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Food allergies affect 32 million Americans. Restricted diets due to food allergies can be difficult to maintain especially when the household is food insecure. Food insecurity is defined as the inability to acquire food for household members due to insufficient money or resources for food. The COVID-19 pandemic has caused many people to face food insecurity for the first time with Latinx, Native American, and Black communities disproportionately affected. Because of the increase in food insecurity, this work group developed a survey regarding food insecurity screening. This survey was sent out to a random sample of American Academy of Allergy Asthma & Immunology members to assess food insecurity knowledge and practices. The majority of survey participants did not routinely screen their patients for food insecurity. The biggest barrier identified to screening was lack of knowledge of how to perform a screen and resources available when a patient screened positive. This work group report provides guidance on how to implement and perform a food insecurity screen, including federal resources and assistance programs.

Eosinophilic esophagitis (EoE) is a chronic, non-IgE immune-mediated reaction characterized by eosinophilic infiltration leading to esophageal dysfunction, inflammation, and potential for fibrotic remodeling. Although food allergens are generally considered the leading trigger for EoE, emerging evidence suggests that modifiable environmental factors may also play a role in the pathogenesis of EoE. This article discusses the latest data regarding the role of the exposome, microbiome, and environmental allergens on the development and ongoing inflammation of EoE, focusing on the last 10 years of relevant studies.

Many students transitioning from high school to college are faced with challenges of getting acclimated to college life and managing their time and heavy course load that is cognitively demanding. Students planning to major in science, technology, engineering, and mathematics (STEM) programs in the United States are mostly required to enroll in general chemistry courses as prerequisites. Unfortunately, these courses are among the STEM gateway courses in which many first-year students struggle to get through, or are weeded out. This is partly due to the use of ineffective study strategies that require more than rote memorization, a common learning approach in high schools. One way to prepare first-year college students for STEM trajectories is by teaching them metacognitive strategies early in their study programs to enable early adoption and sustainability of metacognition knowledge and metacognition regulation skills as they progress to the advanced courses. While a handful of studies have investigated study strategies among students in the general chemistry courses as well as the impact of metacognitive activities on student performance in chemistry, very few in-depth qualitative studies investigating the influence of explicit teaching of metacognition on students’ study strategies have been reported. Using open-ended questionnaires, this unique study investigated general chemistry students’ study strategies that they employed prior to a 50 minute metacognition lesson; strategies they reported to have gained from the instruction; and the influence of the metacognition instruction on students’ study strategies and performance in the final exam. Findings indicated more reported use of rote memorization over higher-order study strategies prior to the metacognition instruction, but more reported gains on higher-order study strategies and fewer strategies related to rote memorization immediately after the metacognition instruction. Furthermore, 67% reported a positive influence of the metacognition instruction on study strategies, with 7% lower DFs in the final exam compared to those who reported ‘no influence’. Findings revealed that most general chemistry students were unaware of effective study strategies; thus, there is a critical need to explicitly teach students in general chemistry courses metacognitive strategies.

Benefits of metacognition and active learning on student performance are well understood; however, little is known about the effect of the “explicit teaching of metacognition” combined with active ...

Introduction: Severe asthma still represents a worldwide challenge. The need for further treatment options has stimulated basic and pharmacological research to focus on the immune and inflammatory background of asthma. The new biologic drugs express the considerable advances in the field and besides providing a revolutionary treatment option for severe asthma, contribute themselves to better understand the pathophysiologic mechanisms they address, paving the way to new potential targets.Areas covered: A selective search on PubMed and Medline was performed, including the evidence on immunology of severe asthma published up to May 2019 by focusing on the immunological effects of biologic drugs underlying their clinical outcomes.Expert opinion: The recent pharmacological research in the field of biologics has represented an exceptional opportunity for exploring severe asthma mechanisms. However, some points deserve to be addressed by further investigation. Although in the absence of safety warnings so far, interfering with the immune system may raise some safety concerns, especially in the long-term use. Particularly when interacting with epithelial and innate immunity the selection of candidates probably deserves special caution. Also, whether biologics exert a true disease-modifying effect is not completely clear. As a direct practical implication, the optimal treatment duration is still controversial.

Asthma is the most common chronic disease of childhood in developed countries, with a continually increasing prevalence. The paradigm of asthma control is shifting from disease management to primary prevention, and the modification of numerous host and external factors have been proposed as methods to prevent recurrent wheeze and asthma in children, some with promising preliminary results. This article reviews potential asthma prevention strategies and identifies future areas of research.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease with incompletely understood pathogenesis. Though disease manifestations were initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that modifiable host factors and environmental allergen exposure may also play critical roles in the pathogenesis and ongoing manifestations of EoE. As with other atopic diseases, lack of early-life exposure to microbial pathogens leads to an immune tolerance defect and reprograms the commensal gut microflora toward a type 2 T helper (Th2) phenotype; the esophageal microbiota, a rich environment consisting of diverse bacterial species, is greatly altered by inflammation. Although multiple early life microbiome-altering factors are associated with EoE development, no causative, direct relationships have been identified. Interestingly, large, cross-sectional analyses of several populations identify an inverse relationship between Helicobacter pylori presence and EoE, likely via virulence factors that downregulate Th2 inflammation, though causality has not been proven. In regard to environmental allergens, some studies support seasonal variation in EoE diagnosis and flares, and EoE can be generated after a large, identifiable aeroallergen exposure. Examples include mouse models of intranasal Aspergillus dosing and following initiation of oral immunotherapy to foods or environmental allergens. Conversely, treatment of allergic rhinoconjunctivitis may improve EoE symptoms, though data is limited to case reports and small series. Unfortunately, biologic therapies for atopic conditions have failed to improve EoE symptoms despite improvement in esophageal eosinophil count, though dupilumab shows promise in ongoing studies. Overall, this chapter shows that EoE pathogenesis is likely multifactorial, and the environment is a key component in our understanding of EoE.

