Search

E Bergroth, M Aakula, V Elenius. J Allergy Clin Immunol Pract. 2020;8(2):588–595.e4 Respiratory syncytial virus (RSV) and rhinovirus (RV)-induced bronchiolitis are associated with increased asthma risk in children. Whether virus types have different risks associated with later development of asthma is not known. RV-A and RV-C cause more severe respiratory illness than RV-B. Cadherin-related family member 3, a receptor for RV-C, and atopy are risk factors for development of early-onset asthma. The current study investigates whether RSV or RV types are differentially associated with use of asthma medications in the 4 years following severe bronchiolitis in infancy. Children less than 24 months of age, hospitalized for bronchiolitis over consecutive winter …

EC McGowan, X Hong, J Selhub. J Allergy Clin Immunol Pract. 2020;8(1):132–140.e5 Food allergy (FA) prevalence has increased within the past decades. Prior studies have postulated an association between folate exposure and the development of allergic disease. Folate is a water-soluble B vitamin involved in DNA methylation, a process that leads to heritable changes in gene expression. The principal folate involved in DNA methylation is 5-methyltetrahydrofolate (5-MTHF). Unmetabolized folic acid (UMFA) appears in circulation when the enzyme dihydrofolate reductase (DHFR), which converts folic acid to tetrahydrofolate, is saturated. The current study is the first to examine the association between UMFA and 5-MTHF and the …

Los templos y monumentos de Copán están repletos de símbolos del agua y de sustento, ambas fuerzas importantes en el desarrollo de complejidad social a través de la región y prevalente en toda Mesoamérica. Nuestro trabajo revela que los sistemas de agua manejados en Copán y áreas circundantes de Honduras tienen una historia larga y se manifiestan en diversas formas. Además de funciones prácticas, desde irrigación hasta el almacenamiento de agua, las fuentes y sistemas de agua tenían numerosos usos religiosos. Discutiremos cómo se concebía, usaba y se representaba el agua en tiempos antiguos y las formas que en que creemos se utilizaba su carácter sagrado en el arte para elevar la autoridad política. Por medio de nuestras investigaciones sabemos que la organización comunitaria era importante para la operación exitosa del manejo de los sistemas antiguos de agua. Puede que algunos de estos métodos sean relevantes en los paisajes actuales para mejorar las condiciones de vida, asegurar la potabilidad del agua y mejorar las cosechas.

RL Wasserman, AR Hague, DM Pence. J Allergy Clin Immunol Pract. 2019;7(2):418–426.e4 This retrospective record review reports observations on the treatment of 270 patients with peanut allergy with peanut oral immunotherapy (POIT). The study included 270 patients between the ages of 4 and 18 years who received POIT in a single practice between 2009 and 2017. A total of 96.7% of patients had a history of an immunoglobulin E–mediated reaction, 70.7% had experienced anaphylaxis, 26% had a peanut-specific immunoglobulin E (PSIgE) concentration of >100 kU/mL, and 9.6% had a positive peanut challenge result within 2 years of inception of POIT. No patient was excluded on …

J Corren, M Castro, T O’Riordan. J Allergy Clin Immunol Pract . 2020;8(2):516–526 IL-4 and IL-13 are drivers of type 2 inflammation, including IgE-mediated allergic inflammation in asthma. Dupilumab blocks the shared receptor component for IL-4 and IL-13, inhibiting subsequent signaling of cytokines which drive type 2 inflammation. This study evaluated the effect of dupilumab on asthma outcome measures in subgroups of patients with asthma. This study is a post hoc analysis of patients enrolled in a phase 3, randomized, double-blind, placebo-controlled study of efficacy and safety of dupilumab, which enrolled adolescents and adults ≥12 years with physician-diagnosed asthma receiving treatment with a medium-to-high …

