Impact of gender, race, and age of onset on the phenotype and comorbidities of pediatric eosinophilic esophagitis.

Objectives: To investigate differences in symptoms, allergy comorbidities, and eosinophilic inflammation at the time of diagnosis for patients with eosinophilic esophagitis (EoE) based on gender, race, and age of onset. Methods: A retrospective study was conducted at a multidisciplinary EoE clinic; the correlation between histological findings, previously identified symptoms, associated comorbidities, and demographics including gender, race, as well as age of onset was examined. Chi-squared and Student's T-tests were utilized for statistical analysis. Results: A total of 91 patients were enrolled in this study, with 70% being male and 67% identifying as White. Among the patients, 45% had an early onset of EoE (defined as ≤6 years old). We revealed that White patients and females were significantly more likely to report dysphagia, while non-White patients experienced significantly more vomiting symptoms and had a higher prevalence of asthma as a comorbidity. Early-onset patients exhibited a significantly higher rate of vomiting and had elevated eosinophilic counts compared to patients with EoE onset at a regular age. We also revealed that abdominal pain is associated with a lower average proximal eosinophilic counts. Conclusions: Our study revealed the significant impact of gender, race, and age of onset on the phenotype and comorbidities of EoE, suggesting these factors should be considered when caring for these patients.

Friends Not Foes: Optimizing Collaboration with Subspecialists.

Pediatric orthopedic patients can be complex to manage. As orthopedists plan for possible surgical interventions, consultation with pediatric subspecialists will be necessary. This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation-both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal format will facilitate quality and expedite the patient's care.

Clinical Management of Infant Anaphylaxis.

Anaphylaxis is a condition that is likely increasing in prevalence and commonly treated by allergists as well as other first responders and emergency room providers. Although a relatively rare event, anaphylaxis can occur in infants, with the most common cause attributed to foods. Infant anaphylaxis can present with unique diagnostic challenges and treatment considerations. While infants can present with classic signs and symptoms of anaphylaxis (eg, urticaria, angioedema, dyspnea, wheeze, and vomiting) they can also present with non-classical signs. Non-classical signs of infant anaphylaxis can include ear pulling, tongue thrusting, fussiness, and increase clinginess to the caregiver. These non-classic signs of infant anaphylaxis can often mimic normal infant behavior further complicating the diagnosis. Additionally, when treating infant anaphylaxis, there are special considerations regarding the use of epinephrine. These include determining appropriate needle length, dosages appropriate to administer depending on the weight of the infant, and the availability of different epinephrine auto-injectors. In this article, we aim to review the clinical management of infant anaphylaxis including diagnosis, recognition, treatment, strategies for follow-up and special considerations regarding epinephrine administration in this demographics.

Scribes, EHRs, and Workflow Efficiencies in Allergy Practices.

PURPOSE OF REVIEW: In the ever-changing healthcare system, along with new advancements in the field of allergy, the workflow for the allergist continues to evolve requiring more time spent doing non-clinical duties such as documentation and reviewing reimbursement challenges in the midst of busy clinics. The use of electronic medical records and medical scribes has emerged as tactics to aid the clinic's workflow and efficiency in the modern allergy and immunology clinic. RECENT FINDINGS: The practicing allergist can implement various additional strategies in their office workflow to maximize and synthesize good medicine and good business. Optimal use of office staff, electronic health records, and various workflow efficiencies has been shown to improve job satisfaction and reduce physician burnout. By utilizing these methods and integrating them into their practices, allergists will be able to meet the demands of the healthcare system and still provide patients with evidence based, compassionate, and cost-effective care.