Sociodemographic inequities in food allergy: Insights on food allergy from birth cohorts.

A large and growing corpus of epidemiologic studies suggests that the population-level burden of pediatric FA is not equitably distributed across major sociodemographic groups, including race, ethnicity, household income, parental educational attainment, and sex. As is the case for more extensively studied allergic disease states such as asthma and atopic dermatitis epidemiologic data suggest that FA may be more prevalent among certain populations experiencing lower socioeconomic status (SES), particularly those with specific racial and ethnic minority backgrounds living in highly urbanized regions. Emerging data also indicate that these patients may also experience more severe FA-related physical health, psychosocial, and economic outcomes relating to chronic disease management. However, many studies that have identified sociodemographic inequities in FA burden are limited by cross-sectional designs that are subject to numerous biases. Compared with cross-sectional study designs or cohorts established later in life, birth cohorts offer advantages relative to other study designs when investigators seek to understand causal relationships between exposures occurring during the prenatal or postnatal period and the atopic disease status of individuals later in life. Numerous birth cohorts have been established across recent decades, which include evaluation of food allergy-related outcomes, and a subset of these also have measured sociodemographic variables that, together, have the potential to shed light on the existence and possible etiology of sociodemographic inequities in food allergy. This manuscript reports the findings of a comprehensive survey of the current state of this birth cohort literature and draws insights into what is currently known, and what further information can potentially be gleaned from thoughtful examination and further follow-up of ongoing birth cohorts across the globe.

Epidemiology and the Growing Epidemic of Food Allergy in Children and Adults Across the Globe.

PURPOSE OF REVIEW: Food allergies are immune-mediated, complex disorders, which are the source of increasing health concern worldwide. The goal of this review is to present an updated summary of the food allergy (FA) burden among children and adults across different populations, focusing on research from the past 5 years. RECENT FINDINGS: FAs impact a growing number of global residents-particularly those residing in higher-income, industrialized regions. Moreover, growing epidemiologic evidence suggests that the population health burden of non-IgE-mediated FAs, such as food protein-induced enterocolitis syndrome, may also be higher than previously reported. FA is a complex trait that impacts infants, children, as well as adults across the globe. The population health burden of both IgE- and non-IgE-mediated FAs is likely to grow in the absence of rapid advances and widespread implementation of effective FA prevention and treatment interventions. Systematic epidemiological research initiatives are needed, both nationally and globally, to better understand and reduce the burden of these allergic diseases.

Asthma and anxiety development in Australian children and adolescents.

BACKGROUND: Evidence has suggested a bidirectional association between both the effects and onset of asthma and anxiety. The direction of this association in children and adolescents is less clear. The study evaluates whether anxiety in children is associated with the development of later asthma or, by contrast, whether asthma in children precedes anxiety. METHODS: Parental reports from 9369 children at two age points (4-5 and 14-15 years old) and from baby (B) (recruited at birth in 2004) and kindergarten (K) (recruited at 4-5 years of age in 2004) cohorts of the Longitudinal Study of Australian Children (LSAC) were analyzed. Asthma cases were defined as reports of doctor-diagnosed asthma and the use of asthma medication or/and wheezing. Scores of the Strengths and Difficulties Questionnaire (SDQ) defined anxiety. RESULTS: We found a unidirectional association between asthma in children aged 4-5 years and future anxiety development in weighted generalized linear adjusted models (B cohort OR (CI 95%) = 1.54 (1.14-2.08); K cohort OR (CI 95%) = 1.87 (1.40-2.49)). Children with asthma (no anxiety at 4 years) had a higher prevalence of anxiety in adolescence compared with nonasthmatics (B cohort = 26.8% vs 17.6%: K cohort = 27.7% vs 14.3%). Anxiety in childhood was not associated with the development of asthma from 6 years old to adolescence. CONCLUSION: Australian children with asthma have a greater risk of developing anxiety from 6 to 15 years old. This suggests that early multidisciplinary intervention may be required to support children with asthma to either prevent the increased risk of anxiety and/or promote optimal anxiety management.

Prevalence and burden of coconut allergy in the United States.

