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 possible approaches to prevention of atopic disorders, risk factors contributing to the development of atopic dermatitis, and emerging treatment options for the treatment of food allergy, atopic dermatitis, and asthma.
The review of risk factors that can contribute to the development of atopic disease is important for the practicing pediatrician. The effects of maternal factors, such as omega-3 supplementation and maternal peanut consumption on the development of atopy, are described. Awareness and beliefs among caregivers regarding early peanut introduction are also discussed, along with factors associated with epinephrine use in the treatment of infants and toddlers. Several reviews describe the improved understanding about the microbiome and its role in development of atopic dermatitis and food allergy. The role of infection and subsequent development of respiratory disease is also addressed. For patients with atopic dermatitis and eczema, reviews are included that describe skin barrier development and early-onset atopic dermatitis, as well as the effects of bullying in patients with atopic dermatitis. This is a reminder that patients with atopic diseases need to be offered support of their emotional health, in addition to their physical health.
Drug allergy and the role of pediatricians is addressed by several reviews in this year’s synopsis book. Antibiotic stewardship continues to be a collective responsibility among pediatricians and pediatric specialists. Additional evidence regarding the importance and safety of direct graded oral challenge to cephalosporins, as well as immediate and nonimmediate β lactam allergy, are reviewed. Another interesting review describes the need for medical advice to be provided by medical professionals with training and experience, as artificial intelligence leads to errors in the diagnosis of allergic disease.
Many aspects of food allergy, from diagnosis to treatment, are addressed. Outcomes of oral food challenge with predictors of outcomes are described, in addition to a comparison of open food challenge to double-blind placebo-controlled food challenge. More practical information regarding the ability of children and families with and without nut allergy to correctly identify nuts is highlighted. 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. New treatment options for our patients with Eosinophilic Esophagitis are also included in this year’s synopsis.
Among the reviews regarding asthma, risk factors, including the effect of early-life weight and childhood obesity, are described. Other factors that may contribute to the development of asthma include the effect of use of hormonal contraceptives on the incidence of asthma. Practical information regarding asthma management is included regarding altered symptom perception and the association with poor outcomes, as well as the effect of Telemedicine asthma management through the Emergency Department for our patients with asthma. A few reviews describe treatment options, which continue to grow, with reviews describing the efficacy of maintenance and reliever therapy, review of the best step-up treatments in uncontrolled asthma, and the use of biologics to treat severe asthma.
Healthcare disparities are once again highlighted in the Supplement. Recognition of the differences and disparities in reaction severity and management of food allergy are essential. Socioeconomic status and diet quality in children with and without food allergy are also described. The role of the environment and the effects of exposure to radon in patients of different racial and ethnic groups is highlighted. In addition to racial and ethnic differences, social determinants of health and health literacy must also be considered, as they impact our patients with asthma.
The immunology section includes reviews that describe the effect of intestinal helminth infection on vaccine efficacy, as well as strategies to improve Human Papillomavirus vaccination rates in adolescents. As we recognize the need to improve the diagnosis of our patients with inborn errors of immunity, recent literature describes the use of the electronic health record to identify undiagnosed patients with Common Variable Immunodeficiency, which may aid in these efforts. Other reviews also discuss the effect of newborn screening on survival after hematopoietic stem cell transplantation for severe combined immunodeficiency, and the need for continued monitoring for late complications posttransplantation in severe combined immunodeficiency.
Over the last year, further contributions have been made to continue to increase our understanding of the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on our patients. Recent literature describes altered coronavirus disease 2019 (COVID-19) immunity in children with asthma by atopic status. Other reviews describe the use of vaccination in patients with different primary immunodeficiency disorders and inborn errors of immunity. T cell responses to SARS-CoV-2 infection and vaccination are elevated in B cell deficiency and reduce risk of severe COVID-19, and vaccination reduces hospitalization and critical care needs related to COVID-19 in patients with inborn errors of immunity. Another review describes the effects of post-COVID-19 condition in children.
On behalf 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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