Claudia H. Lau

Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding.

OBJECTIVE: Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy. METHODS: This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)–endorsed, 3 national action plans endorsed by 6 states). Outcome measures: (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions). RESULTS: Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7–9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions. CONCLUSIONS: Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills.

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.

Prevalence and characteristics of adult-onset food allergy

Food allergy has been estimated to affect nearly 5% of adults and 8% of children, and to be increasing in prevalence. Our understanding of the prevalence and characteristics of food allergy, particularly to the major food allergens of peanut, tree nut, egg, milk, fish, shellfish, wheat, and soy, have been largely built from studies of food allergy in children and infants: however, less is known about food allergy in adults. Although it is common for childhood food allergies to milk, egg, soy, or wheat to be outgrown, those to fish or shellfish have been suggested to develop in adulthood and/or to persist. Indeed, in a previous large, random, telephone-based study focused specifically on seafood and fish allergy in the United States, 60% and 39% of these respective allergies were ascribed to developing in adulthood rather than during childhood. Here, our primary objective was to determine the prevalence of adult-onset food allergy, with secondary objectives of examining the characteristics of these patients further, including the assessment of additional common allergens. By using the Northwestern Medicine Enterprise Data Warehouse, medical records of patients who were seen by allergy physicians at the Northwestern University adult allergy clinics and who received a diagnosis of food allergy (based on

Factors associated with reported food allergy tolerance among US children

BACKGROUND Limited studies exist on predictors of food allergy tolerance. OBJECTIVE To describe factors associated with tolerance to 9 common food allergens based on caregiver report in a nationally representative survey. METHODS Data from children with current and outgrown food allergies were identified for analysis from a randomized, cross-sectional survey administered in US households with children from June 2009 through February 2010. Allergies were analyzed based on type of allergy, age at which allergies were outgrown, and reaction history. Adjusted models were formulated to examine the association of child and food allergy characteristics with odds of reporting an allergy as being outgrown. RESULTS Of 40,104 children surveyed, 1,245 cases of outgrown food allergy were identified. The frequency of tolerance in children with food allergy was 26.6% at a mean age of 5.4 years. Children with milk (41.1%), egg (40.2%), or soy (35.7%) allergy had significantly higher frequencies of tolerance, whereas children with shellfish (13.0%), tree nut (14.3%), and peanut (15.6%) allergies had significantly lower frequencies (P < .05). Factors significantly associated with a report of outgrowing an allergy included a mild to moderate reaction history, being allergic to only 1 food, eczema as the sole allergy symptom, and white compared with black race (P < .05). Probability of tolerance also was significantly higher at younger ages of first reaction and decreased for first reactions occurring later in life, irrespective of allergen, severity, or presentation (P < .05). CONCLUSION Multiple factors were associated with a report of outgrowing an allergy. Understanding factors associated with outgrowing an allergy can improve disease management and counseling.

Food Allergy Diagnosis and Management Practices Among Pediatricians

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.

Food Allergy Sensitization and Presentation in Siblings of Food Allergic Children

BACKGROUND Many parents of food allergic children have concerns about the development of food allergies in their other children. OBJECTIVE We sought to determine prevalence of food sensitization and clinical food allergy among siblings of food allergic children. METHODS Two thousand eight hundred and thirty-four children were enrolled in the Chicago Family Cohort Food Allergy study. One thousand one hundred and twenty children (ages 0-21 years) with a food allergy (defined by a reported reaction history and evidence of food-specific IgE or skin prick test) and at least 1 biological sibling were included in this study. RESULTS Among siblings of children with food allergy, 33.4% had no sensitization and no clinical symptoms to food. Fifty-three percent had a positive food serum-specific IgE or skin prick test, but no reported symptoms of food allergy. Only 13.6% of siblings were both sensitized and clinically reactive to the same food. Milk allergy was the most common allergy among siblings (5.9%), followed by egg allergy (4.4%) and peanut allergy (3.7%). CONCLUSIONS In a large cohort of food allergic families, only a small proportion of siblings were both sensitized and clinically reactive to a food. Sensitization without reactivity was common among siblings. Testing for food allergy in siblings without a history of clinical reactivity appears to be unjustified. Screening may lead to negative consequences related to potential misdiagnosis and unnecessary avoidance of a food. More data are needed to determine the absolute risk of food allergy development in siblings of food allergic children.

Perceived Factors Affecting Asthma Among Adolescents: Experiences and Findings From the Student Asthma Research Team Pilot Study

Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year...

Parent report of childhood shellfish allergy in the United States

Although shellfish allergy frequently results in emergency department visits, national prevalence studies focusing on shellfish allergy in children are scarce. This study describes parent reports of shellfish allergy among children in the United States. Data from shellfish-allergic children were identified for analysis from a randomized, cross-sectional survey administered in US households with children from June 2009 to February 2010. Child characteristics, parent-reported prevalence, severity, symptoms, diagnostic methods, and reaction history were analyzed as weighted proportions. Adjusted models were estimated to examine the association of child characteristics, reaction history, and diagnosis methods with odds of shellfish allergy and severe shellfish allergy. Among the 38,480 children included in this study, 499 were reported to have a shellfish allergy, corresponding to a prevalence of 1.3%. The mean age for first reaction to shellfish allergy was 5.8 years. Nearly one-half of all children with shellfish allergy had a history of severe life-threatening reactions (47.1%). Shellfish allergy was diagnosed by a physician at a rate of 58.5% (35.0% confirmed with testing), significantly lower than the rate of diagnosis for other common childhood food allergies (72.7%). Children with a shellfish allergy had lower odds (odds ratio, 0.39; 95% CI, 0.28-0.54) of developing tolerance compared with children with other common food allergies. Childhood shellfish allergy is a serious and underdiagnosed problem in the United States. Findings suggest that the impact of disease may be greater than previously reported. Accordingly, efforts are needed to improve awareness and management of shellfish allergy among children in the United States.

A brief intervention to improve food allergy knowledge among US pediatricians: lessons learned

Objective:  To evaluate a brief educational tool for pediatricians developed to address known gaps in food allergy knowledge.

The Pediatrician’s Role in the Diagnosis and Management of Food Allergy

CME EDUCATIONAL OBJECTIVES 1. Recognize the signs and symptoms of food allergy versus food intolerance. 2. Review currently available diagnostic testing modalities for food allergy and their applicability in the pediatric outpatient setting. 3. Review appropriate management practices for pediatricians, including prescription of medications, counseling of families, and referrals to keep children safe. Food allergy is a rapidly increasing and potentially life-threatening health concern in the United States. Given the ubiquity of food in our society and the absence of a cure, it is crucial that families receive proper guidance and medication to keep children safe. The pediatrician plays a key role to this end as he or she is often the first, and sometimes the only physician, these children can access. Accordingly, pediatricians must be equipped to recognize, manage, and evaluate food allergies over time while preventing unnecessary avoidance. This review provides practical translation of guidelines into recommended practices that are most pertinent to pediatricians.