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Wolfe J, Rooklin A, Grady J, et al. J Allergy Clin Immunol. 2000;105:1153-1161 Purpose of the Study. To examine the efficacy of fluticasone propionate 200 [micro]g per day administered either [...]

Bunikowski R, Mielke MEA, Skarabis H, et al. J Allergy Clin Immunol. 2000;105:814-819 Purpose of the Study. To establish the effect of superantigen production by Staphylococcus aureus on disease severity [...]

Li X-M, Serebrisky D, Lee S-Y, et al. J Allergy Clin Immunol. 2000;106:150-158 Purpose of the Study. To establish a murine model of immunoglobulin E (IgE)-mediated peanut hypersensitivity that closely [...]

Purpose of the Study. To determine the efficacy of oral prednisone versus intravenous methylprednisolone in equivalent doses for the treatment of an acute asthma exacerbation in hospitalized children. Study Population. Children, 2 to 18 years old, with an acute asthma exacerbation treated in the emergency department (ED) and hospitalized at St Christopher's Hospital for Children between November 1995 and March 1996. Methods. This study was a prospective, randomized, double-blind, double-placebo trial. Subjects were treated in the ED for acute asthma then enrolled and randomized in the study once the decision to admit to a nonintensive care area was made. All study patients received the following: 1) oral dosing of either oral prednisone (2 mg/kg/dose, maximum 120 mg) or placebo (sucrose pill) every 12 hours; and 2) intravenous dosing of either methylprednisolone (1 mg/kg/dose, maximum 60 mg) or saline placebo every 6 hours. Each patient was only given 1 active drug. The 3 study investigators managed all aspects of the trial including the study patients' care. A standardized inpatient protocol for additional oxygen and medication delivery (albuterol, ipratropium bromide, theophylline, and antiinflammatory medications) was instituted for the management of study patients. An asthma symptom score, based on defined criteria, was assigned to each patient 3 times daily and the nebulized [Beta]-agonist dosing adjusted accordingly. Length of hospital stay was recorded and defined as: 1) time elapsed from evaluation by ED triage nurse to hospital discharge, and 2) time elapsed from ED nurse triage evaluation to time when [Beta]-agonist dosing changed from every 4 hours to every 6 hours. Results. Sixty-six patients completed the study protocol, 33 patients per group. Patients in the prednisone group had a mean length of hospital stay of 70 hours compared with 78 hours for the methylprednisolone group (P = .52). Weaning of [Beta]-agonists to 6-hour intervals occurred at 59 hours in the prednisone group compared to 68 hours in the methylprednisolone group (P = .47). The use of supplemental oxygen was slightly longer in the methylprednisolone group compared with the prednisone group, 52 hours versus 30 hours (P = .04), respectively. There were no significant adverse effects reported in either treatment group. The cost of prednisone (120 mg) ranged from $2 to $22, while the cost of methylprednisolone (60 mg) ranged from $14 to $252, depending on community- or university-based hospital costs. Conclusions. There was no difference in length of stay in asthmatic children receiving equivalent doses of oral prednisone and intravenous methylprednisolone, while the cost of therapy for methylprednisolone was estimated to be 10 times higher. Reviewer's Comments. This study outlines the option of altering standard inpatient therapy for acute asthma by providing oral prednisone in place of intravenous methylprednisolone. At equivalent doses, these medications appear to be equally efficacious and tolerated with maintainence of good asthma care. Additionally, oral prednisone provides a cost-saving option for inpatient care. Further studies are needed to determine the optimal dose and frequency of administration of oral prednisone in this setting., Becker JM, Arora A, Scarfone RJ, et al. J Allergy Clin Immunol. 1999;103:586-590 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To examine the relationship between asthma duration and asthma severity. Study Population. The CAMP cohort consists of 1041 children (ages 5-12 years) with mild-to-moderate chronic asthma that were enrolled from 8 centers (United States and Canada) over an 18-month period. Methods. The CAMP study was initiated to follow a cohort of asthmatic children prospectively for approximately 5 years with randomization of asthma therapy (3 study arms--inhaled nedocromil, inhaled budesonide, as-needed albuterol), standardized disease monitoring techniques and education to compare the impact of disease and various treatment options in children with mild-to-moderate asthma. The current report utilizes the extensive CAMP baseline cross-sectional data on asthma duration, spirometry, bronchial responsiveness, symptomatology, and markers of atopy to evaluate whether duration of asthma is associated with disease severity. Results. The cohort of 1041 asthmatic children aged 5 to 12 years (8.9 [+ or -] 2.1 years) had a duration of asthma from the time of physician