The 80th anniversary of Annals of Allergy, Asthma & Immunology (1943-2023).

The year 2023 marks the 80th year of publication of Annals of Allergy, Asthma & Immunology. To celebrate this important milestone, we look back on the history of the journal from its inception to the present day. This special article explores the rationale and people involved in creating the journal and highlights major advances in Annals history. Our celebration of Annals' 80th year of publication concludes with a glimpse into the potential future of Annals.

Practical Challenges and Considerations for Early Introduction of Potential Food Allergens for Prevention of Food Allergy.

Recent randomized controlled trials aimed at the prevention of food allergy have led to sweeping changes in food allergy prevention guidelines. Emphasis is now on the introduction of potential food allergens, particularly peanut and egg, rather than avoidance. Although guidelines recommend against delaying the introduction of other potential allergens, there remains little or no evidence of the benefit of their early introduction. Parents and physicians alike report a need for greater guidance and resources on early potential allergen introduction in the complementary feeding period. A thorough understanding of early introduction literature, current prevention guidelines, and infant nutrition will empower physicians to address patient needs and concerns both when advice is established as effective and where uncertainty remains. We discuss the state of the science, compare recommendations between guidelines, and provide practical options to introduce allergenic foods, alongside other complementary foods, within the first year of life. We include a review of the available literature, including review and suggestions of potential doses of food allergens, and the first published comparison of commercially available products and homemade early introduction foods to help clinicians support their patients. We address the nutritional, dietary, and practical considerations of introducing food allergens in the first year of life while adhering to infant feeding guidelines. Finally, given the limitations of existing guidelines, we review the need for shared decision-making between physicians and parents regarding early allergen introduction.

Use of emergency backup resources during open food challenges at a pediatric tertiary care center.

Background: Oral food challenge (OFC) remains the criterion standard diagnostic procedure for food allergy. Although the need for OFCs has increased, some allergists may not perform them due to the risk for adverse events and lack of backup resources. Objective: The study aimed to elucidate the frequency of reactions in which emergency backup resources were used and reported on various challenge outcomes at a tertiary pediatric hospital. Methods: We retrospectively reviewed children and young adults (ages, 0-21 years) who completed OFCs in 2013-2018 at Cleveland Clinic Children's Hospital. Demographics, atopic history, culprit food, reaction history, and diagnostic testing as well as challenge details and outcomes were collected and analyzed. Results: A total of 1269 challenges of 812 unique patients ages 5 months to 21 years were reviewed. More than half of challenges were performed in patients with a history of a reaction and positive testing result before challenge. The foods with the highest proportion of allergic outcomes were egg, sesame, and baked egg. More than one-third of challenge reactions were grade 3 or 4 anaphylaxis when using a food-induced anaphylaxis grading scale. Epinephrine was used for reactions in 7.2% of all challenges. Reactions in five challenges (0.4%) prompted utilization of backup emergency resources. Conclusion: On review of nearly 1300 OFCs, emergency backup resources were rarely used, despite a large proportion of moderate-to-severe reactions. The need for backup resources during food challenges is rare, which suggests that most typical allergy offices are able to treat OFC reactions.

Moving Past "Avoid All Nuts": Individualizing Management of Children with Peanut/Tree Nut Allergies.

It has been common practice to tell patients with allergy to peanut or tree nuts to avoid all nuts. Evidence that unnecessary avoidance of peanuts and eggs is associated with increased risk for developing anaphylaxis to those foods has changed how allergists view previous recommendations to avoid foods that have not caused a reaction. In the absence of evidence, collaborative decision making between clinicians and families should be used to decide whether to avoid tree nuts and how to safely introduce tree nuts into the diet. This article discusses the options for introducing tree nuts to children with peanut allergy.

YouTube and food allergy: An appraisal of the educational quality of information.

BACKGROUND: Food allergy affects an estimated 8% of children and 3% of adults in the United States. Food-allergic individuals increasingly use the web for medical information. We sought to determine the educational quality of food allergy YouTube videos. METHODS: We performed a YouTube search using keywords "food allergy" and "food allergies". The 300 most viewed videos were included and analyzed for characteristics, source, and content. Source was further classified as healthcare provider, alternative medicine provider, patient, company, media, and professional society. A scoring system (FA-DQS) was created to evaluate quality (-10 to +34 points). Negative points were assigned for misleading information. Eight reviewers scored each video independently. RESULTS: Three hundred videos were analyzed, with a median of 6351.50 views, 19 likes, and 1 dislike. More video presenters were female (54.3%). The most common type of video source was alternative medicine provider (26.3%). Alternative treatments included the following: water fast, juicing, Ayurveda, apple cider, yoga, visualization, and sea moss. Controversial diagnostics included kinesiology, IgG testing, and pulse test. Almost half of the videos depicted a non-IgE-mediated reaction (49.0%).Videos by professional societies had the highest FA-DQS (7.27). Scores for videos by professional societies were significantly different from other sources (P < .001). There was a high degree of agreement among reviewers (ICC = 0.820; P < .001). CONCLUSION: YouTube videos on food allergy frequently recommend controversial diagnostics and commonly depict non-IgE-mediated reactions. There is a need for high-quality, evidence-based, educational videos on food allergy.

What is new in managing patients with food allergy? Almost everything.

PURPOSE OF REVIEW: This review aims to describe current concepts in managing patients with food allergy. There have been many recent advances in the management of patients with IgE-mediated reactions to food, including diagnosis, prevention, management, and ongoing research in the field. Food allergy is increasing in prevalence and may be life threatening. This review aims to highlight changes in recommended practice when diagnosing and managing patients with food allergy. RECENT FINDINGS: Early introduction of highly allergenic foods, particularly peanut, has been shown to decrease the risk for development of food allergy in patients who are at elevated risk. Avoidance of foods without a clinical history of food allergy may increase the risk of subsequent allergy. Epinephrine remains the first line therapy for anaphylaxis, and patients and families need to be instructed on indications and technique for use. Promising research is ongoing in areas of immunotherapy to food allergens. SUMMARY: Food allergy is a potentially life-threatening condition that may persist throughout adulthood. Practitioners should be aware of changes to recommendations for the diagnosis, prevention, and management of patients with food allergy.

