Publications by authors named "Christopher Warren"

172 Publications

Assessment of Allergic and Anaphylactic Reactions to mRNA COVID-19 Vaccines With Confirmatory Testing in a US Regional Health System.

JAMA Netw Open 2021 Sep 1;4(9):e2125524. Epub 2021 Sep 1.

Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California.

Importance: As of May 2021, more than 32 million cases of COVID-19 have been confirmed in the United States, resulting in more than 615 000 deaths. Anaphylactic reactions associated with the Food and Drug Administration (FDA)-authorized mRNA COVID-19 vaccines have been reported.

Objective: To characterize the immunologic mechanisms underlying allergic reactions to these vaccines.

Design, Setting, And Participants: This case series included 22 patients with suspected allergic reactions to mRNA COVID-19 vaccines between December 18, 2020, and January 27, 2021, at a large regional health care network. Participants were individuals who received at least 1 of the following International Statistical Classification of Diseases and Related Health Problems, Tenth Revision anaphylaxis codes: T78.2XXA, T80.52XA, T78.2XXD, or E949.9, with documentation of COVID-19 vaccination. Suspected allergy cases were identified and invited for follow-up allergy testing.

Exposures: FDA-authorized mRNA COVID-19 vaccines.

Main Outcomes And Measures: Allergic reactions were graded using standard definitions, including Brighton criteria. Skin prick testing was conducted to polyethylene glycol (PEG) and polysorbate 80 (P80). Histamine (1 mg/mL) and filtered saline (negative control) were used for internal validation. Basophil activation testing after stimulation for 30 minutes at 37 °C was also conducted. Concentrations of immunoglobulin (Ig) G and IgE antibodies to PEG were obtained to determine possible mechanisms.

Results: Of 22 patients (20 [91%] women; mean [SD] age, 40.9 [10.3] years; 15 [68%] with clinical allergy history), 17 (77%) met Brighton anaphylaxis criteria. All reactions fully resolved. Of patients who underwent skin prick tests, 0 of 11 tested positive to PEG, 0 of 11 tested positive to P80, and 1 of 10 (10%) tested positive to the same brand of mRNA vaccine used to vaccinate that individual. Among these same participants, 10 of 11 (91%) had positive basophil activation test results to PEG and 11 of 11 (100%) had positive basophil activation test results to their administered mRNA vaccine. No PEG IgE was detected; instead, PEG IgG was found in tested individuals who had an allergy to the vaccine.

Conclusions And Relevance: Based on this case series, women and those with a history of allergic reactions appear at have an elevated risk of mRNA vaccine allergy. Immunological testing suggests non-IgE-mediated immune responses to PEG may be responsible in most individuals.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.25524DOI Listing
September 2021

Ethnicity-Based Disparities in Immune-Mediated Diseases-Time for Action!

Mayo Clin Proc 2021 Aug 31. Epub 2021 Aug 31.

Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, IL; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.

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http://dx.doi.org/10.1016/j.mayocp.2021.05.024DOI Listing
August 2021

Access to Allergen-Free Food Among Black and White Children with Food Allergy in the FORWARD Study.

J Allergy Clin Immunol Pract 2021 Aug 19. Epub 2021 Aug 19.

Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.

Background: Racial differences in access to allergen-free food have not been fully described among children with food allergy (FA).

Objective: To examine access to allergen-free foods among Black and White children with FA.

Methods: Black and White children with FA were enrolled in Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD), a multisite prospective cohort study at 4 urban US centers. Caregivers completed questionnaires regarding access to allergen-free foods. Univariable statistics described demographics. Bivariable statistics evaluated crude associations with access to allergen-free foods. Multivariable logistic regression evaluated the adjusted effect of race on access to allergen-free foods. Geospatial analyses examined the distribution of race, socioeconomic status, and food desert residence.

Results: Among participants (n = 336), White caregivers (88.1%) were more likely to report access to allergen-free foods than Black caregivers (59%) (P < .001). White caregivers were more likely to purchase allergen-free foods online (35.2%) than Black caregivers (12%) (P < .001). Although Black children were more likely to live in a food desert, access to allergen-free food was not related to food desert residence. In the unadjusted analysis, White children were 5.2 times as likely to have access than Black children (P < .001); after adjusting for demographics, this increase in access was no longer significant (P = .08). Other predictors of access to allergen-free foods included online food purchasing, annual household income, respondent education level, milk allergy, and child age >5 years.

Conclusion: In the FORWARD cohort, Black children have less access to allergen-free foods than White children, but much of the difference is accounted for by socioeconomic status and other participant characteristics.
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http://dx.doi.org/10.1016/j.jaip.2021.08.005DOI Listing
August 2021

Impact of cyanosis on ventilatory responses during stair climb exercise in Eisenmenger syndrome and idiopathic pulmonary arterial hypertension.

Int J Cardiol 2021 Aug 18. Epub 2021 Aug 18.

Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London. Electronic address:

Studies assessing exercise ventilatory responses during real-life exercise in pulmonary arterial hypertension (PAH) which include patients with cyanotic congenital heart disease are scarce. We assessed the ventilatory response to stairclimbing in patients with idiopathic PAH (IPAH) and congenital heart disease-associated PAH with Eisenmenger (EIS) physiology compared to healthy controls. Fifteen adults with IPAH, six EIS and 15 age and body mass index (BMI) matched controls were prospectively recruited. Participants completed spirometry and a self-paced stair-climb (48 steps) with portable cardiopulmonary exercise testing (CPET) equipment in-situ. Borg dyspnoea scores were measured at rest and on stair-climb cessation. Both IPAH and EIS groups had amplified ventilatory responses compared to Controls. The rate of increase in minute ventilation (VE) was exaggerated in EIS driven by an early increase in tidal volume (Tv) and more gradual increase in respiratory rate (RR). Peak Tv, RR, Tv: forced vital capacity (FVC) ratio, VE/VCO slope and stairclimb duration were significantly higher in EIS and IPAH compared to controls despite similar baseline spirometry and change in oxygen uptake on exercise. A decline in end-tidal carbon dioxide (CO) and arterial oxygen saturations in early exercise distinguished EIS and IPAH patients. Significant correlations were observed between peak exercise Borg score and stair-climb time (r = 0.73, p = 0.002), peak end-tidal CO (r = -0.73, p = 0.001), peak VE (r = 0.53, p = 0.008), peak RR (r = 0.42, p = 0.011) and VE/VCO slope (r = 0.54, p = 0.001). Patients with IPAH and EIS have exaggerated ventilatory responses to stair-climbing compared to the controls with more severe levels of dyspnoea perception in Eisenmenger syndrome for equivalent oxygen uptake and work.
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http://dx.doi.org/10.1016/j.ijcard.2021.08.020DOI Listing
August 2021

Multivariate pattern analysis of electroencephalography data reveals information predictive of charitable giving.

Neuroimage 2021 Nov 14;242:118475. Epub 2021 Aug 14.

Emma Eccles Jones College of Education and Human Services, Utah State University, United States.

Charitable donations are an altruistic behavior whereby individuals donate money or other resources to benefit others while the recipient is normally absent from the context. Several psychological factors have been shown to influence charitable donations, including a cost-benefit analysis, the motivation to engage in altruistic behavior, and the perceived psychological benefits of donation. Recent work has identified the ventral medial prefrontal cortex (MPFC) for assigning value to options in social decision making tasks, with other regions involved in empathy and emotion contributing input to the value computation (e.g. Hare et al., 2010; Hutcherson et al., 2015; Tusche et al., 2016). Most impressively, multivariate pattern analysis (MVPA) has been applied to fMRI data to predict donation behavior on a trial-by-trial basis from ventral MPFC activity (Hare et al., 2010) while identifying the contribution of emotional processing in other regions to the value computation (e.g. Tusche et al., 2016). MVPA of EEG data may be able to provide further insight into the timing and scalp topography of neural activity related to both value computation and emotional effects on donation behavior. We examined the effect of incidental emotional states and the perceived urgency of the charitable cause on donation behavior using support vector regression on EEG data to predict donation amount on a trial by trial basis. We used positive, negative, and neutral pictures to induce incidental emotional states in participants before they made donation decisions concerning two types of charities. One category of charity was oriented toward saving people from current suffering, and the other was to prevent future suffering. Behaviorally, subjects donated more money in a negative emotional state relative to other emotional states, and more money to alleviate current over future suffering. The data-driven multivariate pattern analysis revealed that the electrophysiological activity elicited by both emotion-priming pictures and charity cues could predict the variation in donation magnitude on a trial-by-trial basis.
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http://dx.doi.org/10.1016/j.neuroimage.2021.118475DOI Listing
November 2021

Novel Topical Treatment for Dandruff & Dry Scalp Through Sustained Balance in Skin Microbiome.

Clin Cosmet Investig Dermatol 2021 24;14:945-947. Epub 2021 Jul 24.

Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, IL, USA.

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http://dx.doi.org/10.2147/CCID.S321238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318218PMC
July 2021

Oral Immunotherapy-Related Awareness, Attitudes, and Experiences Among a Nationally Representative Sample of Food Allergy Patients/Caregivers.

J Allergy Clin Immunol Pract 2021 Jul 29. Epub 2021 Jul 29.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Center for Food Allergy and Asthma Research, Chicago, Ill; Division of Advanced General Pediatrics and Primary Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. Electronic address:

Background: Advances in oral immunotherapy (OIT) have led to recently expanded treatment options for food allergy (FA) patients. However, to inform future outreach efforts and ensure equitable access to emerging treatments, a greater understanding of current OIT-related awareness, attitudes, and experiences is needed.

Objective: To characterize current OIT awareness, attitudes, and experiences among a nationally representative sample of U.S. adults with FA and parents/caregivers of pediatric patients.

Methods: A probability-based sample of U.S. adults and parents/caregivers of children with FA was surveyed about OIT-related knowledge, attitudes, and experiences.

Results: Surveys were completed by respondents (n = 781) from all 50 states. Overall, 72% did not know what OIT was prior to the survey. Respondents from households earning over $100,000 or with a college degree each had significantly greater odds of reporting any OIT awareness compared with lower-income (odds ratio 2.0; 95% confidence interval 1.2-3.4) and non-college-educated (odds ratio 1.9; 95% confidence interval 1.2-3.0) respondents. Among respondents familiar or unfamiliar with OIT, 54% and 34%, respectively, reported their expected treatment outcome was to obtain protection against accidental exposure. Among respondents familiar or unfamiliar with OIT, 38% and 35%, respectively, reported their expected treatment outcome to be curing the allergy. Furthermore, 55% of OIT unfamiliar respondents said they would not be comfortable initiating a conversation with their health care provider about their suitability for OIT.

