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ABSTRACT: The optimal time for transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use from adults to children and teenagers has not yet been defined.
To determine whether pediatric allergists have age-specific goals for beginning to transfer responsibilities for anaphylaxis recognition and epinephrine auto-injector use from parents and caregivers to children and teenagers at risk of anaphylaxis in the community.
Members of the American Academy of Pediatrics Section on Allergy and Immunology (AAP-SOAI) were surveyed about when they typically begin to transfer these responsibilities from adults to children and teenagers.
Eighty-eight allergists responded to the survey, 97.7% of whom provided service to children and teenagers with food allergies. Few allergists expected to begin transferring responsibilities for anaphylaxis recognition and epinephrine auto-injector use to children younger than 9 to 11 years. By the time their patients reached age 12 to 14 years, however, most allergists expected them to be able to describe some anaphylaxis symptoms (95.4%), demonstrate how to use an epinephrine auto-injector trainer (93.1%), begin carrying self-injectable epinephrine (88.2%), recognize the need for epinephrine (88.1%), learn to self-inject epinephrine (84.5%), and be able to self-inject epinephrine (78.6%) (cumulative data). The allergists rated the following as "very important" readiness factors for beginning to transfer responsibilities: medical history, developmental level, and ability to demonstrate auto-injector technique.
Most pediatric allergists expected that by age 12 to 14 years, their patients should begin to share responsibilities with adults for anaphylaxis recognition and epinephrine auto-injector use; however, they individualized the timing based on assessment of patient readiness factors.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 05/2012; 108(5):321-5. · 2.83 Impact Factor
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Allergy Asthma and Clinical Immunology 11/2011; 7 Suppl 2:A11.
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Allergy Asthma and Clinical Immunology 11/2011; 7 Suppl 2:A12.
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ABSTRACT: Epinephrine autoinjectors provide life-saving therapy for individuals with peanut allergies. OJECTIVE: To evaluate the association between socioeconomic status (SES) and epinephrine prescription among urban Canadian children with peanut allergy.
Population-based survey data from school children in grades 1 and 2 participating in the Toronto Child Health Evaluation Questionnaire were used. Children with peanut allergy, their epinephrine autoinjector prescription status and their SES were identified by parental report.
Between January and April 2006, 5619 completed questionnaires from 231 Toronto, Ontario, schools were returned. A total of 153 (2.83%) children were identified as having a peanut allergy, 68.6% of whom reported being prescribed an epinephrine autoinjector. Children from upper-middle and high-income homes (OR 8.35 [95% CI 2.72 to 25.61]) and with asthma (OR 4.74 [95% CI 1.56 to 14.47]) were more likely to report having an epinephrine prescription.
A significant health disparity exists in the prescribing pattern of epinephrine autoinjectors for peanut-allergic children from families of differing SES.
Paediatrics & child health 06/2011; 16(6):341-4. · 0.78 Impact Factor
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ABSTRACT: We investigated Upstate New York school building conditions and examined the associations between school absenteeism and building condition problems.
We merged data from the 2005 Building Condition Survey of Upstate New York schools with 2005 New York State Education Department student absenteeism data at the individual school level and evaluated associations between building conditions and absenteeism at or above the 90th percentile.
After adjustment for confounders, student absenteeism was associated with visible mold (odds ratio [OR]=2.22; 95% confidence interval [CI]=1.34, 3.68), humidity (OR=3.07; 95% CI=1.37, 6.89), poor ventilation (OR=3.10; 95% CI=1.79, 5.37), vermin (OR=2.23; 95% CI=1.32, 3.76), 6 or more individual building condition problems (OR=2.97; 95% CI=1.84, 4.79), and building system or structural problems related to these conditions. Schools in lower socioeconomic districts and schools attended by younger students showed the strongest associations between poor building conditions and absenteeism.
We found associations between student absenteeism and adverse school building conditions. Future studies should confirm these findings and prioritize strategies for school condition improvements.
