index date = initial ED visit and/or hospitalization).

Favorable trends in the frequency of U.S. emergency department visits for food allergy, 2001-2009.

Several studies suggest an increase in both the prevalence of food allergy and in the frequency of emergency department (ED) visits for food-related allergic reactions, including anaphylaxis. This study evaluates time trends in the frequency of ED visits for food allergy, with a focus on possible differences by age. Data from two multicenter ED-based studies were used to identify the proportion of patients assigned to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with actual food-related acute allergic reaction and the proportion of these patients with food-induced anaphylaxis.

Longitudinal study of 954 patients with stinging insect anaphylaxis.

Background: Stinging insect anaphylaxis (SIA) is a common cause of anaphylaxis and is potentially life-threatening.

Objectives: To examine US patients with an emergency department (ED) visit or hospitalization for SIA to evaluate postdischarge follow-up care.

Methods: We identified all patients with an ED visit or hospitalization for SIA during 2002-2008 in the MarketScan Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes (index date was the initial ED visit or hospitalization).

An update on self-injectable epinephrine.

Purpose Of Review: Epinephrine is an important life-saving treatment in patients with anaphylaxis. However, despite the guidelines recommending the use of epinephrine in the management of all patients with anaphylaxis, many patients are either not prescribed epinephrine auto-injectors (EAIs) or remain hesitant to use them.

Recent Findings: In this review, we examine our current knowledge base regarding EAIs, including issues related to dosing, medication availability and new modes of administration.

National survey of pediatric services available in US emergency departments.

Background: Children account for nearly 20% of all US emergency department (ED) visits, yet previous national surveys found that many EDs lack specialized pediatric care. In response, a 2001 joint policy statement recommended resources needed by EDs for effective pediatric emergency care delivery. We sought to update and enhance previous estimates of pediatric services available in US EDs.