Multicenter prevalence of anaphylaxis in clinic-based oral food challenges.

BACKGROUND: Although previous single-center studies report the rate of anaphylaxis for oral food challenges (OFCs) as 9% to 11%, little is known regarding the epidemiology of clinical OFCs across multiple centers in the United States. OBJECTIVE: To examine the epidemiology, symptoms, and treatment of clinical low-risk OFCs in the nonresearch setting. METHODS: Data were obtained from 2008 to 2013 through a physician survey in 5 food allergy centers geographically distributed across the United States. Allergic reaction rates and the association of reaction rates with year, hospital, and demographics were determined using a linear mixed model. Meta-analysis was used to pool the proportion of reactions and anaphylaxis with inverse-variance weights using a random-effects model with exact confidence intervals (CIs). RESULTS: A total of 6,377 OFCs were performed, and the pooled estimate of anaphylaxis was 2% (95% CI, 1%-3%). The rate of allergic reactions was 14% (95% CI, 13%-16%) and was consistent during the study period (P = .40). Reaction rates ranged from 13% to 33%. Males reacted 16% more frequently than females (95% CI, 4%-37.5%; P = .04). Foods challenged in 2013 varied geographically, with peanut as the most challenged food in the Northeast, Midwest, and West and egg as the most challenged in the South. CONCLUSION: As the largest national survey of allergic reactions of clinical open OFCs in a nonresearch setting in the United States, this study found that performing clinical nonresearch open low-risk OFCs results in few allergic reactions, with 86% of challenges resulting in no reactions and 98% without anaphylaxis.

Pneumococcal vaccination rates in children with sickle cell disease.

CONTEXT: Sickle cell disease (SCD) confers an increased risk of invasive pneumococcal disease, especially among young children. Pneumococcal vaccination decreases this risk, but the completion rate of age-appropriate vaccinations is not well defined in SCD. OBJECTIVE: The goal of this study was to assess whether pneumococcal vaccines are administered to high-risk children with SCD according to recommended vaccine schedules. DESIGN: A case-control design was used to conduct this study. SETTING: Administrative data were obtained on Michigan Medicaid or Children's Special Health Care Services programs enrollees. In addition, Michigan Newborn Screening and Michigan Care Improvement Registry records were used to confirm diagnosis and vaccine administration. PARTICIPANTS: This study compared pneumococcal vaccination rates in a cohort of 179 children with SCD with 537 age-matched non-SCD controls (1:3) enrolled in the Michigan Medicaid Program between 2001 and 2008. Study subjects were born in the state of Michigan between 2001 and 2005. MAIN OUTCOME MEASURE: The main outcome measure was the proportion of children defined as up to date for pneumococcal vaccines at defined milestone ages. RESULTS: Children with SCD had significantly higher vaccination rates than controls, yet these values were much lower than state and national immunization survey rates. CONCLUSION: Barriers to completing age-appropriate recommended pneumococcal immunizations should be identified and addressed to further reduce invasive pneumococcal disease in this high-risk patient population.

Ethnic variability in persistent asthma after in utero tobacco exposure.

BACKGROUND: The effects of in utero tobacco smoke exposure on childhood respiratory health have been investigated, and outcomes have been inconsistent. OBJECTIVE: To determine if in utero tobacco smoke exposure is associated with childhood persistent asthma in Mexican, Puerto Rican, and black children. PATIENTS AND METHODS: There were 295 Mexican, Puerto Rican, and black asthmatic children, aged 8 to 16 years, who underwent spirometry, and clinical data were collected from the parents during a standardized interview. The effect of in utero tobacco smoke exposure on the development of persistent asthma and related clinical outcomes was evaluated by logistic regression. RESULTS: Children with persistent asthma had a higher odds of exposure to in utero tobacco smoke, but not current tobacco smoke, than did children with intermittent asthma (odds ratio [OR]: 3.57; P = .029). Tobacco smoke exposure from parents in the first 2 years of life did not alter this association. Furthermore, there were higher odds of in utero tobacco smoke exposure in children experiencing nocturnal symptoms (OR: 2.77; P = .048), daily asthma symptoms (OR: 2.73; P = .046), and emergency department visits (OR: 3.85; P = .015) within the year. CONCLUSIONS: Exposure to tobacco smoke in utero was significantly associated with persistent asthma among Mexican, Puerto Rican, and black children compared with those with intermittent asthma. These results suggest that smoking cessation during pregnancy may lead to a decrease in the incidence of persistent asthma in these populations.

An increased risk of breast cancer after delayed first parity.

BACKGROUND: As delayed childbirth increases for socioeconomic and fertility reasons, its impact on breast cancer risk needs definition. METHODS: From 1975 to 1981, 1307 women with childbirth at >or=40 years of age were identified. They were divided into four groups by estimated first birth median ages (EFBMA): 23, 34, 38, and 41 years, corresponding to previous parity of more than 3, 2 or 3, 1, and zero, respectively. Cancer Registry cross-referencing identified those diagnosed with breast cancer. RESULTS: Breast cancer developed in 39 women. The EFBMA of 41 years carried a relative risk of 3.7, (95%CI: 1.30 to 10.5) compared with age 23. Odds ratio of breast cancer was 1.08 (95%CI: 1.02 to 1.14) with each year older at first birth and 0.79 (95% CI: 0.67 to 0.93) for each additional previous birth. CONCLUSIONS: Increased breast cancer risk with advancing maternal age at first childbirth is supported by 3.7 relative risk in women with an EFBMA of 41 years compared with those with an EFBMA of 23 years.