451
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Arakali SR, Green TD, Dinakar C. Prevalence of food allergies in South Asia. Ann Allergy Asthma Immunol 2016; 118:16-20. [PMID: 27864090 DOI: 10.1016/j.anai.2016.09.441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/14/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the published medical literature on the prevalence and types of food allergies in South Asia. DATA SOURCES A PubMed search was performed using the keywords India and food allergy, Asia and food allergy, and South Asia and food allergy for any period. Articles cited in selected studies were reviewed for their appropriateness of inclusion into this review. STUDY SELECTIONS Publications were included that were original research and fit the topic of food allergy and South Asia. South Asia is defined as region inclusive of India, Pakistan, Bangladesh, and Sri Lanka. RESULTS A total of 169 articles were initially identified, and 47 were reviewed in detail for inclusion in this review. The primary focus was placed on 10 studies that consisted of case reports of newly reported or documented food allergy, survey studies that investigated food allergy prevalence in specific demographics, and prospective and cross-sectional studies with case controls, all of which investigated food allergy prevalence by allergy testing in a selected population. CONCLUSION The medical literature on the prevalence and types of food allergy in South Asia indicates that there is a variety of unusual and unique allergens and an overall low incidence of food allergy. There is also an association of increased food allergy prevalence in individuals who live in metropolitan regions or who migrate to communities that have adopted westernization.
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Affiliation(s)
- Schweta R Arakali
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
| | - Todd D Green
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Chitra Dinakar
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
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452
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Food Allergy: What We Know Now. Am J Med Sci 2016; 353:353-366. [PMID: 28317623 DOI: 10.1016/j.amjms.2016.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022]
Abstract
Food allergy is an adverse immune reaction that occurs reproducibly on exposure to a given food. Prevalence rates of food allergy continue to increase worldwide, sparking continual research efforts in finding a suitable and safe cure. Food avoidance, the current standard of care, can be difficult to achieve. This review aims to provide a broad overview of immunoglobulin E-mediated food allergy, highlighting its epidemiology, masqueraders, immunopathophysiology, clinical presentation, diagnostic work-up and available preventative and treatment strategies. This review also discusses novel, investigative therapies that offer promising therapeutic options, yet require continued research efforts to determine safety effects. Inducing tolerance, whether by immunotherapy or by the administration of monoclonal antibodies, allows us to move toward a cure for food allergy, which could vastly change this field of allergic diseases in the coming decades.
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453
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Giavi S, Vissers YM, Muraro A, Lauener R, Konstantinopoulos AP, Mercenier A, Wermeille A, Lazzarotto F, Frei R, Bonaguro R, Summermatter S, Nutten S, Papadopoulos NG. Oral immunotherapy with low allergenic hydrolysed egg in egg allergic children. Allergy 2016; 71:1575-1584. [PMID: 27059671 DOI: 10.1111/all.12905] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND A major drawback of oral immunotherapy for food allergy is the possibility of severe side-effects. We assessed both safety and efficacy of a low allergenic hydrolysed egg (HydE) preparation used in a double-blind placebo-controlled randomized study in egg allergic children. METHODS In a pilot multicentre study, 29 egg allergic patients (aged 1-5.5 years) were administered daily for 6 months 9 g HydE or placebo in a blinded, randomized manner. Safety was verified by oral food challenge to assess tolerance towards HydE at the start and efficacy by an open oral food challenge (OFC, primary outcome) at the end. Additionally, changes in basophil activation and specific IgE and IgG4 were assessed. RESULTS All egg allergic patients randomized to HydE (n = 15) tolerated the full dose at day 1 and received the maintenance dose from the start at home. No statistically significant difference was observed on the final OFC (36% and 21% had a negative OFC in the treatment and placebo groups, respectively). Specific IgG4 levels increased, while both CD203c+ and CD63+ basophils decreased significantly more over time in the treatment than in the placebo group. CONCLUSIONS HydE can be regarded as a safe, low allergenic product to use in children allergic to egg. Although not significant, HydE given for 6 months increased numerically the proportion of patients becoming tolerant to egg. HydE induced a modulation of the immune response towards better tolerance. A longer treatment period and/or a higher dose may improve the clinical outcome and should be evaluated.
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Affiliation(s)
- S. Giavi
- Allergy Department; 2nd Paediatric Clinic; University of Athens; Athens Greece
| | - Y. M. Vissers
- Allergy Group, Nutrition & Health Research; Nestlé Research Center; Lausanne Switzerland
| | - A. Muraro
- Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region; Department of Women and Child Health; Padua University Hospital; Padua Italy
| | - R. Lauener
- Children's Hospital of Eastern Switzerland; St. Gallen Switzerland
- CK-CARE; Davos Switzerland
| | | | - A. Mercenier
- Allergy Group, Nutrition & Health Research; Nestlé Research Center; Lausanne Switzerland
| | - A. Wermeille
- Allergy Group, Nutrition & Health Research; Nestlé Research Center; Lausanne Switzerland
| | - F. Lazzarotto
- Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region; Department of Women and Child Health; Padua University Hospital; Padua Italy
| | - R. Frei
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education; Zurich Switzerland
| | - R. Bonaguro
- Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region; Department of Women and Child Health; Padua University Hospital; Padua Italy
| | | | - S. Nutten
- Allergy Group, Nutrition & Health Research; Nestlé Research Center; Lausanne Switzerland
| | - N. G. Papadopoulos
- Allergy Department; 2nd Paediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics & Child Health; Institute of Human Development; The University of Manchester; Manchester UK
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454
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Miceli Sopo S, Greco M, Monaco S, Bianchi A, Cuomo B, Liotti L, Iacono I. Matrix effect on baked milk tolerance in children with IgE cow milk allergy. Allergol Immunopathol (Madr) 2016; 44:517-523. [PMID: 27480790 DOI: 10.1016/j.aller.2016.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children with IgE-mediated cow's milk allergy (IgE-CMA) often tolerate baked milk within a wheat matrix. In our study we evaluated the impact of wheat matrix and of little standardised cooking procedures on tolerance of baked milk. We also tested tolerance versus parmigiano reggiano (PR) and whey-based partially hydrolysed formula (pHF). METHODS Forty-eight children with IgE-CMA were enrolled. They underwent prick-by-prick (PbP) and open oral food challenge (OFC) with baked cow's milk (CM), both within a wheat matrix (an Italian cake named ciambellone) and without (in a liquid form), with PR and with pHF. After a passed OFC, children continued to eat the food tolerated. In particular, after passed OFC with ciambellone, children were allowed to eat any food containing CM within a wheat matrix, with the only condition that it was baked at 180°C for at least 30min. Three months after, parents were asked to answer a survey. RESULTS 81% of children tolerated ciambellone, 56% liquid baked CM, 78% PR and 82% pHF. Negative predictive value of PbP performed with tested foods was 100%. No IgE-mediated adverse reactions were detected at follow-up carried out by the survey. CONCLUSIONS Wheat matrix effect on tolerance of baked milk was relevant in slightly less than half of cases. If our results are confirmed by larger studies, a negative PbP will allow patients to eat processed CM without undergoing OFC. Moreover, in order to guarantee tolerance towards baked milk, strict standardised cooking procedures do not seem to be necessary.
