Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians.

OBJECTIVE: To characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce. STUDY DESIGN: Pediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines. RESULTS: A total of 250 pediatricians, 250 family physicians, 504 APPs, and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis. CONCLUSIONS: Although pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices.

Food allergen panel testing often results in misdiagnosis of food allergy.

OBJECTIVE: To determine the utility of food allergy panel testing among patients referred to a pediatric food allergy center. STUDY DESIGN: Retrospective chart review of all new patients seen between September 2011 and December 2012 by 1 provider in a tertiary referral pediatric food allergy center. A cost analysis was performed to calculate the estimated cost of evaluation for patients who have received a food allergy panel. RESULTS: Of 797 new patient encounters, 284 (35%) patients had received a food allergy panel. Only 90 (32.8%) individuals had a history warranting evaluation for food allergy; 126 individuals were avoiding a food based on recommendations from the referring provider and 112 (88.9%) were able to re-introduce at least 1 food into their diet. The positive predictive value of food allergy panel testing in this unselected population was 2.2%. The estimated cost of evaluation for this population was $79,412. CONCLUSIONS: Food allergy panel testing often results in misdiagnosis of food allergy, overly restrictive dietary avoidance, and an unnecessary economic burden on the health system.

Prevalence of overweight, obesity and underweight among 5-year-old children in Saint Lucia by three methods of classification and a comparison with historical rates.

BACKGROUND: The study aimed to determine if child obesity rates have risen in the Caribbean nation of Saint Lucia, as found globally, and whether under-nutrition coexists, as in other developing nations. The average adult in Saint Lucia is overweight, thus considerable child obesity might be expected, but there are no current data. METHODS: Heights and weights were obtained from a sample (n= 425) of the 2001 birth cohort of Saint Lucian children measured during the nation-wide 2006/2007 Prior to School Entry Five-Year Assessment. Prevalence of overweight, obesity and underweight were estimated by Centers for Disease Control (CDC), Cole et al. and new World Health Organization (WHO) methods. Previously reported 1976 estimates, including children ≤60 months of age only, based on National Centre for Health Statistics curves, were adjusted to new WHO equivalents using an algorithm developed by Yang and de Onis, and compared with rates in our subsample of children ≤60 months of age (n= 99). RESULTS: Regardless of classification method, overweight and obesity rates were high: 14.4% and 9.2% (WHO); 11.3% and 12.0% (CDC); and 9.9% and 7.1% (Cole et al.), respectively. Underweight estimates also varied: 4.7% (WHO); 11.3% (CDC) and 6.6% (Cole et al.). Obesity in our young subsample (15.2%; WHO) was more than 3 times the adjusted 1976 rate (4.3%). CONCLUSIONS: Obesity among Saint Lucian pre-schoolers has tripled in 30 years. Our findings also suggest that this country, like many undergoing a 'nutrition transition', faces the dual challenge of over-nutrition and under-nutrition. Routine monitoring of overweight and underweight is needed in Saint Lucia, as is the implementation and evaluation of programmes to address these problems.

Molecular Characterization of Rhynchosia mosaic virus-Puerto Rico Associated with Symptomatic Rhynchosia minima and Cajanus cajan in Puerto Rico.

