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Asthma education for pediatric patients and their caregivers improves outcomes
J ALLERGY CLIN IMMUNOL VOLUME 109, NUMBER 1
Abstracts
correlation (0.43) in the emotion domain and an insignificant correlation (0.17) in the activity domain. The relationship between overall mean scores varies by age; for children <12 and their caregivers the correlation was significant but was not in children >= 12. CONCLUSIONS: In this analysis, the PAQLQ and PACQOL scores are moderately associated. Additionally, these data support the theory that the correlation between caregiver and child reported asthma symptoms is stronger in young children than in older. We found the strongest correlation to be in the emotion domain, especially of the younger children.
All Families (n=113) Mean
Child < 12 yrs. (n=57)
Corr. Mean
Child _>12yrs. (n=56)
Corr. Mean
Corr.
Overall QOL
Caregiver 5.645.16 0.38* 5.206.09 0.40* 5.045.28 0.33 Child Emotion Domain Caregiver 5.585.57 0.43* 5.175.40 0.45* 6.005.74 0.38* Child ActivityDomain Caregiver 5.794.75 0.17 5.294.69 0.13 6.294.82 0.22 Child *p
2~N Asthma Education for Pediatric Patients and Their Caregivers ~ I P V Improves Outcomes
Lawrence A Caliguiri*, Wilma Charlean Light§, Richard L Green*, Lloyd CorderE Philip E Gallagher*, Joan Kilby* *Center for Asthma and Allergy Care, Pittsburgh, PA §Pennsylvania Allergy and Asthma Association, Pittsburgh, PA ¥CorCom, Incorporated, Pittsburgh, PA Asthma Care Education: Intensive Training (ACE IT!) is an interactive, small-group education program for pediatric asthma patients and their parents/caregivers. A pilot study showed significant improvement in the intervention group who received formal interactive training compared to the nonintervention group who received only printed material. The parents of the intervention group felt more control/confident in managing asthma and the children improved in self-management, knowledge and health beliefs (J Allergy Clin Immunol 105:$7, 2000). The present study expanded the ACE IT! program to 30 patients, ages 6 to 12 years, and their parents/caregivers. Primary care physicians managed the patients; only two have seen an asthma specialist. Half of the children had previous hospitalizations for asthma, 68% required urgent office and 35% had ED visits in the preceding 12month period. An asthma educator conducted the 3-weekly sessions in Pittsburgh and Erie, Pennsylvania. Following the didactic training the asthma educator and an allergist held separate Q & A sessions with the parents/caregivers and the children. The participants were evaluated using standardized 5-point scales at the beginning, conclusion, 6 months and one year after the 3-weekly sessions. The outcomes measured included behaviors that influence self-management, positive decision-making, knowledge as well as objective clinical outcomes. After the 3-weekly sessions, nocturnal awakenings dropped from 53.6% to 41.2% and the number of patients reporting a frequency of two or more awakenings/month dropped from 9 to 5 with fewer parent interruptions during the night (12 versus 9 times). Symptom-free
$95
days also improved from a mean of 20 days/month to over 25 days/month. There were significant improvements in the daily use of peak flow meters (p=0.001), willingness to continue medications that 'did not work' within the first week (p=0.03), feeling less worried about asthma attacks (p=0.045) and knowledge in the use of peak flow meters (p=0.05). There were positive trends in avoidance of allergic triggers such as furred animals (p=0.07), confidence in changing medications when asthma worsens (p=0.076), doing a peak flow reading when they feel sick (p=0.076) and feeling that asthma is my fault (p=0.086). These results indicate that asthma education in small interactive groups of patients and their parents/caregivers improves their knowledge and health behaviors that advance self-management and positive decision-making. These changes will be monitored to determine the long term effects on morbidity, quality of life and the cost effective index.
