Risk of Incident Asthma Among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 Years in a Northern California Healthcare System.

Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with non-Hispanic White children, whereas Chinese and Japanese children were similar.

Prehospital Treatment and Emergency Department Outcomes in Young Children with Food Allergy.

BACKGROUND: Studies assessing food-induced allergic reactions and prehospital treatments in infants and young children are scarce. OBJECTIVE: To describe differences in clinical characteristics in children aged 0 to 4 years presenting to the emergency department (ED) with food allergy (FA) reactions and investigate the association between prehospital epinephrine use and clinical outcomes. METHODS: Retrospective cohort study of FA ED visits in Kaiser Permanente Northern California from January 2016 to December 2018. Charts were assessed on whether anaphylaxis criteria were met, and outcomes were reviewed after prehospital and ED treatments. RESULTS: A weighted cohort of 1518 children presenting with FA to the ED was evaluated. Infants presented with respiratory symptoms less often than did children age 1 and ages 2 to 4 years (6.8%, 16.1%, and 23.9%, respectively; P < .01), more frequently following first ingestion of offending food (74.8%, 44.2%, and 18.4%, respectively; P < .001), and with egg as the most common trigger (33.8%, 8.6%, and 5.3%, respectively; P < .001). Children younger than age 2 years had a tendency toward meeting anaphylaxis criteria less frequently than older children (31.3% vs 42.2%; P = .06), with ED epinephrine given in 12.6% overall. Prehospital epinephrine was given in 152 patients and was associated with a higher likelihood of admission for observation (adjusted odds ratio, 2.6; 95% CI, 1.0-6.5) but a lower likelihood of ED epinephrine treatment (adjusted odds ratio, 0.2; 95% CI, 0.1-0.5). CONCLUSIONS: Infants treated in the ED for FA reactions presented differently than older children. Most infants presented after first-known ingestion of offending foods. Overall, ED epinephrine use was low necessitating additional education to recognize and treat anaphylaxis in the ED.

Oral tolerance: lessons on treatment of food allergy.

Oral tolerance is the active non-response by the immune system to an antigen administered through the oral route. It is postulated that food hypersensitivity results from a breakdown in oral tolerance induction, and the importance of oral tolerance in food hypersensitivity can be traced back to classic experiments from 1911 in which guinea pigs were protected from anaphylaxis by prior feeding of antigen. Host and antigenic factors play a role in determining the pathways and mechanisms to which a fed antigen can gain tolerance. Recent studies have demonstrated the potential of using oral tolerance to treat food allergies, and additional studies are necessary to further our understanding of mechanisms of oral tolerance induction.

Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study.

BACKGROUND: Food allergy is a common and serious health problem. A new herbal product, called food allergy herbal formula 2 (FAHF-2), has been demonstrated to have a high safety profile and potent long-term efficacy in a murine model of peanut-induced anaphylaxis. OBJECTIVE: To evaluate the safety and tolerability of FAHF-2 in patients with food allergy. METHODS: In this randomized, double-blinded, placebo-controlled, dose escalation, phase 1 trial, patients received 1 of 3 doses of FAHF-2 or placebo: 2.2 g (4 tablets), 3.3 g (6 tablets), or 6.6 g (12 tablets) 3 times a day for 7 days. Four active and 2 placebo patients were treated at each dose level. Vital signs, physical examination results, laboratory data, pulmonary function test results, and electrocardiogram data were monitored. Immunomodulatory studies were also performed. RESULTS: Nineteen food allergic participants were included in the study. Two patients (1 in the FAHF-2 group and 1 in the placebo group) reported mild gastrointestinal symptoms. One patient withdrew from the study because of an allergic reaction that was unlikely related to the study medication. No significant differences were found in vital signs, physical examination results, laboratory data, pulmonary function test results, and electrocardiogram data obtained before and after treatment visits. Significantly decreased interleukin (IL) 5 levels were found in the active treatment group after 7 days. In vitro studies of peripheral blood mononuclear cells cultured with FAHF-2 also demonstrated a significant decrease in IL-5 and an increase in culture supernatant interferon gamma and IL-10 levels. CONCLUSIONS: FAHF-2 appeared to be safe and well tolerated in patients with food allergy.