Conclusions: This study shows that, among a nationally representative sample of FA patients and pediatric caregivers, awareness of OIT is low, and over 95% of patients lack personal experience with OIT. Furthermore, the data suggest current OIT awareness is disproportionately elevated among wealthier, more highly educated respondents.
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http://dx.doi.org/10.1016/j.jaip.2021.07.020DOI Listing
July 2021

Disparities in access to fertility care: who's in and who's out.

F S Rep 2021 Mar 18;2(1):109-117. Epub 2020 Nov 18.

Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Objective: To study the racial and socioeconomic characteristics of women seeking fertility care in a state with mandated insurance coverage for fertility testing and treatment.

Design: Cross-sectional, self-administered survey.

Setting: Academic fertility center in Illinois.

Patients: Of 5,000 consecutive fertility care patients, 1,460 completed the survey and were included in the study sample.

Interventions: None.

Main Outcome Measures: Details about demographic characteristics and health care access on the basis of patient race/ethnicity and socioeconomic status.

Results: The mean age of participants was 36.1 years; 75.5% were White, 10.2% Asian, 7.3% Black, 5.7% Latinx, and 1.3% Other. Most women had a bachelor's (35.5%) or master's degree (40.5%) and an annual household income of >$100,000 (81.5%). Black and Hispanic women traveled twice as far (median 10 miles) as White and Asian women (median 5 miles for both) for treatment. Black women (14.7%) were more likely to report that their race was a barrier to getting fertility treatment compared with White (0.0%), Hispanic (5.1%), and Asian (5.4%) women. Black and Hispanic women were approximately twice as likely to report income level (26.5% and 20.3%, respectively) and weight (7.8% and 8.9%, respectively) as barriers compared with White and Asian respondents.

Conclusions: Significant racial and socioeconomic disparities exist among fertility patients accessing care. Beyond providing all Americans with health insurance that covers fertility treatment, further research in the general population is needed to understand the complex social, cultural, racial, and economic factors that prohibit many individuals from accessing needed fertility care.
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http://dx.doi.org/10.1016/j.xfre.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244333PMC
March 2021

Disparities among infertility patients regarding genetic carrier screening, sex selection, and gene editing.

J Assist Reprod Genet 2021 Jun 25. Epub 2021 Jun 25.

Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Purpose: The purpose of this study is to evaluate the perspectives of infertility patients regarding genetic carrier screening, embryo sex selection, embryo research, and gene editing.

Methods: An anonymous 32-question survey was distributed electronically to all patients who seen at a single academic fertility center for at least one visit between June 2018 and September 2019. Survey questions evaluated patient perspectives on genetic carrier screening, embryo sex selection, embryo research, and gene editing.

Results: There were 1460 survey responses (32.0% response rate). There were significant differences in the proportion of respondents receiving genetic carrier screening between racial groups, 73.1% of White, 45.5% of Black, 49.4% of Hispanic, and 62.8% of Asian respondents. The likelihood of having genetic carrier screening was also significantly influenced by respondent income, insurance status, and religion. Religion significantly influenced the acceptance of embryonic research and embryonic sex selection. While only 8.9% felt that genetically modifying embryos for physical traits should be allowed, 74.1% felt that genetic modification to correct disease should be allowed.

Conclusion: Racial, religious, and socioeconomic factors significantly impacted respondents' likelihood to have genetic carrier screening and views on embryo sex selection, embryo research, and gene editing. These findings highlight the importance of tailoring genetic counseling to the individual, acknowledging individual and cultural differences in agreement with genetic testing and emerging genetic therapies.
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http://dx.doi.org/10.1007/s10815-021-02261-7DOI Listing
June 2021

An investigation of the effectiveness of vibration-reducing gloves for controlling vibration exposures during grinding handheld workpieces.

Appl Ergon 2021 Sep 12;95:103454. Epub 2021 May 12.

Health Effects Laboratory Division, National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV, 26505, USA.

Prolonged and intensive vibration exposures during the grinding of handheld workpieces may cause hand-arm vibration syndrome. The objectives of this study are to develop an on-the-hand method for evaluating vibration-reducing (VR) gloves, and to determine whether VR gloves can significantly reduce the vibration exposures. A worker holding and pressing a typical workpiece (golf club head) against a grinding wheel or belt in order to shape the workpiece was simulated, and the input vibration and those on the workpiece and hand-arm system were measured. Ten human subjects participated in the experiment. The results demonstrate that VR gloves significantly reduced the vibrations at the palm, hand dorsum, and wrist. The grinding interface condition and hand feed force did not substantially affect glove effectiveness. The use of gloves slightly increased the workpiece resonant response, but the resonant response did not significantly affect glove effectiveness. This study concluded that the use of VR gloves can help control vibration exposures of workers performing grinding of handheld workpieces.
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http://dx.doi.org/10.1016/j.apergo.2021.103454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262383PMC
September 2021

Predicting the natural development of peanut tolerance using longitudinal trajectories of peanut-specific serum IgE.

J Allergy Clin Immunol Pract 2021 Aug 26;9(8):3215-3217.e1. Epub 2021 Apr 26.

Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. Electronic address:

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http://dx.doi.org/10.1016/j.jaip.2021.04.030DOI Listing
August 2021

Caregiver Perceptions of Children's Psychological Well-being During the COVID-19 Pandemic.

JAMA Netw Open 2021 04 1;4(4):e2111103. Epub 2021 Apr 1.

Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Importance: Understanding youth well-being during the COVID-19 pandemic can help appropriately allocate resources and inform policies to support youth.

Objective: To examine caregiver-reported changes in the psychological well-being of their children 3 to 4 months after the start of COVID-19 stay-at-home orders, and to examine the association of caregiver-reported COVID-19 exposure and family stressors with caregiver perceptions of child psychological well-being.

