Artificial intelligence (AI), first defined in 1955 by John McCarthy, has transformed daily life across industries through applications such as chatbots, autonomous vehicles, and navigation systems. The 2022 release of ChatGPT marked a pivotal moment, highlighting AI’s rapidly expanding potential. The health care industry is increasingly embracing AI-enabled tools across oncology, pathology, and radiology to augment disease screening and clinical workflows. Ambient listening technologies support clinical documentation, reduce administrative burden, and improve patient-physician interactions. Large language models combined with natural language processing are being evaluated for generating clinical summaries managing patient portal messaging and converting freehand notes to electronic health records, while also uncovering patterns in patient data to support more personalized treatments. Forward-thinking health systems are establishing informatics departments to optimize these models. Notably, with 1 in 6 adults sourcing health information from AI, rising to nearly one-quarter among individuals younger than 30 years, there is a growing need to ensure that these technologies provide accurate and reliable information to safeguard patient safety and support appropriate clinical use. PRACTALL, a collaboration between the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy & Clinical Immunology, aims to equip allergist-immunologists with essential AI insights highlighting tools for clinical practice, education, and research. By addressing potential pitfalls and biases, PRACTALL illustrates how AI can enhance efficiency, improve patient care, and alleviate administrative burdens in health care.

The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.

The allergen immunotherapy practice parameters third update recommendations on dose adjustment after a gap in administration during the build-up are based solely on expert opinion, and no recommendations for gaps during maintenance are given. In a previous survey among American Academy of Allergy, Asthma & Immunology (AAAAI) members on subcutaneous allergen immunotherapy, this was addressed, but details were never published. Members of the Immunotherapy, Allergen Standardization, and Allergy Diagnostics Committee of the AAAAI convened a workgroup to address this issue and reanalyze results on the particular survey section. Build-up: many practitioners start dose-adjusting if a patient comes in 14.1/14 days (mean/median) after the last dose and restart immunotherapy after an interruption of 85/90 days. Dosing frequency during maintenance is generally every 3 (12%) to 4 weeks (73%). Maintenance: allergists start dose-adjusting if a patient comes in 5.1/5 weeks (mean/median) after the last dose and completely restart after an interruption of 16/12 weeks (some replied in days [90.4/90 days] or months [4.43/4 months]). Subgroups: physicians with ≥11 years in practice in nonacademic centers or rural/suburban settings tolerate longer gaps before restarting subcutaneous immunotherapy (SCIT). There is no uniform dose-adjustment protocol after gaps in SCIT administration. Prospective studies shall have to help find the best trade-off between safety (dose reduction) without giving in on efficacy (too much dose reduction).

Treatments for asthma continue to evolve and with the development of biologics, we are now entering an arena in which some patients seem to have their asthma symptoms disappear entirely. This dramatic improvement in a chronic disease is reminiscent of remission in other chronic illnesses, such as rheumatoid arthritis; but until now, there has been no accepted definition for remission in asthma. In this issue of Annals, a workgroup that involved asthma experts from North America has put together a list of 6 criteria that they have defined as indicating remission of asthma.1Blaiss M Oppenheimer JJ Corbett M Bacharier L Bernstein J Carr T et al.Consensus of an ACAAI, AAAAI, and ATS workgroup on definition of clinical remission in asthma on treatment.Ann Allergy Asthma Immunol. 2023; 131: 782-785Abstract Full Text Full Text PDF Scopus (2) Google Scholar The criteria include lack of asthma exacerbations, missed work or school, stable pulmonary function, minimal controller therapy, appropriate asthma control scores, and minimal symptoms requiring reliever therapy. This consensus statement has been accepted by several national societies and is important because of the potential to be used in studies of asthma therapeutics. As such, this is an important document worth perusing, and for researchers, a critical component to include in their research studies. Knowing whether one therapy is better at inducing remission in clinical studies will be helpful in proposing hierarchies of therapeutic approaches. As a clinician, how does the definition of asthma remission affect the care you provide individual patients? The short answer is that it should not. This is a definition for research purposes only and not something that should be applied to individual patients, nor should it be used for authorization or removal of authorization of particular therapies. Care of individual patients should focus on control and risk, as outlined in National Asthma Education Prevention Program guidelines.2National Asthma Education and Prevention ProgramExpert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007.J Allergy Clin Immunol. 