diagnosis ranging from .3 to 12.1 years (mean: 5 [+ or -] 2.7 years, median: 4.8 years). In univariate analyses, asthma duration was associated with lower levels of lung function, including prebronchodilator and postbronchodilator forced expiratory volume in 1 second ([FEV.sub.1]) (percent predicted) and [FEV.sub.1] forced volume capacity (FVC) and bronchial responsiveness to methacholine challenge. Asthma duration was also associated with higher symptoms scores (P [is less than] .001) and borderline enhanced use of albuterol for symptoms (P = .064) during a 28-day screening period before randomization to study drug. After controlling for possible confounding variables (eg, atopy, inflammatory markers, household dust mite level, antiinflammatory medication use, and clinical center), regression analysis revealed that the duration of asthma remained significantly and independently associated with greater bronchial responsiveness to methacholine, prebronchodilator [FEV.sub.1], and prebronchodilator and postbronchodilator [FEV.sub.1]/FVC, as well as more asthma symptoms and albuterol use. Duration was also associated with physician/nurse assessment of asthma severity. Conclusions. These data indicate that asthma duration is associated with lower lung function, greater methacholine responsiveness, more asthma symptoms, and greater albuterol use, which are all measures of asthma severity. Reviewer's Comments. This is the first report from the CAMP Research Group that addresses a key factor in childhood asthma--the impact of asthma duration on asthma severity. A relationship with duration of asthma was found with multiple criteria that reflect severity of disease. Although the changes in lung function reported were small, a similar decline has been previously reported in Scandinavian children followed prospectively by Agertoft and Pederson (Respir Med. 1994;88:373-378). Additionally, the CAMP data analyses included many other indicators of disease severity, all correlating with disease duration. The CAMP Study provides a much-needed model in which to study childhood asthma. Additional information will be forthcoming regarding the utility of early institution of antiinflammatory therapy in terms of preserving lung function and decreasing disease morbidity while assessing for adverse effects of long-term therapy., Zeiger RS, Dawson C, Weiss S for the Childhood Asthma Management Program (CAMP) Research Group. J Allergy Clin Immunol. 1999;103:376-387 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To determine the prevalence of peanut and tree nut allergy among the general population in the United States. Study Population. A total of 7036 US households were contacted by telephone. Respondents were eligible if they were over 17 years of age, were living in the household, understood questions in English, and could provide informed consent. Methods. This was a nationwide, cross-sectional random digit dial telephone survey of households in the United States. The questionnaire used included primarily "yes/no" responses to questions developed by the investigators and administered by using a computer-assisted system. Demographic information was obtained from all households. Adults with tree nut or peanut allergy identified by a surrogate were included in the prevalence estimate but details of the reactions were only included when the affected adult was personally interviewed. For individuals reporting reactions, further questions were administered to obtain detailed information. Reactions were considered "convincing" if the organ system affected and symptoms were typical of allergic reactions and occurred within 1 hour of ingestion. Results. A total of 12 032 individuals participated from 4374 households (67% participation rate). Peanut and tree nut allergy was reported in 164 individuals (1.4%) in 151 households. The prevalence of reported allergy in adults (1.6%) was higher than the prevalence reported in children (.6%). The overall "corrected" prevalence was estimated at 1.1% for the entire population surveyed. A total of 118 individuals fulfilled criteria established for a "convincing" allergic reaction and provided detailed history of those accounts. The allergic reactions involved 1 organ system (skin, respiratory, and gastrointestinal) in 50 individuals, 2 in 45 individuals, and all 3 in 23 individuals. Only 53% of those subjects had ever seen a doctor for the allergic reaction while 45% of those reported more than 5 lifetime reactions. Only 7% had self-injectable epinephrine available at the time of the interview. Conclusions. Peanut and/or tree nut allergy affects approximately 1.1% or about 3 million Americans. Only half of those interviewed had established medical care for their allergy and few had epinephrine readily available for emergency use. Reviewer's Comments. This is a very enlightening study that emphasizes several important points. First, peanut and tree nut allergy affect a large portion of the US population and represent a major health care concern. Second, most affected individuals do not seek health care for their allergy. Third, the vast majority do not have appropriate life-sustaining devices (ie, injectable epinephrine) readily available. The authors very aptly emphasize the importance of appropriate diagnosis and management of these typically lifelong, life-threatening food allergies. This study further serves to challenge all of us as health care providers to better educate and manage our food-allergic patients., Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA. J Allergy Clin Immunol. 