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455
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Ruffner MA, Spergel JM. Non-IgE-mediated food allergy syndromes. Ann Allergy Asthma Immunol 2016; 117:452-454. [PMID: 27788868 DOI: 10.1016/j.anai.2016.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/07/2016] [Accepted: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Melanie A Ruffner
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
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456
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Guest JF, Yang AC, Oba J, Rodrigues M, Caetano R, Polster L. Relative cost-effectiveness of using an extensively hydrolyzed casein formula in managing infants with cow's milk allergy in Brazil. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:629-639. [PMID: 27799804 PMCID: PMC5076537 DOI: 10.2147/ceor.s113448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To estimate the cost-effectiveness of three alternative dietetic strategies for cow’s milk allergy in Brazil: 1) using an extensively hydrolyzed casein formula (eHCF; Nutramigen) as a first-line formula, but switching to an amino acid formula (AAF) if infants remain symptomatic; 2) using an AAF as a first-line formula and then switching to an eHCF after 4 weeks once infants are symptom-free, but switching back to an AAF if infants become symptomatic; and 3) using an AAF as a first-line formula and keeping all infants on that formula. The analysis was conducted from the perspective of the Brazilian public health care system, Sistema Único de Saude. Methods Decision modeling was used to estimate the probability of immunoglobulin E (IgE)-mediated and non-IgE-mediated allergic infants developing tolerance to cow’s milk by 12 months from starting a formula. The models also estimated the Sistema Único de Saude cost (at 2013/2014 prices) of managing infants over 12 months after starting a formula, as well as the relative cost-effectiveness of each of the dietetic strategies. Results The probability of developing tolerance to cow’s milk by 12 months from starting a formula was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were initially fed with an eHCF, compared with those who were initially fed with an AAF. The total health care cost of initially feeding an eHCF to cow’s milk allergic infants was less than that of initially feeding both IgE-mediated and non-IgE-mediated infants with an AAF. Conclusion Within the study’s limitations, using an eHCF instead of an AAF for the first-line management of newly-diagnosed infants with cow’s milk allergy affords a cost-effective use of publicly funded resources, since it improves the outcome for less cost.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, Northwood, Middlesex, UK; Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Ariana C Yang
- Universidade de São Paulo, São Paulo & Universidade Estadual de Campinas, São Paulo, Brazil
| | - Jane Oba
- Hospital Israelita Albert Einstein, São Paulo, Brazil & Hospital Municipal Menino Jesus, São Paulo, Brazil
| | - Maraci Rodrigues
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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457
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Sampson HA. Food allergy: Past, present and future. Allergol Int 2016; 65:363-369. [PMID: 27613366 DOI: 10.1016/j.alit.2016.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 01/26/2023] Open
Abstract
Hippocrates is often credited with first recognizing that food could be responsible for adverse symptoms and even death in some individuals, but it was not until the seminal observations by Prausnitz that the investigation of food allergy was viewed on a more scientific basis. In the first half of the 20th century, there were periodic reports in the medical literature describing various food allergic reactions. In the mid- to late- 1970's, the studies of Charles May and colleagues began to penetrate the medical world's skepticism about the relevance of food allergy and how to diagnose it, since standard skin testing was known to correlate poorly with clinical symptoms. With May's introduction of the double-blind placebo-controlled oral food challenge, the study of food allergy became evidence-based and exponential strides have been made over the past four decades in the study of basic immunopathogenic mechanisms and natural history, and the diagnosis and management of food allergies. Today IgE- and non-IgE-mediated food allergic disorders are well characterized and efforts to treat these allergies by various immunotherapeutic strategies are well under way.
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458
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Abstract
Food allergy has grown in rapidly in prevalence, currently affecting 5% of adults and 8% of children. Management strategy is currently limited to 1) food avoidance and 2) carrying and using rescue intramuscular epinephrine/adrenaline and oral antihistamines in the case of accidental ingestion; there is no FDA approved treatment. Recently, oral, sublingual and epicutaneous immunotherapy have been developed as active treatment of food allergy, though none have completed phase 3 study. Efficacy and safety studies of immunotherapy have been variable, though there is clearly signal that immunotherapy will be a viable option to desensitize patients. The use of bacterial adjuvants, anti-IgE monoclonal antibodies, and Chinese herbal formulations either alone or in addition to immunotherapy may hold promise as future options for active treatment. Active prevention of food allergy through early introduction of potentially offending foods in high-risk infants will be an important means to slow the rising incidence of sensitization.
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459
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Abstract
The term "food allergy" is used by many patients and clinicians to describe a range of symptoms that occur after ingestion of specific foods. However, not all symptoms occurring after food exposure are due to an allergic, or immunologic, response. It is important to properly evaluate and diagnose immunoglobulin E (IgE)-mediated food allergy as this results in reproducible, immediate onset, allergic reactions that can progress toward life-threatening anaphylaxis. Proper diagnosis requires understanding of the common foods that cause these reactions in addition to key historical elements such as symptoms, timing and duration of reaction, and risk factors that may predispose to development of IgE-mediated food allergy. Diagnostic testing for food-specific IgE can greatly aid the diagnosis. However, false-positive test results are very common and can lead to overinterpretation, misdiagnosis, and unnecessary dietary elimination. This review discusses important aspects to consider during evaluation of a patient for suspected IgE-mediated food allergy.
