Introduction:The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens.
Methods:We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders.Results: There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders.Discussion: Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally.Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.
Digital spot radiographs could be omitted in modern flat panel systems during HSG. Fluoroscopy image acquisitions in a modern flat panel unit at 3.75 pps and a beam filtration of 4 mm Al and 0.9 mm Cu demonstrate acceptable image quality with an average D equal to 0.45 mGy. This value is lower compared to the studied literature. For these reasons, the proposed method may be recommended for routine HSG examination in order to limit radiation exposure to the ovaries.
RATIONALE: The electronic medical record (EMR) is an important tool for communication among providers. Use of the EMR for recording peanut allergy (PA) has not been investigated. METHODS: The EMR of a tertiary care medical center was reviewed for patients with at least one well child primary care visit between January 1 and December 31, 2016. Comparisons were made between children who had PA on their problem list (PL), updated by physicians, vs allergy list (AL) alone, updated by multiple individuals. RESULTS: Of 884 charts reviewed, 453 charts had PA on PL and 872 had PA on AL. There were no differences in age or gender between children who did and did not have PA on PL. However, children with PA on their PL were more likely to have an allergy referral, evaluation by an allergist, additional food allergies, epinephrine prescriptions, and repeat peanut IgE levels (p<0.001 for each). Children with PA on PL were more likely to have peanut allergy confirmed by an allergist than children with PA on AL alone (OR 1.8, p5.01). Among children with PA on AL alone, 17% were considered tolerant to peanut, compared to 5% with PA recorded on PL (p<0.001). However, PL could not be relied upon to capture PA consistently, as 67% considered definitely PA by the allergist did not have PA on their PL. CONCLUSIONS: There is inconsistency with how PA is communicated in the EMR, which was associated with significant differences in how PA is confirmed and managed. 825 Barriers preventing Canadian parents of children with food allergy from participating in Oral Food Challenges and possible solutions
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