2007; 120: S94-S138PubMed Google Scholar Indeed, while asthma guidelines continue to evolve, they do not yet include remission as an outcome.3Bacharier LB. Asthma guidelines: where to next?.Ann Allergy Asthma Immunol. 2022; 128: 346-347Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Therefore, the goal of treatment should be to reduce risk and develop prolonged control, but not to try and drive remission. From a clinical standpoint, we do not yet know the relationship between control and remission. It should be stressed that this definition of "remission" is a consensus statement of a group of experts—there are no clinical studies demonstrating that this definition leads to better outcomes for patients. This is a starting point, which will allow comparisons of therapeutics, but will also allow for the definition of remission to be refined in future studies. It is possible that one day, just like with rheumatoid arthritis, we will discuss patients who have had their asthma go into remission as an actual clinical outcome—but we are not there yet. In fact, until more studies are undertaken, we do not yet even know the proportion of properly treated people with asthma who will be able to achieve the criteria in this definition of remission. Therefore, as a clinician, it is important to be aware of these discussions and the potential utility of a definition of remission, but it is too soon to apply this to your clinical practice. Nevertheless, this definition of remission is a good starting point and one that begins to demonstrate the potential to view asthma like many other chronic diseases: a disease that may not necessarily be cured but can be controlled and even sent into a quiescent state with appropriate treatments. Identifying the appropriate therapies and the proper order in which they can be used requires an initial definition, and this workgroup report provides just that. Dr Grayson is the editor-in-chief of Annals of Allergy, Asthma, & Immunology; has served on advisory boards for AbbVie, GlaxoSmithKline, and Merck; has stock options in Invirsa, Inc; serves on the board of directors of the Asthma and Allergy Foundation of America and is Chair of their Medical Scientific Council; and is a member of the American Lung Association Scientific Advisory Committee. Dr Williams has no conflicts of interest to report. The authors have no funding sources to report.

Digital inhalers can offer opportunities such as increased flexibility and access to help optimize patient care; however, evidence on how to implement this technology into complex healthcare environments is poorly reported and categorized. Theoretical frameworks, such as the consolidated framework for implementation research (CFIR), can be used to guide research to understand how digital inhaler technology is implemented in clinical practice. This mixed-methods study aimed to use the CFIR framework to explore the real-world experiences of specialists who implemented a novel digital inhaler in clinical practice. A brief web survey was employed and semi-structured telephone interviews were conducted to evaluate facilitators of and barriers to implementation in clinical practice. Participants were US specialists who had prescribed a novel digital inhaler to ≥1 patient with asthma or chronic obstructive pulmonary disease. Sixteen allergists/immunologists and one pulmonologist who prescribed the novel intervention for a mean of 15.1 months (SD 9.1 months) were enrolled. Almost all physicians worked in a group (52.9%) or solo (41.2%) private practice. Implementation barriers included time spent training and onboarding patients, pharmacy, procurement, and prior authorization challenges, costs, and liability. Implementation facilitators included initial use of the technology, patient types, onboarding strategies, training and documentation, processes to facilitate prior authorization, and inhaler data utilization. Insights on barriers and facilitators from early adopters in this study demonstrate the feasibility of implementing a novel digital inhaler technology, despite challenges across different clinical settings, that can offer clinicians an understanding of how to implement this technology to help optimize patient care.