A begomovirus (family Geminiviridae) has long been suspected to be associated with Rhynchosia mosaic (RhM) disease of Rhynchosia minima (L.) DC., a weed that is widespread in Puerto Rico (PR). The suspect virus has been transmitted by the Sida biotype of Bemisia tabaci (Genn.) and has been designated RhM virus-PR (RhMV-PR) (1) (synonym, Rhynchosia mosaic virus [RMV]). RhM symptoms in R. minima included yellow foliar mosaic and stunting. The virus has a broad experimental host range and infects species in the Fabaceae, including R. minima, pigeon pea (Cajanus cajan (L.) Millsp.), and Clitoria falcata L. (1). However, until now RhMV has not been identified from naturally infected pigeon pea or Clitoria falcata. R. minima and C. cajan plants exhibiting yellow foliar mosaic and stunting symptoms were collected in Puerto Rico. Using the B biotype of B. tabaci as the vector, their whitefly transmissibility from the respective source plant to R. minima and C. cajan test plants was confirmed, and symptoms in inoculated host were indistinguishable for both isolates. Using polymerase chain reaction (PCR) and primers (2), three amplicons were obtained and cloned for each isolate. PCR products (1.1 and 2.1 kbp) were assembled (~200 nucleotide [nt] overlap) to yield an apparent full-length DNA A component (~2.6 kbp) containing the diagnostically informative viral coat protein gene (CP) and common region (CR-A). PCR primers were used to amplify the DNA B component segment (0.7 kbp) containing the CR-B (2). The DNA sequence for the core CP (533 nt) and full CP (750 nt) were compared with analogous sequences for well-studied begomoviruses, and CR-A and CR-B (153 nt) were compared for RhMV isolates. All isolates noted were obtained from GenBank. The core CP for isolates from R. minima (AF442117) and C. cajan (AY062025) shared 97.9% nucleotide identity (100% AA similarity) and the CR-A (AF442118) and CR-B (AF442119) sequences for R. minima and C. cajan isolates were ~96% identical, indicating the A and B components are of the same begomovirus. Comparison of the core CP sequence for an independent isolate from C. cajan from PR (AY028308) (4) with those for R. minima and C. cajan isolates indicated 95.5% (99.4% AA) and 96.2% (99.4% AA) nucleotide identity, respectively, indicating association of RhMV with both C. cajan samples. The recently archived core CP (533 nt) (AY028308) is actually of RhMV-PR, rather than a distinct begomovirus species, as indicated (4). Interestingly, the core CP of R. minima (AF442117) and C. cajan (AY062025) isolates were 91.7% (98.9% AA) and 92.3% (98.9% AA) identical, respectively, with a PR isolate from Clitoria falcata (AF070924), also confirming that RhMV-PR naturally infects Clitoria falcata. Analysis of the full CP for the R. minima and C. cajan isolates revealed that their closest relatives were Macroptilium mosaic virus (MaMV-PR) (AF176092) and Bean golden mosaic virus (BGMV-PR) (M10070) at 89 and 84% nucleotide identity, respectively. Applying the 90% CP rule (3) to RhMV CP sequences, RhMV is a distinct begomovirus species. At least three begomoviruses, BGMV-PR, MaMV-PR, and RhMV-PR, naturally infect leguminous species in Puerto Rico. References: (1) J. Bird. Phytopathology 52:286, 1962. (2) A. M. Idris and J. K. Brown. Phytopathology 88:648, 1998. (3) M. A. Mayo and C. R. Pringle. J. Gen. Virol. 79:649, 1998. (4) R. L. Rodriguez et al. Plant Dis. 85:1119, 2001.

Introduction of the Exotic Tomato yellow leaf curl virus-Israel in Tomato to Puerto Rico.

Thirty-five-day-old tomato plants (cultivar Florasette) exhibited yellow leaf curling, stunting, and extremely reduced fruit set in spring 2001, in Guanica, Puerto Rico (PR). Twenty percent disease incidence was observed in this field and, 8 weeks later, 75% of the plants showed symptoms. These symptoms were distinct from those caused by other tomato-infecting begomoviruses reported previously from PR, namely Merremia mosaic virus, Tomato mottle virus (ToMoV), and Potato yellow mosaic virus (1). A colony of the B biotype of Bemisia tabaci (Genn.) was used to transmit the suspect virus from symptomatic plants collected in the field and established in the greenhouse in Rio Piedras, PR. The suspect virus was transmitted readily to tomato cultivar Roma (10 of 10 plants), and symptoms were like those observed in the field. Symptoms also were reminiscent of those described for several Old World begomoviruses, referred to as Tomato yellow leaf curl virus (TYLCV). Total nucleic acids were isolated from three symptomatic field samples and three greenhouse-inoculated tomato plants showing typical disease symptoms. Extracts were analyzed by polymerase chain reaction (PCR) with primers AV2466 and AC1145 to amplify a begomoviral fragment (approximately 1.1 bp) that contains a portion of the intergenic region and the viral coat protein gene (CP) (2). Amplicons were cloned, and their nucleotide sequences were determined. A comparison of CP with other well-studied begomoviral nucleotide sequences revealed that the CP sequences for field isolates 1 to 6 shared 99.7 to 100% identity with each other and 99.9 to 100% identity with TYLCV from Israel (TYLCV-IL; accession no. X76319) as well as TYLCV-IL isolates discovered in the Dominican Republic (DO; accession no. AF024715) and, subsequently, in Florida. TYLCV-specific PCR primers (forward) 5'-GAATTCCGCCTTTAA-TTTG-3' and (reverse) 5'-GAATTCCCACTATCTTTCTC-3' were used to amplify the complete viral genome form a PR field isolate. An expected-sized amplicon of approximately 2.8 kb was obtained, and the nucleotide sequence of two cloned amplicons was determined. Genome organization revealed a predicted precoat open reading frame of 351 bp, which is characteristic of other Old World begomoviruses, including TYLCV-IL. Nucleotide comparisons indicated that the PR isolate shared 99% nucleotide sequence identity with TYLCV-IL (first reported from Israel) and introduced TYLCV-IL isolates in DO and Florida, thereby confirming the introduction of TYLCV-IL into PR. TYLCV-IL was first identified several years ago in the Western Hemisphere, and the virus has been reported in five offshore locations and three continental U.S. states since its initial introduction into the DO in the early 1990s. Considering the extreme virulence of TYLCV-IL compared with most New World tomato-infecting begomoviruses, this introduction, which likely occurred from a nearby Caribbean country or Florida, has the potential to destroy the fresh-market tomato industry in PR, which supplies tomatoes to the continental United States during the winter months. There is compelling evidence for the routine movement of tomato seedlings from the continental United States to this location in PR throughout the last 10 years, including the previous introduction of ToMoV (1). These incidences and others indicate the need for those in infected areas to take precautions to avoid further spread of this highly damaging virus in and adjacent to the Caribbean region. References: (1) A. M. Idris et al. Phytopathology 88:S42, 1998. (2) A. M. Idris and J. K. Brown, Phytopathology 88:648, 1998.