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460
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Affiliation(s)
- Elissa M Abrams
- Division of Paediatric Allergy and Clinical Immunology (Abrams), University of Manitoba, Winnipeg, Man.; Division of Allergy and Immunology (Sicherer), Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, NY
| | - Scott H Sicherer
- Division of Paediatric Allergy and Clinical Immunology (Abrams), University of Manitoba, Winnipeg, Man.; Division of Allergy and Immunology (Sicherer), Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, NY
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461
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Zelig A, Harwayne-Gidansky I, Gault A, Wang J. Effect of educational and electronic medical record interventions on food allergy management. Allergy Asthma Proc 2016; 37:404-8. [PMID: 27657525 DOI: 10.2500/aap.2016.37.3970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The growing prevalence of food allergies indicates a responsibility among primary care providers to ensure that their patients receive accurate diagnosis and management. OBJECTIVE To improve physician knowledge and management of food allergies by implementing educational and electronic medical record interventions. METHODS Pre- and posttest scores of pediatric residents and faculty were analyzed to assess the effectiveness of an educational session designed to improve knowledge of food allergy management. One year later, a best practice advisory was implemented in the electronic medical record to alert providers to consider allergy referral whenever a diagnosis code for food allergy or epinephrine autoinjector prescription was entered. A review of charts 6 months before and 6 months after each intervention was completed to determine the impact of both interventions. Outcome measurements included referrals to an allergy clinic, prescription of self-injectable epinephrine, and documentation that written emergency action plans were provided. RESULTS There was a significant increase in test scores immediately after the educational intervention (mean, 56.2 versus 84.3%; p < 0.001). Posttest scores remained significantly higher than preintervention scores 6 months later (mean score, 68.0 versus 56.2%; p = 0.006). Although knowledge improved, there was no significant difference in the percentage of patients who were provided allergy referral, were prescribed an epinephrine autoinjector, or were given an emergency action plan before and after both interventions. CONCLUSION Neither intervention resulted in improvements in the management of children with food allergies at our pediatrics clinic. Further studies are needed to identify effective strategies to improve management of food allergies by primary care physicians.
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Affiliation(s)
- Ari Zelig
- Division of Allergy and Immunology, Montefiore Medical Center, Bronx, New York, USA
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462
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Comberiati P, Landi M, Martelli A, Piacentini G, Capristo C, Paiola G, Peroni D. Awareness of allergic enterocolitis among primary-care paediatricians: A web-based pilot survey. Allergol Immunopathol (Madr) 2016; 44:461-6. [PMID: 27498217 DOI: 10.1016/j.aller.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPIES), is an increasingly reported and potentially severe non-IgE mediated food allergy of the first years of life, which is often misdiagnosed due to its non-specific presenting symptoms and lack of diagnostic guidelines. OBJECTIVE We sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians. METHODS A 16-question anonymous web-based survey was sent via email to randomly selected primary care paediatricians working in the north of Italy. RESULTS There were 194 completed surveys (48.5% response rate). Among respondents, 12.4% declared full understanding of FPIES, 49% limited knowledge, 31.4% had simply heard about FPIES and 7.2% had never heard about it. When presented with clinical anecdotes, 54.1% recognised acute FPIES and 12.9% recognised all chronic FPIES, whereas 10.3% misdiagnosed FPIES as allergic proctocolitis or infantile colic. To diagnose FPIES 55.7% declared to need negative skin prick test or specific-IgE to the trigger food, whereas 56.7% considered necessary a confirmatory oral challenge. Epinephrine was considered the mainstay in treating acute FPIES by 25.8% of respondents. Only 59.8% referred out to an allergist for the long-term reintroduction of the culprit food. Overall, 20.1% reported to care children with FPIES in their practice, with cow's milk formula and fish being the most common triggers; the diagnosis was self-made by the participant in 38.5% of these cases and by an allergist in 48.7%. CONCLUSION There is a need for promoting awareness of FPIES to minimise delay in diagnosis and unnecessary diagnostic and therapeutic interventions.
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463
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464
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Adkinson NF, Hamilton RG. Clinical History-Driven Diagnosis of Allergic Diseases: Utilizing in vitro IgE Testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:871-6; quiz 877-8. [PMID: 26553614 DOI: 10.1016/j.jaip.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 02/06/2023]
Abstract
This case illustrates the importance of a thorough clinical history in providing an interpretation of previously collected IgE antibody serology as part of a workup for allergic disease. Although a yellow-jacket sting was the allergenic insult that led the patient to the emergency department, nonindicated IgE antibody serology tests were ordered that subsequently required interpretation. This report systematically evaluates the relative significance of previously measured IgE antibody serology responses to 4 major allergen groups (inhalants [aeroallergens], foods, venoms, and drugs) within the context of the patient's history. An algorithm that takes into account the pretest likelihood of disease and diagnostic sensitivity and specificity of the available IgE antibody tests is proposed for decisions about further IgE testing. This case study concludes that selection of testing methods, extract and molecular allergen specificities, and the final interpretation of the results from tests of sensitization such as serological (in vitro) IgE antibody assays requires knowledge of test parameters and clinical judgments based largely on a carefully collected clinical history and physical examination.