Use of complementary and alternative medicine by food-allergic patients.

BACKGROUND: Interest in complementary and alternative medicine (CAM) is increasing. Use of CAM in food-allergic patients has not previously been evaluated. OBJECTIVES: To determine the prevalence of CAM use, the types of CAM modalities used, and opinions about CAM in food-allergic patients. METHODS: A questionnaire was distributed to attendees at a patient conference in 2002 and to patients at pediatric food allergy clinics in 2005. RESULTS: Surveys were completed by 380 families. Respondents were mainly white, parents of children with multiple food allergies, and from the tri-state (New York, New Jersey, Connecticut) area. Diagnostic modalities considered unproven or disproven (such as serum IgG4, electrodermal skin testing, and kinesiology) were used by 22% of respondents; CAM therapies were used by 18%. Participants used several types of CAM practitioners, the most common being chiropractors, homeopaths, and acupuncturists. Only 49% of patients using CAM disclosed this to their physicians. Efficacy ratings for CAM were poor. Regarding participants' opinions, an herbal therapy of equal efficacy, safety, and cost was preferred to a pharmaceutical drug (37% vs 12%; P = .001), but most participants (51%) had no preference or were unsure. CONCLUSION: Unproven or disproven diagnostic methods and CAM treatments were used by approximately 1 in 5 respondents. Those using CAM noted poor efficacy, but if given a choice, many would prefer herbal therapies to pharmaceutical drugs. Education regarding reliable testing for food allergy and further research on CAM therapies are warranted.

Immune competence and switched memory B cells in common variable immunodeficiency.

Common variable immunodeficiency (CVID) is presumed to be a heterogenous group of disorders with potentially separate etiologies. Memory B cell subsets, characterized by CD27 expression, have been suggested as a means to subclassify CVID patients. 53 patients were subdivided based on percentages of switched memory B cells (CD27+IgM-IgD-): 33 were placed in Group I (<0.4% CD27+IgM-IgD- cells/peripheral lymphocytes) and 20 in Group II (>0.4%). The median serum IgG for subjects in Group I was lower at 145 mg/dl vs. 329.5 mg/dl for Group II (P=0.038). Post-pneumococcal vaccine IgG response was tested; the median protective response was 0.5 serotypes for Group I and 3 serotypes for Group II (P=0.041). Autoimmune and granulomatous disease was found in higher rates in Group I. CVID patients with decreased percentages of switched memory B cells have lower levels of serum IgG, less effective pneumococcal vaccine antibody responses, and higher rates of autoimmune and granulomatous disease.

Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma.

BACKGROUND: Chinese herbal medicine has a long history of human use. A novel herbal formula, anti-asthma herbal medicine intervention (ASHMI), has been shown to be an effective therapy in a murine model of allergic asthma. OBJECTIVE: This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy. METHODS: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks. Spirometry measurements; symptom scores; side effects; and serum cortisol, cytokine, and IgE levels were evaluated before and after treatment. RESULTS: Posttreatment lung function was significantly improved in both groups as shown by increased FEV(1) and peak expiratory flow findings (P<.001). The improvement was slightly but significantly greater in the prednisone group (P<.05). Clinical symptom scores, use of beta(2)-bronchodilators, and serum IgE levels were reduced significantly, and to a similar degree in both groups (P<.001). T(H)2 cytokine levels were significantly reduced in both treated groups (P<.001) and were lower in the prednisone-treated group (P<.05). Serum IFN-gamma and cortisol levels were significantly decreased in the prednisone group (P<.001) but significantly increased in the ASHMI group (P<.001). No severe side effects were observed in either group. CONCLUSION: Anti-asthma herbal medicine intervention appears to be a safe and effective alternative medicine for treating asthma. In contrast with prednisone, ASHMI had no adverse effect on adrenal function and had a beneficial effect on T(H)1 and T(H)2 balance.