November 7, 2011
Research Highlights New Interventions, Recommendations For Controlling Allergies & Asthma In Children
Financial strain and competing priorities at home may contribute to greater number of hospital readmissions of children with asthma from single-parent homes compared to dual-parent households, according to a new study presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston, Nov. 3-8.
The study, performed at Cincinnati Children´s Hospital Medical Center showed that children in single-parent homes were 50 percent more likely to return to the hospital within 12 months for asthma or wheezing compared to children in households with two parents. Single-parent status, annual household income less than $60,000 and time constraints within the home were linked to this increased rate of readmission.
“Parents play an important role in controlling their child´s asthma and it takes time, energy and resources to follow their physician´s treatment plan, including reducing triggers and consistently giving medicines,” says Terri Moncrief, MD, ACAAI member.
“That´s why it´s important to understand the constraints on single parents and identify innovative interventions to help these parents better manage their child´s symptoms and ultimately keep asthma under control.”
Title: Single Parenthood, Increased Household Strain, and Child Asthma-Related morbidity
By the numbers: Uncontrolled asthma accounts for approximately 500,000 hospitalizations, 1.8 million emergency room visits and 10.5 million physician office visits every year. Asthma is the most chronic condition of childhood, accounting for 12.8 million missed school days each year.
Too Few Food Allergies Confirmed by Oral Food Challenge
Oral food challenges are the gold standard for diagnosis of food allergy, yet few physicians are using the diagnostic method, according to a study presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston,
Among the 40,104 children surveyed, 3,339 cases of food allergy were identified.
Only 61.5 percent received a formal physician diagnosis. About 15 percent of children who received a physician diagnosis underwent an oral food challenge. Children with any severe symptoms such as anaphylaxis, wheezing, trouble breathing, and low blood pressure were more frequently diagnosed by a physician, and more frequently confirmed by oral food challenge.
Authors conclude that, because a large proportion of children with convincing food allergy are not diagnosed by a physician and not given a food challenge, food allergy may be underdiagnosed in the U.S. When food allergy is suspected, ACAAI recommends patients be referred to an allergist who can determine which food allergy tests to perform, determine if food allergy exists, and counsel patients on food allergy management.
“Oral food challenge provides a definitive diagnosis which is critical to providing proper disease management and prevent unnecessary avoidance of certain foods,” says Ruchi Gupta, MD, MPH, Children´s Memorial Hospital, Chicago. “Physicians may not be conducting the test due to the length of time it takes, 3-6 hours, and the low reimbursement for a food challenge.”
Title: Diagnosis of Childhood Food Allergy in the United States
By the numbers: Of the 12 million Americans with food allergies, three million are children. That´s about one in 20 children.
Sleep Apnea Linked to Teen Obesity
Obese adolescents have an increased risk of sleep apnea or abnormal breathing during sleep, according to a study presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston, Nov. 3-8.
In one of the first studies to take a closer look at the relationship between teen obesity and sleep-disordered breathing, researchers compared overnight sleep studies of 27 obese teens with and without asthma to overnight sleep studies of 23 average weight adolescents with and without asthma. The study showed nearly 73 percent of obese children were diagnosed with sleep apnea/hypopnea syndrome (SAHS) while none of the adolescents at a healthy weight were diagnosed with SAHS.
“Research shows obesity puts kids at risk for heart disease, diabetes and high blood pressure,” says allergist John Oppenheimer, MD, ACAAI Abstract Committee chair. “This study identifies the additional potential for increased sleep apnea, and the need for a larger scale study.”
Title: Sleep-Disordered Breathing in Obese and Eutrophic Adolescents, Asthmatics and not Asthmatics
By the numbers: Seven million children in the U.S. suffer from asthma. Children who are overweight are nearly 2-1/2 times more likely to have asthma than those who are not overweight.
Single Dose Flu Shot May Be Safe for Children with Severe Egg Allergy
The trivalent seasonal influenza vaccine (TIV)–that protects against three types of influenza—may be safe for children with egg allergy, according to a study presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston, Nov. 3-8.
A two-year, multi-center study is seeking to evaluate the vaccine´s safety in a population of only severely egg allergic children. Interim results from the first 61 patients indicate TIV is safe to administer to egg allergic individuals irrespective of the severity of their egg allergy. These findings are consistent with the experience of 7 other TIV/H1N1 studies of egg allergic children spanning 12 years, in which a total of 185 children with severe egg allergy had also safely received influenza vaccine.
Historically, as a safety precaution, dividing the dose into a 10 percent fraction and observing for symptom development before providing the remaining 90 percent was commonplace. In the current study, all patients safely received their vaccine irrespective of the dosing method. Thus the interim data indicate a single dose is well tolerated.
“The benefits of flu shots are well-established, and clearly outweigh the risks for children with egg allergy,” said allergist Matthew Greenhawt, MD, ACAAI member and assistant professor in the Division of Allergy and Clinical Immunology at the University of Michigan. “Children with food allergies are more likely to have asthma, which can increase their chance of respiratory complications from the flu. Expanding the population of children that receive flu shots will play an important role in decreasing influenza associated hospitalization, and in promoting the overall health of our children.”
Title: Safe Administration of Trivalent Influenza Vaccine to Egg Allergic Children with a History of Anaphylaxis or Severe Allergy to Egg
By the numbers: Egg allergy is one of the seven most common food allergens, and affects from 1.3 to 1.6 percent of children.
Text Message Reminders Keep Kids–but Not Teens–on Track with Asthma Medication
Forgetting to take controller medication is a common challenge for children with asthma and missing doses can to lead poor asthma control. New research shows daily text message reminders can improve medication adherence for some, according to allergists who presented at the American College of Allergy, Asthma and Immunology Annual Meeting in Boston, Nov. 3-8.
In a project founded by allergist Brian Safier, MD, ACAAI member, researchers collected data from study participants ages 6 to 17 who have moderate persistent or more severe asthma and use inhaled corticosteroids. Daily text messages reminding them to take their controller medication were sent, and participants´ asthma control was assessed. Two of seven participants showed improvement, and parents of children in the study found the text message reminders were valuable. The authors report, however, that text messaging did not improve adherence among teens.
“Since teens often communicate by text message, we were surprised to see this approach did not improve the consistency in which they took their medication,” said allergist Jennifer S. Lee, MD, ACAAI member, Women and Children´s Hospital, New York. “Text message reminders help some patients take their medication more regularly. This is a pilot study, so a larger, longer term study is needed to determine if this intervention will ultimately improve asthma control.”
Title: Effect of Text Message Medication Reminders on Asthmatic Medication Adherence.
By the numbers: About one in 10 children suffer from asthma and nearly four million have had an asthma attack in the past year.
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