Design, Setting, And Participants: This survey study used an anonymous survey distributed via email from June 24 to July 15, 2020, to 350 000 families of students attending public schools in Chicago, Illinois. The a priori hypotheses were that caregivers would report worsening in child psychological well-being during the closure period compared with preclosure and that exposure to COVID-19-related stressors would be associated with a higher probability of worsening child psychological well-being. Data were analyzed from September 10, 2020, to March 15, 2021.

Main Outcomes And Measures: Outcomes were 7 mental health concerns and 5 positive adjustment characteristics reported by caregivers using a retrospective pre-post design. COVID-19 exposure and family stressors were also reported by caregivers.

Results: Among 350 000 families invited to participate, 32 217 caregivers (10 827 [39.3%] White, 8320 [30.2%] Latinx, 6168 [22.4%] Black; 2223 [8.1%] with multiple or other races/ethnicities) completed the survey on behalf of 49 397 children in prekindergarten through 12th grade. Child-specific outcomes were reported for 40 723 to 40 852 children depending on the specific question. The frequency of caregiver endorsement of youth mental health concerns ranged from 0.1 percentage point (suicidal ideation or self-harm, reported by 191 caregivers [0.5%] preclosure vs 246 caregivers [0.6%] during closure; P < .001) to 28.3 percentage points (loneliness, reported by 1452 caregivers [3.6%] preclosure vs 13 019 caregivers [31.9%] during closure; P < .001) higher after the end of in-person instruction compared with preclosure. Frequency of caregiver endorsement of youth positive adjustment characteristics ranged from -13.4 percentage points (plans for the future, reported by 18 114 caregivers [44.3%] preclosure vs 12 601 caregivers [30.9%] during closure; P < .001) to -30.9 percentage points (positive peer relationships, reported by 24 666 caregivers [60.4%] preclosure vs 19 130 caregivers [46.8%] during closure; P < .001) lower after the end of in-person instruction. Significant differences in COVID-19 exposure were observed across racial/ethnic (F3,27 534 = 614.8; P < .001) and household income strata (F5,27 506 = 842.0; P < .001). After accounting for covariates, all mental health concerns increased in probability (eg, angry: odds ratio, 1.55 [95% CI, 1.48-1.62]; P < .001) and all the positive adjustment characteristics decreased in probability (eg, hopeful or positive: odds ratio, 0.88 [95% CI, 0.84-0.92]; P < .001) as COVID-19 exposure and family stressors increased.

Conclusions And Relevance: In this survey study of caregivers during the COVID-19 pandemic, COVID-19 and resulting exposure to stress were associated with worse youth psychological well-being, demonstrating the need for a comprehensive public health approach that prioritizes children's well-being and draws broad public attention to the mental health needs of youth.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.11103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085728PMC
April 2021

Fusing imperfect experimental data for risk assessment of musculoskeletal disorders in construction using canonical polyadic decomposition.

Autom Constr 2020 Nov;119

National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, United States of America.

Field or laboratory data collected for work-related musculoskeletal disorder (WMSD) risk assessment in construction often becomes unreliable as a large amount of data go missing due to technology-induced errors, instrument failures or sometimes at random. Missing data can adversely affect the assessment conclusions. This study proposes a method that applies Canonical Polyadic Decomposition (CPD) tensor decomposition to fuse multiple sparse risk-related datasets and fill in missing data by leveraging the correlation among multiple risk indicators within those datasets. Two knee WMSD risk-related datasets-3D knee rotation (kinematics) and electromyography (EMG) of five knee postural muscles-collected from previous studies were used for the validation and demonstration of the proposed method. The analysis results revealed that for a large portion of missing values (40%), the proposed method can generate a fused dataset that provides reliable risk assessment results highly consistent (70%-87%) with those obtained from the original experimental datasets. This signified the usefulness of the proposed method for use in WMSD risk assessment studies when data collection is affected by a significant amount of missing data, which will facilitate reliable assessment of WMSD risks among construction workers. In the future, findings of this study will be implemented to explore whether, and to what extent, the fused dataset outperforms the datasets with missing values by comparing consistencies of the risk assessment results obtained from these datasets for further investigation of the fusion performance.
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http://dx.doi.org/10.1016/j.autcon.2020.103322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064735PMC
November 2020

Kneeling trunk kinematics during simulated sloped roof shingle installation.

Int J Ind Ergon 2020 May;77

National Institute for Occupational Safety & Health, Centers for Disease Control and Prevention, Health Effects Laboratory Division, 1095 Willowdale Rd, Morgantown, WV, 26505, USA.

Trunk musculoskeletal disorders are common among residential roofers. Addressing this problem requires a better understanding of the movements required to complete working tasks, such as affixing shingles on a sloped residential roof. We analyzed the extent to which the trunk kinematics during a shingling process are altered due to different angles of roof slope. Eight male subjects completed a kneeling shingle installation process on three differently sloped roof surfaces. The magnitude of the trunk kinematics was significantly influenced by both slope and task phase of the shingling process, depending on the metric. The results unequivocally point to roof slope and task phase as significant factors altering trunk kinematics. However, extension of the results to roofing workers should be done carefully, depending on the degree to which the study protocol represents the natural setting. Future studies on shingle installation in residential roofing should absolutely consider capturing a wider array of shingling procedures in order to encapsulate all the possible methods that are used due to the lack of a standardized procedure.
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http://dx.doi.org/10.1016/j.ergon.2020.102945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064732PMC
May 2020

Racial/Ethnic Differences in Food Allergy.