KY Wang, J Lee, A Cianferoni. J Allergy Clin Immunol Pract. 2019;7(2):444–450 To describe experience with oral food challenges (OFCs) for food protein-induced enterocolitis syndrome (FPIES), using a protocol that includes ingestion of one-third of the goal food serving size with 4 hours of observation, followed by home titration to goal dose. A total of 119 subjects underwent 169 OFCs at Children’s Hospital of Philadelphia to 19 different foods between 2014 and 2017. Patients with food protein-induced allergic proctocolitis were excluded. Patients with intermittent food exposures and delayed emesis within 1 to 4 hours and/or diarrhea within 5 to 10 hours were classified …

R Garcia Rodriguez, L Moreno Lozano, A Extremera Ortega, J Borja Segade, P Galindo Bonilla, E Gomez Torrijos. J Allergy Clin Immunol Pract. 2019;7(1):265–269 To determine if repeated doses of a β-lactam antibiotic are required to reproduce a nonimmediate hypersensitivity reaction in children. This retrospective observational study included 97 patients younger than 14 years of age with history of at least 1 reaction to a β-lactam antibiotic and with symptoms that began at least 6 hours after the first dose of the implicated medication. All patients underwent a 1-day in-hospital graded provocation test, with a cumulative dose of 65% of the daily dose of …

H Lindvik, Carlsen KC Lodrup, P Mowinckel, J Navaratnam, MP Borres, KH Carlsen. Clin Exp Allergy. 2017;47(6):785–794 To investigate whether the conjunctival provocation test (CPT) may be an alternative to oral food challenge (OFC) for the diagnosis of peanut allergy. The primary aim in this study was to assess the diagnostic value of the CPT. Secondary aims were evaluating the predictive value of the CPT for peanut anaphylactic reactions and examining the safety of the CPT. This cross-sectional, case-control study included 102 children with clinical or laboratory-suspected peanut allergy and a control group of 28 children of similar age who were peanut tolerant. A previous clinical adverse reaction to peanut was …

LA Pinto, S Guerra, JM Anto. Clin Exp Allergy. 2017;47(8):1050–1056 To investigate the association of being born large for gestational age (LGA) with having asthma at 8 years of age in children who are atopic and nonatopic within the Prevention and Incidence of Asthma and Mite Allergy birth cohort study. Complete data on asthma diagnosis, anthropometric measurements, specific immunoglobulin E measurements, atopic disease at the age of 8 years, and potential confounders were available for 1608 children born from the original cohort of 4146 pregnant women enrolled in the Prevention and Incidence of Asthma and Mite Allergy study. LGA was defined as a birth weight >90th percentile for sex, …

ADB Ro, MR Simpson, TB Ro. Clin Exp Allergy. 2017;47(8):1014–1021 To examine whether T helper (Th) cell proportions were affected by maternal probiotic supplementation and whether the preventive effect of probiotics on atopic dermatitis (AD) was mediated through an effect on Th cells. The study included 415 pregnant women recruited from the double-blinded, randomized, placebo-controlled Probiotics in the Prevention of Allergy among Children in Trondheim study. Study subjects were randomly assigned to ingest probiotic milk corresponding to a daily dose of 5 × 1010 colony-forming units (CFUs) of Lactobacillus rhamnosus GG, 5 × 1010 CFUs of …

