COVID-19 & Food Protein-Induced Enterocolitis Syndrome

Although oral challenge (OC) is used to confirm resolution of food protein-induced enterocolitis syndrome (FPIES), barriers to 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 pediatric 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 reporting their duration of mask use prior to these readings. SpO2 levels were the same in both patients with and without asthma, ranging from 93% to 100% (mean, 98%). “The SpO2 mean showed no significant difference when adjusted for gender (male mean, 98%; female mean, 98%), race (African-American, 98.5%; Caucasian, 98%; others, 98% to 99.5%), mask type used [fabric 98% (n = 5119), surgical 98% (n = 583), N95 mask 99% (n = 53)], 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 Allergic Reaction at Milk Oral Challenge 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 a single blind, placebocontrolled 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 (adjusted 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 feeding 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 collected demographic and infant feeding data via questionnaires and performed skin prick tests and food challenges in infants who were sensitized. Following adjustment for parents’ 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 peanuts 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 firstline 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 OR, 0.36)