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Definitive Diagnosis of Nut Allergy
ABSTRACTS
Assistant Editor: Michael J Maloney, M.D.
Definitive Diagnosis of Nut Allergy. D. Armstrong, G. Rylance
Objective: To compare findings of tests for nut allergy in children. Design: Retrospective survey of a clinical practice protocol. Setting: Children's hospital paediatric outpatient clinic. Subjects: 96 children referred by general practitioners and accident and emergency doctors over 27 months (1994-96). Main Outcome Measures: Allergic manifestations (generalized urticarial rash, facial swelling, bronchospasm, anaphylactic shock, vomiting on three occasions) related to specific nut IgE concentrations and following touch, skin prick, or oral ingestion of nuts. Results: 16 children from sample of 51 who were tested for nut allergy had no reaction to an oral challenge. Positive IgE against peanuts was found in nine of these 16 children. Conclusions: Skin prick testing and IgE measured by radioallergosorbent testing are inadequate tests for nut allergy. The definitive diagnostic test for nut allergy in the hospital setting is direct oral challenge. Arch Dis Child 1999;80: 175-177. Reproduced with permission from the BMJ Publishing Group. Estrogen Levels in Girls With Premature Thelarche Compared With Normal Prepubertal Girls as Determined by an Ultrasensitive Recombinant Cell Bioassay. Karen Oerter Klein, MD, Veronica Mercq, MD, Jacquelyn M. Brown-Dawson, Kimberly A. Larmore, Patricia Cabezas, Amanda Cortinez, MD
Objective: Estradiol levels in girls with premature thelarche have not previously been well defined because of the lack of adequate sensitivity of previously available estradiol assays. The ultrasensitive recombinant cell bioassay for estradiol has made the study of estradiol levels in premature thelarche possible. We hypothesized that girls with premature thelarche have higher estradiol levels than normal prepubertal girls. Study Design: We used an ultrasensitive recombinant cell bioassay to study estradiol levels in 20 girls with premature thelarche and 15 normal prepubertal girls less than 3 years of age. The 2 groups were compared by Student t test. Results: Estradiol levels were significantly greater in the girls with premature thelarche (8.4 ± 4.5 pmollL estradiol equivalents) than in the normal prepubertal girls (3.3 ± 3.5 pmol/L estradiol equivalents: P < .01). The estradiol level was not significantly correlated with age, height, weight, body mass index, age at onset of thelarche, or the presence or absence of ovarian cysts. Conclusion: Girls with premature thelarche have significantly higher estradiol levels than normal prepubertal girls. This is consistent with the hypothesis that the mechanism or premature thelarche involves increased estradiol levels rather than increased sensitivity of breast tissue to normal estradiol levels. J Pediatr 1999; 134: 190-192. Reproduced with permission from Mosby-Year Book, Inc. Biopsychological and Cognitive Differences in Children With Premature vs On-Time Adrenarche. Lorah D. Dorn, PhD, RN, CPNp, Stacie F. Hitt, PhD, RN, Deborah Rotenstein, MD
Background: Puberty consists of 2 components: gonadarche and adrenarche. Both components have distinct endocrine changes. Adrenarche has virtually been ignored with respect to examining hormone-behavior relations. Objectives: To provide descriptive biological and behavioral information on children with premature adrenarche (PA) and to examine differences in biological, psychological, and cognitive variables of children with PA and a healthy comparison group of children with on-time adrenarche. Design: Descriptive pilot study. Setting: A consecutive sample of patients was recruited from pediatric endocrine clinics; comparison children were recruited from the community. Participants: Children aged 6 to 9 years. Mean (±SD) age of children with PA (n = 9) was 7.8 (±1.3) years; of children with on-time adrenarche (n = 20), 8.0 (±1.2) years. Methods andMeasures: Serum and saliva samples were collected for measurement of hormone concentrations. Questionnaires, tests and interviews were completed by children and parents. Results: Compared with the on-time group, the PA group had significantly higher concentrations of adrenal androgens, estradiol, thyrotropin, and cortisol. By parent report on the Diagnostic Interview Schedule for Children, 4 children (44%) met diagnostic criteria for psychological disorders (primarily anxiety disorders). The PA group also had more self-reported depression and parent-reported behavior problems and lower scores on various intelligence tests. Conclusions: Although PA is considered a normal variation of pubertal development that warrants no medical intervention, PA presents with significant psychosocial problems. Children with PA may need psychological evaluation and follow-up. Future studies should confirm these findings with a larger sample and examine the long-term ramifications of this early presenting abnormality. Arch Pediatr Adolesc Med 1999;153:137-146. Copyright 1999, American Medical Association. Beach Week: A High School Graduation Rite of Passage for Sun, Sand, Suds, and Sex. Richard H. Schwartz, MD, Regina Milteer, MD, Michael J. Sheridan, DSc, Cynthia P. Horner, MD
