Dr. Arroyo specializes in the treatment of allergic conditions including drug allergy and asthma. She has a special interest in understanding health and healthcare disparities in allergic diseases and how allergies change over a person's lifetime.
- Allergy and Immunology
- Drug allergy
Clinical Assistant Professor, Medicine - Pulmonary, Allergy & Critical Care Medicine
Medical Director, Allergy, Asthma, & Immunodeficiency Clinic, Stanford Health Care (2020 - Present)
Medical Education: Stanford University School of Medicine (2012) CA
Fellowship: Brigham and Women's Hospital Allergy and Immunology Fellowship (2019) MA
Board Certification: American Board of Allergy and Immunology, Allergy and Immunology (2018)
Board Certification: American Board of Internal Medicine, Internal Medicine (2015)
Residency: Stanford University Internal Medicine Residency (2015) CA
MPH, University of California at Berkeley (2012)
- No allergy left behind - the importance of food allergy in longitudinal cohorts. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2021
- Emergency department visits for vaccine-related severe allergic reactions among US adults: 2006-2018. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2021
- Early Introduction of Food Allergens and Risk of Developing Food Allergy NUTRIENTS 2021; 13 (7)
Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions.
Allergy and asthma proceedings
2021; 42 (3): 247–56
Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009-2015) and hospitalizations (2011-2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.
View details for DOI 10.2500/aap.2021.42.210031
View details for PubMedID 33980339
Trends in emergency department visits and hospitalizations for acute allergic reactions and anaphylaxis among US older adults: 2006-2014.
The journal of allergy and clinical immunology. In practice
BACKGROUND: The US older adult population (≥65 years) is increasing and may be at increased risk for severe anaphylaxis. Little is known about the healthcare utilization for acute allergic reactions (AAR), including anaphylaxis, among older adults.OBJECTIVES: To characterize trends in emergency department (ED) visits and hospitalizations for AAR and anaphylaxis among US older adults from 2006-2014, and to examine factors associated with severe anaphylaxis.METHODS: We performed cross-sectional analyses of trends in ED visits and hospitalizations among older adults using data from the Nationwide Emergency Department Sample and the National (Nationwide) Inpatient Sample in 2006-2014. We used International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes to identify visits for AAR, including anaphylaxis. Multivariable logistic regression modeling was used to identify factors associated with severe anaphylaxis (cardiac arrest, intubation and death).RESULTS: In 2006-2014, older adults experienced approximately 1,019,967 AAR-related ED visits; 173,844 AAR-related hospitalizations; 93,795 anaphylaxis-related ED visits; and 72,677 anaphylaxis-related hospitalizations. While AAR-related ED visit and hospitalization rates remained stable (P-trends=0.28 and 0.16, respectively), anaphylaxis-related ED visit and hospitalization rates significantly increased over time (37 visits per 100,000 population in 2006 to 51 in 2014, P-trend<0.001; 13 hospitalizations per 100,000 population in 2006 to 23 in 2014, P-trend<0.001), especially hospitalization rates for drug-related anaphylaxis (47 hospitalizations per 100,000 population in 2006 to 85 in 2014, P-trend<0.001). Risk factors for anaphylaxis-related death included older age and drug-related trigger.CONCLUSIONS: In a nationally representative sample of US older adults, the rate of anaphylaxis-related ED visits and hospitalizations increased over time. Drug-related triggers represented a substantial portion of the increased healthcare utilization and are a growing risk in this vulnerable population.
View details for DOI 10.1016/j.jaip.2021.03.032
View details for PubMedID 33798790
Trends in U.S. emergency department visits for anaphylaxis among infants and toddlers: 2006-2015.
The journal of allergy and clinical immunology. In practice
BACKGROUND: Anaphylaxis is a potentially life-threatening allergic reaction. The overall prevalence of anaphylaxis appears to be rising in children, but temporal trends among infants and toddlers are not well studied.OBJECTIVE: To characterize the trends in U.S. emergency department (ED) visits and hospitalizations among infants and toddlers with anaphylaxis from 2006-2015.METHODS: We conducted a study of temporal trends in anaphylaxis among children (age <18 years) and, more specifically, infants and toddlers (age <3 years) presenting to the ED between 2006-2015 using a large, nationally representative database. For internal consistency, we defined anaphylaxis using ICD-9-CM diagnosis codes and excluded visits with ICD-10-CM (late 2015). We calculated trends in the number and proportion of ED visits and hospitalizations and used multivariable logistic regression to identify predictors of hospitalization.RESULTS: Among infants and toddlers, the proportion of ED visits for anaphylaxis per year increased from 20 per 100,000 visits to 50 per 100,000 visits (Ptrend <0.001). The rate of ED visits for anaphylaxis increased from 15 to 32 ED visits per 100,000 population of infants and toddlers (Ptrend <0.001). Food was the most commonly identified trigger. The proportion of hospitalization among anaphylaxis-related ED visits decreased from 19% to 6% (Ptrend <0.001). Among ED patients, those more likely to be hospitalized were male, privately insured, from higher income families, and presenting to urban, metropolitan teaching hospital EDs.CONCLUSION: In a large, nationally representative US database, from 2006 to 2015, ED visits by infants and toddlers with anaphylaxis increased, while hospitalization of these patients decreased.
