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Shaker MS, Abrams EM, Mack DP, Chan ES, Iglesia EGA, Golden DBK, Greenhawt M. The promise and peril of knowledge translation for food allergy prevention. Ann Allergy Asthma Immunol 2023; 131:544-546. [PMID: 37652233 PMCID: PMC10964205 DOI: 10.1016/j.anai.2023.08.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Marcus S Shaker
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, The University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Edward G A Iglesia
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David B K Golden
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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2
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Bird JA. Please push the peanuts! J Allergy Clin Immunol 2023; 151:1246-1248. [PMID: 36796455 DOI: 10.1016/j.jaci.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Affiliation(s)
- J Andrew Bird
- Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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3
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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4
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Vale SL, Roche I, Netting M, Said M, Joshi P, Clifford R, Campbell DE, Salter SM. Nip allergies in the Bub: a qualitative study for a public health approach to infant feeding for allergy prevention. Aust N Z J Public Health 2022; 46:438-443. [PMID: 35616393 DOI: 10.1111/1753-6405.13241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify a brand, key messages and resources to underpin a public health approach to food allergy prevention. METHODS A focus group design was used to explore perceptions and opinions of potential brands, infant feeding messages and resources for providing standardised food allergy prevention information. Focus groups were conducted in February 2018 using interview guides and were transcribed verbatim. A content analysis of the transcripts was undertaken using thematic analysis software. The University of Western Australia provided ethics approval: RA/4/20/4280. RESULTS Seven focus groups with 39 participants were conducted. Four slogans and styles of imagery were considered. 'Nip Allergies in the Bub' was the most favoured slogan and images of babies with food were most favoured. Participant feedback was sought regarding messages and supporting messages were considered important. Participants were consulted about useful resources and a website was identified. CONCLUSIONS Conducting focus groups assisted the selection of a brand, messages and resources to underpin a public health approach to implementing allergy prevention guidelines. IMPLICATIONS FOR PUBLIC HEALTH This is the first focus group research undertaken for food allergy prevention. Identification of a meaningful brand, key messages and resources will support a public health approach to implementing allergy prevention guidelines.
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Affiliation(s)
- Sandra L Vale
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia.,National Allergy Strategy, New South Wales.,Australasian Society of Clinical Immunology and Allergy, New South Wales
| | - Ingrid Roche
- National Allergy Strategy, New South Wales.,Perth Children's Hospital, Western Australia
| | - Merryn Netting
- National Allergy Strategy, New South Wales.,Women and Kids Theme, South Australian Health and Medical Research Institute, South Australia.,Department of Paediatrics, University of Adelaide, South Australia.,Nutrition Department, Women's and Children's Health Network, South Australia
| | - Maria Said
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia.,National Allergy Strategy, New South Wales.,Allergy & Anaphylaxis Australia, New South Wales
| | - Preeti Joshi
- National Allergy Strategy, New South Wales.,Australasian Society of Clinical Immunology and Allergy, New South Wales.,Department of Allergy and Immunology, The Children's Hospital at Westmead, New South Wales
| | - Rhonda Clifford
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia
| | - Dianne E Campbell
- Australasian Society of Clinical Immunology and Allergy, New South Wales.,Department of Allergy and Immunology, The Children's Hospital at Westmead, New South Wales.,Discipline of Child and Adolescent Health, The University of Sydney, New South Wales
| | - Sandra M Salter
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia
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5
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Marques-Mejias MA, Fisher H, Lack G, Du Toit G. Translating research into practice: What's new in the 2021 EAACI food allergy prevention guidelines? Clin Exp Allergy 2022; 52:476-480. [PMID: 35358370 DOI: 10.1111/cea.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/27/2021] [Accepted: 12/04/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Maria Andreina Marques-Mejias
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK
| | - Helen Fisher
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK
| | - Gideon Lack
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - George Du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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6
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Miceli Sopo S, Sinatti D, Mastellone F, Bersani G, Gelsomino M. Comment on Halken et al. Pediatr Allergy Immunol 2022; 33. [PMID: 35338728 DOI: 10.1111/pai.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Stefano Miceli Sopo
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Dario Sinatti
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Francesco Mastellone
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Giulia Bersani
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Mariannita Gelsomino
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
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7
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Abrams EM, Sicherer SH. Tree nut introduction in a peanut-allergic child: To eat, to screen, or to avoid? Pediatr Allergy Immunol 2022; 33:e13669. [PMID: 34553798 DOI: 10.1111/pai.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
There is no defined standard of care around tree nut introduction in a peanut-allergic child, and the role of screening prior to tree nut introduction is controversial. There is some evidence that peanut-allergic children are at increased risk of tree nut allergy, with approximately 23-68% of children with co-existent peanut/tree nut allergy. In some studies, it has been shown that tree nut allergy in children has the potential to be a severe allergy. However, this appears to be age-specific as infant anaphylaxis in general tends to be milder, and there has been no fatality reported on the first ingestion of an allergen in infancy. Familial hesitancy has been identified as a possible condition for undertaking screening tests prior to allergen introduction. Indeed, there has been limited evidence that caregiver hesitancy may exist in peanut-allergic families with tree nut introduction. However, pre-emptive screening has the potential to overdiagnose tree nut allergy and delay introduction (which could paradoxically increase risk). As a result, the decision is best made in the context of shared decision-making and patient preference-sensitive care.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Chang A, Cabana MD, LaFlam TN, Patel S, Okumura M. Early Peanut Introduction and Testing: A Framework for General Pediatrician Beliefs and Practices. Pediatr Allergy Immunol Pulmonol 2021; 34:53-59. [PMID: 34143689 PMCID: PMC8329693 DOI: 10.1089/ped.2020.1190] [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: 05/06/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022]
