William K. Dolen

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,

Loss of B Cells in Patients with Heterozygous Mutations in IKAROS.

BACKGROUNDnCommon variable immunodeficiency (CVID) is characterized by late-onset hypogammaglobulinemia in the absence of predisposing factors. The genetic cause is unknown in the majority of cases, and less than 10% of patients have a family history of the disease. Most patients have normal numbers of B cells but lack plasma cells.nnnMETHODSnWe used whole-exome sequencing and array-based comparative genomic hybridization to evaluate a subset of patients with CVID and low B-cell numbers. Mutant proteins were analyzed for DNA binding with the use of an electrophoretic mobility-shift assay (EMSA) and confocal microscopy. Flow cytometry was used to analyze peripheral-blood lymphocytes and bone marrow aspirates.nnnRESULTSnSix different heterozygous mutations in IKZF1, the gene encoding the transcription factor IKAROS, were identified in 29 persons from six families. In two families, the mutation was a de novo event in the proband. All the mutations, four amino acid substitutions, an intragenic deletion, and a 4.7-Mb multigene deletion involved the DNA-binding domain of IKAROS. The proteins bearing missense mutations failed to bind target DNA sequences on EMSA and confocal microscopy; however, they did not inhibit the binding of wild-type IKAROS. Studies in family members showed progressive loss of B cells and serum immunoglobulins. Bone marrow aspirates in two patients had markedly decreased early B-cell precursors, but plasma cells were present. Acute lymphoblastic leukemia developed in 2 of the 29 patients.nnnCONCLUSIONSnHeterozygous mutations in the transcription factor IKAROS caused an autosomal dominant form of CVID that is associated with a striking decrease in B-cell numbers. (Funded by the National Institutes of Health and others.).

Pacifier Cleaning Practices and Risk of Allergy Development

B Hesselmar, F Sjoberg, R Saalman, N Aberg, I Adlerberth, AE Wold. Pediatrics . 2013;131(6). Available at: www.pediatrics.org/cgi/content/full/131/6/e1829nnThe study examined the effect of how parents clean their infant’s pacifier on the risk of developing eczema, asthma, or allergic sensitization.nnSubjects were from a cohort of 187 term infants recruited into the AllergyFlora study in Gothenburg, Sweden. Mainly, families with at least 1 parent with allergic disease were approached. A total of 184 children were followed up until 18 months of age, and 174 were followed up to 36 months of age. Fourteen percent were delivered by cesarean delivery, 80% had at least 1 parent with a history of allergic disease, and 74% used a pacifier in the first year …

Adverse Drug Event–Related Emergency Department Visits Associated With Complex Chronic Conditions

JA Feinstein, C Feudtner, A Kempe. Pediatrics. 2014;133(6):1575–1585nnThe purpose of this study was to characterize the incidence and severity of adverse drug events in a population of medically complex and chronic pediatric patients.nnPatients ranging in age from 0 to 18 years presenting to an emergency department (ED) with an adverse drug event.nnA national retrospective cohort study, …

Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

M Andersson, L Hedman, A Bjerg, B Forsberg, B Lundback, E Ronmark. Pediatrics. 2013;132(2). Available at: www.pediatrics.org/cgi/content/full/132/2/e435nnThe goal of this study was to analyze the remission and persistence of childhood asthma in adolescents.nnThe study population included 205 subjects with asthma studied from age 7 to 8 years up until the study end-point age of 19 years.nnSubjects with asthma were identified by distributing an extended International Study of Asthma and Allergies in Childhood questionnaire to the families of all children in the first and second grade in 3 municipalities in northern …

Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study

D Fleischer, T Perry, D Atkins. Pediatrics. 2012;130(e25):25–32nnTo determine the frequency and circumstances of allergic reactions to common food allergens in a multicenter, prospective study of preschool-aged children.nnThe cohort examined was already participating in an observational study to monitor for development of peanut allergy in patients with history of milk/egg allergy. There were 512 infants enrolled between the ages of 3 and 15 months from 5 US sites.nnIn a prospective, 5-site observational study, subjects were scheduled for a clinical evaluation at 6-month intervals for 2 visits, then …

The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions

BA Fassl, FL Nkoy, BL Stone. Pediatrics. 2012;130(3):482–491nnTo examine provider compliance with 3 Joint Commission Children’s Asthma Care (CAC) measures, β-agonist use (CAC 1), systemic steroid use (CAC 2), and patient discharge with a home management plan of care (CAC 3). The study also examined whether use of these measures had an impact on the rate of patient readmission to the hospital for asthma care. Additional measures examined included length of stay, costs, and relative resource units.nnA total of 1865 patients, ages 2 to 17 …

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

IM Paul, JH Maselli, AL Hersh, HA Boushey, DW Nielson, MD Cabana. Pediatrics. 2011;127(6):1014–1121nnTo determine how frequently antibiotics are prescribed during pediatric asthma visits without documented coexisting diagnoses that justify their use.nnPediatric patients <18 years of age seen in outpatient offices and emergency departments in the United States for asthma between 1998 and 2007.nnData from the National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Survey were examined for patients seen for asthma in clinics and emergency departments. Each visit was assessed with regard …

Once- vs twice-daily budesonide/formoterol in 6- to 15-year-old patients with stable asthma

SE Eid, MJ Noonan, B Chipps, B Parasuraman, CJ Miller, CD OBrien. Pediatrics. 2010;126(3). Available at: www.pediatrics.org/cgi/content/full/126/3/e565nnTo compare the clinical effectiveness and tolerability of once-daily budesonide/formoterol pressurized metered-dose inhaler (pMDI) versus budesonide pMDI in asthmatic children aged 6 to 15 years old.nnChildren aged 6 to 15 years with stable mild-to-moderate asthma were enrolled if they had had symptoms for ≥6 months, bronchodilator response, and forced expiratory volume in 1 second (FEV1) of 60% to 90% of that predicted at baseline.nnThe study was a multicenter, 12-week double-blind, parallel-group, active-controlled, randomized study. Enrolled patients had a 4- to 5-week run-in with budesonide/formoterol 80/9 μg twice per day and albuterol as needed for rescue. Patients whose asthma was stable after the run-in period were age-stratified and randomly assigned to receive budesonide pMDI 80 μg (2 inhalations daily), budesonide/formoterol 80/4.5 μg (2 inhalations once daily), or …