View details for DOI 10.1016/j.jaip.2021.01.010
View details for PubMedID 33486144
- Evaluation of Allergic Diseases in Transgender and Gender-Diverse Patients: A Case Study of Asthma. The journal of allergy and clinical immunology. In practice 2021
Trends in U.S. hospitalizations for anaphylaxis among infants and toddlers: 2006-2015.
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
BACKGROUND: Anaphylaxis is a potentially fatal acute allergic reaction. Its overall prevalence appears to be rising, but little is known about U.S. hospitalization trends among infants and toddlers.OBJECTIVE: To identify the trends and predictors of hospitalization for anaphylaxis among infants and toddlers.METHODS: We used the nationally representative National Inpatient Sample (NIS), from 2006-2015, to perform an analysis of trends in U.S. hospitalizations for anaphylaxis among infants and toddlers (age <3 years) and other children (age 3-18 years). For internal consistency, we identified patients with anaphylaxis by ICD-9-CM diagnosis code and excluded those with ICD-10-CM (late 2015). We calculated trends in anaphylaxis hospitalizations over time by age group, then used multivariable logistic regression to describe anaphylaxis hospitalizations among infants and toddlers.RESULTS: Among infants and toddlers, there was no significant change in anaphylaxis hospitalizations during the 10-year study period (P trend =0.14). Anaphylaxis hospitalization among infants and toddlers was more likely in males, with private insurance, in the highest income quartile, with chronic pulmonary disease, who presented on a weekend day, to an urban teaching hospital, located in the Northeast. In contrast, anaphylaxis hospitalizations among older children (age 3 to <18 years) rose significantly during the study (P trend <0.001).CONCLUSION: Anaphylaxis hospitalizations among infants and toddlers in the US were stable from 2006-2015, while hospitalizations among older children were rising. Future research should focus on the trends in disease prevalence and healthcare utilization in the understudied population of infants and toddlers.
View details for DOI 10.1016/j.anai.2020.09.003
View details for PubMedID 32911059
- Allergic sensitization during early life: Concordance between ImmunoCAP and ISAC results. The journal of allergy and clinical immunology. In practice 2020
- Prenatal exposure to acid-suppressant medications and the risk of recurrent wheeze at 3 years of age in children with a history of severe bronchiolitis. The journal of allergy and clinical immunology. In practice 2019
- Where do children die from asthma? National data from 2003 to 2015 JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6 (3): 1034–36
Occupational exposures and asthma prevalence among US farmworkers: National Agricultural Workers Survey, 2003-2014.
The journal of allergy and clinical immunology. In practice
View details for PubMedID 29626636
Staphylococcal infections in children, California, USA, 1985-2009.
Emerging infectious diseases
2013; 19 (1): 10-20
We conducted a retrospective, observational, population-based study to investigate the effect of staphylococcal infections on the hospitalization of children in California during 1985-2009. Hospitalized children with staphylococcal infections were identified through the California Office of Statewide Health Planning and Development discharge database. Infections were categorized as community onset, community onset health care-associated, or hospital onset. Infection incidence was calculated relative to all children and to those hospitalized in acute-care facilities. A total of 140,265 records were analyzed. Overall incidence increased from 49/100,000 population in 1985 to a peak of 83/100,000 in 2006 and dropped to 73/100,000 in 2009. Staphylococcal infections were associated with longer hospital stays and higher risk for death relative to all-cause hospitalizations of children. The number of methicillin-resistant Staphylococcus aureus infections increased, and the number of methicillin-susceptible S. aureus infections remained unchanged. Children <3 years of age, Blacks, and those without private insurance were at higher risk for hospitalization.
View details for DOI 10.3201/eid1901.111740
View details for PubMedID 23260060
The association between insurance status and emergency department disposition of injured California children.
Academic emergency medicine
2012; 19 (5): 541-551
This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.
View details for DOI 10.1111/j.1553-2712.2012.01356.x
View details for PubMedID 22594358
View details for PubMedCentralID PMC3443629