251 With Pre-0perative Penicillin Allergy Testing in 0rthopedic Patients a History of Penicillin Allergy Jacqueline Mary Rothmeier, Patricia Markus, Douglas Osmon, Lynn Estes, Arlen Hanssen, James T Li Mayo Clinic, Rochester, MN PURPOSE: To evaluate the utility of penicillin skin testing to the major and minor determinants in orthopedic patients with a history of penicillin allergy. M E T H O D : Orthopedic patients who have a self-reported history of penicillin allergy undergo same day penicillin skin testing and consultations with an allergy nurse and allergist at Mayo Clinic, Rochester, MN. Patients are asked to describe the reaction they experienced to penicillin. We correlated the medical history, penicillin skin testing results, and clinical outcomes. RESULTS: We studied 422 orthopedic patients (166 males and 256 females) with a history of a penicillin allergy from April 15, 1999 to May 31, 2001. Fourteen (14) patients (3%) had positive skin tests and 408 patients (97%) had negative skin tests to penicillin. Of the 14 patients that had positive skin tests to penicillin, 10 patients (71%) were skin test positive to benzylpenicilloyl polylysine (Pre-Pen); 5 patients (36%) were skin test positive to penicillin G potassium; and 2 patients (14%) were skin test positive to alkaline hydrolysis. Three (3) patients (21%) were skin test positive to more than one of the penicillin determinants. Of the 422 patients, 206 (49%) reported rash; 126 (30%) hives; 49 (12%) localized swelling; 42 (10%) other reactions; 29 (7%) unknown; 22 (5%) itching; 12 (3%) angioedema; 11 (3%) shortness of breath; and 8 (2%) anaphylaxis (some patients reported more than one reaction). Of the 14 patients with a positive skin test to penicillin, 7 (50%) reported rash; 5 (36%) hives; 3 (21%) localized swelling; 1 (7%) other reactions; 1 (7%) itching; and 1 (7%) angioedema. There were no reported reactions to anaphylaxis or shortness of breath. Of the 14 patients with positive skin tests, 11 (79%) received vancomycin for their prophylactic antibiotic and 3 (21%) received cefazolin. Four hundred eight (408) patients had negative skin tests to penicillin, of which 380 (93%) were recommended to receive cefazolin (instead of vancomycin). CONCLUSION: 1. Benzylpenicilloyl polylysine (Pre-Pen) is an essential component of penicillin allergy skin testing. 2. There is no correlation between description of reaction and penicillin skin test results. 3. Skin tests to penicillin and consultation with an allergist significantly reduced the use of vancomycin.
Abstracts
correlation (0.43) in the emotion domain and an insignificant correlation (0.17) in the activity domain. The relationship between overall mean scores varies by age; for children <12 and their caregivers the correlation was significant but was not in children >= 12. CONCLUSIONS: In this analysis, the PAQLQ and PACQOL scores are moderately associated. Additionally, these data support the theory that the correlation between caregiver and child reported asthma symptoms is stronger in young children than in older. We found the strongest correlation to be in the emotion domain, especially of the younger children.
All Families (n=113) Mean
Child < 12 yrs. (n=57)
Corr. Mean
Child _>12yrs. (n=56)
Corr. Mean
Corr.
Overall QOL
Caregiver 5.645.16 0.38* 5.206.09 0.40* 5.045.28 0.33 Child Emotion Domain Caregiver 5.585.57 0.43* 5.175.40 0.45* 6.005.74 0.38* Child ActivityDomain Caregiver 5.794.75 0.17 5.294.69 0.13 6.294.82 0.22 Child *p
2~N Asthma Education for Pediatric Patients and Their Caregivers ~ I P V Improves Outcomes
Lawrence A Caliguiri*, Wilma Charlean Light§, Richard L Green*, Lloyd CorderE Philip E Gallagher*, Joan Kilby* *Center for Asthma and Allergy Care, Pittsburgh, PA §Pennsylvania Allergy and Asthma Association, Pittsburgh, PA ¥CorCom, Incorporated, Pittsburgh, PA Asthma Care Education: Intensive Training (ACE IT!) is an interactive, small-group education program for pediatric asthma patients and their parents/caregivers. A pilot study showed significant improvement in the intervention group who received formal interactive training compared to the nonintervention group who received only printed material. The parents of the intervention group felt more control/confident in managing asthma and the children improved in self-management, knowledge and health beliefs (J Allergy Clin Immunol 105:$7, 2000). The present study expanded the ACE IT! program to 30 patients, ages 6 to 12 years, and their parents/caregivers. Primary care