Strategies to identify and prevent penicillin allergy mislabeling and appropriately de-label patients.

Taking a good drug allergy history is critical, followed by removing the "penicillin-allergic" label in certain low-risk patients and referring for testing those at high risk.

A Novel Mutation in Chronic Granulomatous Disease: Treating the Family, Not Just the Patient.

Chronic Granulomatous Disease (CGD) is caused by genetic defects in the phagocyte NADPH oxidase leading to potentially severe infections with catalase positive micro-organisms. With the innate immune system being affected this disease usually presents before the age of 5 years with infections involving the skin, lung, liver or lymphnodes. Infections with specific catalase positive organisms, especially Burkholderia cepacia, Serratia, Nocardia and Chromobacterium violaceum prompt a workup for CGD in affected patients. In addition, a family history of CGD also warrants testing. The pattern of inheritance of CGD varies across geographic regions of the world and societies, with X-linked inheritance being most prevalent in the United States and Europe. Affected patients require life-long therapy with prophylactic antibiotics, antifungals, and possibly interferon-gamma. Hematopoietic Stem Cell Transplantation is the only curative therapy known to date. Identification, diagnosis and management of patients with CGD usually involves a multi-specialty team including Pediatrics, Immunology, Infectious Diseases, Hematology/Oncology and often also Pulmonology and GI/Hepatology. Frequent follow up is paramount for good outcomes; infections have to be recognized and treated promptly and often preemptively. This is challenging for most patients and their families but presents a significant barrier for patients with limited access to care, limited resources or other challenging social situations. This case report describes the difficulties of managing a family with a novel mutation and multiple affected family members in different custody arrangements. It highlights the importance of close contact and communication with the family in deciding on management and treatment options. Educating the family and patient is critical to avoid complications of the disease and allow shared decision making that ultimately leads to better outcomes.

Generalized rash and pruritus in a 58-year-old woman.

Although allergists often evaluate rashes associated with allergic, IgE mediated etiologies, it is important to consider a wide range of differential diagnoses that includes inflammatory, infectious, and autoimmune etiologies. The case of a 58-year-old woman with a 1-year history of progressive pruritic rash that did not improve with topical creams and steroids is presented. The patient did not state any other symptoms, and a physical examination was notable for a widespread rash. After a detailed evaluation of the rash, a differential diagnosis was made, and results of a skin biopsy confirmed a specific diagnosis. Even in the context of a medical history of atopy, one must consider nonallergic causes of rash, including abnormal presentations of systemic conditions. It is important to determine the specific etiology of the rash because this will dictate treatment and prognosis and/or complications of the disease associated with the skin manifestations.

Report of Sugar-Sweetened Beverages Offered in Pennsylvania Childcare Centers.

The study objective was to quantify sugar-sweetened beverage (SSB) offerings to children in Pennsylvania (PA) childcare centers and determine whether this information is communicated to parents. In October 2014, a SurveyMonkey link was sent to 4461 PA childcare centers. The 518 respondents represented 88% of PA counties. 279 centers (54%) serve SSBs. 330 (65%) of childcare centers provide parents a report of their child's daily intake. Of 185 centers serving SSBs and providing a daily intake report, 91% include SSB consumption. In total, 38% of centers (103/272) offer but do not report SSB consumption. In 96% of centers, parents may request their child not receive SSBs. In conclusion, though more than half of PA childcare centers surveyed offer SSBs, those providing daily intake reports usually include SSB consumption. Requiring daily intake reports may be a strategy to increase parental awareness of items consumed outside the home.