Body mass index in relation to symptom presentation on diagnosis of eosinophilic esophagitis in children.

BACKGROUND: The relationship between body mass index (BMI) and eosinophilic esophagitis (EoE) among children is not well characterized. OBJECTIVE: To evaluate the presentations of EoE in pediatric patients of different weight classes. METHODS: Records of newly diagnosed children with EoE at an academic center from 2015 to 2018 were evaluated regarding demographics, symptom presentation, and endoscopic findings and compared among the underweight, normal weight, overweight, and obese groups. RESULTS: There were 341 patients aged 0 to 18 years old newly diagnosed with EoE from 2015 to 2018 (68.3% male, 233 of 341; 80.9% White, 276 of 341). Of the 341, 17 were underweight (4.9%), 214 normal weight (62.8%), 47 overweight (13.8%), and 63 obese (18.5%). Children with obese and overweight BMI were more likely to be diagnosed at an older age (P = .005) and to present with a chief complaint of abdominal pain (P = .02). Normal- and under-weight children were more likely to have an immunoglobulin E-mediated food allergy (P = .02). Normal weight children were more likely to be tested for food allergies (P = .02) and inhalant allergies (P = .004) and have linear furrows on endoscopy (P = .03), compared with children with overweight and obese BMI. No significant differences were found regarding race, sex, type of insurance, atopic dermatitis, asthma, or allergic rhinitis in relation to BMI status and EoE diagnosis. CONCLUSION: Nearly one-third of children were obese or in overweight status on diagnosis with EoE. Children with BMI in the overweight or obese range were more likely to be older at diagnosis and to have a chief complaint of abdominal pain on presentation.

A Multidisciplinary Quality Improvement Initiative to Facilitate Penicillin Allergy Delabeling Among Hospitalized Pediatric Patients.

BACKGROUND: Penicillin allergy is reported in up to 10% of the general population; however, >90% of patients reporting an allergy are tolerant. Patients labeled as penicillin allergic have longer hospital stays, increased exposure to suboptimal antibiotics, and an increased risk of methicillin-resistant Staphylococcus aureus and Clostridioides difficile. The primary aim with our quality improvement initiative was to increase penicillin allergy delabeling to at least 10% among all hospitalized pediatric patients reporting a penicillin allergy with efforts directed toward patients determined to be low risk for true allergic reaction. METHODS: Our quality improvement project included several interventions: the development of a multidisciplinary clinical care pathway to identify eligible patients, workflow optimization to support delabeling, an educational intervention, and participation in our institution's quality improvement incentive program. Our interventions were targeted to facilitate appropriate delabeling by the primary hospital medicine team. Statistical process control charts were used to assess the impact of this intervention pre- and postpathway implementation. RESULTS: After implementation of the clinical pathway, the percentage of patients admitted to hospital medicine delabeled of their penicillin allergy by discharge increased to 11.7%. More than one-half of those delabeled (51.2%) received a penicillin-based antimicrobial at time of discharge. There have been no adverse events or allergic reactions requiring emergency medication administration since pathway implementation. CONCLUSIONS: Our quality improvement initiative successfully increased the rate of penicillin allergy delabeling among low-risk hospitalized pediatric patients, allowing for increased use of optimal antibiotics.

Nutrition and the Immune System: A Complicated Tango.

Enthusiasm exists for the potential of diet to impact the immune system, prevent disease and its therapeutic potential. Herein, we describe the challenge to nutrition scientists in defining this relationship through case studies of diets and nutrients in the context of allergic and autoimmune diseases. Moderate-quality evidence exists from both human intervention and observational studies to suggest that diet and individual nutrients can influence systemic markers of immune function and inflammation; numerous challenges exist for demonstrating the impact of defined diets and nutrient interventions on clearly influencing immune-mediated-clinical disease endpoints. A growing body of evidence suggests that further consideration of dietary patterns, immune system and gut microbiome composition and function, and subsequent epigenetic modifications are needed to improve our understanding of diet-immune system interactions.

Aging alters interspecific competition between two sympatric insect-parasitic nematode species.

Interspecific competition can vary depending on the stage, age, or physiological state of the competitors. Competitive ability often increases with age or size; alternatively, senescence can lead to a loss of viability and reduced competitive success. Differences between species in their age-specific competitive abilities can promote coexistence in the face of substantial niche overlap.We examined two sympatric species of nematodes (genus Steinernema) to determine whether their competitive relationship changes as a function of age. These obligately killing insect parasites are known for their broad host ranges and are transmitted from insect to insect via a juvenile stage propagule that is free-living in the soil. Here, we tested whether the two species differed in the effects of age by examining the mortality of insect hosts infected with young or old transmission stage nematodes of each species. We also performed mixed infections, where an equal ratio of both species was simultaneously exposed to a host, to determine the effect of age on competitiveness.One species showed reduced performance with age, as older propagules were slower at inducing host mortality. In contrast, the other species increased in killing speed with age. In competition, insect mortality rate was predictive of competitive outcome, such that if one species induced considerably faster host death in a single-species infection, it was competitively dominant in the coinfection. Accordingly, we found a shift in the competitive relationship between the two species with age.Our work demonstrates that species differences in the effects of aging can lead to dramatic shifts in reproductive success. As these effects are realized solely in a competitive environment, both spatial patchiness and temporal niche partitioning may be important for promoting coexistence.