1999;103:559-562 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To better define patterns of response to oral glucocorticoids (GC) in adolescent asthmatics, to evaluate their clinical characteristics, and to determine the prevalence of steroid-insensitive asthma in this population. Study Population. A total of 164 adolescent patients, admitted to National Jewish Medical and Research Center between July 1993 and February 1997 for difficult-to-control asthma. Methods. This was a retrospective study of adolescents with asthma. Data collected included medical history, pulmonary function testing (PFT), methacholine challenge results, AM cortisol levels, serum immunoglobulin E (IgE), total eosinophil counts (TEC), serum eosinophilic cationic protein (ECP), and soluble IL-2 receptor (IL-2R). Patients were first divided into two groups: those who required an oral GC burst (40 mg/day prednisone for at least 7 days) during their hospitalization and those who did not require an oral GC burst. Patients were further divided based on their response to GC therapy. Steroid-sensitive (SS) patients were defined as those whose AM forced expiratory volume in 1 second (FEV0 improved [is greater than]15% after GC therapy. Steroid-insensitive (SI) patients were defined as those with [is less than] 15% improvement in their AM [FEV.sub.1] after GC therapy. The SI group was further evaluated based on PFT patterns, with patients demonstrating a "chaotic" ([is greater than] 30% variability in lung function) versus "nonchaotic" ([is less than] 30% variability) pattern. Results. The mean age of patients was 14 years. Most (90%) were receiving high-dose inhaled GC, and [is greater than] 50% were receiving maintenance oral GC. Of the 164 patients reviewed, 87 (53%) required an oral GC burst during hospitalization. Based on their response to GC therapy, 21 (24%) patients were defined as SI and 61 (76%) patients as SS. Patients with SI asthma required oral GC therapy at a younger age, required larger oral maintenance GC dosing, and were more likely to be African-American, compared to those with SS asthma. The SI asthmatics were defined by their PFT pattern as "chaotic" (n = 12) and "nonchaotic" (n = 9), with the "nonchaotic" group being distinguished by later diagnosis of asthma, treatment with oral GC at a later age, and African-American ethnicity. No difference in inflammatory markers (eg, ECP, TEC, IL-2R levels) were detected among any of the groups compared. Conclusions. The authors conclude that SI asthma 'is common (24%) in their referral population. The overrepresentation of African-Americans in the SI group indicates the need for further study of the prevalence of SI asthma and the impact of early asthma intervention on this form of asthma. Reviewer's Comments. This is the first study to describe patterns of response to oral GC in adolescent asthmatics. Although a retrospective analysis from a tertiary referral center, the numbers of patients involved and the data collection performed in this population certainly provides a framework to begin to address the difficult problem of SI asthma. Of significance, 24% of patients were found to be SI. This prevalence is higher than expected, possibly attributable to the referral population base, yet analysis of these patients allows the authors to provide clinical characteristics of SI asthma that have previously been undefined. The increased incidence African-Americans in the SI group and the finding of two spirometric profiles of SI patients ("chaotic" and "nonchaotic") indicate the need for further study of this important group of SI patients. The current trends in asthma morbidity and mortality further support the analysis of this subset of asthmatics., Chan MTS, Leung DYM, Szefler SJ, Spahn JD. J Allergy Clin Immunol. 1998;101:594-601 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To develop, pretest, and validate a questionnaire to measure quality of life in children with seasonal allergic rhinoconjunctivitis (SAR). Study Population. Children, ages 6 to 12 years, with a history of SAR and troublesome symptoms during the previous month. Methods. Two studies in different locations were conducted to develop the Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ). Study 1 was the "development" phase in which PRQLQ questions were developed and modified in 34 children with SAR. Forty-eight items in 8 initial domains were reduced to 23 questions, in 5 domains (nose symptoms, eye symptoms, other symptoms, practical problems, and activity limitations) to establish the final PRQLQ. Ten children were pretested with the PRQLQ using a 7-point response option