American Journal of Public Health 09/2010; 100(9):1679-86. · 3.93 Impact Factor
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ABSTRACT: We conducted this study to compare environmental exposures in suburban homes of children with asthma to exposures in inner city homes of children with asthma, to better understand important differences of indoor pollutant exposure that might contribute to increased asthma morbidity in the inner city. Indoor PM(10), PM(2.5), NO(2), O(3), and airborne and dust allergen levels were measured in the homes of 120 children with asthma, 100 living in inner city Baltimore and 20 living in the surrounding counties. Home conditions and health outcome measures were also compared. The inner city and suburban homes differed in ways that might affect airborne environmental exposures. The inner city homes had more cigarette smoking (67% vs. 5%, p < .001), signs of disrepair (77% vs. 5%, p < .001), and cockroach (64% vs. 0%, p < .001) and mouse (80% vs. 5%, p < .001) infestation. The inner city homes had higher geometric mean (GM) levels (p < .001) of PM(10) (47 vs. 18 microg/m(3)), PM(2.5) (34 vs. 8.7 microg/m(3)), NO(2) [19 ppb vs. below detection (BD)], and O(3) (1.9 vs. .015 ppb) than suburban homes. The inner city homes had lower GM bedroom dust allergen levels of dust mite (.29 vs. 1.2 microg/g, p = .022), dog (.38 vs. 5.5 microg/g, p < .001) and cat (.75 vs. 2.4 microg/g, p = .039), but higher levels of mouse (3.2 vs. .013 microg/g, p < .001) and cockroach (4.5 vs. .42 U/g, p < .001). The inner city homes also had higher GM airborne mouse allergen levels (.055 vs. .016 ng/m(3), p = .002). Compared with the homes of suburban children with asthma, the homes of inner city Baltimore children with asthma had higher levels of airborne pollutants and home characteristics that predispose to greater asthma morbidity.
Journal of Urban Health 07/2007; 84(4):577-90. · 2.13 Impact Factor
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ABSTRACT: Food allergic consumers depend on ingredient labels for allergen avoidance, and the modality of labeling is changing.
To investigate current responses to food labels so that the impact of future label changes can be anticipated.
Adults who attended Food Allergy & Anaphylaxis Network conferences completed a survey regarding their experiences with food labels for their family's most severely affected food allergic individual (FAI).
There were 489 completed surveys (84% participation). Most FAIs were young (41% <4 years of age and 56% 4-18 years of age) and highly atopic (51% had asthma and 69% had atopic dermatitis). Food allergies included the following: peanut, 81%; tree nuts, 53%; milk, 51%; egg, 51%; and soy, 17%. All chocolate products were avoided by 37% of FAIs who were avoiding peanut and 40% who were avoiding tree nuts; 91% of tree nut allergic FAIs avoided all tree nuts. Of FAIs who avoided soy, 41% avoided soybean oil and 38% avoided soy lecithin. Of those who avoided milk, 82% avoided lactose. Allergic reactions were attributed to misunderstanding label terms (16%) and to nonspecific terms (spice, flavor) (22%). Ingredient labels were "always" or "frequently" read before purchase by 99%. Product brand choice was "very much influenced" by the manner of labeling for 86%, and manufacturers were contacted for more information by 86%.
Our results suggest that improved product allergen labeling will reduce allergic reactions and simplify allergy management. However, the new labeling may not indicate the form or source of the allergen, and individuals who do not currently avoid foods with minimal or irrelevant protein content, such as soy oil or soy lecithin, may face additional ambiguity and unnecessary dietary restrictions.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 11/2005; 95(5):426-8. · 2.83 Impact Factor
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ABSTRACT: Rhinoviruses (RV) cause 50% of common colds and are frequently isolated from children and adults hospitalized for asthma exacerbations. Although colds may trigger severe coughing and wheezing, it is not known whether these symptoms are a result of lower airway infection with RV. Previous efforts to address this question by sampling lower airway secretions during experimental RV infections have been complicated by the possibility of contamination of the bronchoscope with nasopharyngeal cells and secretions. To further test the hypothesis that RV infections involve the lower airways, tracheal and nasal secretions were obtained from 23 pediatric tracheostomy patients, including seven with cold symptoms and 16 asymptomatic controls. RV was detected by reverse-transcription polymerase chain reaction from the nasal and tracheal secretions of three of the seven children with cold symptoms. In the 16 well children, RV was not detected in any samples of nasal secretions, but was isolated from four samples of tracheal secretions. These results demonstrate the presence of RV in the lower airways of children with tracheostomies during community-acquired colds, without the possibility of nasal contamination. In addition, these findings suggest that children with tracheostomies carry subclinical viral infections in their tracheas, rather than their noses.
