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This article presents an overview of potential treatments of food allergy, with an emphasis on various forms of immunotherapy (including oral immunotherapy, sublingual immunotherapy, epicutaneous immunotherapy, immunotherapy with modified food antigens, and immunotherapy with a recombinant peanut vaccine). Allergen nonspecific treatments, such as Chinese herbal formulas, probiotics/prebiotics, helminths, monoclonal antibodies, and toll-like receptor agonists, are also summarized.

Quantification of T-cell receptor excision circles (TRECs) for newborn screening for SCID has advanced the diagnosis of severe combined immune deficiency (SCID). However, it has led to the identification of infants with T cell lymphopenia without known cause. The clinical characteristics, appropriate laboratory monitoring, and outcomes of patients remain unclear. We performed a retrospective review of clinical and laboratory studies for 26 infants collected from 7 New York State referral centers from 2010 to 2016 with low TRECs (mean, 70 copies/μl) and subnormal CD3 counts (mean, 1150/cubic mm). Over time absolute CD3 counts increased in 17 and decreased in 9; 22 (85%) have done well clinically regardless of absolute T cell values. Additional infants with TCL will continue to be identified in newborn screening panels. While most patients seem to do well clinically, parameters for diagnosis and monitoring have yet to be formalized, and additional information needs to be collected, causes and outcomes reported.

Penicillin allergy remains the most common drug allergy, with a reported prevalence of 10% in the United States. Epidemiology of penicillin allergy in outpatient populations is relatively scarce. This study sought to determine the prevalence and characteristics of reported penicillin allergy in an urban outpatient population and to identify trends in clinical evaluation and management from a tertiary center serving a large inner-city population. A retrospective review of electronic medical records was performed of adult patients seen in the Internal Medicine Associates Clinic of Mount Sinai Hospital between January 31, 2012, and July 31, 2012. Medical records were selected based on the documentation of penicillin in patient's allergy section. Of the 11,761 patients seen in the clinic, 1348 patients (11.5%) reported a history of penicillin allergy. The most common allergic reactions were rash (37%), unknown/undocumented (20.2%), hives (18.9%), swelling/angioedema (11.8%), and anaphylaxis (6.8%). There was an increased prevalence of penicillin allergy in female patients compared with male patients (odds ratio [OR] = 1.82; 95% CI = 1.60, 2.08; p < 0.0001), and there were significantly fewer Asians with penicillin allergy compared with Caucasians (OR = 0.51; 95% CI = 0.32, 0.83; p = 0.007). However, only 78 (6%) of the patients reporting penicillin allergy had a referral to an allergy specialist. Overall, improved referral to an allergist will help to identify patients who have penicillin allergy requiring avoidance.

For patients with significant antibody deficiencies, immunoglobulin therapy is the mainstay of treatment as it significantly reduces both the frequency and severity of infections. The formulations and delivery methods of immunoglobulin have evolved over time, and continued improvements have allowed for increased access to this effective medication. This review is an update on the current status of immunoglobulin therapy in immunodeficiency disorders, and discusses the mechanisms, forms and dosing, and indications for immunoglobulin replacement.

Pneumocystis jirovecii is a leading cause of opportunistic infections among the immune compromised. During the 1980s, attention focused on patients with HIV, however, with the advent of anti-retroviral therapy, we wished to revisit the question of underlying diseases associated with Pneumocystis pneumonia in children. We identified 80 cases from 1986 to 2006 and performed a retrospective chart review to identify clinical characteristics for each of the cases. HIV was the single most common associated underlying condition seen in this cohort, accounting for 39% of the cases overall, however, it was seen in just 15% of the cases since 1998. Transplant recipients and oncology patients together comprised another 39% of the cases, with 9% of cases attributed to primary immune deficiency and another 9% of cases associated with less well-recognized causes of susceptibility. This study documents the ongoing need for vigilance to diagnose Pneumocystis pneumonia in less well-recognized clinical scenarios.

With the emergence of food allergy as an important public health problem, it has become clear that there is an unmet need in regard to treatment. In particular, IgE-mediated food allergy that is associated with risk of fatal anaphylaxis has been the subject of multiple studies in the past decade. The growing body of evidence derived from multiple centres and various study designs indicates that for IgE-mediated food allergy, immunomodulation through food immunotherapy is possible; however, the extent of protection afforded by such treatment is highly variable. At this time, the capacity for food immunotherapy to restore permanent tolerance to food has not been demonstrated conclusively. This review will discuss these topics as they apply to the most important studies of food oral immunotherapy.

