New research was presented at ACAAI 2020, the virtual American College of Allergy, Asthma & Immunology Annual Scientific Meeting, from November 13-15. The features below highlight some of the studies emerging from the conference that focused on emergency medicine.
COVID-19 Outcomes Similar With or Without Allergies
With many in the field of allergy and immunology focusing attention during the COVID-19 pandemic on how patients with allergies and asthma may be affected if they become infected with the virus, researchers examined hospital data to determine whether patients with allergic conditions experience more severe COVID-19-related outcomes than those without such conditions. “We examined the charts of 275 patients admitted to the hospital who tested positive for the SARS-CoV-2 virus for any history of allergic disease,” Dylan Timberlake, MD, lead author of the study, said in a press release. “Over the 2-month period when we examined the charts, we found the severity of disease didn’t seem to differ between COVID-19 patients with allergies, versus COVID-19 patients without allergies.” Disease severity was determined by such factors as ICU admission, length of stay, need for supplemental oxygen, and intubation rate. Although more patients with allergies had COPD (39% vs 17%)—a known risk factor for severe COVID-19 outcomes—the study team found a statistical trend suggesting possible protection in patients with pre-existing allergic disease, but not asthma, after controlling for the presence of COPD and its association with more severe COVID-related illness.
Children With Food Allergies & Their Parents Are Often Bullied
In prior research, parents of children with food allergies have reported that their children are often bullied by classmates, as well as parents of other children and teachers. Study investigators who conducted a survey of children aged 4-17 found that nearly one in five parents of children with food allergies are also the targets of bullying from multiple sources. “We know children are often bullied about their food allergies,” said Dannielle Brown, MHS, lead author of the study, in a press release. “What we weren’t aware of was how many parents are bullied by multiple sources. Of the 252 parents or guardians we surveyed, more than 17% said they had been bullied.” Many parents/guardians said it was helpful to take steps to end the bullying, with 13% saying they spoke with their child, 7% with the offended or the offender’s parent, 17% with a teacher, and 15% with a principal or school administrator. Nearly half who took such actions said doing so was helpful. “No child or their parent should be bullied because of their food allergies,” said Ruchi Gupta, MD, MPH, co-author of the study, in a press release. “Having a food allergy puts tremendous stress on the entire family and any form of bullying makes life that much harder.”
With Telemedicine, No-Show Asthma Visits Significantly Reduced During COVID-19
With the COVID-19 pandemic resulting in many patients using telemedicine to attend regular doctor visits, study investigators compared show rates for children with asthma across 4 months during the pandemic with the same period in 2019. “It would be normal to expect parents to be hesitant to bring kids into an asthma checkup during a pandemic,” Kenny Kwong, MD, study author, said in a press release. “We run the LAC+USC Breathmobile program (an urban school-based mobile asthma program) in Los Angeles and have regular asthma patients we work with. The pandemic in 2020 resulted in closure of most Los Angeles schools, and face-to-face visits were converted to telemedicine visits. We found that not only did kids show up for appointments, but their show rates were also significantly higher than during the same period in 2019.” During the telemedicine period, more than 90% of patients reported well-controlled asthma, comparable with pre-COVID rates. Breathmobile staff also reported a 32% to 62% increase in the time spent with each patient while on telemedicine visits when compared with in-person visits.
QOL Disproportionately Affected by Food Allergies in Asian Americans
An examination of 6,829 questionnaires completed by the parents of children with food allergies at Cincinnati Children’s Hospital Medical Center as part of a retrospective chart review expands upon previous studies showing that food allergies negatively affect quality of life (QOL). Questionnaires were scored from 0-100, with higher scores corresponding with worse QOL. “Based on our questionnaire, Asian parents of children with food allergy living in the US had a mean score of 50.5, indicating a ‘fairly’ negative impact on quality of life, which was significantly higher than white and Black parents,” said lead study author Christine Rubeiz, MD, in a press release. “White and Black parents had mean scores of 40.4 and 40.9, respectively, corresponding closer to the food allergy having ‘a little bit’ of a negative impact on quality of life.” Adding to Dr. Rubeiz’s sentiments, senior study author, Amal Assa’ad, MD, said, “Our study showed Asian parents had significantly higher scores (worse QOL) in both higher and lower socioeconomic groups. “Most studies of Asian children have been done in Asia, where the prevalence of food allergy is 3% to 8%. Some estimates of food allergy in the general US population report a similar prevalence—about 8%. Asian families with food allergy appear to have worse food allergy-related quality of life [FAQOL] compared [with] other races, according to our research. This highlights the need for further studies on the impact of food allergy on Asian families, who may be an under-recognized population.” Dr. Rubeiz added, “We found other significant racial disparities in FAQOL scores, particularly with Black and Hispanic patients. Within the Medicaid population, we found that Black and Hispanic patients and parents had significantly higher scores (worse quality of life) compared [with] white patients and parents. Cultural food preferences and the financial burden of food allergy may be a factor in this finding.”
Immune System Shaped into Adolescence by Prenatal Dog Ownership
Prior research indicates an association between prenatal pet exposure and immunoglobulin E (IgE) trajectory through age 2. To determine if this association persists during ages 10-14, researchers assessed data on a cohort of 1,193 mother-child pairs in southeast Michigan. The study team found that the area under the curve for IgE levels during ages 10-14 was 28.8% lower in children with prenatal pet exposure when compared with those with no such exposure. Dog ownership, associated with a 26.7% lower IgE trajectory, was the main driver of this association, with cat ownership having no significant association with IgE trajectory. The findings support the “hygiene hypothesis,” said Jay Portnoy, MD—who was not involved in the study, in a statement—which is based on dogs being particular carriers of bacteria from outside into the home and resulting in a potential influence on a child’s microbiome early in develop. The hypothesis is supported by previous studies suggesting an association between dog ownership and reduced risk of eczema in children. Race/Ethnicity and delivery method affected the association between pet exposure and IgE reductions, with children of African-American mothers experiencing an 11.3% reduction versus a 33.6% reduction in other races and ethnicities, and children delivered via cesarean delivery experiencing a 46.2% lower IgE trajectory versus an 18.1% lower trajectory in children delivered vaginally.