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Nakonechna A, van Bergen A, Anantharachagan A, Arnold D, Johnston N, Nadeau K, Rutkowski K, Sindher SB, Sriaroon P, Thomas I, Vijayadurai P, Wagner A, Davis CM. Fish and shellfish allergy: Presentation and management differences in the UK and US-analysis of 945 patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100309. [PMID: 39253105 PMCID: PMC11381858 DOI: 10.1016/j.jacig.2024.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/19/2024] [Accepted: 06/04/2024] [Indexed: 09/11/2024]
Abstract
Background Seafood allergy (SA), including allergy to shellfish (crustacean and mollusks) and fish, is among the 4 most common food allergies causing anaphylaxis, but there are limited data showing SA clinical management in different countries. Objective We sought to characterize a large cohort of patients with fish and shellfish allergy and to facilitate standardization of future care for this increasingly common allergic disease. Methods We performed a retrospective, observational, noninterventional study from 945 patients from 2015 to 2019 in 7 hospitals in the United States and the United Kingdom to evaluate SA. A chi-square test was used to detect differences in family history, medical history, and current symptoms between patients in 2 countries. Results Underdiagnosed anaphylaxis in patients with SA was associated with underuse of epinephrine (adrenaline) autoinjectors in both countries. Oral food challenge was used only when skin or serologic test results were negative. Asthma and allergic rhinitis were more common in the US patients with SA, but eczema was more common in UK patients with SA (P < .001). Respiratory, gastrointestinal, and neurological symptoms were higher in UK patients with SA than in US patients with SA (P < .001). Conclusions In international multicenter cohorts of patients with fish and shellfish allergy, there are opportunities for improvement in management. Physician identification of anaphylaxis, use of diagnostic oral food challenges, and anaphylaxis treatment with epinephrine are areas with significant knowledge gaps in need of improvement in the United Kingdom and the United States. There is an opportunity for the development of unified, standardized diagnostic protocols for SA with distribution for allergists and trainees.
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Affiliation(s)
- Alla Nakonechna
- University of Liverpool, Liverpool, United Kingdom
- Department of Immunology and Allergy, Hull University Teaching Hospitals NHS Foundation Trust, Hull, United Kingdom
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | | | - Ariharan Anantharachagan
- Department of Allergy & Clinical Immunology, Royal Preston Hospital Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Dilani Arnold
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | - Nicole Johnston
- The University of Texas Health Science Center, McGovern Medical School, Houston, Tex
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Panida Sriaroon
- University of South Florida Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Iason Thomas
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pavaladurai Vijayadurai
- Department of Allergy & Clinical Immunology, Royal Preston Hospital Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Annette Wagner
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carla M Davis
- Division of Immunology, Allergy, and Retrovirology, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
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Lu Y, Yang S, Fu TJ. Quantitation of milk proteins in thermally treated milk samples and commercial food products by ELISA test kits. Food Chem 2024; 455:139736. [PMID: 38823126 DOI: 10.1016/j.foodchem.2024.139736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/03/2024]
Abstract
This study evaluated four ELISA kits for quantitation of milk proteins in thermally treated milk samples and food products. How reference materials may be used for comparison of kit performance was examined. Protein contents determined by Veratox Total Milk generally reflected those determined by the 660 nm total protein assay. BioKits BLG Kit was less affected by thermal treatment but resulted in overestimation of protein contents in samples that were boiled, autoclaved or dry-heated at ≤149 °C, while ELISA Systems Casein (ES Casein) and Beta-Lactoglobulin (ES BLG) assays underestimated protein levels in these samples. The four kits gave similar results for ice cream. Veratox registered higher concentrations in all products tested but its sensitivity was greatly lowered in retorted products. ES Casein underperformed Veratox for baked and retorted products. BioKits BLG maintained a better sensitivity towards fried, baked and retorted products while ES BLG exhibited reduced sensitivity for these products.
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Affiliation(s)
- Yingshuang Lu
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 South Archer Road, Bedford Park, IL 60501, USA.
| | - Shuopeng Yang
- Institute for Food Safety and Health, Illinois Institute of Technology, 6502 South Archer Road, Bedford Park, IL 60501, USA.
| | - Tong-Jen Fu
- U.S. Food and Drug Administration, Division of Food Processing Science and Technology, 6502 South Archer Road, Bedford Park, IL 60501, USA.
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Chong T, Olivieri B, Skypala IJ. Food-triggered anaphylaxis in adults. Curr Opin Allergy Clin Immunol 2024; 24:341-348. [PMID: 39079158 DOI: 10.1097/aci.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children. RECENT FINDINGS Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others. Reactions to natto, fermented soybeans, are currently mainly reported in Japan, but changing dietary practices and an increase in plant-based eating mean natto, other forms of soy and other legumes are increasingly linked to anaphylaxis in Western countries. Anaphylaxis to red meat, caused by sensitization to galactose-α-1,3-galactose and first reported in North America, is now a more world-wide concern. Co-factor induced anaphylaxis is increasingly associated with both wheat allergy and lipid transfer protein allergy. SUMMARY More research is urgently needed to characterize adult food allergy, its triggers and symptom severity. Unusual food triggers and potential co-factors should be considered, so that anaphylaxis in adults can be correctly managed, not merely labelled as idiopathic.
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Affiliation(s)
| | - Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust
- Department of Inflammation & Repair, Imperial College, London, UK
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Lorant V, Klein M, Garçon D, Sotin T, Frey S, Cheminant MA, Ayer A, Croyal M, Flet L, Rimbert A, Colas L, Cariou B, Bouchaud G, Le May C. PCSK9 inhibition protects mice from food allergy. Transl Res 2024; 272:151-161. [PMID: 38471633 DOI: 10.1016/j.trsl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
The Proprotein Convertase Subtilisin Kexin of type 9 (PCSK9) has been identified in 2003 as the third gene involved in familial hypercholesterolemia. PCSK9 binds to the membrane low-density lipoprotein receptor (LDLR) and promotes its cellular internalization and lysosomal degradation. Beyond this canonical role, PCSK9 was recently described to be involved in several immune responses. However, to date, the contribution of PCSK9 in food allergy remains unknown. Here, we showed that Pcsk9 deficiency or pharmacological inhibition of circulating PCSK9 with a specific monoclonal antibody (m-Ab) protected mice against symptoms of gliadin-induced-food allergy, such as increased intestinal transit time and ear oedema. Furthermore, specific PCSK9 inhibition during the elicitation steps of allergic process was sufficient to ensure anti-allergic effects in mice. Interestingly, the protective effect of PCSK9 inhibition against food allergy symptoms was independent of the LDLR as PCSK9 inhibitors remained effective in Ldlr deficient mice. In vitro, we showed that recombinant gain of function PCSK9 (PCSK9 D374Y) increased the percentage of mature bone marrow derived dendritic cells (BMDCs), promoted naïve T cell proliferation and potentiated the gliadin induced basophils degranulation. Altogether, our data demonstrate that PCSK9 inhibition is protective against gliadin induced food allergy in a LDLR-independent manner.
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Affiliation(s)
- Victoria Lorant
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Martin Klein
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec, Canada
| | - Damien Garçon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Thibaud Sotin
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Samuel Frey
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Marie-Aude Cheminant
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Audrey Ayer
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Mikaël Croyal
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France; CRNH-Ouest Mass Spectrometry Core Facility, Nantes, France
| | - Laurent Flet
- Department of Pharmacy, CHU Nantes, Nantes Université, Nantes, France
| | - Antoine Rimbert
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | - Luc Colas
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes F-44000, France; CHU Nantes, Nantes Université, Plateforme transversale d'allergologie et d'immunologie clinique, clinique dermatologique, Nantes, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France
| | | | - Cédric Le May
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 quai Moncousu, BP70721, Nantes 44000, France.
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Orga-Dumitriu D, Harris DM, Porr C. Anaphylactic Shock Caused by Eating Buckwheat. J Clin Med 2024; 13:5243. [PMID: 39274456 DOI: 10.3390/jcm13175243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/15/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. Method: We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. Diagnosis: Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. Result: Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. Conclusions: Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen.
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Affiliation(s)
- Dan Orga-Dumitriu
- Internal Medicine Department, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania
| | - Dana M Harris
- Internal Medicine Department, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Corina Porr
- Allergology Department, County Emergency Clinical Hospital, 550245 Sibiu, Romania
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Abu Risha M, Rick EM, Plum M, Jappe U. Legume Allergens Pea, Chickpea, Lentil, Lupine and Beyond. Curr Allergy Asthma Rep 2024; 24:527-548. [PMID: 38990406 PMCID: PMC11364600 DOI: 10.1007/s11882-024-01165-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF THE REVIEW In the last decade, an increasing trend towards a supposedly healthier vegan diet could be observed. However, recently, more cases of allergic reactions to plants and plant-based products such as meat-substitution products, which are often prepared with legumes, were reported. Here, we provide the current knowledge on legume allergen sources and the respective single allergens. We answer the question of which legumes beside the well-known food allergen sources peanut and soybean should be considered for diagnostic and therapeutic measures. RECENT FINDINGS These "non-priority" legumes, including beans, pea, lentils, chickpea, lupine, cowpea, pigeon pea, and fenugreek, are potentially new important allergen sources, causing mild-to-severe allergic reactions. Severe reactions have been described particularly for peas and lupine. An interesting aspect is the connection between anaphylactic reactions and exercise (food-dependent exercise-induced anaphylaxis), which has only recently been highlighted for legumes such as soybean, lentils and chickpea. Most allergic reactions derive from IgE cross-reactions to homologous proteins, for example between peanut and lupine, which is of particular importance for peanut-allergic individuals ignorant to these cross-reactions. From our findings we conclude that there is a need for large-scale studies that are geographically distinctive because most studies are case reports, and geographic differences of allergic diseases towards these legumes have already been discovered for well-known "Big 9" allergen sources such as peanut and soybean. Furthermore, the review illustrates the need for a better molecular diagnostic for these emerging non-priority allergen sources to evaluate IgE cross-reactivities to known allergens and identify true allergic reactions.
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Affiliation(s)
- Marua Abu Risha
- Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Borstel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany
| | - Eva-Maria Rick
- Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Borstel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany
| | - Melanie Plum
- Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Borstel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany
| | - Uta Jappe
- Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Borstel, Germany.
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany.
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany.
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Xu X, Yuan J, Zhu M, Gao J, Meng X, Wu Y, Li X, Tong P, Chen H. The potential of orally exposed risk factors and constituents aggravating food allergy: Possible mechanism and target cells. Compr Rev Food Sci Food Saf 2024; 23:e70014. [PMID: 39230383 DOI: 10.1111/1541-4337.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/10/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024]
Abstract
Food allergy is a significant concern for the health of humans worldwide. In addition to dietary exposure of food allergens, genetic and environmental factors also play an important role in the development of food allergy. However, only the tip of the iceberg of risk factors in food allergy has been identified. The importance of food allergy caused by orally exposed risk factors and constituents, including veterinary drugs, pesticides, processed foods/derivatives, nanoparticles, microplastics, pathogens, toxins, food additives, dietary intake of salt/sugar/total fat, vitamin D, and therapeutic drugs, are highlighted and discussed in this review. Moreover, the epithelial barrier hypothesis, which is closely associated with the occurrence of food allergy, is also introduced. Additionally, several orally exposed risk factors and constituents that have been reported to disrupt the epithelial barrier are elucidated. Finally, the possible mechanisms and key immune cells of orally exposed risk factors and constituents in aggravating food allergy are overviewed. Further work should be conducted to define the specific mechanism by which these risk factors and constituents are driving food allergy, which will be of central importance to the targeted therapy of food allergy.