Studies reveal deficits in caregivers' ability to prevent and treat food-allergic reactions with epinephrine and a consumer preference for validated educational materials in audiovisual formats. This study was designed to create brief, validated educational videos on food allergen avoidance and emergency management of anaphylaxis for caregivers of children with food allergy. The study used a stepwise iterative process including creation of a needs assessment survey consisting of 25 queries administered to caregivers and food allergy experts to identify curriculum content. Preliminary videos were drafted, reviewed, and revised based on knowledge and satisfaction surveys given to another cohort of caregivers and health care professionals. The final materials were tested for validation of their educational impact and user satisfaction using pre- and postknowledge tests and satisfaction surveys administered to a convenience sample of 50 caretakers who had not participated in the development stages. The needs assessment identified topics of importance including treatment of allergic reactions and food allergen avoidance. Caregivers in the final validation included mothers (76%), fathers (22%), and other caregivers (2%). Race/ethnicity were white (66%), black (12%), Asian (12%), Hispanic (8%), and other (2%). Knowledge tests (maximum score = 18) increased from a mean score of 12.4 preprogram to 16.7 postprogram (p < 0.0001). On a 7-point Likert scale, all satisfaction categories remained above a favorable mean score of 6, indicating participants were overall very satisfied, learned a lot, and found the materials to be informative, straightforward, helpful, and interesting. This web-based audiovisual curriculum on food allergy improved knowledge scores and was well received.

Pneumocystis jirovecii is a leading cause of opportunistic infections among the immune compromised. During the 1980s, attention focused on patients with HIV, however, with the advent of anti-retroviral therapy, we wished to revisit the question of underlying diseases associated with Pneumocystis pneumonia in children. We identified 80 cases from 1986 to 2006 and performed a retrospective chart review to identify clinical characteristics for each of the cases. HIV was the single most common associated underlying condition seen in this cohort, accounting for 39% of the cases overall, however, it was seen in just 15% of the cases since 1998. Transplant recipients and oncology patients together comprised another 39% of the cases, with 9% of cases attributed to primary immune deficiency and another 9% of cases associated with less well-recognized causes of susceptibility. This study documents the ongoing need for vigilance to diagnose Pneumocystis pneumonia in less well-recognized clinical scenarios.

A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in.To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation.Qualitative study with a participatory and iterative/dynamic design.Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed.Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers' compliance with hospital infection prevention standards. Patient satisfaction with health workers' hygiene practices also improved significantly.Hospital-based health workers' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion's share of post-war rebuilding of lives, livelihoods, and the country as a whole.

MA Ruffner, K Ruymann, S Barni, A Cianferoni, T Brown-Whitehorn, JM Spergel. J Allergy Clin Immunol Pract. 2013;1(4):343–349 The goal of this study was to describe the demographic characteristics, clinical symptoms, and allergy test results in a large cohort of patients with food protein–induced enterocolitis syndrome (FPIES). Patient charts were reviewed from The Children’s Hospital of Philadelphia, a large referral hospital with patients primarily from Pennsylvania, New Jersey, and Delaware. This study was a retrospective chart review of electronic medical records from 2007 to 2012. Originally, 992 patients were identified as having “allergic gastroenteritis and colitis” according to International Classification of Diseases, Ninth Revision , coding. …

S U N D A Y 332 Studies On Cohort Of Infants With Di-George Syndrome Detected By New York State Newborn Screening For Severe Combined Immunodeficiency (SCID) Dr. Doerthe A. Andreae, MD, Dr. Stephanie Albin, MD, Dr. Harshna Mehta, MD, Dr. Charlotte Cunningham-Rundles, MD, PhD, FAAAAI; The Icahn School of Medicine at Mount Sinai, New York, NY, Mt. Sinai Medical Center, New York, NY. RATIONALE: To assess immune and clinical status of infants with DiGeorge Syndrome referred toMount Sinai from the NewYork State (NYS) newborn screening program for severe lymphopenia. METHODS: We collected clinical and laboratory data on infants with DiGeorge Syndrome referred to Mount Sinai, one of 8 referral centers in New YorkState. Patientswith levels of T-cell receptor excision circles (TRECs) of below 125 were referred. Data collected included TREC values, CD3, CD4, CD8, NK and B cell absolute numbers as well as genotype and phenotype. RESULTS: In the first 33 months of newborn screening we saw 6 patients at Mount Sinai finally diagnosed with Di-George syndrome. 5 of these patients were female. 4 patients had undetectable TREC levels at birth (ranging from average 0 to 188 (?) and 0 to 889 on 2-4 follow up visits). All but one of those patients also had congenital heart defects of different degrees. T-cell lymphopenia ranged from 0 to 2189/cu mm absolute CD3. At least half of the patients were known to have a 22q11 deletion. One patient with 22q11 deletion had hypocalcemia and lymphopenia but no cardiac involvement. Another patient had complete DiGeorge Syndrome without chromosomal deletion due to maternal diabetes and subsequently successfully underwent thymic transplantation. A third patient with a maternal history of Di-George syndrome and 22q11 deletion was found to have Di-George syndrome with the same chromosomal abnormality. CONCLUSIONS: Newborn screening for SCID can identify patients with Di-George syndrome with varying degrees of lymphopenia.