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Prithvi A, Govardhan C, Dinakar C. Myriad of Mucocutaneous Manifestations in Multisystem Inflammatory Syndrome Associated with COVID-19. Indian J Pediatr 2023; 90:1152-1153. [PMID: 37246160 PMCID: PMC10225285 DOI: 10.1007/s12098-023-04606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Ashwini Prithvi
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
| | - Chaitra Govardhan
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Chitra Dinakar
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Gupta V, Singh A, Ganju S, Singh R, Thiruvengadam R, Natchu UCM, Gupta N, Kaushik D, Chanana S, Sharma D, Gosain M, Rao SP, Pandey N, Gupta A, Singh S, Jhamb U, Annayappa Venkatesh L, Dinakar C, Pandey AK, Gera R, Chellani H, Wadhwa N, Bhatnagar S. Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study. Lancet Reg Health Southeast Asia 2023; 13:100203. [PMID: 37159588 PMCID: PMC10110927 DOI: 10.1016/j.lansea.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Background It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India. Methods Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, 'unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes. Findings Among 2468 eligible children enrolled, 2148 were hospitalised. Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18.6%), severe acute COVID-19 (13.3%) and the unclassified severe COVID-19 disease (12.3%). Mortality remained high (17.5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14.1% mortality when associated with comorbidity. Interpretation Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Funding Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva, Switzerland.
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Affiliation(s)
- Vidushi Gupta
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Amitabh Singh
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Sheetal Ganju
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
- All India Institute of Medical Sciences (AIIMS)-Jammu, Vijaypur, Jammu, India
| | - Raghvendra Singh
- Maulana Azad Medical College, and Lok Nayak Hospital (MAMC & LNH), New Delhi, India
| | - Ramachandran Thiruvengadam
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- Pondicherry Institute of Medical Sciences (PIMS), Puducherry, India
| | | | - Nitesh Gupta
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Deepali Kaushik
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Surbhi Chanana
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Dharmendra Sharma
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Mudita Gosain
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Suman Pn Rao
- St. John's Medical College and Research Institute (SJRI), Bengaluru, India
| | - Narendra Pandey
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Arvind Gupta
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Sandeep Singh
- Asian Institute of Medical Sciences (ASIAN), Faridabad, India
| | - Urmila Jhamb
- Maulana Azad Medical College, and Lok Nayak Hospital (MAMC & LNH), New Delhi, India
| | | | - Chitra Dinakar
- St. John's Medical College and Research Institute (SJRI), Bengaluru, India
| | - Anil Kumar Pandey
- Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, India
| | - Rani Gera
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Harish Chellani
- Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, India
| | - Nitya Wadhwa
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
| | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
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3
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Hegde A, Srinivasan R, Dinakar C. Congenital syphilis: a rare presentation of a forgotten infection. J Infect Dev Ctries 2023; 17:135-138. [PMID: 36795921 DOI: 10.3855/jidc.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/25/2022] [Indexed: 02/17/2023] Open
Abstract
Congenital syphilis (CS), a common but forgotten disease has a broad spectrum of clinical presentation. Vertical transmission of this spirochaetal infection from the pregnant mother to the foetus can result in varied manifestations ranging from asymptomatic infection to life- threatening conditions in the form of stillbirth and neonatal death. The haematological and visceral manifestations of this disease can closely mimic various conditions including haemolytic anaemia and malignancies. Congenital syphilis should be considered as a differential in any infant presenting with hepatosplenomegaly and haematological abnormalities even if the antenatal screen was negative. We report a 6-month-old infant with congenital syphilis presenting with organomegaly, bicytopenia and monocytosis. A strong index of suspicion and early diagnosis is the key to the good outcome as treatment is simple and cost- effective.
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Affiliation(s)
- Anusha Hegde
- Department of Pediatrics, St. Johns Medical College Hospital, Johnnagar, Bengaluru, Karnataka, India
| | - Ranjini Srinivasan
- Department of Pediatrics, St. Johns Medical College Hospital, Johnnagar, Bengaluru, Karnataka, India
| | - Chitra Dinakar
- Department of Pediatrics, St. Johns Medical College Hospital, Johnnagar, Bengaluru, Karnataka, India
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4
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Galagali PM, Dinakar C, Bala P, Shah D, Gupta P, Rao C, Ravichandran L, Aroor AR, Shastri D, Kumar RR, Russell P, Nair MKC. Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents. Indian Pediatr 2022; 59:553-562. [PMID: 35481486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
JUSTIFICATION Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. OBJECTIVES To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. PROCESS Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. GUIDELINES Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.
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Affiliation(s)
- Preeti M Galagali
- Bengaluru Adolescent Care and Counselling Center, Bengaluru, Karnataka. Correspondence to: Dr Preeti M Galagali, Director, Bengaluru Adolescent Care and Counselling Centre, 528 2nd Block Rajajinagar, Bengaluru, Karnataka 560010.
| | - Chitra Dinakar
- Department of Pediatrics, St John's Medical College Hospital and St John's National Academy of Health Sciences, Bengaluru, Karnataka
| | - Poongodi Bala
- Department of Psychiatry, Kaizen Mind Care, Chennai, Tamil Nadu
| | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, New Delhi
| | - Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, New Delhi
| | - Chandrika Rao
- Department of Pediatrics, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka
| | - Latha Ravichandran
- Department of Pediatrics, Sri Ramachandra Medial College and Research Institute, Chennai, Tamil Nadu
| | - Amitha Rao Aroor
- Department of Pediatrics, AJ Institute of Medical Sciences, Mangalore, Karnataka
| | | | - R Ramesh Kumar
- Honorary Secretary-General, Indian Academy of Pediatrics, 2019
| | - Paul Russell
- Department of Psychiatry, Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore, Tamil Nadu
| | - M K C Nair
- NIMS-SPECTRUM-Child Development Research Center, NIMS Medicity, Thiruvananthapuram, Kerala
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Abstract
An estimated 7 million children in the United States have asthma, which causes a significant health care burden and affects quality of life. The minority of these children have asthma that does not respond to Global Initiative for Asthma steps 4 and 5 care, and biological medications are recommended at this level in the 2019 Global Initiative for Asthma recommendations. In addition, biologics have been introduced into the care of children with allergic skin diseases. Omalizumab and mepolizumab are approved for children as young as 6 years, and benralizumab and dupilumab are approved for people aged ≥12 years. Reslizumab is approved only for people aged ≥18 years. These monoclonal antibodies may be added for appropriate patients when asthma or allergic skin diseases are not well controlled. Pediatricians and pediatric subspecialists should work together and be aware of the benefits and risks of these medications for their patients, as well as the practical implications of providing these options for their patients. This clinical report serves as an evaluation of the current literature on these types of medications in the treatment of children with asthma and allergic skin disease.