scale. Study 2 was the "validation" phase in which 83 children with SAR were tested with the PRQLQ in a 3-week, single cohort study conducted during the fall pollen season of 1996. Children were seen at enrollment and after 1 and 3 weeks. Subjects completed a symptom diary twice daily for 1 week before each visit. At the 1-week visit, medication was prescribed for the child's symptoms. The PRQLQ was given at each visit and results analyzed with symptom profiles. Results. Study 1 established the PRQLQ format of 23 questions in 5 domains. Study 2 tested the instrument in 83 children. Of the 83 children enrolled, 75 children completed the analysis with a mean age of 9.8 years (40% female, 76% white, 11% black). The reliability and validity of the PRQLQ were found to be very consistent in the population tested. Good evidence was found for cross-sectional correlations between quality of life and diary symptom scores. The PRQLQ was also able to detect difference in those subjects who remained clinically stable and those who changed clinically. Responsiveness data showed that children did not have trouble understanding the 7-point scale used. The only problem encountered was the apparent difficulty of some children understanding the time specification. Some younger children had problems understanding the concept of "during the last week." Conclusions. The PRQLQ can be completed reliably in children 6 to 12 years old. The instrument demonstrates good measurement properties and can be used with confidence in clinical studies. Reviewer's Comments. Once again, Juniper and colleagues have developed a validated, reliable quality of life instrument for children with chronic disease. This tool will be useful in the assessment of children with rhino-conjunctivitis, especially with regard to clinical studies. The authors recognize some limitation to their study, primarily that the instrument development was conducted in one population and validated in another. This problem was minimized by inclusion of a wide range of disease severity in the test population. Further use of the PRQLQ in pediatric patients will be helpful and will likely strengthen these findings., Juniper EF, Howland WC, Roberts NB, Thompson AK, King DR, Math B. J Allergy Clin Immunol. 1998;101: 163-170 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To study the clinical pharmacology of epinephrine in allergic children with a history of anaphylaxis. Study Population. A total of 17 children, ages 4 to 12 years old, with a history of severe allergies and systemic anaphylaxis. Methods. This was a randomized, single-blind, single-dose, parallel-group study. Subjects received either a subcutaneous injection of 0.01 mL/kg (maximum 0.3 ml [0.3 mg]) epinephrine solution or an intramuscular injection of 0.3 mL (0.3 mg) of epinephrine via an EpiPen Auto-Injector (Dey; Napa, CA). Before injection and at timepoints up to 180 minutes afterwards, blood samples were collected for plasma epinephrine measurement. Heart rate, blood pressure, and rhythm strip monitoring were also performed during the same intervals. Plasma epinephrine concentrations were measured with a high-performance chromatography (HPLC) reverse-phase system with electrochemical detection. Results. Nine subjects were randomized to the subcutaneous epinephrine group (epinephrine solution) and 8 to the intramuscular injection group (EpiPen Auto-Injector). The mean peak plasma epinephrine concentration in the subcutaneous group was 1802 [+ or -] 214 pg/mL. The mean time to reach maximum plasma concentrations was 34 [+ or -] 14 minutes in this group, with only 2 subjects achieving maximum concentration by 5 minutes. In contrast, the mean peak maximum plasma epinephrine concentration in the intramuscular group was 2136 [+ or -] 351 pg/mL. The mean time to reach maximum plasma concentration was 8 [+ or -] 2 minutes (P [is less than] .05, compared to subcutaneous group), with 6 achieving the peak concentration by 5 minutes. No serious adverse effects were reported in either group. Conclusions. Epinephrine has a delayed absorption when given via the subcutaneous route compared with the intramuscular route in children. Reviewer's Comments. Although a small sample size, this study of the pharmacologic dynamics of epinephrine delivery in children has great implications. Epinephrine remains the drug of choice for the treatment of acute systemic anaphylaxis, yet epinephrine dosing in children is currently recommended on the basis of findings in adult populations and anecdotal reports. This study is the first to demonstrate the pharmacokinetics of epinephrine in children. The authors clearly demonstrate delayed absorption and lower peak plasma concentrations when epinephrine is given via the subcutaneous route compared with the intramuscular route. These findings have important clinical implications for use of epinephrine in all settings of systemic anaphylaxis, indicating that intramuscular delivery of epinephrine may be preferable., Simons FER, Roberts JR, Gu A, Simons KJ. J Allergy Clin Immunol. 1998;101:33-37 STACIE M. JONES, MD Little Rock, [...]

