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Pfaar O, Portnoy J, Nolte H, Chaker AM, Luna-Pech JA, Patterson A, Pandya A, Larenas-Linnemann D. Future Directions of Allergen Immunotherapy for Allergic Rhinitis: Experts' Perspective. J Allergy Clin Immunol Pract 2024; 12:32-44. [PMID: 37716529 DOI: 10.1016/j.jaip.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
Allergen immunotherapy (AIT) is broadly used all over the world as the only available disease-modifying treatment option. The aim of this experts' perspective is to address 7 important unmet needs for the further direction of AIT and to provide the readership with the authors' positions on these topics. An international group of experts in the field of AIT have formulated 7 important aspects for the future position of AIT, performed a current literature review, and proposed a consented position on these topics. The aspects discussed and consented by the authors include: (1) alternative routes of allergen application in AIT, (2) potential of recombinant vaccines, (3) the role of allergy diagnosis based on component-resolved diagnosis for AIT composition, (4) the impact of COVID-19 vaccination for further innovations in AIT, (5) potential of combining biologics to AIT, (6) future innovations in high-risk children/adolescents, and (7) the future regulatory position on AIT. Important unmet needs and topics for AIT have been addressed in this expert review. The authors' views and personal position on these 7 aspects have also been elaborated.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Jay Portnoy
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Mo
| | | | - Adam M Chaker
- TUM School of Medicine, Department of Otorhinolaryngology and Center of Allergy and Environment, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge A Luna-Pech
- Departamento de Disciplinas Filosófico, Metodológico e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Amber Patterson
- Department of Pediatrics, University of Toledo College of Medicine, Toledo, Ohio; Auni Allergy, Findlay, Ohio
| | - Aarti Pandya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Mo
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Lugogo N, O'Connor M, George M, Merchant R, Bensch G, Portnoy J, Oppenheimer J, Castro M. Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach. Curr Allergy Asthma Rep 2023; 23:621-634. [PMID: 37991672 PMCID: PMC10716188 DOI: 10.1007/s11882-023-01111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta2-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3). RECENT FINDINGS In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
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Affiliation(s)
- Njira Lugogo
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Maeve O'Connor
- Allergy Asthma and Immunology Relief, Charlotte, NC, USA
| | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | - Rajan Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, CA, USA
| | - Greg Bensch
- Allergy Immunology and Asthma Medical Group, Stockton, CA, USA
| | - Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, NJ, USA
- Pulmonary and Allergy Associates, Morristown, NJ, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Pandya A, Parashar S, Waller M, Portnoy J. Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic. Expert Rev Clin Immunol 2023; 19:1063-1073. [PMID: 37354030 DOI: 10.1080/1744666x.2023.2229956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/22/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes. AREAS COVERED Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs. EXPERT OPINION The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.
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Affiliation(s)
- Aarti Pandya
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Sonya Parashar
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Morgan Waller
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jay Portnoy
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, MO, United States
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Portnoy J, Shroba J, Tilles S, Romdhani H, Donelson SM, Latremouille-Viau D, Bungay R, Chen K, McCann W. Real-world experience of pediatric patients treated with peanut (Arachis hypogaea) allergen powder-dnfp. Ann Allergy Asthma Immunol 2023; 130:649-656.e4. [PMID: 36738781 DOI: 10.1016/j.anai.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) is the first oral immunotherapy indicated for children aged 4 to 17 years with peanut allergy. There are limited real-world data on patients treated with PTAH. OBJECTIVE To characterize pediatric patients treated with PTAH and associated treatment patterns in US clinical practice. METHODS US-based physicians with allergy and immunology training treating patients with peanut allergy aged 4 to 17 years with PTAH were recruited from an existing physician panel and completed an online case report form (October to December 2021) with data abstracted from patient medical charts. Physician practice circumstances, patient characteristics, and PTAH treatment patterns were reported. Time to reach the 300-mg dose and treatment persistence were assessed using Kaplan-Meier analysis. RESULTS A geographically balanced sample of 43 physicians contributed data for 118 demographically diverse pediatric patients. Patients had heterogeneous diagnostic test results, with a wide range of peanut-specific immunoglobulin E levels; 6.8% received an oral food challenge. During the updosing phase, there were no temporary interruptions and 5.1% of the patients required downdosing. Patients reached the 300-mg dose at a median of 21.3 weeks post-initiation. The rate of PTAH persistence at 24 weeks was 93.4%. Only 1 patient discontinued treatment because of treatment-related systemic allergic symptoms, and the remaining discontinuations were for reasons other than treatment-related symptoms. Prophylactic antihistamines were used by 33.9% of the patients to prevent PTAH adverse effects. CONCLUSION PTAH was prescribed in demographically diverse patients with a wide range of peanut-specific immunoglobulin E levels. Treatment persistence with PTAH was high in this study population, with a small number of patients experiencing treatment modification.
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Affiliation(s)
| | | | - Stephen Tilles
- Aimmune Therapeutics, a Nestlé Health Science Company, Brisbane, California
| | | | - Sarah M Donelson
- Aimmune Therapeutics, a Nestlé Health Science Company, Brisbane, California
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Casale T, Lockey R, Portnoy J, Kaliner M, Lieberman J, Lowenthal R, Tanimoto S. Pharmacokinetics of Self-administration of Epinephrine Nasal Spray 2.0 mg Versus Manual Intramuscular (IM) Epinephrine 0.3 mg by Health Care Provider (HCP). J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lieberman J, Portnoy J, Kaliner M, Lockey R, Casale T, Lowenthal R, Tanimoto S. Epinephrine Intranasal Spray 2.0 mg Versus Epinephrine Injection Products: An Integrated Pharmacokinetic Analysis. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Pandya A, Portnoy J. Does improved indoor air quality lead to better asthma control? Ann Allergy Asthma Immunol 2023; 130:147-148. [PMID: 36737155 DOI: 10.1016/j.anai.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Aarti Pandya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Jay Portnoy
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, Missouri.