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Affiliation(s)
- Heather Hoch De Keyser
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, School of Medicine, University of Colorado Anschutz, Breathing Institute at Children's Hospital Colorado, Denver, Colorado
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Chitra Dinakar
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
- Deceased
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6
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Greenhawt M, Shaker M, Wang J, Oppenheimer JJ, Sicherer S, Keet C, Swaggart K, Rank M, Portnoy JM, Bernstein J, Chu DK, Dinakar C, Golden D, Horner C, Lang DM, Lang ES, Khan DA, Lieberman J, Stukus D, Wallace D. Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol 2020; 146:1302-1334. [PMID: 32810515 DOI: 10.1016/j.jaci.2020.07.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a "positive" test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY
| | - John J Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Morristown, NJ
| | - Scott Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY
| | - Corinne Keet
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Keri Swaggart
- Library Services, Children's Mercy Hospital, Kansas City, Mo
| | - Matthew Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz; Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Ariz
| | - Jay M Portnoy
- Division of Allergy, Asthma & Immunology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Mo
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Derek K Chu
- Department of Health Research Methods, Evidence & Impact, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Chitra Dinakar
- Division of Allergy and Asthma, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - David Golden
- Department of Allergy-Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Carolyn Horner
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Khan
- Division of Allergy & Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Jay Lieberman
- Division of Allergy and Immunology, Department of Pediatrics, The University of Tennessee, Memphis, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
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7
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Oppenheimer JJ, Dinakar C, Khan DA, Fineman SM. From the pages of AllergyWatch®: August 2020. Ann Allergy Asthma Immunol 2020; 125:232-233. [PMID: 32442598 DOI: 10.1016/j.anai.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Chitra Dinakar
- Department Medicine, Stanford University School of Medicine, Stanford, California
| | - David A Khan
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, Texas
| | - Stanley M Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Shaker MS, Oppenheimer J, Wallace DV, Golden DBK, Lang DM, Lang ES, Bernstein JA, Campbell RL, Chu D, Dinakar C, Ellis AK, Greenhawt M, Horner C, Lieberman JA, Rank MA, Stukus DR, Wang J. Making the GRADE in anaphylaxis management: Toward recommendations integrating values, preferences, context, and shared decision making. Ann Allergy Asthma Immunol 2020; 124:526-535.e2. [PMID: 32199979 DOI: 10.1016/j.anai.2020.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methods and discuss the clinical application of conditional recommendations in clinical guidelines, specifically in the context of anaphylaxis. DATA SOURCES Articles that described GRADE, evidence synthesis, evidence to recommendation frameworks, and shared decision making were used to discuss conditional recommendations of the 2020 Anaphylaxis GRADE guideline. STUDY SELECTIONS A narrative review detailing concepts of GRADE and approaches to translate conditional recommendations to individualized and contextualized patient care. RESULTS GRADE methods encourage a nuanced relationship between certainty of evidence and strength of recommendations. Strength of recommendation must incorporate key factors, including the balance between benefits and harms, patient values and preferences, and resource allocation (costs), with equity, feasibility, and acceptability also often included as considerations. GRADE guidelines provide recommendations that are characterized by directionality (for or against) and strength (strong or conditional). A conditional recommendation is tailored to context and primarily applied through a lens of patient preferences related to the likelihood of outcomes of importance and a shared decision-making approach. Although the 2020 Anaphylaxis GRADE guideline better informs the practice of anaphylaxis prevention through (1) identification and mitigation of risk factors for biphasic anaphylaxis and (2) evaluation of the use of glucocorticoid and/or antihistamine pretreatment, all GRADE recommendations, although directional, are conditional and as such should not be universally applied to every circumstance. CONCLUSION Clinical guidelines provide an important opportunity to critically appraise evidence and translate evidence to practice. Patients, practitioners, and policy makers should appreciate the strength of recommendation and certainty of evidence and understand how this affects guideline applicability and implementation.
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Affiliation(s)
- Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - John Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, UMDNJ-Rutgers New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, New Jersey
| | - Dana V Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Florida
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins University, Baltimore, Maryland
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Derek Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Dinakar
- Allergy, Asthma, and Immunodeficiency, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
| | - Caroline Horner
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Affiliation(s)
- Kishore D. Phadke
- Children's Kidney Care Center, St. John's Medical College Hospital, Bangalore, India
| | - Chitra Dinakar
- Children's Kidney Care Center, St. John's Medical College Hospital, Bangalore, India
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11
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Chipps BE, Dinakar C, Fineman SM, Tilles SA. Recent advances in asthma. Ann Allergy Asthma Immunol 2020; 120:128-130. [PMID: 29413335 DOI: 10.1016/j.anai.2017.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Bradley E Chipps
- Assistant Editor, AllergyWatch, Sacramento, California; President, American College of Allergy, Asthma & Immunology, Sacramento, California; Medical Director, Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Chitra Dinakar
- Associate Editor, AllergyWatch, Sacramento, California; Clinical Professor, Pulmonary & Critical Care Medicine, Stanford University, Stanford, California; Clinical Chief of Allergy, Asthma and Immunodeficiency, Stanford Health Care, Stanford, California
| | - Stanley M Fineman
- Assistant Editor, AllergyWatch, Marietta, Georgia; Atlanta Allergy & Asthma, Marietta, Georgia
| | - Stephen A Tilles
- Editor-in-Chief, AllergyWatch, Redmond, Washington; Northwest Asthma & Allergy Center, Redmond, Washington.
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Chan ES, Dinakar C, Gonzales-Reyes E, Green TD, Gupta R, Jones D, Wang J, Winders T, Greenhawt M. Unmet needs of children with peanut allergy: Aligning the risks and the evidence. Ann Allergy Asthma Immunol 2020; 124:479-486. [PMID: 32007568 DOI: 10.1016/j.anai.2020.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/05/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventive measures. OBJECTIVE To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. METHODS Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions after unintentional peanut exposures. RESULTS The following key unmet needs in the prevention and management of peanut allergy were identified: (1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy, (2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice, and (3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for unintentional exposures that provoke severe reactions. Practitioners should help educate caregivers about the actual risks associated with peanut allergy and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. CONCLUSION There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.