Background: Every year, thousands of suburban high school graduates from mid Atlantic states flock to nearby coastal beaches for a long-anticipated rite of passage known as "beach week." Sand, sun, and sea, and also smoking, binge drinking, drugs, and sex, are reported to be dominant themes. Objective: To document risk-taking beahviors by girls during beach week. Method: Fifty-nine female suburban high school graduates who attended beach week in 1996 volunteered to fill out a confidential printed survey. Twenty-five girls (42%) completed the survey during a typical beach week party. Their activities were verified on site by a peer, recommended by her grade advisor for her integrity and popularity. Breath alcohol values were obtained at entry and departure from the party. The remaining 34 girls completed the supervised survey 2 to 3 months later. Results: Daily cigarette smoking (54%), daily drunkenness (75%), and sex (46%) were the norm among respondents of our survey. Few reported first-time sex (n = 4) or drug use (n = 2). Abstinence from drugs (67%) and sex (55%) was not unusual but only 12% abstained from getting drunk. Sixteen girls (64%) reported that they drank 8 or more beers/wine during a typical beach week party. By departure from the party, 15 girls had breath alcohol values of 0.017 mmollL or greater (reference range, <21.7 mmollL), and 8 additional girls had breath alcohol values of 0.01 mmollL to 0.015 mmollL. Fifteen percent of the 59 reported injuries or illness were related to alcohol or drugs. Conclusion: Most respondents enjoyed beach week but a large percentage engaged in serious risk-taking behaviors. Arch Pediatr Adolesc Med 1999; 153: 180-183. Copyright 1999, American Medical Association.
1062
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 38:8, AUGUST 1999
Assistant Editor: Michael J Maloney, M.D.
Definitive Diagnosis of Nut Allergy. D. Armstrong, G. Rylance
Objective: To compare findings of tests for nut allergy in children. Design: Retrospective survey of a clinical practice protocol. Setting: Children's hospital paediatric outpatient clinic. Subjects: 96 children referred by general practitioners and accident and emergency doctors over 27 months (1994-96). Main Outcome Measures: Allergic manifestations (generalized urticarial rash, facial swelling, bronchospasm, anaphylactic shock, vomiting on three occasions) related to specific nut IgE concentrations and following touch, skin prick, or oral ingestion of nuts. Results: 16 children from sample of 51 who were tested for nut allergy had no reaction to an oral challenge. Positive IgE against peanuts was found in nine of these 16 children. Conclusions: Skin prick testing and IgE measured by radioallergosorbent testing are inadequate tests for nut allergy. The definitive diagnostic test for nut allergy in the hospital setting is direct oral challenge. Arch Dis Child 1999;80: 175-177. Reproduced with permission from the BMJ Publishing Group. Estrogen Levels in Girls With Premature Thelarche Compared With Normal Prepubertal Girls as Determined by an Ultrasensitive Recombinant Cell Bioassay. Karen Oerter Klein, MD, Veronica Mercq, MD, Jacquelyn M. Brown-Dawson, Kimberly A. Larmore, Patricia Cabezas, Amanda Cortinez, MD
Objective: Estradiol levels in girls with premature thelarche have not previously been well defined because of the lack of adequate sensitivity of previously available estradiol assays. The ultrasensitive recombinant cell bioassay for estradiol has made the study of estradiol levels in premature thelarche possible. We hypothesized that girls with premature thelarche have higher estradiol levels than normal prepubertal girls. Study Design: We used an ultrasensitive recombinant cell bioassay to study estradiol levels in 20 girls with premature thelarche and 15 normal prepubertal girls less than 3 years of age. The 2 groups were compared by Student t test. Results: Estradiol levels were significantly greater in the girls with premature thelarche (8.4 ± 4.5 pmollL estradiol equivalents) than in the normal prepubertal girls (3.3 ± 3.5 pmol/L estradiol equivalents: P < .01). The estradiol level was not significantly correlated with age, height, weight, body mass index, age at onset of thelarche, or the presence or absence of ovarian cysts. Conclusion: Girls with premature thelarche have significantly higher estradiol levels than normal prepubertal girls. This is consistent with the hypothesis that the mechanism or premature thelarche involves increased estradiol levels rather than increased sensitivity of breast tissue to normal estradiol levels. J Pediatr 1999; 134: 190-192. Reproduced with permission from Mosby-Year Book, Inc. Biopsychological and Cognitive Differences in Children With Premature vs On-Time Adrenarche. Lorah D. Dorn, PhD, RN, CPNp, Stacie F. Hitt, PhD, RN, Deborah Rotenstein, MD
Background: Puberty consists of 2 components: gonadarche and adrenarche. Both components have distinct endocrine changes. Adrenarche has virtually been ignored with respect to examining hormone-behavior relations. Objectives: To provide descriptive biological and behavioral information on children with premature adrenarche (PA) and to examine differences in biological, psychological, and cognitive variables of children with PA and a healthy comparison group of children with on-time adrenarche. Design: Descriptive pilot study. Setting: A consecutive sample of patients was recruited from pediatric endocrine clinics; comparison children were recruited from the community. Participants: Children aged 6 to 9 years. Mean (±SD) age of children with PA (n = 9) was 7.8 (±1.3) years; of children with on-time adrenarche (n = 20), 8.0 (±1.2) years. Methods andMeasures: Serum and saliva samples were collected for measurement of hormone concentrations. Questionnaires, tests and interviews were completed by children and parents. Results: Compared with the on-time group, the PA group had significantly higher concentrations of adrenal androgens, estradiol, thyrotropin, and cortisol. By parent report on the Diagnostic Interview Schedule for Children, 4 children (44%) met diagnostic criteria for psychological disorders (primarily anxiety disorders). The PA group also had more self-reported depression and parent-reported behavior problems and lower scores on various intelligence tests. Conclusions: Although PA is considered a normal variation of pubertal development that warrants no medical intervention, PA presents with significant psychosocial problems. Children with PA may need psychological evaluation and follow-up. Future studies should confirm these findings with a larger sample and examine the long-term ramifications of this early presenting abnormality. Arch Pediatr Adolesc Med 1999;153:137-146. Copyright 1999, American Medical Association. Beach Week: A High School Graduation Rite of Passage for Sun, Sand, Suds, and Sex. Richard H. Schwartz, MD, Regina Milteer, MD, Michael J. Sheridan, DSc, Cynthia P. Horner, MD
Background: Every year, thousands of suburban high school graduates from mid Atlantic states flock to nearby coastal beaches for a long-anticipated rite of passage known as "beach week." Sand, sun, and sea, and also smoking, binge drinking, drugs, and sex, are reported to be dominant themes. Objective: To document risk-taking beahviors by girls during beach week. Method: Fifty-nine female suburban high school graduates who attended beach week in 1996 volunteered to fill out a confidential printed survey. Twenty-five girls (42%) completed the survey during a typical beach week party. Their activities were verified on site by a peer, recommended by her grade advisor for her integrity and popularity. Breath alcohol values were obtained at entry and departure from the party. The remaining 34 girls completed the supervised survey 2 to 3 months later. Results: Daily cigarette smoking (54%), daily drunkenness (75%), and sex (46%) were the norm among respondents of our survey. Few reported first-time sex (n = 4) or drug use (n = 2). Abstinence from drugs (67%) and sex (55%) was not unusual but only 12% abstained from getting drunk. Sixteen girls (64%) reported that they drank 8 or more beers/wine during a typical beach week party. By departure from the party, 15 girls had breath alcohol values of 0.017 mmollL or greater (reference range, <21.7 mmollL), and 8 additional girls had breath alcohol values of 0.01 mmollL to 0.015 mmollL. Fifteen percent of the 59 reported injuries or illness were related to alcohol or drugs. Conclusion: Most respondents enjoyed beach week but a large percentage engaged in serious risk-taking behaviors. Arch Pediatr Adolesc Med 1999; 153: 180-183. Copyright 1999, American Medical Association.
1062
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 38:8, AUGUST 1999