BACKGROUND: Epidemiologic data on coconut allergy remains sparse in the United States despite the labeling requirement by the Food Allergen Labeling and Consumer Protection Act for products containing coconut. OBJECTIVE: To provide current estimates of the prevalence, severity, determinants, and distribution of coconut allergy in the United States. METHODS: A comprehensive food allergy prevalence survey was administered to a nationally representative, probability-based sample of US households between October 1, 2015 and September 30, 2016. Eligible respondents included adults who were able to complete self- and parent-proxy report surveys in English or Spanish by means of web or phone. RESULTS: Using survey responses from 78,851 individuals, 0.39% (95% confidence interval [CI], 0.33-0.45) of the US general population were categorized as having convincing coconut allergy. Among children, 0.22% (95% CI, 0.16-0.30) were estimated to have coconut allergy compared with 0.43% (95% CI, 0.37-0.51) of adults, whereas only 0.12% (95% CI, 0.08-0.18) of these children and 0.20% (95% CI, 0.16-0.24) of adults with convincing immunoglobulin E (IgE)-mediated coconut allergy reported physician-confirmed diagnoses. A current epinephrine prescription was reported by 40.1% (95% CI, 33.3-47.4) of those with convincing coconut allergy. Reactions involving multiple organ systems were reported by 47.5% (95% CI, 40.1-54.9) of those with convincing coconut allergy. CONCLUSION: Roughly 1 in 260 Americans report symptoms consistent with an IgE-mediated allergy to coconut, although fewer than half of these individuals report receiving a physician diagnosis. Our data indicate that most individuals with reported coconut allergy meeting symptom-based criteria for convincingly IgE-mediated disease have comorbid FAs, and for many patients, clinical management seems to be suboptimal.

The epidemiology of multifood allergy in the United States: A population-based study.

BACKGROUND: Immunoglobulin E (IgE)-mediated food allergies (FAs) are increasingly common among US children and adults. Not only can living with FA impose considerable physical health impacts, but it also imposes economic burden and can negatively affect quality of life. Limited data indicate that allergy to multiple foods (multi-FA) also may be common, but much remains unknown about its distribution and determinants. OBJECTIVE: To characterize the prevalence, characteristics, determinants, psychosocial burden, and distribution of multi-FA among a large, nationally representative sample of US children and adults. METHODS: A US population-based survey was administered. Estimates of multi-FA prevalence, conditional frequencies of multi-FA combinations, and associated factors were derived. Latent class analyses were conducted using 9 dichotomized indicators of specific FA prevalence, which were used to determine factors associated with latent class membership and characterize FA-related psychosocial burden within each class. RESULTS: Surveys were completed for 38,408 children and 40,443 adults. Among children and adults meeting established symptom-report criteria for FA, an estimated 40% and 48% had multi-FA, respectively. Among pediatric and adult populations with convincing FAs, the lifetime reported prevalence of physician-diagnosed atopic comorbidities increased significantly as the number of reported current convincing FAs increased, as did the proportion reporting multi-FA-related health care utilization and higher perceived psychosocial burden. Latent class analyses suggested the existence of the following 4 key latent phenotypes of multi-FA: milk and egg-dominant, seafood-dominant, peanut and tree nut-dominant, and broadly multi-food allergic. CONCLUSION: The US population-level burden of multi-FA is high among both children and adults, and data indicate the presence of 4 major phenotypes of multi-FA in both populations.

Evaluations from Superiors Matter More: Evidence from Behavior and Event-related Potentials.

As an essential feature of social groups, social hierarchies influence how people interact in daily life. However, it is unknown how external evaluations from peers at different levels in a social hierarchy influence feedback processing. In the current study, participants were instructed to establish a social hierarchy through a novel stick drawing task. With their status in the social hierarchy manipulated to be in the middle, participants received positive or negative evaluations from superiors and inferiors separately with ERPs signals recorded. Behaviorally, participants rated their happiness highest, and most quickly, after receiving positive evaluations from superiors. ERP results showed that P3 amplitude exhibited an interaction between social hierarchy and feedback valence, such that larger P3 amplitude was elicited by positive evaluations from superiors than any other condition, whereas the feedback-related negativity was only sensitive to the difference between high and low social statuses. Moreover, a generalized linear mixed model examining single-trial ERP data showed P3 amplitude correlated with happiness ratings as a function of feedback valence: a significant positive correlation in the positive feedback condition and a significant negative correlation in the negative feedback condition. P3 was also negatively correlated with RT across all conditions. These results demonstrate that brain activity associated with feedback processing predicted participants' emotion ratings and their decision time. Our study provides the first ERP evidence that positive feedback from superiors impacts neural activity related to reward processing differently than positive feedback from those of lower social standing.

Multivariate pattern analysis of electroencephalography data reveals information predictive of charitable giving.