INTRODUCTIONSustainable water management (an organizational mode that preserves the renewability of the resource and equitable access to it) in less developed countries is fast becoming one of the greatest environmental challenges of the twenty-first century (UNICEF and WHO 2011). The United Nations Human Rights Council recently passed a global resolution (Resolution 64/292) declaring "safe and clean drinking water and sanitation" a basic human right (cf. Bakker 2007; Mirosa and Harris 2011; UN 2010), and calling on states and international agencies to supply financial resources, technology transfer, and capacity building to provide for safe and accessible water and sanitation. Meanwhile, in Honduras, government agencies charged with overseeing water and sanitation have largely failed to meet the demands of growing metropolitan areas (Balthasar 2011). Private sector participation in water and sanitation services in periurban regions of the country has also experienced significant challenges and setbacks (Phumpiu and Gustafsson 2009). Community-based interventions in rural sectors by outside development organizations seeking to design treatment and delivery of potable water have also been largely ineffective (Fogelberg 2010). Even self-organized efforts by communities in different residential contexts have been unsustainable (Casey 2005). Why are communities in Honduras struggling to obtain safe and clean water?In this article, we take a holistic look at the social, economic, ecological, and engineered contexts of gravity-fed water systems in the Palmarejo Valley, a predominantly rural sector in northwest Honduras, with the greater goal of identifying key barriers to long-term sustainability of water provisioning. In doing so, we apply a systems-based perspective employing a grounded-theory and mixed-methods approach to cultural analysis (e.g., Billgreen and Holmen 2008; Loker 2003; Wells et al. 2014), which allows us to view water management as a socioecological system (Bennett 1976) that couples human behaviors and perceptions with the biophysical environment. This perspective resembles what geographers and other social scientists increasingly refer to as the "hydrosocial cycle" (Linton 2014; Sultana and Loftus 2012; Swyngedouw 2009), which "attends to the social nature of [hydrological] flows as well as the agential role played by water, while highlighting the dialectical and relational processes through which water and society interrelate" (Linton and Budds 2013:1). After describing the household and community contexts of water management systems in Honduras, we present the results of our emerging work in the Palmarejo Valley, where we have conducted interviews with valley residents and community leaders, mapped cultural and environmental features using GPS, and performed water quality tests to measure levels and isolate sources of heavy metals and bacterial contamination.We have observed that community-based approaches commonly employed in development projects in this region may not be appropriate in all contexts due, in part, to the scale at which they operate. While the utility of the concept of scale has been debated (Leitner and Miller 2007; Marston et al. 2005; Moore 2008), we find it useful in our research for characterizing the sociospatial constructs that actors develop and deploy in different political and economic contexts to influence how individuals, organizations, and institutions manage resources (see Herod 2011; e.g., Goodman et al. 2008). Here, our emphasis is not on spatial categories, per se, but on the social processes that constitute them (Marston 2000) and the connections that link them (Latour 1993). The social construction of scale can thus be seen as a material expression of power relations (MacKinnon 2010). Water, in particular, is increasingly subject to "scale challenges" (Cash et al. 2006), because it moves across social and natural landscapes-or waterscapes (Budds and Hinojosa 2012)-that crosscut multiple scales (Norman et al. …

Ulúa-style marble vases played important social, political, economic, and religious roles in southern Mesoamerica during the seventh through eleventh centuries A.D. However, most such vessels known to archaeologists are part of looted collections or else were unearthed before the advent of modern archaeological practices. As a result, little is known about the context, use, and chronology of these objects. Recent investigations at the site of Palos Blancos in northwest Honduras discovered an Ulúa-style marble vase in an undisturbed mortuary context. Excavation of the burial context, along with bioarchaeological and stable isotope analysis of the human remains, suggests that the vase was placed as an offering, possibly to an ancestor of the residential group. Phosphate and pollen studies indicate that the vase once held a corn-based beverage . Radiocarbon dating of four charcoal samples from immediately below and adjacent to the vase yielded a range of dates from the beginning of the Late Classic period, ca.A.D. 600-800. Through analyses of the context and contents of the vase, this research contributes to a more holistic understanding of the use and meaning of Ulúa-style marble vases in southern Mesoamerica.

B Tao, K Bernardo, P Eldi. Clin Exp Allergy. 2016;46(7):1004–1014 To evaluate the impact of extended boiling on peanut allergenicity and T cell reactivity. Blood samples were collected from 10 peanut-allergic children ages 8 to 14 years with peanut-specific IgE ranging from 91.8 to >100 kU/L. Skin prick tests using boiled peanut extracts were performed on 20 known peanut-allergic children ages 2 to 16 years. Blood samples were collected for peanut antigen-specific T cell assays from 3 peanut-allergic patients and 3 nonallergic volunteer controls. Raw peanuts were boiled for 30 minutes, 1 hour, 2 hours, 4 hours, and 12 hours in deionized water. After …

Exploring the implications of a recent discovery in NW Honduras, this paper considers the ethical dilemma that arises when an archaeologist's responsibility to disseminate information conflicts with her/his commitment to protect cultural resources. We suggest that applied archaeology that benefits local communities among which investigations are conducted is a first step toward developing long-term solutions to conservation and stewardship challenges.

