Introduction The 2020 Protection of Students with Life-Threatening Allergies Act, obligates schools across Alberta, Canada to hold a common use stock of at least one epinephrine autoinjector (EAI) and to maintain a protocol for the prevention and management of anaphylaxis Herein, we assessed the effectiveness of this policy by comparing pre-hospital EAI use before and after implementation of the act. Methods The Cross-Canada Anaphylaxis Registry (C-CARE) enrolls patients presenting to a participating emergency department with anaphylaxis defined as the involvement of ≥2 systems and/or hypotension. Specific to this project, we extracted data on pediatric patients recruited from the Stollery Children’s Hospital in Edmonton, Alberta from 2016-2024. Data were collected on demographics, comorbidities, symptomatology, pre- and intra-hospital management, and outcome of anaphylaxis by standardized chart review. Multivariable logistic regression was used to assess pre-hospital EAI use for cases occurring at school before versus after the enactment of the Act on January 1, 2020. Evaluating pre-hospital EAI use in Quebec and Ontario and antihistamine use pre versus post act in Alberta were used as negative controls. Result Of the 59 cases of in-school anaphylaxis identified over the study period, 52.5% occurred post-Act. The median age was 13.0 years (IQR=9.5-15.8) and 40.7% were male. EAI use in schools was greater post-act versus pre-act (64.5% versus 35.7%, aOR=3.82, 95%CI=1.24-11.7). There was no difference in pre-hospital EAI use pre versus post 2020 in Quebec and Ontario, that did not use the act (aOR=0.72, 95%CI=0.31-1.70). There was no difference in pre-hospital antihistamine use pre versus post act (aOR=0.31, 95%CI=0.07-1.41). Conclusion Implementation of the provincial policy was associated with an increase in pre-hospital EAI use in cases of pediatric anaphylaxis occurring at school. These preliminary results support the effectiveness of policy interventions for anaphylaxis management.

Background/Rationale Weekly cholecalciferol can be an alternative to daily supplementation to reduce pill burden in patients with complex medication regimens and hypovitaminosis D, but evidence supporting this switch is unclear. Objective We aimed to determine whether weekly cholecalciferol was superior to daily cholecalciferol to replete patients with hypovitaminosis D. Methods We conducted a systematic review of randomized controlled trials involving participants with baseline hypovitaminosis D (<30ng/ml) comparing weekly versus daily cholecalciferol dosing and where serum cholecalciferol was measured within 90 days of starting treatment. We searched MEDLINE, CINAHL and EMBASE from inception to May 7 th, 2024. A random-effects meta-analysis evaluated the odds ratio for repletion of serum Vitamin D levels. Findings Eight trials involving 542 patients were included in the analysis. Weekly D3 and daily cholecalciferol were not significantly different in correcting hypovitaminosis D (OR=1.5, 95% CI = 0.3-6.9, p=0.6, favoring weekly dosing, I 2=85.3%). A sensitivity analysis excluding otherwise healthy patients had similar findings (OR=0.8, 95% CI=0.3–2.1, p=0.6). Most studies were judged to be at risk of bias, the different doses being compared increased the heterogeneity (I 2=85.3%). Conclusions There is limited direct evidence supporting a switch from daily to weekly cholecalciferol dosing; however, weekly supplementation was not demonstrably worse at repleting levels and decreases a patient’s daily pill burden.

ABSTRACT Background No validated tools exist to evaluate chronic urticaria (CU) control in children. While the Urticaria Control Test (UCT) exhibits favourable clinometric properties in adult CU, it is not yet validated in children. Therefore, we sought to evaluate the validity of the UCT for the assessment of pediatric CU. Methods Children presenting with CU were consecutively recruited. Participants completed both the UCT and the Children’s Dermatology Life Quality Index (CDLQI). We assessed the internal consistency, convergent and known-groups validity, and screening accuracy of the UCT at study entry and at follow-up. Results A total of 52 children with CU were recruited. The UCT exhibited respectable internal consistency in the evaluation of CU (Cronbach’s α=0.73 [95%CI: 0.62, 0.85]). UCT and CDLQI scores strongly correlated (r=-0.74, P<0.01). The UCT distinguished between different strata of disease severities established by the CDLQI (P<0.01). Screening accuracy of the UCT was excellent in the discrimination of poorly controlled CU (area under the curve=0.82). An optimal cut-off of ≤10 was determined for defining poorly controlled CU (sensitivity=95.5%, specificity=63.3%). Data at follow-up were consistent with data at study entry. Conclusion The UCT is a valid tool for the assessment of pediatric CU and CSU, as evidenced by acceptable internal consistency, convergent and known-groups validity, and screening accuracy at multiple time points.

Background Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU). Methods We prospectively enrolled children with coldU from 2013-2021 in a cohort study at the Montreal Children’s Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution. Results Fifty-two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second generation H1-antihistamines (sgAHs). Well-controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR)=0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold-induced anaphylaxis (coldA) (aOR=1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient-years, which was lower than that of CSU (adjusted hazard ratio=0.43 [95%CI: 0.21, 0.89], P<10-2). Conclusion Pediatric coldU bears a substantial risk of anaphylaxis and a low resolution rate. Absolute eosinophil count and co-existing CSU may be useful predictive factors.

Increased prevalence of Autoimmune Diseases in Children with Chronic Spontaneous UrticariaMichelle Le, MD1, Lydia Zhang MD2, Sofianne Gabrielli MSc2, Connor Prosty BSc, MD(c)1, Laura May Miles LLM, MD(c)2, Elena Netchiporouk, MD, MSc1, Sharon Baum, MD3, Shoshana Greenberger, MD3, Luis F. Ensina, MD, MSc, PhD4, Fatemeh Jafarian, MD1, Xun Zhang, PhD5, Moshe Ben-Shoshan, MD, MSc21Division of Dermatology, McGill University, Montreal, QC, Canada2Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada3Department of Dermatology, Chaim Sheba Medical Center, Tel-Aviv University, Sackler School of Medicine, Tel Hashomer, Israel4Department of Pediatrics, Federal University of São Paolo, Brazil5Centre for Outcome Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, CanadaCorrespondence: Michelle Le, M.D., 1001 Decarie Blvd, Montréal, Québec, H4A 3J1 email: michelle.le@mail.mcgill.caArticle type: LetterManuscript word count: 981References : 10Tables : 1Figures: NoneFunding sources : NoneConflicts of interest: None declaredIRB Approval Status : Reviewed and approved by McGill University Health Centre; approval 12-255GEN