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Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr 2024; 12:1373373. [PMID: 38873581 PMCID: PMC11169649 DOI: 10.3389/fped.2024.1373373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. Observations This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Conclusions and relevance Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.
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Affiliation(s)
- Ruchi S. Gupta
- Institute for Public Health and Medicine, Center for Food Allergy & Asthma, Northwestern University, Chicago, IL, United States
| | - Ellen Epstein
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Moore A, Blumenthal KG, Chambers C, Namazy J, Nowak-Wegrzyn A, Phillips EJ, Rider NL. Improving Clinical Practice Through Patient Registries in Allergy and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00470-7. [PMID: 38734373 DOI: 10.1016/j.jaip.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Patient registries are a mechanism for collecting data on allergic and immunologic diseases that provide important information on epidemiology and outcomes that can ultimately improve patient care. Key criteria for establishing effective registries include the use of a clearly defined purpose, identifying the target population and ensuring consistent data collection. Registries in allergic diseases include those for diseases such as inborn errors of immunity (IEI), food allergy, asthma and anaphylaxis, pharmacological interventions in vulnerable populations, and adverse effects of pharmacologic interventions including hypersensitivity reactions to drugs and vaccines. Important insights gained from patient registries in our field include contributions in phenotype and outcomes in IEI, the risk for adverse reactions in food-allergic patients in multiple settings, the benefits and risk of biologic medications for asthma during pregnancy, vaccine safety, and the categorization and genetic determination of risk for severe cutaneous adverse reactions to medications. Impediments to the development of clinically meaningful patient registries include the lack of funding resources for registry establishment and the quality, quantity, and consistency of available data. Despite these drawbacks, high-quality and successful registries are invaluable in informing clinical practice and improving outcomes in patients with allergic and immunological diseases.
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Affiliation(s)
- Andrew Moore
- ENTAA Care, Johns Hopkins Regional Physicians, Glen Burnie, Md.
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, Calif
| | - Jennifer Namazy
- Division of Allergy and Immunology, Scripps Clinic, La Jolla, Calif
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Elizabeth J Phillips
- Department of Medicine, Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Nicholas L Rider
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Va; Carilion Clinic, Section of Allergy-Immunology, Roanoke, Va
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3
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Warren C, Gupta R, Seetasith A, Schuldt R, Wang R, Iqbal A, Gupta S, Casale TB. The clinical burden of food allergies: Insights from the Food Allergy Research & Education (FARE) Patient Registry. World Allergy Organ J 2024; 17:100889. [PMID: 38523669 PMCID: PMC10959723 DOI: 10.1016/j.waojou.2024.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Background Food allergies are serious and potentially life-threatening, and often place a large burden on patients and their caregivers, including impacts on quality of life. Objective To assess the real-world patient burden of food allergies, using self-reported data available from the Food Allergy Research & Education (FARE) Patient Registry (NCT04653324). Methods The FARE Patient Registry is voluntary and captures real-world experiences of adults and pediatric patients in the United States, and their caregivers, through a series of surveys assessing patient health and experiences with food allergies. Self-reported data were descriptively analyzed. Results The FARE study cohort included 5587 patients with food allergies; 82% had multiple food allergies and 62% were aged <18 years. About half of the patients were first diagnosed by an allergist/immunologist (53%), most commonly with a skin prick test (71%) or a serum immunoglobulin E test (62%). This analysis found that food allergies (most commonly peanut [66%], tree nuts [61%], egg [43%], and milk [37%]) impart a large clinical burden on patients, many of whom experience food-related allergic reactions and comorbidities. Many patients experienced >1 food-related allergic reaction per year (42%), with 46% experiencing food-induced anaphylaxis. Half of all food-related allergic reactions occurred at home. Accidental exposures to food allergens were experienced by 77% of patients. The most common allergic comorbidities reported by patients with food allergies were atopic dermatitis (48%), asthma (46%), and allergic rhinitis (39%). The clinical burden of food allergies were found to be greater in patients with multiple food allergies, and different for adults versus pediatric patients. Conclusion This is the first study to assess patient experience and disease burden information from patients contributing to the FARE Patient Registry, thus providing a unique insight into the lives of patients in the United States with food allergies. These insights may assist clinicians and other public health stakeholders in the management of patients with food allergies.