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Rehman N, Portnoy J, Wu AC. Could Telemedicine Be Here to Stay? Understanding the Rapidly Changing Landscape of Telemedicine in Allergy and Immunology Practice. J Allergy Clin Immunol Pract 2022; 10:2550-2551. [PMID: 36216459 PMCID: PMC9538626 DOI: 10.1016/j.jaip.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Narmeen Rehman
- Wayne State University School of Medicine, Ann Arbor, Mich
| | - Jay Portnoy
- Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass,Corresponding author: Ann Chen Wu, MD, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA 02215
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Portnoy J, Abrams EM, Chan ES. Reply to "The added value of reporting likelihood ratios to laboratory test results in allergy and clinical immunology". J Allergy Clin Immunol Pract 2022; 10:1668. [PMID: 35688505 DOI: 10.1016/j.jaip.2022.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jay Portnoy
- Department of Allergy and Immunology, Children's Mercy Hospital Kansas City, Miss.
| | - Elissa M Abrams
- Department of Allergy and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
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Portnoy J, Ciaccio CE, Beausoleil J, Du Toit G, Fineman S, Tilles SA, Zhang J, Lawrence C, Yassine M, Mustafa SS. Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice. Allergy Asthma Clin Immunol 2022; 18:37. [PMID: 35534909 PMCID: PMC9088027 DOI: 10.1186/s13223-022-00671-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Shared learnings from the early use of novel therapies can aid in their optimization. The recent introduction of peanut oral immunotherapy (peanut OIT; Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp]) for peanut allergy addresses a significant unmet need but also highlights the requirement for consideration of several factors by both prescribers and patients. OBJECTIVE To provide guidance for prescribers of licenced peanut OIT to facilitate treatment delivery and improve outcomes. METHODS Clinicians with experience of licenced peanut OIT (United States n = 6, United Kingdom n = 1) participated in a series of interviews and group discussions designed to elicit tips for successful implementation. RESULTS Clinicians identified 8 tips that were considered the most relevant, practical, and impactful for prescribers of Peanut (Arachis hypogaea) Allergen Powder-dnfp: (1) preparing to provide treatment, (2) assessing the medical indication for treatment and (3) shared decision making, (4) staff education, (5) establishing office processes, (6) managing patient expectations and using anticipatory guidance, (7) optimising adherence and (8) maintaining flexibility throughout the treatment process. In addition, a range of supporting materials (e.g., checklists and action plans) are provided. CONCLUSION The introduction of a novel therapy often requires healthcare providers to modify or adopt practices to effectively employ the treatment. The provision of guidance based upon early real-world experiences of licenced peanut OIT may help inform clinical practice and improve treatment outcomes.
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Affiliation(s)
- Jay Portnoy
- Section of Allergy, Asthma & Immunology. Children's Mercy Hospital, Kansas City, MO, United States
| | - Christina E Ciaccio
- Section of Allergy/Immunology and Pediatric Pulmonology, The University of Chicago, Chicago, IL, United States
| | - Janet Beausoleil
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, United States
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's and St Thomas' National Health Service Foundation Trust and King's College London National Institute for Health Research Biomedical Research Centre Translational Bioinformatics Platform, Guy's Hospital, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Stanley Fineman
- Division of Allergy & Immunology, Emory University School of Medicine, Atlanta Allergy & Asthma, GA, Atlanta, United States
| | - Stephen A Tilles
- Aimmune Therapeutics, a Nestlé Health Science Company, 8000 Marina Blvd. Suite 300, Brisbane, CA, 94005, United States.
| | - June Zhang
- Latitude Food Allergy Care, Redwood City, CA, United States
| | | | - Mohamed Yassine
- Aimmune Therapeutics, a Nestlé Health Science Company, 8000 Marina Blvd. Suite 300, Brisbane, CA, 94005, United States
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology Rochester Regional Health, School of Medicine and Dentistry, University of Rochester, Rochester, United States
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Stout S, Pandya A, Murphy H, Yeh HW, Portnoy J. Factors Leading to Reduced Unscheduled Pediatric Asthma Visits During COVID-19. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abrams EM, Chan ES, Portnoy J. Evolving Interpretation of Screening and Diagnostic Tests in Allergy. J Allergy Clin Immunol Pract 2021; 9:4183-4191. [PMID: 34893185 DOI: 10.1016/j.jaip.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 06/14/2023]
Abstract
Diagnostic tests for allergy usually are performed to confirm a diagnosis of an allergic disease. If a food allergy suspected, a test can help to determine whether it is present, to monitor its activity over time, and to determine whether the allergy is resolving. In this way, tests are used for diagnosis, monitoring, screening, and prognosis. There are 2 schools of thought for using tests: Frequentist and Bayesian approaches. The Frequentist approach defines probability in terms of the frequency of an event if it were to be repeated numerous times and uses parameters such as sensitivity, specificity, and predictive values to make a diagnosis. In contrast, the Bayesian approach defines probability as the degree of belief or disbelief regarding the diagnosis and asserts that only data are real and that test parameters are to be inferred from the data. There are strengths and limitations to each approach; however, the Bayesian approach provides an algorithm leading to a disease probability. To use the Bayesian approach, test results need to be expressed as a likelihood ratio. This helps to determine how much the result of a test changes the probability of a particular diagnosis. Once a probability of disease is determined, decision thresholds need to be defined so that a treatment decision can be made. Using this Bayesian approach, the concept of a false-positive or false-negative test result becomes obsolete.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Edmond S Chan
- Division of Allergy & Immunology, Department of Pediatrics, the University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Jay Portnoy
- Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, Mo.
