Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel

Publication date: Available online 5 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Alkis Togias, Susan F. Cooper, Maria L. Acebal, Amal Assa'ad, James R. Baker, Lisa A. Beck, Julie Block, Carol Byrd-Bredbenner, Edmond S. Chan, Lawrence F. Eichenfield, David M. Fleischer, George J. Fuchs, Glenn T. Furuta, Matthew J. Greenhawt, Ruchi S. Gupta, Michele Habich, Stacie M. Jones, Kari Keaton, Antonella Muraro, Marshall Plaut, Lanny J. Rosenwasser, Daniel Rotrosen, Hugh A. Sampson, Lynda C. Schneider, Scott H. Sicherer, Robert Sidbury, Jonathan Spergel, David R. Stukus, Carina Venter, Joshua A. Boyce
BackgroundFood allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.ObjectivesPrompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy.ResultsThe addendum provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation.ConclusionsGuidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.



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Comparison of effects of zoledronic acid and clodronate on the bone structure: Imaginological and histomorphometrical study in vivo

Abstract

Objectives

To compare histologically and imaginologically the bone structure of rats' mandibles treated with bisphosphonates (BPs) and rats that did not receive BPs.

Methods

Thirty-four rat specimens (Rattus novergicus, Wistar strain) were divided in 3 groups: (1) 12 rats treated with zoledronic acid; (2) 12 rats treated with clodronate; and (3) the control group, containing 10 rats that received saline solution. All individuals were exposed to cone beam computed tomography (CBCT). The images were processed and analised to obtain the Hounsfield scores, using the software OsiriX 7.0. Sixty-eight histological slides were obtained from the specimens and stained with hematoxilin and eosin (HE). Using the software Adobe Photoshop CS6, the histological areas containing non-vital bone were identified and quantified.

Results

Non-vital bone presented positive association with the zoledronic acid and clodronate groups. Statistically, no significant difference in bone density was observed among the groups.

Conclusions

Based on the results, the BP therapy alone was sufficient to induce osteonecrosis. In addition, the CBCT was not a sensible method for detection of the early signs of bone modification in individuals under BP therapy.

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Enzymatic antioxidants status in patients with recurrent aphthous stomatitis

Abstract

Background

Oxidative stress (OS) has been thought to play a main role in the etiopathogenesis of recurrent aphthous stomatitis (RAS), which is one of the most common oral mucosal diseases characterized by recurrent and painful oral ulcers. The aim of this investigation was to evaluate the enzymatic antioxidants status in patients with RAS in the active stage and remission stage.

Methods

Ninety seven patients with idiopathic minor RAS and 102 race, age and gender-matched healthy individuals were recruited. All these subjects were allocated to three groups: RAS patients with active lesion (group A); the same patients in group A in the remission stage of RAS (group B); healthy individuals without RAS (group C). Following an overnight fast, blood samples were obtained. The serum levels of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSHPx) were measured by the spectrophotometric method. Independent sample t-test and paired t-test were performed for statistical evaluation.

Results

The serum levels of SOD, GSHPx, and CAT (83.9±17.1 U/mL, 6687.2±2629.2 U/mL, 1789.7±593.8 U/L) were found to be significantly lower in group A as compared to those of group B (99.8±11.1 U/mL, 9364.1±1607.9 U/mL, 2789.1±1113.4 U/L; P<0.05) or group C (97.3±12.1 U/mL, 9246.2±2376.1 U/mL, 2819.0±914.8 U/L; P<0.05). No significant differences were found between group B and group C with respect to any one of these enzymatic antioxidants (P>0.05).

Conclusions

Our results indicate that enzymatic antioxidant defense system is impaired in RAS patients with active lesion and seems to play a crucial role in its pathogenesis.

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Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea

Abstract

Objective

Oral appliances (OA) are recommended for patients with severe obstructive sleep apnea who fail to comply with continuous positive airway pressure (CPAP) therapy. This mixed methods study aimed to quantify adherence to OA therapy and evaluate subjective reasons associated with non-adherence.

Materials and Methods

The medical records of 52 patients with an apnea-hypopnea index (AHI) ≥ 40, treated with OA after discontinuation of CPAP treatment, were examined for OA adherence. Patients were divided according to usage at the time of a phone interview. The USER group included all forms of usage whereas those who completely ceased using the OA were in the NUSE group. The timing of the phone interview was from five months to six years (average 44.63±17.17 months) after OA delivery.

Results

The overall adherence rate was 57.7% (30/52 patients). The mean usage times were 10.07±8.96 and 44.30±17.3 months in the NUSE and NUSE groups respectively. The main factors associated with non-adherence were concerns about the effects of the OA on teeth (22%) and insufficient efficacy (22%). Other factors were discomfort (15%) or improved wellbeing following weight loss (15%). The overall number of interfering and discontinuity factors was significantly higher in the NUSE group than in the USER group (p=0.041). Nine out of 52 (17.3%) patients resumed CPAP use. Subjective and objective outcomes, determined by using a second sleep test with OA in 69.2% of patients, were related to the continuation of treatment.

Conclusions

Non-adherence to OA is strongly associated with patient reservations regarding the effects of the device on teeth, possible lack of efficacy and discomfort. Clinicians should closely monitor adherence patterns and assess potential interfering factors during their diagnostic work up. Patients should be reassured regarding device safety, particularly following dental work that may interfere with the insertion of the OA.

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Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

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Subglottic Metastatic Rectal Adenocarcinoma: A Specialist Multidisciplinary Airway Team Approach for Optimized Voice and Airway Outcome

A 56-year-old female with a background of metastatic rectal adenocarcinoma presented with a subglottic mass causing biphasic stridor. Transoral laser microsurgery and the use of fibrin glue prevented the need for tracheostomy. Six months postoperatively there was no evidence of recurrence. Laryngeal metastasis of colorectal adenocarcinoma, although remarkably rare, is perhaps more prevalent than commonly perceived and the presence of laryngeal symptoms in a patient with colorectal adenocarcinoma should raise concern. This case is presented to aid physicians should they encounter a similar presentation of metastasis to the subglottis.

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Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel

Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.

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