Does website-based information add any value in counseling mothers expecting a baby with severe congenital diaphragmatic hernia?

OBJECTIVE: We aimed to measure whether website-provided information about congenital diaphragmatic hernia (CDH) and fetal therapy for severe cases provides added value compared with clinical counseling of parents. METHODS: This is a single center study in 102 couples who earlier opted for fetoscopic endoluminal tracheal occlusion (FETO) because of isolated severe CDH. They were asked to fill out an anonymized web-based survey of 12 questions. Then, they were offered access to information on the web pages of the randomized Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial. One week later, their appreciation was measured again by a second questionnaire. RESULTS: Eighty-two (80%) parents completed the first questionnaire, and 48 (47%) completed the entire survey. Several items became more clear to the parents after reading the website, such as the length of hospital stay (23.2% prior to web information, 60.4% after; P = 0.004), maternal risk, or the requirement of fetal anesthesia for FETO (43.9% resp. 79.2%; P = <0.001). CONCLUSION: Complementing prenatal counseling on CDH and FETO by standardized information via website is perceived by parents as of added value. Maternal risks and the need for fetal medication need more clarification during the verbal counseling prior to prenatal interventions.

The Indirect Basophil Activation Test Is a Safe, Reliable, and Accessible Tool to Diagnose a Peanut Allergy in Children.

BACKGROUND: The gold standard for the diagnosis of a peanut allergy is an oral food challenge (OFC), but it is a time-consuming, patient-unfriendly, and expensive test. The in vitro direct basophil activation test (BAT) for peanuts was shown to be a promising diagnostic tool for replacing the OFC. OBJECTIVE: To determine the diagnostic accuracy of the indirect (passive) BAT. Compared with the direct BAT, the timing of the indirect BAT is more flexible, and the problem of nonresponding basophils (unresponsive to IgE receptor-mediated signaling) is circumvented. METHODS: In 74 children, suspected of peanut allergy and eligible for an OFC, indirect BAT results for peanut extract, Ara h2, and Ara h6 were compared with the results of a double-blind placebo-controlled food challenge. The reactivity and sensitivity of the basophils in the BAT were correlated to both the allergy status and the threshold dose in the OFC. RESULTS: The combined basophil reactivity for Ara h2 and Ara h6 showed the highest accuracy (94%) for the diagnosis of a peanut allergy, with positive and negative predictive values of 96% and 89%, respectively. The sensitivity of the basophils for Ara h2 significantly discriminates between patients who tolerated up to 0.4 g of peanut protein in the OFC and those who did not. CONCLUSIONS: Because the indirect BAT showed a high diagnostic accuracy for peanut allergy, it is a promising alternative to the classical direct BAT and could lead to a reduction in OFC use.