Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure

Background The severity of allergic rhinoconjunctivitis (AR) symptomatology elicited after exposure to pollen in the absence versus the presence of confounding cofactors, such as in a pollen challenge chamber (PCC) and the natural pollinating season, respectively, might differ. Objective We sought t...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of allergy and clinical immunology 2014-05, Vol.133 (5), p.1340-1346.e7
Hauptverfasser: Jacobs, Robert L., MD, Harper, Nathan, BS, He, Weijing, MD, Andrews, Charles P., MD, Rather, Cynthia G., CCRC, Ramirez, Daniel A., MD, Ahuja, Sunil K., MD
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1346.e7
container_issue 5
container_start_page 1340
container_title Journal of allergy and clinical immunology
container_volume 133
creator Jacobs, Robert L., MD
Harper, Nathan, BS
He, Weijing, MD
Andrews, Charles P., MD
Rather, Cynthia G., CCRC
Ramirez, Daniel A., MD
Ahuja, Sunil K., MD
description Background The severity of allergic rhinoconjunctivitis (AR) symptomatology elicited after exposure to pollen in the absence versus the presence of confounding cofactors, such as in a pollen challenge chamber (PCC) and the natural pollinating season, respectively, might differ. Objective We sought to determine the correlation of AR severity in the natural season versus out-of-season PCC exposures. Methods Twenty-four Virginia live oak (VLO)–positive, 14 VLO-negative, 16 mountain cedar (MC)−positive, 8 MC-negative, and 26 ragweed-positive participants recorded AR symptoms (total symptom score [TSS]) during the VLO, MC, and ragweed pollinating seasons and during 2 consecutive PCC exposures of 3 hours each to these pollens separately. Results The TSSs recorded before the natural season were higher than the pre-PCC values. This prepriming was greater among VLO+ than MC+ participants, and it blunted further increases in TSSs during the VLO natural season. Nonatopic participants were nonreactive in the PCC. There was wide variation in the level of AR symptomatology after exposure to VLO, MC, or ragweed pollen in the PCC. Prepriming formed the basis for higher AR responses observed in the natural season than in the PCC, resulting in the identification of distinct PCC/natural season endophenotypes and a partial correlation between the TSSs recorded in the natural season versus those recorded in the PCC ( r  = 0.34, 0.54, and 0.65 for VLO+ , MC+ , and ragweed-positive participants, respectively). Conclusions Prepriming in the natural pollinating season might obscure the true correlation between AR severity in the natural season versus the PCC. By mitigating confounding cofactors, PCC exposures have utility for evaluation of novel AR therapeutics.
doi_str_mv 10.1016/j.jaci.2013.09.051
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1519842253</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0091674913015650</els_id><sourcerecordid>3284928461</sourcerecordid><originalsourceid>FETCH-LOGICAL-c568t-bc67da10b388c5cf66aaacd144caa210c5a78e2b17a0864f4be94db59b30d5363</originalsourceid><addsrcrecordid>eNqNklGL1DAQx4Mo3t7qF_BBCiL40po0TZqACHLcqXDgg_oc0nR6pnaTNdMu3rc3dVcP7kF8mgn8Zibz_w8hzxitGGXy9ViN1vmqpoxXVFdUsAdkw6huS6lq8ZBsKNWslG2jz8g54kjzmyv9mJzVDeeMt-2GHC6HAdxcxKFwMQxxCb0PNzkfrJtjwiKGIgHuY0DAYo7FPk4TBCz6Ja1gsPOS7FQgWMzoARIueIIK982u8QbWbNdBKuDnPuKS4Al5NNgJ4ekpbsnXq8svFx_K60_vP168uy6dkGouOyfb3jLacaWccIOU1lrXs6Zx1taMOmFbBXXHWkuVbIamA930ndAdp73gkm_Jq2PffYo_FsDZ7Dw6mCYbIC5omGBaNXUt-P-gWUqhs9pb8uIeOsYlhbzISilNm6ZVmaqPlEsRMcFg9snvbLo1jJrVQDOa1UCzGmioNtnAXPT81HrpdtD_LfnjWAZengCLzk5DssF5vOOUkKz9Pf3NkYMs78FDMug8BAe9T9lw00f_73-8vVfuJh98nvgdbgHv9jVYG2o-r6e2XhrjlAkpKP8FdFrPZA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1518904478</pqid></control><display><type>article</type><title>Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Jacobs, Robert L., MD ; Harper, Nathan, BS ; He, Weijing, MD ; Andrews, Charles P., MD ; Rather, Cynthia G., CCRC ; Ramirez, Daniel A., MD ; Ahuja, Sunil K., MD</creator><creatorcontrib>Jacobs, Robert L., MD ; Harper, Nathan, BS ; He, Weijing, MD ; Andrews, Charles P., MD ; Rather, Cynthia G., CCRC ; Ramirez, Daniel A., MD ; Ahuja, Sunil K., MD</creatorcontrib><description>Background The severity of allergic rhinoconjunctivitis (AR) symptomatology elicited after exposure to pollen in the absence versus the presence of confounding cofactors, such as in a pollen challenge chamber (PCC) and the natural pollinating season, respectively, might differ. Objective We sought to determine the correlation of AR severity in