Synopsis The prevalence of food allergy is rising for unclear reasons, with prevalence estimates in the developed world approaching 10%. Knowledge regarding the natural course of food allergies is important because it can aid the clinician in diagnosing food allergies and in determining when to consider evaluation for food allergy resolution. Many food allergies with onset in early childhood are outgrown later in childhood, although a minority of food allergy is persistent into adolescence and even adulthood. More research is needed to improve food allergy diagnosis, treatment, and prevention.

Survivors of preterm birth experience long-lasting behavioral problems characterized by increased risk of depression, anxiety, and impairments in social functioning. The amygdala is a key region for social functioning and alterations in amygdala structure and connectivity are thought to underlie social functioning deficits in many disorders, including preterm birth. However, functional connectivity of the amygdala and its association with social impairments is not well-studied in preterm participants (PTs). In a group of late adolescents born very PT (600–1250 g birth weight), measures of social and emotional development were examined using the Child Behavior Checklist (CBCL) administered at age 16 (66 term and 161 preterm participants), the Youth Self Report (YSR) administered at age 16 (56 term and 45 preterm participants), and the Vineland Adaptive Behavior Scales (VABS) administered at age 18 (71 term and 190 preterm participants). Amygdala functional connectivity was also examined using resting-state functional magnetic resonance imaging at age 20 (17 term and 19 preterm participants). By parent report, preterm-born adolescents demonstrate increased social impairment compared to their term-born peers. Amygdala connectivity is altered for those prematurely-born, and markers of social functioning correlate with altered amygdala-PCC connectivity. These findings add to knowledge regarding the developmental trajectory of amygdala connectivity in PT and suggest a possible neural underpinning for the well-characterized social impairment experienced by prematurely-born individuals.

In a subset of patients with AERD, we observed elevated total serum IgE even when atopy was not present. To better understand the disease, the cause and clinical relevance of this phenomenon deserves further exploration.

Background Aspirin-exacerbated respiratory disease (AERD) is characterized by three clinical features: asthma, nasal polyposis, and respiratory reactions to cyclooxygenase-1 inhibitors (NSAIDs). Electronic health records (EHRs) contain information on each feature of this triad. Objective To determine if an informatics algorithm applied to the EHR could electronically identify patients with AERD. Methods We developed an informatics algorithm to search the EHRs of patients age 18 and older from the Partners Healthcare system over a 10 year period (2004–2014). Charts with search terms for asthma, nasal polyps and record of respiratory (Cohort A) or unspecified (Cohort B) reactions to NSAIDs were identified as “possible AERD”. Two clinical experts reviewed all charts to confirm a diagnosis of “clinical AERD” and classify cases as “diagnosed AERD” or “undiagnosed AERD” based on physician documented AERD-specific terms in patient notes. Results Our algorithm identified 731 “possible AERD” cases, of which 638 were not in our AERD patient registry. Chart review of cohorts A (n=511) and B (n=127) demonstrated a positive predictive value (PPV) of 78.4% for “clinical AERD”, which rose to 88.7% when unspecified reactions were excluded. Of those with clinical AERD, 12.4% had no mention of AERD by any treating caregiver and were classified as “undiagnosed AERD”. “Undiagnosed AERD” cases were less likely to have been seen by an allergist/immunologist than “diagnosed AERD” cases (38.7% vs. 93.2%, P<.0001). Conclusion An informatics algorithm can successfully identify both known and previously undiagnosed cases of AERD with a high PPV. Involvement of an allergist/immunologist significantly increases the likelihood of an AERD diagnosis.

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