Digital technologies offer potential benefits for practitioners and patients if successfully implemented in the clinic. The experiences and recommendations from early adopters of a novel FDA-approved fully digital inhaler system were explored in a theory-based implementation research study to inform future best practices for implementation. This mixed-methods study comprised semi-structured telephone interviews and a brief web survey with US specialists who had prescribed the novel digital inhaler to ≥1 patient with asthma or chronic obstructive pulmonary disease. A third-party recruitment vendor selected and contacted the physicians to introduce the study, evaluate their initial interest, and assess their eligibility for participation; the sponsor was blinded to the study participants. Physicians were asked to make recommendations for implementation. The study involved 16 allergists/immunologists and one pulmonologist, all of whom had been prescribing the novel intervention for a mean of 15.1 months (SD 9.1 months). Of physicians who were asked directly for recommendations, 12 made 11 different recommendations, while four had no specific recommendations; physicians also provided other unsolicited recommendations throughout the interviews. Recommendations provided by participants could be grouped as: physician/staff training; patient onboarding; patient selection; interactions with pharmacy; and interactions with payers. Participant recommendations included ensuring availability of educational materials for patients and staff, preparing staff to train patients in use of the intervention, and allocation of resources for procurement and/or reimbursement. This implementation study identified recommendations from specialists with early experience of using a novel digital health intervention, providing valuable guidance to inform best practice for implementation of such interventions.

To evaluate the relationship between snoring frequency, primary symptom of sleep-disordered breathing (SDB), and asthma morbidity in children enrolled in the School Inner-City Asthma Study.Study population included 339 students with physician-diagnosed asthma in kindergarten through sixth grade from schools participating in the School Inner-City Asthma study. Inclusion criteria included the presence of typical symptoms in the past 12 months, daily controller medications, or an unscheduled office visit for asthma in the past year.As part of the longitudinal cohort study that followed children for 1 year, questionnaire data on sleep habits were assessed through caregiver report at the baseline and quarterly phone interview. Parents were asked “How often does your child snore?” and possible responses were never, rarely (1–2 nights per week), sometimes (3–5 nights), always or almost always (6–7 nights), or don’t know. Outcomes included maximum symptom days in the previous 2 weeks, health care utilization for asthma and asthma morbidity in the previous 2 weeks.Half of the subjects were overweight or obese. Those reporting habitual snoring were more likely to be obese. One-third had environmental tobacco exposure, two-thirds were atopic, and almost three-quarters had rhinitis, but there were no differences in atopy or rhinitis among the snoring groups. Over the year of follow-up, frequency of snoring fluctuated. Habitual snoring was associated with statistically significant differences in maximum symptom days, healthcare utilization, poor asthma control, and adverse impacts on caregiver sleep and plans compared with nonsnoring or rare snoring.Within this cohort of inner-city school children, snoring is highly prevalent and associated with higher asthma morbidity and increased healthcare. Additionally, symptoms of SDB fluctuates substantially over time, which is important to consider in clinical practice. The findings highlight the importance of screening children for SDB at each encounter. Treatment of this underlying comorbidity may significantly improve asthma-related outcomes.We know that rhinitis is associated with SDB, but in this study, there was no difference in the prevalence of rhinitis among the snoring groups. We need to ask specifically about snoring in our assessments of children with asthma and focus on treatment of the problem, if possible.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1016/j.jaip.2021.05.022