the natural season versus out-of-season PCC exposures. Methods Twenty-four Virginia live oak (VLO)–positive, 14 VLO-negative, 16 mountain cedar (MC)−positive, 8 MC-negative, and 26 ragweed-positive participants recorded AR symptoms (total symptom score [TSS]) during the VLO, MC, and ragweed pollinating seasons and during 2 consecutive PCC exposures of 3 hours each to these pollens separately. Results The TSSs recorded before the natural season were higher than the pre-PCC values. This prepriming was greater among VLO+ than MC+ participants, and it blunted further increases in TSSs during the VLO natural season. Nonatopic participants were nonreactive in the PCC. There was wide variation in the level of AR symptomatology after exposure to VLO, MC, or ragweed pollen in the PCC. Prepriming formed the basis for higher AR responses observed in the natural season than in the PCC, resulting in the identification of distinct PCC/natural season endophenotypes and a partial correlation between the TSSs recorded in the natural season versus those recorded in the PCC ( r  = 0.34, 0.54, and 0.65 for VLO+ , MC+ , and ragweed-positive participants, respectively). Conclusions Prepriming in the natural pollinating season might obscure the true correlation between AR severity in the natural season versus the PCC. By mitigating confounding cofactors, PCC exposures have utility for evaluation of novel AR therapeutics.</description><identifier>ISSN: 0091-6749</identifier><identifier>EISSN: 1097-6825</identifier><identifier>DOI: 10.1016/j.jaci.2013.09.051</identifier><identifier>PMID: 24331377</identifier><identifier>CODEN: JACIBY</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Allergies ; Allergy ; Allergy and Immunology ; Ambrosia ; Biological and medical sciences ; Calendars ; challenge ; confounding ; Conjunctivitis, Allergic - immunology ; Conjunctivitis, Allergic - pathology ; Conjunctivitis, Allergic - therapy ; Desensitization, Immunologic ; Diaries ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Immunopathology ; Likert scale ; Male ; Medical sciences ; Middle Aged ; Mold ; Plant reproduction ; Pollen ; Pollen - immunology ; Quercus ; Rhinitis, Allergic, Seasonal - immunology ; Rhinitis, Allergic, Seasonal - pathology ; Rhinitis, Allergic, Seasonal - therapy ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; season ; Seasons ; Studies ; Time Factors</subject><ispartof>Journal of allergy and clinical immunology, 2014-05, Vol.133 (5), p.1340-1346.e7</ispartof><rights>American Academy of Allergy, Asthma &amp; Immunology</rights><rights>2013 American Academy of Allergy, Asthma &amp; Immunology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2013 American Academy of Allergy, Asthma &amp; Immunology. Published by Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c568t-bc67da10b388c5cf66aaacd144caa210c5a78e2b17a0864f4be94db59b30d5363</citedby><cites>FETCH-LOGICAL-c568t-bc67da10b388c5cf66aaacd144caa210c5a78e2b17a0864f4be94db59b30d5363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0091674913015650$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=28561778$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24331377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jacobs, Robert L., MD</creatorcontrib><creatorcontrib>Harper, Nathan, BS</creatorcontrib><creatorcontrib>He, Weijing, MD</creatorcontrib><creatorcontrib>Andrews, Charles P., MD</creatorcontrib><creatorcontrib>Rather, Cynthia G., CCRC</creatorcontrib><creatorcontrib>Ramirez, Daniel A., MD</creatorcontrib><creatorcontrib>Ahuja, Sunil K., MD</creatorcontrib><title>Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure</title><title>Journal of allergy and clinical immunology</title><addtitle>J Allergy Clin Immunol</addtitle><description>Background The severity of allergic rhinoconjunctivitis (AR) symptomatology elicited after exposure to pollen in the absence versus the presence of confounding cofactors, such as in a pollen challenge chamber (PCC) and the natural pollinating season, respectively, might differ. Objective We sought to determine the correlation of AR severity in the natural season versus out-of-season PCC exposures. Methods Twenty-four Virginia live oak (VLO)–positive, 14 VLO-negative, 16 mountain cedar (MC)−positive, 8 MC-negative, and 26 ragweed-positive participants recorded AR symptoms (total symptom score [TSS]) during the VLO, MC, and ragweed pollinating seasons and during 2 consecutive PCC exposures of 3 hours each to these pollens separately. Results The TSSs recorded before the natural season were higher than the pre-PCC values. This