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Affiliation(s)
- Edmond S Chan
- BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | | | | | - Todd D Green
- UPMC Children's Hospital of Pittsburgh, Pennsylvania; DBV Technologies, Montrouge, France
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern Medicine Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H Lurie Children's Hospital of Chicago, Illinois
| | | | - Julie Wang
- The Mount Sinai Hospital, New York, New York
| | | | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
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Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan DA, Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR, Wang J, Riblet N, Bobrownicki AMP, Bontrager T, Dusin J, Foley J, Frederick B, Fregene E, Hellerstedt S, Hassan F, Hess K, Horner C, Huntington K, Kasireddy P, Keeler D, Kim B, Lieberman P, Lindhorst E, McEnany F, Milbank J, Murphy H, Pando O, Patel AK, Ratliff N, Rhodes R, Robertson K, Scott H, Snell A, Sullivan R, Trivedi V, Wickham A, Shaker MS, Wallace DV, Shaker MS, Wallace DV, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Golden DBK, Greenhawt M, Lieberman JA, Rank MA, Stukus DR, Wang J, Shaker MS, Wallace DV, Golden DBK, Bernstein JA, Dinakar C, Ellis A, Greenhawt M, Horner C, Khan DA, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020; 145:1082-1123. [PMID: 32001253 DOI: 10.1016/j.jaci.2020.01.017] [Citation(s) in RCA: 324] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.
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Affiliation(s)
- Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Dana V Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins University, Baltimore, Md
| | - John Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Chitra Dinakar
- Allergy, Asthma, and Immunodeficiency, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colo
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Jay Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | | | - Teresa Bontrager
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jarrod Dusin
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jennifer Foley
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Becky Frederick
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Eyitemi Fregene
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Sage Hellerstedt
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ferdaus Hassan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kori Hess
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Caroline Horner
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Kelly Huntington
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Poojita Kasireddy
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - David Keeler
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Bertha Kim
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Phil Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Erin Lindhorst
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Fiona McEnany
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jennifer Milbank
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Helen Murphy
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Oriana Pando
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ami K Patel
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Nicole Ratliff
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Robert Rhodes
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kim Robertson
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Hope Scott
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Audrey Snell
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Rhonda Sullivan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Varahi Trivedi
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Azadeh Wickham
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
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Dinakar C, Chipps BE, Fineman SM. From the pages of AllergyWatch: March 2020. Ann Allergy Asthma Immunol 2019; 124:300-301. [PMID: 31857245 DOI: 10.1016/j.anai.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Chitra Dinakar
- Department of Medicine, Stanford University, Stanford, California; Department of Allergy, Asthma, and Immunodeficiency, Stanford Health Care, Stanford, California
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Stanley M Fineman
- Atlanta Allergy and Asthma Clinic, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Dinakar C, Hernandez-Trujillo V, Lee GB, Fineman SM. From the Pages of Allergy Watch: November 2019. Ann Allergy Asthma Immunol 2019; 123:527-528. [PMID: 31676021 DOI: 10.1016/j.anai.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
A new Annals feature in 2018, "From the Pages of AllergyWatch" is devoted to publishing synopses of Allergy and Asthma literature relevant to a topic of emphasis. These unbiased synopses and comments by our Editors have been previously printed in the AllergyWatch bimonthly newsletter, and it is our hope that presenting carefully selected article summaries and comments in the Annals will serve as a valuable educational resource for practicing allergists.
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Affiliation(s)
- Chitra Dinakar
- Department of Medicine-Medical/Pulmonary and Critical Care Medicine, Allergy and Immunology, Stanford, California
| | - Vivian Hernandez-Trujillo
- Allergy and Immunology Care Center of South Florida, Miami Lakes, Florida; Division of Allergy and Immunology, Nicklaus Children's Hospital, Miami, Florida
| | - Gerald B Lee
- Atlanta Allergy & Asthma, Emory University School of Medicine, Atlanta, Georgia
| | - Stanley M Fineman
- Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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Oppenheimer J, Chipps B, Dinakar C, Fineman S. Are PPIs beneficial for nasal polyps? Ann Allergy Asthma Immunol 2019; 123:624-626. [PMID: 31562938 DOI: 10.1016/j.anai.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
A new Annals feature in 2018, "From the Pages of AllergyWatch" is devoted to publishing synopses of Allergy and Asthma literature relevant to a topic of emphasis. These unbiased synopses and comments by our Editors have been previously printed in the AllergyWatch bimonthly newsletter, and it is our hope that presenting carefully selected article summaries and comments in the Annals will serve as a valuable educational resource for practicing allergists.
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Bhattad S, Dinakar C, Pinnamaraju H, Ganapathy A, Mannan A. Chronic Mucocutaneous Candidiasis in an Adolescent Boy Due to a Novel Mutation in TRAF3IP2. J Clin Immunol 2019; 39:596-599. [PMID: 31292894 DOI: 10.1007/s10875-019-00664-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND IL-17-mediated signaling is crucial in defense against fungi and bacteria. Defective Th17 immunity has been implicated in a group of disorders called chronic mucocutaneous candidiasis (CMC). TRAF3IP2 is an adaptor protein involved in downstream signaling for IL-17 receptors. CASE An 18-year-old boy, product of consanguineous wedlock, presented with history of repeated episodes of oral thrush and recurrent pneumonia from first year of life. On examination, he was wasted and had oral thrush and abnormal dentition; grade 2 clubbing and respiratory system examination revealed coarse crepitations. On evaluation, HIV status was negative and basic immunological screen was unrewarding. Genetic testing by next-generation sequencing showed a novel homozygous mutation in TRAF3IP2 gene not reported to date. The defect is likely to cause ACT1 deficiency. He was started on antibiotic and antifungal prophylaxis and remains well on follow-up. CONCLUSION We describe an adolescent boy with recurrent oral candidiasis and bronchiectasis due to a novel mutation in TRAF3IP2 gene, not reported to date. This is also the only second report of CMC due to ACT1 deficiency.