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Mustafa S, Portnoy J, Zhang J, Fineman S, DuToit L, Beausoleil J, Tilles S, Lawrence C, Yassine M, Ciaccio C. P112 ORAL IMMUNOTHERAPY IMPLEMENTATION FOR PEANUT ALLERGY IN CLINICAL PRACTICE IN THE UNITED STATES: TEN TIPS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shroba J, Bandelier C, Pandya A, Parashar S, Portnoy J. P113 OUTCOMES OF PEANUT ORAL IMMUNOTHERAPY IN AN ALLERGY CLINIC. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Portnoy J, Shroba J, Tilles S, Romdhani H, Donelson S, Latremouille-Viau D, Bungay R, Chen K, Yassine M, McCann W. P114 PHYSICIAN EXPERIENCE WITH PRESCRIBING PEANUT (ARACHIS HYPOGAEA) ALLERGEN POWDER-DNFP IN PEDIATRIC PATIENTS WITH PEANUT ALLERGY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wu AC, Rehman N, Portnoy J. The Good, the Bad, and the Unknown of Telemedicine in Asthma and Allergy Practice. J Allergy Clin Immunol Pract 2020; 7:2580-2582. [PMID: 31706487 DOI: 10.1016/j.jaip.2019.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
| | - Narmeen Rehman
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Jay Portnoy
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
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Abstract
Purpose of Review The purpose of this review is to describe the determinants of satisfaction with telemedicine (TM) and how they compare with in-person visits from both the perspective of patients and of providers. Recent Findings The use of TM will expand only if patients and providers are at least as satisfied with it as they are with in-person visits. Since deviations from expected care can result in reduced satisfaction regardless of the quality of the visit or objective medical outcomes, it is important to understand and to help form those expectations when possible. Patients consistently report 95–100% satisfaction rate with TM when compared with in-person appointments. They tend to cite the convenience of decreased travel times and costs as the main drivers for satisfaction with TM. Providers tend to be satisfied with TM if they have input into its development, there is administrative support, the technology is reliable and easy to use, and if there is adequate reimbursement for its use. Summary Satisfaction with TM is necessary for adoption of this new technology. To improve satisfaction it is important to consider factors that drive it both for patients and for providers.
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Affiliation(s)
- Mary Nguyen
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Morgan Waller
- Division of Telemedicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Aarti Pandya
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,Division of Telemedicine, Children's Mercy Hospital, Kansas City, MO, USA.
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Nalin UG, Shroba J, Pandya A, Portnoy J. Diagnosis of peanut allergy using continuous likelihood ratios. Ann Allergy Asthma Immunol 2020; 125:680-685. [PMID: 32470523 DOI: 10.1016/j.anai.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Peanut allergy (PA) is associated with an economic and psychological burden on patients and families. Its diagnosis includes tests for peanut specific immunoglobulin E (sIgE), the values of which usually are categorized as positive or negative using a predefined cutoff (usually 0.35 kU/L). With the use of Bayes' theorem, this categorization can be replaced with a continuous interpretation of sIgE, which accounts for the prevalence of PA and history of ingestion. OBJECTIVE To evaluate a method for estimating the likelihood ratio (LR) for each value of sIgE by performing a pilot investigation with the results of oral food challenges. The LR could be used to estimate the probability of PA. METHODS The outcomes of oral food challenges and serum IgE values from 117 children seen in an allergy clinic between January 2017 and November 2019 were obtained. Polynomial regression of the receiver operation characteristics curve was used to determine an LR for each value of sIgE. Linear regression was used to estimate an LR for each value of sIgE. RESULTS sIgE ranged from less than 0.1 kU/L to 35 kU/L. Bayes' theorem and a receiver operation characteristics curve were used to estimate LRs for each value of peanut sIgE. The value of IgE associated with an LR of 1 was 0.22 kU/L, which is comparable to other studies that used a value of 0.35 kU/L to separate positive from negative results. CONCLUSION When combined with estimates of pretest probability, this method should permit the development of computerized decision-making algorithms to estimate the probability that a patient has PA.
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Affiliation(s)
- U G Nalin
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri
| | - Jodi Shroba
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri
| | - Aarti Pandya
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri
| | - Jay Portnoy
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri.
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Searing DA, Dutmer CM, Fleischer DM, Shaker MS, Oppenheimer J, Grayson MH, Stukus D, Hartog N, Hsieh EWY, Rider NL, Vander Leek TK, Kim H, Chan ES, Mack D, Ellis AK, Abrams EM, Bansal P, Lang DM, Lieberman J, Golden DB, Wallace D, Portnoy J, Mosnaim G, Greenhawt M. A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services. J Allergy Clin Immunol Pract 2020; 8:2125-2134. [PMID: 32450236 PMCID: PMC7242939 DOI: 10.1016/j.jaip.2020.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/09/2023]
Abstract
In early 2020, the first US and Canadian cases of the novel severe acute respiratory syndrome coronavirus 2 infection were detected. In the ensuing months, there has been rapid spread of the infection. In March 2020, in response to the virus, state/provincial and local governments instituted shelter-in-place orders, and nonessential ambulatory care was significantly curtailed, including allergy/immunology services. With rates of new infections and fatalities potentially reaching a plateau and/or declining, restrictions on provision of routine ambulatory care are lifting, and there is a need to help guide the allergy/immunology clinician on how to reinitiate services. Given the fact that coronavirus disease 2019 will circulate within our communities for months or longer, we present a flexible, algorithmic best-practices planning approach on how to prioritize services, in 4 stratified phases of reopening according to community risk level, as well as highlight key considerations for how to safely do so. The decisions on what services to offer and how fast to proceed are left to the discretion of the individual clinician and practice, operating in accordance with state and local ordinances with respect to the level of nonessential ambulatory care that can be provided. Clear communication with staff and patients before and after all changes should be incorporated into this new paradigm on continual change, given the movement may be forward and even backward through the phases because this is an evolving situation.
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Affiliation(s)
- Daniel A Searing
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Cullen M Dutmer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Mitchell H Grayson
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - David Stukus
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Nicholas Hartog
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Elena W Y Hsieh
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo; Department of Immunology and Microbiology, University of Colorado School of Medicine, Denver, Colo
| | - Nicholas L Rider
- The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Texas
| | - Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Harold Kim
- Western University, London, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - Edmond S Chan
- BC Children's Hospital, Division of Allergy & Immunology, The University of British Columbia, Vancouver, BC, Canada
| | - Doug Mack
- McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, MB, Canada
| | - Priya Bansal
- Asthma and Allergy Wellness Center, St Charles, Ill
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - David Bk Golden
- Division of Allergy and Clinical Immunology, John Hopkins University School of Medicine, Baltimore, Md
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Jay Portnoy
- Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
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Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, Rider N, Dutmer CM, Vander Leek TK, Kim H, Chan ES, Mack D, Ellis AK, Lang D, Lieberman J, Fleischer D, Golden DBK, Wallace D, Portnoy J, Mosnaim G, Greenhawt M. Reply to "Subcutaneous terbutaline as an alternative to aerosolized albuterol". J Allergy Clin Immunol Pract 2020; 8:2450-2452. [PMID: 32340824 PMCID: PMC7174169 DOI: 10.1016/j.jaip.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Marcus S Shaker
- Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Departments of Pediatrics, Medicine, and Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, NH.