Recent research on pre-Hispanic Maya water management has revealed a diverse array of water-control techniques that were employed in the Maya Lowlands. Since much of this research has focused on water management for consumption and agriculture, other forms of water management—namely, for drainage and flood control—remain poorly understood. This report describes the various water-control techniques dedicated to drainage and flood control at Late Classic Copan, Honduras (a.d.600–900), and explores the social implications of this form of water control. Technological variation in water control throughout urban Copan and between Copan and Palenque, the other major Maya center where drainage and flood control have been investigated, suggests that water management at Copan may have been organized differentially across the urban center.

Recent research on prehispanic water management throughout the Americas has made significant contributions to our understanding of the diversity of adaptive systems employed in regions where water is seasonally scarce, such as the Maya Lowlands. Since much of this workfocuses on large-scale technologies, the political and economic consequences of these systems for smaller social units remain poorly understood. Social dynamics associated with less-intensive forms of water use and control are investigated at Late Classic (A.D. 600–900) Copán, in a water-rich setting of western Honduras. Ethnographic, iconographic, and archaeological datasets suggest that lagoons located in Copán’s urban residential sectors may have been conceptualized, utilized, and maintained as communal property with ancestral ties by the inhabitants of surrounding domestic groups. By shifting the scale of analysis from the polity to the community level, these lagoons can be viewed as forms of communal property that created an economic and ideological basis for local social integration but offered limited opportunity for the centralization of power through monopolistic control. Yet, toward the end of the Late Classic, the appropriation of water-related dynastic symbolism and possibly ritual seems to have provided nonroyal elites with a means for creating local social identities, which undercut and eroded royal authority.

T Gulen, H Hagglund, B Sander, B Dahlen, G Nilsson. Clin Exp Allergy. 2014;44(9):1179–1187 There is substantial overlap between the clinical manifestations of unexplained anaphylaxis (UEA) and clonal mast cell disorders (CMDs). The objective of the study was to examine the hypothesis that the pathogenesis of UEA reflects the presence of aberrant subpopulations of mast cells. Thirty (14 men, 16 women) patients (aged ≥18 years) referred to the Mastocytosis Centre at the Karolinska University Hospital for suspicion of a clonal mast cell disorder, with history of ≥1 episodes of UEA and without signs of cutaneous mastocytosis, were recruited for study. Initial retrospective data were collected through review of electronic records. UEA was diagnosed after …

A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

TR Abrahamsson, HE Jakobsson, AF Andersson, B Bjorksten, L Engstrand, MC Jenmalm. Clin Exp Allergy. 2014;44(6):842–850 To assess diversity and characterize stool bacteria during the first year of life in relation to the prevalence of allergic disease in school-age children. The children in the current study are a subset of a larger study of infants with a family history of allergic disease conducted in Sweden between 2001 and 2005. Study participants received either Lactobacillus reuteri ATCC 55730 or placebo daily from day 1 to 3 of life until 12 months of age. Stool samples were collected at ages 5 to 7 days, 1 month, and 12 months. At 2 years of age, 20 …

L Korhonen, A Kondrashova, S Tauriainen. Clin Exp Allergy. 2013;43(6):625–632 The goal of this study was to assess the relationship between enterovirus infections in the first 2 years of life and atopic diseases. It also studied the importance of different enterovirus serotypes in atopic diseases. The study population was derived from the Finnish DIPP (Diabetes Prediction and Prevention) Study. Newborn infants with HLA-DQB1 risk alleles had clinic visits every 3 to 6 months for the first 2 years of life and at subsequent intervals of 6 to 12 months. At each visit, children had a comprehensive history and physical examination performed and a venous blood sample obtained. …

This chapter examines the historical relationship between Honduran Lenca worldview and how ecological resources are managed through ritual practice. The way in which the Lenca conceive of the biophysical environment is an active process of meaning-making that takes place through their interaction with the environment. The Lenca codify this relationship in the compostura, a complex set of ceremonial performances linked to economic practices that mediate human needs and desires with those of the ancestors who animate the landscapes surrounding households and communities. Through an examination of contemporary, historical, and archeological cases in western Honduras, this chapter explores how ritual economy shapes, and is shaped by, environmental worldview.

