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Publications (6)13.47 Total impact

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    ABSTRACT: The aim of this study was to determine whether screening for food hypersensitivity could be a clinically useful biomarker for eosinophilic duodenitis in the pediatric population. Twenty-two patients with functional dyspepsia and 19 controls with no significant history of gastrointestinal or allergic disorders were enrolled. Participants underwent skin prick, atopy patch, and serum-specific (S)-IgE, -IgG, and -IgG4 testing to corn, wheat, soy, peanut, milk, and egg. Participants in the patient group also underwent endoscopy with biopsies as part of standard care. Three participants in the patient group did not exhibit duodenal eosinophilia on biopsy and were excluded from data analyses. The patient group consisted of 13 females and 6 males, 8 to 17 years of age. The control group consisted of 10 females and 9 males, 8 to 17 years of age. Seven patients had at least 1 positive reaction to food by skin prick, atopy patch, or SIgE testing compared with 7 controls; odds ratio 1; 95% confidence interval 0.3 to 3.7. Receiver operating characteristics curves showed SIgG and SIgG4 performed poorly or no better than chance for predicting group assignment. Allergy screening for the foods tested was not useful as a biomarker for eosinophilic duodenitis in this small study. A higher rate of positive reactions to patch testing was observed in the control group than previous studies have reported. The incidence of a positive food patch test in nonselected subjects needs further investigation. Method standardization and establishment of reference intervals are needed for atopy patch tests, SIgG, and SIgG4 to better evaluate the clinical value of these measures.
    Journal of pediatric gastroenterology and nutrition 02/2010; 50(4):377-84. · 2.18 Impact Factor
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    ABSTRACT: Intervention in the home environment to reduce asthma triggers theoretically improves health outcomes for asthmatic children. Practical benefit from application of these interventions has proven difficult. This single-blind study tested the effectiveness of simple low-cost home interventions in improving health scores of children with asthma. Families with at least one asthmatic child were recruited. Initial health examination, health, and home assessments were conducted and targeted interventions were implemented. Interventions included dehumidification, air filtration, furnace servicing, and high-efficiency furnace filters. When present, gross fungal contamination was remediated. Asthma education was provided along with education in healthy home practices. Follow-up assessments were conducted after 6 months. Health surveys were completed at enrollment and follow-up. This study enrolled 219 children with asthma. Home inspections and interventions were conducted in 181 homes and 83 families completed all phases. Reduction in asthma and allergy-related health scores was shown in follow-up health surveys. Health improvements were significant for cough when heating, ventilation, and air conditioning (HVAC) service and dehumidification were used. Breathing problems were significantly improved for dehumidification, HVAC service, and room air cleaners. Total dust allergen load was reduced for the dehumidification group (p < 0.05). Mold spore counts were reduced one order of magnitude in 25% of the homes. Indoor spore counts adjusted for outdoor spore levels were reduced overall (p < 0.01). Simple low-cost interventions directed to producing cleaner indoor air coupled with healthy home education improve the indoor air quality and health in asthmatic children.