First Report of a Bean-Infecting Begomovirus from Macroptilium lathyroides in Puerto Rico That Is Distinct from Bean Golden Mosaic Virus.

Bean golden mosaic begomovirus (BGMV) was long suspected to cause bright yellow mosaic symptoms in Macroptilium lathyroides (L.), a weed common to Puerto Rico. M. lathyroides plants exhibiting bright yellow mosaic symptoms were collected from Puerto Rico during 1994 to 1999, and the biotic and molecular characteristics of the suspect begomovirus were determined. Symptoms in M. lathyroides, indistinguishable from those observed in field-infected plants, were reproducible by whitefly transmission (Bemisia tabaci type B) and biolistic inoculation of leaf extracts (1). In bean, Phaseolus vulgaris (L.) 'Topcrop,' the M. lathyroides virus caused green-yellow mosaic foliar symptoms and stunting, reminiscent of symptoms caused by BGMV from Puerto Rico (BGMV-PR). However, biolistic- or whitefly-mediated inoculation of M. lathyroides with BGMV-PR resulted in no discernible infection. Sequence analysis (2) of the coat protein (CP) gene (AF176092) and common region of the A (CR-A) (AF176093) and B (CR-B) (AF176094) components of the virus from M. lathyroides indicated that these sequences shared only 77.3 to 79.3% and 62.4 to 68.8% identity, respectively, with BGMV from the Dominican Republic, Honduras, Guatemala, Jamaica (JAM), and PR. Alignment of the M. lathyroides virus CP sequence with other well-studied begomoviruses indicate its closest relative is BGMV-PR (82%) and that it shares less than 73% identity with partial CP sequences of Macroptilium golden mosaic virus-JAM (AF089839, AF089840). The directly repeated CR sequences of the M. lathyroides virus, putatively involved in AC1 binding, are TGGTGACTGGTG and are distinct from TGGAGACTGGAG, the analogous direct repeat in BGMV-PR. We provisionally designate the new, previously undescribed begomovirus species from M. lathyroides, Macroptilium mosaic virus (MaMV). Results indicate MaMV-PR and BGMV are distinct, bean-infecting begomoviruses from the Caribbean and that MaMV-PR may pose a new threat to bean production, particularly where the type B vector is established. References: (1) J. K. Brown and R. Ryan. Phytopathology 81:1217, 1991; (2) A. M. Idris and J. K. Brown. Phytopathology 88:648, 1998.

Characterization and distribution of esterase electromorphs in the whitefly, Bemisia tabaci (Genn.) (Homoptera: Aleyrodidae).

Esterase profiles were examined for over 40 populations of the whitefly, Bemisia tabaci, obtained from native and cultivated plant hosts worldwide. Twelve unique electromorphs were identified from distinct populations concentrated largely in Central America, Africa, and India. One electromorph, type B, has recently been proposed as a separated species, Bemisia argentifolii, and has recently spread throughout much of the world. When considered with evidence from mating studies and the ability to induce phytotoxic disorders (squash silverleaf disorder), our data suggest that the single taxon Bemisia tabaci may actually represent a species complex.

Dentition of Chilean paleo-Indians and peopling of the Americas.

Teeth of 12 cremated paleo-Indians (11,000 years old) from caves in southern Chile have crown and root morphology like that of recent American Indians and north Asians, but unlike that of Europeans. This finding supports the view that American Indians originated in northeast Asia. This dental series also suggests that paleo-Indians could easily have been ancestral to most living Indians, that very little dental evolution has occurred, and that the founding paleo-Indian population was small, genetically homogeneous, and arrived late in the Pleistocene.