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This review highlights studies from the past 3 years that add to the understanding of the impact of environmental exposures on allergic disease. These include aeroallergens, air quality, prenatal or early life exposures, and occupational exposures. Recent studies focused on the relationship between the environment, the microbiome, and allergic disease as well as new therapeutic options are also reviewed. Lastly, there has been significant recent research that improves our knowledge of the link between health disparities and environmental exposures. These scientific advances have resulted in a better understanding that sets the foundation for current and future research dedicated to improving health outcomes by modifying environmental exposures.
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BACKGROUND: Sunflower seeds are a popular allergen-free peanut alternative. OBJECTIVE: To describe sunflower seed allergy incidence and characteristics. METHODS: We conducted a retrospective cohort study of patients with sunflower seed allergy from 1995 to 2021 in a pediatric allergy clinic. We described demographics, testing results, atopic comorbidities, and reaction histories of patients with sunflower seed allergy, and calculated the annual cumulative incidence of the allergy. Logistic regression was used to estimate the increase in odds of sunflower seed allergy diagnosis for each year from 1995 to 2021. RESULTS: From 1995 to 2021, we identified 235 patients with sunflower seed allergy. Among patients with sunflower seed allergy, the median age at diagnosis was 3.9 years. Over three quarters of patients had another atopic condition. Half of reactions consisted of mild urticaria or rash, and a quarter met criteria for anaphylaxis. The cumulative incidence ranged from 0% (1995-1999, 2001-2004 and 2006) to 0.38% (2021). From 1995 to 2021, the odds of sunflower seed allergy diagnosis increased annually by 21% (OR 1.21, 95% CI: 1.17-1.25). CONCLUSION: In our single-center cohort of children with sunflower seed allergy, most children were diagnosed in early childhood, had high rates of comorbid atopic conditions, and had high rates of cutaneous reactions to sunflower seed products. Moreover, in our cohort, incidence of sunflower seed allergy increased.
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Asthma, allergic rhinitis, and food allergy are common allergic diseases, yet adherence to many management options remains poor, leading to worse health outcomes and financial implications for society and health systems. The underlying causes of nonadherence are numerous, ranging from patient-specific factors to broader socioeconomic and systems-based factors. In this review, we aim to discuss the definition of adherence, which can be divided into 3 components: initiation, implementation, and persistence, as well as to review various methods of measuring adherence. Subsequently, we will review the epidemiology of adherence to asthma and allergic rhinitis medications, allergen immunotherapy, and oral immunotherapy. Finally, we will discuss the multifaceted etiology of poor adherence and its subsequent impact on patients and society.
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Human Immunodeficiency Virus (HIV) causes a chronic illness requiring lifelong medical care to prevent opportunistic infections and death. It is important to identify medical neglect in children that are perinatally exposed to or living with human immunodeficiency virus and to take steps to prevent it. Diagnosis of medical neglect must be considered in the context of the caregivers' understanding of the risks of harm, and the logistical, cultural and social factors that may influence their actions or non-actions. When medical neglect as failure of treatment or prevention of infection is suspected, medical providers should work collaboratively with caregivers to assess and address barriers to adherence and to provide resources and support. Medical neglect may be diagnosed if repeated preventive efforts fail.
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OBJECTIVES/HYPOTHESIS: Resonance tubes are commonly used in voice therapy. These devices modify supraglottal impedance, potentially decreasing the aerodynamic power necessary for phonation. We modeled phonation with resonance tubes in excised larynges and evaluated the effects of varying tube width, tube length, and flow input on phonation threshold pressure (PTP) and phonation threshold flow (PTF). We hypothesized that the increased vocal economy observed in human subjects and several other models would be observed in excised larynges. STUDY DESIGN: Repeated measures excised canine larynx bench experiment with each larynx serving as own control. METHODS: Nine conditions were evaluated, namely control, two tube diameters (17.5 and 6.5mm), three tube lengths (7.8, 15.0, and 30.0cm), and three levels of flow input (80, 114, and 200mL/s). Aerodynamic data were collected for 11 excised canine larynges attached to an artificial vocal tract, and results from each experimental configuration were compared with control. RESULTS: A significant decrease in average PTP occurred compared with control for the 114- and 200-mL/s flow inputs, 30-cm extension, and 17.5- and 6.5-mm constrictions. Average PTF decreased compared with control for every configuration, although statistically significant changes were only observed for 200-mL/s flow and 6.5-mm constriction. CONCLUSIONS: Knowledge regarding the effect of vocal tract alterations could be clinically useful in determining the optimal "straw" configuration for voice therapy. Further exploration of the relationships among width, length, and flow input could provide theoretical support for the development of new therapies and resonance tube devices.