Pediatric Allergy and Immunology 06/2005; 16(3):276-8. · 2.46 Impact Factor
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ABSTRACT: Airborne mouse allergen has not previously been measured in inner-city homes, and its relationship to settled dust mouse allergen levels is unknown.
To quantify airborne and settled dust Mus m 1 levels in homes of inner-city patients with asthma and to identify risk factors for mouse allergen exposure.
One hundred inner-city school-age children with asthma in Baltimore underwent skin testing to a panel of aeroallergens, and their homes were inspected by a trained technician. Air and settled dust were sampled in the child's bedroom. Mus m 1, particulate matter smaller than 10 microns (PM 10 ), and particulate matter smaller than 2.5 microns were quantified in air samples, and Mus m 1 was quantified in settled dust samples.
Mus m 1 was detected in settled dust samples from 100% of bedrooms. Airborne mouse allergen was detected in 48 of 57 (84%) bedrooms, and the median airborne mouse allergen concentration was 0.03 ng/m 3 . The median PM 10 concentration was 48 microg/m 3 . Airborne and settled dust mouse allergen levels were moderately correlated ( r = .52; P < .0001), and airborne Mus m 1 and PM 10 levels were weakly correlated ( r = .29; P = .03). Having cracks or holes in doors or walls, evidence of food remains in the kitchen, and mouse infestation were all independently associated with having detectable airborne mouse allergen.
Airborne mouse allergen concentrations in many inner-city homes may be similar to those found in animal facilities, where levels are sufficiently high to elicit symptoms in sensitized individuals. Exposed food remains, cracks and holes in doors or walls, and evidence of mouse infestation appear to be risk factors for having detectable airborne Mus m 1.
Journal of Allergy and Clinical Immunology 02/2005; 115(2):358-63. · 11.00 Impact Factor
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Journal of Allergy and Clinical Immunology 05/2003; 111(4):899-901. · 11.00 Impact Factor
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ABSTRACT: We calculated the population attributable fraction (PAF) of Canadian childhood asthma due to modifiable environmental exposures, in order to estimate their relative contributions to asthma development based on the current literature.
We conducted a systematic review to determine Canadian childhood asthma incidence, Canadian prevalence of exposure to airborne pollutants and indoor allergens, and international estimates of the risk of developing physician-diagnosed asthma (PDA) associated with each exposure. Combining risk estimates by meta-analysis where possible, PAF was calculated by the formula: PAF = Attributable risk *Exposure prevalence* 100%/Asthma incidence.
Age-specific Canadian childhood asthma incidence ranged from 2.8%-6.9%. Canadian exposure prevalences were: PM10 16%, PM2.5 7.1%, NO2 25%, environmental tobacco smoke (ETS) 9.0%, cat 22%, dog 12%, mouse 17%, cockroach 9.8%, dust mite 30%, moisture 14% and mould 33%. Relative risk estimates of PDA were: PM10 1.64, PM2.5 1.44, NO2 1.29, ETS 1.40, mouse 1.23, cockroach 1.96, and spanned 1.00 for cat, dog, dust mites, moisture and mould. PAF estimates for incident asthma among preschool children were: PM10 11%, PM2.5 1.6%, NO2 4.0%, ETS 2.9%, mouse 6.5% and cockroach 13%.
This systematic review suggests contributions to childhood asthma development from exposure to particulates, NO2, ETS, mouse and cockroach. The associations appeared to be more complex for cat, dog and dust mite allergens and more variable for mould and moisture. Additional prospective, population-based studies of childhood asthma development with objectively-measured exposures are needed to further quantify these associations.
Canadian journal of public health. Revue canadienne de santé publique 102(1):35-41. · 1.02 Impact Factor