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Affiliation(s)
- Sagar Bhattad
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, Aster CMI Hospital, Bangalore, India.
| | - Chitra Dinakar
- Department of Pediatrics, St. John's Medical College Hospital, Bangalore, India
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Dinakar C, Lang DM, Fineman SM. Drug Allergy. Ann Allergy Asthma Immunol 2019; 123:112-114. [PMID: 31255191 DOI: 10.1016/j.anai.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Chitra Dinakar
- Department of Medicine, Med/Pulmonary and Critical Care Medicine, Allergy and Immunology, Stanford, CA
| | - David Michael Lang
- Respiratory Institute, Department of Allergy and Clinical Immunology, Cleveland Clinic Foundation, Cleveland, OH
| | - Stanley M Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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19
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Oppenheimer JJ, Dinakar C, Fineman SM. AllergyWatch. Ann Allergy Asthma Immunol 2019; 123:319-320. [PMID: 31247305 DOI: 10.1016/j.anai.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
A new Annals feature in 2018, "From the Pages of AllergyWatch" is devoted to publishing synopses of Allergy and Asthma literature relevant to a topic of emphasis. These unbiased synopses and comments by our Editors have been previously printed in the AllergyWatch bimonthly newsletter, and it is our hope that presenting carefully selected article summaries and comments in the Annals will serve as a valuable educational resource for practicing allergists. For this issue of 'From the Pages of Allergy Watch' articles are presented that coincide with the theme of this month's Annals. The first article addresses the impact of allergic rhinitis on work productivity in affected patients. The second article review data from a large number of children presenting to Canadian emergency departments with asthma exacerbations and the impact of certain viral pathogens. The last article reviewed investigates data showing that patients who 'run out' of asthma inhalers were more likely to present to the emergency room for their asthma care.
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Affiliation(s)
- John J Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, New Jersey; and Pulmonary and Allergy Associates, Morristown, New Jersey
| | - Chitra Dinakar
- Department of Medicine-Medical/Pulmonary and Critical Care Medicine, Allergy and Immunology, Stanford, California
| | - Stanley M Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Fineman SM, Khan DA, Dinakar C. Race and Allergy. Ann Allergy Asthma Immunol 2019; 122:543-545. [PMID: 30772388 DOI: 10.1016/j.anai.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Stanley M Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - David A Khan
- UT Southwestern Medical School, 5939 Harry Hines Blvd, 9th Floor, Dallas, Texas
| | - Chitra Dinakar
- Department of Medicine, Med/Pulmonary and Critical Care Medicine, Allergy and Immunology, Stanford, California
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Wood RA, Khan DA, Lang DM, Fasano MB, Peden DB, Busse PJ, Carter MC, Demain JG, Dinakar C, Grayson MH, Markovics SB, Sicherer SH, Stone KD, Sullivan KE, Williams PV, Fleisher TA, Casale TB. American Academy of Allergy, Asthma and Immunology response to the EAACI/GA 2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of Urticaria 2017 revision. Allergy 2019; 74:411-413. [PMID: 30338538 DOI: 10.1111/all.13636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert A. Wood
- Johns Hopkins University School Medicine Baltimore Maryland
| | - David A. Khan
- University of Texas Southwestern Medical Center Dallas Texas
| | | | | | - David B. Peden
- University of North Carolina School of Medicine Chapel Hill North Carolina
| | | | | | | | - Chitra Dinakar
- Stanford University School of Medicine Stanford California
| | | | | | | | - Kelly D. Stone
- NIH/NIAID‐ Laboratory of Allergic Diseases Bethesda Maryland
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Agusala V, Dinakar C, Dinakarpandian D. Informatics Analysis of Cross-Reactivity of Food Allergens in South Asian Cuisine. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dinakar C, Fineman SM, Tilles SA. Recent advances in atopic dermatitis. Ann Allergy Asthma Immunol 2019; 120:8-9. [PMID: 29273133 DOI: 10.1016/j.anai.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
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Maffucci P, Chavez J, Jurkiw TJ, O’Brien PJ, Abbott JK, Reynolds PR, Worth A, Notarangelo LD, Felgentreff K, Cortes P, Boisson B, Radigan L, Cobat A, Dinakar C, Ehlayel M, Ben-Omran T, Gelfand EW, Casanova JL, Cunningham-Rundles C. Biallelic mutations in DNA ligase 1 underlie a spectrum of immune deficiencies. J Clin Invest 2018; 128:5489-5504. [PMID: 30395541 PMCID: PMC6264644 DOI: 10.1172/jci99629] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/04/2018] [Indexed: 12/30/2022] Open
Abstract
We report the molecular, cellular, and clinical features of 5 patients from 3 kindreds with biallelic mutations in the autosomal LIG1 gene encoding DNA ligase 1. The patients exhibited hypogammaglobulinemia, lymphopenia, increased proportions of circulating γδT cells, and erythrocyte macrocytosis. Clinical severity ranged from a mild antibody deficiency to a combined immunodeficiency requiring hematopoietic stem cell transplantation. Using engineered LIG1-deficient cell lines, we demonstrated chemical and radiation defects associated with the mutant alleles, which variably impaired the DNA repair pathway. We further showed that these LIG1 mutant alleles are amorphic or hypomorphic, and exhibited variably decreased enzymatic activities, which lead to premature release of unligated adenylated DNA. The variability of the LIG1 genotypes in the patients was consistent with that of their immunological and clinical phenotypes. These data suggest that different forms of autosomal recessive, partial DNA ligase 1 deficiency underlie an immunodeficiency of variable severity.
