Harvey L. Leo

Section on allergy and immunology

Founded in 1948, the Section on Allergy and Immunology is dedicated to ensuring that children receive the highest quality of allergy and immunology care. To accomplish its mission, the Section provides a number of educational, training, and research programs and continually advocates for improved allergy and immunology care and services. The Section sponsors educational programs for both pediatric generalists and subspecialists at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE) each fall and at the American Academy of Allergy Asthma & Immunology annual meeting each spring. The Section’s other educational endeavors include this annual “Best Articles Relevant to Pediatric Allergy and Immunology” supplement to Pediatrics, Visiting Professor Program, Pediatric Asthma Speaker’s Kit, online continuing medical education course on “asthma gadgets,” electronic quality improvement in practice program on asthma diagnosis and management (Education in Quality Improvement for Pediatric Practice [eQIPP], which meets the American Board of Pediatrics maintenance-ofcertification criteria), school nurse allergy tool kit, and a number of public education materials. The Section is also active in contributing to educational programs and resources such as AAP News, educational brochures, clinical reports, and many other endeavors. To support training and promote research in pediatric allergy and immunology, the Section awards travel grants to residents and training fellows to participate and present cases at the AAP NCE and provides outstanding abstract awards for training fellows and junior faculty for presentation at the American Academy of Allergy Asthma & Immunology annual meeting. In close collaboration with other subspecialty societies, the Section is actively involved with initiatives to improve subspecialty education such as the American Board of Allergy and Immunology maintenance-of-certification requirements. Section members represent the AAP in national and government conferences and provide input on federal legislation on behalf of the AAP. For more information on all AAP allergy and immunology resources and initiatives, visit www.aap.org/sections/allergy. The reviews contained in the 2011 synopsis were written by Fellows of the AAP Section on Allergy and Immunology and fellows in allergy and immunology training programs who contributed reviews with their mentors. The editor selected the journals to be reviewed on the basis of the likelihood that they would contain articles on allergy and immunology that would be of value and interest to the pediatrician. Each journal was assigned to a voluntary reviewer who was responsible for selecting articles and writing reviews of their articles. Only articles of original research were selected for review. Final selection of the articles to be included was made by the editor. The 2010–2011 journals chosen for review were Allergy, American Journal of Asthma & Allergy for Pediatricians, Archives of Pediatric and Adolescent Medicine, American Journal of Medicine, American Journal of Respiratory and Critical Care Medicine, Annals of Allergy, Asthma, and Immunology, Annals of Internal Medicine, Archives of Disease in Childhood, Archives of Internal Medicine, Blood, British Journal of Dermatology, British Medical Journal, Chest, Clinical and Experimental Allergy, Clinical Pharmacology and Therapeutics, Critical Care Medicine, European Journal of Pediatrics, European Respiratory Journal, Immunology, Journal of Allergy and Clinical Immunology, Journal of the American Academy of Dermatology, Journal of the American Medical Association, Journal of Applied Physiology, Journal of Experimental Medicine, Journal of Immunology, Journal of Infectious Diseases, Journal of Pediatric Gastroenterology and Nutrition, Journal of Pediatrics, Journal of Pharmacology and Experimental Therapeutics, Lancet, Nature, New England Journal of Medicine, Pediatrics, Medicine, Pediatric Allergy and Immunology, Pediatric Asthma, Allergy & Immunology, Pediatric Dermatology, Pediatric Infectious Disease Journal, and Science. The editor and the Section on Allergy and Immunology gratefully acknowledge the work of the reviewers and their trainees who assisted. The reviewers were Stuart L. Abramson, MD, PhD, Sugar Land, TX; James R. Banks, MD, Arnold, MD; Theresa A. Bingemann, MD, Rochester,

Peanut-allergic subjects and their peanut-tolerant siblings have large differences in peanut-specific IgG that are independent of HLA class II.