Charitable donations are an altruistic behavior whereby individuals donate money or other resources to benefit others while the recipient is normally absent from the context. Several psychological factors have been shown to influence charitable donations, including a cost-benefit analysis, the motivation to engage in altruistic behavior, and the perceived psychological benefits of donation. Recent work has identified the ventral medial prefrontal cortex (MPFC) for assigning value to options in social decision making tasks, with other regions involved in empathy and emotion contributing input to the value computation (e.g. Hare et al., 2010; Hutcherson et al., 2015; Tusche et al., 2016). Most impressively, multivariate pattern analysis (MVPA) has been applied to fMRI data to predict donation behavior on a trial-by-trial basis from ventral MPFC activity (Hare et al., 2010) while identifying the contribution of emotional processing in other regions to the value computation (e.g. Tusche et al., 2016). MVPA of EEG data may be able to provide further insight into the timing and scalp topography of neural activity related to both value computation and emotional effects on donation behavior. We examined the effect of incidental emotional states and the perceived urgency of the charitable cause on donation behavior using support vector regression on EEG data to predict donation amount on a trial by trial basis. We used positive, negative, and neutral pictures to induce incidental emotional states in participants before they made donation decisions concerning two types of charities. One category of charity was oriented toward saving people from current suffering, and the other was to prevent future suffering. Behaviorally, subjects donated more money in a negative emotional state relative to other emotional states, and more money to alleviate current over future suffering. The data-driven multivariate pattern analysis revealed that the electrophysiological activity elicited by both emotion-priming pictures and charity cues could predict the variation in donation magnitude on a trial-by-trial basis.

Disparities among infertility patients regarding genetic carrier screening, sex selection, and gene editing.

PURPOSE: The purpose of this study is to evaluate the perspectives of infertility patients regarding genetic carrier screening, embryo sex selection, embryo research, and gene editing. METHODS: An anonymous 32-question survey was distributed electronically to all patients who seen at a single academic fertility center for at least one visit between June 2018 and September 2019. Survey questions evaluated patient perspectives on genetic carrier screening, embryo sex selection, embryo research, and gene editing. RESULTS: There were 1460 survey responses (32.0% response rate). There were significant differences in the proportion of respondents receiving genetic carrier screening between racial groups, 73.1% of White, 45.5% of Black, 49.4% of Hispanic, and 62.8% of Asian respondents. The likelihood of having genetic carrier screening was also significantly influenced by respondent income, insurance status, and religion. Religion significantly influenced the acceptance of embryonic research and embryonic sex selection. While only 8.9% felt that genetically modifying embryos for physical traits should be allowed, 74.1% felt that genetic modification to correct disease should be allowed. CONCLUSION: Racial, religious, and socioeconomic factors significantly impacted respondents' likelihood to have genetic carrier screening and views on embryo sex selection, embryo research, and gene editing. These findings highlight the importance of tailoring genetic counseling to the individual, acknowledging individual and cultural differences in agreement with genetic testing and emerging genetic therapies.

Knowledge, attitude, and practices of medical clinicians regarding food allergy and anaphylaxis in Hyderabad, India.

BACKGROUND: Food allergy (FA) is a chronic condition of emerging global concern. Surveys have been conducted in numerous countries to assess physician knowledge, attitude, and practices (KAP) pertaining to FA and anaphylaxis, and substantial deficits in their KAP were identified. OBJECTIVE: To assess the KAP of medical clinicians in Hyderabad, India, with respect to FA and anaphylaxis. METHODS: A regionally representative sample of 570 physicians including 113 general practitioners, 123 pediatricians, 110 pulmonologists, 113 dermatologists, and 111 gastroenterologists were recruited from all major institutions in Hyderabad, India. A validated questionnaire was used to assess their KAP. RESULTS: Overall, 90% of questions were correctly answered and differences emerged with respect to specific items, namely the following: (1) the lateral thigh being the preferred location for epinephrine administration (P = .001); (2) a positive skin prick test or radioallergosorbent test is sufficient for FA diagnosis (P = .04); and (3) the appropriate epinephrine dose for a 27-kg child (P = .006). Approximately 95% of the participants in each group were confident in their ability to care for patients with FA, yet 91% desired additional periodic FA training sessions. CONCLUSION: Survey findings suggest that although FA knowledge among South Indian clinicians seems high across all major specialties who care for patients with FA, there are differences in the level of knowledge among them, which in turn reflects the differences in attitude and approach toward their patients. These FA care providers still desire to further participate in continuing medical education efforts in the field of food allergy. Efforts to provide periodic training and education for all FA clinical care providers remain vital in South India.

Epidemiology and Burden of Food Allergy.

