Background
Food insecurity (FI), limited availability of or access to nutritional foods, is linked to poor child/caregiver health. We examined FI in food‐allergic and non‐food‐allergic children to determine whether dietary limitations associated with food allergy increases risk of FI.
Methods
Food‐allergic and non‐food‐allergic children (1‐17 years) were recruited from Arkansas Children's Hospital allergy/asthma clinics. The USDA Food Security Survey, the Newest Vital Sign Health Literacy (HL) questionnaire, and the Food Allergy Impact Scale QOL survey were administered. Logistic regression and analysis of covariance models were utilized for data analysis.
Results
Subjects (n = 650) included 325 food‐allergic and 325 non‐food‐allergic children. Overall rate of FI was 21.5% (food allergic 22.2% and non‐food allergic 20.9%) with no significant difference in the prevalence of FI between groups (OR = 1.30; 95% CI 0.86‐1.96; P = 0.21). FI was increased in households of children with both milk and egg allergy when compared to those without food allergy and those with single food allergy (OR = 2.5; 95% CI 1.4‐4.6; P = 0.003). Mean HL rates were higher in the food‐secure vs food‐insecure groups (mean diff = 0.31; 95% CI 0.03‐0.59; P = 0.03). Among food‐allergic children, QOL was better in the food‐secure vs food‐insecure group (mean diff = 0.61; 95% CI 0.002‐1.23; P = 0.049).
Conclusion
Food allergy to milk and egg was associated with increased risk of household FI. Food‐insecure participants had lower HL than their food‐secure counterparts. Further work is needed to define risks associated with FI among food‐allergic children to improve screening and management strategies.
Asthma is a heterogeneous syndrome that might be better described as a constellation of phenotypes or endotypes, each with distinct cellular and molecular mechanisms, rather than as a singular disease. One of these phenotypes is eosinophilic asthma. As the development of eosinophilic inflammation is categorically dependent on the biological activity of Interleukin (IL)-5, IL-5 antagonism became an obvious target for therapy in this phenotype. Early trials of monoclonal antibodies targeting the biological activity of IL-5, including reslizumab, mepolizumab, and benralizumab, were performed on asthmatics with no concern for evidence of eosinophilia. These trials were largely unsuccessful. However, during these trials, researchers recognized the need to quantify eosinophilia in asthma subjects in order to identify those asthmatics in whom these medications would be more likely to improve symptoms and lung function. Using biomarkers, such as sputum and blood eosinophilia, recent studies of these medications have shown improvements in blood and sputum eosinophilia, forced expiratory volume in 1 second, and quality of life assessments as well as reducing occurrences of exacerbations. Moving forward, better and less invasive biomarkers of eosinophilia are necessary to ensure that the correct patients are chosen to receive these medications to receive maximal benefit.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
In this cohort study of hospitalized patients with linked medical record data, we developed International Classification of Diseases (ICD) criteria that accurately identified laboratory-confirmed, severe influenza hospitalizations (positive predictive value [PPV] 80%, 95% confidence interval [CI] 71-87%), which we validated through medical record documentation. These criteria identify patients with clinically important influenza illness outcomes to inform evaluation of preventive and therapeutic interventions and public health policy recommendations.
Food allergy or intolerance is often attributed by patients as the cause of many symptoms unknown to be directly related to food ingestion. For immunoglobulin E (IgE) mediated food allergy, diagnostic modalities are currently limited to the combination of clinical history, evidence
of sensitization with food-specific IgE testing and skin-prick testing, and oral food challenge. Many patients find an appeal in the promise of identification of the etiology of their symptoms through alternative food allergy or intolerance diagnostic modalities. These patients may seek guidance
from allergists or their general providers as to the legitimacy of these tests or interpretation of results. These tests include food-specific serum IgG or IgG4 testing, flow cytometry to measure the change in leukocyte volume after exposure to food, intradermal or sublingual provocation-neutralization,
electrodermal testing, applied kinesiology, hair analysis, and iridology. In addition, there are some unconventional therapeutic modalities for adverse reactions to foods, including rotary diets. None of these have been supported by scientific evidence, and some even carry the risk of severe
adverse reactions. It is important that we offer our patients evidence-based, accurate counseling of these unproven modalities by understanding their methods, their paucity of credible scientific support, and their associated risks.
RATIONALE: Eosinophilic esophagitis (EoE) is likely to recur when medicine or diet treatment is discontinued; thus, adherence to long-term therapy seems critical. Some EoE experts have recommended basing therapy on patient preference and available resources. Our goal was to develop a decision aid tool (DAT) for EoE in order to educate patients/ families about treatment options and involve them in choosing a therapy consistent with their personal values. METHODS: Twenty EoE patients were randomly assigned to one of two study groups to complete a DAT or receive verbal information describing treatment options. After this intervention, patients/families chose to start treatment with cow's milk elimination diet or swallowed corticosteroids. Symptoms were reassessed after 8 weeks, and the results of repeat biopsies were reviewed. RESULTS: Five patients (25%) chose treatment with cow's milk elimination and 15 patients (75%) started swallowed fluticasone. Treatment choice was not related to study group (p50.9). All together, 16 completed a second study visit (n513) and/or repeat esophagogastroduodenoscopy (n513). Most patients who returned for follow up reported that symptoms were at least somewhat improved with treatment (12/13). For those who had repeat esophageal biopsy, histologic remission (i.e. <15 eosinophils/ high power field) was noted in 7/13 (54%) with 5/9 (56%) taking swallowed fluticasone as compared with 2/4 (50%) who had removed foods with cow's milk from the diet (p50.9). CONCLUSIONS: In spite of offering the simplest dietary treatment for EoE, the majority of our patients preferred starting medicine. Histologic remission was challenging even in the setting of close follow up and individualized treatment plans.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.