Frederick E. Leickly

Implementation of Evidence Based Guidelines for Paediatric Asthma Management in a Teaching Hospital

Massie J, Efron D, Cerritelli B, et al. Arch Dis Child . 2004;89:660–664 To evaluate a systemic and coordinated approach to the development and implementation of evidence-based asthma guidelines for a pediatric hospital. This was a comparative study conducted at the Royal Children’s Hospital in Melbourne, Australia. There were 3 cohorts of children evaluated between the ages of 2 and 18 years who presented with acute asthma to the emergency department. Cohort 1 presented before the development of asthma guidelines, cohort 2 was recruited to assess the effectiveness of guideline implementation, and cohort 3 was …

Peanut Allergy: An Epidemiologic Analysis of a Large Database

Objective To confirm new observations on peanut allergy and answer current concerns that families and healthcare providers have about peanut allergy. Study design Children who presented with a story of peanut allergy or peanut sensitization were asked to participate in a registry, which allowed an analysis focused on questions that a food allergy support group had about children with peanut allergy or sensitization. Results A total of 1070 children were entered into the registry over 5 years. Two‐thirds had a reaction to peanut. Children with peanut allergy were predominantly male (63%), white (78%), and with private health insurance (80%). Most reactions involved the skin (55%) and anaphylaxis occurred in 35%. The median age of a reaction was 1 year old. Atopic dermatitis was noted in 60% and asthma in 41%. Additional food allergy was noted in 58%. When second exposures occurred 28% had a more severe reaction. Skin test size did not differentiate the type of a reaction and children with anaphylaxis had slightly higher specific IgE levels. Severe reactions with inadvertent exposure in children who were peanut sensitized was rare (<1%). Conclusions The strategies for peanut allergy prevention and treatment have evolved. The data obtained in this large registry can answer many questions that families and healthcare providers have during this transition.

ORAL FOOD CHALLENGE FAILURES AMONG FOODS RESTRICTED DUE TO ATOPIC DERMATITIS

BACKGROUND Recent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy test results, may lead to immediate allergic reactions on reintroduction of that food. OBJECTIVE To examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the 5 major food allergens in the United States. METHODS OFCs to egg, milk, peanut, soy, and wheat, performed from 2008 to 2014, at a childrens hospitals allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within 2 hours); sensitization only (lack of introduction because of positive test results); and removal because of test results during AD evaluation. RESULTS There were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320 of 442 [72.4%]), food sensitization without any introduction (77 of 442 [17.4%]), and AD (45 of 442 [10.2%]). OFC failures among those who had food allergy (70 of 320 [21.9%]), sensitization only (13 of 77 [16.9%]), and suspected AD trigger (6 of 45 [13.3%]) did not significantly differ (P = .63). Wheat was more likely to be avoided than the other 4 foods for AD concerns (P < .001). CONCLUSION The frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.

Persistence of Asthma Symptoms During Adolescence: Role of Obesity and Age at the Onset of Puberty

Guerra S, Wright AL, Morgan WJ, Sherrill DL, Holberg CJ, Martinez FD. Am J Respir Crit Care Med . 2004;170:78–85 To evaluate factors the may influence the persistence or remission of childhood asthma after the onset of puberty. A subset of the birth cohort ( n = 1246) enrolled in the Tucson Children’s Respiratory Study between 1980 and 1984. The population underwent a series of evaluations and questionnaires at years 2, 3, 6, 8, 11, 13, and 16. Questions regarding the onset of puberty appeared at years 13 and 16. Questions were also asked about the presence and frequency of wheezing. Onset of puberty was defined by parental report of early signs; asthma was defined …

FLUTICASONE PROPIONATE IN ASTHMA: A LONG-TERM, DOSE-COMPARISON STUDY

Verona E, Petrov D, Cserhati E, et al. Arch Dis Child. 2003;88:503–509 To compare the efficacy and tolerability of 2 doses of fluticasone propionate (FP), 100 μg and 200 μg, administered twice daily, among children with moderate/severe asthma. This was in effect a dose-response study of FP among children. A total of 528 children, 4 to 11 years of age, who had at least a 6-month history of asthma and required high doses of inhaled corticosteroids (ICSs) were eligible for the study. These children had received budesonide, beclomethasone dipropionate, triamcinolone acetonide, or flunisolide (800–1600 μg/day), FP (400–600 μg/day), or orally administered corticosteroids (≤5 mg/day) for at least 4 weeks before enrollment. Participants in the study were also required to have experienced at least 1 …