We enrolled 53 peanut-allergic subjects and 64 peanut-tolerant full siblings, measured peanut-specific IgG and IgE, determined HLA class II at high resolution, and analyzed DRB1 alleles by supertypes. Peanut-specific IgG and IgE were elevated in the peanut-allergic subjects (p<0.0001) but did not stratify with HLA alleles, haplotypes, or supertypes. There were no significant differences in HLA class II between the peanut-allergic and peanut-tolerant siblings but there was an increased frequency of DRB1*0803 in both sets of siblings compared to unrelated controls (p(c)=4.5×10⁻⁹). Furthermore, we identified 14 sibling pairs in which the peanut-allergic and the peanut-tolerant siblings have identical HLA class II and again found an elevation of anti-peanut IgG in the peanut-allergic subjects (p<0.0001). In conclusion, although DRB1*0803 may identify a subset of families with increased risk of peanut allergy, differences in peanut-specific immunoglobulin production between peanut-allergic subjects and their peanut-tolerant siblings are independent of HLA class II.

Outcomes Associated With Spirometry for Pediatric Asthma in a Managed Care Organization

BACKGROUND. The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing “at least every 1 to 2 years to assess the maintenance of airway function.” OBJECTIVE. The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma. METHODS. We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003). We included all of the continuously enrolled patients with active asthma between 7 and 21 years of age. Our outcomes of interest were the presence of ≥1 claim for spirometry testing (Common Procedural Terminology 94010–6, 94060, 94070, or 94150) and the time to emergency department visit. We used multivariate logistic regression to determine factors associated with receipt of spirometry and survival analyses techniques to assess the association between receipt of spirometry with the likelihood of an emergency department asthma visit in the next year, controlling for patient age, gender, severity of illness, and type of insurance. RESULTS. There were 2688 eligible children of whom 1509 (56%) were male, 324 (12%) had Medicaid insurance, and 624 (24%) had persistent asthma in the initial year. Of the 2688 children, only 612 (23%) had ≥1 claim for spirometry testing during the study period. In all of the multivariate logistic analysis models, increased severity of illness was consistently associated with increased likelihood of receiving spirometry testing. Compared with patients without Medicaid insurance, children with Medicaid insurance were consistently less likely to receive spirometry testing. After adjusting for age, gender, severity, and insurance type, receipt of spirometry did not affect the likelihood of future emergency department asthma use. CONCLUSIONS. Children with Medicaid insurance are less likely to receive spirometry testing. Reasons may be because of access to care, inadequate provider referral for testing, or patient preferences. Objective lung function tests, such as spirometry, are a potentially important component of monitoring chronic disease status. However, it is not clear whether spirometry testing by itself, completed every 1 to 2 years, helps prevent the likelihood of emergency department asthma visits. Compared with guideline recommendations, spirometry is underused; however, additional work is needed to understand how to best integrate such testing to improve asthma outcomes.

Asthma outcomes in children and adolescents with multiple morbidities: Findings from the National Health Interview Survey.

BACKGROUND More Americans are managing multiple chronic conditions (MCCs), and trends are particularly alarming in youth. OBJECTIVE The purpose of this study was to examine the prevalence and distribution of 9 chronic conditions in children and adolescents with and without asthma, and adverse asthma outcomes associated with having MCCs. METHODS Cross-sectional interview data from the National Health Interview Survey were analyzed (N = 66,790) between 2007 and 2012 in youth 0 to 17 years of age. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. RESULTS Five percent of children with asthma had 1 or more coexisting health conditions. The prevalence of 1 or more comorbidities was greater among those with asthma than those without (5.07% [95% CI: 4.5-5.6] vs. 2.73% [95% CI: 2.6-2.9]). Those with asthma were twice as likely to have co-occurring hypertension (prevalence ratio [PR] = 2.2 [95% CI: 1.5-3.2]) and arthritis (PR = 2.7 [95% CI: 1.8-4.0]) compared with those without asthma. Every additional chronic condition with asthma was associated with a greater likelihood of an asthma attack (PR = 1.1 [95% CI: 1.0-1.2]), all-cause emergency department visits (PR = 1.3 [95% CI: 1.1-1.5]), and missed school days (PR = 2.3 [95% CI: 1.7-3.2]). CONCLUSIONS Children and adolescents with asthma in the US who suffer from MCCs have increased asthma symptoms, missed school days, and all-cause emergency department visits. Further research on optimal management strategies for this group is needed.

A Developmental, Community, and Psychosocial Approach to Food Allergies in Children

Recent estimates show that food allergies affect a substantial proportion of children in the United States and appear to have increased in prevalence. At present, management of food allergies consists of strict avoidance of the responsible allergen and an appropriate response should a reaction occur. Creating safe environments for the growing number of children with food allergies requires a partnership between affected families and members of the caregiving and educational communities. This article reviews issues affecting children with food allergies at different stages of psychosocial development and discusses strategies that can be implemented to promote food safety within child care and school environments as well as in the community. It also presents an overview of policy developments at the state and national level that have implications for children with food allergies.