Venom immunotherapy (VIT) is a life-saving medical treatment for individuals allergic to Hymenoptera species. Delivery of VIT is a complex process that requires proper extract preparation, shipping, storage, refrigeration, and administration by qualified medical personnel in a facility that can manage a life-threatening allergic emergency (anaphylaxis). Successful VIT requires 3 to 5 years of uninterrupted maintenance injections, which may be difficult to maintain during deployments, particularly in combat operations. The complexity of VIT has resulted in service members being deemed nondeployable and has led to interruption or discontinuation of VIT for deployed service members in the past. We report the case of a 34-year-old Army National Guard soldier who successfully received maintenance VIT while deployed to Operation Iraqi Freedom. This case demonstrates that, with proper coordination and appropriate risk assessment, continuation of complex medical care, such as VIT, can be supported in a c...

A Martorell, B De la Hoz, MD Ibanez. Clin Exp Allergy. 2011;41(9):1297–1304 To assess the safety and efficacy of an oral desensitization protocol in 2-year-old children with allergy to cow’s milk protein (CMP) as a therapeutic alternative to elimination diet. Sixty patients aged 24 to 36 months with immunoglobulin (Ig) E-mediated allergy to CMP enrolled in this multicenter study. Inclusion criteria included immediate-type clinical manifestations within 2 hours of cow’s milk ingestion, skin prick tests ≥3 mm, and serum specific IgE levels ≥0.35 kU/L for whole cow’s milk, casein, α-lactalbumin, or β-lactoglobulin. Persistence of CMP …

Rodriguez R Garcia, JM Urra, F Feo-Brito. Clin Exp Allergy. 2011;41(9):1289–1296 Previously published oral desensitization protocols require weeks to months. The current study evaluates the safety, efficacy, and immunologic effects of a rapid egg oral desensitization protocol. Twenty-three patients between 5 and 17 years of age with symptomatic immunoglobulin (Ig) E-mediated egg allergy were recruited from the Allergy Clinic of Ciudad Real General Hospital. Patients had a clinical history of IgE-mediated egg allergy and at least 1 of the following: a positive skin prick test to commercial egg extract, detection of serum specific IgE (>0.35 kU/L) to egg white or its proteins measured by fluorescence …

C Lundholm, AK Ortqvist, P Lichtenstein, S Cnattingius, C Almqvist. Clin Exp Allergy. 2010;40(7):1044–1053 Previous studies have revealed an association between high birth weight and gestational age and increased risk for subsequent atopic eczema. These researchers sought to evaluate associations between fetal growth and risk of atopic eczema or allergic rhinitis in a prospective twin cohort. Data were collected via telephone interviews between October 2004 and July 2007 from parents participating in the Swedish Twin and Medical Birth registers. Children were 9 or 12 years old. The study base included 11 020 twins; data were …

MA Rose, F Stieglitz, A Koksal, R Schubert, J Schulze, S Zielen. Clin Exp Allergy. 2010;40(9):1398–1405 Previous studies have yielded conflicting data regarding the effects of probiotics on the prevention and treatment of allergic diseases. This prospective study examined the impact of dietary supplementation with Lactobacillus rhamnosus strain GG (ATCC 53103) on allergic sensitization, asthma, and atopic eczema. Children ( N = 131) between the ages of 6 and 24 months with a history of at least 2 physician-diagnosed episodes of wheezing within the previous year and a first-degree relative with atopic disease were recruited from a clinic of the Children's Hospital at …

ME Jensen, PG Gibson, CE Collins, JM Hilton, LG Wood. Clin Exp Allergy. 2013;43(7):775–784 The goal of this study was to assess if dietary intervention (DI) can achieve weight loss in obese asthmatic children and if diet-induced weight loss leads to changes in asthma outcomes. The study evaluated 32 obese (BMI z score ≥1.64 SD score) Australian children aged 8 to 17 years, with a physician diagnosis of asthma. Exclusion criteria included unexplained weight change during the past 3 months, inflammatory or endocrine disorders, and respiratory disorders other than asthma. In this 10-week, randomized controlled trial, 32 obese asthmatic children were randomized to …

