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ORIGINAL ARTICLE HIGHLIGHTS FROM THIS ISSUE
Wet Wrap Therapy in Children with Moderate to Severe Atopic Dermatitis in a Multidisciplinary Treatment Program Nicol et al
400
What is already known about this topic? Atopic dermatitis (AD) remains a complex, common, chronic, and relapsing skin disorder. National and international AD guidelines discuss treatment of AD based on severity of AD and include wet wrap therapy (WWT). What does this article add to our knowledge? Although WWT was first described in the AD treatment literature in 1987, only 15 studies of WWT have been published. This study is the largest to date of patients treated with WWT by using a validated outcomes tool and the only one in which WWT was administered under direct nursing supervision. How does this study impact current management guidelines? WWT plays an important role as an acute therapeutic intervention for management of moderate-to-severe AD. WWT should be considered as a treatment option ahead of the systemic therapies for patients for whom topical therapy failed. Effect of a Drug Allergy Educational Program and Antibiotic Prescribing Guideline on Inpatient Clinical Providers’ Antibiotic Prescribing Knowledge Blumenthal et al 407 What is already known about this topic? Patients commonly report allergy to penicillin. General providers lack knowledge of penicillin allergy evaluation. Allergy assessment of inpatients with reported penicillin allergy is important for high quality patient care and appropriate utilization of antibiotics. What does this article add to our knowledge? Providers lack formal education in drug allergy and express interest in tools to help them care for drug-allergic inpatients. A brief educational initiative, paired with a clinical guideline, was associated with improved drug allergy knowledge. How does this study impact current management guidelines? Allergists can work effectively with colleagues from infectious diseases and pharmacy to create guidelines that improve the care of inpatients with drug allergy. Inpatient providers will require additional education about drug allergy. Nonsteroidal Anti-Inflammatory Drugs are Major Causes of Drug-Induced Anaphylaxis Aun et al
414
What is already known about this topic? Drugs are responsible for 40% to 60% of anaphylactic reactions treated in the emergency department. What does this article add to our knowledge? Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis, and they are prescribed to many patients despite a history of a previous reaction. How does this study impact current management guidelines? This study raises awareness of nonsteroidal anti-inflammatory drug anaphylaxis, which can improve the prevention, diagnosis, and treatment of these reactions. Growth Velocity Reduced with Once-Daily Fluticasone Furoate Nasal Spray in Prepubescent Children with Perennial Allergic Rhinitis Lee et al 421 What is already known about this topic? Growth suppression with intranasal corticosteroid treatment ranges from 0.2 to 0.9 cm during 1 year of treatment. Previous intranasal corticosteroid studies have inadequate power or controls for normal variability in growth patterns, which resulted in a lack of clarity on the true effect. What does this article add to our knowledge? This study of approximately 450 prepubescent children was able to detect a small reduction in growth velocity ( 0.27 cm/y [95% CI, 0.48 to 0.06 cm/y]) after 52 weeks of treatment with fluticasone furoate nasal spray 110 mcg once daily compared with placebo. How does this study impact current management guidelines? Clinicians will need to balance the reduction in growth observed with fluticasone furoate nasal spray to its potential for clinical benefit.
