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A Randomized Evaluator-blinded Trial of Behavioral Modification Program for Mothers of Children with Atopic Dermatitis
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A Randomized Evaluator-blinded Trial of Behavioral Modification Program for Mothers of Children with Atopic Dermatitis I. Masuko1,2, M. Futamura2,3, K. Hahashi2,4, K. Ito3, Y. Ohya2; 1Gunma Prefectural College of Health Sciences, Maebashi, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3Aichi Children’s Health and Medical Center, Obu, Japan, 4Teikyo University, Tokyo, Japan. RATIONALE: The purpose of this study was to measure the effect of behavioral modification program to mothers of children with atopic dermatitis on disease severity and parents’ quality of life. METHODS: An evaluator-blinded randomized controlled trial (block randomization) was carried out to evaluate the disease severity, parents’ quality of life on the beginning, three and six months after intervention. Parents were randomized in intervention group with two-day hands-on behavioral modification session and three-times follow-up by nurse educators or control group. Two independent blinded allergists scored SCORAD (SCORing of Atopic Dermatitis) on digital image. The scores of quality of life were compared among DFI (Family Impact of Childhood Eczema Questionnaire), QPCAD (Quality of Life in Primary Caregivers of children with Atopic Dermatitis) and SDS (Zung’s Self-Rating Depression Scale). RESULTS: Thirty four children (aged 6 months to 5 years) and their mothers were randomized. Intervention group showed 49.8% reduction in SCORAD index (from 35.3 to 17.2), while control showed only 25.3% reduction in three months (P 5 0.044). The effect of behavioral modification program seems to last for six months with slight attenuation (43.6% vs. 29.1% P 5 0.17). The scores of quality of life did not statistically show significant difference. Furthermore, amount of steroid ointment prescribed was significantly decreased from first three months to second three months only in intervention group (P 5 0.010). CONCLUSIONS: Behavioral modification program significantly improves severity in addition to conventional treatment. However, more rigorous add-on might be needed to maintain good control and to improve parents’ quality of life. This work was supported by KAKENHI (20592591)
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Referral Patterns and Comfort Level of Primary Care Physicians and Residents for Allergy and Immunology Disorders W. Li, I. Paek, A. W. Smith, B. Silverman, A. T. Schneider; Long Island College Hospital, Brooklyn, NY. RATIONALE: To study primary care physicians referral patterns and comfort with common disorders in Allergy and Immunology. METHODS: A survey was electronically distributed to resident or attending physicians practicing Internal Medicine or Pediatrics. The survey consisted of 19 questions that assessed the physician’s comfort level and referral patterns for common disorders encountered in Allergy and Immunology. RESULTS: 40 physicians responded to the survey. The majority of respondents were comfortable managing food allergy (62.5%), atopic dermatitis (77.5%), urticaria (77.5%), allergic rhinitis (100%), and asthma (97.4%) most of the time. The majority was not comfortable managing a primary immunodeficiency disorder (80%) and angioedema (69.2%). Those that completed an Allergy and Immunology (AI) rotation in training (35%) were more comfortable than those physicians who had not done an AI rotation in managing patients with atopic dermatitis (100% vs. 65.4%) and food allergy (85.7% vs. 50%). They were also more likely to refer patients to an AI physician for atopic dermatitis (42.9% vs. 7.7%), angioedema (100% vs. 76.9%), urticaria (92.9% vs. 50%), and allergic rhinitis (85.7% vs. 48%). CONCLUSIONS: Those that completed an AI rotation were more comfortable with common AI disorders and more likely to refer to AI physicians. AI rotations should be enthusiastically encouraged by AI training programs.
170
Shift in Pollen Season and Aeroallergen Index affected Allergic Rhinitis in Texas Panhandle N. Ghosh1, M. Whiteside1, C. Saadeh2, M. Gaylor2, D. W. Smith3, J. Bennert4; 1West Texas A&M University, Canyon, TX, 2Allergy AARTS, Amarillo, TX, 3University of North Texas, Denton, TX, 4Air Oasis, Amarillo, TX. RATIONALE: This study covered characterization of the aeroallergen, comparing the meteorological data, aeroallergen index and clinical data to detect any possible relationship between early flowering and increased cases of seasonal allergic rhinitis in Texas Panhandle. METHODS: We have been analyzing the aeroallergen samples collected on Melinex tape from a Burkard Volumetric Spore Trap every 24 hours for last eight years. We characterized local pollen using fluorescence emitted from pollen using an Olympus BX40 Microscope equipped with fluorescein-isothiocyanate (FITC) and tetramethylrhodamine (TRITC) filters, a mercury lamp source, and an Olympus DP70 digital camera with Image Pro 6.0 software. We compared the pollen data with daily mean temperature, precipitation, peak wind speed and clinical studies established at Allergy A.R.T.S. Clinical Research Laboratory. RESULTS: Early flowering and a gradual shift in arrival of spring have been recorded in recent years. We have recorded early blooming and prolific pollen production among the weeds in Texas Panhandle area that has significant correlation with increased cases of allergic rhinitis cases. The pollen count increased significantly in short ragweed (Ambrosia artemisiifolia), all the grasses (Poaceae), hairy sunflower (Helianthus hirsutus), buffalo bur (Solanum rostratum), purple nightshade (Solanum elaeagnifolium) and lamb’s quarters (Chenopodium album) and many other weeds. CONCLUSIONS: In recent years the number of cases of allergic rhinitis is up significantly. We found a strong correlation between the early flowering, change in pollen season and higher count among allergenic taxa with the increased cases of allergic rhinitis in Texas Panhandle.