AI Stritzke, PA Eng. Clin Exp Allergy. 2013;43(8):950–955 The goal of this study was to investigate the rate of sting recurrence and outcome of Hymenoptera venom anaphylaxis in children treated with venom immunotherapy (VIT). The study included a cohort of 83 Swiss children consecutively referred for Hymenoptera venom anaphylaxis between 1990 and 2007. Inclusion criteria were diagnosis of Hymenoptera anaphylaxis followed by commencement of VIT. Diagnosis of Hymenoptera anaphylaxis required a sting followed by a systemic adverse reaction affecting the respiratory and/or cardiovascular system, a positive intracutaneous test result with European honey bee (BV) and/or Vespula (VV) venom, and specific IgE (>0.7 kU/L) to …

Gronlund H, Adedoyin J, Reininger R, et al. Clin Exp Allergy . 2008;38(8):1275–1281 PURPOSE OF THE STUDY. To measure immunoglobulin E (IgE) and IgG4 antibodies to an engineered recombinant major cat allergen, rFel d 1, among sera from cat-allergic children and adults. STUDY POPULATION. One hundred forty cat-allergic children and adults with rhinoconjunctivitis and/or asthma were selected; all had positive skin-prick test results to cat dander extract (CDE). Seventy-five healthy, age-matched, CDE-skin-test–negative children and adults were selected as control subjects. METHODS. Sera from …

Palmer D, Gold M, Makridess M. Clin Exp Allergy . 2008;38(7):1186–1191 PURPOSE OF THE STUDY. To assess human milk ovalbumin concentrations after daily maternal ingestion of 1 cooked egg for a 3-week period. STUDY POPULATION. There were 32 mothers of singleton, breastfed, egg-sensitive infants with moderate-to-severe eczema. Egg sensitivity was identified by a positive skin-prick test result. Eczema was evaluated by using a standardized scoring system. METHODS. Families had an initial home visit by an experienced dietitian, which involved collection of demographic and dietary information. All women and children were asked to follow an egg-free diet from day 1 through the duration of the trial. Adherence to the egg-free diet was …

Wickens K, Ingham T, Epton M, et al; New Zealand Asthma and Allergy Cohort Study Group. Clin Exp Allergy . 2008;38(8):1318–1324 PURPOSE OF THE STUDY. The goal was to examine the association between antibiotic exposure in infancy and the development of asthma, eczema, and atopy in early childhood. A secondary goal was to determine whether the association is secondary to confounding chest infections in infancy. STUDY POPULATION. Expectant mothers were recruited from a random sample of midwives in 2 major New Zealand cities between 1997 and 2001; full details on the nonresponding mothers are incomplete. METHODS. This was a birth cohort study that collected reported antibiotic exposure before 3 months and before 15 months, along with outcomes (wheeze, asthma, eczema, rash, and inhaler use) at 15 months ( N = 1011) and 4 …

Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E. Clin Exp Allergy . 2008;38(8):1342–1348 PURPOSE OF THE STUDY. To explore factors in infant sensitization and the effect of probiotics. STUDY POPULATION. The researchers evaluated 171 mother-infant pairs from an ongoing, placebo-controlled, double-blind study with nutrition modulation through dietary counseling and probiotic supplementation. METHODS. Mothers with no chronic or metabolic disease before or during early pregnancy had dietary counseling and were randomly assigned to receive either probiotics ( Lactobacillus rhamnosus strain GG and Bifidobacterium lactis Bb12) or placebo from the first trimester of pregnancy to the end of exclusive breastfeeding. Atopic sensitization of the infants was assessed by skin-prick test to cow's milk, egg white, wheat, rice, gliadin, cod, soya bean, birch, 6 grasses, cat, dog, Dermatophagoides …