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Affiliation(s)
| | | | | | | | | | - Ahmar Iqbal
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Thomas B. Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA
- Food Allergy Research & Education (FARE), McLean, VA, USA
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McIntyre A, Lee KE, Patel GB, Mathur SK, Singh AM. Food allergy symptoms in adults and children using the Food Allergy Research & Education Patient Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:249-251.e1. [PMID: 37778628 DOI: 10.1016/j.jaip.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Amanda McIntyre
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kristine E Lee
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Sameer K Mathur
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Medicine, William S. Middleton Veterans Hospital, Madison, Wis
| | - Anne Marie Singh
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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Herbert LJ, Cooke F, Ramos A, Miller E, Padgett S, Green TD. A Qualitative Study to Inform Development of a Behavioral Intervention to Promote Food Allergy Self-Management and Adjustment among Early Adolescents. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2023; 11:6-16. [PMID: 37007844 PMCID: PMC10065466 DOI: 10.1037/cpp0000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Adolescence is a high-risk period for patients with food allergy (FA) as management responsibilities shift to the youth. This study used qualitative methods to explore FA experiences among a diverse pediatric FA population and inform behavioral intervention development. Methods A total of 26 adolescents ages 9-14 years with IgE-mediated FA (M age = 11.92 years; 62% male; 42% Black, 31% White, 12% Hispanic/Latinx) and 25 primary caregivers (M age = 42.57 years; 32% annual income > $100,000) were recruited from FA clinics to complete separate qualitative interviews about FA-related experiences. Interviews were audio-recorded, transcribed, and entered into Dedoose, a qualitative software program. A grounded theory qualitative analytic approach was used to analyze data. Results Emergent themes include: 1) FA is a chronic burden that affects daily life, 2) Families experience anxiety about FA, 3) Families find it challenging to transition FA management from parent to child, 4) FA families feel the need to be prepared, 5) FA families frequently advocate for their needs, and 6) Social experiences affect the FA experience. Conclusions Adolescents with FA and their caregivers experience daily stress related to their chronic illness. A behavioral intervention that provides FA education, bolsters stress/anxiety management, assists parents in transitioning FA management responsibility to the youth, teaches executive functioning and advocacy skills, and fosters peer support could help adolescents successfully cope with and manage FA in their daily lives.
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Affiliation(s)
- Linda Jones Herbert
- Children's National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Ashley Ramos
- Children's National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Shaylar Padgett
- Allergy and Asthma Center of NC, Cone Health Medical Group, Greensboro, NC
| | - Todd D Green
- DBV Technologies, Montrouge, France
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Bilaver LA, Thivalapill N, Zaslavsky J, Galic I, Gupta RS, Nimmagadda SR. Prevalence and correlates of co-occurring allergies in a US food allergy patient registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:332-334.e1. [PMID: 36272719 DOI: 10.1016/j.jaip.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/26/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Lucy A Bilaver
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill.
| | - Neil Thivalapill
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill
| | - Justin Zaslavsky
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill
| | - Isabel Galic
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Sai R Nimmagadda
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Food Allergy & Asthma Research, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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Roche I, Vale SL, Hornung CJ, Zurzolo GA, Netting MJ, Dharmage SC, Gray C, Lee NA, Lacis-Lee J, Jorgensen PF, Smith J, Freeman W, Perrett KP, Voukelatos S, McWilliam VL, Grinter K, Koplin JJ, Said M, Campbell DE. An International First: Stakeholder Consensus Statement for Food Allergen Management in Packaged Foods and Food Service for Australia and New Zealand. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2056-2065. [PMID: 35381394 DOI: 10.1016/j.jaip.2022.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Food-allergic consumers encounter inadequate, confusing, and ambiguous allergen information for packaged and unpackaged foods. Key Australian and New Zealand allergy organizations convened multiple forums to facilitate discussions among consumers, food manufacturers, food retailers, regulatory bodies, researchers, and health professionals to develop a unified approach to improving food allergen management. The following stakeholder consensus statement provides a foundation for advocacy for improved food allergen management and safety. It is the responsibility of consumers to: 1. declare their food allergies and read food labels (including ingredient lists and allergen declaration statements), and 2. ultimately make their own judgment about the foods they choose to consume. We consider that to enable consumers to make informed decisions about their safety, It is the responsibility of packaged food manufacturers to: 1. follow robust allergen management practices including quantitative risk assessment, and 2. use clear, consistent labeling to inform consumers about that food's allergen content, including the possible presence of unintended allergens. It is the responsibility of food service establishments and providers to: 1. follow robust allergen management practices, and 2. ensure that staff understand and can inform consumers about the allergen content of the food they provide, including the possible presence of unintended allergens.