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Affiliation(s)
- Patrick Maffucci
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, and
- Graduate School of Biomedical Sciences, Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jose Chavez
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, and
| | - Thomas J. Jurkiw
- Department of Biological Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick J. O’Brien
- Department of Biological Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordan K. Abbott
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Paul R. Reynolds
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Austen Worth
- Department of Pediatric Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Luigi D. Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kerstin Felgentreff
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Patricia Cortes
- Department of Molecular, Cellular and Biomedical Science, CUNY School of Medicine, City College of New York, New York, New York, USA
| | - Bertrand Boisson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
- Paris Descartes University, Imagine Institute, Paris, France
| | - Lin Radigan
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, and
| | - Aurélie Cobat
- Paris Descartes University, Imagine Institute, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
| | - Chitra Dinakar
- Allergy, Asthma & Immunodeficiency, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Mohammad Ehlayel
- Section of Pediatric Allergy-Immunology, Department of Pediatrics, Weill Cornell Medical College, Hamad Medical Corporation, Doha, Qatar
| | - Tawfeg Ben-Omran
- Department of Clinical and Metabolic Genetics, Department of Pediatrics, Weill Cornell Medical College, Hamad Medical Corporation, Doha, Qatar
| | - Erwin W. Gelfand
- Immunodeficiency Diagnosis and Treatment Program, Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
- Paris Descartes University, Imagine Institute, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Howard Hughes Medical Institute, New York, New York, USA
- Pediatric Hematology-Immunology Unit, Necker Hospital for Sick Children, Paris, France
| | - Charlotte Cunningham-Rundles
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, and
- Graduate School of Biomedical Sciences, Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lang D, Dinakar C, Oppenheimer JJ, Hernandez-Trujillio V. Penicillin allergy. Ann Allergy Asthma Immunol 2018; 121:637-639. [PMID: 30389083 DOI: 10.1016/j.anai.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chitra Dinakar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California
| | - John J Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, New Jersey; Pulmonary and Allergy Associates, Morristown, New Jersey
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Lippner E, Sicherer SH, Land MH, Schatz M, Dinakar C. Needs assessment survey for a food allergy control tool. J Allergy Clin Immunol Pract 2018; 7:701-703.e2. [PMID: 30317004 DOI: 10.1016/j.jaip.2018.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/04/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
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Fineman SM, Khan DA, Dinakar C, Lang DM, Tilles SA. Pharmacotherapy. Ann Allergy Asthma Immunol 2018; 121:22-23. [PMID: 29777743 DOI: 10.1016/j.anai.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Stanley M Fineman
- AllergyWatch, Sacramento, California; Atlanta Allergy & Asthma, Marietta, Georgia
| | - David A Khan
- AllergyWatch, Sacramento, California; Division of Allergy & Immunology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Chitra Dinakar
- AllergyWatch, Sacramento, California; Medicine, Pulmonary & Critical Care Medicine, Stanford University, Stanford, California; Asthma and Immunodeficiency, Stanford Health Care, Stanford, California
| | - David Michael Lang
- AllergyWatch, Sacramento, California; Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen A Tilles
- AllergyWatch, Sacramento, California; Northwest Asthma & Allergy Center, Redmond, Washington.
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Dinakar C, Fineman SM, Chipps BE, Khan DA, Tilles SA. Recent advances in our understanding of the environment's role in allergy. Ann Allergy Asthma Immunol 2018; 120:465-467. [PMID: 29577979 DOI: 10.1016/j.anai.2018.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Chitra Dinakar
- AllergyWatch, Sacramento, California; Medicine, Pulmonary & Critical Care Medicine, Stanford University, Stanford, California; Asthma and Immunodeficiency, Stanford Health Care, Stanford, California
| | - Stanley M Fineman
- AllergyWatch, Sacramento, California; Atlanta Allergy & Asthma, Marietta, Georgia
| | - Bradley E Chipps
- AllergyWatch, Sacramento, California; American College of Allergy, Asthma & Immunology, Arlington Heights, Illinois; Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - David A Khan
- AllergyWatch, Sacramento, California; Division of Allergy & Immmunology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Stephen A Tilles
- AllergyWatch, Sacramento, California; Northwest Asthma & Allergy Center, Redmond, Washington.
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Shreffler WG, Baumert JL, Remington BC, Koppelman SJ, Dinakar C, Fleischer DM, Kim E, Tilles SA, Spergel JM. The importance of reducing risk in peanut allergy: Current and future therapies. Ann Allergy Asthma Immunol 2018; 120:124-127. [PMID: 29289463 DOI: 10.1016/j.anai.2017.10.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Joe L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska
| | | | - Stef J Koppelman
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska
| | | | | | - Edwin Kim
- University of North Carolina, Chapel Hill, North Carolina
| | - Stephen A Tilles
- ASTHMA, Inc. Clinical Research Center; Northwest Asthma and Allergy Center, Seattle, Washington
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Dinakar C, Shroba J, Portnoy JM. The transforming power of proximity food challenges. Ann Allergy Asthma Immunol 2017; 117:135-7. [PMID: 27499540 DOI: 10.1016/j.anai.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Chitra Dinakar
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri.
| | - Jodi Shroba
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri
| | - Jay M Portnoy
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri
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Golden DBK, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Wallace D. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017; 118:28-54. [PMID: 28007086 DOI: 10.1016/j.anai.2016.10.031] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Dykewicz MS, Wallace DV, Baroody F, Bernstein J, Craig T, Finegold I, Huang F, Larenas-Linnemann D, Meltzer E, Steven G, Bernstein DI, Blessing-Moore J, Dinakar C, Greenhawt M, Horner CC, Khan DA, Lang D, Oppenheimer J, Portnoy JM, Randolph CR, Rank MA, Dykewicz MS, Wallace DV. Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Ann Allergy Asthma Immunol 2017; 119:489-511.e41. [PMID: 29103802 DOI: 10.1016/j.anai.2017.08.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
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Elliott T, Shih J, Dinakar C, Portnoy J, Fineman S. American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists. Ann Allergy Asthma Immunol 2017; 119:512-517. [PMID: 29103799 DOI: 10.1016/j.anai.2017.09.052] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty.
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Affiliation(s)
- Tania Elliott
- New York University Medical Center, New York, New York
| | - Jennifer Shih
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Chitra Dinakar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jay Portnoy
- Division of Allergy, Asthma, & Immunology, Telemedicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Lin C, Lee IT, Sampath V, Dinakar C, DeKruyff RH, Schneider LC, Nadeau KC. Combining anti-IgE with oral immunotherapy. Pediatr Allergy Immunol 2017; 28:619-627. [PMID: 28782296 DOI: 10.1111/pai.12767] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/24/2022]
Abstract
Food allergy is a significant medical problem that affects up to 8% of children in developed countries. At present, there are no curative therapies available in routine practice and management of food allergy involves strict allergen avoidance, education, and prompt treatment upon accidental exposure. Oral immunotherapy (OIT) is an efficacious experimental approach to food allergy and has been shown to provide a substantial benefit in terms of allergen desensitization. However, OIT is associated with high rates of allergic reactions, and the period of protection offered by OIT appears to be limited and highly variable. Recurrence of allergen sensitivity after a period of treatment discontinuation is commonly observed. With the aim of overcoming these limitations of OIT, several trials have studied omalizumab (anti-IgE monoclonal antibody) as an adjuvant treatment for patients undergoing OIT. Results from these trials have shown that the addition of omalizumab to OIT leads to a significant decrease in the frequency and severity of reactions, which allows for an increase in the threshold of tolerance to food allergens. This review provides a summary of the current literature and addresses some of the key questions that remain regarding the use of omalizumab in conjunction with OIT.