Yu JA, Kagan R, Verreault N, et al. J Allergy Clin Immunol. 2006;118:466–472 PURPOSE OF THE STUDY. To determine the current frequency of accidental exposures occurring in peanut-allergic children and identify factors associated with exposure. STUDY POPULATION. Children 4 years of age and older, who were diagnosed with peanut allergy at the Montreal Children's Hospital Allergy Clinic (Quebec, Canada) between January 2000 and February 2005. METHODS. Parents of children with peanut allergy completed questionnaires about accidental exposure to peanut occurring over the preceding year. Details of the accidental exposure requested included age of the child, quantity and type of food ingested, location of ingestion, allergic symptoms, onset and duration of reaction, and treatment administered. Medical charts were reviewed to confirm eligibility criteria, demographic information, atopic history, family history, details of the initial and most severe accidental reaction, number of previous accidental reactions, and previous use of epinephrine. RESULTS. A total of 252 (57.7%) of 437 parents of children with peanut allergy completed a questionnaire. Chart review allowed comparison between participants and nonparticipants. Of participants, 62% were boys and the mean age was 8.1 years. The mean age at diagnosis was 2 years. There were 35 accidental exposures among 29 children over a period of 244 patient-years (annual incidence rate: 14.3%). Reactions were mild (15), moderate (16), and severe (4). Of the 20 children with reactions that were moderate to severe, only 4 received epinephrine. Eighty percent of children attended schools that prohibit peanut; only 1 accidental exposure occurred at school. Neither univariate nor multivariate logistic regression analyses identified any clinically important associations with inadvertent exposure to peanut. CONCLUSIONS. Children with peanut allergy residing in Quebec had an annual incidence rate of accidental exposure to peanut of 14.3%. This finding is substantially lower than previously reported incidence rates. Predictors of accidental exposure could not be identified. REVIEWER COMMENTS. In this study, only 1 of 35 accidental exposures occurred in school. Coupled with the lower incidence of accidental exposures reported in this study, these data may suggest that enhanced education about and awareness of peanut allergy in the public sector have been effective. The majority of accidental exposures occurred at the patient's home (14) or the home of a friend or relative (12), which underscores the critical importance of education of the family, friends, and caregivers of children with peanut allergy.

Purpose of the Study. Food allergy affects up to 6% of children, and adverse reactions can be fatal. Appropriate emergency treatment consists of early administration of injectable epinephrine. Previous studies have revealed deficiencies in parental knowledge surrounding indications for self-injection, deficiencies in the method of EpiPen administration, and underuse in children experiencing anaphylaxis. This study explores whether underuse of EpiPen may be attributed to parental discomfort with administration, as measured by a lack of parental empowerment and knowledge of proper administration. Study Population. Parents of children with physician-diagnosed food allergy who had been prescribed an EpiPen. Methods. A self-administered survey was mailed to parents of children with food allergy, recruited through a food-allergy support group and a pediatric allergist’s practice. The questionnaire collected demographic information, medical history, history of previous “life-threatening allergic reaction(s),” past experience with EpiPen use, and knowledge of EpiPen indications. Knowledge was assessed with a series of multiple-choice and true/false queries. Perceived parental comfort with EpiPen administration was measured with a 10-cm analog scale, anchored with “uncomfortable” versus “very comfortable” at either end. Empowerment was measured with a 16-item instrument, including statements directly from or modified from the previously validated Family Empowerment Scale. Results. Of 360 mailed surveys, 165 eligible surveys were included in the study (46%). The majority of respondents were married white mothers with college or advanced degrees. The children of respondents ranged in age from 1 to 19 years. Previous anaphylaxis was reported in 70 responses (42%). Fourteen parents (8%) had administered the EpiPen to their child. Factors correlating with parental comfort with EpiPen administration included previous administration of EpiPen, EpiPen training, and high empowerment scores. Neither a history of previous anaphylaxis nor parental knowledge correlated with an increased level of reported comfort with EpiPen administration. Conclusions. Increased empowerment scores directly correlated with increased parental comfort with EpiPen use. Although increased knowledge scores did not prove to be a significant contributor to parental comfort, training on EpiPen use is an important component in improving parental comfort. The authors question the impact of other psychological factors, such as fear, that may contribute to underuse of the EpiPen. Reviewer Comments. Previous studies of parental EpiPen administration have reported incorrect use of autoinjectors despite training at the time of prescription. This study suggests that factors beyond parental knowledge are critical for proper administration of this potentially life-saving medication. The importance of hands-on training to increase caregiver comfort is underscored by this study. Demonstration units and training videos are available free of charge through the manufacturers for EpiPen and the Twinject, another epinephrine self-injection unit not discussed in this study.

