Jodi Shroba

A large outbreak of Trichophyton tonsurans among health care workers in a pediatric hospital

BACKGROUND Although Trichophyton tonsurans remains a major cause of dermataophytoses in US children, nosocomial spread may go unrecognized in health care settings. We describe a staff outbreak of T tonsurans infection among health care workers in a freestanding pediatric hospital. METHODS Epidemiologic evaluation (retrospective and prospective) was performed in the health care providers and ancillary staff assigned to a 27-bed inpatient medical unit in which the suspected outbreak occurred. RESULTS Twenty-one individuals, including staff, a hospital volunteer, and a patient, developed tinea corporis during a 5-month period. All infections coincided with multiple admissions of a 2-year-old suspected index patient who demonstrated persistent infections of the scalp and arm. Fungal isolates obtained from the index patient and affected staff (when available) were subjected to multilocus strain typing, which revealed an identical genetic match between the index case and infected hospital personnel. CONCLUSION T tonsurans can spread widely among staff members caring for children with recalcitrant dermatophyte infections. Recognition that workplace transmission may be the etiology of a succession of infections occurring in a single inpatient unit is necessary to limit the number of infected individuals.

Current treatment options for idiopathic angioedema.

BACKGROUND Idiopathic angioedema is defined as localized swelling of the cutaneous and mucosal tissue that occurs in episodes without a clear etiology. It can be problematic to treat when the underlying pathophysiology is not well understood. OBJECTIVE To identify successful treatments of idiopathic angioedema reported in the literature. METHODS A literature search was performed using PubMed. Published case reports and articles discussing treatment of idiopathic angioedema were used in the formulation of this review. In addition, 2 case reports are provided. RESULTS Although there are no approved treatments for idiopathic angioedema, several medications used for the treatment of hereditary angioedema, such as bradykinin receptor antagonists (icatibant), kallikrein inhibitors (ecallantide), and C1 inhibitors, were successful in 10 patients. Anti-IgE monoclonal antibody (omalizumab) proved successful in 5 patients. The most widely used and successful medication was tranexamic acid (154 patients). CONCLUSION Despite an unknown etiology, this article highlights viable treatment options for idiopathic angioedema. More clinical trials and better markers identifying the cause of angioedema are needed.

The transforming power of proximity food challenges

In recent years, food allergy has become a problem that affects the physical health and emotional well-being of individuals and their families. As many as 15 million people in the United States have food allergies, with nearly 6 million of them being children.1 Both medical and lay publications (www.foodallergy.org) reiterate the prevalence and effect of food allergy and attempt to educate practitioners and patients on appropriate management.2,3 Patients and families are informed that every 3 minutes a food allergy reaction sends someone to the emergency department and every 6 minutes the reaction is anaphylactic.1 They learn that more than 15% of school aged children with food allergies have a reaction at school,4 that almost half of fatal food allergy reactions are triggered by food consumed outside the home,5 and that, of the food allergens, peanuts are most commonly associated with severe allergic reactions.6 They are educated that failure to promptly treat food anaphylaxis with epinephrine is a risk factor for fatalities.2,5 Although it is essential for patients and families to be aware of the possibility of anaphylaxis occurring in any setting, misinformation regarding the triggers of anaphylaxis is widespread. These myths force patients and families to live in a perpetual state of alarm, causing significant disruption in their daily activities. Often, patients, especially younger children, become psychologically conditioned to a degree of avoidance that may be unnecessary given their true sensitivity. Families with food allergies already

Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance

BACKGROUND Approximately 1% of the U.S. population has a peanut allergy. Previous studies that measured peanut protein in house dust support the hypothesis that household peanut consumption may lead to clinical sensitization through transdermal exposure. OBJECTIVE The aim of this pilot study was to characterize Ara h2 levels in house dust from homes with and without individuals with peanut allergy. METHODS Household dust was obtained from homes with an individual with peanut allergy and from homes with no individual with peanut allergy. Ara h2 levels were determined by using a monoclonal antibody-based immunoassay with a level of determination of 150 ng per gram of dust. Peanut consumption information was obtained by questionnaire. RESULTS A total of 85 dust samples were collected: 38 from homes with a individual with peanut allergy and 47 from control homes. The median Ara h2 level in homes with an individual with peanut allergy was 1236 ng/g (interquartile range [IQR], 256-1342 ng/g), whereas the median Ara h2 level in homes without an individual with peanut allergy was 650 ng/g (IQR, 163-2201 ng/g). Ara h2 levels in dust from homes of individuals with peanut allergy were not significantly lower than in dust from control homes. Of the homes with an individual with peanut allergy, 15 reported complete avoidance of peanut in the home (39%). Ara h2 levels in homes that completely avoided peanuts were not significantly lower than Ara h2 levels in homes that did not restrict peanuts (p = 0.531). CONCLUSION Although families may restrict peanuts and peanut products in the home, there was still detectable Ara h2 levels found in homes. Each subjects definition of restriction may vary, there seemed to be peanut protein entering the home, although the protein origin is not known. Possibilities include cross-reactivity with another antigen or transport into the home on some vector. Further investigation of hypotheses regarding cross-reactivity and environmental exposure to Ara h2 is necessary.