New research was presented at AAAAI 2021, the American Academy of Allergy Asthma & Immunology Virtual Annual Meeting, from February 26 to March 1. The features below highlight some of the studies emerging from the conference.
COVID-19 & Food Protein-Induced Enterocolitis Syndrome
Although oral challenge (OC) is used to confirm resolution of food protein-induced enterocolitis syndrome (FPIES), barriers of in-person care with the COVID-19 pandemic have caused delays in scheduling OCs. To assess parental attitudes on the possibility of supervised, remote, at-home OCs in the hopes of facilitating early reintroduction of FPIES allergenic foods, researchers conducted a 12-point questionnaire of parents to children aged 2-4 that was focused on FPIES re-assessment during the pandemic, parental consideration for at-home OC, and consideration of a hybrid in-office/home OC model. Among parents of toddlers with FPIES, 48% reported that they would proceed with an FPIES OC during a pandemic, whereas 52% said they would delay the OC. Supervised, at-home OC was agreed to among 69% of those who chose to proceed with FPIES OC during a pandemic. Among parents who agreed to proceed with an FPIES OC as soon as possible, 87% agreed to the in-home challenge.
Oxygen Saturation in Patients With Asthma Not Affected by Face Masks
With evidence that patients with asthma often question the effects of face mask use—to reduce COVID-19 transmission—on oxygen saturation (SpO2), investigators asked adult and pediatrics patients presenting to an allergy clinic to complete a survey on demographics, asthma diagnosis, perceived control of asthma, and mask type worn. Pulse oximetry readings were performed while respondents wore a mask, with respondents reported their duration of make use prior to these readings. SpO2 levels were the same in both patients with asthma and patients without asthma, ranging from 93% to 100% (mean 98%). “The SpO2 mean showed no significant difference when adjusted for gender (male mean 98%, female 98%), race (African-American 98.5%, Caucasian 98%, others 98 to 99.5%), mask type used [fabric 98% (n5119), surgical 98% (n583), N95 mask 99% (n53)], or duration of mask use (<1 hour 98%, 1 or more hours 99%),” write the study authors. Perceived asthma control was also found to not correlate with SpO2 level.
Resolving Milk Oral Challenge Allergic Reaction By Dosing Interval Adjustment
Prior research indicates that the risk for adverse reactions during oral food challenge (OFC) for diagnosing food allergy remains high despite wide acceptance of published guidelines. For a study, children with confirmed cow’s milk allergy were orally challenged using single blind, placebo-controlled protocol with semi-logarithmic dose increment. Adverse reactions from the OFC were most common in the mucocutaneous (84.3%) and gastrointestinal systems (83.2%), followed by the respiratory system (64.2%). The initial dose of 0.1 mL resulted in a positive OFC in 9% of children. Among those who reacted to higher doses, shorter average dosing interval (adjust odds ratio, 0.88) was associated with the use of multiple ≥ 2) epinephrine doses to control reactions. The average dosing interval in children requiring multiple epinephrine doses (median, 18.5 mins) was shorter, but not significantly, when compared with those who received one or no epinephrine dose (median, 21.0 mins). “A dosing interval of 30 minutes will likely reduce the need for multiple doses of epinephrine to resolve severe allergic reactions during milk oral challenge,” write the study authors.
Peanut Allergy Prevalence Down With Earlier Peanut Introduction
Researchers who had previously shown a dramatic increase in peanut introduction by age 12 months following changes in 2016 infant feeding guidelines evaluated the impact on peanut allergy prevalence following these changes to infant feed practices. Using the same sampling frame and methods, they recruited a population-based sample of nearly 2,000 12-month-olds in 2018-2019, who were compared with a sample of more than 5,200 infants recruited in 2007-2011. They collect demographic and infant feeding data via questionnaires and performed skin prick tests and food challenges in infants who were sensitized. Following adjustment for parent’s country of birth, family history of allergy, dog ownership, and number of siblings, the peanut allergy prevalence in 2018-2019 was 2.6%, compared with 3.1% in 2007-2011, a 16% decrease. Little difference was observed in these rates following further adjustment for eczema. Among infants in the 2018-2019 cohort, 77.7% consumed peanut before age 12 months, with a peanut allergy prevalence of 2.6%, compared with a prevalence of 4.8% among those who avoided peanut until after 12 months.
Beta-Lactam Allergy Associated With Decreased First-Line Antibiotic Use
While anti-pseudomonal beta-lactam is the first-line treatment for neutropenic fever, more than 10% of patients report a beta-lactam allergy. However, data indicate that 90% of patients with a documented beta-lactam allergy do not have a true allergy. For a national, cross-sectional study of 290 inpatients at 64 US hospitals, investigators sought to assess the association between documented beta-lactam allergy (penicillin and/or cephalosporin allergy in the electronic medical record) with first-line febrile neutropenia treatment (cefepime, anti-pseudomonal carbapenem, or piperacillin-tazobactam) using generalized estimating equations models with logit link adjusted for age, sex, race, ICU location, and resistant organism colonization/infection. Among the 19% of participants with a documented beta-lactam allergy, first-line treatment was less frequently received when compared with those without documented allergy (36% vs 63%), with less frequent cefepime (36% vs 63%) and piperacillin-tazobactam (9% vs 15%) but more frequent meropenem (35% vs 11%). Patients with a documented beta-lactam allergy had reduced use of first-line febrile neutropenia treatment upon full adjustment (adjusted odds ratio, 0.36)
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