prepriming was greater among VLO+ than MC+ participants, and it blunted further increases in TSSs during the VLO natural season. Nonatopic participants were nonreactive in the PCC. There was wide variation in the level of AR symptomatology after exposure to VLO, MC, or ragweed pollen in the PCC. Prepriming formed the basis for higher AR responses observed in the natural season than in the PCC, resulting in the identification of distinct PCC/natural season endophenotypes and a partial correlation between the TSSs recorded in the natural season versus those recorded in the PCC ( r  = 0.34, 0.54, and 0.65 for VLO+ , MC+ , and ragweed-positive participants, respectively). Conclusions Prepriming in the natural pollinating season might obscure the true correlation between AR severity in the natural season versus the PCC. By mitigating confounding cofactors, PCC exposures have utility for evaluation of novel AR therapeutics.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Allergies</subject><subject>Allergy</subject><subject>Allergy and Immunology</subject><subject>Ambrosia</subject><subject>Biological and medical sciences</subject><subject>Calendars</subject><subject>challenge</subject><subject>confounding</subject><subject>Conjunctivitis, Allergic - immunology</subject><subject>Conjunctivitis, Allergic - pathology</subject><subject>Conjunctivitis, Allergic - therapy</subject><subject>Desensitization, Immunologic</subject><subject>Diaries</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Immunopathology</subject><subject>Likert scale</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mold</subject><subject>Plant reproduction</subject><subject>Pollen</subject><subject>Pollen - immunology</subject><subject>Quercus</subject><subject>Rhinitis, Allergic, Seasonal - immunology</subject><subject>Rhinitis, Allergic, Seasonal - pathology</subject><subject>Rhinitis, Allergic, Seasonal - therapy</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>season</subject><subject>Seasons</subject><subject>Studies</subject><subject>Time Factors</subject><issn>0091-6749</issn><issn>1097-6825</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNklGL1DAQx4Mo3t7qF_BBCiL40po0TZqACHLcqXDgg_oc0nR6pnaTNdMu3rc3dVcP7kF8mgn8Zibz_w8hzxitGGXy9ViN1vmqpoxXVFdUsAdkw6huS6lq8ZBsKNWslG2jz8g54kjzmyv9mJzVDeeMt-2GHC6HAdxcxKFwMQxxCb0PNzkfrJtjwiKGIgHuY0DAYo7FPk4TBCz6Ja1gsPOS7FQgWMzoARIueIIK982u8QbWbNdBKuDnPuKS4Al5NNgJ4ekpbsnXq8svFx_K60_vP168uy6dkGouOyfb3jLacaWccIOU1lrXs6Zx1taMOmFbBXXHWkuVbIamA930ndAdp73gkm_Jq2PffYo_FsDZ7Dw6mCYbIC5omGBaNXUt-P-gWUqhs9pb8uIeOsYlhbzISilNm6ZVmaqPlEsRMcFg9snvbLo1jJrVQDOa1UCzGmioNtnAXPT81HrpdtD_LfnjWAZengCLzk5DssF5vOOUkKz9Pf3NkYMs78FDMug8BAe9T9lw00f_73-8vVfuJh98nvgdbgHv9jVYG2o-r6e2XhrjlAkpKP8FdFrPZA</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Jacobs, Robert L., MD</creator><creator>Harper, Nathan, BS</creator><creator>He, Weijing, MD</creator><creator>Andrews, Charles P., MD</creator><creator>Rather, Cynthia G., CCRC</creator><creator>Ramirez, Daniel A., MD</creator><creator>Ahuja, Sunil K., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7SS</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure</title><author>Jacobs, Robert L., MD ; Harper, Nathan, BS ; He, Weijing, MD ; Andrews, Charles P., MD ; Rather, Cynthia G., CCRC ; Ramirez, Daniel A., MD ; Ahuja, Sunil K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c568t-bc67da10b388c5cf66aaacd144caa210c5a78e2b17a0864f4be94db59b30d5363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Allergies</topic><topic>Allergy</topic><topic>Allergy and Immunology</topic><topic>Ambrosia</topic><topic>Biological and medical sciences</topic><topic>Calendars</topic><topic>challenge</topic><topic>confounding</topic><topic>Conjunctivitis, Allergic - immunology</topic><topic>Conjunctivitis, Allergic - pathology</topic><topic>Conjunctivitis, Allergic - therapy</topic><topic>Desensitization, Immunologic</topic><topic>Diaries</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Immunopathology</topic><topic>Likert scale</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mold</topic><topic>Plant reproduction</topic><topic>Pollen</topic><topic>Pollen - immunology</topic><topic>Quercus</topic><topic>Rhinitis, Allergic, Seasonal - immunology</topic><topic>Rhinitis, Allergic, Seasonal - pathology</topic><topic>Rhinitis, Allergic, Seasonal - therapy</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>season</topic><topic>Seasons</topic><topic>Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jacobs, Robert