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Affiliation(s)
- Chunrong Lin
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ivan T Lee
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chitra Dinakar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Rosemarie H DeKruyff
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Kari Christine Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
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Abstract
PURPOSE OF REVIEW Food allergy prevalence is increasing very rapidly, causing a significant disease burden. The threat of severe allergic reactions occurring unexpectedly and in settings that are not equipped to recognize and treat anaphylaxis is a constant source of worry for individuals and families with food allergies. Inadequate knowledge and understanding in the community significantly impairs the overall quality of life of these individuals and families. Additionally, families face challenges in finding and affording appropriate allergen-free foods. RECENT FINDINGS Advancements have been made in understanding the impact of food allergies on patient-centered outcomes such as quality of life and economic impact, and attempts have been made to develop tools to assess patient-centered variables. Innovative national and regional initiatives are helping to spread awareness of the disease condition and to create resources, including access to allergen-free foods. While there is a growing momentum toward recognition of food allergic disorders as a condition that profoundly impacts activities of daily living, greater effort needs to be expounded to develop validated tools and interventions that can adequately address these issues.
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Affiliation(s)
- Brooke I Polk
- Section of Allergy/Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Portnoy JM, Waller M, De Lurgio S, Dinakar C. Telemedicine is as effective as in-person visits for patients with asthma. Ann Allergy Asthma Immunol 2017; 117:241-5. [PMID: 27613456 DOI: 10.1016/j.anai.2016.07.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine. OBJECTIVE To compare asthma outcomes during 6 months in children managed by telemedicine vs in-person visits. METHODS Children with asthma residing in 2 remote locations were offered the choice of an in-person visit or a telemedicine session at a local clinic. The telemedicine process involved real-time use of a Remote Presence Solution (RPS) equipped with a digital stethoscope, otoscope, and high-resolution camera. A telefacilitator operated the RPS and performed diagnostic and educational procedures, such as spirometry and asthma education. Children in both groups were assessed initially, after 30 days, and at 6 months. Asthma outcome measures included asthma control using validated tools (Asthma Control Test, Childhood Asthma Control Test, and Test for Respiratory and Asthma Control in Kids) and patient satisfaction (telemedicine group only). Noninferiority analysis of asthma control was performed using the minimally important difference of an adjusted asthma control test that combined the 3 age groups. RESULTS Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits. All had a small, although statistically insignificant, improvement in asthma control over time. Telemedicine was noninferior to in-person visits. Most of the telemedicine group subjects were satisfied with their experience. CONCLUSION Children with asthma seen by telemedicine or in-person visits can achieve comparable degrees of asthma control. Telemedicine can be a viable alternative to traditional in-person physician-based care for the treatment and management of asthma.
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Kim H, Dinakar C, McInnis P, Rudin D, Benain X, Daley W, Platz E. Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers. Ann Allergy Asthma Immunol 2017; 118:719-725.e1. [PMID: 28483294 DOI: 10.1016/j.anai.2017.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/12/2017] [Accepted: 03/28/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Epinephrine injection represents the standard of care for anaphylaxis treatment. It is most effective if delivered intramuscularly, whereas inadvertent intraosseous injection may be harmful. The needle length in current pediatric epinephrine autoinjectors (EAIs) is 12.7 mm; however, the ideal needle length for infants and toddlers weighing less than 15 kg is unknown. OBJECTIVE To determine the skin-to-bone distance (STBD) and skin-to-muscle distance (STMD) at baseline and after simulated EAI application in infants and toddlers (weighing 7.5-15 kg). METHODS Study participants recruited from 2 North American allergy clinics underwent baseline and compression (10-lb pressure) ultrasonography of the anterolateral thigh with a modified ultrasound transducer mimicking the footprint and maximum pressure application of an EAI device. Ultrasound images, with clinical data masked, were analyzed offline for STBD and STMD in short-axis approach. RESULTS Of 53 infants (mean age, 18.9 months; 54.7% male; 81.1% white; mean weight, 11.0 kg), 51 had adequate images for short-axis STBD measurements. In these infants, the mean (SD) baseline STBD was 22.4 (3.8 mm), and the mean (SD) STMD was 7.9 (1.7) mm. With 10-lb compression, the mean (SD) STBD was 13.3 (2.1) mm, and the mean (SD) STMD was 6.3 (1.2) mm. An EAI with a needle length of 12.7 mm applying 10-lb pressure could strike the bone in 43.1% of infants and toddlers in this cohort. CONCLUSION Our data suggest that the optimal EAI needle length for infants and toddlers weighing 7.5 to 15 kg should be shorter than the needle length in currently available pediatric EAIs to avoid accidental intraosseous injections.
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Affiliation(s)
- Harold Kim
- Department of Medicine, Western University, London, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Chitra Dinakar
- Department of Medicine, Stanford University, Stanford, California
| | - Paul McInnis
- Department of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Dan Rudin
- Clinical and Exploratory Pharmacology, Sanofi US, Bridgewater, New Jersey
| | | | - William Daley
- Clinical and Exploratory Pharmacology, Sanofi US, Bridgewater, New Jersey
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Shroba J, Barnes C, Nanda M, Dinakar C, Ciaccio C. Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance. Allergy Asthma Proc 2017; 38:192-196. [PMID: 28441989 PMCID: PMC6479458 DOI: 10.2500/aap.2017.38.4049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Approximately 1% of the U.S. population has a peanut allergy. Previous studies that measured peanut protein in house dust support the hypothesis that household peanut consumption may lead to clinical sensitization through transdermal exposure. OBJECTIVE The aim of this pilot study was to characterize Ara h2 levels in house dust from homes with and without individuals with peanut allergy. METHODS Household dust was obtained from homes with an individual with peanut allergy and from homes with no individual with peanut allergy. Ara h2 levels were determined by using a monoclonal antibody-based immunoassay with a level of determination of 150 ng per gram of dust. Peanut consumption information was obtained by questionnaire. RESULTS A total of 85 dust samples were collected: 38 from homes with a individual with peanut allergy and 47 from control homes. The median Ara h2 level in homes with an individual with peanut allergy was 1236 ng/g (interquartile range [IQR], 256-1342 ng/g), whereas the median Ara h2 level in homes without an individual with peanut allergy was 650 ng/g (IQR, 163-2201 ng/g). Ara h2 levels in dust from homes of individuals with peanut allergy were not significantly lower than in dust from control homes. Of the homes with an individual with peanut allergy, 15 reported complete avoidance of peanut in the home (39%). Ara h2 levels in homes that completely avoided peanuts were not significantly lower than Ara h2 levels in homes that did not restrict peanuts (p = 0.531). CONCLUSION Although families may restrict peanuts and peanut products in the home, there was still detectable Ara h2 levels found in homes. Each subject's definition of restriction may vary, there seemed to be peanut protein entering the home, although the protein origin is not known. Possibilities include cross-reactivity with another antigen or transport into the home on some vector. Further investigation of hypotheses regarding cross-reactivity and environmental exposure to Ara h2 is necessary.
