Introduction Epidemiologic studies have found low/absence of atopy in obese asthmatic children, but the association or lack thereof of atopy with disease morbidity, including pulmonary function, in obese asthma is not well understood. We sought to define the association of atopy with pulmonary function in overweight/obese minority children with asthma. Methods In a retrospective chart review of 200 predominantly minority children evaluated at an academic Pediatric Asthma Center over 5 years, we compared the prevalence of atopy, defined as ≥1 positive skin prick test or serum‐specific immunoglobulin E quantification to environmental allergens, and its association with pulmonary function in overweight/obese (body mass index [BMI] > 85th percentile) (n = 99) to healthy‐weight children (BMI, 5th‐85th percentile for age) (n = 101). Results In a cohort comprised of 47.5% Hispanics and 39.5% African Americans, 81% of overweight/obese and 74% of healthy‐weight children were atopic. While atopic healthy‐weight children had lower percent‐predicted forced expiratory volume in the first second (FEV1) (93 ± 13.6 vs 107% ± 33.2%, P = .03) and lower percent‐predicted forced vital capacity (FVC) (93% ± 12.2% vs 104% ± 16.1%, P = .01) as compared to nonatopic children, atopy was not associated with FEV1 (P = .7) or FVC (P = .17) in overweight/obese children. Adjusting for demographic and clinical variables, atopy was found to be an independent predictor of FEV1 and FVC in healthy‐weight (β = −2.4, P = .07 and β = −1.7, P = .04, respectively) but not in overweight/obese children (β = .6, P = .5 and β = .8, P = .3). Conclusions Atopy is associated with lower lung function in healthy‐weight asthmatics but not in overweight/obese asthmatics, supporting the role of nonallergic mechanisms in disease burden in pediatric obesity‐related asthma.

No abstract

A 17-year-old male with history of neuromyelitis optica and seizures presented to the pulmonology clinic for evaluation of recurrent pneumonias. He had received rituximab for the past 6 years. Over the past 2 years, he experienced four episodes of pneumonia. In between these episodes, he would improve briefly but continued to have daily cough that was productive with yellow phlegm. He also had recurrent rhinitis and sinusitis despite multiple antibiotic courses. Review of chest X-rays revealed localized right middle lobe and right lower lobe infiltrates. An extensive workup was performed, including computed tomography (CT) of the chest and bronchoscopy to rule out congenital lesions of the right lung and foreign body aspiration. Chest CT showed right lower lobe bronchiectasis. Flexible bronchoscopy with bronchoalveolar lavage showed normal anatomy with thick mucus secretions in the right lower lobe. Immunologic evaluation was performed and revealed low levels of immunoglobulin (Ig)-G, IgM, and IgA, which had declined since initiation of rituximab. Lymphocyte subset testing was remarkable for low cluster of differentiation (CD)-19. He was referred to allergy and immunology and was initiated on immunoglobulin-replacement therapy (IGRT) for acquired hypogammaglobulinemia secondary to rituximab. There was marked clinical improvement after initiation of IGRT.

Northwestern Medicine. RATIONALE: Although racial and ethnic disparities in the use of food allergy (FA)-related services have been documented, little is known about access to services among children in the Medicaid program. The purpose of this study is to measure the utilization of FA-related services and identify factors associated with appropriate care among Medicaid-enrolled U.S. children with FA. METHODS: Using 2012 Medicaid Analytic eXtract data, we conducted an observational study of children having at least one claim with a FA diagnosis. FA-related services included allergist visits and epinephrine prescription fills. Factors associated with services were assessed using logistic regression. Cox proportional hazard models were used to identify factors associated with time to allergist visit and epinephrine prescription fill in two risk groups. RESULTS: There were 203,480 children ages 0-19 years with a FA diagnosis claim in 2012. Among these children, 18% saw an allergist and 21% visited the ED for FA. Black and Hispanic children with FAwere more likely to visit the ED as were those living in less urban counties compared with White children. Hispanic ethnicity and living in a high poverty county were associated with lower hazards of subsequent allergy visits and epinephrine prescription fills. CONCLUSION: This study finds that few children with FA in the Medicaid program visit allergists or fill epinephrine prescriptions after visits to general pediatricians or family practice clinicians and the ED. Both indicators represent a starting point for measuring quality care for Medicaid enrolled children with FA.