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Affiliation(s)
- Xiaoqian Xu
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- College of Food Science & Technology, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Jin Yuan
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- College of Food Science & Technology, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Mengting Zhu
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- College of Food Science & Technology, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Jinyan Gao
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- College of Food Science & Technology, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Xuanyi Meng
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Yong Wu
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Xin Li
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- College of Food Science & Technology, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Ping Tong
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, P. R. China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, P. R. China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang, P. R. China
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Turner PJ, Conrado AB, Kallis C, O'Rourke E, Haider S, Ullah A, Custovic D, Custovic A, Quint JK. Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data. Lancet Public Health 2024; 9:e664-e673. [PMID: 39214635 DOI: 10.1016/s2468-2667(24)00163-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset. METHODS We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England. The main outcomes were incidence and prevalence of food allergy, according to three definitions of food allergy: possible food allergy, probable food allergy, and probable food allergy with adrenaline autoinjectors prescription. We also evaluated the difference in proportion of patients prescribed adrenaline autoinjectors by English Index of Multiple Deprivation (IMD), age, and by previous food anaphylaxis, and explored differences in patient encounters (general practice vs emergency department setting). FINDINGS 7 627 607 individuals in the dataset were eligible for inclusion, of whom 150 018 (median age 19 years [IQR 4-34]; 82 614 [55·1%] female and 67 404 [44·9%] male) had a possible food allergy. 121 706 met diagnostic criteria for probable food allergy, of whom 38 288 were prescribed adrenaline autoinjectors. Estimated incidence of probable food allergy doubled between 2008 and 2018, from 75·8 individuals per 100 000 person-years (95% CI 73·7-77·9) in 2008 to 159·5 (156·6-162·3) individuals per 100 000 person-years in 2018. Prevalence increased from 0·4% (23 399 of 6 432 383) to 1·1% (82 262 of 7 627 607) over the same period and was highest in children under 5 years (11 951 [4·0%] of 296 406 in 2018) with lower prevalence in school-aged children (from 11 353 [2·4%] of 473 597 in 2018 for children aged 5-9 years to 6896 [1·7%] of 404 525 for those aged 15-19 years) and adults (42 848 [0·7%] of 5 992 454 in 2018). In those with previous food anaphylaxis, only 2321 (58·3%) of 3980 (975 [64·0%] of 1524 children and young people and 1346 [54·8%] of 2456 adults) had a prescription for adrenaline autoinjector. Adrenaline autoinjectors prescription was less common in those resident in more deprived areas (according to IMD). In the analysis of health-care encounters, 488 604 (97·1%) of 503 198 visits recorded for food allergy occurred in primary care, with 115 655 (88·4%) of 130 832 patients managed exclusively in primary care. INTERPRETATION These estimates indicate an important and increasing burden of food allergy in England. Our findings that most patients with food allergy are managed outside the hospital system, with low rates of adrenaline autoinjector prescription in those with previous anaphylaxis, highlight a need to better support those working in primary care to ensure optimal management of patients with food allergy. FUNDING UK Food Standards Agency and UK Medical Research Council.
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Affiliation(s)
- Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK.
| | | | | | - Eimear O'Rourke
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Sadia Haider
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Anhar Ullah
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Darije Custovic
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Adnan Custovic
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Jennifer K Quint
- National Heart & Lung Institute, Imperial College London, London, UK
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Davis EC, Monaco CL, Insel R, Järvinen KM. Gut microbiome in the first 1000 days and risk for childhood food allergy. Ann Allergy Asthma Immunol 2024; 133:252-261. [PMID: 38494114 PMCID: PMC11344696 DOI: 10.1016/j.anai.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To summarize recent data on the association between gut microbiome composition and food allergy (FA) in early childhood and highlight potential host-microbiome interactions that reinforce or abrogate oral tolerance. DATA SOURCES PubMed search of English-language articles related to FA, other atopic disease, and the gut microbiome in pregnancy and early childhood. STUDY SELECTIONS Human studies published after 2015 assessing the relationship between the gut bacteriome and virome in the first 2 years of life and FA or food sensitization development in early childhood were prioritized. Additional human studies conducted on the prenatal gut microbiome or other atopic diseases and preclinical studies are also discussed. RESULTS Children who developed FA harbored lower abundances of Bifidobacterium and Clostridia species and had a less mature microbiome during infancy. The early bacterial microbiome protects against FA through production of anti-inflammatory metabolites and induction of T regulatory cells and may also affect FA risk through a role in trained immunity. Infant enteric phage communities are related to childhood asthma development, though no data are available for FA. Maternal gut microbiome during pregnancy is associated with childhood FA risk, potentially through transplacental delivery of maternal bacterial metabolites, though human studies are lacking. CONCLUSION The maternal and infant microbiomes throughout the first 1000 days of life influence FA risk through a number of proposed mechanisms. Further large, longitudinal cohort studies using taxonomic, functional, and metabolomic analysis of the bacterial and viral microbiomes are needed to provide further insight on the host-microbe interactions underlying FA pathogenesis in childhood.
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Affiliation(s)
- Erin C Davis
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, New York
| | - Cynthia L Monaco
- Division of Infectious Disease, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard Insel
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, New York
| | - Kirsi M Järvinen
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, New York; Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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Jeong S, Khandokar R, Sicherer SH. The impact of peer influence and social pressure on the management of food allergy in adolescents and young adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2522-2523.e4. [PMID: 38825037 DOI: 10.1016/j.jaip.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Stephanie Jeong
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Radiah Khandokar
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
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11
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Anyogu A, Somorin YM, Oladipo AO, Raheem S. Food safety issues associated with sesame seed value chains: Current status and future perspectives. Heliyon 2024; 10:e36347. [PMID: 39253262 PMCID: PMC11381738 DOI: 10.1016/j.heliyon.2024.e36347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
Sesame (Sesamum indicum) is an oilseed crop which is increasingly recognised as a functional food by consumers due to its nutritional and nutraceutical components. Consequently, global demand for sesame has increased significantly over the last three decades. Sesame is an important export crop in producing countries, contributing to their socio-economic development. However, in recent years, major foodborne incidents have been associated with imported sesame seeds and products made with these seeds. Foodborne hazards are a potential risk to consumer health and hinder international trade due to border rejections and increased import controls. An insight into the routes of contamination of these hazards across the value chain and factors affecting persistence may lead to more focused intervention and prevention strategies. It was observed that Salmonella is a significant microbial hazard in imported sesame seeds and has been associated with several global outbreaks. Sesame is mainly cultivated in the tropical and subtropical regions of Africa and Asia by smallholder farmers. Agricultural and manufacturing practices during harvesting, storage, and processing before export may allow for the contamination of sesame seeds with Salmonella. However, only a few studies collect data on the microbiological quality of sesame across the value chain in producing countries. In addition, the presence of mycotoxins and pesticides above regulatory limits in sesame seeds is a growing concern. Eliminating foodborne hazards in the sesame value chain requires urgent attention from researchers, producers, processors, and regulators and suggestions for improving the safety of these foods are discussed.
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Affiliation(s)
- Amarachukwu Anyogu
- Food Safety and Security, School of Biomedical Sciences, University of West London, London, W5 5RF, United Kingdom
| | - Yinka M Somorin
- University of Glasgow, Glasgow, G12 8QQ, United Kingdom
- Department of Biological Science, Ajayi Crowther University, Oyo, Nigeria
| | - Abigail Oluseye Oladipo
- Food Safety and Security, School of Biomedical Sciences, University of West London, London, W5 5RF, United Kingdom
| | - Saki Raheem
- School of Life Sciences, University of Westminster, London, W1W 6UW, United Kingdom
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12
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Bannon M, Thivalapill N, Fithian E, Jiang J, Herbert L, Fox S, Warren C, Sharma H, Mahdavinia M, Gupta R, Bilaver L, Assa'Ad A. Differences in familiarity with oral immunotherapy among caregivers of White and Black children with food allergy. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00534-9. [PMID: 39179104 DOI: 10.1016/j.anai.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/15/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Potential racial and ethnic disparities related to oral immunotherapy (OIT) have not been fully described among children with food allergy (FA). OBJECTIVE To characterize the differences in attitudes toward, familiarity with, and utilization of OIT among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic or Latino (H/L) caregivers of children with FA. METHODS Surveys were administered to the caregivers of children enrolled in Food Allergy Outcomes Related to White and African American Racial Differences, a prospective, multisite cohort of children with FA. The distribution of responses by caregiver-reported race and ethnicity was described using an analysis of variance for continuous outcomes and χ2 tests for categorical outcomes. A logistic regression model was used to determine associations between familiarity with OIT as a treatment option and various other covariates. RESULTS The NHB and H/L respondents were more frequently not familiar with OIT compared with NHW responders (54.3% and 62.5% vs 9.2%, P < .001). This finding remained true, even after adjusting for household income (odds ratio: 0.1, 95% CI: 0.1-0.4 for NHB participants and odds ratio: 0.1, 95% CI: 0.0-0.3 for H/L participants). NHB and H/L participants more frequently reported that they had never heard of OIT before the survey compared with NHW participants (76.7% and 50.0% vs 26.7%, P < .001). None of the NHB and H/L respondents initiated OIT compared with 14.8% of NHW participants (P < .001). CONCLUSION In the Food Allergy Outcomes Related to White and African American Racial Differences cohort, familiarity with OIT was lower among caregivers of minoritized racial and ethnic groups, even after adjusting for household income.
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Affiliation(s)
- Megan Bannon
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| | - Neil Thivalapill
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eirene Fithian
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jialing Jiang
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda Herbert
- Division of Allergy and Immunology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan Fox
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Christopher Warren
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Ruchi Gupta
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lucy Bilaver
- Center for Food Allergy & Asthma Research; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amal Assa'Ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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13
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Li Q, Tang X, Huang L, Wang T, Huang Y, Jiang S. Anti-allergic effect of vitamin C through inhibiting degranulation and regulating T H1/T H2 cell polarization. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:5955-5963. [PMID: 38415860 DOI: 10.1002/jsfa.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Food allergy has become a global public health problem. This study aimed to explore the possible anti-allergic effect of vitamin C (VC). A rat basophilic leukemia (RBL)-2H3 cell degranulation model was used to assess the effect of VC on degranulation in vitro, and an ovalbumin (OVA)-induced BALB/c mouse allergy model was used to assess the anti-allergy effect of VC in vivo. RESULTS In vitro, VC significantly attenuated the release of β-hexosaminidase, tryptase and histamine, and also reduced cytokine production (interleukins 4 and 6, tumor necrosis factor α) significantly (P < 0.05), with the inhibitory effect demonstrating a positive correlation with VC dose. In vivo, compared with the OVA group, the levels of serum immunoglobulins E and G1 of the VC low-dose (VCL) group (50 mg kg-1) and high-dose (VCH) group (200 mg·kg-1) were significantly reduced (P < 0.05). Furthermore, the plasma histamine level was also significantly decreased (P < 0.05). Moreover, TH2 cell polarization in mice of the VCL and VCH groups was significantly inhibited (P < 0.05), promoting the TH1/TH2 cell polarization balance. Additionally, VC treatment enhanced the expression of CD80 (P < 0.05) in spleen and small intestine tissues, while significantly inhibiting the expression of CD86 (P < 0.05); notably, high-dose VC treatment was more effective. CONCLUSION VC exerted an anti-allergic effect through inhibiting degranulation and regulating TH1/TH2 cell polarization balance. © 2024 Society of Chemical Industry.