Immunol Allergy Clin North Am 2021 May 24;41(2):189-203. Epub 2021 Mar 24.

Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 6th Floor, Suite 680, Chicago, IL 60611, USA; Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL 60611, USA; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 86, Chicago, IL 60611, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address:

Immunoglobulin E-mediated food allergy is an increasingly prevalent public health concern globally. In North America, particularly in the United States, racial and ethnic differences in food allergy prevalence and rates of sensitization have become apparent. Black and Hispanic children in the United States have been estimated to have the highest rates of food allergy. Beyond rates of prevalence, food allergy outcomes, such as health care utilization, psychosocial outcomes, and economic burden, also vary considerably by race and ethnicity. It is important to consider socioeconomic status in conjunction with race and ethnicity in studying differences in food allergy outcomes.
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http://dx.doi.org/10.1016/j.iac.2021.01.007DOI Listing
May 2021

Food Allergies: An Example of Translational Research.

Immunol Allergy Clin North Am 2021 May;41(2):143-163

Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA.

Food allergies have been rising in prevalence since the 1990s, imposing substantial physical, psychosocial, and economic burdens on affected patients and their families. Until recently, the only therapy for food allergy was strict avoidance of the allergenic food. Recent advances in translational studies, however, have led to insights into allergic sensitization and tolerance. This article provides an overview of cutting-edge research into food allergy and immune tolerance mechanisms utilizing mouse models, human studies, and systems biology approaches. This research is being translated and implemented in the clinical setting to improve diagnosis and reduce food allergy's public health burden.
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http://dx.doi.org/10.1016/j.iac.2021.01.003DOI Listing
May 2021

International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020).

Front Hum Neurosci 2020 23;14:568051. Epub 2021 Mar 23.

Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation(VNS) and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice.
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http://dx.doi.org/10.3389/fnhum.2020.568051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040977PMC
March 2021

YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy.

Sex Med 2021 Apr 19;9(2):100324. Epub 2021 Mar 19.

Division of Urology, Department of Surgery, Rutgers-New Jersey Medical School, Newark NJ, USA; Department of Urology, Hackensack UMC-Meridian Health, Hackensack NJ, USA. Electronic address:

Introduction: YouTube is an unregulated platform that patients are using to learn about treatment options.

Aim: To assess the reliability of YouTube videos (YTVs) related to male hypogonadism and testosterone therapy.

Methods: Searching on YouTube by relevance and view count, we analyzed the top 10 videos (80 videos total) for the following search terms: low testosterone, testosterone replacement therapy, AndroGel, and hypogonadism.

Main Outcome Measure: We recorded the number of views for each video, evaluated videos using the DISCERN score (DS) criterion, and compared the DS for videos including board-certified physicians and videos without. A second comparison was made between videos with board-certified physicians in urology, endocrinology, other MD, and those without any physician.

Results: The YTVs analyzed received a total of 38,549,090 views, a median of 25,201 and 17.30 views/day. Videos that featured physicians had significantly fewer views/day than videos that did not (39.48 CI 9,72 vs 1,731 CI 330, 3,132; P = .019). Most YTVs studied were unreliable. The median DS across all videos was 2. However, most videos created by physicians were found to be reliable with a median DS of 4. In addition, YTVs that did not feature a physician were found to be significantly less reliable than videos that featured a physician (3.22 CI 3.06, 4.09 vs 1.87 CI 1.56, 2.18; P < .001). There was no significant difference in the reliability or viewership of YTVs stratified by physician type.

Conclusion: Most YTVs related to male hypogonadism/testosterone therapy were unreliable, but there are reliable YTVs available. Reliable videos usually feature a physician and receive fewer views than unreliable YTVs. Physicians and academic societies should work to provide verified videos to provide patients with reliable information about male hypogonadism and testosterone therapy. CJ Warren, J Wisener, B Ward, et al. YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy. Sex Med 2021;9:100324.
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http://dx.doi.org/10.1016/j.esxm.2021.100324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072170PMC
April 2021

The Psychosocial Burden of Food Allergy Among Adults: A US Population-Based Study.

J Allergy Clin Immunol Pract 2021 06 4;9(6):2452-2460.e3. Epub 2021 Mar 4.

Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address:

Background: Food allergy (FA) affects >25 million US adults, resulting in substantial health care utilization. Data suggest that patients with FA suffer impairments in FA-related quality of life (FAQoL); however, little is known regarding psychosocial impacts of FA among US adults.

Objective: To characterize FAQoL among a large, nationally representative adult sample, and its determinants, including sociodemographic characteristics, severity, comorbid conditions, allergic symptoms, number and type of allergens, and health care utilization.

Methods: A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on patient quality of life. FAIM responses were analyzed from adults reporting current FA (N = 6207). Linear regression models examined associations with sociodemographic and FA characteristics.

Results: The overall estimated mean FAIM score was 2.87 (95% confidence interval: 2.83-2.90). FAIM scores (range = 1-7) in adjusted models were invariant by race/ethnicity, private/public insurance status, and census division. Significant differences (P < .05) by lower household income, lower age, and greater education emerged, resulting in higher FAIM scores indicating FAQoL impairment. Among major food allergens, wheat, soy, and milk allergies were each associated with the greatest increases in adjusted FAIM scores. Reporting a current epinephrine autoinjector (EAI) prescription, severe allergic reaction history, history of EAI use, FA-related emergency department visits, or more FAs were also associated with significantly higher FAIM scores.