physicians managed the patients; only two have seen an asthma specialist. Half of the children had previous hospitalizations for asthma, 68% required urgent office and 35% had ED visits in the preceding 12month period. An asthma educator conducted the 3-weekly sessions in Pittsburgh and Erie, Pennsylvania. Following the didactic training the asthma educator and an allergist held separate Q & A sessions with the parents/caregivers and the children. The participants were evaluated using standardized 5-point scales at the beginning, conclusion, 6 months and one year after the 3-weekly sessions. The outcomes measured included behaviors that influence self-management, positive decision-making, knowledge as well as objective clinical outcomes. After the 3-weekly sessions, nocturnal awakenings dropped from 53.6% to 41.2% and the number of patients reporting a frequency of two or more awakenings/month dropped from 9 to 5 with fewer parent interruptions during the night (12 versus 9 times). Symptom-free
$95
days also improved from a mean of 20 days/month to over 25 days/month. There were significant improvements in the daily use of peak flow meters (p=0.001), willingness to continue medications that 'did not work' within the first week (p=0.03), feeling less worried about asthma attacks (p=0.045) and knowledge in the use of peak flow meters (p=0.05). There were positive trends in avoidance of allergic triggers such as furred animals (p=0.07), confidence in changing medications when asthma worsens (p=0.076), doing a peak flow reading when they feel sick (p=0.076) and feeling that asthma is my fault (p=0.086). These results indicate that asthma education in small interactive groups of patients and their parents/caregivers improves their knowledge and health behaviors that advance self-management and positive decision-making. These changes will be monitored to determine the long term effects on morbidity, quality of life and the cost effective index.
251 With Pre-0perative Penicillin Allergy Testing in 0rthopedic Patients a History of Penicillin Allergy Jacqueline Mary Rothmeier, Patricia Markus, Douglas Osmon, Lynn Estes, Arlen Hanssen, James T Li Mayo Clinic, Rochester, MN PURPOSE: To evaluate the utility of penicillin skin testing to the major and minor determinants in orthopedic patients with a history of penicillin allergy. M E T H O D : Orthopedic patients who have a self-reported history of penicillin allergy undergo same day penicillin skin testing and consultations with an allergy nurse and allergist at Mayo Clinic, Rochester, MN. Patients are asked to describe the reaction they experienced to penicillin. We correlated the medical history, penicillin skin testing results, and clinical outcomes. RESULTS: We studied 422 orthopedic patients (166 males and 256 females) with a history of a penicillin allergy from April 15, 1999 to May 31, 2001. Fourteen (14) patients (3%) had positive skin tests and 408 patients (97%) had negative skin tests to penicillin. Of the 14 patients that had positive skin tests to penicillin, 10 patients (71%) were skin test positive to benzylpenicilloyl polylysine (Pre-Pen); 5 patients (36%) were skin test positive to penicillin G potassium; and 2 patients (14%) were skin test positive to alkaline hydrolysis. Three (3) patients (21%) were skin test positive to more than one of the penicillin determinants. Of the 422 patients, 206 (49%) reported rash; 126 (30%) hives; 49 (12%) localized swelling; 42 (10%) other reactions; 29 (7%) unknown; 22 (5%) itching; 12 (3%) angioedema; 11 (3%) shortness of breath; and 8 (2%) anaphylaxis (some patients reported more than one reaction). Of the 14 patients with a positive skin test to penicillin, 7 (50%) reported rash; 5 (36%) hives; 3 (21%) localized swelling; 1 (7%) other reactions; 1 (7%) itching; and 1 (7%) angioedema. There were no reported reactions to anaphylaxis or shortness of breath. Of the 14 patients with positive skin tests, 11 (79%) received vancomycin for their prophylactic antibiotic and 3 (21%) received cefazolin. Four hundred eight (408) patients had negative skin tests to penicillin, of which 380 (93%) were recommended to receive cefazolin (instead of vancomycin). CONCLUSION: 1. Benzylpenicilloyl polylysine (Pre-Pen) is an essential component of penicillin allergy skin testing. 2. There is no correlation between description of reaction and penicillin skin test results. 3. Skin tests to penicillin and consultation with an allergist significantly reduced the use of vancomycin.