<p><strong>BACKGROUND: </strong>Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school.</p>

<p><strong>METHODS: </strong>We conducted semi-structured interviews with 178 participants about their experiences managing food allergies outside the home. Interviews were transcribed and analyzed using an iterative approach in NVivo 10.</p>

<p><strong>RESULTS: </strong>Participants reported highly varied school experiences across the ecological model. They described the need to be proactive and self-sufficient to manage food allergies. Whereas food allergy-related social exclusion was common, participants also described positive peer interactions, including intensive peer engagement and support. They perceived that formal school policies were limited in scope and inconsistently implemented. Prevention-oriented policies were more common in lower grades than in higher grades.</p>

<p><strong>CONCLUSIONS: </strong>Poorly defined and implemented policies disrupted students' social and educational experiences at school, families' relationships with school staff, and, ultimately, the safety and wellbeing of students with allergies. Given the high prevalence of food allergies among children, these findings demonstrate the need for multiple layers of support to facilitate safe, socially inclusive food allergy management at schools.</p>

<p><strong>OBJECTIVES: </strong>To determine if maternal intrapartum group B (GBS) antibiotic prophylaxis is associated with increased risk of childhood asthma, eczema, food allergy, or allergic rhinitis.</p>

<p><strong>METHODS: </strong>Retrospective cohort study of 14 046 children. GBS prophylaxis was defined as administration of intravenous penicillin, ampicillin, cefazolin, clindamycin, or vancomycin to the mother, ≥4 hours before delivery. Composite primary outcome was asthma, eczema, or food allergy diagnosis within 5 years of age, identified by diagnosis codes and appropriate medication prescription. Allergic rhinitis was defined by using diagnostic codes only and analyzed as a separate outcome. Analysis was a priori stratified by delivery mode and conducted by using Cox proportional hazards model adjusted for multiple confounders and covariates. Secondary analyses, restricted to children retained in cohort at 5 years' age, were conducted by using multivariate logistic regression.</p>

<p><strong>RESULTS: </strong>GBS prophylaxis was not associated with increased incidence of composite outcome among infants delivered vaginally (hazard ratio: 1.13, 95% confidence interval [CI]: 0.95-1.33) or by cesarean delivery (hazard ratio: 1.08, 95% CI: 0.88-1.32). At 5 years of age, among 10 404 children retained in the study, GBS prophylaxis was not associated with the composite outcome in vaginal (odds ratio: 1.21, 95% CI: 0.96-1.52) or cesarean delivery (odds ratio: 1.17, 95% CI: 0.88-1.56) cohorts. Outcomes of asthma, eczema, food allergy, separately, and allergic rhinitis were also not associated with GBS prophylaxis.</p>

<p><strong>CONCLUSIONS: </strong>Intrapartum GBS prophylaxis was not associated with subsequent diagnosis of asthma, eczema, food allergy, or allergic rhinitis in the first 5 years of age.</p>

<p><strong>BACKGROUND: </strong>Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. Its relationship to the major atopic manifestations (atopic dermatitis, AD; IgE-mediated food allergy, IgE-FA; allergic rhinitis, AR; asthma) is not understood.</p>

<p><strong>OBJECTIVE: </strong>Determine the clinical characteristics, epidemiologic features, and natural history of FPIES in relation to the major atopic manifestations.</p>

<p><strong>METHODS: </strong>We examined our primary care birth cohort of 158,510 pediatric patients, of which 214 patients met 2017 FPIES diagnostic criteria. We measured the influence of FPIES on developing subsequent atopic disease.</p>

<p><strong>RESULTS: </strong>Pediatric FPIES incidence was between 0.17% and 0.42% depending on birth year. As in prior reports, most patients had an acute presentation (78%) and milk, soy, oat, rice, potato, and egg were common triggers. The mean age of diagnosis was 6.8 months. Atopic comorbidity was higher in FPIES patients compared to healthy children (AD, 20.6% vs. 11.7%; IgE-FA, 23.8% vs. 4.0%; asthma, 26.6% vs. 18.4%; AR, 28.0% vs. 16.7%; p&lt;0.001 Chi-squared). However, longitudinal analyses indicated that prior FPIES did not influence the rate of atopy development.</p>