Nannies' knowledge, attitude, and management of food allergies of children: an online survey.

BACKGROUND: Rates of food allergies in children as well as the rate of families who employ nannies have increased dramatically over the past decade. It is essential that nannies have the knowledge and tools necessary to recognize and treat food allergy reactions. OBJECTIVE: To identify gaps in knowledge in the nanny population with regard to food allergy in children. METHODS: A Web-based survey was sent by e-mail to 709 nannies. RESULTS: A total of 153 nannies (22%) completed the online survey: 26% of respondents had formal educational training at a nanny school; 99% recognized food allergy as a potentially fatal event; 37% reported caring for a child with food allergies. Of these, 71% had food allergy action plans, and 63% had epinephrine available. A total of 71% reported training on administering epinephrine. The nannies' major concerns included accidental ingestion and discomfort in administering epinephrine. A total of 36% were uncomfortable with recognizing a food allergy emergency, whereas 46% were uncomfortable administering epinephrine; 6% thought that a sensitized child could safely eat a small amount of allergenic food, whereas 14% believed that dilution with water might reduce an allergic reaction. A total of 66% desired additional information about recognizing food allergies, and 71% agreed that food allergy training should be required for all nannies. CONCLUSION: Nannies demonstrated gaps in knowledge with regard to food allergy in children, which reflects the need for more stringent training and education. Increased communication among parents, nannies, and physicians is needed to protect children with food allergy.

Nonallergic rhinitis: common problem, chronic symptoms.

Nonallergic rhinitis can significantly affect a patient's quality of life. It is difficult to distinguish from allergic rhinitis, but it has different triggers, and its response to treatment can vary. We review its differential diagnosis, causes, and treatment.

Physician work intensity among medical specialties: emerging evidence on its magnitude and composition.

BACKGROUND: Similarities and differences in physician work intensity among specialties are poorly understood but have implications for quality of care, patient safety, practice organization and management, and payment. OBJECTIVE: To determine the magnitude and important dimensions of physician work intensity for 4 specialties. RESEARCH DESIGN: Cross-sectional assessment of work intensity associated with actual patient care in the examination room or operating room. SUBJECTS: A convenience sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons, located in Kansas, Kentucky, Maryland, Ohio, and Virginia. MEASURES: Work intensity measures included the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Subjective Work Assessment Technique (SWAT), and Multiple Resource Questionnaire. Stress was measured by the Dundee Stress State Questionnaire. RESULTS: Physicians reported similar magnitude of work intensity on the NASA-TLX and Multiple Resource Questionnaire. On the SWAT, general internists reported work intensity similar to surgeons but significantly lower than family physicians and neurologists (P=0.035). Surgeons reported significantly higher levels of task engagement on the stress measure than the other specialties (P=0.019), significantly higher intensity on physical demand (P < 0.001), and significantly lower intensity on the performance dimensions of the NASA-TLX than the other specialties (P=0.003). Surgeons reported the lowest intensity for temporal demand of all specialties, being significantly lower than either family physicians or neurologists (P=0.014). Family physicians reported the highest intensity on the time dimension of the SWAT, being significantly higher than either general internists or surgeons (P=0.008). CONCLUSIONS: Level of physician work intensity seems to be similar among specialties.

Temporal and subjective work demands in office-based patient care: an exploration of the dimensions of physician work intensity.

BACKGROUND: Physician work intensity (WI) during office-based patient care affects quality of care and patient safety as well as physician job-satisfaction and reimbursement. Existing, brief work intensity measures have been used in physician studies, but their validity in clinical settings has not been established. OBJECTIVES: Document and describe subjective and temporal WI dimensions for physicians in office-based clinical settings. Examine these in relation to the measurement procedures and dimensions of the SWAT and NASA-TLX intensity measures. DESIGN: A focused ethnographic study using interviews and direct observations. PARTICIPANTS: Five family physicians, 5 general internists, 5 neurologists, and 4 surgeons. METHODS: Through interviews, each physician was asked to describe low and high intensity work responsibilities, patients, and events. To document time and task allotments, physicians were observed during a routine workday. Notes and transcripts were analyzed using the editing method in which categories are obtained from the data. RESULTS: WI factors identified by physicians matched dimensions assessed by standard, generic instruments of work intensity. Physicians also reported WI factors outside of the direct patient encounter. Across specialties, physician time spent in direct contact with patients averaged 61% for office-based services. CONCLUSIONS: Brief work intensity measures such as the SWAT and NASA-TLX can be used to assess WI in the office-based clinical setting. However, because these measures define the physician work "task" in terms of effort in the presence of the patient (ie, intraservice time), substantial physician effort dedicated to pre- and postservice activities is not captured.

Haddad syndrome: a case of an infant with central congenital hypoventilation syndrome and Hirschsprung disease.

This report presents an otherwise healthy infant who developed unexplained apnea and long-segment Hirschsprung disease. After extensive evaluation that included a paired-like homeobox 2b gene (PHOX2B) analysis, he was found to have Haddad syndrome, a congenital disorder that features central congenital hypoventilation syndrome in conjunction with Haddad syndrome. Recent work has associated polyalanine repeats within the PHOX2B gene on chromosome 4p12 with central congenital hypoventilation syndrome, whereas PHOX2B knockout mice develop aganglionic bowels.