Stafford RS, Ma J, Finkelstein SN, Haver K, Cockburn I. J Allergy Clin Immunol. 2003;111:729-735 Purpose of the Study. To analyze asthma clinic visits and changes in asthma pharmacotherapy during [...]

Purpose of the Study. To compare 0.03% and 0.1% tacrolimus ointment with 1% hydrocortisone acetate ointment in children 2 to 15 years of age with moderate-to-severe atopic dermatitis (AD). Study Population. Children ages 2 to 15 years with a diagnosis of AD were recruited from 27 centers in 6 European countries and Canada. Patients were required to have a severity grading of moderate to severe (using established criteria) and at least 5%, but not >60%, total body surface area (BSA) involvement. Methods. This was a phase III, multicenter, randomized, double-blind, parallel-group trial. Patients were randomized (1:1:1) to receive 0.03% or 0.1% tacrolimus or 1% hydrocortisone acetate. Treatment included application of a thin layer of ointment twice daily to active skin lesions until clearing of lesions for 7 days. Other therapies were prohibited with the exception of inhaled or intranasal corticosteroids (maximum dose: 1 mg/day) and nonmedicated emollients or bath oils. Assessments were at baseline, days 3 and 7 and weeks 2 and 3 of treatment and 2 weeks after completing treatment (week 5). Assessments included investigator rating of skin disease and BSA involvement and patient symptoms assessment symptoms. These were used to calculate the modified eczema area and severity index (mEASI). A graded physician's global evaluation regarding clinical response was also included. Adverse events and laboratory assessments were obtained. Results. A total of 560 patients were enrolled. Study discontinuations were as follows: 21 of 189 in 0.03% tacrolimus group, 13 of 186 in 0.1% tacrolimus group, and 20 of 185 in hydrocortisone group. The mEASI, mean area under the curve (mAUC) as percentage of baseline showed the 0.03% tacrolimus (44.8%) and 0.1% tacrolimus (39.8%) to be more effective than 1% hydrocortisone (64%), and 0.1% tacrolimus to be the most effective treatment. Transient skin-burning was reported more often in the tacrolimus groups. Laboratory parameters showed no treatment differences and no significant changes between groups. Conclusions. Tacrolimus 0.03% and 0.1% ointments were more effective and showed equivalent safety when compared with 1% hydrocortisone in the treatment of children with moderate-to-severe AD. Reviewer's Comments. This study demonstrates the usefulness and safety of tacrolimus ointment for children with moderate-to-severe AD. This new class of nonsteroid, immunomodulatory medications provides important therapeutic alternatives to long-term corticosteroid therapies for young children., Reitamo S, Van Leent EJM, Ho V, et al. J Allergy Clin Immunol. 2002;109:539-546 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To determine if specific immunotherapy can prevent the development of asthma and reduce bronchial hyperresponsiveness in children with seasonal allergic rhinoconjunctivitis. Methods. A total of 205 children, 6 to 14 years old, from 6 European pediatric centers were enrolled from 1992-1994. All children had a clinical history of moderate-to-severe rhinoconjunctivitis caused by birch and/or grass pollen allergy, as well as positive skin testing and a conjunctival provocation test to birch and/or grass pollen. At enrollment, none had asthma requiring daily controller therapy. Patients were randomized to 1) active treatment group receiving specific immunotherapy (SIT) to birch and/or grass pollen for 3 years or 2) an observational control group. Symptomatic treatment was limited to loratadine, levocabastine, sodium cromoglycate, and nasal budesonide. Patients were evaluated based on the following: 1) asthma diagnosis, symptoms, and peak flow; 2) methacholine provocation during the pollen season(s) and winter; and 3) visual analog scale (VAS) for rhinoconjunctivitis after every season. Results. Of the 205 patients, 43 were allergic to birch, 124 were allergic to grass, and 41 were allergic to both. Ninety-seven children received SIT while 94 served as controls. At study enrollment, 40 (20%) children had mild seasonal asthma symptoms despite negative histories of asthma. After 3 years, 38 of 40 with asthma still had symptoms. Among those with asthma, the SIT group had fewer asthma symptoms after 3 years of therapy as evaluated by clinical diagnosis (odds ratio: 2.52; P < .05). Bronchial hyperresponsiveness was significantly reduced in the SIT group, both in and out of season, when compared with controls (P < .05). Of nonasthmatics, asthma developed in 19 of 79 in SIT group and 32 of 72 controls. Children receiving SIT had improved VAS scores for conjunctivitis (P < .001) and rhinitis (P < .01). Conclusions. This study indicates that specific immunotherapy for seasonal rhinoconjunctivitis can reduce development of asthma. The authors also demonstrate a reduction in symptom profiles and medication usage in the active treatment group. Reviewer&apos;s Comments. Allergic rhinitis is a known risk factor for the development of asthma. Additionally, other investigators have demonstrated a link between upper airway disease and bronchial hyperresponsiveness. This study profiles a group of children with clinically relevant seasonal rhinoconjunctivitis and suggests that specific immunotherapy may have a role preventing the development of asthma. This study challenges clinicians to evaluate children with significant upper airway disease and consider the benefits of allergen immunotherapy. Additional work is needed to further define the role of allergen immunotherapy in the prevention of asthma development in children with both seasonal and perennial disease. Additionally, this study highlights the importance of surveillance for asthma symptoms in children with allergic rhinoconjunctivitis., Moller C, Dreborg S, Ferdousi HA, et al. J Allergy Clin Immunol. 