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Affiliation(s)
- Qian Li
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
| | - Xinlei Tang
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
| | - Lu Huang
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
| | - Tao Wang
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
| | - Yutong Huang
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
| | - Songsong Jiang
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, People's Republic of China
- Key Laboratory of Chinese Cuisine Intangible Cultural Heritage Technology Inheritance, Ministry of Culture and Tourism, Yangzhou, People's Republic of China
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14
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Mattison CP, Dupre RA, Clermont K, Gibbons JG, Yu JH. Proteomic characterization of peanut flour fermented by Rhizopus oryzae. Heliyon 2024; 10:e34793. [PMID: 39144949 PMCID: PMC11320294 DOI: 10.1016/j.heliyon.2024.e34793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Fermentation alters the protein content and composition of foods. To characterize fungal catabolism of peanut proteins, defatted peanut flour was fermented by Rhizopus oryzae (R. oryzae) for up to 48 h and evaluated by SDS-PAGE, mass spectrometry, and antibody binding. A clear change in peanut protein migration was observed by SDS-PAGE after 16 h of fermentation. Mass spectrometric analysis indicated changes in allergen peptides and R. oryzae proteins. Several low molecular weight allergen fragments produced during fermentation were identified by mass spectrometry. Immunoassays using anti-peanut allergen antibodies demonstrated reduced allergen content as early as 16 h of fermentation. However, ELISA with peanut allergic IgE indicated only slightly reduced allergen binding even after 48 h. These results indicate that while R. oryzae fermentation efficiently metabolizes peanut allergens, significant IgE binding remains in lower molecular mass peptides, and therefore R. oryzae fermented peanut products would not be safe for peanut allergic individuals.
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Affiliation(s)
- Christopher P. Mattison
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, FPSQ, New Orleans, LA, 70124, USA
| | - Rebecca A. Dupre
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, FPSQ, New Orleans, LA, 70124, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, TN, 37831, USA
| | - Kristen Clermont
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, FPSQ, New Orleans, LA, 70124, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Oak Ridge, TN, 37831, USA
- Department of Biology, La Salle University, Philadelphia, PA, 19141, USA
| | - John G. Gibbons
- Department of Food Science, College of Natural Sciences, University of Massachusetts, Amherst, MA, 01003, USA
| | - Jae-Hyuk Yu
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, 53706, USA
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15
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Alibrahim I, AlSulami M, Alotaibi T, Alotaibi R, Bahareth E, Abulreish I, Alsuruji S, Khojah I, Goronfolah L, Rayes H, Bukhari A, Khojah A. Prevalence of Parent-Reported Food Allergies Among Children in Saudi Arabia. Nutrients 2024; 16:2693. [PMID: 39203829 PMCID: PMC11356889 DOI: 10.3390/nu16162693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Food allergy (FA) is an immune-mediated hypersensitivity to foods, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence, characteristics, and influencing factors of parent-reported FAs among children in Saudi Arabia. (2) Methods: This cross-sectional study utilized a validated parental questionnaire distributed across all regions of Saudi Arabia. Data from 2130 participants were collected and analyzed using SPSS v. 26 and Prism software v. 10.3.0. (3) Results: Parent-reported FA prevalence was 15.2%. Egg was the most common allergen (6.2%), followed by tree nuts (4.1%), peanuts (4.0%), milk (3.8%), and sesame (3.2%). Significant geographical variations were observed, with the western region having the highest burden (p < 0.001). Older children had higher rates of shellfish and fish allergies. Parental allergies and co-existing asthma/drug allergies were positively associated with childhood FAs. (4) Conclusions: This study highlights a substantial burden of parent-reported FAs in Saudi Arabia, with regional variations in food allergen distribution. Parental allergies and co-existing allergic conditions may influence FA risk.
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Affiliation(s)
- Ibrahim Alibrahim
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Maria AlSulami
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Turki Alotaibi
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Ruba Alotaibi
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Elaf Bahareth
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Inam Abulreish
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Sumayyah Alsuruji
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Imad Khojah
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Loie Goronfolah
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
| | - Husni Rayes
- Department of Pediatrics, Makkah Maternity and Children Hospital, Makkah 24246, Saudi Arabia;
| | - Ameera Bukhari
- College of Science, Taif University, Taif 21944, Saudi Arabia;
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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16
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Zielinska J, Zagórska W, Krupa-Łaska A, Łyżwa K, Lewandowski Z, Kulus M, Grzela K. Efficacy and safety of low-dose sesame oral immunotherapy in paediatric patients: a protocol for a single-centre, randomised controlled trial. BMJ Open 2024; 14:e085811. [PMID: 39134434 PMCID: PMC11331968 DOI: 10.1136/bmjopen-2024-085811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Sesame allergy, though with low prevalence, can result in severe, potentially life-threatening reactions and poses challenges in allergen avoidance due to hidden sources. In the majority of patients, sesame allergy persists and there is currently no effective long-term treatment available. Therefore, oral immunotherapy (OIT) is a promising alternative approach to managing sesame allergy. In this study protocol, we present a randomised controlled trial evaluating the efficacy and safety of OIT with low-dose sesame protein in paediatric patients. The study's aim is to compare OIT with a 300 mg maintenance dose of sesame protein against controls. METHODS AND ANALYSIS 39 participants aged 3-17 with IgE-mediated sesame allergy confirmed by oral food challenge will be enrolled into the study. The trial will be conducted at the Paediatric Hospital of the Medical University of Warsaw, Poland. The study comprises two arms-sesame OIT and control. In the sesame OIT group, interventions will be administered once daily for up to 18 months. During the first phase, the dose will be escalated every 2-4 weeks, and in the second phase, the maintenance dose of 300 mg sesame protein will continue for 3 months. Members of the control group will receive standard treatment, which includes an elimination diet and will remain under observation for 1 year. The primary outcome is the proportion of participants tolerating a single dose of 4000 mg of sesame protein during the final oral food challenge in the experimental group versus the control group. Secondary outcomes assess adverse events, changes in immunological parameters and the maximum tolerated doses of sesame protein in each group. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Medical University of Warsaw (approval number: KB/269/2023). Results will be published in peer-reviewed journals and disseminated via presentations at international conferences. TRIAL REGISTRATION NUMBER NCT06261554.
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Affiliation(s)
- Joanna Zielinska
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Krupa-Łaska
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | | | - Zbigniew Lewandowski
- Institute of Hygiene and Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Grzela
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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17
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Kubala SA, Young FD, Callier V, Rasooly MM, Dempsey C, Brittain E, Frischmeyer-Guerrerio PA. Key factors that influence quality of life in patients with IgE-mediated food allergy vary by age. Allergy 2024. [PMID: 39096008 DOI: 10.1111/all.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 06/18/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND While food allergy (FA) can be fatal, the greatest public health impact of FA arguably lies in its detrimental effect on quality of life (FAQOL). Understanding the factors that contribute to FAQOL at different ages is essential to develop personalized interventions that will improve FAQOL. OBJECTIVE To determine the most influential factors that impact FAQOL across ages in well-phenotyped participants with confirmed FA. METHODS One hundred and twenty-five individuals aged 2-28 years with IgE-mediated FA completed validated age-specific FAQOL questionnaires. The relationship between demographic/clinical variables and scores were analyzed to identify key predictors of FAQOL. RESULTS Poor FAQOL was associated with increasing age, strict avoidance practices, reactions to trace exposures, and more severe reactions as assessed by epinephrine use, anaphylaxis, and/or treatment in the emergency department; FAQOL improved with time from the event. FAQOL was worse in subjects avoiding >2 versus ≤2 foods and in those avoiding milk, egg, soy, sesame, or wheat. Number of foods avoided had greatest impact on children ages 2-7 years, while total number of allergic reactions strongly impacted FAQOL in teens and adults; FAQOL of subjects ages 8-12 years appeared less affected by these variables compared to other age groups. A decision tree analysis identified key predictors of overall FAQOL (age, number of food avoidances, and time since epinephrine use) that can be used to guide intervention strategies to improve FAQOL. CONCLUSION We directly compared FAQOL in extensively phenotyped children, teenagers, and adults with confirmed IgE-mediated FA. Age; timing, number, and severity of reactions; type and number of FA; and food avoidance practices influence FAQOL and should guide intervention strategies.
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Affiliation(s)
- Stephanie A Kubala
- Food Allergy Research Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
| | - Fernanda D Young
- Food Allergy Research Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
| | - Viviane Callier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Marjohn M Rasooly
- Food Allergy Research Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
| | - Caeden Dempsey
- Food Allergy Research Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
| | - Erica Brittain
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
| | - Pamela A Frischmeyer-Guerrerio
- Food Allergy Research Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland, USA
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18
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Marques-Mejias A, Bartha I, Ciaccio CE, Chinthrajah RS, Chan S, Hershey GKK, Hui-Beckman JW, Kost L, Lack G, Layhadi JA, Leung DYM, Marshall HF, Nadeau KC, Radulovic S, Rajcoomar R, Shamji MH, Sindher S, Brough HA. Skin as the target for allergy prevention and treatment. Ann Allergy Asthma Immunol 2024; 133:133-143. [PMID: 38253125 DOI: 10.1016/j.anai.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
The fact that genetic and environmental factors could trigger disruption of the epithelial barrier and subsequently initiate a TH2 inflammatory cascade conversely proposes that protecting the same barrier and promoting adequate interactions with other organs, such as the gut, may be crucial for lowering the risk and preventing atopic diseases, particularly, food allergies. In this review, we provide an overview of structural characteristics that support the epithelial barrier hypothesis in patients with atopic dermatitis, including the most relevant filaggrin gene mutations, the recent discovery of the role of the transient receptor potential vanilloid 1, and the role involvement of the microbiome in healthy and damaged skin. We present experimental and human studies that support the mechanisms of allergen penetration, particularly the dual allergen exposure and the outside-in, inside-out, and outside-inside-outside hypotheses. We discuss classic skin-targeted therapies for food allergy prevention, including moisturizers, steroids, and topical calcineurin inhibitors, along with pioneering trials proposed to change their current use (Prevention of Allergy via Cutaneous Intervention and Stopping Eczema and ALlergy). We provide an overview of the novel therapies that enhance the skin barrier, such as probiotics and prebiotics topical application, read-through drugs, direct and indirect FLG replacement, and interleukin and janus kinases inhibitors. Last, we discuss the newer strategies for preventing and treating food allergies in the form of epicutaneous immunotherapy and the experimental use of single-dose of adeno-associated virus vector gene immunotherapy.