    Allergy and Asthma Proceedings 06/2009; 30(4):377-85. · 2.19 Impact Factor
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    ABSTRACT: Methods for assessing and controlling fungi in the indoor environment have been well documented, but the role of fungal allergen avoidance and respiratory disease control is just beginning to be studied. To investigate indoor fungal spore levels to determine if remediation produced reduction of these levels. The study was performed on homes remediated for excessive fungal load during 2000 to 2002. Homes were included in the study if they had professional fungal remediation. Airborne spore samples were taken both before and after remediation. Slides were mounted with glycerin jelly that contained Calberla's solution. Spores were identified and counted microscopically at a magnification of X 1000. Counts were represented as the number of spores per cubic meter of air. Preevaluations and postevaluations were conducted for 17 structures. There were 92 individual collections before remediation and 99 collections after remediation. Mean counts were 131,687 (median, 9461) before remediation and 1291 (median, 409) after remediation. Aspergillus and Penicillium spores (which were counted together) occurred with the highest frequency in preremediation structures (88%). Stachybotrys spores were present in 53% of structures before remediation. Cladosporium spores were found in highest frequency in postremediation collections. Preremediation houses contained at least a 1-log increase in AspergilluslPenicillium spores over outside collections. In postremediation houses, indoor spore counts averaged 18% of outdoor counts. Remediation for indoor fungal spore contamination can significantly reduce spore counts. Indoor collections in preremediation buildings are generally much higher than outdoor counts for critical spore types, including Aspergillus/Penicillium and Stachybotrys. Remediation provides indoor spore levels substantially lower than outdoor counts.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 04/2007; 98(3):262-8. · 3.45 Impact Factor
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    ABSTRACT: To review the nontoxic harmful effects that poor indoor air quality caused by fungi can have on health. We searched PubMed for publications related to the various topics discussed in this review, and we relied on our knowledge of the field. Where more than one publication was relevant, we attempted to identify a consensus of the reports and cited the most relevant articles. Priority was given to randomized controlled trials and expert reports when available, although much of the information herein relates to laboratory research. Actively growing fungal colonies can release volatile substances that have an unpleasant smell, leading to psychological responses in the occupants such as fatigue and nausea. Symptoms that are likely caused by indoor fungi include respiratory complaints that involve the nose and lungs, eye symptoms, and mucous membrane irritation. These adverse effects can occur by a variety of mechanisms, including IgE-mediated hypersensitivity, fungal infection, irritant reaction to spores or fungal metabolites, and possibly toxic reaction to mycotoxins. Reduced fungal exposure can reasonably be expected to improve health. Removal of moisture from the indoors and proper maintenance of air filters can aid in prevention and elimination of fungi from the home environment. Small areas of present contamination can be cleaned with a dilute bleach solution, which kills viable colonies and removes their mycelia. If fungal contamination is not addressed early, substantial damage can occur, requiring professional remediation. Above all, the individual should not panic at the first sight of fungi growing in the home. Regular inspection and cleaning can prevent many fungus-related problems.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 04/2005; 94(3):313-9; quiz 319-22, 390. · 3.45 Impact Factor
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    ABSTRACT: RationaleImmunotherapy (IT) is designed to modulate allergic airway response. Exhaled nitric oxide (eNO) is a sensitive marker of airway inflammation in allergic respiratory disorders. We aim to characterize the pattern of eNO levels in pediatric patients undergoing immunotherapy.
    Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2004; 113(2).
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    ABSTRACT: The mechanisms by which immunotherapy (IT) modulates allergic airway response are not entirely clear. Exhaled nitric oxide (eNO) is a sensitive marker of airway inflammation in allergic respiratory disorders. We hypothesize that eNO may serve as a barometer of the immunomodulatory changes occurring during IT. We aimed to characterize the pattern of eNO levels in children undergoing traditional IT (TradIT) and rush IT (RushIT). Off-line measurements of eNO were obtained in children electing to undergo RushIT or TradIT at a University-based Allergy/Asthma Clinic. The eNO was measured before IT (pre-IT, week 0) was initiated, and at 2, 4, 6, 8, and 12 weeks after starting IT. Nine children received TradIT and 10 children received RushIT. Pre-IT eNO in the RushIT group averaged 12.6 parts per billion (ppb). This was followed by a rise to 17.7 ppb at week 2. The elevated eNO levels persisted till week 8, and then dramatically dropped below the pre-IT values to 8.9 ppb at week 12 (p = 0.038). Similar changes in eNO were not seen in the TradIT group. The difference in eNO levels between the two groups was most marked at 4 weeks (p = 0.014). Initiation of IT produces significant immunomodulatory changes such as a rise in eNO levels. Temporally, the changes appear to be accelerated in the RushIT group compared with the TradIT group, with return to baseline as maintenance IT levels are achieved.
    Allergy and Asthma Proceedings 27(2):140-4. · 2.19 Impact Factor