Conclusion: The population-level psychosocial burden of adults with FA is substantial, broadly distributed, and differs by demographic and allergic disease characteristics.
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http://dx.doi.org/10.1016/j.jaip.2021.02.039DOI Listing
June 2021

Infertility in the Midwest: perceptions and attitudes of current treatment.

Am J Obstet Gynecol 2021 07 19;225(1):61.e1-61.e11. Epub 2021 Feb 19.

Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address:

Background: Although infertility affects an estimated 6.1 million individuals in the United States, only half of those individuals seek fertility treatment and the majority of those patients are White and of high socioeconomic status. Research has shown that insurance mandates are not enough to ensure equal access. Many workplaces, schools, and medical education programs have made efforts in recent years to improve the cultural humility of providers in efforts to engage more racially and economically underrepresented groups in medical care. However, these efforts have not been assessed on a population of patients receiving fertility care, an experience that is uniquely shaped by individual social, cultural, and economic factors.

Objective: This study aimed to better understand the racial, cultural, economic, and religious factors that impact patient experiences obtaining fertility care.

Study Design: A cross-sectional self-administered survey was administered at an academic fertility center in Chicago, Illinois. Of 5000 consecutive fertility care patients, 1460 completed the survey and were included in the study sample. No interventions were used. Descriptive univariate frequencies and percentages were calculated to summarize sociodemographic and other relevant patient characteristics (eg, race or ethnicity, age, household income, religious affiliation, insurance coverage). Rates of endorsing perceived physician cultural competency were compared among demographic subgroups using Pearson chi-squared tests with 2-sided P<.05 indicative of statistical significance. To identify the key determinants of patient-reported worry regarding 9 different fertility treatment outcomes and related concerns, a series of multiple logistic regression models were fit to examine factors associated with patient report of being "very worried" or "extremely worried."

Results: Members of our sample (N=1460) were between 20 and 58 years of age (mean, 36.2; standard deviation, 4.4). Among Black participants, 42.3% reported that their physician does not understand their cultural background compared with 16.5% of White participants (P<.0001). Participants who identified as Latinx were significantly more likely than White participants to report being very/extremely worried about side effects of treatment, a miscarriage, ectopic pregnancies, and birth defects (P<.05, P=.02, P=.002, P=.001, respectively). Individuals who identify as Hindu were nearly 4 times more likely to report being very/extremely worried about experiencing an ectopic pregnancy than nonreligious participants (P<.0002). Respondents most strongly identified the biology or physiology of the couple (mean, 21.6; confidence interval, 20.4-22.7) and timing or age (mean, 27.8; confidence interval, 26.5-29.1) as being associated with fertility. Overall, respondents most strongly disagreed that the ability to bear children rests upon God's will (mean, 65.4; confidence interval, 63.7-67.1), which differed most significantly by race (P<.0001) and religion (P<.0001).

Conclusion: Of the patient characteristics investigated, racial and ethnic subgroups showed the greatest degree of variation in regard to worries and concerns surrounding the experience of fertility treatment. Our findings emphasize a need for improved cultural humility on behalf of physicians, in addition to affordable psychological support for all patients seeking fertility care.
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http://dx.doi.org/10.1016/j.ajog.2021.02.015DOI Listing
July 2021

YouTube and Men's Health: A Review of the Current Literature.

Sex Med Rev 2021 Apr 18;9(2):280-288. Epub 2021 Feb 18.

Rutgers-New Jersey Medical School, Newark, USA; Hackensack UMC-Meridian Health, Hackensack, USA. Electronic address:

Introduction: YouTube is the most used social media website, and there is a growing body of literature examining the reliability of healthcare information on this platform. Patients seeking men's health information may be more likely to use YouTube owing to the sensitivity of these issues.

Objectives: The objective of this study is to review the literature for studies related to the reliability of YouTube videos about men's health topics.

Methods: A literature review was conducted using PubMed and Google Scholar for publications related to the reliability of YouTube videos about men's health as of July 1, 2020.

Results: There were 17 studies related to YouTube and Men's Health. Most videos were found to be unreliable, and videos uploaded by physicians or healthcare organizations were usually more reliable. However, there were no studies in which more reliable videos had higher metrics of user engagement (views, likes, comments) than unreliable videos and there were several studies where unreliable videos had higher metrics of user engagement. In addition, the methods used to evaluate YouTube videos are not uniform across studies including the way that terms are searched (filtering by relevance vs view count) and the way in which reliability is assessed. For example, some studies create custom evaluation forms based on clinical guidelines, whereas others use validated questionnaires. The only validated questionnaire used across multiple studies was the DISCERN score criterion.

Conclusions: Most information on YouTube about men's health is unreliable. Videos created by physicians and healthcare organizations are more reliable, and videos that are advertisements are less reliable. Physicians and healthcare systems should continue to upload educational YouTube videos but work to increase their views and user engagement. It may benefit patients if physician organizations could work with YouTube to create verified videos disseminating healthcare information that are favored in the search algorithm. Warren CJ, Sawhney R, Shah T, et al. YouTube and Men's Health: A Review of the Current Literature. Sex Med Rev 2021;9:280-288.
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http://dx.doi.org/10.1016/j.sxmr.2020.09.002DOI Listing
April 2021

Integrated plasma proteomic and single-cell immune signaling network signatures demarcate mild, moderate, and severe COVID-19.

bioRxiv 2021 Feb 10. Epub 2021 Feb 10.