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Affiliation(s)
- Andreina Marques-Mejias
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Irene Bartha
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Christina E Ciaccio
- Department of Pediatrics, The University of Chicago, Chicago, Illinois; Department of Medicine, The University of Chicago, Chicago, Illinois
| | - R Sharon Chinthrajah
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Susan Chan
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laurie Kost
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Gideon Lack
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Janice A Layhadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Kari C Nadeau
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Suzana Radulovic
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Reena Rajcoomar
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Helen A Brough
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Barshow SM, Islam M, Commins S, Macauley MS, Paulson JC, Kulis MD. Targeting inhibitory Siglec-3 to suppress IgE-mediated human basophil degranulation. J Allergy Clin Immunol 2024; 154:492-497.e1. [PMID: 38593870 DOI: 10.1016/j.jaci.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/12/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Sialic acid-binding immunoglobulin-like lectin-3 (Siglec-3 [CD33]) is a major Siglec expressed on human mast cells and basophils; engagement of CD33 leads to inhibition of cellular signaling via immunoreceptor tyrosine-based inhibitory motifs. OBJECTIVE We sought to inhibit human basophil degranulation by simultaneously recruiting inhibitory CD33 to the IgE-FcεRI complex by using monoclonal anti-IgE directly conjugated to CD33 ligand (CD33L). METHODS Direct and indirect basophil activation tests (BATs) were used to assess both antigen-specific (peanut) and antigen-nonspecific (polyclonal anti-IgE) stimulation. Whole blood from donors with allergy was used for direct BAT, whereas blood from donors with nonfood allergy was passively sensitized with plasma from donors with peanut allergy in the indirect BAT. Blood was incubated with anti-IgE-CD33L or controls for 1 hour or overnight and then stimulated with peanut, polyclonal anti-IgE, or N-formylmethionyl-leucyl-phenylalanine for 30 minutes. Degranulation was determined by measuring CD63 expression on the basophil surface by flow cytometry. RESULTS Incubation for 1 hour with anti-IgE-CD33L significantly reduced basophil degranulation after both allergen-induced (peanut) and polyclonal anti-IgE stimulation, with further suppression after overnight incubation with anti-IgE-CD33L. As expected, anti-IgE-CD33L did not block basophil degranulation due to N-formylmethionyl-leucyl-phenylalanine, providing evidence that this inhibition is IgE pathway-specific. Finally, CD33L is necessary for this suppression, as monoclonal anti-IgE without CD33L was unable to reduce basophil degranulation. CONCLUSIONS Pretreating human basophils with anti-IgE-CD33L significantly suppressed basophil degranulation through the IgE-FcεRI complex. The ability to abrogate IgE-mediated basophil degranulation is of particular interest, as treatment with anti-IgE-CD33L before antigen exposure could have broad implications for the treatment of food, drug, and environmental allergies.
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Affiliation(s)
- Suzanne M Barshow
- Duke University School of Medicine, Durham, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Scott Commins
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Michael D Kulis
- University of North Carolina at Chapel Hill, Chapel Hill, NC.
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20
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Gallagher LA, Schuler CF, Troost JP, Slack IF, Sanders GM, Baker JR, Smith JA, O'Shea KM. Racial and Socioeconomic Disparities Exist in Patients Pursuing Peanut Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2102-2108. [PMID: 38692485 DOI: 10.1016/j.jaip.2024.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising treatment for food allergy. Prior studies demonstrate significant differences among food-allergic individuals across race, ethnicity, and socioeconomic groups. Disparities in OIT have not been evaluated. OBJECTIVE We assessed disparities in the use of OIT in patients with peanut allergy based on race, ethnicity, and socioeconomic status at a single academic medical center. METHODS We identified 1028 peanut-allergic patients younger than 18 years receiving care in the University of Michigan food allergy clinics. Of these, 148 patients who underwent peanut OIT (treatment group) were compared with the 880 patients who avoided peanut (control group). Pertinent demographic and socioeconomic characteristics were compared. RESULTS There were no differences in gender or ethnicity between the OIT and control groups. However, Black patients comprised 18% of the control group but only 4.1% of the OIT treatment group (P < .0001). The proportion of patients with private insurance was significantly higher in the treatment group compared with the control group (93.2% vs 82.2%, P = .0004). Finally, the neighborhood affluence index, a census-based measure of the relative socioeconomic prosperity of a neighborhood, was significantly higher in the OIT group than the control group (0.51 ± 0.18 vs 0.47 ± 0.19, P = .015), whereas the neighborhood disadvantage index, a census-based measure of the relative socioeconomic disadvantage of a neighborhood, was significantly lower (0.082 ± 0.062 vs 0.10 ± 0.093, P = .020). CONCLUSIONS Significant racial and economic disparities exist at our institution between peanut-allergic individuals who receive OIT and those who do not. Efforts to understand the basis for these disparities are important to ensure that patients have equitable access to OIT.
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Affiliation(s)
- Lindsay A Gallagher
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Charles F Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Mich
| | - Ian F Slack
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Georgiana M Sanders
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - James R Baker
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Mich; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Mich
| | - Kelly M O'Shea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich.
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21
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Risemberg EL, Smeekens JM, Cruz Cisneros MC, Hampton BK, Hock P, Linnertz CL, Miller DR, Orgel K, Shaw GD, de Villena FPM, Burks AW, Valdar W, Kulis MD, Ferris MT. A mutation in Themis contributes to anaphylaxis severity following oral peanut challenge in CC027 mice. J Allergy Clin Immunol 2024; 154:387-397. [PMID: 38670234 PMCID: PMC11323216 DOI: 10.1016/j.jaci.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The development of peanut allergy is due to a combination of genetic and environmental factors, although specific genes have proven difficult to identify. Previously, we reported that peanut-sensitized Collaborative Cross strain CC027/GeniUnc (CC027) mice develop anaphylaxis upon oral challenge to peanut, in contrast to C3H/HeJ (C3H) mice. OBJECTIVE This study aimed to determine the genetic basis of orally induced anaphylaxis to peanut in CC027 mice. METHODS A genetic mapping population between CC027 and C3H mice was designed to identify the genetic factors that drive oral anaphylaxis. A total of 356 CC027xC3H backcrossed mice were generated, sensitized to peanut, then challenged to peanut by oral gavage. Anaphylaxis and peanut-specific IgE were quantified for all mice. T-cell phenotyping was conducted on CC027 mice and 5 additional Collaborative Cross strains. RESULTS Anaphylaxis to peanut was absent in 77% of backcrossed mice, with 19% showing moderate anaphylaxis and 4% having severe anaphylaxis. There were 8 genetic loci associated with variation in response to peanut challenge-6 associated with anaphylaxis (temperature decrease) and 2 associated with peanut-specific IgE levels. There were 2 major loci that impacted multiple aspects of the severity of acute anaphylaxis, at which the CC027 allele was associated with worse outcome. At one of these loci, CC027 has a private genetic variant in the Themis gene. Consistent with described functions of Themis, we found that CC027 mice have more immature T cells with fewer CD8+, CD4+, and CD4+CD25+CD127- regulatory T cells. CONCLUSIONS Our results demonstrate a key role for Themis in the orally reactive CC027 mouse model of peanut allergy.
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Affiliation(s)
- Ellen L Risemberg
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Johanna M Smeekens
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marta C Cruz Cisneros
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brea K Hampton
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pablo Hock
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Colton L Linnertz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darla R Miller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly Orgel
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ginger D Shaw
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fernando Pardo Manuel de Villena
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Wesley Burks
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William Valdar
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Michael D Kulis
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Martin T Ferris
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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22
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Mauldin K, Pignotti GAP, Gieng J. Measures of nutrition status and health for weight-inclusive patient care: A narrative review. Nutr Clin Pract 2024; 39:751-771. [PMID: 38796769 DOI: 10.1002/ncp.11158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/07/2024] [Accepted: 04/25/2024] [Indexed: 05/28/2024] Open
Abstract
In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.
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Affiliation(s)
- Kasuen Mauldin
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
- Clinical Nutrition, Stanford Health Care, Stanford, California, USA
| | - Giselle A P Pignotti
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
| | - John Gieng
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
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23
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Wang J, Bird JA, Cleary K, Doucette J, du Toit G, Groetch M, Gupta R, Hathaway KH, Klein S, Lack G, Leeds S, Leon T, Lewis MO, Lieberman J, Nowak-Wegrzyn A, Scribner P, Vickery BP, Warren CM. Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians. J Pediatr 2024; 275:114218. [PMID: 39074733 DOI: 10.1016/j.jpeds.2024.114218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/27/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE To characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce. STUDY DESIGN Pediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines. RESULTS A total of 250 pediatricians, 250 family physicians, 504 APPs, and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis. CONCLUSIONS Although pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices.
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Affiliation(s)
- Julie Wang
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, UT Southwestern Medical Center, Dallas, TX
| | - Kelly Cleary
- Food Allergy Research & Education (FARE), McLean, VA
| | - Julianne Doucette
- Primary Care Pediatric Nurse Practitioner DNP Program, Rush University, Chicago, IL
| | | | - Marion Groetch
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Sara Klein
- Food Allergy Research & Education (FARE), McLean, VA
| | - Gideon Lack
- Pediatric Allergy, King's College London, London, UK
| | - Stephanie Leeds
- Division of Pediatric Allergy and Immunology, Yale School of Medicine, New Haven, CT
| | - Tiffany Leon
- Food Allergy Research & Education (FARE), McLean, VA
| | - Megan O Lewis
- Food Allergy Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jay Lieberman
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Paul Scribner
- Food Allergy Research & Education (FARE), McLean, VA
| | - Brian P Vickery
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Christopher M Warren
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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24
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Hung L, Zientara B, Berin MC. Contribution of T cell subsets to different food allergic diseases. Immunol Rev 2024. [PMID: 39054597 DOI: 10.1111/imr.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Food allergies occur due to a lack of tolerance to the proteins found in foods. While IgE- and non-IgE-mediated food allergies have different clinical manifestations, epidemiology, pathophysiology, and management, they share dysregulated T cell responses. Recent studies have shed light on the contributions of different T cell subsets to the development and persistence of different food allergic diseases. This review discusses the role of T cells in both IgE- and non-IgE-mediated food allergies and considers the potential future investigations in this context.
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Affiliation(s)
- Lisa Hung
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brianna Zientara
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M Cecilia Berin
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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25
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Frischmeyer-Guerrerio PA, Young FD, Aktas ON, Haque T. Insights into the clinical, immunologic, and genetic underpinnings of food allergy. Immunol Rev 2024. [PMID: 39034662 DOI: 10.1111/imr.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
The last few decades have seen striking changes in the field of food allergy. The prevalence of the disease has risen dramatically in many parts of the globe, and management of the condition has undergone major revision. While delayed introduction of common allergenic foods during infancy was advised for many years, the learning early about peanut allergy (LEAP) trial and other studies led to a major shift in infant feeding practices, with deliberate early introduction of these foods now recommended. Additionally, the Food and Drug Administration approved the first treatment for food allergy in 2020-a peanut oral immunotherapy (OIT) product that likely represents just the beginning of new immunotherapy-based and other treatments for food allergy. Our knowledge of the environmental and genetic factors contributing to the pathogenesis of food allergy has also undergone transformational advances. Here, we will discuss our efforts to improve the clinical care of patients with food allergy and our understanding of the immunological mechanisms contributing to this common disease.