2002;109:251-256 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To increase awareness about the patient with a negative skin test response and insect sting allergy and to determine the frequency and significance of negative skin test responses in patients with a history of systemic reactions to insect stings. Study Population. Subjects were recruited for insect sting challenge study using advertisements. Subjects with a history consistent with a systemic immunoglobulin E (IgE)-mediated allergy to insects were evaluated. Methods. Venom skin testing, serologic IgE venom testing, and insect sting challenges were conducted. Intradermai skin testing to venom extracts (ALK-Abello Labs, Copenhagen, Denmark) was conducted in a range from 0.001/[micro] g/mL to 1.0 [micro]g/mL. Venom-specific serum IgE was detected using radioallergosorbent testing (RAST) (on-site assay using precommercial venom preparations). Sting challenge was performed using standards reported by this group with stings classified as mild, moderate, or severe based on defined criteria. Results. After 4 years of recruitment, 307 subjects were enrolled. Skin testing was positive in 208 (68%) of patients. Skin testing was negative in 99 (32%) of whom 56 (57%) also had a negative RAST and 43 (43%) had a positive RAST. Of those with negative skin testing and positive RAST, 36 had a low-level RAST (1-3 ng/mL) and 7 had a high-level RAST (4-243 ng/mL). Sting challenge was conducted in 51 of the 99 patients with negative skin tests. Systemic reactions occurred in 11 of these 51 patients: 9 had low-level RAST and 2 had no specific IgE. Positive sting challenge was mild in 7 patients and moderate in 4, with no patient demonstrating a severe reaction. All systemic reactions occurred with yellow jacket stings, the focus of this group&apos;s research. The systemic reaction rate to sting challenge in skin test negative patients (22%) was not different from the systemic reaction rate (21%) in skin test positive patients. The reaction rate was higher in patients with negative skin tests and positive RAST results (24%) than in those with negative RAST results (14%). Additionally, there was no significant difference in the severity of the reported past systemic reactions by patients with positive or negative skin tests, with both groups reporting 25% mild, 55% moderate, and 20% severe reactions. Conclusions. The authors conclude that negative venom test results do not exclude the possibility of a systemic reaction. Authors also note their low recruitment of patients with negative skin tests and RAST for sting challenge make it possible that the overall frequency of reaction is as low as 11%; however, this does not diminish the potential risk of reaction in patients with a convincing history and negative testing. These results likely reflect limited diagnostic sensitivity of current testing methods. Authors recommend that patients with a convincing history of systemic reaction and negative skin testing to insects should be evaluated by means of RAST analysis and repeat skin testing after 3 to 6 months. If all results are negative, the authors suggest that patients be counseled to the limitations of testing and the possibility of systemic reaction, as well as appropriate avoidance and treatment recommendations. Reviewer&apos;s Comments. This study provides a practical assessment of an important aspect of insect sting allergy. Current practice guidelines state that patients with negative skin tests are not candidates for immunotherapy, but they provide no guidance for the management of these patients. The authors of this study have thus provided insight into the clinical risks for these patients and have provided practical diagnostic and management suggestions to more fully evaluate and care for these patients. In addition, this study highlights the need for improved diagnostic testing for insect sting allergy. Golden DBK, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. J Allergy Clin Immunol. 2001;107: 897-901, STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To define features of peanut (PN) and tree nut (TN) allergy among 5149 members of a voluntary registry. Study Population. Food-allergic subjects (n = 5149) were enrolled from May 1977 to May 2000, with 75% voluntarily registered through membership in the Food Allergy and Anaphylaxis Network (FAAN) and 25% recruited by physicians. Eighty-nine percent of the registrants were children Methods. A structured questionnaire was distributed to 7000 lay members and 1000 health professional members of the FAAN, as well as to 4000 members of the American Academy of Allergy, Asthma, and Immunology (AAAAI). Participants or parental surrogates provided demographic information and details about allergic reactions to PNs and TNs. Data were analyzed by [chi square] analysis. Results. Isolated PN allergy was reported by 3482 registrants (68%), isolated TN allergy was reported by 464 individuals (9%), and allergy to both by 1203 individuals (23%). Other self-reported food allergies included egg (29%), cow&apos;s milk (22%), soy (11%), wheat (6%), fish (4%), and shellfish (2%). Atopic disorders included atopic dermatitis (50%), asthma (46%), and allergic rhinitis (27%). Participants were more likely to have been born in October, November, or December (P < .0001). Eighty-two percent (n = 3877) had been breastfed for a median of 7 months. The median age at first known exposure to PN was age 12 months (mean = 18.5 months), while the first known reaction was at a median age of 14 months (mean = 29.5 months). Seventy-four percent report that the first reaction to PN occurred with the first exposure, and ingestion was reported as the most common route of exposure (91%). The first reactions occurred primarily in the home, beginning a median of 3 minutes after exposure, 76% requiring medications. The median age at first known exposure to TN was 24 months (mean = 48 months), while the median age at first reaction to TN was 36 months (mean = 77 months). Sixty-eight percent reported that the first reaction occurred with the first exposure, and the majority of first TN reactions (61%) occurred in the home. Ingestion was the most common route of exposure to TN (88%). Half of all the reactions involved >1 organ system. A second reaction to PN was described by 2226 registrants (48%), and 1072 (23%) reported a third reaction. A second reaction to TN was reported by 564 people (34%) and 240 (14%) described a third. Subsequent PN and TN reactions attributable to accidental ingestion were more severe, more common outside the home and more likely to require treatment with epinephrine, when compared with initial reactions. Ninety percent of the participants reported having epinephrine available at all times. Of the 10% who did not, 45% had not been given a prescription. Conclusions. This registry is the largest collection of patients with food allergies and emphasizes important and novel features of PN and TN reactions. Reactions are often severe, often occur on the first exposure, and require some type of medication or medical intervention. Subsequent reactions to PN and TN reportedly worsened in most patients. The majority of patients reported having epinephrine on hand, but it is worrisome that >500 patients did not have epinephrine readily available, and almost half of these patients had not ever been given a prescription. Reviewers&apos; Comments. This study provides valuable insight into a very important aspect of food allergy. Because 89% of the registrants are children, this data is very valuable for pediatricians, as it provides new insights into the features of these PN and TN allergies, reaffirms previous observations, and provides a valuable source of information for health care providers. Sicherer SH, Furlong TJ, Munoz-Furlong A, Burks AW, Sampson HA. J Allergy Clin Immunol. 2001;108:128-132, AMY M. SCURLOCK, MD STACIE M. JONES, MD Little Rock, [...]