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Affiliation(s)
- N Franklin Adkinson
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert G Hamilton
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
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465
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Ruszczyński M, Horvath A, Dziechciarz P, Szajewska H. Cow's milk allergy guidelines: a quality appraisal with the AGREE II instrument. Clin Exp Allergy 2016; 46:1236-41. [DOI: 10.1111/cea.12784] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/20/2016] [Accepted: 07/17/2016] [Indexed: 01/22/2023]
Affiliation(s)
- M. Ruszczyński
- Department of Paediatrics; The Medical University of Warsaw; Warsaw Poland
| | - A. Horvath
- Department of Paediatrics; The Medical University of Warsaw; Warsaw Poland
| | - P. Dziechciarz
- Department of Paediatrics; The Medical University of Warsaw; Warsaw Poland
| | - H. Szajewska
- Department of Paediatrics; The Medical University of Warsaw; Warsaw Poland
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466
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Hill DA, Grundmeier RW, Ram G, Spergel JM. The epidemiologic characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis, and food allergy in children: a retrospective cohort study. BMC Pediatr 2016; 16:133. [PMID: 27542726 PMCID: PMC4992234 DOI: 10.1186/s12887-016-0673-z] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The rates of childhood allergic conditions are changing, prompting the need for continued surveillance. Examination of healthcare provider-based diagnosis data is an important and lacking methodology needed to complement existing studies that rely on participant reporting. METHODS Utilizing our care network of 1,050,061 urban and sub-urban children, we defined two retrospective cohorts: (1) a closed birth cohort of 29,662 children and (2) a cross-sectional cohort of 333,200 children. These cohorts were utilized to determine the epidemiologic characteristics of the conditions studied. Logistic regression was utilized to determine the extent to which food allergy was associated with respiratory allergy. RESULTS In our birth cohort, the peak age at diagnosis of eczema, asthma, rhinitis, and food allergy was between 0 and 5 months (7.3 %), 12 and 17 months (8.7 %), 24 and 29 months (2.5 %), and 12 and 17 months (1.9 %), respectively. In our cross-sectional cohort, eczema and rhinitis prevalence rates were 6.7 % and 19.9 %, respectively. Asthma prevalence was 21.8 %, a rate higher than previously reported. Food allergy prevalence was 6.7 %, with the most common allergenic foods being peanut (2.6 %), milk (2.2 %), egg (1.8 %), shellfish (1.5 %), and soy (0.7 %). Food allergy was associated with development of asthma (OR 2.16, 95 % CI 1.94-2.40), and rhinitis (OR 2.72, 95 % CI 2.45-3.03). CONCLUSIONS Compared with previous reports, we measure lower rates of eczema and higher rates of asthma. The distribution of the major allergenic foods diverged from prior figures, and food allergy was associated with the development of respiratory allergy. The utilization of provider-based diagnosis data contributes an important and lacking methodology that complements existing studies.
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Affiliation(s)
- David A Hill
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market St., Philadelphia, PA, 19104, USA. .,Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Robert W Grundmeier
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gita Ram
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market St., Philadelphia, PA, 19104, USA
| | - Jonathan M Spergel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market St., Philadelphia, PA, 19104, USA.,Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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467
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Zubrinich C, Hew M, O'Hehir R. Egg provoked food protein-induced enterocolitis-like syndrome in an adult. Clin Case Rep 2016; 4:899-901. [PMID: 27648271 PMCID: PMC5018597 DOI: 10.1002/ccr3.665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/18/2016] [Accepted: 07/24/2016] [Indexed: 11/12/2022] Open
Abstract
Food protein‐induced enterocolitis syndrome is a non‐IgE‐mediated food allergy usually diagnosed in infancy. We report a case of a similar syndrome in an adult, following ingestion of egg. We remind clinicians to consider this diagnosis which may present to emergency physicians and gastroenterologists long before an allergist is consulted.
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Affiliation(s)
| | - Mark Hew
- The Alfred Hospital Prahran Victoria Australia
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468
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Role of immunoglobulin G antibodies in diagnosis of food allergy. Postepy Dermatol Alergol 2016; 33:253-6. [PMID: 27605894 PMCID: PMC5004213 DOI: 10.5114/ada.2016.61600] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
This paper presents current views on the role of immunoglobulin G (IgG) antibodies in the reactions with food antigens in the digestive tract and their role in the diagnosis of food allergy based on the assays of specific IgG class antibodies, with a special focus on contemporary practice guidelines. In the light of current scientific knowledge, the IgG-specific antibody-mediated reactions are a body's natural and normal defensive reactions to infiltrating food antigens, which are considered as pathogens. On the other hand, specific IgG antibodies against food allergens play a crucial role in the induction and maintaining of immunological tolerance to food antigens. The statements of many scientific societies stress that sIgG are of no significant importance in the diagnosis of food allergy since their presence is associated with a normal immune response to food allergens and attests to a protracted exposure to food antigens.
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469
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Local Side Effects of Sublingual and Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:13-21. [PMID: 27527548 DOI: 10.1016/j.jaip.2016.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 01/23/2023]
Abstract
Sublingual immunotherapy (SLIT) is increasingly used worldwide, and several products have been recently registered as drugs for respiratory allergy by the European Medicine Agency and the Food and Drug Administration. Concerning inhalant allergens, the safety of SLIT is overall superior to that of subcutaneous immunotherapy in terms of systemic adverse events. No fatality has been ever reported, and episodes of anaphylaxis were described only exceptionally. Looking at the historical and recent trials, most (>90%) adverse events are "local" and confined to the site of administration. For this reason, a specific grading system has been developed by the World Allergy Organization to classify and describe local adverse events. There is an increasing amount of literature concerning oral desensitization for food allergens, referred to as oral immunotherapy. Also, in this case, local side effects are predominant, although systemic adverse events are more frequent than with inhalant allergens. We review herein the description of local side effects due to SLIT, with a special focus on large trials having a declared sample size calculation. The use of the Medical Dictionary for Regulatory Activities nomenclature for adverse events is mentioned in this context, as recommended by regulatory agencies. It is expected that a uniform classification/grading of local adverse events will improve and harmonize the surveillance and reporting on the safety of SLIT.
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470
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Affiliation(s)
- A Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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471
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Stathopoulos L, King SK, Southwell BR, Hutson JM. Nuclear transit study in children with chronic faecal soiling after Hirschsprung disease (HSCR) surgery has revealed a group with rapid proximal colonic treatment and possible adverse reactions to food. Pediatr Surg Int 2016; 32:773-7. [PMID: 27392639 DOI: 10.1007/s00383-016-3919-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE Long-term problems with faecal incontinence occur in up to 50 % of patients after pull-through for Hirschsprung disease (HSCR). The cause often remains unknown, leading to empirical treatments. Using nuclear transit study, we found some patients surprisingly had rapid proximal colonic transit, suspicious of occult diarrhoea. We aimed to assess whether these patients had unrecognized adverse reactions to food. METHODS Patients (n = 10, all males, 9.6 year; 4.25-15.5 years) with persistent faecal incontinence following pull-through for HSCR referred to the senior author and after exclusion of anatomical defects, underwent nuclear transit studies. Most (8) subsequently underwent breath hydrogen tests for sugar malabsorption and were tested for adverse reactions to food. Exclusion diets for protein allergens, lactose or fructose were then trialed. RESULTS Of the 10 patients with rapid intestinal transit proven on nuclear transit study, breath hydrogen tests for fructose and/or lactose malabsorption were done in 8, and were positive in 7/8 patients. Exclusion diets contributed to either resolution or improvement in faecal incontinence in 9/10 patients. CONCLUSIONS Rapid transit in the proximal, ganglionated colon may be present in children with faecal incontinence following pull-through for HSCR, possibly secondary to adverse reactions to food. This study suggests that children with post-operative soiling may benefit from a transit study and hydrogen breath tests to diagnose adverse reactions to food caused by sugar malabsorption.