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Affiliation(s)
- Ingrid Roche
- Perth Children's Hospital, Perth, Western Australia, Australia; Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Sandra L Vale
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia.
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Giovanni A Zurzolo
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Merryn J Netting
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nanju A Lee
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | | | - Jill Smith
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Wendy Freeman
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sally Voukelatos
- National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Vicki L McWilliam
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Jennifer J Koplin
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Said
- National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; The Children's Hospital at Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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Newman KL, Chater A, Knibb RC. Beliefs about food allergies in adolescents aged 11–19 years: A systematic review. Clin Transl Allergy 2022; 12:e12142. [PMID: 35414890 PMCID: PMC8984676 DOI: 10.1002/clt2.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Research suggests of people with food allergy (FA), adolescents have the highest risk of fatal allergic reactions to food, yet understanding of this population and how they manage their condition is limited. Understanding beliefs and how they affect behaviour could inform ways to reduce risk taking behaviour and fatal reactions in adolescents. This systematic review aimed to explore beliefs adolescents hold about their FA, and how these may be associated with FA management. Demographics Adolescents aged 11–19 years with FA. Methodology A systematic search of seven databases was conducted. Papers of any design were included that reported on the beliefs about FA in adolescents aged 11–19 years. Data was systemised by narrative thematic analysis. Findings 20 studies were included. Themes included navigating FA in different environments, carriage and use of adrenaline auto‐injectors, management of the risk of anaphylaxis, behaviour and understanding of others, and food‐allergic identity. Implications Adolescents with FA hold a variety of condition beliefs; some beliefs were related to behaviour that could lead to an allergic reaction, while other beliefs were related to protective behaviours. Further research into understanding adolescent beliefs in order to inform clinical management and reduce the risk of potential fatal reactions is essential.
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Affiliation(s)
- Kristina L. Newman
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
- Department of Psychology School of Social Sciences Nottingham Trent University Nottingham UK
| | - Angel Chater
- Department for Sport Science and Physical Activity University of Bedfordshire Bedford UK
| | - Rebecca C. Knibb
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
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Herbert L, Cooke F, Ramos A, Amatya K, Sharma HP. Assessing daily food allergy self-management among adolescents using a 24-hour recall interview. Ann Allergy Asthma Immunol 2021; 127:206-213. [PMID: 33722785 DOI: 10.1016/j.anai.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe food allergic reactions can be life-threatening or fatal and are experienced by up to 40% of children with food allergies, with adolescents at greatest risk. There are no comprehensive measures to assess food allergy management behaviors that could prevent allergic reactions. OBJECTIVE To describe food allergy self-management behaviors as reported by adolescents on a 24-hour recall measure and identify related factors. METHODS Adolescents aged 10 to 14 years with immunoglobulin E-mediated food allergy completed the Food Allergy Management 24-Hour Recall as an interview. Participants answered questions on each food they ate on the previous day and food allergy self-management behaviors. RESULTS Participants were a diverse sample (28% White) of 101 adolescents (mean age = 11.80 years; 53% male sex). Most meals and snacks (76%) were observed by adults. Epinephrine autoinjectors (EAIs) were reportedly available for almost all meals and snacks (93%). Almost all foods had been eaten before (95%) and were verified as allergen free (92%). Furthermore, 35% of the time, past experience with the food was the only method used to verify safety. Child age, number of food allergies, or time since allergic reaction was not related to self-management behavior. EAI availability and ingredient verification were most common at home and in school; adult observation was least likely in the home. CONCLUSION Adolescents reported that EAIs were frequently available, but they relied on past experience with food to determine safety. Appropriate assessment of food safety should be a primary intervention target. The Food Allergy Management 24-Hour Recall may be a useful tool to assess and track food allergy self-management.
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Affiliation(s)
- Linda Herbert
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Frances Cooke
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Kaushalendra Amatya
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC
| | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
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