Melinda M. Rathkopf

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,

Passive Smoking Impairs Histone Deacetylase-2 in Children With Severe Asthma

Y Kobayashi, C Bossley, A Gupta. Chest. 2014;145(2):305–312 The oxidative stress from tobacco smoke impairs histone deacetylase–2 (HDAC2) via phosphorylation of phosphoinositide-3-kinase (PI3K)/Akt activation, leading to corticosteroid insensitivity. This study tested the hypothesis that passive exposure to tobacco smoke is associated with reduced HDAC2 in alveolar macrophages in children with severe, refractory asthma. The study population included children aged 8.5 to 13.5 years with severe asthma, already receiving inhaled corticosteroids plus a long-acting β-agonist. Bronchoalveolar lavage fluid was obtained from …

Has Asthma Medication Use Caught Up With the Evidence?: A 12-Year Population-Based Study of Trends

M Sadatsafavi, H Tavakoli, L Lynd, JM FitzGerald. Chest. 2017;151(3):612–618 Both national and international guidelines on the treatment of asthma emphasize the use of controller medications in persistent asthma and discuss the role of controller versus rescue medications. This study looked at 12 years of data to study the extent and trends of inappropriate or excessive use of SABAs. The study used a health database in British Columbia (population 4.67 million). They created a cohort of patients with asthma, aged 15–55 years. Asthma was defined as meeting at least 1 of 3 criteria over 12 months: (1) use of 3 asthma-related …

Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report

AB Chang, JJ Oppenheimer, MM Weinberger. Chest. 2017;151(4):875–883 Use of cough algorithms or pathways can potentially lead to earlier diagnosis and reduce morbidity, unnecessary costs, and medication use associated with chronic cough. The 2006 CHEST guidelines on chronic cough in children advocated use of a cough pathway based on limited data, and research in chronic cough has progressed in the past decade. This study looked at 10 years of systematic reviews to present the summary of evidence behind these CHEST recommendations. The age cutoff for the CHEST cough guidelines is ≤14 years. Chronic cough is defined as the presence …

Budesonide Nebulization Added to Systemic Prednisolone in the Treatment of Acute Asthma in Children: A Double-Blind, Randomized, Controlled Trial

AA Alangari, N Malhis, M Mubasher. Chest. 2014;145(4):772–778 The goal of the study was to test the hypothesis that adding high-dose nebulized budesonide to standard asthma treatment in children in the emergency department (ED) during the first hour would decrease their hospital admission rate. The study population included children aged 2 to 12 years with physician-diagnosed asthma (or previous episodes of shortness of breath responsive to a β-agonist) who presented to the ED with a moderate or severe acute asthma exacerbation. Children were randomized within …

Disagreement Among Common Measures of Asthma Control in Children

RJ Green, M Klein, P Becker. Chest. 2013;143(1):117–122 The primary goal of asthma management is control. This can be assessed by history, physical examination, and measurement of lung function. There are multiple methods to measure control. The purpose of this study was to describe agreement among different measures of asthma control in children. Atopic children ages 4 to 11 with chronic asthma attending routine follow-up examinations. Asthma was defined as chronic cough or wheezing responsive to bronchodilator. Atopy was defined as a positive skin prick …

Risk Factors and Predictive Clinical Scores for Asthma Exacerbation in Childhood

METHODS. Severe asthma exacerbation, defined as any hospitalization, urgent visit, or systemic steroid course for asthma in the previous year, was the primary outcome. A scoring questionnaire was developed and verified in the initial cohort. On the basis of their clinical score, children were categorized into 1 of 3 groups: low risk (score 5); average risk (score 6–8); and high risk (score 9). Effectiveness of the scoring system was then evaluated in the Costa Rican validation set and in the CAMP cohort.

Changes in Environmental Tobacco Smoke Exposure and Asthma Morbidity Among Urban School Children

Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Chest . 2009;135(4):911–916 PURPOSE OF THE STUDY. Using data from a large randomized trial of supervised asthma therapy in urban elementary schools, the authors of this study sought to document the relationship between changes in environmental tobacco smoke (ETS) exposure and childhood asthma morbidity. STUDY POPULATION. There were 290 children with physician-diagnosed persistent asthma that required daily controller medication who were enrolled in 1 of 36 participating schools. METHODS. By …

β2-Adrenergic Receptor Polymorphisms Affect Response to Treatment in Children With Severe Asthma Exacerbations

Carroll CL, Stoltz P, Schramm CM, Zucker AR. Chest . 2009;135(5):1186–1192 PURPOSE OF THE STUDY. The purpose of this study was to explore the hypothesis that genotypic differences of the β2-adrenergic receptor (β2-AR) affect patient responses to short-term β2-AR agonist treatment for children who experience severe exacerbations of asthma. STUDY POPULATION. Children between 2 and 18 years of age with physician-diagnosed asthma admitted to the ICU at a Connecticut medical center during a 4-year period ( N = 37). METHODS. A modified pulmonary index …

Evaluation of Chronic Cough in Children

Asilsoy S, Bayram E, Agin H, et al. Chest . 2008;134(6):1122–1128 PURPOSE OF THE STUDY. To evaluate chronic cough in children in accordance with the 2006 American College of Chest Physicians (ACCP) guidelines. STUDY POPULATION. The study included 108 children between 6 and 14 years of age who presented with a cough lasting >4 weeks. METHODS. Using the algorithm suggested by the ACCP guidelines for chronic cough in children, a detailed history was obtained and a physical examination …