Abstract
Background: Peanut introduction guidelines have undergone significant reversal since 2001 from recommending delayed introduction to rescinding the recommendations in 2008 to actively recommending early introduction of peanut between 4 and 11 months of age in high-risk infants in 2015. This qualitative study aims to explore pediatrician beliefs, practices, facilitators, and barriers regarding peanut introduction and testing. Methods: General pediatricians from academic, private, large group, and underserved practices in Northern California underwent individual semi-structured interviews in 2017. We asked about experiences surrounding infant peanut introduction, strategies for staying up-to-date with current recommendations, and barriers and facilitators to the new peanut introduction and testing recommendations. The data were coded, and using grounded theory methodology, a conceptual framework was developed around early peanut introduction and testing in infants. Results: Eighteen general pediatricians participated. We identified barriers that may contribute to pediatrician reluctance to recommending early peanut introduction or testing including lack of awareness, lack of agreement, lack of resources, and lack of outcome expectancy. A framework was created that suggests that pediatricians need to be knowledgeable about new recommendations, agree with the recommendations, have resources to carry out the counseling and testing, and have buy-in from the parents in order for successful uptake of peanut introduction guidelines. Conclusion: Recommending early peanut introduction or testing causes significant apprehension in some pediatricians, and there are many barriers to following recent early peanut introduction recommendations. A potential limitation of the study is that it was conducted right after the addendum guidelines were changed, leaving the possibility that attitudes and practices may have evolved since 2017. It is still likely that a multifaceted approach that addresses primary care provider guideline awareness, limited primary care resources for education and testing, and includes support and collaboration from subspecialty practices is more likely to lead to improved early peanut introduction uptake.
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Affiliation(s)
- Angela Chang
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Michael D. Cabana
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Taylor N. LaFlam
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Saharsh Patel
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Megumi Okumura
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
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9
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Tham EH, Shek LPC, Van Bever HP, Vichyanond P, Ebisawa M, Wong GW, Lee BW. Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective-An Asia Pacific Association of Pediatric Allergy, Respirology & Immunology (APAPARI) consensus statement. Pediatr Allergy Immunol 2018; 29:18-27. [PMID: 29068090 DOI: 10.1111/pai.12820] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/03/2017] [Accepted: 10/15/2017] [Indexed: 12/29/2022]
Abstract
Emerging evidence for the early introduction of allergenic foods for the prevention of food allergies, such as peanut allergy in Western populations, has led to the recent publication of guidelines in the USA and Europe recommending early peanut introduction for high-risk infants with severe eczema or egg allergy. Peanut allergy is, however, much less prevalent in Asia compared to the West. Varying patterns of food allergy are seen even within Asian countries-such as a predominance of wheat allergy in Japan and Thailand and shellfish allergy in Singapore and the Philippines. Customs and traditions, such as diet and infant feeding practices, also differ between Asian populations. Hence, there are unique challenges in adapting guidelines on early allergenic food introduction to the Asian setting. In this paper, we review the evidence and discuss the possible approaches to guide the timely introduction of allergenic food in high-risk infants in Asia.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Hugo Ps Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Pakit Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Gary Wk Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
Food allergy is common in children. An accurate diagnosis remains a key element in order to instigate an effective management plan. Traditional management strategies have relied on a reactive approach, with allergen avoidance, management of accidental ingestion and monitoring for resolution. Active management of food allergies relies on strategies to prevent food allergy through early introduction of allergenic foods and anticipatory testing. With an established food allergy diagnosis, active management through modifying the natural history, and risk management strategies can be instigated. This review will discuss each of these areas in turn.
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Affiliation(s)
- Sadreddini Helyeh
- Childrens Allergy Service, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Luyt David
- Childrens Allergy Service, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.,University of Leicester, Leicester, United Kingdom
| | - Stiefel Gary
- Childrens Allergy Service, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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11
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Tham EH, Leung DYM. How Different Parts of the World Provide New Insights Into Food Allergy. Allergy Asthma Immunol Res 2018; 10:290-299. [PMID: 29949829 PMCID: PMC6021584 DOI: 10.4168/aair.2018.10.4.290] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/21/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
The prevalence and patterns of food allergy are highly variable in different parts of the world. Differences in food allergy epidemiology may be attributed to a complex interplay of genetic, epigenetic, and environmental factors, suggesting that mechanisms of food allergy may differ in various global populations. Genetic polymorphisms, migration, climate, and infant feeding practices all modulate food allergy risk, and possibly also the efficacy of interventions aimed at primary prevention of food allergy development. Approaches to diagnosis, treatment, and prevention of food allergy should thus be tailored carefully to each population's unique genetic and environmental make-up. Future research in the context of food allergy prevention should focus on elucidating factors determining differential responses between populations.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.,Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colorado, USA.
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