ABSTRACT
BACKGROUND: Little is known about exposure to mouse allergen (Mus m 1) and allergic rhinitis (AR). OBJECTIVE: To evaluate the association between mouse allergen exposure and AR in children. METHODS: We examined the relation between mouse allergen level in house dust and AR in 511 children aged 6 to 14 years in San Juan, Puerto Rico. Study participants were chosen from randomly selected households using a multistage probability sample design. The study protocol included questionnaires, allergy skin testing, and collection of blood and dust samples. AR was defined as current rhinitis symptoms and skin test reactivity to at least one allergen. RESULTS: In the multivariate analyses, mouse allergen level was associated with a 25% decreased odds of AR in participating children (95% confidence interval, 0.62-0.92). Although endotoxin and mouse allergen levels were significantly correlated (r = 0.184, P < .001), the observed inverse association between Mus m 1 and AR was not explained by levels of endotoxin or other markers of microbial or fungal exposure (peptidoglycan and glucan). CONCLUSION: Mouse allergen exposure is associated with decreased odds of AR in Puerto Rican school-aged children.
Subject(s)
Air Pollution, Indoor , Allergens/immunology , Asthma/immunology , Dust/immunology , Rhinitis, Allergic/immunology , Adolescent , Animals , Asthma/complications , Asthma/diagnosis , Child , Endotoxins/immunology , Female , Humans , Male , Mice , Odds Ratio , Puerto Rico , Rhinitis, Allergic/complications , Rhinitis, Allergic/diagnosis , Skin Tests , Surveys and QuestionnairesSubject(s)
Asthma/diagnosis , Asthma/epidemiology , Health Services Accessibility , Rhinitis, Allergic/diagnosis , Rhinitis, Allergic/epidemiology , Adolescent , Algorithms , Animals , Antigens, Dermatophagoides/immunology , Asthma/complications , Child , Female , Health Services Accessibility/statistics & numerical data , Humans , Immunoglobulin E/blood , Male , Practice Guidelines as Topic , Predictive Value of Tests , Puerto Rico , Pyroglyphidae , Rhinitis, Allergic/complications , Risk Factors , Skin TestsABSTRACT
BACKGROUND: Initial food-allergic reactions are often poorly recognized and under-treated. METHODS: Parents of food-allergic children were invited to complete an online questionnaire, designed with Kids with Food Allergies Foundation, about their children's first food-allergic reactions resulting in urgent medical evaluation. RESULTS: Among 1361 reactions, 76% (95% CI 74-79%) were highly likely to represent anaphylaxis based on NIAID/FAAN criteria. Only 34% (95% CI 31-37%) of these were administered epinephrine. In 56% of these, epinephrine was administered by emergency departments; 20% by parents; 9% by paramedics; 8% by primary care physicians; and 6% by urgent care centers. In 26% of these, epinephrine was given within 15 min of the onset of symptoms; 54% within 30 min; 82% within 1 h; and 93% within 2 h. Factors associated with a decreased likelihood of receiving epinephrine for anaphylaxis included age <12 months, milk and egg triggers, and symptoms of abdominal pain and/or diarrhea. Epinephrine was more likely to be given to asthmatic children and children with peanut or tree nut ingestion prior to event. Post-treatment, 42% of reactions likely to represent anaphylaxis were referred to allergists, 34% prescribed and/or given epinephrine auto-injectors, 17% trained to use epinephrine auto-injectors, and 19% given emergency action plans. Of patients treated with epinephrine, only half (47%) were prescribed epinephrine auto-injectors. CONCLUSIONS: Only one-third of initial food-allergic reactions with symptoms of anaphylaxis were recognized and treated with epinephrine. Fewer than half of patients were referred to allergists. There is still a need to increase education and awareness about food-induced anaphylaxis.
Subject(s)
Anaphylaxis/drug therapy , Anaphylaxis/immunology , Epinephrine/therapeutic use , Food Hypersensitivity/drug therapy , Food Hypersensitivity/immunology , Abdominal Pain/diagnosis , Anaphylaxis/diagnosis , Anti-Asthmatic Agents/therapeutic use , Arachis/adverse effects , Asthma/drug therapy , Bronchodilator Agents/therapeutic use , Diarrhea/diagnosis , Eggs/adverse effects , Emergency Medical Services/statistics & numerical data , Female , Food Hypersensitivity/diagnosis , Humans , Infant , Male , Surveys and QuestionnairesABSTRACT
OBJECTIVE: A possible association between long-acting beta-agonists (LABA) and severe asthma exacerbations including death remains controversial. We examined whether LABA in the setting of combination therapy with inhaled corticosteroids (ICS) increase the risk of near-fatal asthma in children using a case-control study design. METHODS: Medical records from admissions for asthma exacerbations in children 4-18 years of age during the 2005 calendar year at Children's Hospital of Pittsburgh of UPMC were reviewed. Cases and controls were determined by pediatric intensive care unit (PICU) and floor admission, respectively. Exposure was defined by LABA use in combination with ICS versus ICS alone. RESULTS: Records from 85 PICU and 96 pediatric floor admissions were reviewed. LABA use in combination with ICS did not increase the risk of PICU admission (odds ratio 1.07, 95% CI 0.46-2.52) compared to ICS only without LABA. After adjusting for demographics, asthma severity, history of PICU admissions, and concurrent infection, LABA/ICS use still did not increase the risk of PICU admission (adjusted odds ratio 0.84, 95% CI 0.26-2.76) compared to ICS alone. There were no deaths and five intubations within the study period. CONCLUSIONS: The combination of LABA and ICS did not appear to increase the risk of near-fatal asthma in children.
