Background Adherence to inhaled steroid regimens for asthma is poor in adults and children. Although it is assumed that nonadherence contributes to morbidity in older adolescents, investigation is limited. Objective To describe adherence to preventive asthma medications and explore relevant beliefs and attitudes in older urban adolescents including their ideas for improving adherence. Methods Quantitative and qualitative methods were employed to collect data from a convenience sample of adolescents with asthma previously prescribed fluticasone/salmeterol. Two semi-structured face-to-face interviews were conducted one month apart and analyzed for themes. Fluticasone/salmeterol use was electronically monitored between visits and calculated as the number of actuations divided by the number of inhalations prescribed. Results 40 participants, 15–18 years, 19 female, 30 Black/African-American, 11 Medicaid-insured, 24 previously hospitalized for asthma, median FEV1 98% predicted, (range 67%–127%), had median adherence 43% (range 4%–89%). Adherence was not associated with FEV1 or ED visits. Themes emerged from interviews: teens 1) take fluticasone/salmeterol inconsistently; 2) believe fluticasone/salmeterol is “supposed to help me breathe”; 3) dislike its taste; 4) are “too busy” and “forget”; and 5) recommend “reminder” solutions to poor adherence. 20% believed that taking fluticasone/salmeterol was unnecessary and another 18% expressed ambivalence about its benefits. Conclusion Adherence was poor. Examining and acknowledging health beliefs of older teens in the context of their complicated lives may facilitate discussions about self-management.

BackgroundWheat allergy is among the most common food allergy in children, but few publications are available assessing the risk of anaphylaxis due to wheat.MethodsIn this study, we report the case of near-fatal anaphylaxis to wheat in a patient undergoing an oral food challenge (OFC) after the ingestion of a low dose (256 mg) of wheat. Moreover, for the first time, we analyzed the risk of anaphylaxis during an OFC to wheat in 93 children, compared to other more commonly challenged foods such as milk, egg, peanuts, and soy in more than 1000 patients.ResultsThis study, which includes a large number of OFCs to wheat, shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration (Odds Ratio [OR] = 2.4) and anaphylaxis requiring epinephrine administration to low dose antigen (OR = 8.02). Other risk factors for anaphylaxis, anaphylaxis requiring epinephrine administration, and anaphylaxis to low dose antigen was a history of a prior reaction not involving only the skin (OR = 1.8, 1.9 and 1.8 respectively). None of the clinical variables available prior to performing the OFC could predict which children among those undergoing OFCs to wheat would develop anaphylaxis or anaphylaxis for low dose antigen.ConclusionThis study shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration and anaphylaxis requiring epinephrine administration to low dose antigen.

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As the largest national survey of allergic reactions of clinical open OFCs in a nonresearch setting in the United States, this study found that performing clinical nonresearch open low-risk OFCs results in few allergic reactions, with 86% of challenges resulting in no reactions and 98% without anaphylaxis.