The coronavirus disease 2019 (COVID-19) pandemic has demanded changes in the asthma and allergy practice, including staff administration, office layout, patient interactions, care provision, and procedures.1Shaker MS Oppenheimer J Grayson M et al.COVID-19: pandemic contingency planning for the allergy and immunology clinic.J Allergy Clin Immunol Pract. 2020; 8: 1477-1488.e5Google Scholar,2Searing DA Dutmer CM Fleischer DM et al.A phased approach to resuming suspended allergy/immunology clinical services.J Allergy Clin Immunol Pract. 2020; 8: 2125-2134Google Scholar Control of viral disease and transmission by vaccination may allow for a return to more normal practice, but in reality, with the emergence of new viral variants, it is unlikely that COVID-19 will entirely disappear. (Authors' note to the reader: This Perspective was written in July 2021, so please forgive any inaccuracies in our predictive capabilities) At the same time, necessary adaptation during the pandemic with telemedicine, in-office infectious disease modifications, and vaccination could facilitate not only a return to pre–COVID-19 patient flow but also even practice expansion. This pandemic has taught us that identifying the viral etiology for acute exacerbations, particularly for our patients with allergic rhinitis and asthma who often have similar symptoms, is important for therapeutic and prognostic reasons. Although offices were forced to adopt rapid mitigation efforts at the start of the pandemic, we now have the benefit of experience and valuable information to make better informed decisions. What office changes will remain in 2022 and what can we eliminate? The discussion which follows assumes that vaccination will be available for all ages in 2022 and that COVID-19 will continue to cause seasonal infections, although it is hoped that they are less prevalent and severe. Liberal sick leave policies that encourage sick employees to remain at home when acutely ill with paid time off should remain a standard part of practice. Adequate personal protective equipment (PPE) for staff should be readily available, and policies for use should remain. Effective contact tracing procedures should remain intact. Special attention to address staff burnout should remain a priority. Strong encouragement for staff vaccination will remain important in the future. Physical distancing was a major challenge in limiting patient visits and immunotherapy administration. Improvement in ventilation to maximize air exchange, use of high-efficiency particulate air filters, and perhaps separate waiting areas for vaccinated or unvaccinated ill or well patients could be considered to enable a return to more normal patient volume and immunotherapy schedules. Immunotherapy scheduling vs walk-in may also continue to be used to assist with practice flow and distancing. Screening new and returning patients on the night before their visit for symptoms, personal contacts, and vaccination status will inform staff and improve patient safety. Although governmental ordinances may vary, ongoing use of face masks for patients and staff during sick visit encounters and perhaps routinely during viral seasons may become our new normal. High community viral transmission rate and unvaccinated patients are also considerations for extra precautions. Finally, sensitive point-of-care rapid antigen tests, if available, may help triage patients, inform precautions, and potentially dictate immediate specific viral therapy. The ability to provide patient care through telehealth has great potential for practices if adequate reimbursement remains in place and site restrictions remain relaxed. Telehealth visits can be as effective as in-person visits for many conditions routinely evaluated in the allergy office,3Mustafa SS Vadamalai K Ramsey A Patient satisfaction with in-person, video, and telephone allergy/immunology evaluations during the COVID-19 pandemic.J Allergy Clin Immunol Pract. 2021; 9: 1858-1863Google Scholar especially routine follow-up visits for nonpulmonary disease and as an option for unvaccinated patients during peak viral seasons. This could not only improve patient convenience and satisfaction but also potentially increase practice reach to areas that previously could not be served. Distant satellite offices for new patient visits, with virtual follow-up, for example, could be a practice enhancement. Virtual patient monitoring and teaching, which took the place of in-office procedures during the pandemic, can be continued in some form for better patient management and to facilitate virtual visits. Spirometry, fractional exhaled nitric oxide measurement, bronchoprovocation, oral challenges, and oral or parenteral immunotherapy can be performed without special considerations in vaccinated patients when viral transmission is low and staff are vaccinated, but some precautions, such as PPE and special ventilation, may be needed during periods of higher transmission. For unvaccinated patients, sensitive rapid antigen tests in asymptomatic patients can provide a measure of safety and affect precautions or procedures. In potentially infectious patients, such procedures should be avoided unless medically necessary for treatment decisions. Provision of subcutaneous immunotherapy