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Affiliation(s)
- Lefteris Stathopoulos
- Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Sebastian K King
- Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Bridget R Southwell
- Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - John M Hutson
- Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. .,Department of Urology, The Royal Children's Hospital, Melbourne, VIC, Australia.
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472
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, #200, 233-16th Avenue North West, Calgary, Alberta T2M 0H5, Canada.
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China
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473
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Badellino H, Jares E. Advances in Food-Induced Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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474
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Mudde ACA, Lexmond WS, Blumberg RS, Nurko S, Fiebiger E. Eosinophilic esophagitis: published evidences for disease subtypes, indications for patient subpopulations, and how to translate patient observations to murine experimental models. World Allergy Organ J 2016; 9:23. [PMID: 27458501 PMCID: PMC4947322 DOI: 10.1186/s40413-016-0114-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/01/2016] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus and commonly classified as a Th2-type allergy. Major advances in our understanding of the EoE pathophysiology have recently been made, but clinicians struggle with highly unpredictable therapy responses indicative of phenotypic diversity within the patient population. Here, we summarize evidences for the existence of EoE subpopulations based on diverse inflammatory characteristics of the esophageal tissue in EoE. Additionally, clinical characteristics of EoE patients support the concept of disease subtypes. We conclude that clinical and experimental evidences indicate that EoE is an umbrella term for conditions that are unified by esophageal eosinophilia but that several disease subgroups with various inflammatory esophageal patterns and/or different clinical features exist. We further discuss strategies to study the pathophysiologic differences as observed in EoE patients in murine experimental EoE. Going forward, models of EoE that faithfully mimic EoE subentities as defined in humans will be essential because mechanistic studies on triggers which regulate the onset of diverse EoE subpopulations are not feasible in patients. Understanding how and why different EoE phenotypes develop will be a first and fundamental step to establish strategies that integrate individual variations of the EoE pathology into personalized therapy.
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Affiliation(s)
- Anne C A Mudde
- Department of Medicine, Harvard Medical School, and Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Willem S Lexmond
- Department of Medicine, Harvard Medical School, and Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Richard S Blumberg
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Samuel Nurko
- Department of Medicine, Harvard Medical School, and Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 USA ; Center for Motility and Functional Gastrointestinal Disorders, Boston, MA USA ; Eosinophilic Gastrointestinal Disease Center, Boston Children's Hospital, Boston, MA USA
| | - Edda Fiebiger
- Department of Medicine, Harvard Medical School, and Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
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475
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Simberloff T, Parambi R, Bartnikas LM, Broyles AD, Hamel V, Timmons KG, Miller DM, Graham DA, Schneider LC, MacGinnitie AJ. Implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) for Food Challenges. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:335-344.e3. [PMID: 27373725 DOI: 10.1016/j.jaip.2016.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs. OBJECTIVE The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients. METHODS Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions. RESULTS Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location. CONCLUSIONS By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.
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Affiliation(s)
- Tander Simberloff
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass
| | - Ron Parambi
- Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Ana Dioun Broyles
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Victoria Hamel
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Karol G Timmons
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - D Marlowe Miller
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass
| | - Dionne A Graham
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass; Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Andrew J MacGinnitie
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
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476
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477
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Doctor, can I desensitize my food-allergic child using directly the allergenic molecules? Curr Opin Allergy Clin Immunol 2016; 16:278-83. [DOI: 10.1097/aci.0000000000000264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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478
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Affiliation(s)
- Louise Manning
- Department of Food Science and Agri-Food Supply Chain Management, Harper Adams University, Newport, Shropshire, United Kingdom
| | - Jan Mei Soon
- International Institute of Nutritional Sciences and Applied Food Safety Studies, School of Sport and Wellbeing, University of Central Lancashire, Preston, United Kingdom
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479
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Pascal M, Muñoz-Cano R, Milà J, Sanz ML, Diaz-Perales A, Sánchez-López J, García-Moral A, Juan M, Valero A, Yagüe J, Picado C, Bartra J. Nonsteroidal anti-inflammatory drugs enhance IgE-mediated activation of human basophils in patients with food anaphylaxis dependent on and independent of nonsteroidal anti-inflammatory drugs. Clin Exp Allergy 2016; 46:1111-9. [DOI: 10.1111/cea.12735] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Pascal
- Servei d'Immunologia; Centre de Diagnostic Biomedic (CDB); Hospital Clinic; Universitat de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - R. Muñoz-Cano
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - J. Milà
- Servei d'Immunologia; Centre de Diagnostic Biomedic (CDB); Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - M. L. Sanz
- Clinica Universitaria de Navarra (CUN); Pamplona Spain
| | - A. Diaz-Perales
- Centro de Biotecnologia y Genomica de Plantas; Universidad Politecnica de Madrid-Instituto Nacional de Investigacion y Tecnologia Agraria y Alimentaria; Madrid Spain
| | - J. Sánchez-López
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - A. García-Moral
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - M. Juan
- Servei d'Immunologia; Centre de Diagnostic Biomedic (CDB); Hospital Clinic; Universitat de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - A. Valero
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - J. Yagüe
- Servei d'Immunologia; Centre de Diagnostic Biomedic (CDB); Hospital Clinic; Universitat de Barcelona; Barcelona Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - C. Picado
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - J. Bartra
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Unitat d'Al·lergia; Servei de Pneumologia; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
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480
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Azofra J, Berroa F, Gastaminza G, Saiz N, Gamboa PM, Vela C, García BE, Lizarza S, Echenagusia MA, Joral A, Aranzabal MA, Quiñones MD, Jauregui I, Madera JF, Navarro JA, Lizaso MT, Bernad A, Goikoetxea MJ. Lipid Transfer Protein Syndrome in a Non-Mediterranean Area. Int Arch Allergy Immunol 2016; 169:181-8. [PMID: 27144406 DOI: 10.1159/000445893] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plant food allergies associated with lipid transfer protein (LTP) have been widely described in the Mediterranean Basin. OBJECTIVE The aim of this work was to describe the clinical profile and pollen sensitization of plant food- allergic patients sensitized to LTP in a non-Mediterranean area. METHODS Patients with clear IgE-mediated symptoms associated with plant foods and a positive skin prick test (SPT) to Pru p 3 were included in a prospective study in the north of Spain. Reported symptoms were analyzed together with a battery of food and pollen SPTs and specific IgE components by ISAC microarray. Cross-inhibition studies were performed by ImmunoCAP with plane tree, mugwort and rPru p 3. RESULTS Among the 72 patients included, the most frequent food allergy reported was to peaches (69%) followed by nuts (walnuts 55%, peanuts 54% and hazelnuts 43%). Most patients suffered from symptoms with multiple plant foods (a median of 6 foods per patient). Regarding the patients' pollen sensitization, 36% were sensitized to mugwort pollen (72% showing sIgE to Art v 3), 33% to grass pollen and 24% to plane tree pollen (94% with sIgE to Pla a 3). Inhibition studies showed that specific IgEs against mugwort and plane tree pollen are inhibited by Pru p 3 in a strong manner, whereas Pru p 3 was less inhibited by pollen extracts. CONCLUSIONS LTP syndrome occurs in a non-Mediterranean area and is related to multiple sensitizations to foods and pollens such as plane tree and mugwort. In these pollen sensitizations, Pru p 3 seems to be the primary sensitizer.
