Clinical and Immunological Evaluation of Children with A

Niaid Extramural Activities

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Abstract

Allergic disorders are among the most common chronic diseases of childhood and have been increasing over the past several decades for reasons that are still not understood. The impact that these disorders have on health, educational and social activities and costs of medical care are profound and widespread. Consistent with this important health priority, the first ever Pediatric Allergy Clinic in the NIH Clinical Center was created to provide a necessary cohort of pediatric patients with allergic diseases to allow residents in the allergy and immunology program to gain experience in the treatment of children with asthma and other allergic diseases; and to provide a clinical resource for LAD and collaborative research. During the current fiscal year there have been well over 250 patient care visits. First and second year Fellows in the A and I residency program rotate through the clinic to obtain medical training in pediatric allergic diseases, and a continuity of clinical care experience. In addition to the standard evaluation of allergic disease, this clinic provides experience in pulmonary function testing, skin prick and patch testing. The impact of allergic diseases and its therapies on children with allergies is evaluated with computerized cognitive testing modules and pediatric mood questionnaires. Experience is also provided on non-invasive clinical techniques in the evaluation of allergic inflammation including acoustic rhinometry, expired breath condensate, and exhaled nitric oxide. The staff is submitting a review on acoustic rhinometry and it's impact on allergic diseases. In collaboration with the NHBLI pulmonology service, exercise challenge pulmonary function testing is available. . Other experimental non-invasive diagnostic techniques to be tested include impulse oscillometry that measures non-effort dependant airway resistance and a computer integrated treadmill for exercise challenge in patients with urticaria and anaphylaxis. Research blood is collected for screening laboratory studies, markers of allergic disease and to determine cytokine, signaling and eosinophil profiles. In addition to evaluating and treating pediatric diseases that are common to the local community, the clinic evaluates allergic disease manifestations in patients with periodic fever syndromes. All patient data has been documented into CRIMSON, the NIAID database, for longitudinal analysis.