should return to a normal schedule as patients are already discouraged from receiving immunotherapy while ill or symptomatic. Bronchoprovocation, which requires nebulized administration of a product, should only be performed in vaccinated patients or those with negative screening test results. Initial dosing and up-dosing visits for oral food immunotherapy carry increased risk for anaphylaxis, and nursing staff should consider the use of PPE when monitoring these patients if either they or the patient is not vaccinated. Oral food challenges in patients in whom the purpose is to rule out a food allergy have a low risk for systemic reactions, but because these are elective procedures, they could be limited to those who are vaccinated or have a negative test result before the challenge. Ultimately, staff members who are fully immunized can partake in individualized decision making surrounding their personal risk while interacting with patients during various procedures and address any concerns with their office manager to guide office policy. Allergists are equipped to assist patient decision making on a variety of chronic medical conditions.4Blaiss MS Steven GC Bender B Bukstein DA Meltzer EO Winders T Shared decision making for the allergist.Ann Allergy Asthma Immunol. 2019; 122: 463-470Google Scholar This is even more the case with COVID-19, wherein the allergist/immunologist is the best specialist to help patients understand key elements essential to viral transmission, personal risk, and risks/benefits of vaccines and correct dys/misinformation related to the disease and immunization. We can continue to be an important resource for our own patients, the general public, and media moving forward. Most allergy practices had substantial financial losses during the pandemic, but the response and adjustments that were made allowed for the introduction of new tools and approaches that will likely improve patient care and physician satisfaction in the future. Table 1 summarizes the key areas of adaptation during the pandemic that will likely continue in some capacity moving forward. Special precautions will need to continue in those who are not vaccinated and in anyone who presents with symptoms consistent with infection. Evolving rapid, sensitive, and specific point-of-care antigen tests can help clarify infectious etiology and guide specific therapies and precautions. We have collectively learned how to provide high-level care to our patients while also decreasing risk for spread of infection within our facilities. None of us know how long we will need to contend with severe acute respiratory syndrome coronavirus 2 or when the next pandemic may occur. Although the rules of engagement may have changed, we are still here to help patients and will continue to do so regardless of what the future holds.Table 1Contingency Plans Within the Medical Office During and After COVID-19Area of adaptationLong-term changes that may remainStaff•Encouragement for paid sick leave when ill•Routine preparedness meetings and modification of clinic plan•Provision of PPE for all staff•Evaluating and addressing staff burnoutStructural changes•Physical distancing in waiting areas•Enhanced cleaning protocols for exam rooms•Separate ill vs well waiting roomPatient interactions•Routine screening before visits•Continued masking during respiratory viral season•Immunotherapy scheduling vs walk-inCare provision•Continued use of telehealth based on pay parity, continued relaxed site restrictions and malpractice coverageProcedures•Alterations based on patient vaccination status•Sensitive point-of-care rapid antigen testing before aerosol-generating procedures•Alter safety protocols based on community transmissionShared decision making•Proactive discussion with patients and the general public regarding risks and benefits of vaccination•Ongoing efforts to acknowledge areas of knowledge gaps•Focus on decision making process rather than outcomesAbbreviations: COVID-19, coronavirus disease 2019; exam, examination; PPE, personal protective equipment. 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AAP Policy SupplementsSupplements Publish Supplement MultimediaVideo Abstracts Pediatrics On Call Podcast Subscribe Alerts Careers We will not be accepting article comments until November 8, 2021, while our site undergoes major changes. We apologize for the inconvenience. For questions, contact the editorial office. Asthma Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents Paul V. Williams Pediatrics December 2020, 146 (Supplement 4) S360-S361; DOI: https://doi.org/10.1542/peds.2020-023861LLL Paul V. Williams Everett, WashingtonFind this author on Google ScholarFind this author on PubMedSearch for this author on this site ArticleInfo & MetricsComments Download PDF SP Shah, J Grunwell, J Shih, S Stephenson, AM Fitzpatrick. J Allergy Clin Immuinol Pract. 