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Affiliation(s)
- Julian Azofra
- Allergology Unit, Hospital Central de Asturias, Oviedo, Spain
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481
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 512] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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482
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Keet CA. A call to improve standards for reporting of diagnostic test research in allergy. J Allergy Clin Immunol 2016; 137:1761-1763. [PMID: 27094361 DOI: 10.1016/j.jaci.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/02/2016] [Accepted: 03/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
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483
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Petrovic-Dovat L, Fausnight T, White AM, Zeiger T, Bansal PS, Garg N, Annapareddy J, Iriana S, Slattery MJ, Meyer RE, Bixler EO. Degree of anxiety in food allergic children in a tertiary care center. Ann Allergy Asthma Immunol 2016; 116:528-32. [PMID: 27066944 DOI: 10.1016/j.anai.2016.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND The link between internalizing psychiatric disorders, such as anxiety and depression, and allergic diseases has attracted a high level of interest from psychiatrists and immunologists. Recent studies have found increased anxiety in children with asthma, but findings in children with food allergy (FA) have been inconsistent. OBJECTIVE It was hypothesized that children with FA would score significantly higher on a standardized anxiety screen than general pediatric (GP) patients but not as high as patients with diagnosed anxiety disorders. METHODS A total of 114 patients aged 8 to 16 years (37 with confirmed anxiety disorder from a pediatric psychiatry clinic, 40 with confirmed FA from a pediatric allergy clinic, and 43 well-care patients from a GP clinic) and their mothers completed the Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS Children and mothers in the allergy group did not report increased levels of anxiety in children on total SCARED scores or subscales compared with children and mothers from the GP group. There was a trend toward increased panic disorder symptoms reported in children by mothers of children in the allergy group, but this finding did not reach statistical significance. CONCLUSION Children with FA did not have increased anxiety; however, there was a trend for mothers of children with allergies to report more symptoms of panic disorder in their children. It remains important to screen families for anxiety-related symptoms and refer them to mental health services when indicated.
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Affiliation(s)
| | - Tracy Fausnight
- Division of Allergy and Immunology, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Amanda M White
- Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Timothy Zeiger
- Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Pevitr S Bansal
- Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | - Sarah Iriana
- Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Marcia J Slattery
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Roger E Meyer
- Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
| | - Edward O Bixler
- Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania
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484
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Redmond M, Kempe E, Strothman K, Wada K, Scherzer R, Stukus DR. Food allergy prevalence and management at an overnight summer camp. Ann Allergy Asthma Immunol 2016; 116:518-522.e3. [PMID: 27048948 DOI: 10.1016/j.anai.2016.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/12/2016] [Accepted: 03/09/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND In recent years, increased awareness of food allergy management has focused on the school setting. A lack of awareness and relevant literature prompted evaluation of the camp experience. OBJECTIVE To characterize the prevalence of food allergies among children attending an overnight summer camp and to evaluate the knowledge and comfort of camp personnel before and after a training session. METHODS The database for the 2014 season at Flying Horse Farms was reviewed for information pertaining to food allergies and provision of epinephrine and treatment plans. Camp personnel completed surveys regarding food allergy knowledge and comfort. Surveys were redistributed 30 days after the training session. RESULTS Among 445 campers, 15% reported at least one food allergy, with 8.5% reporting allergy to 1 of the top 8 food allergens. Only 32% of campers with food allergy supplied an epinephrine autoinjector, and 0% provided written treatment plans. Before training, 84% of personnel desired additional information about food allergies. Knowledge of food allergies among personnel was high at baseline but increased after training in regard to epinephrine use for anaphylaxis and postepinephrine management. Staffers who reported feeling very comfortable caring for campers with food allergy increased from 16% to 46% after the training session; comfort in treating a food allergy emergency increased from 2% to 29%. CONCLUSION Management of food allergies at overnight summer camps warrants similar education and preparation strategies as those implemented in schools. Camp personnel should receive annual training regarding food allergies and anaphylaxis.
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Affiliation(s)
| | - Erin Kempe
- Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Kasey Strothman
- Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara Wada
- Nationwide Children's Hospital, Columbus, Ohio
| | - Rebecca Scherzer
- Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - David R Stukus
- Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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485
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486
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Abstract
The number of infant formulas intended for food allergy treatment or prevention has been increasing. Some products fulfill the criteria for hypoallergenicity, such as extensively hydrolyzed protein (casein or whey) and synthesized amino acid formulas (elemental diet). Numerous partially hydrolyzed formulas have been derived from bovine milk, soybean, and rice. They are not hypoallergenic and are not recommended for children allergic to the parent protein, yet certain preparations have shown efficacy for allergy prevention. Soybean-derived preparations, although not hypoallergenic, have been tolerated by a majority of children allergic to bovine milk. Studies on the addition of probiotics or prebiotics to infant formulas have shown inconsistent findings. Numerous hypoallergenic formulas or milk substitutes are available for pediatricians to choose for children with food allergy. Caution is needed in prescribing formulas that are erroneously marketed as hypoallergenic.