The biological determinants of the wide spectrum of COVID-19 clinical manifestations are not fully understood. Here, over 1400 plasma proteins and 2600 single-cell immune features comprising cell phenotype, basal signaling activity, and signaling responses to inflammatory ligands were assessed in peripheral blood from patients with mild, moderate, and severe COVID-19, at the time of diagnosis. Using an integrated computational approach to analyze the combined plasma and single-cell proteomic data, we identified and independently validated a multivariate model classifying COVID-19 severity (multi-class AUCtraining = 0.799, p-value = 4.2e-6; multi-class AUCvalidation = 0.773, p-value = 7.7e-6). Features of this high-dimensional model recapitulated recent COVID-19 related observations of immune perturbations, and revealed novel biological signatures of severity, including the mobilization of elements of the renin-angiotensin system and primary hemostasis, as well as dysregulation of JAK/STAT, MAPK/mTOR, and NF-κB immune signaling networks. These results provide a set of early determinants of COVID-19 severity that may point to therapeutic targets for the prevention of COVID-19 progression.
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http://dx.doi.org/10.1101/2021.02.09.430269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885914PMC
February 2021

Prevalence and characteristics of peanut allergy in US adults.

J Allergy Clin Immunol 2021 Jun 9;147(6):2263-2270.e5. Epub 2021 Feb 9.

Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. Electronic address:

Background: Peanut allergy (PA) is the leading pediatric food allergy and a common cause of anaphylaxis. Little is known, however, on the prevalence and characteristics of PA in the adult population and whether phenotypic differences exist between adult-onset and childhood-onset PA.

Objectives: This study describes the current US population-level burden of adult PA.

Methods: A cross-sectional food allergy survey was administered via phone and web in 2015 and 2016, resulting in nationally representative complex-survey weighted data for 40,443 adults. Reported food allergies were considered "convincing" if symptoms to specific allergens were consistent with an IgE-mediated reaction.

Results: The prevalence of current self-reported PA was 2.9% among US adults, with 1.8% having convincing PA. Over 17% of adults with peanut allergy reported onset of their PA in adulthood. In adults with childhood-onset PA, 75.4% reported physician-diagnosed PA, compared with only 58.9% of adult-onset PA. Despite a similar frequency of food allergy-related emergency department visits within the past year (approximately 1 in 5 adults with PA allergy), adults with childhood-onset PA were significantly more likely to have a current epinephrine prescription compared with those with adult-onset PA (56% vs 44% respectively; P = .02) and were more likely to use an epinephrine autoinjector (48% vs 35%, P = .01).

Conclusions: Approximately 4.6 million US adults have PA-over 800,000 of whom appear to have developed their PA after age 18 years. Further examination of phenotypic differences between childhood-onset and adult-onset PA may improve understanding and management of adult PA.
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http://dx.doi.org/10.1016/j.jaci.2020.11.046DOI Listing
June 2021

Emotional stress and reproduction: what do fertility patients believe?

J Assist Reprod Genet 2021 Apr 6;38(4):877-887. Epub 2021 Feb 6.

Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Purpose: To better understand the beliefs about a causal role of emotional stress maintained by women seeking fertility care.

Methods: A cross-sectional, self-administered survey was distributed to fertility care patients at an academic fertility center in Illinois. Of 5000 consecutive patients, 1460 completed the survey and were included in the study sample.

Results: Members of our sample (N = 1460) were between 20 and 58 years (mean = 36.2, SD = 4.4). Most respondents were White (72.2%), were in a heterosexual relationship (86.8%), and felt that their physician understood their cultural background (79.4%). Of the sample, 28.9% believed emotional stress could cause infertility, 69.0% believed emotional stress could reduce success with fertility treatment, and 31.3% believed that emotional stress could cause a miscarriage, with evidence of significant racial differences. Less than a quarter (23.8%) of the sample believed emotional stress had no impact on fertility. Lower household income and educational attainment were associated with a greater belief in emotional stress as a causative factor in reproduction with regard to infertility, fertility treatment, and miscarriage.

Conclusion: The majority of women seeking fertility care believe emotional stress could reduce the success of fertility treatment. Furthermore, beliefs about emotional stress and reproduction significantly differ based on race/ethnicity, income, and education. Particular attention should be paid to specific groups of women who may more likely not be aware of the lack of a proven biological relationship between emotional stress and reproduction.
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http://dx.doi.org/10.1007/s10815-021-02079-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079591PMC
April 2021

#MedEd Twitter Response to the USMLE Step 1 Pass/Fail Score Reporting Announcement.

Acad Med 2021 02;96(2):162

Professor, Department of Urology, Rutgers New Jersey Medical School, Newark, New Jersey;

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http://dx.doi.org/10.1097/ACM.0000000000003779DOI Listing
February 2021

Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial.

Pediatrics 2021 01;147(1)

Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Background: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear.

Methods: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline.

Results: Dyads were assigned to the control ( = 127) or intervention ( = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δ = 2.2; SE = 0.6; < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratio = 2.2; SE = 0.5; < .01; incidence rate ratio = 3.4; SE = 1.4; < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δ = 0.3; SE = 0.2; = .1) than the control.

Conclusions: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.
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http://dx.doi.org/10.1542/peds.2020-1330DOI Listing
January 2021

African American Children Are More Likely to Be Allergic to Shellfish and Finfish: Findings from FORWARD, a Multisite Cohort Study.

J Allergy Clin Immunol Pract 2021 07 19;9(7):2867-2873.e1. Epub 2021 Jan 19.

Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.

Background: Despite major differences in health profiles and rates of health care utilization between African American and White children with food allergy (FA), the detailed phenotypic variables that can potentially impact these outcomes have not been thoroughly studied.

Objective: We aimed to characterize phenotypic differences such as allergies to different foods and allergic comorbidities between African American and White children with FA enrolled in the Food Allergy Outcomes Related to White and African American Racial Differences study.

Methods: Our active, prospective, multicenter cohort study is currently enrolling African American and White children aged 0 to 12 years diagnosed with FA and followed by allergy/immunology clinics at 4 urban tertiary centers in the United States. To evaluate associations between race and phenotypic variables, we used multivariable logistic regression, adjusting for important demographic and confounding factors, as well as potential household clustering.

Results: As of May 2020, there were 239 African Americans and 425 Whites with complete intake information enrolled in the study. In comparison with Whites, we found that African Americans had significantly higher adjusted odds of allergy to finfish (odds ratio [OR]: 2.54, P < .01) and shellfish (OR: 3.10, P < .001). African Americans also had higher adjusted odds of asthma than Whites (asthma prevalence of 60.5% in African Americans and 27.2% in Whites; OR: 2.70, P < .001). In addition, shellfish allergy was associated with asthma, after controlling for race.

Conclusion: Among a diverse cohort of children with physician-diagnosed FA, we observed that African American children had higher odds of allergy to shellfish and finfish, and higher rates of asthma. Interestingly, having asthma was independently associated with allergy to shellfish, after controlling for race.
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http://dx.doi.org/10.1016/j.jaip.2020.12.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277659PMC
July 2021

A high-resolution remotely sensed benthic habitat map of the Qatari coastal zone.

Mar Pollut Bull 2020 Nov 6;160:111634. Epub 2020 Oct 6.

Environmental Management Division, ExxonMobil Research Qatar, Qatar Science and Technology Park, Tech 2, PO BOX 22500, Al Wosail Tower, Doha, Qatar.

A comprehensive, high resolution, ground truthed benthic habitat map has been completed for Qatar's coastal zone and Halul Island. The objectives of this research were to; 1. Systematically compare and contrast pixel- and object-based classifiers for benthic mapping in a limited focus area and then to, 2. Apply these learnings to develop an accurate high resolution benthic habitat map for the entirety of the Qatari coastal zone. Results indicate object-based methods proved more efficient and accurate when compared to pixel based classifiers. The developed country-wide map covers 4500 km and underscores the complex interplay of seagrass, macroalgal, and reefal habitats, as well as areas of expansive mangrove forests and microbial mats. The map developed here is a first of its kind in the region. Many potential applications exist for the datasets collected to provide fundamental information that can be used for ecosystem-based management decision making.
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http://dx.doi.org/10.1016/j.marpolbul.2020.111634DOI Listing
November 2020

Food allergy-related bullying and associated peer dynamics among Black and White children in the FORWARD study.

Ann Allergy Asthma Immunol 2021 03 4;126(3):255-263.e1. Epub 2020 Nov 4.

Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford University School of Medicine, Stanford, California.

Background: The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes.

Objective: To evaluate bullying experiences of Black and White children with FA, including associations with peer relationships, anxiety, and school policies.

Methods: Surveys were administered to parents of 252 children with physician-diagnosed FA enrolled in the multisite FORWARD cohort. The surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared by χ tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child sex, and multi-FA compared adjusted probabilities of bullying victimization by school policies.

Results: Nearly 20% of school-aged children were bullied for FA with no substantial racial differences overall, though for children ages 11 years and up, White children reported higher rates of bullying. However, Black children experienced non-FA-related bullying twice as frequently as White children (38.6% vs 17.7%; P = .002). Most of the caregivers (85.7%) who intervened in their child's bullying reported that it was helpful. Among parents, 17.3% reported that they were teased or bullied owing to their child's FA. More than half of the respondents (54.8%) reported that some allergens are banned from their child's school, most typically peanut. In schools banning peanuts, FA-related bullying was less frequently reported by all students who have food allergy.

Conclusion: Bullying owing to FA is common, and caregivers, medical professionals, and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies.
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http://dx.doi.org/10.1016/j.anai.2020.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897313PMC
March 2021

Advancing Food Allergy Through Epidemiology: Understanding and Addressing Disparities in Food Allergy Management and Outcomes.

J Allergy Clin Immunol Pract 2021 01 14;9(1):110-118. Epub 2020 Oct 14.

Center for Food Allergy and Asthma Research at the Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.

Epidemiological studies have been pivotal in advancing understanding of the etiology of food allergy and in guiding the development of evidence-based guidelines for food allergy prevention and clinical management. In recent years, as research into the population-level distribution and determinants of food allergy has accumulated, data indicate that substantial differences in food allergy outcomes and management exist across racial/ethnic and other socioeconomic strata. This clinical commentary aims to provide a review of existing epidemiological studies and shed valuable light on the disparate burden of food allergy. Emerging methods to quantify environmental exposure and food allergy outcomes are detailed, as are specific areas in which future research is warranted. We also highlight the role that epidemiology plays in advancing health equity and provide a framework as to how it can effectively inform health policy at all phases of the policy cycle-from initial population health assessment to the evaluation and refinement of specific health policies (ie, national guidelines to promote earlier introduction of peanut-containing foods for allergy prevention).
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http://dx.doi.org/10.1016/j.jaip.2020.09.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938932PMC
January 2021
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