Anaphylaxis to raw potato.

BACKGROUND: Potato allergy has been described rarely, generally in relation to the Oral Allergy Syndrome (OAS). Adults with seasonal allergic rhinitis have been reported in whom peeling of raw potatoes causes oculonasal symptoms, wheezing, and contact urticaria. Skin testing with fresh fruits and vegetables has been recommended in cases of OAS, although the sensitivity of commercial potato extract is reportedly equal to that of fresh potato. CASE REPORT: This report describes a 4-year-old with raw potato-induced anaphylaxis. He rapidly developed urticaria, angioedema, respiratory distress, vomiting and diarrhea after biting into a raw potato that was being used for painting in preschool. Review of systems is significant for viral-induced wheezing, but no symptoms suggestive of seasonal allergic rhinitis were evident. His mother has a history of seasonal allergic rhinitis and contact urticaria with raw potato. Skin testing to commercial potato extract was negative and skin testing to fresh potato by the prick + prick method was markedly positive. Skin testing to birch tree was negative. An open challenge to a small amount of cooked potato was negative. Food challenge to raw potato was not considered indicated in this case of immediate anaphylaxis to a single food. CONCLUSIONS: This patient had clinical and skin test reactivity to raw and uncooked potato in the absence of OAS. The patient will be followed for the development of seasonal allergic rhinitis.

Resolution of childhood peanut allergy.

BACKGROUND: Peanut allergy creates great fear in many families because it is one of the leading causes of fatal and near-fatal food-induced allergies. Earlier reports suggested that peanut allergy was life-long, but a recent study described resolution of peanut allergy in some children. OBJECTIVE: Tolerance to peanut allergy in childhood was studied. Examination of the natural history of childhood peanut allergy was explored. METHODS: A retrospective review of all children with peanut allergy seen at the Children's Hospital of Philadelphia in a 3-year period (n = 293). Children with histories of peanut allergy were challenged at the mean age [3.8 years; range 1.5 to 8 year] which was 1.8 years [range: 0.5 to 6.8 years], following their last known clinical reaction. Food allergy or tolerance was confirmed by open challenges. RESULTS: Thirty-three patients with histories of peanut allergy and a positive skin test to peanut underwent oral challenges. Not one patient (n = 5) with a history of peanut anaphylaxis developed tolerance to peanuts. In comparison, 9 of 17 patients with history of urticaria upon ingestion to peanuts developed tolerance. Also, 4 of 10 patients with flaring of their atopic dermatitis upon ingestion to peanuts developed tolerance. The 14 patients with a negative challenge to peanut had a significantly smaller wheal and flare reaction than the 19 patients with positive challenges. Tolerance to peanut was documented by a positive challenge reverting to a negative challenge in one patient. Oral challenge of 13 additional patients with positive skin tests and histories of only refusing to eat peanut resulted in 5 (39%) positive challenges. CONCLUSION: A selected group of peanut-allergic children, who do not have a history anaphylaxis to peanut, may develop tolerance to peanuts.

Beta 2-agonist metered dose inhaler overuse: psychological and demographic profiles.

OBJECTIVE: To identify psychological and demographic correlates of children and adolescents known to overuse beta 2-agonist metered dose inhalers (beta-MDIs). DESIGN: During residential care for severe asthma, demographic and psychological characteristics of 17 children and adolescents known to be beta-MDI overusers were compared with 38 asthmatic subjects of similar age without such history. RESULTS: beta-MDI overuse occurred among all groups; however, males, minorities, and those from lower socioeconomic groups were overrepresented. Overusers scored significantly lower on standardized IQ tests. Subtests of arithmetic for numeric reasoning, comprehension for understanding of social values, and picture completion for visual attention to detail were also significantly lower in beta-MDI overusers, as were reading achievement tests. Testing also revealed tendencies toward dominant, shrewd, and undisciplined personality traits in the overusers. CONCLUSION: Recognition of these characteristics of children prone to beta-MDI overuse will raise the clinician's awareness of this potential. Greater efforts and alternative approaches toward education and treatment of the at-risk patient and family are indicated.

The influence of education and experience on ethical attitudes in neonatal intensive care.

A cross-sectional survey of medical students, pediatrics residents, and neonatologists attempted to identify the combined influence of education and experience on ethical attitudes regarding the management of infants weighing less than 750 g at birth. Of the 120 people surveyed, 94 (78%) returned usable surveys. All groups rated quality of life the most important criterion in treatment decisions. Conversely, cost was rated least important by each group. In addition, cost was rated relatively more important by the clinical medical students than by the preclinical students, residents, or neonatologists. The neonatologist was rated the most important decision maker by the neonatologists and the residents. The parents were rated most important by both groups of students. Severe mental retardation was regarded as an unacceptable quality of life by 82% of the neonatologists, 63% of the residents, 61% of the clinical students, and 48% of the preclinical students. Severe cerebral palsy was considered an unacceptable quality of life by 73% of the neonatologists, 63% of the residents, 50% of the clinical students, and only 32% of the preclinical students. Finally, the anticipated long-term outcome of extremely-low-birth-weight infants was viewed more positively by the neonatologists than by the other groups surveyed.