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Affiliation(s)
- Jodi Shroba
- From the Division of Allergy/Immunology, Children's Mercy Hospital, Kansas City Missouri, and
| | - Charles Barnes
- From the Division of Allergy/Immunology, Children's Mercy Hospital, Kansas City Missouri, and
| | - Maya Nanda
- From the Division of Allergy/Immunology, Children's Mercy Hospital, Kansas City Missouri, and
| | - Chitra Dinakar
- From the Division of Allergy/Immunology, Children's Mercy Hospital, Kansas City Missouri, and
| | - Christina Ciaccio
- Division of Allergy and Immunology, University of Chicago, Chicago Illinois
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Warren CM, Dyer AA, Otto AK, Smith BM, Kauke K, Dinakar C, Gupta RS. Food Allergy-Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults. J Allergy Clin Immunol Pract 2017; 5:381-390.e13. [PMID: 28132799 DOI: 10.1016/j.jaip.2016.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear. OBJECTIVE To characterize FA-related risk-taking and self-management behaviors of AYA with FA. METHODS A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership. RESULTS Two distinct FA behavioral risk classes were identified, representing less (N = 120) and more (N = 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.
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Affiliation(s)
| | - Ashley A Dyer
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alana K Otto
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Bridget M Smith
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Edward J. Hines Jr VA Hospital, Center for Management of Complex Chronic Care, Hines, Ill
| | | | | | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
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Abstract
Asthma affects an estimated 7 million children and causes significant health care and disease burden. The most recent iteration of the National Heart, Lung and Blood Institute asthma guidelines, the Expert Panel Report 3, emphasizes the assessment and monitoring of asthma control in the management of asthma. Asthma control refers to the degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met. Although assessment of asthma severity is used to guide initiation of therapy, monitoring of asthma control helps determine whether therapy should be maintained or adjusted. The nuances of estimation of asthma control include understanding concepts of current impairment and future risk and incorporating their measurement into clinical practice. Impairment is assessed on the basis of frequency and intensity of symptoms, variations in lung function, and limitations of daily activities. "Risk" refers to the likelihood of exacerbations, progressive loss of lung function, or adverse effects from medications. Currently available ambulatory tools to measure asthma control range are subjective measures, such as patient-reported composite asthma control score instruments or objective measures of lung function, airway hyperreactivity, and biomarkers. Because asthma control exhibits short- and long-term variability, health care providers need to be vigilant regarding the fluctuations in the factors that can create discordance between subjective and objective assessment of asthma control. Familiarity with the properties, application, and relative value of these measures will enable health care providers to choose the optimal set of measures that will adhere to national standards of care and ensure delivery of high-quality care customized to their patients.
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Mettman D, Thiffault I, Dinakar C, Saunders C. Immunodeficiency-Associated Lymphoid Hyperplasia As a Cause of Intussusception in a Case of Activated PI3K-δ Syndrome. Front Pediatr 2017; 5:71. [PMID: 28469999 PMCID: PMC5395656 DOI: 10.3389/fped.2017.00071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/22/2017] [Indexed: 11/13/2022] Open
Abstract
Activated PI3K-δ syndrome refers to a recently described primary immunodeficiency syndrome consisting of recurrent sinopulmonary infections, lymphadenopathy, mucosal lymphoid aggregates, increased susceptibility to Epstein-Barr virus and cytomegalovirus, and increased incidence of B-cell lymphomas. Variants in PIK3CD, which encodes the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta isoform, enhance membrane association and kinase activity, resulting in increased signal transduction through the PI3K-Akt pathway. Whole-exome sequencing revealed a pathogenic PIK3CD variant in a patient with history of immunologic impairment, recurrent sinopulmonary infections, and lymphoid hyperplasia presenting as intussusception. This case illustrates that while lymphoid hyperplasia secondary to immunodeficiency is most often unsurprising and non-threatening, it can present as an emergency-like intussusception.
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Affiliation(s)
- Daniel Mettman
- Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, MO, USA
| | - Isabelle Thiffault
- Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, MO, USA.,Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, USA
| | - Chitra Dinakar
- Stanford University School of Medicine, Stanford, CA, USA
| | - Carol Saunders
- Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, MO, USA.,Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, USA
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43
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Arakali SR, Green TD, Dinakar C. Prevalence of food allergies in South Asia. Ann Allergy Asthma Immunol 2016; 118:16-20. [PMID: 27864090 DOI: 10.1016/j.anai.2016.09.441] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/14/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the published medical literature on the prevalence and types of food allergies in South Asia. DATA SOURCES A PubMed search was performed using the keywords India and food allergy, Asia and food allergy, and South Asia and food allergy for any period. Articles cited in selected studies were reviewed for their appropriateness of inclusion into this review. STUDY SELECTIONS Publications were included that were original research and fit the topic of food allergy and South Asia. South Asia is defined as region inclusive of India, Pakistan, Bangladesh, and Sri Lanka. RESULTS A total of 169 articles were initially identified, and 47 were reviewed in detail for inclusion in this review. The primary focus was placed on 10 studies that consisted of case reports of newly reported or documented food allergy, survey studies that investigated food allergy prevalence in specific demographics, and prospective and cross-sectional studies with case controls, all of which investigated food allergy prevalence by allergy testing in a selected population. CONCLUSION The medical literature on the prevalence and types of food allergy in South Asia indicates that there is a variety of unusual and unique allergens and an overall low incidence of food allergy. There is also an association of increased food allergy prevalence in individuals who live in metropolitan regions or who migrate to communities that have adopted westernization.