Purpose of the Study. Reports of paracetamol (acetaminophen) allergic and nonallergic hypersensitivity reactions are rare. However, urticaria, angioedema, dyspnea, and allergic and nonallergic anaphylactic reactions have been reported in both children and adults in association with paracetamol administration. Most reactions to paracetamol occur in patients with a nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs (NSAIDs). Alternatively, reactions may result from an allergic hypersensitivity to paracetamol, with tolerance of NSAIDs. This study reports an investigation of 25 children with suspected paracetamol hypersensitivity. Study Population. Twenty-five children, aged 8 months to 15 years, with a history of adverse reactions associated with paracetamol administration. In 12 of the 25 children studied, paracetamol adverse reactions were associated with concurrent administration of other medications or biological agents. Methods. Diagnosis of paracetamol hypersensitivity was based on either clinical history or the results of an oral challenge test. Reported reactions included urticaria, angioedema, conjunctivitis, dyspnea, and a maculopapular rash. Oral challenge tests with paracetamol were performed in the hospital setting. Paracetamol dosing was initiated at 1 mg and gradually increased until the appropriate cumulative dose for age and weight was achieved. An oral challenge with acetylsalicylic acid was performed in 1 child with a history highly suggestive of paracetamol hypersensitivity. Results. Paracetamol hypersensitivity was diagnosed in 1 patient (4%) on the basis of clinical history. The child reported accelerated reactions on 2 occasions, including facial angioedema, conjunctivitis, and dyspnea with wheezing, after isolated intake of paracetamol. Oral challenge to acetylsalicylic acid in this patient induced urticaria and angioedema. Oral challenges to paracetamol in the 24 other children studied were tolerated. Conclusions. Results of this study of 25 children with suspected paracetamol hypersensitivity concur with those of previous reports: paracetamol hypersensitivity is rare and is associated with hypersensitivity reactions to antiinflammatory medications. Reviewer Comments. Adverse reactions temporally associated with paracetamol may result from reactions to other medications or the underlying conditions for which these medications have been prescribed. Diagnostic evaluation of suspected paracetamol hypersensitivity is complicated further by the lack of validated, available skin or in vitro testing. Adverse reactions to paracetamol can be both allergic and nonallergic in nature. The results of this study underscore the need for careful evaluation for both paracetamol and NSAID hypersensitivity in children with a history suggestive of adverse reactions to paracetamol.

CJ Lodge, AJ Lowe, LC Gurrin. Clin Exp Allergy. 2012;42(9):1377–1385 To investigate the relationship between pet keeping at birth and the risk of sensitization, wheeze, allergic rhinitis, and eczema over the first 12 years in a cohort selected for familial allergy. A total of 620 infants were enrolled in a prospective birth cohort in Australia between 1990 and 1994. Eligible infants had at least 1 first-degree family member with a history of eczema, asthma, allergic rhinitis, or severe food allergy. Data on pet keeping, demographics, and cord blood samples were collected. Demographic information included parental smoking history, presence of carpets in the home, number of siblings, parental history of atopic …

C Almqvist, S Cnattingius, P Lichtenstein, C Lundholm. Clin Exp Allergy. 2012;42(9):1369–1376 To investigate if cesarean delivery (CD) increases the risk of asthma in childhood and adolescence. The study population consisted of a cohort of 87 555 Swedish siblings (175 110 children). This register-based cohort study linked the study population to the Swedish Prescribed Drug Register and the National Patient Data Register. These databases contain prescriptions and inpatient and outpatient visit diagnoses for the majority of the study period. Asthma outcome variables, including medication and asthma diagnosis, were collected at the 10th or 13th year of life (age 10 for children born June 1996 through …