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487
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Wood RA. Food allergen immunotherapy: Current status and prospects for the future. J Allergy Clin Immunol 2016; 137:973-982. [DOI: 10.1016/j.jaci.2016.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 12/23/2022]
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488
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Plasek JM, Goss FR, Lai KH, Lau JJ, Seger DL, Blumenthal KG, Wickner PG, Slight SP, Chang FY, Topaz M, Bates DW, Zhou L. Food entries in a large allergy data repository. J Am Med Inform Assoc 2016; 23:e79-87. [PMID: 26384406 PMCID: PMC4954633 DOI: 10.1093/jamia/ocv128] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/07/2015] [Accepted: 07/10/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Accurate food adverse sensitivity documentation in electronic health records (EHRs) is crucial to patient safety. This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. METHODS Using the Medical Text Extraction, Reasoning, and Mapping System (MTERMS), we processed both structured and free-text entries stored in an enterprise-wide allergy repository (Partners' Enterprise-wide Allergy Repository), normalized diverse food allergen terms into concepts, and encoded these concepts using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) and Unique Ingredient Identifiers (UNII) terminologies. Concept coverage also was assessed for these two terminologies. We further categorized allergen concepts into groups and calculated the frequencies of these concepts by group. Finally, we conducted an external validation of MTERMS's performance when identifying food allergen terms, using a randomized sample from a different institution. RESULTS We identified 158 552 food allergen records (2140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3%), fruits or vegetables (18.4%), dairy (9.0%), peanuts (8.5%), tree nuts (8.5%), eggs (6.0%), grains (5.1%), and additives (4.7%). Ambiguous, generic concepts such as "nuts" and "seafood" accounted for 8.8% of the records. SNOMED-CT covered more concepts than UNII in terms of exact (81.7% vs 68.0%) and partial (14.3% vs 9.7%) matches. DISCUSSION Adverse sensitivities to food are diverse, and existing standard terminologies have gaps in their coverage of the breadth of allergy concepts. CONCLUSION New strategies are needed to represent and standardize food adverse sensitivity concepts, to improve documentation in EHRs.
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Affiliation(s)
- Joseph M Plasek
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Foster R Goss
- Department of Emergency Medicine and Clinical Decision Making, Tufts Medical Center, Boston, MA, USA Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Kenneth H Lai
- Clinical & Quality Analysis, Partners HealthCare System, Boston, MA, USA
| | - Jason J Lau
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Diane L Seger
- Clinical & Quality Analysis, Partners HealthCare System, Boston, MA, USA
| | | | - Paige G Wickner
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah P Slight
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Frank Y Chang
- Clinical Informatics, Partners eCare, Partners HealthCare System, Boston, MA, USA
| | - Maxim Topaz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA Clinical Informatics, Partners eCare, Partners HealthCare System, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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489
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Couch C, Franxman T, Greenhawt M. The economic effect and outcome of delaying oral food challenges. Ann Allergy Asthma Immunol 2016; 116:420-4. [PMID: 27017564 DOI: 10.1016/j.anai.2016.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Food specific IgE (sIgE) is a useful marker to assess predictability of oral food challenge (OFC) outcome. A threshold of less than 2 kUA/L for peanut, egg, and milk has been proposed as a 50% negative predictive value at which patients may pass an OFC. OBJECTIVE To assess the economic effect and outcome of delaying OFCs. METHODS A retrospective analysis was performed for peanut, egg, and milk OFCs conducted between 2001 and 2012 at a tertiary food allergy referral center. Delayed OFC was defined as greater than 12 months from the time the sIgE level became less than 2 kUA/L. Time to OFC was explored in association with skin prick test result (wheal size), OFC outcome, and the economic effect of delay. RESULTS Of 319 challenges, 173 OFCs were delayed (54.2%) by a mean time of 35.5 months (range, 13-123 months) vs a mean time of 4.2 months in the 146 challenges that were not delayed (P < .001). The overall OFC passage rate was 89.9%. There was no association between delayed OFC and history of anaphylaxis, type of allergen, age at OFC, or challenge outcome. Delay in OFC was associated with an estimated mean economic cost of $12,203 per patient ($4,184 per 12 months) and $1,951,487 total (total delay, 5,597 months) in this population. CONCLUSION Despite a 50% negative predictive value, more than 50% of OFCs were delayed in this population by a mean time of nearly 3 years. Delaying OFC is associated with increased costs, and quality improvement is needed to help decrease time to OFC and reduce the economic burden of food allergy on families and the health care system.
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Affiliation(s)
- Christopher Couch
- Division of Allergy and Clinical Immunology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Tim Franxman
- Family Allergy and Asthma Center, Florence, Kentucky
| | - Matthew Greenhawt
- Division of Allergy and Clinical Immunology, The University of Michigan Medical School, Ann Arbor, Michigan; The Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Section of Allergy, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
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490
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Current concepts: diagnosis and management of food allergy in children. Curr Opin Otolaryngol Head Neck Surg 2016; 24:250-5. [PMID: 26982622 DOI: 10.1097/moo.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Advances in the prevention and treatment of food allergy have been published in the last few years and are placed in context using a review format. RECENT FINDINGS Preventing food allergy has been studied for years with questions of whether avoidance or exposure was a better strategy. Recent research has suggested that peanut allergy can be substantially reduced in high-risk infants through intentional oral exposure. For children with food allergy, the primary treatment remains avoidance, but controlled trials have shown some success with oral immunotherapy and sublingual immunotherapy. SUMMARY Providers who see children with food allergies should be aware of the newer recommendations of preventing peanut allergy and the emerging therapies for children with immunoglobulin E-mediated food allergy.
