Ashley A. Dyer

Pediatric emergency department visits and hospitalizations due to food-induced anaphylaxis in Illinois.

BACKGROUND Rates of food-induced anaphylaxis among children remain uncertain. In addition, little is known about the demographics of children who have experienced food-induced anaphylaxis resulting in emergency department (ED) visits and/or subsequent hospitalizations. OBJECTIVES To evaluate trends in ED visits and hospital admissions due to food-induced anaphylaxis among Illinois children and to identify socioeconomic variation in trend distribution. METHODS Illinois hospital discharge data compiled by the Illinois Hospital Association were used to identify ED visits or hospitalizations for food-induced anaphylaxis in Illinois hospitals from 2008-2012. Data for children aged 0 to 19 years who were Illinois residents and received a diagnosis of food-induced anaphylaxis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.60 through 995.69) were included for analysis. RESULTS There was a significant increase in the rate of ED visits and hospital admissions due to food-induced anaphylaxis among children in Illinois during the 5-year period, with an annual percent increase of 29.1% from 6.3 ED visits and hospital admissions per 100,000 children in 2008 to 17.2 in 2012 (P < .001). Increases in visit frequency were observed for all study variables, including age, sex, race/ethnicity, insurance type, metropolitan status, hospital type, and allergenic food. Visits were most frequent each year for Asian children and children with private insurance. However, the annual percent increase in visits was most pronounced among Hispanic children (44.3%, P < .001) and children with public insurance (30.2%, P < .001). CONCLUSION ED visits and hospital admissions for food-induced anaphylaxis have increased during a 5-year period among children in Illinois, regardless of race/ethnicity and socioeconomic status.

Epidemiology of childhood food allergy

Food allergy is a public health problem that affects nearly 6 million children in the United States. The extent to which children, families, and communities live with food allergies varies as much as the range of clinical symptoms associated with the disease itself. Food allergy is defined as the reproducible adverse event that elicits a pathologic immunoglobulin E (IgE)-mediated or non-IgE-mediated reaction. Once an allergic child ingests a specific food allergen, the reaction can result in clinical symptoms ranging from mild hives to life-threatening anaphylaxis.Not surprisingly, food allergies have been shown to limit social interactions and impair childrens quality of life due to the ubiquity of food where children live, learn, and play. To ensure the safety of our children, the development of sound policy, clinical practice, and health programs must be informed by current research characterizing childhood food allergy at the population level. To set the stage for understanding the current evidence base, this article reviews: 1) epidemiology of childhood food allergy; 2) severity of symptoms; 3) geographic distribution of childhood food allergy; 4) tolerance; 5) economic impact of childhood food allergy; and 6) future directions in childhood food allergy epidemiological research.

Epidemiology of childhood peanut allergy.

Although peanut allergy is among the most common food allergies, no study has comprehensively described the epidemiology of the condition among the general pediatric population. Our objective was to better characterize peanut allergy prevalence, diagnosis trends, and reaction history among affected children identified from a representative sample of United States households with children. A randomized, cross sectional survey was administered to parents from June 2009 to February 2010. Data from 38,480 parents were collected and analyzed in regard to demographics, allergic symptoms associated with food ingestion, and methods of food allergy diagnosis. Adjusted models were estimated to examine association of these characteristics with odds of peanut allergy. Of the 3218 children identified with food allergy, 754 (24.8%) were reported to have a peanut allergy. Peanut allergy was reported most often among 6- to 10-year-old children (25.5%), white children (47.7%), and children from households with an annual income of

Food Allergy Diagnosis and Management Practices Among Pediatricians

50,000-

The Development of a Clinical Decision Support System for the Management of Pediatric Food Allergy

99,999 (41.7%). Although peanut allergy was diagnosed by a physician in 76% of cases, significantly more peanut allergy reactions were severe as compared with reactions to other foods (53.7% versus 41.0%, p < 0.001). Parents were significantly less likely to report tolerance to peanut as compared with the odds of tolerance reported for other foods (odds ratio 0.7, 95% confidence interval: 0.5-0.9). Childhood peanut allergy, which represents nearly a quarter of all food allergy, presents more severe reactions and is least likely to be outgrown. Although it is diagnosed by a physician in nearly three-fourths of all cases, socioeconomic disparities in regard to diagnosis persist.