| | - John Oppenheimer
- Department of Internal Medicine, Pulmonary, and Allergy, UMDNJ Rutgers University School of Medicine, Morristown, NJ
| | - Mitchell Grayson
- Division of Allergy and Immunology, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Nicholas Hartog
- Division of Allergy and Immunology, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Elena W Y Hsieh
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Nicholas Rider
- The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Tex
| | - Cullen M Dutmer
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Timothy K Vander Leek
- Division of Pediatric Allergy and Asthma, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Western University, London, ON, Canada; Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Doug Mack
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Lang
- Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - David Fleischer
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Jay Portnoy
- Division of Allergy, Asthma, and Immunology, Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, Rider N, Dutmer CM, Vander Leek TK, Kim H, Chan ES, Mack D, Ellis AK, Lang D, Lieberman J, Fleischer D, Golden DBK, Wallace D, Portnoy J, Mosnaim G, Greenhawt M. COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic. J Allergy Clin Immunol Pract 2020; 8:1477-1488.e5. [PMID: 32224232 PMCID: PMC7195089 DOI: 10.1016/j.jaip.2020.03.012] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 01/15/2023]
Abstract
In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. Recommendations and feedback were developed iteratively, using an adapted modified Delphi methodology to achieve consensus. During the ongoing pandemic while social distancing is being encouraged, most allergy/immunology care could be postponed/delayed or handled through virtual care. With the exception of many patients with primary immunodeficiency, patients on venom immunotherapy, and patients with asthma of a certain severity, there is limited need for face-to-face visits under such conditions. These suggestions are intended to help provide a logical approach to quickly adjust service to mitigate risk to both medical staff and patients. Importantly, individual community circumstances may be unique and require contextual consideration. The decision to enact any of these measures rests with the judgment of each clinician and individual health care system. Pandemics are unanticipated, and enforced social distancing/quarantining is highly unusual. This expert panel consensus document offers a prioritization rational to help guide decision making when such situations arise and an allergist/immunologist is forced to reduce services or makes the decision on his or her own to do so.
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Affiliation(s)
- Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Mitchell Grayson
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - David Stukus
- Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Nicholas Hartog
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Elena W Y Hsieh
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Nicholas Rider
- The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Texas
| | - Cullen M Dutmer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Timothy K Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Harold Kim
- Western University and McMaster University, London, ON, Canada
| | - Edmond S Chan
- BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Doug Mack
- McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Lang
- Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - David Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - David B K Golden
- Division of Allergy and Clinical Immunology, John Hopkins University School of Medicine, Baltimore, Md
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Jay Portnoy
- Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
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Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan DA, Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR, Wang J, Riblet N, Bobrownicki AMP, Bontrager T, Dusin J, Foley J, Frederick B, Fregene E, Hellerstedt S, Hassan F, Hess K, Horner C, Huntington K, Kasireddy P, Keeler D, Kim B, Lieberman P, Lindhorst E, McEnany F, Milbank J, Murphy H, Pando O, Patel AK, Ratliff N, Rhodes R, Robertson K, Scott H, Snell A, Sullivan R, Trivedi V, Wickham A, Shaker MS, Wallace DV, Shaker MS, Wallace DV, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Golden DBK, Greenhawt M, Lieberman JA, Rank MA, Stukus DR, Wang J, Shaker MS, Wallace DV, Golden DBK, Bernstein JA, Dinakar C, Ellis A, Greenhawt M, Horner C, Khan DA, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020; 145:1082-1123. [PMID: 32001253 DOI: 10.1016/j.jaci.2020.01.017] [Citation(s) in RCA: 324] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.
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Affiliation(s)
- Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Dana V Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins University, Baltimore, Md
| | - John Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Chitra Dinakar
- Allergy, Asthma, and Immunodeficiency, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colo
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Jay Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | | | - Teresa Bontrager
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jarrod Dusin
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jennifer Foley
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Becky Frederick
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Eyitemi Fregene
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Sage Hellerstedt
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ferdaus Hassan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kori Hess
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Caroline Horner
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Kelly Huntington
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Poojita Kasireddy
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - David Keeler
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Bertha Kim
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Phil Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Erin Lindhorst
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Fiona McEnany
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jennifer Milbank
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Helen Murphy
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Oriana Pando
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ami K Patel
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Nicole Ratliff
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Robert Rhodes
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kim Robertson
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Hope Scott
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Audrey Snell
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Rhonda Sullivan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Varahi Trivedi
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Azadeh Wickham
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
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Portnoy J, Miller C. Relationship between exposure to fungi and asthma-an ongoing conundrum. Ann Allergy Asthma Immunol 2019; 122:554-555. [PMID: 31171237 DOI: 10.1016/j.anai.2019.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, Kansas City, Missouri.
| | - Christopher Miller
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, Kansas City, Missouri
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U.G. N, Portnoy J, Shroba J, Aljubran S. P301 HOW TO USE PEANUT IGE LEVELS TO PREDICT CHALLENGE OUTCOMES IN THE PEDIATRIC POPULATION. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Portnoy J, Wade RL, Kessler C. Patient Carrying Time, Confidence, and Training with Epinephrine Autoinjectors: The RACE Survey. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:2252-2261. [DOI: 10.1016/j.jaip.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
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Abstract
Telemedicine (TM) is undergoing unprecedented growth that is being driven by numerous factors, one of which is patient preference. Providers who use this tool to deliver health care tend to be early adoptors of new technology, but do they also represent a nascent specialty of pediatric virtualist? We believe that such practitioners, although exhibiting characteristics common to all early adopters, represent the cutting edge of what will become routine medical care. They tend to engage in less small talk with patients, focus more on efficient problem-solving, and collect less data while achieving patient outcomes and satisfaction that are as good as, or possibly even better than, their colleagues who practice in traditional settings. In doing so, they are leading the way for all providers to deliver care to patients using this new technology. Eventually, we feel that medical encounters using TM will be referred to simply as "patient care." [Pediatr Ann. 2019;48(6):e243-e248.].