The Extent and Patterns of Multiple Chronic Conditions in Low-Income Children

Background and objectives. Little is known about the magnitude of multiple chronic conditions (MCC) in children. This study describes the prevalence of and patterns of comorbidities in children receiving Medicaid assistance. Methods. Diagnoses from 5 years of Medicaid claims data were reviewed and identified 128 044 children with chronic conditions. The relationship between comorbidities and significant urgent health care events was analyzed using logistic regression modeling. Results. More than 15 000 children (12%) had claims for more than 1 condition. The most frequent combination was asthma and allergic rhinitis. Significant health care events ranged from 18% to 51% in children, and the odds of having a significant event increased with each additional condition. Those with ≥4 conditions had 4.5 times the odds of a significant event compared with those with 1 condition (P < .0001). Conclusion. MCC are prevalent in low-income children and are associated with greater risk for urgent health care use.

The relationship of season of birth to asthma and allergy in urban African American children from 10 to 13 years of age.

Objectives. To assess the relationship between season of birth and presence of asthma and allergy in preteen, low-income, African American children. Methods. The study consisted of a self-administered survey followed by telephone interviews of parents of children attending 19 middle schools in Detroit, Michigan. Out of 4194 children, 1292 were identified with asthma and 962 parents of these children provided informed consent and took part in telephone interviews. Results. No statistically significant relationships were observed between season of birth and diagnosis of asthma (p > .05) or with diagnosis adjusting for income, age, gender, parent’s education, or parent being a smoker (p > .05). No statistically significant association was evident between season of birth and presence of allergy (p > .05) or with allergy adjusting for the above variables (p > .05). Conclusions. Identifying children vulnerable to problems with asthma and allergy, especially in populations exhibiting high prevalence of the conditions and significant disparities in outcomes, requires use of all possible means. Season of birth does not appear to be a useful indicator in identification of such children. The findings from this study do not support the proposition that season of birth, associated with early exposure to viruses as evident in the winter and to seasonal allergens, contributes to more asthma and/or allergy.

Addressing Food Allergy Issues Within Child Care Centers

The prevalence of food allergies in the pediatric population has risen significantly in the past decade. School districts and advocacy groups have made progress in developing systematic approaches to address pediatric food allergies; however, the widespread variance in child care settings, organization, and staff training still presents unique challenges. Addressing these obstacles requires multiple approaches to policy and guideline formulation and dissemination. This review discusses current issues in food allergy prevention and education in child care settings and offers potential solutions.

The economic effect of the hydrofluoroalkane albuterol transition on children with asthma

inflammation and mucus secretion. This remains speculative, however, because the relationship between the duration of asthma and the pathological features of airways remains unknown. In conclusion, patients with asthma who have long-standing disease and lack a smoking history are less likely to produce induced sputum successfully. The characteristics of patients should be considered when analyzing the results of induced sputum studies, because potential selection bias may preclude the extrapolation of such results to patients with asthma in general. Hirofumi Matsuoka, MD Akio Niimi, MD, PhD Hisako Matsumoto, MD, PhD Tetsuya Ueda, MD, PhD Masaya Takemura, MD, PhD Masafumi Yamaguchi, MD Makiko Jinnai, MD Liang Chang, MD Kojiro Otsuka, MD Tsuyoshi Oguma, MD Tomoshi Takeda, MD Kazuo Chin, MD, PhD Michiaki Mishima, MD, PhD

Cat, Dog and House Dust Mite Allergen Levels on Children’s Soft Toys

FF Wu, MW Wu, MH Ting, J Crane, R Siebers. J Asthma. 2014;51(1):75–78 Childrens soft toys are known to harbor house dust mite (HDM) allergens, but little is known about whether they harbor cat or dog allergens. The objective of the study was to measure cat (Fel d 1), dog (Can f 1), and HDM allergens on childrens soft toys. Children’s soft toys and mattresses were analyzed. Dust was collected from 40 childrens soft toys and their mattresses, and data were gathered on pet ownership. Dust samples were analyzed for Fel d …