ABSTRACT
This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n = 199; aged 7-17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (chi2[1] = .11, p =.74, NFI = .99, RMSEA = .00). Observed NFEC predicted child depression (beta = .19, p < .01), which predicted asthma disease severity beta = .23, p < .01). Relational security inversely predicted depressive symptoms (p = -.40, p < .001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms.
Subject(s)
Asthma/psychology , Depression/psychology , Family Health , Family/psychology , Interpersonal Relations , Parent-Child Relations , Adolescent , Asthma/physiopathology , Child , Emotions , Female , Humans , Male , Models, Psychological , Psychological Tests , Psychometrics , Stress, PsychologicalABSTRACT
Food allergies have increased significantly in the past decade. An accurate history is crucial in approaching the management. At the outset, food intolerance must be distinguished from food allergies and, furthermore, these allergies should be classified into either an IgE, Non-IgE, or a mixed response. The clinical features vary from life-threatening anaphylaxis to milder IgE-mediated responses, atopic dermatitis, and gastrointestinal symptoms. The severity of the reaction and the potential risk for anaphylaxis on reexposure should be assessed. Milk, soy, egg, wheat, and peanut allergies are common in children, whereas peanut, tree nut, fish, shell fish allergies, and allergies to fruits and vegetables are common in adults. Structural proteins are important determinants of the severity of the reactions and may often predict the natural history and cross reactivity. Diagnostic work up must be guided by the clinical history. Skin testing and food-specific IgE done by standard methods are very useful, whereas oral challenges may be indicated in some situations. Majority of the patients outgrow their allergies to milk, soy, egg, and wheat, and some to peanut also, therefore, patients should be periodically reassessed. Novel diagnostic techniques which detect specific allergenic epitopes have been developed. Several newer therapies are promising.
Subject(s)
Allergens/immunology , Dermatitis, Allergic Contact/immunology , Dermatitis, Atopic/immunology , Food Hypersensitivity , Immunoglobulin E/blood , Child , Food Hypersensitivity/diagnosis , Food Hypersensitivity/epidemiology , Food Hypersensitivity/immunology , Food Hypersensitivity/therapy , Humans , Skin TestsABSTRACT
Antibiotic hypersensitivity reactions are relatively common in patients with cystic fibrosis (CF). The nature of the reactions and the mechanisms are no different in CF than the general population. Beta-lactam agents are the most common cause of these reactions. The risk depends on the specific beta-lactam agent used with Penicillins having a higher frequency of allergic reactions. There are several risk factors for developing these allergic responses, especially the increased usage. Since the available choices for antibiotic therapy is limited by the sensitivity of the organisms, management becomes a challenge. It is essential to classify the nature of the hypersensitivity reactions and determine the risks of repeat administration of the drug. Unfortunately, reliable skin tests are not available for all the antibiotics. RAST is of limited value. Recent data on cross-reactions between beta-lactam antibiotics and the option of newer agents offer useful alternative choices. Knowledge of the chemical structures of the antibiotics is useful for selecting suitable substitutes. Desensitization is a viable option in many of the reactions unless otherwise contradicted.