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Affiliation(s)
- Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Fernanda D Young
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozge N Aktas
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tamara Haque
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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26
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Miller ME, Virkud Y, Rodriguez GM, Pake WG. The availability of allergen-friendly food for college students experiencing food insecurity: Exploring current campus practices. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00425-3. [PMID: 39019435 DOI: 10.1016/j.anai.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/20/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The burden of dietary restrictions includes the high cost and limited availability of allergen-friendly products which disproportionately affects people with food insecurity. OBJECTIVE To better understand access to allergen-friendly food for college students experiencing food insecurity with food allergies or other diet-treated conditions by surveying college campus food pantries. METHODS A total of 120 randomly selected US colleges/universities were recruited to complete FOODiversity's Food Insecurity Questionnaire about campus food pantry operations, dietary restrictions, and food-insecurity initiatives and provide details about their resources and training dedicated to supporting food-insecure young adults who avoid specific food(s). RESULTS Of the respondents, 48% ask students about dietary restrictions at food pantry intake, 37% track the number of patrons with restrictions, 30% process allergen-friendly product requests, 17% train staff about dietary restrictions, and 4% modify processes to accommodate dietary restrictions. Of the 48% who inquire about dietary restrictions, follow-up interventions vary in levels of accommodation. Dairy-free and gluten-free products are most frequently requested, and gluten-free products are the most donated/stocked and most difficult to accommodate. CONCLUSION Food pantries play a critical role in reducing the burden experienced by food-insecure individuals; however, most pantries are unable to provide sufficient accommodations for clients with food allergies or other diet-treated conditions, including staff training, provision of allergen-friendly products, or identifying food-insecure college students with dietary restrictions, and promoting food allergy safety and nutritional impacts.
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Affiliation(s)
- Megan Elaine Miller
- Department of Population Health, New York University Langone Health, New York, New York
| | - Yamini Virkud
- Division of Pediatric Allergy & Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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27
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Figueroa-Gómez XA, Oliveras-López MJ, Poyanco-Bugueño MF, Ocaña-Peinado FM, López-García de la Serrana H, Araya Quezada M. Knowledge, attitude, and practices of restaurant and foodservice personnel in food allergy. A systematic review and meta-analysis. Heliyon 2024; 10:e33431. [PMID: 39040259 PMCID: PMC11260967 DOI: 10.1016/j.heliyon.2024.e33431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Background Currently, there may be 240-250 million people worldwide affected by food allergies. Dining out can be challenging for individuals with food allergies who rely on restaurant and food service staff to properly prepare allergen-free meals. For this reason, the personnel working in restaurants and other food services play a significant role in managing the risks faced by customers with food allergies. Objectives A systematic review and meta-analysis was conducted to assess the existing evidence concerning the knowledge, attitudes, and practices related to food allergies among restaurant and foodservice personnel. Methods To identify, characterize, and synthesize published research on the prevalence of positive responses regarding knowledge, attitudes, and practices related to food allergies among restaurant and food service personnel, international recommendations for systematic reviews and PRISMA guidelines were followed. The search was conducted between January 2012 and January 2022, utilizing the electronic databases PubMed, Web of Science, Scopus, and the Cochrane Library. Selection and data extraction were carried out following predefined protocols, and constructs based on reported outcomes were generated and subsequently analyzed in the meta-analysis. Trials were evaluated using the Cochrane tool for risk of bias. The results are presented using summary tables, forest plots, and box plots, showcasing the combined proportion of constructs obtained from independent surveys conducted without control groups. These constructs were then grouped into categories as an organizational framework and analyzed to determine their distribution among quintiles, aiming to provide a detailed overview of data variability. This strategy allowed us to demonstrate how results from the analyzed categories were distributed. Results The algorithm identified 23 relevant studies, primarily originating from the United States and Europe. The main observed variability was related to the evaluated populations and the instruments used. A total of 28 constructs were identified, with 10 related to knowledge, 9 to attitudes, and 9 to practices. A proportion meta-analysis was conducted to determine the prevalence of positive responses within these three study categories. The results obtained reveal that, in the knowledge category, quintiles 4 and 5 exhibit strong knowledge on the subject (over 84 %). In contrast, starting from quintile 2, the majority of participants shows a positive attitude toward catering to consumers with food allergies (over 85 %). However, after examining the practices category, responses belonging to quintile 5 reflect a low level of risk, while in the other quintiles, behaviors with a higher potential risk for consumers with food allergies are identified. Conclusions The knowledge, attitudes, and practices of personnel in the food service sector are crucial due to the increasing prevalence of food allergies today, as well as the growing frequency of eating out. Knowledge is the most extensively studied category, showing generally acceptable but still insufficient levels in some areas. Positive attitudes are expressed towards individuals disclosing allergic conditions, yet they do not necessarily correlate with high levels of knowledge. The identified practices do not ensure the safety of the dish served to the customer. There is limited awareness regarding the importance of preventing acute allergic reactions at the time of food consumption. Restaurants and food services should train all staff involved in customer service, implement protocols aimed at preventing allergic reactions during food service, and establish guidelines for handling a customer experiencing an acute reaction.The limitations of this research are related to the heterogeneity present in the synthesized results, urging caution when interpreting the overall estimate of the combined effect, as the findings may not be applicable to all populations or study settings. Indeed, more studies are needed to enhance result precision and provide more specific recommendations for catering to allergic customers in restaurants and food services.
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Affiliation(s)
- Ximena A. Figueroa-Gómez
- Nutrition and Food Science Doctoral Program at the Department of Nutrition and Bromatology, Faculty of Pharmacy, University of Granada, 18071, Granada, Spain
- Nutrition and Food Science Doctoral Program at the Human Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, El Líbano 5524, CP. 7830490, Macul, Santiago, Chile
| | - María Jesús Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain
| | | | | | | | - Magdalena Araya Quezada
- Institute of Nutrition and Food Technology (INTA), University of Chile, El Líbano 5524, CP. 7830490, Macul, Santiago, Chile
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28
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Alotiby A. Quality of Life in the Management of Anaphylaxis in Food-Allergic Adults. Int J Gen Med 2024; 17:3047-3055. [PMID: 39011422 PMCID: PMC11249098 DOI: 10.2147/ijgm.s467915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
Background Anaphylaxis is a life-threatening allergic reaction that can significantly affect the quality of life of those affected. Factors including undiagnosed allergies, lack of allergen information, and insufficient emergency training can impact the quality of life for food-allergic individuals. Well-informed patients are less likely to experience severe allergic responses, ensuring their safety and quality of life. Aim This study aims to evaluate the effectiveness of following preventive behavior, focusing on routine counseling and training provided by healthcare professionals in preventing anaphylaxis and assessing the impact of strict adherence to an allergen avoidance regimen against anaphylaxis. Methods This study was a descriptive, cross-sectional survey conducted in the Makkah region of Saudi Arabia. It involved adults aged 18 and above who had food allergies. A structured online questionnaire of seven items was developed and distributed to achieve the study's goals from October 2023 to January 2024. The data collected was automatically exported to Excel and then analyzed using the Statistical Package for the Social Sciences. Results The study involved 93 participants, 65.6% female and 34.4% male. Among those with food allergies, 34.4% had experienced anaphylaxis, with 50% allergic to eggs and seafood. The study found no significant association between specific food allergens and a history of anaphylaxis, but strict allergen avoidance was linked to lower anaphylaxis rates. Counseling or training for managing food allergy reactions also showed potential benefits. The research indicated that males were less likely to have anaphylaxis than females, and age increased the severity of anaphylaxis reactions regardless of gender. Conclusion The study emphasizes the importance of preventive behaviors and healthcare professional support in reducing the risk of anaphylactic reactions for food-allergic adults. Future research could focus on improving their quality of life through education programs, policy development, and better access to emergency medications and psychosocial support strategies.
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Affiliation(s)
- Amna Alotiby
- Department of Hematology and Immunology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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29
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Lu C, Jiang Y, Lan M, Wang L, Zhang W, Wang F. Children's food allergy: Effects of environmental influences and antibiotic use across critical developmental windows. JOURNAL OF HAZARDOUS MATERIALS 2024; 472:134506. [PMID: 38714059 DOI: 10.1016/j.jhazmat.2024.134506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Increasing studies linked outdoor air pollution (OAP), indoor environmental factors (IEFs), and antibiotics use (AU) with the first wave of allergies (i.e., asthma, allergic rhinitis, and eczema), yet the role of their exposures on children's second wave of allergy (i.e., food allergy) are unknown. OBJECTIVES To investigate the association between exposure to OAP and IEFs and childhood doctor-diagnosed food allergy (DFA) during the pre-pregnancy, prenatal, early postnatal, and current periods, and to further explore the effect of OAP and IEFs on DFA in children co-exposed to antibiotics. METHODS A retrospective cohort study involving 8689 preschoolers was carried out in Changsha, China. Data on the health outcomes, antibiotic use, and home environment of each child were collected through a questionnaire. Temperature and air pollutants data were obtained from 8 and 10 monitoring stations in Changsha, respectively. Exposure levels to temperature and air pollutants at individual home addresses were calculated by the inverse distance weighted (IDW) method. Multiple logistic regression models were employed to assess the associations of childhood DFA with exposure to OAP, IEF, and AU. RESULTS Childhood ever doctor-diagnosed food allergy (DFA) was linked to postnatal PM10 exposure with OR (95% CI) of 1.18 (1.03-1.36), especially for CO and O3 exposure during the first year with ORs (95% CI) = 1.08 (1.00-1.16) and 1.07 (1.00-1.14), as well as SO2 exposure during the previous year with OR (95% CI) of 1.13 (1.02-1.25). The role of postnatal air pollution is more important for the risk of egg, milk and other food allergies. Renovation-related IAP (new furniture) and dampness-related indoor allergens exposures throughout all time windows significantly increased the risk of childhood DFA, with ORs ranging from 1.23 (1.03-1.46) to 1.54 (1.29-1.83). Furthermore, smoke-related IAP (environmental tobacco smoke [ETS], parental and grandparental smoking) exposure during pregnancy, first year, and previous year was related to DFA. Additionally, exposure to pet-related indoor allergens (cats) during first year and total plant-related allergens (particularly nonflowering plants) during previous year were associated with DFA. Moreover, exposure to plant-related allergy during first and previous year was specifically associated with milk allergy, while keeping cats during first year increased the risk of fruits/vegetables allergy. Life-time and early-life AU was associated with the increased risk of childhood DFA with ORs (95% CI) = 1.57 (1.32-1.87) and 1.46 (1.27-1.67), including different types food allergies except fruit/vegetable allergy. CONCLUSIONS Postnatal OAP, life-time and early-life IEFs and AU exposure played a vital role in the development of DFA, supporting the "fetal origin of childhood FA" hypothesis.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China; Hunan Provincial Key Laboratory of Low Carbon Healthy Building, Central South University, Changsha, China.
| | - Ying Jiang
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Mengju Lan
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Lin Wang
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Wanzhen Zhang
- Department of GICU, Henan Provincial Chest Hospital, Weiwu Road No. 1, Zhengzhou, China
| | - Faming Wang
- Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
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Trevisonno J, Venter C, Pickett-Nairne K, Bégin P, Cameron SB, Chan ES, Cook VE, Factor JM, Groetch M, Hanna MA, Jones DH, Wasserman RL, Mack DP. Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1809-1818.e3. [PMID: 38492666 DOI: 10.1016/j.jaip.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective. OBJECTIVE We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians. METHODS A survey in Canada and the United States involved families currently enrolled in food OIT programs. RESULTS Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a "very significant" barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with a slower buildup (P = .02) and a reduction in dose (P = .002). Taste aversion was a strongly age-dependent barrier for initiation (P < .001) and continuation (P < .002), with older children over 6 years of age reporting it as a very significant barrier (P < .001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (P < .05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (P < .001). CONCLUSIONS Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success.