2019;7(8):2624–2633.e2PURPOSE OF THE STUDY:To show that blood eosinophil counts in children and adolescents with exacerbation-prone asthma would predict 1 or more acute visits for asthma in the 6–12 months after measurement and that prediction of acute events could be improved with the addition of a second, noninvasive type 2 inflammatory marker.STUDY POPULATION:589 children and adolescents with exacerbation-prone asthma (exacerbation requiring systemic steroid treatment in the previous year) who were participating in asthma research studies at Emory University between January 2007 and December 2016.METHODS:This was a secondary analysis. Data were collected concerning demographics, medical history and symptoms, neighborhood characteristics. All participants underwent spirometry before and after a bronchodilator, and those that did not have a significant response underwent methacholine challenge to confirm airway hyperresponsiveness. Exhaled nitric oxide, specific IgE to a variety of aeroallergens, blood eosinophil counts and total serum IgE were also measured. Phone call follow-up occurred at 6 and 12 months after the study visit. The primary outcome measure was 1 or more acute visits for asthma requiring systemic corticosteroids at 6 or 12 months. Secondary outcomes included time to first acute visit and hospitalization.RESULTS:The majority of children were sensitized to aeroallergens. An acute visit for asthma occurred in 35.5% of children and 24.8% of adolescents. Hospitalizations occurred in 20.8% of children and 26.4% of adolescents. In children, blood eosinophils ≥150 cells/µl (adjusted OR 2.39, 95% CI 1.83–3.13) were most strongly associated with acute visit, but sensitization (adjusted OR 1.65, 95% CI 1.21–2.25) and frequency of daytime symptoms (adjusted OR 1.23, 95% CI 1.02–1.47) were also significant predictors. In adolescents, blood eosinophils ≥300 cells/µl (adjusted OR 2.04, 95% CI 1.60–2.60) were most strongly associated with an acute visit, additionally sensitization (adjusted OR 2.39, 95% CI 1.54–3.71), daytime symptoms (adjusted OR 1.85, 95% CI: 1.47–2.33), and serum IgE ≥100 kU/L (adjusted OR 1.43, 95% CI 1.06–1.92) were significant predictors, although specificity was poor for all measures in each age group. In children, the addition of a secondary T2 marker was not any more predictive than the blood eosinophil count alone, but in adolescents the association of serum eosinophils ≥300 cells/µl and sensitization increased the predictability of an acute visit.CONCLUSIONS:In exacerbation-prone children and adolescents, elevated blood eosinophils are associated with increased odds and shorter time to the first acute visit for asthma. Sensitization to aeroallergens contributes to these odds in adolescents.REVIEWER COMMENTS:It is known that a history of an exacerbation in the last year is a predictor of additional exacerbations in the following year. This is evidenced by the 35% rate of acute visits and 20% rate of hospitalization in the study population. The presence of eosinophilia increases that risk, as does frequent symptoms and sensitization in adolescents. This study does not tell us whether treatment aimed at T2 inflammation (eg, higher doses of inhaled steroids or stronger avoidance of aeroallergens) will reduce the risk, but is something to be considered.Copyright © 2020 by the American Academy of Pediatrics PreviousNext Back to top Advertising Disclaimer » In this issue Pediatrics Vol. 146, Issue Supplement 4 1 Dec 2020 Table of ContentsIndex by author View this article with LENS PreviousNext Email Article Thank you for your interest in spreading the word on American Academy of Pediatrics.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents Message Subject (Your Name) has sent you a message from American Academy of Pediatrics Message Body (Your Name) thought you would like to see the American Academy of Pediatrics web site. Your Personal Message CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Request Permissions Article Alerts Log in You will be redirected to aap.org to login or to create your account. Or Sign In to Email Alerts with your Email Address Email * Citation Tools Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents Paul V. Williams Pediatrics Dec 2020, 146 (Supplement 4) S360-S361; DOI: 10.1542/peds.2020-023861LLL Citation Manager Formats BibTeXBookendsEasyBibEndNote (tagged)EndNote 8 (xml)MedlarsMendeleyPapersRefWorks TaggedRef ManagerRISZotero Share Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents Paul V. Williams Pediatrics Dec 2020, 146 (Supplement 4) S360-S361; DOI: 10.1542/peds.2020-023861LLL Share This Article: Copy Print Download PDF Insight Alerts Table of Contents Jump to section ArticlePURPOSE OF THE STUDY:STUDY