Rosenfeldt V, Benfeldt E, Nielsen SD, et al. J Allergy Clin Immunol. 2003;111:389-395 Purpose of the Study. To evaluate the clinical and anti-inflammatory effects of probiotic supplementation among children with [...]

Chalada P, Arbes S, Dunson D, Zeldin DC. J Allergy Clin Immunol. 2003;111:328-336 Purpose of the Study. To determine whether breastfeeding has an association with the development of recurrent wheeze, [...]

Purpose of the Study. To evaluate the safety and efficacy of rush immunotherapy (RIT) with imported fire ant (IFA) whole body extract and to determine if prophylactic pretreatment with antihistamines and steroids reduces the rate of associated systemic reactions. Study Population. Patients, 18 to 65 years old, with IFA hypersensitivity were enrolled from August 1996-June 1999. Hypersensitivity was defined as history of systemic reaction to IFA sting and positive IFA skin test result. Methods. IFA-allergic patients enrolled in the RIT protocol were randomized in a double-blind manner to one of 2 prophylaxis regimens: 1) placebo pretreatment and 2) premedication with twice-daily treatment of terfenadine 60 mg, ranitidine 150 mg, and prednisone 30 mg. The pretreatment was begun 2 days before protocol start and continued through the evening of the last RIT dose. The RIT protocol included hourly injections on days 1, 2, 8, and 15. Protocol efficacy was determined on day 22 using a pair of IFA sting challenges 2 hours apart. Results. Fifty-eight patients (age range: 18-49 years) entered the 2-day RIT. Only 5.2% experienced mild systemic reaction during the protocol. There was no statistical difference between the 2 premedication groups (3.6% active vs 6.7% placebo; P = .87). Efficacy was 98.2% in 56 patients undergoing sting challenge. Conclusions. The authors conclude that RIT is both safe and efficacious for adults patients that have IFA hypersensitivity. The rate of systemic reactions is low and premedication with a combination of H1 and H2 antihistamines and oral corticosteroids is not necessary. Reviewer&apos;s Comments. One limitation of traditional immunotherapy is the long build-up period required for desensitization. This not only serves to discourage some patients but provides an additional hazard for patients with hypersensitivity reactions to insect venom and continual exposure. These authors have effectively demonstrated that RIT is safe and efficacious in adult patients. Although encouraging, additional studies are needed in children to confirm the same safety and efficacy parameters in fire ant-hypersensitive individuals., Tankersley MS, Walker RL, Butler WK, Hagan LL, Napoli DC, Freeman TM. J Allergy Clin Immunol. 2002; 109:556-562 STACIE M. JONES, MD Little Rock, [...]

Purpose of the Study. To establish the prevalence and socioeconomic pattern of allergic disease as well as the pattern of allergen sensitization to markers of socioeconomic status (SES). Study Population. Participants were mothers (n = 458) of children in the Epidemiology of Home Allergen and Asthma Study (a longitudinal birth and family cohort study) with the following inclusion criteria: 1) delivered a child between September 1994 and June 1996 in Boston, Massachusetts, 2) ability to speak English or Spanish, and 3) mother or father had a doctor&apos;s diagnosis of asthma, hayfever, or allergen sensitivity. Methods. Markers of race, SES, and diagnosis of asthma, hay fever, or allergy were elicited by questionnaire. Using 1990 US Census data, a marker of poverty in the zip code of residence was evaluated in terms of the proportion of the population living below the poverty level. Serum was collected for total immunoglobulin (IRE) and specific IRE to mites, cat, cockroach, dog, ryegrass, ragweed, Alternaria, and Aspergillus using the UNICAP system. Results. The population was 18 to 46 years old, mostly white (79%), educated to a college level or above (78%), and lived with a household income >$50 000 (70%). Only 5% smoked. Hayfever was reported in 43%, asthma in 31%, and eczema in 22%. When restricted to women with allergic disease and/or asthma, asthma was more common in areas of poverty while hayfever was more common in areas of affluence (P = .007). Eczema was not related to any markers of SES. Allergen sensitivity was found in 60%, with mite the commonest (36%) and Aspergillus the rarest (4%). Multiple sensitivities were typical, while only mite allergy occurred commonly as a sole sensitivity. Eleven percent had cockroach sensitivity with 94% also sensitive to 1 or more other allergens. Subjects living in areas of greatest poverty were at greatest risk for allergen sensitivities with cat, ragweed, and dog sensitivity common in high poverty areas. Sensitivity to cockroach allergen was much higher in relation to area poverty (P < .001). Sensitivities to mite and mold were equally common across all markers of SES. Ryegrass was the only allergen more common with markers of high SES. The mean total IgE levels was higher across areas of poverty (P < .001). Allergen sensitivity was increased in women of household incomes Conclusions. A socioeconomic gradient was demonstrated showing that the poorest had higher total and specific IRE levels, increased allergen sensitization, and asthma. Cockroach, cat, dog, and ragweed sensitivities were higher in the poorer areas, with additional risk the higher the specific IRE level. An increased risk for asthma was associated with cat, dog, and cockroach sensitivity. In contrast to asthma, hayfever was found to be more common in areas of affluence. Reviewers&apos; Comments. In the United States, asthma prevalence is highest in the inner cities while in Europe asthma and allergic disease has been associated with greater affluence. This study provides a possible mechanism for the association of asthma and lower SES in the United States. Increased exposures to allergens may explain the increased incidence of asthma in the inner-city. Lewis SA, Weiss ST, Platts-Mills TAE, Syrin BA, Gold DR. J Allergy Clin Immunol. 2001;107:615-622, ORRIN J. DAVIS, MD STACIE M. JONES, MD Little Rock, [...]