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Portnoy J, Cox LS. Is the Benefit From Prescribing Epinephrine Autoinjectors for Sublingual Immunotherapy Worth the Cost? Lessons Learned From Clinical Trials. J Allergy Clin Immunol Pract 2018; 5:90-91. [PMID: 28065345 DOI: 10.1016/j.jaip.2016.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jay Portnoy
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Mo; Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, Mo
| | - Linda S Cox
- Department of Medicine, University of Miami Miller School of Medicine at Holy Cross Hospital, Ft Lauderdale, Fla.
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Golden DBK, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Wallace D. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017; 118:28-54. [PMID: 28007086 DOI: 10.1016/j.anai.2016.10.031] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Elliott T, Shih J, Dinakar C, Portnoy J, Fineman S. American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists. Ann Allergy Asthma Immunol 2017; 119:512-517. [PMID: 29103799 DOI: 10.1016/j.anai.2017.09.052] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty.
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Affiliation(s)
- Tania Elliott
- New York University Medical Center, New York, New York
| | - Jennifer Shih
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Chitra Dinakar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jay Portnoy
- Division of Allergy, Asthma, & Immunology, Telemedicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Portnoy J, Altaras C, Miller J, Foley F. A-67Cognition, Depression, and Physical Disability in Multiple Sclerosis as Predictors of Illness Intrusiveness. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Portnoy J, Weiss E, Facchini R, Masur D, Mcginley J. PGR-3A Case of Autism Spectrum Disorder Associated with Chromosome 17p13.3 Duplication: Implications for Pediatric Neuropsychological Practice. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx073.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
INTRODUCTION fungi produce substances that contain pathogen-associated molecular patterns (pamps) and damage-associated molecular patterns (damps) which bind to pattern recognition receptors, stimulating innate immune responses in humans. they also produce allergens that induce production of specific ige. Areas covered: In this review we cover both innate and adaptive immune responses to fungi. Some fungal products can activate both innate and adaptive responses and in doing so, cause an intense and complex health effects. Methods of testing for fungal allergy and evidence for clinical treatment including environmental control are also discussed. In addition, we describe controversial issues including the role of Stachybotrys and mycotoxins in adverse health effects. Expert commentary: Concerns about long-term exposure to fungi have led some patients, attorneys and fungus advocates to promote fears about a condition that has been termed toxic mold syndrome. This syndrome is associated with vague symptoms and is believed to be due to exposure to mycotoxins, though this connection has not been proven. Ultimately, more precise methods are needed to measure both fungal exposure and the resulting health effects. Once that such methods become available, much of the speculation will be replaced by knowledge.
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Affiliation(s)
- Amanda Rudert
- a Division of Allergy, Asthma & Immunology , Children's Mercy Hospitals & Clinics , Kansas City , MO , USA
| | - Jay Portnoy
- a Division of Allergy, Asthma & Immunology , Children's Mercy Hospitals & Clinics , Kansas City , MO , USA
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Alsayegh MA, Alshamali H, Khadada M, Ciccolini A, Ellis AK, Quint D, Powley W, Lee L, Fiteih Y, Baksh S, Vliagoftis H, Gerega SK, Millson B, Charland K, Barakat S, Sun X, Jimenez R, Waserman S, FitzGerald MJ, Hébert J, Cognet-Sicé J, Renahan KE, Huq S, Chooniedass R, Sawyer S, Pasterkamp H, Becker A, Smith SG, Zhang S, Jayasundara K, Tacon C, Simidchiev A, Nadeau G, Gunsoy N, Mullerova H, Albers F, Kim YW, Shannon CP, Singh A, Neighbour H, Larché M, Tebbutt SJ, Klopp A, Vehling L, Becker AB, Subbarao P, Mandhane PJ, Turvey SE, Sears MR, Azad MB, Loewen K, Monchka B, Mahmud SM, Jong G‘, Longo C, Bartlett G, Ducharme FM, Schuster T, MacGibbon B, Barnett T, North ML, Brook J, Lee E, Omana V, Thiele J, Steacy LM, Evans G, Diamond M, Sussman GL, Amistani Y, Abiteboul K, Tenn MW, Yang C, Carlsten C, Conway EM, Mack D, Othman Y, Barber CM, Kalicinsky C, Burke AE, Messieh M, Nair P, Che CT, Douglas L, Liem J, Duan L, Miller C, Dupuis P, Connors LA, Fein MN, Shuster J, Hadi H, Polk B, Raje N, Labrosse R, Bégin P, Paradis L, Roches AD, Lacombe-Barrios J, Mishra S, Lacuesta G, Chiasson M, Haroon B, Robertson K, Issekutz T, Leddin D, Couban S, Connors L, Roos A, Kanani A, Chan ES, Schellenberg R, Rosenfield L, Cvetkovic A, Woodward K, Quirt J, Watson WTA, Castilho E, Sullivan JA, Temple B, Martin D, Cook VE, Mills C, Portales-Casamar E, Fu LW, Ho A, Zaltzman J, Chen L, Vadas P, Gabrielli S, Clarke A, Eisman H, Morris J, Joseph L, LaVieille S, Ben-Shoshan M, Graham F, Barnes C, Portnoy J, Stagg V, Simons E, Lefebvre D, Dai D, Mandhane P, Sears M, Tam H, Simons FER, Alotaibi D, Dawod B, Tunis MC, Marshall J, Desjardins M, Béland M, Lejtenyi D, Drolet JP, Lemire M, Tsoukas C, Noya FJ, Alizadehfar R, McCusker CT, Mazer BD, Maestre-Batlle D, Gunawan E, Rider CF, Bølling AK, Pena OM, Suez D, Melamed I, Hussain I, Stein M, Gupta S, Paris K, Fritsch S, Bourgeois C, Leibl H, McCoy B, Noel M, Yel L, Scott O, Reid B, Atkinson A, Kim VHD, Roifman CM, Grunebaum E, AlSelahi E, Aleman F, Oberle A, Trus M, Sussman G, Kanani AS, Chambenoi O, Chiva-Razavi S, Grodecki S, Joshi N, Menikefs P, Holt D, Pun T, Tworek D, Hanna R, Heroux D, Rosenberg E, Stiemsma L, Turvey S, Denburg J, Mill C, Teoh T, Zimmer P, Avinashi V, Paina M, Darwish Hassan AA, Oliveria JP, Olesovsky C, Gauvreau G, Pedder L, Keith PK, Plunkett G, Bolner M, Pourshahnazari P, Stark D, Vostretsova K, Moses A, Wakeman A, Singer A, Gerstner T, Abrams E, Johnson SF, Woodgate RL. Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016. Allergy Asthma Clin Immunol 2017. [PMCID: PMC5390240 DOI: 10.1186/s13223-017-0192-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jara D, Portnoy J, Dhar M, Barnes C. Relation of indoor and outdoor airborne fungal spore levels in the Kansas City metropolitan area. Allergy Asthma Proc 2017; 38:130-135. [PMID: 28234050 DOI: 10.2500/aap.2017.38.4030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Environmental control is an important component of asthma management for persons with asthma. A damp indoor environment and elevated airborne spore levels are factors in housing environmental control. OBJECTIVES We investigated if indoor airborne fungal spore levels correlated with outdoor ground-level airborne fungal spores or outdoor centrally collected spore levels as to types and abundance. METHODS Air collections were taken from home interiors, outdoor areas adjacent to the homes, and at a central location in the metropolitan area at the approximate same time. All air collections were examined and enumerated microscopically, and airborne spore estimates per cubic meter of air were reported for total fungal spores and for 11 identifiable spore groups. RESULTS The 244 homes in the study were typical of the North American Midwest. The overall mean total spore counts in spores per cubic meter of air was indoors (4076 spores/m3), outdoors at ground level (8899 spores/m3), and outdoor metropolitan area (8342 spores/m3). All of the major indoor taxa were strongly correlated with the mean total spores present in the home. Total outdoor ground spore levels were highly correlated with levels of major outdoor taxa, such as ascospores and Cladosporium. Correlations of indoor spore levels with outdoor spore levels are strong for most major outdoor taxa. Indoor Aspergillus-Penicillium and Chaetomium are significantly correlated between indoor and local ground-level outdoor air. CONCLUSION Although conditions may exist where indoor or outdoor spore levels were not well aligned, in most circumstances, the outdoor airborne spore community was reflected in the indoor airborne spore community.
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Allenbrand R, Barnes CS, Mohammed M, Gard L, Pacheco F, Kennedy K, DiDonna A, Portnoy J, Dinakar C. Comparison of allergens collected from furnace filters and vacuum floor dust. Ann Allergy Asthma Immunol 2016; 118:108-109. [PMID: 27839669 DOI: 10.1016/j.anai.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Luke Gard
- The Children's Mercy Hospital, Kansas City, Missouri
| | | | - Kevin Kennedy
- The Children's Mercy Hospital, Kansas City, Missouri
| | - Anita DiDonna
- The Children's Mercy Hospital, Kansas City, Missouri
| | - Jay Portnoy
- The Children's Mercy Hospital, Kansas City, Missouri
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Fonacier L, Bernstein DI, Pacheco K, Holness DL, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Contact dermatitis: a practice parameter-update 2015. J Allergy Clin Immunol Pract 2016; 3:S1-39. [PMID: 25965350 DOI: 10.1016/j.jaip.2015.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.
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Portnoy J, Waller M, Dinakar C. TeleAllergy: a new way to manage asthma. J Allergy Clin Immunol Pract 2015; 3:302-3. [PMID: 25754720 DOI: 10.1016/j.jaip.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Jay Portnoy
- Division of Allergy, Asthma and Immunology and Division of Telemedicine, Children's Mercy Hospitals & Clinics, Kansas City, Mo.
| | - Morgan Waller
- Division of Allergy, Asthma and Immunology and Division of Telemedicine, Children's Mercy Hospitals & Clinics, Kansas City, Mo
| | - Chitra Dinakar
- Division of Allergy, Asthma and Immunology and Division of Telemedicine, Children's Mercy Hospitals & Clinics, Kansas City, Mo
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Hanson JR, Lee BR, Williams DD, Murphy H, Kennedy K, DeLurgio SA, Portnoy J, Reddy M. Developing a risk stratification model for predicting future health care use in asthmatic children. Ann Allergy Asthma Immunol 2015; 116:26-30. [PMID: 26553446 DOI: 10.1016/j.anai.2015.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have stratified pediatric asthma patients for risk of future exacerbation and/or health care use, but most incorporate multiple clinical parameters. OBJECTIVE To determine whether historical acute care visits (ACVs) alone could predict risk of future health care use. METHODS Children seen for asthma in an outpatient visit during a 3-year period were identified. The number of ACVs in the 12 months before and after the outpatient visit was determined. Logistic regression models were used to determine the odds of a future ACV. Models were adjusted for age, sex, race, and insurance status. RESULTS Of 28,047 outpatient visits, 21,099 (75.2%) had no historical ACVs. The probability of a future ACV increased from 30% with one historical ACV to 87% with 5 or more historical ACVs. Outpatient visits with one historical ACV had significantly higher odds of a future ACV compared with those with no historical ACVs (adjusted odds ratio [OR], 3.60; 95% confidence interval [CI], 3.14-4.12; P < .001). The OR increased with each additional historical ACV to an adjusted OR of 58.71 (95% CI, 24.34-141.61; P < .001) with 5 or more historical ACVs. Outpatient visits with 5 or more historical ACVs represented only 1.1% of the study sample but accounted for a higher mean number of future ACVs. CONCLUSION The historical count of ACVs was predictive of future ACVs. A significant increase in the probability of future ACVs was observed with each additional historical visit, effectively stratifying risk by the historical visit count. Notably, a small group of patients accounted for a disproportionate number of future ACVs.
