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RATIONALE: HAE is a rare, genetic disease that can cause recurrent angioedema attacks, significantly affecting patients' quality of life. Communication dynamics for patients and physicians regarding HAE and its overall impact was assessed in the US. METHODS: Following an Institutional Review Board-approved protocol, four sources of communication data were obtained, namely in-office conversations between adult patients with HAE and physicians, follow-up dictations with physicians, tele-depth interviews with patients and physicians, and publically available social media posts from Jan 2015-May 2017. Patient-physician dialogue dynamics were qualitatively assessed. Key communication elements and communication gaps were identified. RESULTS: Twenty five in-office conversations, 14 follow-up physician dictations and 17 tele-depth interviews with patients and physicians were collected. In interviews and online forums, patients frequently described the multifaceted burden of HAE whereas their physicians' conversations focused primarily on symptom frequency and severity. Patients highlighted difficulties they experience with HAE using repetition, minimizers, and metaphors, and utilized different descriptors for attacks that varied by swelling locations. In general, in-office conversations were patient-driven and lexicon from both parties centered on ''episodes'' and ''swelling''. Physicians reported inconsistences in quality of life discussions during visits. Physicians used intensifiers to emphasize necessity of having access to rescue medications, whereas prophylactic treatments were positioned as an option for patients with frequent episodes and laryngeal attacks. Patients shared different dimensions of their burden depending upon type of communication forum. CONCLUSIONS: The study findings show that the full impact of HAE is not consistently communicated between patients and physicians, possibly affecting their treatment plan.

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RATIONALE: Histamine regulates immune response and inflammation, and impairs the skin barrier dysfunction that initiates a clinical manifestation of eczema, and then atopic dermatitis (AD). Using skin prick tests (SPTs) to histamine as a marker of skin hypersensitivity mediated mast cells, we investigated whether parental allergic diseases affect skin hypersensitivity to histamine and skin diseases in their infants. METHODS: A total of 256 infant-parents pairs were enrolled in this cross-sectional study with self-writing questioners about parental and infantile eczema, AD, and other allergic diseases. SPTs to saline and histamine (1.0 mg/dl) were performed on the arms using a bifurcated needle. Wheal sizes were recorded at 15 minutes. Statistical analyses were performed by using Mann-whitney U test by STATA software. RESULTS: Among the infants (age 10.4 6 0.8 months; 124 males, 132 females), wheal sizes to histamine were significantly larger in infants with eczema than in those without eczema (4.4 6 2.0 mm vs. 3.6 6 1.9 mm; P 5 .04). In infants with maternal and paternal allergic diseases, wheal sizes to histamine were significantly larger in infants with eczema than in those without eczema (4.9 6 2.3 mm vs. 3.7 6 1.9 mm; P 5 .02, 4.8 6 2.1 mm vs. 3.6 6 1.7 mm; P5 .01, respectively). In infants without maternal and paternal allergic diseases, no significant difference in wheal sizes to histamine was between infants with and without eczema. CONCLUSIONS: Parental allergic diseases may effect skin hypersensitivity to histamine mediated mast cells or histamine receptors in their infants, and initiate eczema.