those without S aureus colonization (70% vs 48%, P < .0001). Diagnostic code for anaphylaxis, prescription for an epinephrine autoinjector, or both were also found to be significantly more prevalent in patients with S aureus colonization versus those without S aureus colonization (53% vs 44%, P 5 .04; see Tables E1 and E2 in this article's Online Repository at www.jacionline.org).These data suggest there is an association between S aureus colonization and food allergy to peanut, egg white, and cow's milk in patients with AD. S aureus is a pathogenic microbe that produces multiple virulence factors (eg, superantigens, cytolysins, proteases, lipases, protein A, and microbial surface components recognizing adhesive matrix molecules) that can lead to break down of the epithelial barrier. 9 Additionally, exposure of murine models to S aureus toxin leads to increased T H 2-mediated responses 4,5 and decreased regulatory T-cell function, 4 both of which are described in patients with food allergy. 10 We propose that the skin microbiome plays an important role in skin barrier function and directs immune responses. Aberrancies in the skin microbiome, including S aureus colonization, lead to skin barrier dysfunction and immune dysregulation, ultimately contributing to the development of food allergy through topical exposure of antigen.Furthermore, these findings show a unique association between peanut allergy and MRSA because peanut sIgE levels were higher in patients with MRSA colonization compared with those with MSSA. These findings support the theory that S aureus causes skin breakdown, leading to epicutaneous absorption of peanut. MRSA produces more superantigens than MSSA 9 and might be contributing to more significant skin barrier breakdown. Additionally, studies have demonstrated that peanut allergy, in particular, occurs through epicutaneous allergen absorption. 2,3 These results are of particular relevance to the events that predispose subjects to food allergy. Recent studies have demonstrated that environmental peanut drives sensitization and peanut allergy in patients with AD. 2 Further studies looking at peanut protein and S aureus in house dust could shed new light on the effect of S aureus and food allergy. The clinical relevance to our findings are suggested by increased diagnostic codes for anaphylaxis, epinephrine autoinjector prescription, or both in patients with S aureus colonization, indicating there was physician concern for clinically relevant food allergy.In the future, studies are needed to assess the association between S aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations open up the possibility that therapy directed at eradicating S aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. REFERENCES 1. Leung DY, Guttman-Yassky E. Deciphering the compl...

Background: Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age. Methods: Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador. Results: In 250 children included, HIV diagnosis was revealed at a median age of 11 years (p25-p75 9-12). Children 12 years old or older (P < 0.0001), 10 or more years since HIV diagnosis (P = 0.001), antiretroviral initiation above 3 years of age (P = 0.018) and decease of the mother (P = 0.048) were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age (28.4%) than before (15.4%, P = 0.047). According to the simplified medication adherence questionnaire, 194 children (78.2%) were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 (67.7%). In multivariate analysis, variables associated with nonadherence were age ≥14 years (P < 0.001), taking ≥3 daily antiretroviral pills (P = 0.013) and the presence of adverse effects (P < 0.001), whereas nonadherence (P = 0.001) was the only variable significantly associated with an unsuppressed HIV-RNA viral load. Conclusions: Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.

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Background: Suspected antibiotic hypersensitivity in children is a frequent reason for consultation. Skin test performance and drug provocation test (DPT) duration are controversial issues. The objective of this study was to assess the effectiveness of diagnostic tests used in the study of antibiotic hypersensitivity and to estimate an optimal duration for DPT. Methods: Sixty-two children with a suspected hypersensitivity reaction to antibiotics were studied. Skin tests were performed on all patients. In the case of negative results, DPTs were performed for a duration similar to the time elapsed from the start of treatment until the onset of the reaction. Results: The frequency of antibiotic hypersensitivity in the study population was 8.1% (5 of 62). Only 1 patient showed positive skin tests. The other allergic patients were diagnosed by DPT, which reproduced the reaction within the first 6 hours in all but one of them. Conclusions: Shortening DPT duration may decrease the sensitivity of the test for the diagnosis of non–IgE-mediated hypersensitivity; however, it should be considered as an opportunity to reduce the resulting microbial resistances.