PURPOSE OF REVIEW: In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. RECENT FINDINGS: Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.

Psychosocial factors and multiple health risk behaviors among early adolescents: a latent profile analysis.

Early adolescence is a pivotal developmental period when multiple health risk behaviors, such as obesity and substance use, are often established. Several psychosocial factors, often considered traits, have been independently associated with these increases, including executive function (EF), mindfulness disposition (MD), perceived stress, distress tolerance (DT), and anhedonia. However, these factors have not been evaluated for their conjoint relationships to determine whether different patterns may signal greater or lesser risk for obesity and substance use, and whether the same patterns relate to obesity and substance use in the same ways (same magnitude of risk). To evaluate these patterns, a latent profile analysis was conducted, resulting in a three-profile model. Profile 1 (8% of sample) was characterized by the lowest levels of EF, MD, DT and highest levels of stress and anhedonia, profile 2 (44%) intermediate levels, and profile 3 (48%) the highest levels of EF, MD, DT and lowest levels of stress and anhedonia. Youth classified to profile 1 reported significantly greater levels of both obesogenic and substance use behaviors relative to other profiles. Findings suggest that adolescents engaging in obesogenic and substance use behaviors may share common profiles of psychosocial risk.

The effect of sensation seeking on alcohol use among middle school students: a latent state-trait analysis.

BACKGROUND: Sensation seeking has been implicated as a major risk factor for underage alcohol use, however little research into this personality trait has been conducted among children. OBJECTIVE: The current study examined if sensation seeking presents as a state or trait in children, and if the state or trait predicted future alcohol use. METHODS: A latent state-trait (LST) analysis was conducted among 552 individuals (54.3% female; age range 8-13; mean age 9.3) to determine the state or trait-based aspects of sensation seeking, and if this state or trait predicted future alcohol use. Sensation seeking behavior and lifetime alcohol use were assessed at four time points using two previously validated measures. RESULTS: Between 49.4% and 95.3% of individual differences in sensation seeking could be attributed to a stable underlying sensation seeking trait. Further, logistic regression of the stable trait of sensation seeking predicted future alcohol use. A one unit increase in the latent trait increased the odds a student would try alcohol by 7.83 times (95% CI = 1.49-41.11, p = .015). Standardized regression coefficients revealed that an increase of one standard deviation in the latent trait of sensation seeking increased the odds of experimentation with alcohol by 1.29 times (95% CI = 1.11-1.49, p = .001). CONCLUSION: Findings suggest sensation seeking presents as a stable trait during childhood, which can cause children to seek out a novel or exciting behaviors such as alcohol use. Future substance use interventions may need to account for the influence of the underlying trait.

Effects of working posture and roof slope on activation of lower limb muscles during shingle installation.

Awkward and extreme kneeling during roofing generates high muscular tension which can lead to knee musculoskeletal disorders (MSDs) among roofers. However, the combined impact of roof slope and kneeling posture on the activation of the knee postural muscles and their association to potential knee MSD risks among roofers have not been studied. The current study evaluated the effects of kneeling posture and roof slope on the activation of major knee postural muscles during shingle installation via a laboratory assessment. Maximum normalized electromyography (EMG) data were collected from knee flexor and extensor muscles of seven subjects, who mimicked the shingle installation process on a slope-configurable wooden platform. The results revealed a significant increase in knee muscle activation during simulated shingle installation on sloped rooftops. Given the fact that increased muscle activation of knee postural muscles has been associated with knee MSDs, roof slope and awkward kneeling posture can be considered as potential knee MSD risk factors. Practitioner Summary: This study demonstrated significant effects of roof slope and kneeling posture on the peak activation of knee postural muscles. The findings of this study suggested that residential roofers could be exposed to a greater risk of developing knee MSDs with the increase of roof slope during shingle installation due to increased muscle loading. Abbreviations: MSDs: musculoskeletal disorders; EMG: electromyography; ANOVA: analysis of variance; MNMA: maximum normalized muscle activation; RF: rectus femoris; VL: vastus lateralis; VM: vastus medialis; BF: biceps femoris; S: semitendinosus.

Kneeling trunk kinematics during simulated sloped roof shingle installation.

