In this Synopsis Book, our reviewers have selected articles with relevant data that will optimize the clinical care of children affected by allergic and immunologic disorders. These include publications from the past year that have impactful findings which can support current practice and/or advance our understanding, leading to new insights and approaches to allergic and immunologic disorders. A wide spectrum of allergy disorders that affect children are covered, with articles providing observations and new knowledge ranging from identifying risk factors and the effects of early food introduction on food allergy, possible approaches to prevention of atopic disorders, and factors contributing to the development of atopic dermatitis and treatment options.
Since atopic disorders often present with other comorbidities, the reviewers describe several recent studies describing these associations. Although some comorbidities may be expected, such as in asthma, allergic rhinitis, atopic dermatitis and food allergy, the presence of autoimmunity in patients with atopy may not be. Quality of life is also important in our patients with different atopic or immunologic disorders. The importance of addressing mental health to optimize physical health is increasingly evident. The reviewers emphasize the need to consider psychological components of living with chronic diseases, whether in food allergy, asthma, or inborn errors of immunity.
Drug allergy and the importance of delabeling is highlighted by several reviews in this year’s synopsis book. As pediatricians, we have a responsibility to contribute to antibiotic stewardship. Additional evidence regarding the importance and safety of removing penicillin allergy labels in the settings of both the pediatric office, as well as in the subspecialty clinic, are presented. In addition, pediatricians play a key role in providing accurate information regarding the safety and efficacy of vaccinations. To combat the increasing amounts of misinformation, the reviewers arm us with several studies that describe inaccurate information in social media regarding allergic rhinitis, whereas others focused on the efficacy of vaccinations, as well as reassuring data regarding the safety of revaccination in patients with a history of adverse reaction to vaccines.
Many aspects of food allergy, from diagnosis to treatment, are addressed. Factors that may be associated with persistent forms of food allergy are described, the likely role of the gut in the development of food allergy is included, whereas another study examined the use of epitopes to predict the probability of tolerating peanut protein in allergic children. Although one FDA approved treatment of peanut in young children and adolescents is available in the form of oral immunotherapy, interest in other treatment options continues to grow. Multiple research studies focused on treatment, in the forms of oral immunotherapy, sublingual immunotherapy, epicutaneous immunotherapy, and the use of biologics, in place of avoidance, for pediatric patients with food allergy are included. The need to improve carriage of injectable epinephrine among patients with food allergy is addressed by a study to incentivize adolescent patients with food allergy. New diagnostic modalities and treatment options, as well as recognition of risk factors, to aid in our diagnosis of patients with eosinophilic esophagitis are also included in this year’s synopsis.
Among the reviews regarding asthma, risk factors including maternal depression and prepregnancy maternal BMI are described. Other factors that may contribute to the development of asthma include low birth weight, growth pattern during early infancy, and BMI during childhood. Practical information regarding asthma management is included in reviews about cardiopulmonary fitness among asthmatics, as well as how patients can tell when their inhalers are “empty.” Treatment options continue to grow with several reviews describing the efficacy of allergen immunotherapy and increasing options among biologics to treat asthma.
Healthcare disparities are highlighted in the Supplement. Recognition of the differences and disparities in atopic comorbidities among children with food allergy is needed. The role of the environment and the effects of exposure to viral illnesses in patients of different racial and ethnic groups are also highlighted. In addition to racial and ethnic differences, social determinants of health must also be considered, as they impact our patients with atopy.
The immunology section includes reviews that describe the need to improve the diagnosis of our patients with inborn errors of immunity, and recent literature offers hope that through the use of artificial intelligence (the other AI), this may aid in these efforts. The association between autoimmunity and immunologic disorders should be a warning sign to consider an immunologic evaluation. The role of metagenomics to improve lower respiratory tract infection diagnosis in critically ill children, as well as gut dysbiosis and its possible effects on immune dysregulation, are also included in the synopsis.
Over the last year, important contributions have been made to improve our understanding of the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on our patients. Many studies regarding risk factors for infection and transmission, along with obesity as a risk factor for decreases in lung function in children with asthma after infection, are included. Recent literature supports prior studies that asthma is not a risk factor for severe disease secondary to SARS-CoV-2. Other reviews describe the production of neutralizing antibodies, as well as long-term antibody levels after SARS-CoV-2 infection in pediatric patients. Postacute sequelae of SARS-CoV-2 infection in children are also described. In addition, we now have a better understanding about how inborn errors of immunity may be responsible for pediatric patients with multisystem inflammatory syndrome in children secondary to infection with SARS-CoV-2.
On behalf of our reviewers, we hope that this Supplement provides you updated information and clinical “pearls” that can improve the clinical care of children with allergic and immunologic diseases. For additional information about our Section, please visit: http://www.aap.org/sections/allergy/.
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