POPULATION:METHODS:RESULTS:CONCLUSIONS:REVIEWER COMMENTS:Info & MetricsComments Related ArticlesNo related articles found.Google Scholar Cited By...No citing articles found.Google Scholar More in this TOC SectionAsthma Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen Lung Computational Models and the Role of the Small Airways in Asthma Increased Capsaicin Sensitivity in Patients With Severe Asthma Is Associated With Worse Clinical Outcome Show more Asthma Risk Factors Depression, Anxiety, and Emergency Department Use for Asthma Increased Capsaicin Sensitivity in Patients With Severe Asthma Is Associated With Worse Clinical Outcome Show more Risk Factors Similar Articles Journal Info Editorial Board Editorial Policies Overview Licensing Information Authors/Reviewers Author Guidelines Submit My Manuscript Open Access Reviewer Guidelines Librarians Institutional Subscriptions Usage Stats Support Contact Us Subscribe Resources Media Kit About International Access Terms of Use Privacy Statement FAQ AAP.org shopAAP Follow American Academy of Pediatrics on Instagram Visit American Academy of Pediatrics on Facebook Follow American Academy of Pediatrics on Twitter Follow American Academy of Pediatrics on Youtube RSS © 2021 American Academy of Pediatrics

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Many abrupt adjustments in the delivery of medical care became necessary owing to the unexpected emergence of the coronavirus disease 2019 pandemic in early 2020. To ensure social distancing and the concomitant requirements for personal protective equipment, practitioners have had to make a myriad of adjustments to continue providing subcutaneous allergen immunotherapy (SCIT). In many practices, SCIT was stopped or administration intervals have been increased, whereas other practices have transitioned some patients to the sublingual administration route.

Chronic urticaria is an uncommon disorder in children but can present considerable morbidity, as well as frustration for the healthcare provider and parent. The prevalence is 0.1–0.3% but can vary considerably by country. Chronic spontaneous urticaria (no identifiable cause) is responsible for 70–80% of chronic urticaria, about half of this due to a subtype called chronic autoimmune urticaria identified by the presence of autoantibodies to IgE or the IgE receptor. Chronic urticaria that is triggered by external physical stimuli is called chronic inducible urticaria and is present in another 15–20%. Allergies, infection, and other underlying diseases such as thyroid disease, celiac disease, or Helicobacter pylori infection cause a minor proportion of cases. Chronic urticaria has considerable impact on quality of life and healthcare costs. An adverse impact on quality of life is more prevalent in older children and adolescents and can be comparable to other diseases of childhood such as diabetes and epilepsy. Healthcare costs can be 50% higher than the national estimates for healthy patients and include more hospitalizations, longer duration of hospitalizations, and more emergency department (ED) and outpatient visits. Allergic and autoimmune diseases can be comorbidities that add to healthcare utilization. Resolution can take years. Guidelines are available for diagnosis and treatment. A good history is the key to identifying the cause. Minimal laboratory tests are required and should be guided by the history. Patients with easily controlled urticaria may not need any laboratory tests. Suggested treatment emphasizes the use of non-sedating antihistamines, utilized in a step-wise fashion beginning with normal doses and advancing the dose based on the response up to four times the recommended dose for age. Other treatments are left to the urticaria specialist and are not discussed in this paper. These guidelines are not well utilized based on real-world studies; sedating antihistamines and oral steroids are overutilized. Medications should be taken daily, not as needed. Additional medications, if required, should be added to prior medications in a step-wise fashion. The gap between the guidelines for diagnosis and treatment and what is happening in the real world needs to be closed to reduce the cost and morbidity associated with this disorder.

SJ Szelfer, C Vogelberg, JA Bernstein. J Allergy Clin Immunol Pract. 2019;7(7):2286–95.e4 Exploratory analysis to determine whether treatment with tiotropium added to inhaled corticosteroids (ICS) is effective in children and adolescents regardless of T2 status and phenotype. Approximately 1500 children with symptomatic moderate or severe asthma ages 6–17 years who had participated in 4 Phase III randomized, double-blind, placebo controlled parallel group trials. Only a minority of patients with moderate asthma were on long-acting bronchodilator (LABA), but the majority of those with …