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Affiliation(s)
| | - Carina Venter
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - Kaci Pickett-Nairne
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Philippe Bégin
- Section of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada; Section of Allergy, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Victoria E Cook
- Division of Allergy, Department of Pediatrics, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | | | - Marion Groetch
- Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mariam A Hanna
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Sansweet S, Roach A, Pappalardo AA, Yost JC, Asante J, Warren C. Food Insecurity and Psychosocial Burden in a National Community-Based Sample of Households Managing Food Allergy. Health Promot Pract 2024; 25:634-643. [PMID: 38288585 DOI: 10.1177/15248399231223740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Experiencing food allergies and food insecurity has been linked to socioeconomic, physical, and mental health-related challenges, but less is known about the intersection of these experiences. This study aims to better understand the impact of food insecurity on food allergy patients and their caregivers, with the intention of informing ongoing efforts to improve screening for food insecurity and mental health concerns and reducing their burden among households managing food allergy. METHOD As part of a community needs assessment, a cross-sectional survey was administered to a large, national sample (N=5,940) of US households with at least one food-allergic individual, The Hunger Vital Sign was utilized to assess food insecurity, the Patient Health Questionnaire (PHQ-4) and Food Allergy Independent Measure (FAIM) were leveraged to measure psychosocial outcomes. RESULTS Among respondents, 69.9% screened at-risk of food insecurity on the Hunger Vital Sign, while 5.6% reported very low food security. Both adults and children with food allergy (FA) from households at risk for food insecurity were more likely to report FA-related anxiety, anger, loneliness, fear of eating, and bullying victimization than their counterparts from households not at risk of food insecurity (p < .0001 for all). Among these specific experiences, FA-related anxiety was the most common (25.4%/30.1% of children/adults). Perceived risk of food allergy-related fatality was positively associated with food insecurity status. CONCLUSION Individuals with food allergies who are concomitantly experiencing food insecurity are at greater risk of a variety of mental health concerns, including those specific to food allergy as well as more general anxiety and depressive symptoms.
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Affiliation(s)
- Samantha Sansweet
- Center for Food Allergy & Asthma Research, Northwestern University, Chicago, IL, USA
| | - Anita Roach
- Food Allergy Research & Education, McLean, VA, USA
| | | | | | | | - Christopher Warren
- Center for Food Allergy & Asthma Research, Northwestern University, Chicago, IL, USA
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Yoshisue H, Homma Y, Ito C, Ebisawa M. Prevalence of food allergy increased 1.7 times in the past 10 years among Japanese patients below 6 years of age. Pediatr Allergy Immunol 2024; 35:e14192. [PMID: 39007449 DOI: 10.1111/pai.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/06/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND While food allergy (FA) has been increasingly recognized as a growing public health burden worldwide, epidemiological studies on FA in Japan are limited. METHODS This was a noninterventional, observational study using the administrative claims data from 2010 to 2019 (10 years). Patients with physician-diagnosed FA in Japan (prevalent cohort) were divided into high-risk or low-risk cohorts using adrenaline prescription. The high-risk cohort was further divided into anaphylaxis or nonanaphylaxis cohort based on the occurrence of anaphylaxis or a serious allergic reaction (SAR) during 1 year after adrenaline prescription. The primary objective was to examine yearly prevalence of FA. The secondary objectives were to describe demographics/clinical characteristics and healthcare resource utilization (HCRU), to evaluate the number of occurrences of anaphylaxis/SAR in the high-risk cohort, and the impact of anaphylaxis/SAR on HCRU. RESULTS The overall standardized prevalence rate was 0.325% (95% confidence interval [CI], 0.311-0.339) in 2010 and 0.797% (95% CI, 0.790-0.804) in 2019 and predominant in patients age <6 years (preschool; 3.377% [95% CI, 3.229-3.525] in 2010 and 5.726% [95% CI, 5.663-5.789] in 2019). Majority of FA patients (>80%) were children/adolescent throughout the 10 years. While high-risk cohort was a relatively minor population (8.5% in the prevalent cohort in 2019), the occurrence of anaphylaxis/SAR in the high-risk cohort was 227,690/100,000 patient-years. Multivariate analysis showed a significant increase in HCRU variables in the anaphylaxis versus nonanaphylaxis cohort (e.g., 2.08 [95% CI, 2.05-2.11] times more FA-related outpatient visits). CONCLUSIONS Prevalence of FA increased in a statistically significant way from 2010 to 2019; 1.7-fold increase was observed in patients <6 years old. Patients in the high-risk cohort appear to have suffered from frequent anaphylaxis/SAR, highlighting an unmet medical need for FA patients at "high-risk," considering the unavailability of approved medications to prevent anaphylaxis/SAR.
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Affiliation(s)
| | | | - Chie Ito
- Novartis Pharma K.K., Tokyo, Japan
- JMDC Co. Ltd, Tokyo, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
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Iglesia EGA, Fleischer DM, Abrams EM. Health Promotion of Early and Sustained Allergenic Food Introduction for the Prevention of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1670-1683.e9. [PMID: 38796104 DOI: 10.1016/j.jaip.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Observational studies and landmark randomized control trials support early and sustained allergenic food introduction in infancy as an effective preventive strategy against food allergy development. Despite a consensus regarding the intended goals of early and sustained allergenic food introduction, there have been myriad policy recommendations among health authorities in how to achieve both individual and population-level health outcomes for food allergy prevention. This clinical management review provides an overview on the data that informs early and sustained allergenic food introduction strategies, suggestions on how to advise allergenic food introduction, principles of prevention programs as they relate to food allergy prevention, and health promotion and systems-level challenges that impede achievement of food allergy prevention goals.
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Affiliation(s)
- Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David M Fleischer
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Sandoval A, Jung Y, Kim I, Sadigh N, Kwon J, Demirdag YY, Naderi AG, Jean T. Evaluation of atopic diseases in patients with allergic contact dermatitis. Allergy Asthma Proc 2024; 45:262-267. [PMID: 38982608 DOI: 10.2500/aap.2024.45.240019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: There is controversy on whether allergic contact dermatitis (ACD) is associated with atopy. Research on eczema and the risk of ACD is mixed, and there is sparse literature on other atopic conditions. Objective: Our study examined the prevalence of several atopic conditions, including allergic rhinitis, eczema, asthma, and food allergies in patients with ACD, and compared these to patients without ACD. Methods: We retrospectively reviewed adult patients ages ≥ 18 years with ACD (n = 162) with positive patch testing results and documented any history of atopy, including childhood eczema, asthma, allergic rhinitis, and immunoglobulin E-mediated food allergy. The prevalence of atopic conditions was compared between our ACD cohort and controls without ACD (n = 163) from our electronic medical records system (age and gender matched). Results: Among our patients with ACD, 53 (33%) had allergic rhinitis, 22 (14%) had childhood eczema, 32 (20%) had asthma, and 8 (5%) had food allergies. We observed that the odds of atopy overall (n = 76) in the ACD group compared with the control group were increased (odds ratio [OR] 1.88; p = 0.007). Allergic rhinitis was the highest risk factor (n = 53) with an OR of 12.64 (p < 0.001). Childhood eczema (n = 22) was also increased in the ACD group (OR 2.4; p = 0.026). The odds of asthma and food allergy in the ACD group were also increased; however, the difference was not statistically significant from the control group (OR 1.76 [p = 0.071] and OR 2.76 [p = 0.139], respectively). Conclusion: Patients with ACD had increased odds of eczema, allergic rhinitis, and atopic conditions overall. Asthma and food allergies were not found to have a statistically significant correlation. Larger studies that delve into atopic risk factors in ACD would be important to confirm these findings.
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Affiliation(s)
- Ashley Sandoval
- From the Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange, California
| | - Yela Jung
- From the Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange, California
| | - Iris Kim
- From the Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange, California
| | - Nina Sadigh
- Department of Allergy, Asthma, and Clinical Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Jimmy Kwon
- Department of Statistics, University of California Irvine, Irvine, California, and
| | - Yesim Yilmaz Demirdag
- From the Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange, California
| | - Asal Gharib Naderi
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Tiffany Jean
- Department of Allergy, Asthma, and Clinical Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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35
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Mulé P, Zhang X, Prosty C, Beaudette L, Cohen CG, Chan E, Clarke AE, Grunebaum E, Ke D, Lejtenyi D, Lucchesi C, Mazer B, McCusker C, Upton J, Zhang L, Ben-Shoshan M. Long-Term Adherence and Risk of Allergic Reactions in Patients Who Attained Milk Oral Immunotherapy Maintenance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00668-8. [PMID: 38944196 DOI: 10.1016/j.jaip.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 05/27/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Oral immunotherapy (OIT) has emerged as the most popular therapy for food allergy. However, data on the long-term adherence and efficacy of this approach are sparse. OBJECTIVE We aimed to assess the long-term adherence rates to OIT protocol and the associated risk of allergic reactions. METHODS Patients who completed milk OIT and reached a maintenance dose of 200 mL of milk were surveyed biannually on their dairy consumption and occurrence of allergic reactions. A survival analysis was performed to evaluate the association between the risk of reaction and the adherence to OIT maintenance protocol. RESULTS The cohort consisted of 50 patients. Only 56% of the cohort adhered to the protocol, which consisted of ingesting a minimum of 200 mL of milk at least 3 times per week. Adherent patients had a significantly reduced risk of allergic reactions as well as a reduced incidence of anaphylaxis, health care/emergency room visits, and epinephrine/antihistamine administration. CONCLUSIONS The findings demonstrate the importance of consistent maintenance dose consumption in the management of food allergies, with regular milk consumption contributing to the maintenance of unresponsiveness and decreased risk of allergic symptoms.