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Affiliation(s)
- Jill R Hanson
- Department of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Missouri.
| | - Brian R Lee
- Center for Clinical Effectiveness, Children's Mercy Hospital, Kansas City, Missouri
| | - David D Williams
- Department of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri
| | - Helen Murphy
- Respiratory Care, Children's Mercy Hospital, Kansas City, Missouri
| | - Kevin Kennedy
- Center for Environmental Health, Children's Mercy Hospital, Kansas City, Missouri
| | - Stephen A DeLurgio
- Department of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri
| | - Jay Portnoy
- Department of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Missouri
| | - Mamta Reddy
- Department of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Missouri
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Ciaccio CE, Barnes C, Kennedy K, Chan M, Portnoy J, Rosenwasser L. Home dust microbiota is disordered in homes of low-income asthmatic children. J Asthma 2015; 52:873-80. [PMID: 26512904 DOI: 10.3109/02770903.2015.1028076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Exposure to microorganisms has repeatedly been found to influence development of atopic diseases, such as asthma. Innovative techniques have been developed that can comprehensively characterize microbial communities. The objective of this study was to characterize the home microbiota of asthmatic children utilizing 16S rRNA-based phylogenetic analysis by microarray. METHODS In this cross-sectional study, DNA was extracted from home dust and bacterial 16S rRNA genes amplified. Bacterial products were hybridized to the PhyloChip Array and scanned using a GeneArray scanner (Affymetrix, Santa Clara, CA). The Adonis test was used to determine significant differences in the whole microbiome. Welch's t-test was used to determine significant abundance differences and genus-level richness differences. RESULTS Nineteen homes were included in the analysis (14 asthma and five no asthma). About 1741 operational taxonomic units (OTUs) were found in at least one sample. Bacterial genus richness did not differ in the homes of asthmatics and non-asthmatics (p = 0.09). The microbial profile was significantly different between the two groups (p = 0.025). All the top 12 OTUs with significant abundance differences were increased in homes of asthmatics and belonged to one of the five phyla (p = 0.001 to p = 7.2 × 10(-6)). Nearly half of significant abundance differences belonged to the phylum Cyanobacteria or Proteobacteria. CONCLUSIONS These results suggest that home dust has a characteristic microbiota which is disturbed in the homes of asthmatics, resulting in a particular abundance of Cyanobacteria and Proteobacteria. Further investigations are needed which utilize high-throughput technology to further clarify how home microbial exposures influence human health and disease.
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Affiliation(s)
- Christina E Ciaccio
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
| | - Charles Barnes
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
| | - Kevin Kennedy
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
| | - Marcia Chan
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
| | - Jay Portnoy
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
| | - Lanny Rosenwasser
- a Department of Pediatrics and the Center for Environmental Health , Children's Mercy Hospital , Kansas City , MO , USA
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D'Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JTM, D'Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJW, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J 2015; 8:25. [PMID: 26207160 PMCID: PMC4499913 DOI: 10.1186/s40413-015-0073-0] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023] Open
Abstract
The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population. Increased concentrations of greenhouse gases, and especially carbon dioxide (CO2), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges. This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.
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Affiliation(s)
- Gennaro D'Amato
- Department of Respiratory Diseases, Division of Pneumology and Allergology, High Specialty Hospital "A. Cardarelli" Napoli, Italy, University of Naples Medical School, Via Rione Sirignano, 10, 80121 Napoli, Italy
| | - Stephen T Holgate
- Southampton General Hospital, Clinical and Experimental Sciences, University of Southampton, Hampshire, UK
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Dennis K Ledford
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Lorenzo Cecchi
- Interdepartmental Centre of Bioclimatology, University of Florence Allergy and Clinical Immunology Section, Azienda Sanitaria di Prato, Italy
| | - Mona Al-Ahmad
- Department of Allergy, Al-Rashid Center, Ministry of Health, Khobar, Kuwait
| | - Fatma Al-Enezi
- Al-Rashid Allergy and Respiratory Center, Khobar, Kuwait
| | - Saleh Al-Muhsen
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - Carlos E Baena-Cagnani
- Centre for Research in Respiratory Medicine, Faculty of Medicine, Catholic University of Córdoba, Córdoba, Argentina
| | - David J Baker
- Emeritus Consultant Anaesthesiologist, SAMU de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Hasan Bayram
- Department of Chest Diseases, Respiratory Research Laboratory, Allergy Division, School of Medicine, University of Gaziantep, Şehitkamil/Gaziantep, 27310 Turkey
| | | | - Louis-Philippe Boulet
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Sainte-Foy, Quebec City, G1V 4G5 Canada
| | - Jeroen T M Buters
- ZAUM - Center of Allergy and Environment, Helmholtz Zentrum München/Technische Universität München, Munich, Germany
| | - Maria D'Amato
- University of Naples, Institute of Respiratory Diseases, Naples, Italy
| | - Sofia Dorsano
- World Allergy Organization, Milwaukee, Wisconsin United States
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Sarah Elise Finlay
- Consultant in Emergency Medicine, Chelsea and Westminster Hospital, London, UK
| | - Donata Garrasi
- Development Assistance Committee, Organisation of Economic Cooperation and Development, Paris, France
| | | | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Rabih Halwani
- Prince Naif Center for Immunology Research, College of Medicine, King Saud University, P.O.Box 2925, Postal Code 11461 Riyadh, Saudi Arabia
| | - Youssouf Hassani
- Epidemiology of Respiratory and Allergic Disease Department, UMR-S, Institute Pierre Louis of Epidemiology and Public Health, INSERM Medical School Saint-Antoine, UPMC Sorbonne Universités, Paris, France
| | - Basam Mahboub
- University of Sharjah, and, Rashid Hospital DHA, Abu Dhabi, United Arab Emirates
| | - Guy Marks
- South Western Sydney Clinical School, UNSW, Australia and Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Paola Michelozzi
- Dipartimento Epidemiologia Regione Lazio, UOC Epidemiologia Ambientale, Roma, Italy
| | - Marcello Montagni
- Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Carlos Nunes
- Center of Allergy of Algarve, Hospital Particular do Algarve, Particular do Algarve, Brasil
| | - Jay Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Todor A Popov
- Clinic of Allergy and Asthma, Medical University in Sofia, Sofia, Bulgaria
| | - Jay Portnoy
- Children's Mercy Hospitals & Clinics, Kansas City, Missouri USA
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Nelson Rosário
- Division of Pediatric Respiratory Medicine, Hospital de Clínicas, Federal University of Parana, Rua Tte. João Gomes da Silva 226, 80810-100 Curitiba, PR Brazil
| | - Menachem Rottem
- Allergy Asthma and Immunology, Emek Medical Center, Afula, and the Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Harare, Zimbabwe
| | - Juan José Sienra-Monge
- Allergy and Immunology Department, Hospital Infantil de México Federico Gómez, SSA, México City, Mexico
| | - Carolina Vitale
- University of Naples, Institute of Respiratory Diseases, Naples, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Respiratory and Allergic Disease Department (EPAR), Institute Pierre Louis of Epidemiology and Public Health, UMR-S 1136, INSERM, Paris, France ; UPMC, Sorbonne Universités, Medical School Saint-Antoine, 803-804-806, 8 etage/Floor 27, Rue Chaligny, CEDEX 12, 75571 Paris, France
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Dinakar C, Portnoy J. Sailing to the port of best practice on the A/I practice parameters Mayflower. Ann Allergy Asthma Immunol 2014; 113:123-4. [PMID: 25065348 DOI: 10.1016/j.anai.2014.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Chitra Dinakar
- Division of Allergy, Asthma and Immunology, Children's Mercy Hospitals, Kansas City, Missouri.