10A
J ALLERGY CLIN IMMUNOL PRACT VOLUME 2, NUMBER 4
11A
Management of Hypersensitivity Reactions to Carboplatin and Paclitaxel in an Outpatient Oncology Infusion Center: A 5-Year Review Banerji et al 428 What is already known about this topic? Carboplatin and Taxol are frequently associated with drug hypersensitivity reactions. Drug desensitization is a successful way to manage these patients after a hypersensitivity reaction. What does this article add to our knowledge? The clinical symptoms and timing of hypersensitivity reactions to carboplatin is distinct from hypersensitivity reactions to Taxol. Many patients with Taxol hypersensitivity reactions tolerated rechallenge in the outpatient infusion center without desensitization. How does this study impact current management guidelines? Desensitization should be offered to all patients with severe hypersensitivity reactions to carboplatin and paclitaxel who need to remain on first-line therapy. Whether patients reactive to paclitaxel with mild-to-moderate reactions can be safely rechallenged with premedications needs further study. Treatment of Chronic Urticaria in Children with Antihistamines and Cyclosporine Neverman et al
434
What is already known about this topic? Controlled clinical trials of cyclosporine have demonstrated efficacy and relative safety for cyclosporine for adults. What does this article add to our knowledge? This report demonstrates that cyclosporine appears to be effective and safe for pediatric patients with chronic idiopathic urticaria resistant to antihistamines and that antihistamine resistance is not explained by the presence of autoantibodies as currently determined. How does this study impact current management guidelines? Other agents proposed for antihistamine resistant chronic idiopathic urticaria include H2 antagonists, leukotriene modifiers, prednisone, doxepin, sulfasalazine, and omalizumab. The apparent relative efficacy and safety of cyclosporine justify considering cyclosporine an option for children with antihistamine resistant chronic idiopathic urticaria. Penicillin Skin Testing Is a Safe and Effective Tool for Evaluating Penicillin Allergy in the Pediatric Population Fox et al 439 What is already known about this topic? Penicillin skin testing is safe and effective in the evaluation of adult patients with a history of penicillin allergy but has not been validated in the pediatric population. What does this article add to our knowledge? Penicillin skin testing was safe and effective in the evaluation of children with a history of penicillin allergy. How does this study impact current management guidelines? Our study confirms the safety and validity of penicillin skin testing in the pediatric population and enables clinicians to have a robust discussion with the parents of pediatric patients with a history of penicillin allergy regarding penicillin skin testing. Real-Time Asthma Outreach Reduces Excessive Short-acting b2-Agonist Use: A Randomized Study Zeiger et al 445 What is already known about this topic? Excessive short-acting b2-agonist (SABA) use is an administrative asthma impairment marker that identifies patients with uncontrolled asthma; however, efforts to improve care of such patients have been challenging and inadequately studied in managed care organizations. What does this article add to our knowledge? A novel asthma outreach randomized study that uses innovative information technology in a large managed care organization with an electronic medical record system demonstrated that real-time identification, notification, and facilitated allergy specialist referral for excessive SABA users reduce subsequent SABA canister dispensings and improves markers of asthma care in patients without prior asthma specialist care. How does this study impact current management guidelines? This novel administrative-based outreach intervention directed at excessive SABA users could be adaptable to other managed care organizations with electronic medical records.
Wet Wrap Therapy in Children with Moderate to Severe Atopic Dermatitis in a Multidisciplinary Treatment Program Nicol et al
400
What is already known about this topic? Atopic dermatitis (AD) remains a complex, common, chronic, and relapsing skin disorder. National and international AD guidelines discuss treatment of AD based on severity of AD and include wet wrap therapy (WWT). What does this article add to our knowledge? Although WWT was first described in the AD treatment literature in 1987, only 15 studies of WWT have been published. This study is the largest to date of patients treated with WWT by using a validated outcomes tool and the only one in which WWT was administered under direct nursing supervision. How does this study impact current management guidelines? WWT plays an important role as an acute therapeutic intervention for management of moderate-to-severe AD. WWT should be considered as a treatment option ahead of the systemic therapies for patients for whom topical therapy failed. Effect of a Drug Allergy Educational Program and Antibiotic Prescribing Guideline on Inpatient Clinical Providers’ Antibiotic Prescribing Knowledge Blumenthal et al 407 What is already known about this topic? Patients commonly report allergy to penicillin. General providers lack knowledge of penicillin allergy evaluation. Allergy assessment of inpatients with reported penicillin allergy is important for high quality patient care and appropriate utilization of antibiotics. What does this article add to our knowledge? Providers lack formal education in drug allergy and express interest in tools to help them care for drug-allergic inpatients. A brief educational initiative, paired with a clinical guideline, was associated with improved drug allergy knowledge. How does this study impact current management guidelines? Allergists can work effectively with colleagues from infectious diseases and pharmacy to create guidelines that improve the care of inpatients with drug allergy. Inpatient providers will require additional education about drug allergy. Nonsteroidal Anti-Inflammatory Drugs are Major Causes of Drug-Induced Anaphylaxis Aun et al
414
What is already known about this topic? Drugs are responsible for 40% to 60% of anaphylactic reactions treated in the emergency department. What does this article add to our knowledge? Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis, and they are prescribed to many patients despite a history of a previous reaction. How does this study impact current management guidelines? This study raises awareness of nonsteroidal anti-inflammatory drug anaphylaxis, which can improve the prevention, diagnosis, and treatment of these reactions. Growth Velocity Reduced with Once-Daily Fluticasone Furoate Nasal Spray in Prepubescent Children with Perennial Allergic Rhinitis Lee et al 421 What is already known about this topic? Growth suppression with intranasal corticosteroid treatment ranges from 0.2 to 0.9 cm during 1 year of treatment. Previous intranasal corticosteroid studies have inadequate power or controls for normal variability in growth patterns, which resulted in a lack of clarity on the true effect. What does this article add to our knowledge? This study of approximately 450 prepubescent children was able to detect a small reduction in growth velocity ( 0.27 cm/y [95% CI, 0.48 to 0.06 cm/y]) after 52 weeks of treatment with fluticasone furoate nasal spray 110 mcg once daily compared with placebo. How does this study impact current management guidelines? Clinicians will need to balance the reduction in growth observed with fluticasone furoate nasal spray to its potential for clinical benefit.