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Affiliation(s)
- Pasquale Mulé
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Xun Zhang
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Connor Prosty
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Liane Beaudette
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Casey G Cohen
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Edmond Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ann Elaine Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eyal Grunebaum
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ont, Canada
| | - Danbing Ke
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Duncan Lejtenyi
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chiara Lucchesi
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruce Mazer
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ont, Canada
| | - Lydia Zhang
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Knibb RC, Herbert LJ, Jones CJ, Protudjer JLP, Screti C, Roleston C, Brough HA, Warren C, Lombard L, Santos AF, Gupta R, Vickery BP, Marchisotto MJ. Global availability and uptake of psychological services for adults, caregivers and children with food allergy. Allergy 2024. [PMID: 39031702 DOI: 10.1111/all.16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/24/2024] [Accepted: 05/12/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Food allergy (FA) is associated with poor health-related quality of life and high levels of psychological distress. Psychological support is extremely important but not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) study, we aimed to assess psychological distress and service use among adults, caregivers and children with FA in a global survey. METHODS Participants (n = 1329 adults with FA; n = 1907 caregivers of children with FA) from >20 countries were recruited through patient organisations, social media advertisements and online survey panels to complete an online survey. Surveys were available in six languages. RESULTS A total of 67.7% of adults and 77.2% of caregivers reported direct experience, and 51.6% of caregivers said their child had experienced FA-related psychological distress. The most commonly reported issue was anxiety about having an allergic reaction. Less than 20% had been assessed for FA-related psychological distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA-related mental health disorder (all p < .001). The United Kingdom, Australia and Brazil had the highest number of participants reporting distress. The most commonly reported barrier to seeing a mental health professional was cost. CONCLUSIONS FA-related distress is common across countries, but with substantial country-to-country variability. Allergy providers are encouraged to routinely assess families for psychological distress and provide access to appropriate mental health resources. Development and implementation of evidence-based, patient-informed accessible, affordable FA interventions in multiple languages is urgently needed.
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Affiliation(s)
- R C Knibb
- Aston Institute for Health and Neurodevelopment, Aston University, Birmingham, UK
| | - L J Herbert
- Children's National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - C J Jones
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - J L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Screti
- Aston Institute for Health and Neurodevelopment, Aston University, Birmingham, UK
| | - C Roleston
- Aston Institute for Health and Neurodevelopment, Aston University, Birmingham, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - H A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - C Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - L Lombard
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Private Practice, Chicago, Illinois, USA
| | - A F Santos
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - R Gupta
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - B P Vickery
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Wong GWK. Food allergies around the world. Front Nutr 2024; 11:1373110. [PMID: 38938666 PMCID: PMC11208673 DOI: 10.3389/fnut.2024.1373110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/03/2024] [Indexed: 06/29/2024] Open
Abstract
The increase in the prevalence of food allergy has been considered as the second wave in the allergy epidemic following the first wave of increase in asthma and allergic rhinitis. It is well known that the prevalence of allergic conditions would follow economic development and urbanization in many countries or regions. In developed countries, one in three children suffered from at least one allergic disorder and these conditions include food allergy, eczema, allergic rhinitis and asthma. Food allergy is very often the first allergic manifestation affecting infants and young children. The exact etiologies are not known. The clinical manifestations ranged from a simple rash or an itch around the mouth, to the more severe manifestations of angioedema and potentially fatal anaphylaxis. Among all cases of childhood anaphylaxis, food is the most common cause. The common allergens resulting in food allergies in developed countries include egg, milk, fish, wheat, peanuts and tree nuts. However, there are marked variations in the patterns of food allergens in developing countries. In line with the epidemiology of asthma, food allergy is also much less common in rural areas. Clear understanding of reasons explaining the disparity of food allergies between urban and rural population would pave the way to the development of effective primary prevention for food allergy.
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Affiliation(s)
- Gary Wing-Kin Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Furiness KN, El Ansari YS, Oettgen HC, Kanagaratham C. Allergen-specific IgA and IgG antibodies as inhibitors of mast cell function in food allergy. FRONTIERS IN ALLERGY 2024; 5:1389669. [PMID: 38919913 PMCID: PMC11196826 DOI: 10.3389/falgy.2024.1389669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Food allergy, a group of adverse immune responses to normally innocuous food protein antigens, is an increasingly prevalent public health issue. The most common form is IgE-mediated food allergy in which food antigen-induced crosslinking of the high-affinity IgE-receptor, FcεRI, on the surface of mast cells triggers the release of inflammatory mediators that contribute to a wide range of clinical manifestations, including systemic anaphylaxis. Mast cells also play a critical function in adaptive immunity to foods, acting as adjuvants for food-antigen driven Th2 cell responses. While the diagnosis and treatment of food allergy has improved in recent years, no curative treatments are currently available. However, there is emerging evidence to suggest that both allergen-specific IgA and IgG antibodies can counter the activating effects of IgE antibodies on mast cells. Most notably, both antigen-specific IgA and IgG antibodies are induced in the course of oral immunotherapy. In this review, we highlight the role of mast cells in food allergy, both as inducers of immediate hypersensitivity reactions and as adjuvants for type 2 adaptive immune responses. Furthermore, we summarize current understanding of the immunomodulatory effects of antigen-specific IgA and IgG antibodies on IgE-induced mast cell activation and effector function. A more comprehensive understanding of the regulatory role of IgA and IgG in food allergy may provide insights into physiologic regulation of immune responses to ingested antigens and could seed novel strategies to treat allergic disease.
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Affiliation(s)
- Kameryn N. Furiness
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Yasmeen S. El Ansari
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany
| | - Hans C. Oettgen
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Cynthia Kanagaratham
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Kenee PRM, Zimmer MS, Kamath RR, Son S, Gulde CH, Campbell JR, Jaffery SS, Patel BT. Gadolinium-Based Contrast Agents: Rationale for Use in Patients with Iodine Contrast or Shellfish Allergy? Anesth Analg 2024:00000539-990000000-00826. [PMID: 38833554 DOI: 10.1213/ane.0000000000006976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Parker R M Kenee
- From the University of Texas Southwestern Medical School, Dallas, Texas
| | - Mark S Zimmer
- From the University of Texas Southwestern Medical School, Dallas, Texas
| | - Rohit R Kamath
- From the University of Texas Southwestern Medical School, Dallas, Texas
| | - Sumin Son
- From the University of Texas Southwestern Medical School, Dallas, Texas
| | - Christian H Gulde
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - Jarrett R Campbell
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - Syed S Jaffery
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - Biral T Patel
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
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Pelletier de Chambure D, Fry S, Chenivesse C. Association between the presence of food allergy and asthma outcomes in allergic asthmatic adults: A case-control study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1652-1654. [PMID: 38423285 DOI: 10.1016/j.jaip.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Affiliation(s)
| | - Stéphanie Fry
- Univ. Lille, CNRS, Inserm, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France; CRISALIS, F-CRIN Inserm Network, Toulouse, France
| | - Cécile Chenivesse
- Univ. Lille, CNRS, Inserm, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France; CRISALIS, F-CRIN Inserm Network, Toulouse, France
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Kasputis T, Hosmer KE, He Y, Chen J. Ensuring food safety: Microfluidic-based approaches for the detection of food contaminants. ANALYTICAL SCIENCE ADVANCES 2024; 5:e2400003. [PMID: 38948318 PMCID: PMC11210746 DOI: 10.1002/ansa.202400003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 07/02/2024]
Abstract
Detecting foodborne contamination is a critical challenge in ensuring food safety and preventing human suffering and economic losses. Contaminated food, comprising biological agents (e.g. bacteria, viruses and fungi) and chemicals (e.g. toxins, allergens, antibiotics and heavy metals), poses significant risks to public health. Microfluidic technology has emerged as a transformative solution, revolutionizing the detection of contaminants with precise and efficient methodologies. By manipulating minute volumes of fluid on miniaturized systems, microfluidics enables the creation of portable chips for biosensing applications. Advancements from early glass and silicon devices to modern polymers and cellulose-based chips have significantly enhanced microfluidic technology, offering adaptability, flexibility, cost-effectiveness and biocompatibility. Microfluidic systems integrate seamlessly with various biosensing reactions, facilitating nucleic acid amplification, target analyte recognition and accurate signal readouts. As research progresses, microfluidic technology is poised to play a pivotal role in addressing evolving challenges in the detection of foodborne contaminants. In this short review, we delve into various manufacturing materials for state-of-the-art microfluidic devices, including inorganics, elastomers, thermoplastics and paper. Additionally, we examine several applications where microfluidic technology offers unique advantages in the detection of food contaminants, including bacteria, viruses, fungi, allergens and more. This review underscores the significant advancement of microfluidic technology and its pivotal role in advancing the detection and mitigation of foodborne contaminants.
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Affiliation(s)
- Tom Kasputis
- Department of Biological Systems EngineeringVirginia TechBlacksburgVirginiaUSA
| | | | - Yawen He
- Department of Biological Systems EngineeringVirginia TechBlacksburgVirginiaUSA
| | - Juhong Chen
- Department of Biological Systems EngineeringVirginia TechBlacksburgVirginiaUSA
- Department of BioengineeringUniversity of CaliforniaRiversideCaliforniaUSA
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Epstein-Rigbi N, Elizur A. Oral immunotherapy in food-allergic adults is safe and effective, particularly for foods other than milk. Ann Allergy Asthma Immunol 2024; 132:782. [PMID: 38839142 DOI: 10.1016/j.anai.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Tel Aviv University School of Medicine, Tel Aviv, Israel.
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Tel Aviv University School of Medicine, Tel Aviv, Israel
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Keswani T, LaHood NA, Marini-Rapoport O, Karmakar B, Andrieux L, Reese B, Sneed SL, Pedersen LC, Mueller GA, Patil SU. Neutralizing IgG 4 antibodies are a biomarker of sustained efficacy after peanut oral immunotherapy. J Allergy Clin Immunol 2024; 153:1611-1620.e7. [PMID: 38460677 DOI: 10.1016/j.jaci.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Clinical efficacy of oral immunotherapy (OIT) has been associated with the induction of blocking antibodies, particularly those capable of disrupting IgE-allergen interactions. Previously, we identified mAbs to Ara h 2 and structurally characterized their epitopes. OBJECTIVE We investigated longitudinal changes during OIT in antibody binding to conformational epitopes and correlated the results with isotype and clinical efficacy. METHODS We developed an indirect inhibitory ELISA using mAbs to block conformational epitopes on immobilized Ara h 2 from binding to serum immunoglobulins from peanut-allergic patients undergoing OIT. We tested the functional blocking ability of mAbs using passive cutaneous anaphylaxis in mice with humanized FcεRI receptors. RESULTS Diverse serum IgE recognition of Ara h 2 conformational epitopes are similar before and after OIT. Optimal inhibition of serum IgE occurs with the combination of 2 neutralizing mAbs (nAbs) recognizing epitopes 1.2 and 3, compared to 2 nonneutralizing mAbs (non-nAbs). After OIT, IgG4 nAbs, but not IgG1 or IgG2 nAbs, increased in sustained compared to transient outcomes. Induction of IgG4 nAbs occurs after OIT only in those with sustained efficacy. Murine passive cutaneous anaphylaxis after sensitization with pooled human sera is significantly inhibited by nAbs compared to non-nAbs. CONCLUSIONS Serum IgE conformational epitope diversity remains unchanged during OIT. However, IgG4 nAbs capable of uniquely disrupting IgE-allergen interactions to prevent effector cell activation are selectively induced in OIT-treated individuals with sustained clinical efficacy. Therefore, the induction of neutralizing IgG4 antibodies to Ara h 2 are clinically relevant biomarkers of durable efficacy in OIT.
