Low Adoption of Peanut Guidelines
Recently released guidelines from the NIH recommend that high-risk infants be introduced to peanut-containing foods between ages 4 and 6 months. General pediatricians’ knowledge and use of these new guidelines is unknown. For a study, general pediatricians were surveyed regarding their demographics, practice characteristics, counseling practices, and knowledge of the guidelines. On a 0-4 scale measuring physician adherence to guideline recommendations, more than one-third (38%) scored 1 or less. Only 11% scored a 4. Additionally, 77% recommended introducing peanuts later than 4 to 6 months in high-risk patients, and 44% reported not testing high-risk patients prior to peanut introduction. While pediatricians who treat more patients with food allergies were significantly more likely to be adherent with the guidelines, no differences were observed between academic and community-based providers. Patients may benefit from allergy and immunology specialists sharing the importance of following these guidelines with their pediatrician colleagues.
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Asthma Worse in the Winter
Previous research on seasonal trends in asthma exacerbations report conflicting results. Some suggest a peak in winter, but various trends have been shown by age and geographic region. Current understanding of seasonal and regional age-specific trends of asthma-related hospitalization and mortality in the United States is lacking. A nationwide database was used for a study to identify patients admitted with asthma between 2009 and 2011 and note monthly distributions with stratification per age group and region. Of the nearly 18.5 million asthma-related hospitalizations during the study period, one-third occurred in the South. Across all age groups and regions, the highest incidence rates of asthma-related hospitalizations were observed during winter months. Overall asthma-related mortality rates were also highest during winter, though peaks were seen in the fall for those aged 18-34, spring for those aged 35-64, and winter for those aged 65 and older.
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Penicillin Skin Testing to De-Label Allergies
Recent evidence indicates that many patients reporting penicillin allergy do not, in fact, have the allergy upon testing. However, data are lacking on the clinical characteristics of penicillin-allergic patients and the use of penicillin skin testing (PST) to confirm their self-reports. For a study, researchers obtained penicillin allergy history in new and existing patients and offered PST to appropriate patients, followed by an amoxicillin challenge with 30-minute observation if PST results were negative. Among patients reporting penicillin allergy who underwent PST, results were negative for 85.4%. Direct challenge was performed in 1.7% of patients, and 3.4% were de-labeled based on history. In the remaining penicillin-allergic patients not undergoing PST, 30.7% were on interfering medications, 11.0% reported a delayed reaction, 7.7% reported anxiety or needle fear, 7.7% experienced time constraints, 7.7% had a recent reaction, 6.2% had a recent positive PST, 12.3% were scheduled for future PST or challenge, and16.9% were not tested for various other reasons.
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Eczema, Asthma, & Pediatric Hospitalizations
Prior research indicates that children hospitalized for asthma have higher levels of immunoglobulin E (IgE) than children evaluated for asthma in the outpatient setting. Few studies, however, have assessed relationships between allergic sensitization and total IgE with hospital course severity in children hospitalized for asthma. Demographics and asthma history data—including controller medications, medical, atopic, family, and environmental history—were obtained from interviews and reviews of the medical records of children hospitalized with asthma for a small study. Each participant received a blood draw for aeroallergen and total IgE testing. Among participants, 95% tested positive for at least one allergen, and 77% had total serum IgE levels greater than 200 IU/mL. While no significant association was observed between total IgE level and hospital course severity, patients with a family history of asthma were more likely than those without a family history to require pediatric ICU admission (62% vs 14%). History of eczema was associated with longer length of stay and longer continuous albuterol requirement.
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Outpatient Chemotherapy Desensitization
Desensitization protocols allow patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapies to receive first-line therapy. Often performed in the inpatient setting, these protocols come with delays in medication administration, patient inconvenience, and lengthy overall treatment times that may be addressed with safe and effective outpatient desensitization. Time from patient arrival to desensitization start-time was compared before and after implementation of two dedicated outpatient infusion chairs at an institution. Use of outpatient infusion chairs reduced time to desensitization start from 261 minutes to 37 minutes. One instance of a grade I HSR in the post-intervention period was managed with antihistamines and corticosteroids. Survey results showed improvements in perceived patient experience following implementation of the outpatient infusion chairs.
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The Latest Food Allergy Stats
Food allergy has been thought of by many to be a condition most seen in Caucasians, despite data showing that rates of asthma and eczema are higher in minority populations. However, results of a survey conducted between October 2015 and September 2016 suggest that peanut allergy risk may be twice as high in African-American children as in Caucasian children. Overall peanut allergies in children have risen 21% since 2010, according to the self-report-based survey. Among adult respondents, 45% reported developing at least one allergy after age 17, with 43.3% saying they had an adult-onset allergy to any shellfish, 35.6% to fin fish, 35.6% to any tree nut, 24.7% to sesame, and 17.4% to peanut. As in children, allergies varied greatly by race among adults. Asian adults were 2.1 times more likely to report shellfish allergy than Caucasian adults, whereas Hispanic adults were 2.3 times more likely to report peanut allergy than Caucasian adults.