10A
J ALLERGY CLIN IMMUNOL PRACT VOLUME 2, NUMBER 4
11A
Management of Hypersensitivity Reactions to Carboplatin and Paclitaxel in an Outpatient Oncology Infusion Center: A 5-Year Review Banerji et al 428 What is already known about this topic? Carboplatin and Taxol are frequently associated with drug hypersensitivity reactions. Drug desensitization is a successful way to manage these patients after a hypersensitivity reaction. What does this article add to our knowledge? The clinical symptoms and timing of hypersensitivity reactions to carboplatin is distinct from hypersensitivity reactions to Taxol. Many patients with Taxol hypersensitivity reactions tolerated rechallenge in the outpatient infusion center without desensitization. How does this study impact current management guidelines? Desensitization should be offered to all patients with severe hypersensitivity reactions to carboplatin and paclitaxel who need to remain on first-line therapy. Whether patients reactive to paclitaxel with mild-to-moderate reactions can be safely rechallenged with premedications needs further study. Treatment of Chronic Urticaria in Children with Antihistamines and Cyclosporine Neverman et al
434
What is already known about this topic? Controlled clinical trials of cyclosporine have demonstrated efficacy and relative safety for cyclosporine for adults. What does this article add to our knowledge? This report demonstrates that cyclosporine appears to be effective and safe for pediatric patients with chronic idiopathic urticaria resistant to antihistamines and that antihistamine resistance is not explained by the presence of autoantibodies as currently determined. How does this study impact current management guidelines? Other agents proposed for antihistamine resistant chronic idiopathic urticaria include H2 antagonists, leukotriene modifiers, prednisone, doxepin, sulfasalazine, and omalizumab. The apparent relative efficacy and safety of cyclosporine justify considering cyclosporine an option for children with antihistamine resistant chronic idiopathic urticaria. Penicillin Skin Testing Is a Safe and Effective Tool for Evaluating Penicillin Allergy in the Pediatric Population Fox et al 439 What is already known about this topic? Penicillin skin testing is safe and effective in the evaluation of adult patients with a history of penicillin allergy but has not been validated in the pediatric population. What does this article add to our knowledge? Penicillin skin testing was safe and effective in the evaluation of children with a history of penicillin allergy. How does this study impact current management guidelines? Our study confirms the safety and validity of penicillin skin testing in the pediatric population and enables clinicians to have a robust discussion with the parents of pediatric patients with a history of penicillin allergy regarding penicillin skin testing. Real-Time Asthma Outreach Reduces Excessive Short-acting b2-Agonist Use: A Randomized Study Zeiger et al 445 What is already known about this topic? Excessive short-acting b2-agonist (SABA) use is an administrative asthma impairment marker that identifies patients with uncontrolled asthma; however, efforts to improve care of such patients have been challenging and inadequately studied in managed care organizations. What does this article add to our knowledge? A novel asthma outreach randomized study that uses innovative information technology in a large managed care organization with an electronic medical record system demonstrated that real-time identification, notification, and facilitated allergy specialist referral for excessive SABA users reduce subsequent SABA canister dispensings and improves markers of asthma care in patients without prior asthma specialist care. How does this study impact current management guidelines? This novel administrative-based outreach intervention directed at excessive SABA users could be adaptable to other managed care organizations with electronic medical records.