The effect of age, sex, race/ethnicity, health insurance, and food specific serum immunoglobulin E on outcomes of oral food challenges.

Background: Although oral food challenge (OFC) is an important clinical procedure for diagnosing food allergy, there is a paucity of literature on the outcome of the procedure and specifically the patients on whom the procedure is performed from the aspects of their age, sex, race/ethnicity, health insurance status, and serum specific IgE to the food tested. Objective: We aimed to review results of OFC and determine the impact of patient age, sex, race/ethnicity, insurance status, private or public, and food specific serum IgE on the outcome of OFC. Methods: A retrospective chart review was performed of patients undergoing OFCs at a children's hospital outpatient allergy clinic over a two-year period. The outcome of OFC was allergic or non-allergic based on determination and documentation by the treating physician. A logistic regression model was built to determine the association between the OFC outcomes, age, and symptoms at the time of OFC. A Chi-square analysis was performed to check for any significant relationship between the OFC outcome and age when stratified by insurance status. Results: Five hundred and eight children underwent 641 OFCs. Twenty nine percent of OFCs had an allergic outcome with the most commonly challenged foods being peanuts, eggs, and milk. Patient age and gender, when stratified by insurance status, did not have a significant effect on OFC outcomes. Serum IgE to peanuts and egg was significantly different between allergic OFC and non-allergic outcome. Vomiting and urticaria/angioedema correlated with an allergic OFC outcome. Conclusion: OFCs confirm the food allergy diagnosis in about one-third of patients tested, and they should continue to be used when possible for an accurate diagnosis. Age, sex, and insurance status do not have a significant association with the outcome of OFC and cannot be added as predictive factors.

Maternal somatic symptoms, psychosocial correlates, and subsequent pediatric emergency department use.

BACKGROUND: Somatization is associated with increased health care use in adults. Whether mothers with somatic symptoms use more health care resources for their children has not been investigated. OBJECTIVE: This study aimed to explore the association of maternal somatic symptoms and emergency department (ED) use. DESIGN/METHODS: Mothers from a cohort of 319 mother-child dyads were screened for somatic symptoms using the Patient Health Questionnaire 15. Dyads were followed up for 3 years after the initial ED visit to record ED use. The outcome variable was ED use (lower ED use, 0-3 visits, higher ED use, 4+ visits). The primary independent variable was somatization, with a dichotomous variable analyzing the Patient Health Questionnaire 15 symptom count of less than 7 symptoms (lower somatization) and 7 or more symptoms (higher somatization [HISOM]). Secondary independent variables included demographic data, maternal major depression, and maternal difficulty in taking care of the child or themselves. Statistical analysis included bivariate and multivariate analyses. RESULTS: Mothers with HISOM symptoms did not demonstrate an increased use of the ED in bivariate analysis. Higher somatization mothers did show an increased (1) endorsement of maternal major depression symptoms and (2) maternal perception of difficulty in taking care of the child and themselves. When adjusted for these and other covariates, HISOM mothers were more likely to be in the higher ED use group (1.83; 95% confidence interval, 0.99-3.38) P = 0.055). CONCLUSIONS: Mothers with higher somatic symptom loads were more likely to screen positive for depression and to report difficulty caring for their child and for themselves. A trend toward higher use of the pediatric ED warrants further study.