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Affiliation(s)
- Schweta R Arakali
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
| | - Todd D Green
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Chitra Dinakar
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
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Allenbrand R, Barnes CS, Mohammed M, Gard L, Pacheco F, Kennedy K, DiDonna A, Portnoy J, Dinakar C. Comparison of allergens collected from furnace filters and vacuum floor dust. Ann Allergy Asthma Immunol 2016; 118:108-109. [PMID: 27839669 DOI: 10.1016/j.anai.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Luke Gard
- The Children's Mercy Hospital, Kansas City, Missouri
| | | | - Kevin Kennedy
- The Children's Mercy Hospital, Kansas City, Missouri
| | - Anita DiDonna
- The Children's Mercy Hospital, Kansas City, Missouri
| | - Jay Portnoy
- The Children's Mercy Hospital, Kansas City, Missouri
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Affiliation(s)
- Chitra Dinakar
- From the Division of Allergy, Asthma, and Immunology, Children's Mercy Kansas City and the University of Missouri, Kansas City (C.D.); and the Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston (G.T.O.)
| | - George T O'Connor
- From the Division of Allergy, Asthma, and Immunology, Children's Mercy Kansas City and the University of Missouri, Kansas City (C.D.); and the Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston (G.T.O.)
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Murphy H, Wolverton J, Dinakar C. Building a Targeted Asthma Education and Management Program. Mo Med 2016; 113:409-414. [PMID: 30228510 PMCID: PMC6139837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
For individuals with asthma, self-management at home can be complex and overwhelming. The National Asthma Guidelines recommend education, ongoing assessment of control, and identification of those at high risk, as integral elements of improving outcomes for these individuals. Children's Mercy implemented standardized, patient-centered asthma education interventions along with institution of asthma control assessment tools and targeted management of high risk asthmatics. Many of these tools are applicable for use in primary care ambulatory practices.
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Affiliation(s)
- Helen Murphy
- Helen Murphy, BHS, RRT, AE-C, Asthma Coordinator, is in the Allergy, Asthma and Immunology department at Children's Mercy in Kansas City
| | - Jamie Wolverton
- Jamie Wolverton, BHS, RRT-NPS, AE-C, Asthma Educator, is in the Allergy, Asthma and Immunology department at Children's Mercy in Kansas City
| | - Chitra Dinakar
- Chitra Dinakar, MD, MSMA member since 2002, and Missouri Medicine Editorial Board member for Allergy and Immunology, is Professor of Pediatrics, University of Missouri-Kansas City and Director, FARE Center of Excellence at Children's Mercy, Division of Allergy/Immunology, Children's Mercy Kansas City
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Polk BI, Dinakarpandian D, Nanda M, Barnes C, Dinakar C. Association of tree nut and coconut sensitizations. Ann Allergy Asthma Immunol 2016; 117:412-416. [PMID: 27566863 DOI: 10.1016/j.anai.2016.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coconut (Cocos nucifera), despite being a drupe, was added to the US Food and Drug Administration list of tree nuts in 2006, causing potential confusion regarding the prevalence of coconut allergy among tree nut allergic patients. OBJECTIVE To determine whether sensitization to tree nuts is associated with increased odds of coconut sensitization. METHODS A single-center retrospective analysis of serum specific IgE levels to coconut, tree nuts (almond, Brazil nut, cashew, chestnut, hazelnut, macadamia, pecan, pistachio, and walnut), and controls (milk and peanut) was performed using deidentified data from January 2000 to August 2012. Spearman correlation (ρ) between coconut and each tree nut was determined, followed by hierarchical clustering. Sensitization was defined as a nut specific IgE level of 0.35 kU/L or higher. Unadjusted and adjusted associations between coconut and tree nut sensitization were tested by logistic regression. RESULTS Of 298 coconut IgE values, 90 (30%) were considered positive results, with a mean (SD) of 1.70 (8.28) kU/L. Macadamia had the strongest correlation (ρ = 0.77), whereas most other tree nuts had significant (P < .05) but low correlation (ρ < 0.5) with coconut. The adjusted odds ratio between coconut and macadamia was 7.39 (95% confidence interval, 2.60-21.02; P < .001) and 5.32 (95% confidence interval, 2.18-12.95; P < .001) between coconut and almond, with other nuts not being statistically significant. CONCLUSION Our findings suggest that although sensitization to most tree nuts appears to correlate with coconut, this is largely explained by sensitization to almond and macadamia. This finding has not previously been reported in the literature. Further study correlating these results with clinical symptoms is planned.
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Affiliation(s)
- Brooke I Polk
- Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri.
| | - Deendayal Dinakarpandian
- Division of Computer Science and Electrical Engineering, University of Missouri-Kansas City, Kansas City, MO
| | - Maya Nanda
- Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Charles Barnes
- Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Chitra Dinakar
- Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri
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Dinakar C. Updated epinephrine autoinjector labeling. J Allergy Clin Immunol Pract 2016; 4:1020-1. [PMID: 27406970 DOI: 10.1016/j.jaip.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Chitra Dinakar
- Division of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Mo.
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Dinakar C, Warady B. Food Allergy Care: "It Takes a Team". Mo Med 2016; 113:314-319. [PMID: 30228485 PMCID: PMC6139929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2011, the Division of Allergy/Immunology at Children's Mercy published a themed mini-series1 including an article on food allergies that recommended allergen avoidance and prevention/treatment of anaphylaxis as the key pillars of management.2 Since then, the escalating food allergy "epidemic" has stimulated diagnostic and therapeutic advances, as well as coordinated multidisciplinary approaches to treat nutritional imbalances and psychosocial issues. We aim to highlight the team approach to food allergy care in this article.
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Affiliation(s)
- Chitra Dinakar
- Chitra Dinakar, MD, MSMA member since 2002, and Missouri Medicine Editorial Board Member, is Professor of Pediatrics, University of Missouri-Kansas City and Director, FARE Center of Excellence at Children's Mercy, Division of Allergy/Immunology, Children's Mercy Kansas City
| | - Barbara Warady
- Barbara warady, MS, RD, LD, is Senior Clinical Nutrition Specialist in Nutrition Services, Children's Mercy Kansas City
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Affiliation(s)
- Travis M. Sifers
- Department of Internal Medicine—Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
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