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PURPOSE OF THE STUDY: To identify risk factors for home epinephrine-treated reactions (HETR), a marker of severe reactions during oral immunotherapy (OIT) to peanut and tree nuts. may improve its utility, particularly in patients where no trigger is identified. STUDY POPULATION: Participants included 642 patients, aged 3.7 to 35.6 years (median age 6.8 years), with a confirmed allergy to peanut, tree nut (walnut, cashew, hazelnut), sesame, or egg who underwent 756 OIT treatments in an open-label OIT program. METHODS: Enrolled patients had immunoglobulin E sensitization to the treated food and either a history of recent (within the last year) allergic reaction or a positive oral food challenge. They were first evaluated in the clinic to confirm the diagnosis and determine the individualized single highest tolerated dose (SHTD), which did not elicit symptoms. Patients then ingested the SHTD at home daily with up-dosing in the office every 4 weeks with a goal of reaching a maintenance dose of 300 mg daily for most foods. Any severe reactions (defined by severe abdominal pain, significant shortness of breath, lethargy, or otherwise if in doubt) were recommended to be treated with epinephrine and were later assessed by questionnaire for potential triggers. RESULTS: Full desensitization was achieved in 656 treatments (86.7%), partial desensitization in 64 (8.4%), and 37 (4.9%) failed to reach the maintenance dose. HETRs occurred in 83 patients (10.9%) and reactions treated with epinephrine during clinic up-dosing occurred in 107 patients (14.2%). In 34% of HETRs, no trigger could be identified beyond the OIT dose. In cases where a specific trigger was identified, physical exercise (19%) was the most common, followed by fatigue (12%) and concurrent illness (10%). Asthma exacerbations were not a trigger in any of the HETRs. Risk factors for HETR were older age (P = .04), a history of anaphylactic reactions, a reaction treated with epi-nephrine or in the emergency department before OIT or during in-clinic OIT induction (P < .001), and a low SHTD at OIT start (P = .001). CONCLUSIONS: The main risk factor for HETRs was the severity of reaction(s) to the treated food before or during the induction of OIT. HETRs also increased with increasing patient age in early and midadolescence and lower SHTD. Some triggers identified in this study (exercise, illness, and fatigue) have been described in other studies, although no trigger was identified in one-third of HETRs. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY: To evaluate safety, tolerability, pharmacokinetics, and efficacy of ruxolitinib cream (topical formulation of JAK1/JAK2 inhibitor ruxolitinib) in chil- dren and adolescents with atopic dermatitis (AD). STUDY POPULATION: The study population included patients aged 2 to 17 years with AD affecting 8% to 20% of their body surface area (excluding scalp) and had an Investigator's Global Assessment score of 2 or greater. METHODS: The study population was enrolled stepwise into 6 cohorts defined by age (12-17 years, 7 to <12 years, and 2 to <7 years) and ruxolitinib cream strength (0.5%, 0.75%, or 1.5%) with 2 cohorts within in each range. Ruxo-litinib cream was applied topically twice daily as a thin film to the affected areas for 28 days. Assessments for safety, pharmacokinetics, and efficacy were collected on day 1 (baseline), day 10 (week 2), and day 29 (week 4). RESULTS: A total of 71 patients were enrolled into the 6 cohorts. Treatment emergent adverse events related to ruxolitinib cream occurred in 4 patients (5.6%). No clinically significant changes in bone biomarkers, hematology, or chemistry values were observed. Plasma concentrations of ruxolitinib within all cohorts (range 23.1-97.9 nM) were generally low. All patients had reductions in baseline Eczema Area and Severity Index scores at week 2, and the mean percentage improvement increased in 5 out of 6 cohorts at week 4. Investigator's Global Assessment treatment success was achieved by 5 out of 6 cohorts at week 2 and was increased in all cohorts at week 4. Mean total body surface area affected by AD and Patient-Oriented Eczema Measure decreased in all cohorts at week 2, with further decreases in all cohorts at week 4. Substantial improvements were seen in itch scores in cohorts 1 to 4 (assessed only in cohorts with children aged 7 and older) at week 2 and were maintained or improved at week 4. CONCLUSIONS: In an open label study, ruxolitinib cream was a safe and well tolerated treatment option for children aged 2 to 17 with atopic dermatitis affecting <20% of body surface area. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY: To evaluate the feasibility and safety of a novel strategy of performing direct amoxicillin-graded oral challenge (GOC) in a pediatric general practitioner office in a prospective pilot study. STUDY POPULATION: Children aged 2 to 17 years old with emergency medical record-listed penicillin allergy labels were recruited from Children's Health Medical Center of Dallas between December 2021 and October 2022. METHODS: Once eligibility was confirmed (excluding those with history of severe cutaneous adverse reaction phe-notypes), patients underwent a 2-step nonblinded GOC with amoxicillin 50 mg followed by a 200 mg dose with a 10-minute interval in between doses and a 60-minute observation period performed during routine health care maintenance visits. RESULTS: Eighty-six of the initial 112 (77%) screened were deemed eligible for participation. Twenty-three proceeded on to the challenge (21%). Of the 23 that underwent GOC, 21 passed without any reaction (91%). Of the 2 with reactions, 1 was an immediate erythematous macule, and the other patient had a delayed mild maculopapular exan-them that occurred approximately 4 hours after completion of the challenge. Both reactions were nonurticarial and improved with oral antihistamine therapy. All (100%) of the parents and caregivers reported satisfaction with the amoxicillin challenge testing, and all patients who completed the challenge without any reaction said they would CONCLUSIONS: This pilot study supports known data that most children who are labeled to have penicillin allergy are indeed not allergic when challenged, but also offers a novel process for completing in-office challenges by primary care physicians. Importantly, it supports evidence that direct GOC to amoxicillin is safe and parents and care-givers of those challenged are satisfied with the procedure and are likely to use penicillin antibiotics in the future if needed. [ABSTRACT FROM AUTHOR]

A review of the article "Racial Disparities in Allergic Outcomes Persist to Age 10 Years in Black and White Children" by A. Sitarki et al, which appeared in a 2020 issue of the journal "Annals of Allergy, Asthma and Immunology" is presented.