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Affiliation(s)
- Tarun Keswani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Nicole A LaHood
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Orlee Marini-Rapoport
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Bijoya Karmakar
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Léna Andrieux
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass; Master de Biologie, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Brian Reese
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Sunny L Sneed
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Lars C Pedersen
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC
| | - Sarita U Patil
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass.
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Virkud YV, Styles JN, Kelly RS, Patil SU, Ruiter B, Smith NP, Clish C, Wheelock CE, Celedón JC, Litonjua AA, Bunyavanich S, Weiss ST, Baker ES, Lasky-Su JA, Shreffler WG. Metabolomics of IgE-Mediated Food Allergy and Oral Immunotherapy Outcomes based on Metabolomic Profiling. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.31.24308233. [PMID: 38952781 PMCID: PMC11216533 DOI: 10.1101/2024.05.31.24308233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Background The immunometabolic mechanisms underlying variable responses to oral immunotherapy (OIT) in patients with IgE-mediated food allergy are unknown. Objective To identify novel pathways associated with tolerance in food allergy, we used metabolomic profiling to find pathways important for food allergy in multi-ethnic cohorts and responses to OIT. Methods Untargeted plasma metabolomics data were generated from the VDAART healthy infant cohort (N=384), a Costa Rican cohort of children with asthma (N=1040), and a peanut OIT trial (N=20) evaluating sustained unresponsiveness (SU, protection that lasts after therapy) versus transient desensitization (TD, protection that ends immediately afterwards). Generalized linear regression modeling and pathway enrichment analysis identified metabolites associated with food allergy and OIT outcomes. Results Compared with unaffected children, those with food allergy were more likely to have metabolomic profiles with altered histidines and increased bile acids. Eicosanoids (e.g., arachidonic acid derivatives) (q=2.4×10 -20 ) and linoleic acid derivatives (q=3.8×10 -5 ) pathways decreased over time on OIT. Comparing SU versus TD revealed differing concentrations of bile acids (q=4.1×10 -8 ), eicosanoids (q=7.9×10 -7 ), and histidine pathways (q=0.015). In particular, the bile acid lithocholate (4.97[1.93,16.14], p=0.0027), the eicosanoid leukotriene B4 (3.21[1.38,8.38], p=0.01), and the histidine metabolite urocanic acid (22.13[3.98,194.67], p=0.0015) were higher in SU. Conclusions We observed distinct profiles of bile acids, histidines, and eicosanoids that vary among patients with food allergy, over time on OIT and between SU and TD. Participants with SU had higher levels of metabolites such as lithocholate and urocanic acid, which have immunomodulatory roles in key T-cell subsets, suggesting potential mechanisms of tolerance in immunotherapy. Key Messages - Compared with unaffected controls, children with food allergy demonstrated higher levels of bile acids and distinct histidine/urocanic acid profiles, suggesting a potential role of these metabolites in food allergy. - In participants receiving oral immunotherapy for food allergy, those who were able to maintain tolerance-even after stopping therapyhad lower overall levels of bile acid and histidine metabolites, with the exception of lithocholic acid and urocanic acid, two metabolites that have roles in T cell differentiation that may increase the likelihood of remission in immunotherapy. Capsule summary This is the first study of plasma metabolomic profiles of responses to OIT in individuals with IgE-mediated food allergy. Identification of immunomodulatory metabolites in allergic tolerance may help identify mechanisms of tolerance and guide future therapeutic development.
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Dinardo G, Cafarotti A, Fierro V, Artesani MC, Indolfi C, Miraglia Del Giudice M, Fiocchi A. Role of biologics in severe food allergy. Curr Opin Allergy Clin Immunol 2024; 24:138-143. [PMID: 38538153 DOI: 10.1097/aci.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This review examine the dynamic landscape of food allergy treatment within the context of emerging biologics. Our purpose is to comprehensively evaluate the potential benefits, challenges, and transformative impact associated with the utilization of biologics in comparison to conventional therapeutic modalities. RECENT FINDINGS This document synthesizes recent scientific investigations to various biologics, such as omalizumab, ligelizumab, dupilumab, and tezepelumab, providing a nuanced understanding of their roles in oral immunotherapy, rapid desensitization, and overall food allergy management. Recent studies and clinical trials highlight the impact of anti-IgE treatment on food allergies, revealing critical findings such as dose-related efficacy, facilitation of rapid desensitization in peanut allergies, and the sustained positive outcomes observed in individuals with multifood allergies. SUMMARY The use of biologics presents a groundbreaking approach in the treatment of food allergies. The multifaceted action of these agents, along with their potential to overcome the challenges associated with traditional therapies, marks a significant advancement. Despite the persisting challenges of economic constraints and the need for further safety studies, biologics offer a promising avenue for improving the quality of life for individuals with food allergies. Ongoing research and collaborative efforts are imperative to fully realize the transformative potential inherent in these emerging therapeutic frontiers.
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Affiliation(s)
- Giulio Dinardo
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Arianna Cafarotti
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Vincenzo Fierro
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Cristiana Indolfi
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Michele Miraglia Del Giudice
- Department of Women, Children, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples
| | - Alessandro Fiocchi
- Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024; 153:1621-1633. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Buchan ML, Goel K, Schneider CK, Steullet V, Bratton S, Basch E. National Implementation of an Artificial Intelligence-Based Virtual Dietitian for Patients With Cancer. JCO Clin Cancer Inform 2024; 8:e2400085. [PMID: 38832697 DOI: 10.1200/cci.24.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE Nutritional status is an established driver of cancer outcomes, but there is an insufficient workforce of registered dietitians to meet patient needs for nutritional counseling. Artificial intelligence (AI) and machine learning (ML) afford the opportunity to expand access to guideline-based nutritional support. METHODS An AI-based nutrition assistant called Ina was developed on the basis of a learning data set of >100,000 expert-curated interventions, peer-reviewed literature, and clinical guidelines, and provides a conversational text message-based patient interface to guide dietary habits and answer questions. Ina was implemented nationally in partnership with 25 advocacy organizations. Data on demographics, patient-reported outcomes, and utilization were systematically collected. RESULTS Between July 2019 and August 2023, 3,310 users from all 50 states registered to use Ina. Users were 73% female; median age was 57 (range, 18-91) years; most common cancer types were genitourinary (22%), breast (21%), gynecologic (19%), GI (14%), and lung (12%). Users were medically complex, with 50% reporting Stage III to IV disease, 37% with metastases, and 50% with 2+ chronic conditions. Nutritional challenges were highly prevalent: 58% had overweight/obese BMIs, 83% reported barriers to good nutrition, and 42% had food allergies/intolerances. Levels of engagement were high: 68% texted questions to Ina; 79% completed surveys; median user retention was 8.8 months; 94% were satisfied with the platform; and 98% found the guidance helpful. In an evaluation of outcomes, 84% used the advice to guide diet; 47% used recommended recipes, 82% felt the program improved quality of life (QoL), and 88% reported improved symptom management. CONCLUSION Implementation of an evidence-based AI virtual dietitian is feasible and is reported by patients to be beneficial on diet, QoL, and symptom management. Ongoing evaluations are assessing impact on other outcomes.
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Affiliation(s)
| | - Keshav Goel
- Perelman School of Medicine, Philadelphia, PA
| | | | - Vera Steullet
- IMD International Institute for Management Development, Lausanne, Switzerland
| | | | - Ethan Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Arasi S, Mazzuca C, Urbani S, Cafarotti A, Fiocchi A. Perspectives in the validation of DEFASE: a paradigm shift in food allergy management. Curr Opin Allergy Clin Immunol 2024; 24:171-176. [PMID: 38656289 DOI: 10.1097/aci.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW To explore the groundbreaking international consensus on the DEFASE (DEfinition of Food Allergy Severity) project as a revolutionary grading system for IgE-mediated food allergy severity. Against the backdrop of the growing public health challenge posed by food allergy, this article delves into the importance of validating and implementing DEFASE in real-world clinical settings. RECENT FINDINGS With new therapeutic options available for food allergy, including biologics alongside immunotherapy, it is urgent to properly support clinical decision-making in the management of the disease. The DEFASE score is the first international consensus-based grading system of severity associated with food allergy as a whole disease embracing multidisciplinary perspectives from different stakeholders involved. In its current version, this comprehensive scoring system has been developed to be used in research settings. SUMMARY The review emphasizes the potential impact of DEFASE on patient outcomes, healthcare management, and resource allocation, underscoring its significance for the allergy scientific community. Future research should focus on internal and external validation of the scoring system, targeting these models to various food allergenic sources, populations, and settings.
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Affiliation(s)
- Stefania Arasi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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D’Aiuto V, Mormile I, Granata F, Napolitano F, Lamagna L, Della Casa F, de Paulis A, Rossi FW. Worldwide Heterogeneity of Food Allergy: Focus on Peach Allergy in Southern Italy. J Clin Med 2024; 13:3259. [PMID: 38892968 PMCID: PMC11173152 DOI: 10.3390/jcm13113259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Food allergy (FA) has shown an increasing prevalence in the last decades, becoming a major public health problem. However, data on the prevalence of FA across the world are heterogeneous because they are influenced by several factors. Among IgE-mediated FA, an important role is played by FA related to plant-derived food which can result from the sensitization to a single protein (specific FA) or to homologous proteins present in different foods (cross-reactive FA) including non-specific lipid transfer proteins (nsLTPs), profilins, and pathogenesis-related class 10 (PR-10). In addition, the clinical presentation of FA is widely heterogeneous ranging from mild symptoms to severe reactions up to anaphylaxis, most frequently associated with nsLTP-related FA (LTP syndrome). Considering the potential life-threatening nature of nsLTP-related FA, the patient's geographical setting should always be taken into account; thereby, it is highly recommended to build a personalized approach for managing FA across the world in the precision medicine era. For this reason, in this review, we aim to provide an overview of the prevalence of nsLTP-mediated allergies in the Mediterranean area and to point out the potential reasons for the different geographical significance of LTP-driven allergies with a particular focus on the allergenic properties of food allergens and their cross reactivity.
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Affiliation(s)
- Valentina D’Aiuto
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Filomena Napolitano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Laura Lamagna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy;
| | - Francesca Della Casa
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (V.D.); (I.M.); (F.N.); (F.D.C.); (A.d.P.); (F.W.R.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
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Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr 2024; 12:1373373. [PMID: 38873581 PMCID: PMC11169649 DOI: 10.3389/fped.2024.1373373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. Observations This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Conclusions and relevance Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.
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Affiliation(s)
- Ruchi S. Gupta
- Institute for Public Health and Medicine, Center for Food Allergy & Asthma, Northwestern University, Chicago, IL, United States
| | - Ellen Epstein
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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