Parent report of food allergy management by pediatricians and allergists

Our goals were to (1) estimate the rates of parent-reported versus physician-diagnosed food allergy, (2) determine pediatrician adherence to national guidelines, and (3) obtain pediatricians’ perspectives on guideline nonadherence. A mixed method approach was used, including survey, chart review, and qualitative methods. Overall, 10.9% of parents reported having a child with food allergy and two thirds of these cases were detected by the pediatrician. Chart reviews revealed high rates of guideline adherence with respect to allergist referral (67.3%), but less consistent adherence regarding documentation of reaction history (38.8%), appropriate use of diagnostic tests (34.7%), prescription of epinephrine autoinjectors (44.9%), and counseling families in food allergy management (24.5%). Pediatricians suggested that poor adherence was due to lack of documentation, familiarity with guidelines, and clarity regarding the pediatrician’s role in managing food allergy. Findings emphasize the need to better establish the role of the pediatrician and to improve awareness and adherence to guidelines.

Leveraging Mobile Technology in a School-Based Participatory Asthma Intervention: Findings From the Student Media-Based Asthma Research Team (SMART) Study

Pediatricians are often first-line providers for children with food allergy. Food allergy management guidelines have been developed but are cumbersome and confusing, and significant variation exists in pediatricians’ management practices. We therefore consolidated the guidelines into 5 key steps for pediatricians caring for patients with food allergy and used rapid-cycle improvement methods to create a clinical decision support system to facilitate the management of food allergy in the primary care setting. This report details the development of the Food Allergy Support Tool (FAST), its pilot testing in 4 primary care pediatric practices, and our ongoing efforts to improve its utility and ease of use. Key themes identified during these processes include the importance of both initial and ongoing provider education as well as the limitations of a tool that must be actively initiated by providers.

Leaving the nest

Childhood food allergy is a serious and growing health problem affecting 8% of children in the United States. Patientphysician relationship, communication, and guideline-directed management are critical to keep children with food allergies safe. Management based on the National Institute of Allergy and Infectious Diseases guidelines involves making an accurate diagnosis, prescribing medications including epinephrine autoinjectors (EAs), explaining how and when to use medications, and counseling. With recent changes in guidelines, physician food allergy knowledge, beliefs, and practice style may play a role in patient care. The goal of this study was to describe the experiences of parents of food-allergic children with management by both pediatricians and allergists.

SMART (Student Media-based Asthma Research Team): Engaging Adolescents to Understand Asthma in Their Communities

Background: Asthma places a heavy burden on Chicagos schoolchildren, particularly in low-income, minority communities. Recently, our group developed a 10-week afterschool program, the Student Asthma Research Team (START), which successfully engaged high school youth in a Photovoice investigation of factors impacting their asthma at school and in their community. Purpose: The present Student Media-Based Asthma Research Team (SMART) intervention adapted START to target middle school students with asthma during the school day. The 13-week SMART intervention leverages recent trends in mobile technology and the power of participatory media to improve student asthma self-management and outcomes, while enhancing asthma knowledge and support at the school and community levels through a student-led participatory media-based campaign. Methods: To assess the effectiveness of SMART, pre/postintervention data were collected from student participants, their caregivers, and their classmates. Results: Pre/post assessments identified significant increases in participant asthma knowledge (z = − 2.83; P < .05), self-efficacy (z = 2.00; P < .05), control (z = 2.01; P < .05), lung function (z = − 3.41; P < .01), and empowerment (z = 2.00; P < .05). Participants also produced 4 educational videos. Through dissemination of these videos, peer (z = − 2.72; P < .01) and parental asthma knowledge (z = − 2.64; P < .05) increased. Parental asthma caregiver-related quality of life (z = 2.83; P < .01) also improved. Translation to Health Education Practice: Future health education work should consider leveraging ongoing advances in mobile technology and adopting a participatory media-based approach.

Acceptability of a modular, community-informed disaster risk reduction training programme in Delmas, Haiti

BACKGROUND The transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies. OBJECTIVE The study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. METHODS Key informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions. RESULTS The convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the students campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions-collectively called Spotlight-were developed. CONCLUSION The use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders-including pediatricians that care for adolescents-can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.