Trunk musculoskeletal disorders are common among residential roofers. Addressing this problem requires a better understanding of the movements required to complete working tasks, such as affixing shingles on a sloped residential roof. We analyzed the extent to which the trunk kinematics during a shingling process are altered due to different angles of roof slope. Eight male subjects completed a kneeling shingle installation process on three differently sloped roof surfaces. The magnitude of the trunk kinematics was significantly influenced by both slope and task phase of the shingling process, depending on the metric. The results unequivocally point to roof slope and task phase as significant factors altering trunk kinematics. However, extension of the results to roofing workers should be done carefully, depending on the degree to which the study protocol represents the natural setting. Future studies on shingle installation in residential roofing should absolutely consider capturing a wider array of shingling procedures in order to encapsulate all the possible methods that are used due to the lack of a standardized procedure.

Development of a finger adapter method for testing and evaluating vibration-reducing gloves and materials.

The objective of this study was to develop a convenient and reliable adapter method for testing and evaluating vibration-reducing (VR) gloves and VR materials at the fingers. The general requirements and technical specifications for the design of the new adapter were based on our previous studies of hand-held adapters for vibration measurement and a conceptual model of the fingers-adapter-glove-handle system developed in this study. Two thicknesses (2 mm and 3 mm) of the adapter beam were fabricated using a 3-D printer. Each adapter is a thin beam equipped with a miniature tri-axial accelerometer (1.1 g) mounted at its center, with a total weight ≤ 2.2 g. To measure glove vibration transmissibility, the adapter is held with two gloved fingers; a finger is positioned on each side of the accelerometer. Each end of the adapter beam is slotted between the glove material and the finger. A series of experiments was conducted to evaluate this two-fingers-held adapter method by measuring the transmissibility of typical VR gloves and a sample VR material. The experimental results indicate that the major resonant frequency of the lightweight adapter on the VR material (≥800 Hz) is much higher than the resonant frequencies of the gloved fingers grasping a cylindrical handle (≤300 Hz). The experimental results were repeatable across the test treatments. The basic characteristics of the measured glove vibration transmissibility are consistent with the theoretical predictions based on the biodynamics of the gloved fingers-hand-arm system. The results suggest that VR glove fingers can effectively reduce only high-frequency vibration, and VR effectiveness can be increased by reducing the finger contact force. This study also demonstrated that the finger adapter method can be combined with the palm adapter method prescribed in the standardized glove test, which can double the test efficiency without substantially increasing the expense of the test.

Are knee savers and knee pads a viable intervention to reduce lower extremity musculoskeletal disorder risk in residential roofers?

One factor commonly associated with musculoskeletal disorder risk is extreme postures. To lessen this risk, individuals must be in an as neutral posture as possible while working. We analyzed how the inclusion of different combinations of two interventions-knee pads and knee savers-can alter lower extremity kinematics during deep or near full flexion kneeling occurs while on different sloped surfaces. Nine male subjects were requested to keep a typical resting posture while kneeling on sloped roofing simulator. We observed that the introduction of a wearable third party device considerably altered lower extremity full flexion kneeling kinematics compared to level deep kneeling. This study provided a sound base for the use of third party devices to reduce musculoskeletal disorder risk on a sloped surface, however further testing with other musculoskeletal disorder risk factors is needed prior to conclusive recommendation.

Epinephrine auto-injector carriage and use practices among US children, adolescents, and adults.

BACKGROUND: Previous studies have suggested that epinephrine auto-injector (EAI) carriage and emergency use practices could be suboptimal for patients prescribed these devices for anaphylaxis management. OBJECTIVE: To characterize EAI prescription fill rates, carriage, and use practices and associated factors and perceived barriers to recommended anaphylaxis management behaviors in US children, adolescents, and adults. METHODS: Survey data were collected for adults (n = 450) and parents of children (n = 255) and adolescents (n = 212) who had been prescribed an EAI. Of eligible participants, survey completion rates were higher than 90%. A multiple-group structural equation model was fit to test adjusted associations. RESULTS: Most patients (89%) filled their EAI prescriptions; however, of those who did not, the most commonly cited barriers to filling prescriptions were no history of reactions (26%) and EAI cost (25%). Forty-four percent carried at least 1 EAI "all the time" and 24% carried multiple EAIs. Sixty-five percent of respondents reported a personal history of EAI use. Most adults (52%) reported that an EAI was not used, although it would have been beneficial during their most severe allergic reaction. The most frequently given reasons for not using an EAI among respondents owning one were that an EAI was not available (45%) followed by their allergy was undiagnosed at the time (35%). To improve clinical anaphylaxis management, 61% of patients desired more effective patient education and 47% desired more time dedicated to patient education during the physician visit. CONCLUSION: These data suggest that current anaphylaxis management practices are suboptimal but could be facilitated through lowering EAI-related out-of-pocket costs and improving patient education efforts.