Respiratory tract infections, in particular acute otitis media (AOM), are some of the most frequent infections for which pediatric patients seek medical treatment (15.8 ± 1.5 million clinical encounters for AOM in the United States during 2006-2008).¹ This is associated with significant financial and sociological burden in North America. During the past decade, guidelines have been developed that recommend observation in lieu of antibiotic use for patients with AOM under select circumstances. Despite this, recent studies in the United States indicate that 83.1% ± 2.2% of children with a diagnosis of AOM received an antibiotic prescription, mostly amoxicillin (40.9%).¹ Up to 10% of children develop rashes while receiving antibiotics.² Most are diagnosed without further evaluation as allergic to the implicated antibiotic,³ and most continue to avoid the suspect antibiotic in favor of alternatives, which may be less effective, more toxic, and more expensive.

Background: We previously estimated that the annual rate of accidental exposure to peanut in 1411 children with peanut allergy, followed for 2227 patient‐years, was 11.9% (95% CI, 10.6, 13.5). This cohort has increased to 1941 children, contributing 4589 patient‐years, and we determined the annual incidence of accidental exposure, described the severity, management, location, and identified associated factors.Findings: Children with physician‐confirmed peanut allergy were recruited from Canadian allergy clinics and allergy advocacy organizations from 2004 to May 2014. Parents completed questionnaires regarding accidental exposure to peanut over the preceding year. Five hundred and sixty‐seven accidental exposures occurred in 429 children over 4589 patient‐years, yielding an annual incidence rate of 12.4% (95% CI, 11.4, 13.4). Of 377 accidental exposures that were moderate or severe, only 109 (28.9%) sought medical attention and of these 109, only 40 (36.7%) received epinephrine. Of the 181 moderate/severe accidental exposures treated outside a health care facility, only 11.6% received epinephrine. Thirty‐seven percent of accidental exposures occurred at home. In multivariate analyses, longer disease duration, recruitment through an allergy advocacy association, and having other food allergies decreased the likelihood of accidental exposures. Age ≥ 13 years at study entry and living with a single parent increased the risk.Conclusion: Despite increased awareness, accidental exposures continue to occur, mainly at home, and most are managed inappropriately by both health care professionals and caregivers. Consequently, more education is required on the importance of strict allergen avoidance and the need for prompt and correct management of anaphylaxis.

Chronic urticaria (CU) is defined by the occurrence of wheals, angioedema, or both lasting more than 6 weeks. Physical urticaria (PU) occurs when the CU is associated with a specific physical stimulus (eg, cold urticaria, solar urticaria, delayed pressure urticaria, localized heat urticaria, dermographic urticaria, or vibration urticaria^1,2). The point prevalence of CU is 0.5% to 1.0% of the general population,^3-6 and it affects 0.1% to 0.3% of children.⁷ Although to our knowledge, no studies assessing the prevalence of CU in Canadians had been published so far, assuming a similar 0.3% lifetime prevalence, it is likely that more than 100 000 Canadian children are affected by CU.⁸

Sesame is an important global allergen affecting ~0.1% of the North American population. It is a major cause of anaphylaxis in the Middle East and is the third most common food allergen in Israel. We conducted a systematic review of original articles published in the last 10 years regarding the diagnosis and management of sesame allergy. Skin prick testing appears to be a useful predictor of sesame allergy in infants, although data are less consistent in older children and adults. The diagnostic capacity of serum-specific immunoglobulin E is poor, especially in studies that used oral food challenges to confirm the diagnosis. Double-blind, placebo-controlled food challenge thus remains the diagnostic gold standard for sesame allergy. The cornerstone of sesame allergy management is allergen avoidance, though accidental exposures are common and patients must be prepared to treat the consequent reactions with epinephrine. Novel diagnostic and treatment options such as component-resolved diagnostics, basophil activation testing, and oral immunotherapy are under development but are not ready for mainstream clinical application.