Data from many studies have suggested a rise in the prevalence of food allergies during the past 10 to 20 years. Currently, no curative treatments for food allergy exist, and there are no effective means of preventing the disease. Management of food allergy involves strict avoidance of the allergen in the patient's diet and treatment of symptoms as they arise. Because diagnosis and management of the disease can vary between clinical practice settings, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored development of clinical guidelines for the diagnosis and management of food allergy. The guidelines establish consensus and consistency in definitions, diagnostic criteria, and management practices. They also provide concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions. The original guidelines encompass practices relevant to patients of all ages, but food allergy presents unique and specific concerns for infants, children, and teenagers. To focus on those concerns, we describe here the guidelines most pertinent to the pediatric population. [ABSTRACT FROM AUTHOR]

The article presents a study that assessed individualized therapy for persistent asthma in children. Topics discussed include results which show that daily inhaled corticosteroids conferred the most protection against symptoms and exacerbations in children with type 2 inflammation and comments on the study.

The article presents a study that defined the relationships among specific viral illnesses and the type and timing of aeroallergen sensitization with the persistence of asthma into adolescence. Topics discussed include results which show that high-risk children with a parental history of allergies and/or asthma were more likely to develop asthma when they had rhinovirus and aeroallergen sensitization in early childhood and comments on the study.

The article presents a study that evaluated the efficacy, safety, and feasibility of early oral immunotherapy (E-OIT) for treatment of peanut-allergic children. Topics discussed include the effectiveness of early oral immunotherapy with peanut protein at both high- and low-maintenance dosing for inducing sustained unresponsiveness and accelerating the introduction of peanut in the diet of preschool, peanut-allergic children and a review of the study.

The article discusses research on the impact of environmental peanut exposure to peanut sensitization and allergy, in which discussions include increased peanut sensitization and allergy among children exposed to peanut antigen and the need for further research to delineate risks versus benefits of different routes of exposure.

The article discusses research on the impact of infant consumption of processed and raw cow's milk on common infections and fever, in which the value of unprocessed milk on preventing common childhood respiratory illnesses and fever is highlighted.

An abstract of the article "Parental Psychological Distress During Pregnancy and Wheezing in Preschool Children: The Generation R Study" by M. Guxens, A. M. Sonnenschein-van der Voort, and H. Tiemeier is presented.

An abstract for the article "Adherence to Inhaled Corticosteroids: An Ancillary Study of the Childhood Asthma Management Program Clinical Trial" by J. A. Krishnan and colleagues, is presented.

An abstract of the article "Natural Course and Comorbidities of Allergic and Nonallergic Rhinitis in Children," by M. Westman, P. Stjärne, and A. Asarnoj, is presented.

The article presents a research study involving a comparison of the cost-effectiveness between fluticasone and montelukast in children with mild to moderate persistent asthma. It notes that the findings of the study reveal that fluticasone is more effective in patients who are exhibiting more airway inflammation and are more responsive to methacholine compared with montelukast. It is also affordable which makes fluticasone the preferred asthma controller.

The article discusses research on the contribution of environmental exposures on sensitization and food allergy among inner-city children, in which discussions include the impact of longitudinal exposures in an urban setting and modifiable factors associated with the development of food allergy.

An abstract of the article "The Natural History of Egg Allergy," by J.H. Savage and colleagues are presented.

An abstract of the article "Sustained Unresponsiveness to Peanut in Subjects Who Have Completed Peanut Oral Immunotherapy" by B. P. Vickery, A. M. Scurlock, and M. Kulis is presented.

An abstract of the article "The Natural History and Clinical Predictors of Egg Allergy in the First 2 Years of Life: A Prospective, Population-Based Cohort Study" by R. L. Peters, S. C. Dharmage, and L. C. Gurrin is presented.

The article presents a research study which determines the connection between allergic rhinitis (AR) and wheezing cough in school-age children. Study shows the variation of acquiring wheezing cough in these children due to different stratification age and phenotypes of the said rhinitis. However, it cites the association of the two diseases in preschool children. Moreover, the benefits of this study for the early treatment of children is also reported.

An abstract of the article "Effect of Different Antiasthmatic Treatments on Exercise-Induced Bronchoconstriction in Children With Asthma," by I. Stelmach and colleagues is presented.

An abstract of the article "Specific Verbal Tolerance Induction in Children With Very Severe Cow's Milk-Induced Reactions," by G. Longo and colleagues is presented.

Objective: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children., Methods: We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions., Results: Over a median follow-up of 36 months (range: 0-48.4), the annualized reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions [95% confidence interval: 0.76-0.85]). Overall, 269/512 (52.5%) reported >1 reaction. The majority of reactions (71.2%) were triggered by milk (495 [42.3%]), egg (246 [21.0%]), and peanut (93 [7.9%]), with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P < .0001) and higher food-specific immunoglobulin E (P < .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration., Conclusions: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers.