Margaret Redmond

Food allergy prevalence and management at an overnight summer camp.

BACKGROUND In recent years, increased awareness of food allergy management has focused on the school setting. A lack of awareness and relevant literature prompted evaluation of the camp experience. OBJECTIVE To characterize the prevalence of food allergies among children attending an overnight summer camp and to evaluate the knowledge and comfort of camp personnel before and after a training session. METHODS The database for the 2014 season at Flying Horse Farms was reviewed for information pertaining to food allergies and provision of epinephrine and treatment plans. Camp personnel completed surveys regarding food allergy knowledge and comfort. Surveys were redistributed 30 days after the training session. RESULTS Among 445 campers, 15% reported at least one food allergy, with 8.5% reporting allergy to 1 of the top 8 food allergens. Only 32% of campers with food allergy supplied an epinephrine autoinjector, and 0% provided written treatment plans. Before training, 84% of personnel desired additional information about food allergies. Knowledge of food allergies among personnel was high at baseline but increased after training in regard to epinephrine use for anaphylaxis and postepinephrine management. Staffers who reported feeling very comfortable caring for campers with food allergy increased from 16% to 46% after the training session; comfort in treating a food allergy emergency increased from 2% to 29%. CONCLUSION Management of food allergies at overnight summer camps warrants similar education and preparation strategies as those implemented in schools. Camp personnel should receive annual training regarding food allergies and anaphylaxis.

A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma

ABSTRACT Objective: Since the Affordable Care Acts implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining childrens missed asthma management primary care (PC) appointments and subsequent ED visits. Methods: Longitudinal, retrospective review at a childrens hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2–18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. Results: None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children. Conclusions: The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.

Anaphylaxis knowledge in camp personnel

Food allergies are estimated to affect 5% to 8% of children and have increased in prevalence from 1997 to 2011. Effective food allergy management requires careful avoidance of food allergens, verbal or written communication with food handlers and caregivers, and rapid access to an epinephrine autoinjector in case of anaphylaxis. Efforts have been made to change policies in schools to make these environments safer for children with food allergies, but established guidelines for summer camps are lacking. A study using a camp electronic health record identified 2.5% of campers with food allergy, but the prevalence across the United States among children attending camp is unknown. The primary aim of our study was to assess the knowledge and comfort level of camp personnel regarding food allergies and anaphylaxis. The education and management recommendations provided by the 2014 Center for Disease Control (CDC) voluntary guidelines provided the framework for this assessment. In May 2016, surveys were developed for camp directors (CD), medical personnel (MP), and camp staff (CS). CD and MP were identified from online directories and private list-serves. CS were invited to participate through their CD because a database of CS does not exist. Participants were invited via e-mail to complete an electronic survey (SurveyGizmo Inc., Boulder, Colo). Survey questions were developed by the authors. A portion of the survey was adapted from a similar study involving school staff. Other questions were based on clinical guidelines including the CDC 2014 voluntary guidelines for schools. Participation in the survey was voluntary and anonymous. The

Pediatric Allergic Rhinitis: the Stepwise Treatment Approach

Opinion StatementTreatment of allergic rhinitis in children requires a thoughtful, stepwise approach. Before considering medication for rhinitis, possibly chronic medication, you must (1) confirm disease based on symptoms or testing for offending allergens, (2) implement environmental controls when possible, (3) understand how allergy medication will affect children, and (4) recognize the need to use the minimum amount of medicine necessary to treat symptoms. Special attention to the impact of medication on school performance and social interactions is important when treating children. For intermittent symptoms, an oral antihistamine should be tried first. Chronic symptoms will respond best to a topical nasal steroid spray. Spending the time to figure out what most troubles the child will focus therapy (such as an antihistamine eye drop when ocular itching is a primary symptom) and prevent use of unnecessary medication. Moving past medication to immunotherapy is an important next step as we look for ways to change the natural course of atopic disease. There are now multiple approved forms of immunotherapy in the USA; this should allow a tailored approach to treating symptoms that have progressed beyond pharmacologic therapy. These layers of therapy, environmental control, pharmacologic management focused on bothersome symptoms, and immunotherapy, naturally allow for escalation of treatment with increasing symptoms. Working with the parents is imperative to fully understand the impact symptoms are having on the child and to achieve compliance with medications. This combined, stepwise approach will lead to good relief for the child and satisfaction among both parents and treating physician.