Ann Dodge

Safety of and cellular response to segmental bronchoprovocation in allergic asthma.

Rationale Despite its incorporation into research studies, the safety aspects of segmental allergen bronchoprovocation and differences in cellular response among different allergens have received limited consideration. Methods We performed 87 segmental challenges in 77 allergic asthma subjects. Allergen dose was based on each subject’s response to whole lung allergen challenge. Bronchoalveolar lavage was performed at 0 and 48 hours. Safety indicators included spirometry, oxygen saturation, heart rate, and symptoms. Results Among subjects challenged with ragweed, cat dander, or house dust mite, there were no differences in safety indicators. Subjects demonstrated a modest oxygen desaturation and tachycardia during the procedure that returned to normal prior to discharge. We observed a modest reduction in forced vital capacity and forced expiratory volume in one second following bronchoscopy. The most common symptoms following the procedure were cough, sore throat and fatigue. Total bronchoalveolar lavage fluid cell numbers increased from 13±4 to 106±108×104 per milliliter and eosinophils increased from 1±2 to 44±20 percent, with no significant differences among the three allergens. Conclusions In mild allergic asthma, segmental allergen bronchoprovocation, using individualized doses of aeroallergens, was safe and yielded similar cellular responses.

Referral Patterns and Cascade Screening for Familial Hypercholesterolemia in a Pediatric Lipid Clinic

Charts of 42 children with familial hypercholesterolemia from a dyslipidemia clinic were reviewed for initial cholesterol screen indication and cascade screening results. Indications were universal screening (8/28 after guideline release, none before), family history (26/42), risk factor (5/42), and other (3/42). Cascade screening identified 63 relatives with unknown familial hypercholesterolemia.

Novel Lipid Thresholds for Screening Predict the Need for Pharmacotherapy

Objective To identify non‐high‐density lipoprotein cholesterol (HDL‐C) and HDL‐C thresholds for pediatric nonfasting lipid screens that are more predictive of the need for lipid‐lowering pharmacotherapy and estimate numbers of potentially avoidable fasting lipid panels. Study design In this retrospective review of children and youths aged 8‐21 years presenting for preventive cardiology care, initial lipid results, recommendations for pharmacotherapy, and presence of additional cardiovascular risk factors were noted. Receiver operating characteristic curve analysis calculated threshold lipid values predicting the need for pharmacotherapy and were applied to 2 screening populations. Rates of potentially unnecessary fasting lipid panels were calculated. Results A non‐HDL‐C value >156 mg/dL for children with ≥1 cardiovascular risk factors and >199 mg/dL for children without risk factors conferred 95% or greater sensitivity in predicting a recommendation for pharmacotherapy with higher specificity, positive predictive value, and negative predictive value compared with current guidelines. HDL‐C was a poor predictor of pharmacotherapy. Application of the current thresholds to screening populations indicated that 38.5%‐92.3% of follow‐up fasting lipid panels would not result in pharmacotherapy. Conclusion Using higher non‐HDL‐C and lower HDL‐C thresholds could prevent unnecessary follow‐up lipid panels and reduce patient anxiety, cost, and time. This could improve compliance with universal pediatric lipid screening for both health care providers and families.