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491
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Greenhawt MJ, Fleischer DM, Atkins D, Chan ES. The Complexities of Early Peanut Introduction for the Practicing Allergist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:221-5. [DOI: 10.1016/j.jaip.2015.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
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492
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Parent report of food allergy management by pediatricians and allergists. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:319-21.e1. [DOI: 10.1016/j.jaip.2015.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022]
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493
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Sicherer SH, Wood RA, Vickery BP, Perry TT, Jones SM, Leung DYM, Blackwell B, Dawson P, Burks AW, Lindblad R, Sampson HA. Impact of Allergic Reactions on Food-Specific IgE Concentrations and Skin Test Results. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:239-45.e4. [PMID: 26718150 PMCID: PMC4789127 DOI: 10.1016/j.jaip.2015.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although there is concern that food allergy reactions may negatively affect the natural history of food allergy, the impact of reactions on food-specific IgE (sIgE) levels or skin prick test (SPT) wheal size is unknown. OBJECTIVE To measure the effects of allergic reactions on SPT wheal size and sIgE concentrations to milk, egg, and peanut. METHODS Participants included 512 infants with likely milk or egg allergy enrolled in a multicenter observational study. Changes in sIgE level and SPT wheal size to milk, egg, and peanut were measured before and after oral food challenge (OFC) or accidental exposure for 377 participants. RESULTS The median age of the cohort at the time of analysis was 8.5 years (67% males). There were no statistically significant changes in sIgE level or SPT wheal size after positive OFC to milk, egg, or peanut (n = 20-27 for each food). Change in sIgE level and SPT wheal size was measured after 446 and 453 accidental exposure reactions, respectively. The median change in sIgE level was a decrease of 0.33 kU(A)/L (P < .01) after milk and 0.34 kU(A)/L (P < .01) after egg reactions, but no other statistically significant changes in sIgE level or SPT wheal size were observed for milk, egg, or peanut. When we limited the analysis to only those participants who had diagnostic testing done within 6 months of an accidental exposure reaction, we found that peanut SPT wheal size increased by 1.75 mm (P < .01), but a significant increase was not noted when all participants with testing done within 12 months were considered. CONCLUSIONS The results suggest that reactions from OFCs and accidental exposure are not associated with increases in sensitization among children allergic to milk, egg, or peanut.
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Affiliation(s)
- Scott H Sicherer
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | | | | | | | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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494
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The Heterogeneity of Oral Immunotherapy Clinical Trials: Implications and Future Directions. Curr Allergy Asthma Rep 2016; 16:25. [DOI: 10.1007/s11882-016-0602-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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495
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Elizur A, Appel MY, Goldberg MR, Yichie T, Levy MB, Nachshon L, Katz Y. Clinical and laboratory 2-year outcome of oral immunotherapy in patients with cow's milk allergy. Allergy 2016; 71:275-8. [PMID: 26482941 DOI: 10.1111/all.12794] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/28/2022]
Abstract
Studies examining the long-term effect of oral immunotherapy in food-allergic patients are limited. We investigated cow's milk-allergic patients, >6 months after the completion of oral immunotherapy (n = 197). Questionnaires, skin prick tests, and basophil activation assays were performed. Of the 195 patients contacted, 180 (92.3%) were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. Thirteen patients (6.7%) required injectable epinephrine. Higher reaction rate after immunotherapy was associated with more anaphylactic episodes before treatment and a lower starting dose (OR = 2.1, P = 0.035 and OR = 2.3, P = 0.035, respectively). Reaction rate in patients who were 6-15 months, 15-30 months, or >30 months post-treatment decreased from 0.28/month to 0.21/month to 0.15/month, respectively (P < 0.01). Milk-induced %CD63 and %CD203c expression was significantly lower in patients >24 months vs in patients <24 months post-treatment (P = 0.038 and P = 0.047, respectively). In conclusion, many patients experience mild adverse reactions after completing oral immunotherapy and some require injectable epinephrine. Progressive desensitization, both clinically and in basophil reactivity, occurs over time.
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Affiliation(s)
- A. Elizur
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. Y. Appel
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. R. Goldberg
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - T. Yichie
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. B. Levy
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - L. Nachshon
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - Y. Katz
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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496
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Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DBK, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol 2016; 115:341-84. [PMID: 26505932 DOI: 10.1016/j.anai.2015.07.019] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 12/12/2022]
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497
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Miceli Sopo S, Monaco S, Greco M, Onesimo R. Prevalence of adverse reactions following a passed oral food challenge and factors affecting successful re-introduction of foods. A retrospective study of a cohort of 199 children. Allergol Immunopathol (Madr) 2016; 44:54-8. [PMID: 26242568 DOI: 10.1016/j.aller.2015.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/16/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND After a passed oral food challenge (OFC), regular and normal food consumption is attended. The main objective of this study is to assess the safety of tested food dietary re-introduction after a passed OFC. PATIENTS AND METHODS In 2014, a telephone survey was submitted to patients who passed OFC and those who failed it only presenting with contact urticaria (we consider these OFC as passed), between 2009 and 2013. Questionnaire items included demographic data, food allergy details, food consumption after the OFC was performed, recurring symptoms and life style changes. RESULTS 249 OFC questionnaires were collected from 199 children, 228 OFC were passed, 21 were failed exclusively due to contact urticaria. The most tested food was cows' milk. In 71% of cases target food was re-introduced in patients diet in normal amounts. We found children >2 years introduced less frequently tested food than infants. In 2% of cases adverse reactions to offending food were reported, but severe reactions never occurred. DISCUSSION The majority of children of this study ate target food regularly and their family's quality of life improved. In our study, adverse reactions frequency in patients who passed OFC was very low and never serious. We highlight the importance of re-assessing proper food consumption in every patient who passed OFC.
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498
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Hsieh FH. A new approach to epinephrine deficiency and fatal food anaphylaxis. Ann Allergy Asthma Immunol 2015; 115:166-7. [PMID: 26356587 DOI: 10.1016/j.anai.2015.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Fred H Hsieh
- Allergy and Immunology, Respiratory Institute, Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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499
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Scott JF, Hammond MI, Nedorost ST. Food Avoidance Diets for Dermatitis. Curr Allergy Asthma Rep 2015; 15:60. [PMID: 26300528 DOI: 10.1007/s11882-015-0563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Food allergy is relatively common in both children and adults, and its prevalence is increasing. Early exposure of food allergens onto skin with an impaired epidermal barrier predisposes to sensitization and prevents the development of oral tolerance. While immediate-type food allergies are well described, less is known about delayed-type food allergies manifesting as dermatitis. This is due, in part, to limitations with current diagnostic testing for delayed-type food allergy, including atopy patch testing. We conducted a systematic review of food avoidance diets in delayed-type food allergies manifesting as dermatitis. While beneficial in some clinical circumstances, avoidance diets should be used with caution in infants and children, as growth impairment and developmental delay may result. Ultimately, dermatitis is highly multifactorial and avoidance diets may not improve symptoms of delayed-type food allergy until combined with other targeted therapies, including restoring balance in the skin microbiome and re-establishing proper skin barrier function.
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Affiliation(s)
- Jeffrey F Scott
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA,
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500
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Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol 2015; 12:389-403. [DOI: 10.1586/1744666x.2016.1124761] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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