| | - Jay Portnoy
- Division of Allergy, Asthma and Immunology, Children's Mercy Hospitals, Kansas City, Missouri
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Dinakar C, Oppenheimer J, Portnoy J, Bacharier LB, Li J, Kercsmar CM, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D. Management of acute loss of asthma control in the yellow zone: a practice parameter. Ann Allergy Asthma Immunol 2014; 113:143-59. [PMID: 25065350 DOI: 10.1016/j.anai.2014.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, Phipatanakul W, Kennedy K, Barnes C, Grimes C, Larenas-Linnemann D, Sublett J, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol 2014; 111:465-507. [PMID: 24267359 DOI: 10.1016/j.anai.2013.09.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 12/15/2022]
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46
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Portnoy J, Chew GL, Phipatanakul W, Williams PB, Grimes C, Kennedy K, Matsui EC, Miller JD, Bernstein D, Blessing-Moore J, Cox L, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Seltzer J, Sublett J. Environmental assessment and exposure reduction of cockroaches: a practice parameter. J Allergy Clin Immunol 2013; 132:802-8.e1-25. [PMID: 23938214 DOI: 10.1016/j.jaci.2013.04.061] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/27/2013] [Accepted: 04/22/2013] [Indexed: 12/15/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Environmental assessment and remediation: a practice parameter." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single person, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295-9.e1-27. [PMID: 23374261 DOI: 10.1016/j.jaci.2012.12.672] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.
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Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, Caraballo L, Demain J, Portnoy J, von Hertzen L. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J 2013; 6:3. [PMID: 23663440 PMCID: PMC3646540 DOI: 10.1186/1939-4551-6-3] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 12/21/2022] Open
Abstract
Biodiversity loss and climate change secondary to human activities are now being associated with various adverse health effects. However, less attention is being paid to the effects of biodiversity loss on environmental and commensal (indigenous) microbiotas. Metagenomic and other studies of healthy and diseased individuals reveal that reduced biodiversity and alterations in the composition of the gut and skin microbiota are associated with various inflammatory conditions, including asthma, allergic and inflammatory bowel diseases (IBD), type1 diabetes, and obesity. Altered indigenous microbiota and the general microbial deprivation characterizing the lifestyle of urban people in affluent countries appear to be risk factors for immune dysregulation and impaired tolerance. The risk is further enhanced by physical inactivity and a western diet poor in fresh fruit and vegetables, which may act in synergy with dysbiosis of the gut flora. Studies of immigrants moving from non-affluent to affluent regions indicate that tolerance mechanisms can rapidly become impaired in microbe-poor environments. The data on microbial deprivation and immune dysfunction as they relate to biodiversity loss are evaluated in this Statement of World Allergy Organization (WAO). We propose that biodiversity, the variability among living organisms from all sources are closely related, at both the macro- and micro-levels. Loss of the macrodiversity is associated with shrinking of the microdiversity, which is associated with alterations of the indigenous microbiota. Data on behavioural means to induce tolerance are outlined and a proposal made for a Global Allergy Plan to prevent and reduce the global allergy burden for affected individuals and the societies in which they live.
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Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, PO Box 160, 00029, Helsinki, HUCH, Finland
| | - Stephen Holgate
- School of Medicine, University of Southampton, Southampton, UK
| | | | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland
| | - Suwat Benjaponpitak
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Jeffrey Demain
- Allergy, Asthma & Immunology Center of Alaska, Dept of Pediatrics, University of Washington, Washington, USA
| | - Jay Portnoy
- University of Missouri-Kansas City School of Medicine, Missouri, USA
| | - Leena von Hertzen
- Skin and Allergy Hospital, Helsinki University Hospital, PO Box 160, 00029, Helsinki, HUCH, Finland
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Duncan CL, Hogan MB, Tien KJ, Graves MM, Chorney JM, Zettler MD, Koven L, Wilson NW, Dinakar C, Portnoy J. Efficacy of a parent-youth teamwork intervention to promote adherence in pediatric asthma. J Pediatr Psychol 2012; 38:617-28. [PMID: 23248342 DOI: 10.1093/jpepsy/jss123] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.
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Affiliation(s)
- Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV 26506-6040, USA.
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Phipatanakul W, Matsui E, Portnoy J, Williams PB, Barnes C, Kennedy K, Bernstein D, Blessing-Moore J, Cox L, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sublett J, Bernstein J, Grimes C, Miller JD, Seltzer J. Environmental assessment and exposure reduction of rodents: a practice parameter. Ann Allergy Asthma Immunol 2012; 109:375-87. [PMID: 23176873 PMCID: PMC3519934 DOI: 10.1016/j.anai.2012.09.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Wanda Phipatanakul
- Department of Pediatrics, Division of Allergy and Immunology, Harvard Medical School Children's Hospital, Boston, Massachusetts, USA
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