Physician approaches to beta-lactam use in patients with penicillin hypersensitivity.

Beta-lactam antibiotics are widely used, but hypersensitivity reactions are common and difficult to manage. This study was designed to identify lack of knowledge regarding the safe use of alternative beta-lactams in penicillin-allergic patients and assess management differences between allergists and nonallergists. An electronic physician survey was sent to 623 providers in allergy, internal medicine, pediatrics, and family medicine, querying beta-lactam use in patients with a history of penicillin allergy. A total of 110 (17.7%) surveys were completed. For patients with a prior maculopapular rash to penicillin, most providers were uncomfortable prescribing penicillins again, although they would use other beta-lactams. In patients with an exfoliative dermatitis to penicillin, 46% of responders would not prescribe any beta-lactam again. For patients with a positive skin test to penicillin, only 45.1% of nonallergists were comfortable prescribing monobactams versus 62.5% of allergists; 30.3% of all responders would give a carbapenem. In patients with urticaria to penicillin, pediatricians were the most comfortable prescribing third- or fourth-generation cephalosporins. Providers (both allergists and nonallergists) were unfamiliar with the safety of prescribing penicillin in patients with history of maculopapular rash, the safety of monobactams, and low cross-reactivity with carbapenems in penicillin-allergic individuals. Nonallergists were also unfamiliar with the usefulness of penicillin skin testing. Improved education is needed to address these areas. Additionally, we found variability in responses regarding exfoliative dermatitis and comfort prescribing cephalosporins in patients with suspected IgE-mediated drug allergy to penicillin, highlighting the need for additional research in these areas.

A pediatric food allergy support group can improve parent and physician communication: results of a parent survey.

Rationale. We sought to evaluate the impact of having an allergist at a food allergy support group (FASG) on the relationship between parents and their child's allergist. Methods. Ninety-eight online surveys were sent to parents who attend a FASG affiliated with our institution. Responses were analyzed looking for reasons for attending the support group and comfort with having an allergist present at the meetings. The main objective of this study was to evaluate the impact of having an allergist at the food allergy support group on the relationship between parents and their child's allergist. Results. The FASG decreased anxiety about food allergies for 77.7% of those who responded. Most (71.4%) felt the FASG improved their child's quality of life. Greater than 90% felt comfortable having an allergist at the support group meeting, and 64.3% felt that talking to an allergist at the FASG made it easier to speak with their child's allergist. Conclusions. FASG meetings appear to be a good way for families of children with food allergies to learn more about food allergies, improve quality of life, and increase comfort in communicating with a child's allergist.

Identical twin Hispanic male infants with nonbilious nonbloody vomiting and diarrhea.

We present a case of twin Hispanic male infants fed with cow's milk formula who presented at 3 weeks of life with nonbilious, nonbloody vomiting and diarrhea. Laboratory evaluation revealed leukocytosis, acidosis, and methemoglobinemia. Sepsis evaluation was negative. Although they recovered quickly with i.v. fluids, symptoms recurred again with ingestion of soy formula. An underlying diagnosis was sought that could explain their symptoms.

Treatment of hereditary angioedema with plasma-derived C1 inhibitor.

BACKGROUND: Plasma-derived C1 inhibitor (C1-INH) concentrate is a treatment option for acute hereditary angioedema (HAE) attacks and is considered the standard-of-care in many countries, although it is not yet available in the United States. Studies are still being conducted to establish its safety and efficacy as required by the FDA. OBJECTIVE: To review the medical literature to determine if C1-INH concentrate is a safe and effective treatment for acute HAE attacks. METHODS: THE FOLLOWING KEYWORDS WERE SEARCHED IN PUBMED AND OVID: C1 esterase inhibitor, C1-inhibitor, C1 inhibitor, and hereditary angioedema treatment. English-language articles were searched from 1966 to the present to look for studies demonstrating the efficacy and the safety of C1-INH concentrate. RESULTS: The English-language literature search revealed several studies showing significantly improved relief of HAE symptoms with the administration of C1-INH concentrate - many studies demonstrated some improvement of symptoms within 30 minutes. Side effects have been similar to placebo, and no proven cases of viral transmission have occurred in over 20 years. CONCLUSION: C1-INH concentrate appears to be a very safe and effective treatment option for HAE.