Strategies to Implement Proposed Combined Sewer Discharge Community Notification Requirements in Massachusetts

Communities across the U.S. are burdened by combined sewer systems, which dump raw sewage containing harmful pathogens into public waters during wet weather. Public notification of discharges is a common strategy to reduce public health risks from exposure to contaminated waters. We helped MassDEP prepare to implement proposed regulations that would strengthen public notification requirements of combined sewer overflows in Massachusetts. Through interviews and content analysis, we characterized current municipal notification practices for these events in the Commonwealth and identified potential challenges and strategies to meet the new requirements. We recommended 9 strategies that MassDEP can use to assist Massachusetts communities as they increase their community notification practices

Real World Adoption of FDA-approved Peanut Oral Immunotherapy with Palforzia

Clinical Implications: This is the first study to evaluate real-world uptake of FDA-approved POIT, revealing that approximately 10% of peanut-allergic individuals and families chose to pursue therapy, whereas the majority declined due to concerns over time commitment and adverse effects

Differences in Oral Food Challenge Reaction Severity Based on Increasing Age in a Pediatric Population

Background: Food allergy (FA) reactions range from mild to severe with differences in age appearing to be an important factor associated with reaction severity. Objective: To define differences in oral food challenge (OFC) reaction severity in pediatric patients from infancy to adolescence using objective clinical outcomes and standardized reaction grading tools. Methods: Retrospective review of all positive OFCs at two large institutions between September 2016 and February 2019. Reaction severity was defined by presence of cardiovascular, neurologic, lower respiratory or laryngeal symptoms (CV/N/LR/L), epinephrine requirement and grading using two established FA reaction scales. Results: Infants and toddlers demonstrated fewer reactions involving CV/N/LR/L symptoms compared to older age groups. Epinephrine was also required less frequently during reactions in infants and toddlers, compared to older age groups. There was no difference in reaction severity in infants and toddlers based on clinical history of eczema. Increasing age was significantly correlated with increased epinephrine requirement (R 2 =0.12, p=0.002), elevated CoFAR score (R 2 =.012, p=.003), and approached significance for increased PRACTALL score (R 2 =.005, p=.057). History of asthma and sesame allergy were identified to be positively correlated with more severe reactions. Conclusion: Infants and young toddlers demonstrate less severe reactions during OFCs compared to older age groups supporting early food introduction practices. In children under 12 months of age, severe reactions are most rare calling into question screening practices using specific allergy testing prior to food introduction. Standardized reaction grading tools may be valuable instruments to categorize reaction severity during OFCs