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Linking Numeracy and Health-related Quality of Life A. J. Apter, X. Wang, D. K. Bogen, I. M. Bennett, R. M. Jennings, L. Garcia, T. Sharpe, C. Frazier, T. Ten Have; University of Pennsylvania, Philadelphia, PA. RATIONALE: We examined how numerical skills that can play a role in patient management of asthma contribute to asthma-related quality of life (AQOL). METHODS: Adults with moderate or severe asthma completed the Asthma Numeracy Questionnaire (ANQ), the Mini Asthma Quality of Life Questionnaire (miniAQLQ), and a questionnaire of sociodemographics and self-efficacy related to asthma self-management barriers. The numeracy-AQOL relationship was assessed in the context of potential confounders and mediators with Spearman correlations. Confounders (demographic variables) were defined to be variables that conceptually impacted both numeracy and quality of life. Mediators (income, self-efficacy) were variables conceptually influenced by numeracy but still impacting AQOL. RESULTS: 80 adults, 47 6 13 years, 55 female, 52 African American, 9 Latino, 69 high school graduates, mean FEV1ppd 66% 6 17%, 21 with hospitalizations and 39 with ED visits for asthma in the last year were evaluated. On univariable analysis, ANQ (r 5 0.24, p 5 0.03) was correlated with miniAQLQ. The association of ANQ with miniAQLQ was sustained (r 5 0.27, p 5 0.02) when controlling for potential confounders significantly associated with quality of life (age and Latino ethnicity). Furthermore, the ANQ-miniAQLQ association was clearly mediated by household income with an 81% reduction in the correlation when adjusting for income (r 5 0.05, p 5 0.66), but only partially mediated by selfefficacy with a 26% reduction in the correlation when controlling for self-efficacy (r 5 0.20, p 5 0.08). CONCLUSIONS: Numerical skills specific to health-related tasks such as self-management of asthma are associated with health-specific quality of life. Numeracy may influence AQOL by its impact on income and somewhat by its impact on self-efficacy.
SATURDAY
Abstracts S47
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2
A Randomized Evaluator-blinded Trial of Behavioral Modification Program for Mothers of Children with Atopic Dermatitis I. Masuko1,2, M. Futamura2,3, K. Hahashi2,4, K. Ito3, Y. Ohya2; 1Gunma Prefectural College of Health Sciences, Maebashi, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3Aichi Children’s Health and Medical Center, Obu, Japan, 4Teikyo University, Tokyo, Japan. RATIONALE: The purpose of this study was to measure the effect of behavioral modification program to mothers of children with atopic dermatitis on disease severity and parents’ quality of life. METHODS: An evaluator-blinded randomized controlled trial (block randomization) was carried out to evaluate the disease severity, parents’ quality of life on the beginning, three and six months after intervention. Parents were randomized in intervention group with two-day hands-on behavioral modification session and three-times follow-up by nurse educators or control group. Two independent blinded allergists scored SCORAD (SCORing of Atopic Dermatitis) on digital image. The scores of quality of life were compared among DFI (Family Impact of Childhood Eczema Questionnaire), QPCAD (Quality of Life in Primary Caregivers of children with Atopic Dermatitis) and SDS (Zung’s Self-Rating Depression Scale). RESULTS: Thirty four children (aged 6 months to 5 years) and their mothers were randomized. Intervention group showed 49.8% reduction in SCORAD index (from 35.3 to 17.2), while control showed only 25.3% reduction in three months (P 5 0.044). The effect of behavioral modification program seems to last for six months with slight attenuation (43.6% vs. 29.1% P 5 0.17). The scores of quality of life did not statistically show significant difference. Furthermore, amount of steroid ointment prescribed was significantly decreased from first three months to second three months only in intervention group (P 5 0.010). CONCLUSIONS: Behavioral modification program significantly improves severity in addition to conventional treatment. However, more rigorous add-on might be needed to maintain good control and to improve parents’ quality of life. This work was supported by KAKENHI (20592591)
169
Referral Patterns and Comfort Level of Primary Care Physicians and Residents for Allergy and Immunology Disorders W. Li, I. Paek, A. W. Smith, B. Silverman, A. T. Schneider; Long Island College Hospital, Brooklyn, NY. RATIONALE: To study primary care physicians referral patterns and comfort with common disorders in Allergy and Immunology. METHODS: A survey was electronically distributed to resident or attending physicians practicing Internal Medicine or Pediatrics. The survey consisted of 19 questions that assessed the physician’s comfort level and referral patterns for common disorders encountered in Allergy and Immunology. RESULTS: 40 physicians responded to the survey. The majority of respondents were comfortable managing food allergy (62.5%), atopic dermatitis (77.5%), urticaria (77.5%), allergic rhinitis (100%), and asthma (97.4%) most of the time. The majority was not comfortable managing a primary immunodeficiency disorder (80%) and angioedema (69.2%). Those that completed an Allergy and Immunology (AI) rotation in training (35%) were more comfortable than those physicians who had not done an AI rotation in managing patients with atopic dermatitis (100% vs. 65.4%) and food allergy (85.7% vs. 50%). They were also more likely to refer patients to an AI physician for atopic dermatitis (42.9% vs. 7.7%), angioedema (100% vs. 76.9%), urticaria (92.9% vs. 50%), and allergic rhinitis (85.7% vs. 48%). CONCLUSIONS: Those that completed an AI rotation were more comfortable with common AI disorders and more likely to refer to AI physicians. AI rotations should be enthusiastically encouraged by AI training programs.