L., MD</creatorcontrib><creatorcontrib>Harper, Nathan, BS</creatorcontrib><creatorcontrib>He, Weijing, MD</creatorcontrib><creatorcontrib>Andrews, Charles P., MD</creatorcontrib><creatorcontrib>Rather, Cynthia G., CCRC</creatorcontrib><creatorcontrib>Ramirez, Daniel A., MD</creatorcontrib><creatorcontrib>Ahuja, Sunil K., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of allergy and clinical immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jacobs, Robert L., MD</au><au>Harper, Nathan, BS</au><au>He, Weijing, MD</au><au>Andrews, Charles P., MD</au><au>Rather, Cynthia G., CCRC</au><au>Ramirez, Daniel A., MD</au><au>Ahuja, Sunil K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><addtitle>J Allergy Clin Immunol</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>133</volume><issue>5</issue><spage>1340</spage><epage>1346.e7</epage><pages>1340-1346.e7</pages><issn>0091-6749</issn><eissn>1097-6825</eissn><coden>JACIBY</coden><abstract>Background The severity of allergic rhinoconjunctivitis (AR) symptomatology elicited after exposure to pollen in the absence versus the presence of confounding cofactors, such as in a pollen challenge chamber (PCC) and the natural pollinating season, respectively, might differ. Objective We sought to determine the correlation of AR severity in the natural season versus out-of-season PCC exposures. Methods Twenty-four Virginia live oak (VLO)–positive, 14 VLO-negative, 16 mountain cedar (MC)−positive, 8 MC-negative, and 26 ragweed-positive participants recorded AR symptoms (total symptom score [TSS]) during the VLO, MC, and ragweed pollinating seasons and during 2 consecutive PCC exposures of 3 hours each to these pollens separately. Results The TSSs recorded before the natural season were higher than the pre-PCC values. This prepriming was greater among VLO+ than MC+ participants, and it blunted further increases in TSSs during the VLO natural season. Nonatopic participants were nonreactive in the PCC. There was wide variation in the level of AR symptomatology after exposure to VLO, MC, or ragweed pollen in the PCC. Prepriming formed the basis for higher AR responses observed in the natural season than in the PCC, resulting in the identification of distinct PCC/natural season endophenotypes and a partial correlation between the TSSs recorded in the natural season versus those recorded in the PCC ( r  = 0.34, 0.54, and 0.65 for VLO+ , MC+ , and ragweed-positive participants, respectively). Conclusions Prepriming in the natural pollinating season might obscure the true correlation between AR severity in the natural season versus the PCC. By mitigating confounding cofactors, PCC exposures have utility for evaluation of novel AR therapeutics.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>24331377</pmid><doi>10.1016/j.jaci.2013.09.051</doi><tpages>7</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0091-6749
ispartof Journal of allergy and clinical immunology, 2014-05, Vol.133 (5), p.1340-1346.e7
issn 0091-6749
1097-6825
language eng
recordid cdi_proquest_miscellaneous_1519842253
source MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
subjects Adolescent
Adult
Aged
Allergies
Allergy
Allergy and Immunology
Ambrosia
Biological and medical sciences
Calendars
challenge
confounding
Conjunctivitis, Allergic - immunology
Conjunctivitis, Allergic - pathology
Conjunctivitis, Allergic - therapy
Desensitization, Immunologic
Diaries
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Immunopathology
Likert scale
Male
Medical sciences
Middle Aged
Mold
Plant reproduction
Pollen
Pollen - immunology
Quercus
Rhinitis, Allergic, Seasonal - immunology
Rhinitis, Allergic, Seasonal - pathology
Rhinitis, Allergic, Seasonal - therapy
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
season
Seasons
Studies
Time Factors
title Effect of confounding cofactors on responses to pollens during natural season versus pollen challenge chamber exposure
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T22%3A07%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20confounding%20cofactors%20on%20responses%20to%20pollens%20during%20natural%20season%20versus%20pollen%20challenge%20chamber%20exposure&rft.jtitle=Journal%20of%20allergy%20and%20clinical%20immunology&rft.au=Jacobs,%20Robert%20L.,%20MD&rft.date=2014-05-01&rft.volume=133&rft.issue=5&rft.spage=1340&rft.epage=1346.e7&rft.pages=1340-1346.e7&rft.issn=0091-6749&rft.eissn=1097-6825&rft.coden=JACIBY&rft_id=info:doi/10.1016/j.jaci.2013.09.051&rft_dat=%3Cproquest_cross%3E3284928461%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1518904478&rft_id=info:pmid/24331377&rft_els_id=S0091674913015650&rfr_iscdi=true