<p><strong>CONCLUSIONS: </strong>The incidence of FPIES in our cohort was initially low, but is increasing. Food allergen distribution, presentation, and age of onset are similar to prior reports. FPIES patients have high rates of atopic comorbidity, however, longitudinal analysis does not support direct causation as the etiology of these associations. Rather it suggests a shared predisposition to both types of allergy, or associative bias effects. This work refines our understanding of the natural history of FPIES by elucidating associations between FPIES and atopy.</p>

<p><strong>BACKGROUND: </strong>The allergic march describes the natural history of allergic conditions as they develop during childhood. Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that can be triggered by specific foods. Despite its allergic pathophysiology, the epidemiologic relationship between EoE and established members of the allergic march is unknown.</p>

<p><strong>OBJECTIVE: </strong>We sought to determine whether EoE meets epidemiologic criteria for being considered a member of the allergic march.</p>

<p><strong>METHODS: </strong>Using a primary care birth cohort of 130,435 children, we determined the natural histories of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, EoE, and allergic rhinitis (AR) in individual patients. We then performed case-control analyses to establish the extent that existing allergic conditions influence the rate of subsequent EoE diagnosis.</p>

<p><strong>RESULTS: </strong>A total of 139 children developed EoE during the observation period (prevalence of 0.11%). The peak age of EoE diagnosis was 2.6 years, as compared with 0.3 years, 1 year, 1.1 years, and 2.1 years for AD, IgE-FA, asthma, and AR, respectively. The presence of AD (hazard ratio [HR] 3.2, 95% confidence interval [CI] 2.2-4.6), IgE-FA (HR 9.1, 95% CI 6.5-12.6), and asthma (HR 1.9, 95% CI 1.3-2.7) was independently and cumulatively associated with subsequent EoE diagnosis. The presence of AR was associated with subsequent EoE diagnosis (HR 2.8, 95% CI 2.0-3.9), and the presence of EoE was associated with subsequent AR diagnosis (HR 2.5, 95% CI 1.7-3.5).</p>

<p><strong>CONCLUSIONS: </strong>Allergic comorbidities are positively associated with EoE diagnosis. Together, our findings suggest that EoE is a late manifestation of the allergic march.</p>

<p><strong>BACKGROUND: </strong>The rates of childhood allergic conditions are changing, prompting the need for continued surveillance. Examination of healthcare provider-based diagnosis data is an important and lacking methodology needed to complement existing studies that rely on participant reporting.</p>

<p><strong>METHODS: </strong>Utilizing our care network of 1,050,061 urban and sub-urban children, we defined two retrospective cohorts: (1) a closed birth cohort of 29,662 children and (2) a cross-sectional cohort of 333,200 children. These cohorts were utilized to determine the epidemiologic characteristics of the conditions studied. Logistic regression was utilized to determine the extent to which food allergy was associated with respiratory allergy.</p>

<p><strong>RESULTS: </strong>In our birth cohort, the peak age at diagnosis of eczema, asthma, rhinitis, and food allergy was between 0 and 5&nbsp;months (7.3&nbsp;%), 12 and 17&nbsp;months (8.7&nbsp;%), 24 and 29&nbsp;months (2.5&nbsp;%), and 12 and 17&nbsp;months (1.9&nbsp;%), respectively. In our cross-sectional cohort, eczema and rhinitis prevalence rates were 6.7&nbsp;% and 19.9&nbsp;%, respectively. Asthma prevalence was 21.8&nbsp;%, a rate higher than previously reported. Food allergy prevalence was 6.7&nbsp;%, with the most common allergenic foods being peanut (2.6&nbsp;%), milk (2.2&nbsp;%), egg (1.8&nbsp;%), shellfish (1.5&nbsp;%), and soy (0.7&nbsp;%). Food allergy was associated with development of asthma (OR 2.16, 95&nbsp;% CI 1.94-2.40), and rhinitis (OR 2.72, 95&nbsp;% CI 2.45-3.03).</p>

<p><strong>CONCLUSIONS: </strong>Compared with previous reports, we measure lower rates of eczema and higher rates of asthma. The distribution of the major allergenic foods diverged from prior figures, and food allergy was associated with the development of respiratory allergy. The utilization of provider-based diagnosis data contributes an important and lacking methodology that complements existing studies.</p>