170
Shift in Pollen Season and Aeroallergen Index affected Allergic Rhinitis in Texas Panhandle N. Ghosh1, M. Whiteside1, C. Saadeh2, M. Gaylor2, D. W. Smith3, J. Bennert4; 1West Texas A&M University, Canyon, TX, 2Allergy AARTS, Amarillo, TX, 3University of North Texas, Denton, TX, 4Air Oasis, Amarillo, TX. RATIONALE: This study covered characterization of the aeroallergen, comparing the meteorological data, aeroallergen index and clinical data to detect any possible relationship between early flowering and increased cases of seasonal allergic rhinitis in Texas Panhandle. METHODS: We have been analyzing the aeroallergen samples collected on Melinex tape from a Burkard Volumetric Spore Trap every 24 hours for last eight years. We characterized local pollen using fluorescence emitted from pollen using an Olympus BX40 Microscope equipped with fluorescein-isothiocyanate (FITC) and tetramethylrhodamine (TRITC) filters, a mercury lamp source, and an Olympus DP70 digital camera with Image Pro 6.0 software. We compared the pollen data with daily mean temperature, precipitation, peak wind speed and clinical studies established at Allergy A.R.T.S. Clinical Research Laboratory. RESULTS: Early flowering and a gradual shift in arrival of spring have been recorded in recent years. We have recorded early blooming and prolific pollen production among the weeds in Texas Panhandle area that has significant correlation with increased cases of allergic rhinitis cases. The pollen count increased significantly in short ragweed (Ambrosia artemisiifolia), all the grasses (Poaceae), hairy sunflower (Helianthus hirsutus), buffalo bur (Solanum rostratum), purple nightshade (Solanum elaeagnifolium) and lamb’s quarters (Chenopodium album) and many other weeds. CONCLUSIONS: In recent years the number of cases of allergic rhinitis is up significantly. We found a strong correlation between the early flowering, change in pollen season and higher count among allergenic taxa with the increased cases of allergic rhinitis in Texas Panhandle.
171
Linking Numeracy and Health-related Quality of Life A. J. Apter, X. Wang, D. K. Bogen, I. M. Bennett, R. M. Jennings, L. Garcia, T. Sharpe, C. Frazier, T. Ten Have; University of Pennsylvania, Philadelphia, PA. RATIONALE: We examined how numerical skills that can play a role in patient management of asthma contribute to asthma-related quality of life (AQOL). METHODS: Adults with moderate or severe asthma completed the Asthma Numeracy Questionnaire (ANQ), the Mini Asthma Quality of Life Questionnaire (miniAQLQ), and a questionnaire of sociodemographics and self-efficacy related to asthma self-management barriers. The numeracy-AQOL relationship was assessed in the context of potential confounders and mediators with Spearman correlations. Confounders (demographic variables) were defined to be variables that conceptually impacted both numeracy and quality of life. Mediators (income, self-efficacy) were variables conceptually influenced by numeracy but still impacting AQOL. RESULTS: 80 adults, 47 6 13 years, 55 female, 52 African American, 9 Latino, 69 high school graduates, mean FEV1ppd 66% 6 17%, 21 with hospitalizations and 39 with ED visits for asthma in the last year were evaluated. On univariable analysis, ANQ (r 5 0.24, p 5 0.03) was correlated with miniAQLQ. The association of ANQ with miniAQLQ was sustained (r 5 0.27, p 5 0.02) when controlling for potential confounders significantly associated with quality of life (age and Latino ethnicity). Furthermore, the ANQ-miniAQLQ association was clearly mediated by household income with an 81% reduction in the correlation when adjusting for income (r 5 0.05, p 5 0.66), but only partially mediated by selfefficacy with a 26% reduction in the correlation when controlling for self-efficacy (r 5 0.20, p 5 0.08). CONCLUSIONS: Numerical skills specific to health-related tasks such as self-management of asthma are associated with health-specific quality of life. Numeracy may influence AQOL by its impact on income and somewhat by its impact on self-efficacy.
SATURDAY
Abstracts S47
J ALLERGY CLIN IMMUNOL VOLUME 123, NUMBER 2