The immune system possesses a vast number of potential targets for therapeutic intervention. Although therapies for many pathways have been pursued, only few have yielded significant success. Hindrances in altering biologic pathways include the potential for unwanted downstream effects, ineffectiveness owing to biological redundancy, recognition of a therapeutic molecule as foreign by the body's innate immune system, and the risks of subsequent malignancy and/or autoimmunity. This article covers currently available biotherapeutic agent classes as well as potential direction for future therapy.

Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies.There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others.Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative.

During transport, horses are subjected to acceleration in three dimensions, rapid braking, turning, noise, and other stressors. The animal's ability to make postural corrections may be insufficient to prevent injury or distress, and so knowledge of the compensatory motion patterns of the horse in the trailer is a necessary precondition for smart design of transport systems. A custom two-horse trailer was built for this project. It had a horse compartment 1.85 m wide by 3.95 m long, with adjustable bulkheads and a centre divider separating the horses. The floor was instrumented with 24 shearbeam load cells to measure the vertical load imposed by each horse and its horizontal motion. Two horses were driven on a 56 km trip on both rural and urban roads. Load data were collected at 100 Hz for the 58-minute trip and were filtered with a cut-off frequency of 5 Hz using a Butterworth low-pass filter and then vertical acceleration computed. A pivot table counted sign reversals in the vertical acceleration signal, and vertical displacement was calculated using the fundamental frequency of the resulting acceleration data. Total vertical motion was calculated by making the negative displacements absolute and summing these with the positive displacements, and vertical work done was calculated by multiplying the force by the displacement measures. Horizontal motion was calculated by averaging the transverse and cranio-caudal position of the centre of pressure every second and adding the resultant displacements. Absolute vertical displacement of the two horses was 69.55 m and 97.56 m. In addition to the work done by standing, vertical work done in response to vibration was 322.4 kJ and 443.2 kJ. Horizontal excursion was 227.1 m and 243.0 m. This is a first effort to quantify the additional workload imposed on animals during transport, which will aid in the design of smart transport vehicles that will minimize the stress to horses.

Software innovations at our laboratory have made novel measures of shooting performance available to researchers, even when the data comes from a fielded military firearms training simulator not designed for research. This study analyzed specific patterns of rifle handling and control to determine how they affected reaction time and accuracy among shooters of differing skill levels. The results indicated the skilled shooters employed smoother and more efficient rifle movement while aiming than less-skilled shooters. While shooters know that trigger control and sight picture are important, this study confirms that skilled shooting is also influenced by the efficiency of the rifle movements that immediately precede the shot.

BE Chipps, T Haselkorn, K Rosen, DR Minks, BL Trzaskoma, AT Luskin. J Allergy Clin Immunol Pract. 2018;6(1):169–176.e2 To assess the impact of asthma triggers and exacerbations on asthma-specific quality of life in children. A 3-year observational study, The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens, included a cohort of 438 children aged 6 to 12 years with severe or difficult-to-treat asthma recruited from 283 sites in the United States. …

JL Baumert, SL Taylor, SJ Koppelman. J Allergy Clin Immunol Pract. 2018;6(2):457–465.e4 To calculate the clinical benefit (risk reduction of allergic reactions) of increased peanut tolerance threshold in patients who are allergic, such as those who undergo peanut immunotherapy. Included in this study is a projected model of individuals with peanut allergy who consume food products with precautionary allergen labels (eg, “may contain peanut”). The authors performed quantitative risk assessment to predict the …

Food allergy prevalence is increasing very rapidly, causing a significant disease burden. The threat of severe allergic reactions occurring unexpectedly and in settings that are not equipped to recognize and treat anaphylaxis is a constant source of worry for individuals and families with food allergies. Inadequate knowledge and understanding in the community significantly impairs the overall quality of life of these individuals and families. Additionally, families face challenges in finding and affording appropriate allergen-free foods. Advancements have been made in understanding the impact of food allergies on patient-centered outcomes such as quality of life and economic impact, and attempts have been made to develop tools to assess patient-centered variables. Innovative national and regional initiatives are helping to spread awareness of the disease condition and to create resources, including access to allergen-free foods. While there is a growing momentum toward recognition of food allergic disorders as a condition that profoundly impacts activities of daily living, greater effort needs to be expounded to develop validated tools and interventions that can adequately address these issues.