In the absence of DPβE69, DRβE71 is a risk factor for CBD and BeS. DPβE69 and DRβE71 are adjacent to other amino acids that are also negatively charged, suggesting that the positively charged Be²⁺ modifies the local environment of the epitopes in a way that promotes interactions between peptides and T cells and results in CBD. Finally, the protective effect of the DPB1*0201 positive haplotype may involve particular polymorphisms outside of the DPB1 gene.

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OBJECTIVES. To describe the development and evaluation of a pilot emergency department (ED)-based asthma surveillance system for childhood asthma visits based on billing data and to illustrate how the data can be used to document trends and patterns in ED visits for asthma in children.METHODS. During 2001 and 2002, aggregate reports based on ED billing data from 3 hospitals in western Michigan were obtained from a single physician billing company. Data were tabulated and graphed to show trends in the monthly number of ED visits for asthma in children. Comparisons were made by age, gender, and site. We evaluated the system by using established guidelines.RESULTS. The data illustrated strong seasonal trends, as well as marked differences in ED use according to age and gender. The total numbers of asthma ED visits were remarkably similar between the 2 years evaluated; however, the timing and duration of the seasonal peaks differed. Our evaluation of the system found that it met many of the characteristics that define successful surveillance systems, including simplicity, flexibility, acceptability, sensitivity and positive predictive value, timeliness, and stability. However, the surveillance system's representativeness was limited by the inability to calculate valid population-based ED-visit rates. Despite this limitation, the data provided useful information by documenting the burden and demographic profile of children who use the ED for asthma care and in identifying seasonal and time-related trends.CONCLUSIONS. We were able to successfully implement a pilot ED-based surveillance system for childhood asthma visits by using billing data. This system promotes the understanding of the burden of asthma among children visiting the ED. The development of an ED-based surveillance system for childhood asthma visits using billing data is recommended, particularly when there is a desire to understand the characteristics of children with asthma who use the ED and/or a need to understand the impact of local asthma quality-improvement programs. A STHMA IS ONE of the most common reasons for presentation to emergency departments (EDs), and this chronic disease places a heavy but potentially preventable burden on the US health care system. 1-3 Children Յ14 years of age make ϳ600 000 ED visits for asthma every year in the United States, and the number of ED visits increased by 14% during the 1990s. 1 Between 10% and 30% of ED visits for asthma are repeat visits, and frequent ED use is associated with greater asthma severity and/or poor management, as well as poverty, ethnicity, and urban residence. [4][5][6][7] The current high level of interest concerning asthma stems from several features including the increase in asthma prevalence and mortality observed over recent decades, 8,9 the large costs involved, 10 the disproportionate effect on minority populations, 11 the concern about possible environmental causes, and the belief that the application of current clinical guidelines should result in better asthma control. 12 ...

The DPB1*1902 allele resulted from a single-nucleotide substitution at codon 35 (TTC --> CTC/F --> L) of exon 2 of DPB1*0402 or 0602.