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Dobbin-Williams K, Crossman R, Swab M. Experiences of parents of teenagers with life-threatening food allergies: a qualitative systematic review protocol. JBI Evid Synth 2024:02174543-990000000-00332. [PMID: 39039829 DOI: 10.11124/jbies-23-00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVE The objective of this review is to synthesize the experiences of parents of teenagers with life-threatening food allergies. INTRODUCTION Life-threatening food allergies are increasing globally, with a significant effect on families, particularly parents. The teenage years are a time of increasing autonomy for young people; however, for parents living with and caring for a teenager with a life-threatening food allergy, this responsibility can have a considerable impact. INCLUSION CRITERIA This review will include qualitative studies on the experiences of parents of teenagers with life-threatening food allergies, including, but not limited to, caregiving, parenting, and psychosocial experiences; any day-to-day activities, happenings, thoughts, or feelings related to parenting a teenager with life-threatening food allergies; and the handing over of responsibility for the allergy to the teenager. The review will include studies on participants in the community and in health care settings such as inpatient hospitalizations, outpatient visits, school and sports events, family dinners, restaurants, and travel. Participants from all cultural backgrounds, socio-economic backgrounds, and countries will be included. METHODS The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search for published studies will include CINAHL, MEDLINE, and PsycINFO (EBSCOhost); Embase (Ovid); LILACS, IBSS, and Sociological Abstracts (ProQuest). The search for unpublished studies will include ProQuest Dissertations and Theses, Open Access Theses and Dissertations (OATD), Bielefeld Academic Search Engine (BASE), Google, and Google Scholar. Databases will be searched from inception until the present. JBI tools and guidelines will be used to conduct critical appraisal, data extraction, data synthesis, and assessment of confidence in the findings. REVIEW REGISTRATION NUMBER PROSPERO CRD42024503698.
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Affiliation(s)
- Karen Dobbin-Williams
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
- Memorial University Nursing Collaboration for Evidence-based Health Care: A JBI Affiliated Group, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Renee Crossman
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
- Memorial University Nursing Collaboration for Evidence-based Health Care: A JBI Affiliated Group, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Nursing Collaboration for Evidence-based Health Care: A JBI Affiliated Group, Memorial University of Newfoundland, St. John's, NL, Canada
- Health Sciences Library, Memorial University of Newfoundland, St. John's, NL, Canada
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Espinosa R, Garrido-Arandia M, Romero-Sahagun A, Herreros P, Tramarin L, Laguna M, Díaz-Perales A, Holgado M. A new optical interferometric-based in vitro detection system for the specific IgE detection in serum of the main peach allergen. Biosens Bioelectron 2020; 169:112641. [DOI: 10.1016/j.bios.2020.112641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
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Ontiveros N, Gallardo JAL, Arámburo-Gálvez JG, Beltrán-Cárdenas CE, Figueroa-Salcido OG, Mora-Melgem JA, Granda-Restrepo DM, Rodríguez-Bellegarrigue CI, Vergara-Jiménez MDJ, Cárdenas-Torres FI, Gracia-Valenzuela MH, Cabrera-Chávez F. Characteristics of Allergen Labelling and Precautionary Allergen Labelling in Packaged Food Products Available in Latin America. Nutrients 2020; 12:nu12092698. [PMID: 32899689 PMCID: PMC7576488 DOI: 10.3390/nu12092698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/30/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023] Open
Abstract
The characteristics of food allergen labelling are relevant for avoiding accidental exposure to the allergens of interest but no Latin American country has evaluated these characteristics. Our aim was to evaluate the characteristics of food allergen labelling and precautionary allergen labelling (PAL) in six Latin American countries. All data were collected directly from the supermarkets surveyed. A total of 10,254 packaged food products were analyzed, of which 63.3% (n = 6494) and 33.2% (n = 3405) featured allergen labelling and/or PAL, respectively. Most products complied with local regulations (≥87.4% for both locally produced and imported). Thirty-three types of PAL statements were detected; the most frequent was “may contain traces of…” (35.1%). Countries without regulations on the characteristics of allergen labelling had two-fold more products that contained allergens in their ingredients lists but no food allergen labelling. The use of PAL in countries that regulate it (38.2%) was as high as that in countries without PAL regulations (19.2%–44.7%). The findings suggest that the lack of regulations for the characteristics of allergen labeling increases the risk of accidental exposure to allergens of interest. Our findings also suggest that beyond regulations, a scientific approach is required for minimizing and standardizing the use of PAL.
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Affiliation(s)
- Noé Ontiveros
- Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, Clinical and Research Laboratory (LACIUS, URS), University of Sonora, Navojoa 85880, Sonora, Mexico
| | | | - Jesús Gilberto Arámburo-Gálvez
- Postgraduate in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo 83000, Sonora, Mexico
| | | | - Oscar Gerardo Figueroa-Salcido
- Postgraduate in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo 83000, Sonora, Mexico
| | | | - Diana María Granda-Restrepo
- Food Department, Faculty of Pharmaceutical and food sciences, University of Antioquia, Medellín, Antioquia 50010, Colombia
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The role of peanut-free school policies in the protection of children with peanut allergy. J Public Health Policy 2020; 41:206-213. [DOI: 10.1057/s41271-019-00216-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Remington BC, Krone T, Koppelman SJ. Quantitative risk reduction through peanut immunotherapy: Safety benefits of an increased threshold in Europe. Pediatr Allergy Immunol 2018; 29:762-772. [PMID: 30054934 DOI: 10.1111/pai.12961] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/16/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical relevance of increasing an allergic individual's peanut sensitivity threshold by immunotherapy, that is, eliciting dose (ED) to 300 or 1000 mg peanut protein, has not been previously characterized in a European population. In this study, we quantify the clinical benefits of an increased threshold of reaction following immunotherapy for the peanut-allergic individual. METHODS Quantitative risk assessments incorporated numerous inputs to predict the risk of an allergic reaction after exposure to residual peanut protein in packaged foods. The three primary inputs for the risk assessment were the peanut-allergic individual's clinical threshold value, the amount of food consumed per eating occasion of selected packaged foods, and the concentration of peanut protein in the consumed product. Individual risk reductions were calculated for both children and adolescents-adults. RESULTS Using available consumption and packaged food contamination data, children reaching an ED of 300 mg (if initial ED ≤ 100 mg) or 1000 mg (if initial ED 300 mg) achieved >99.99% risk reduction. Adolescents-adults also achieved >99.99% risk reduction in all cases but one. Adolescents-adults who reached an ED of 300 mg (if initial ED ≤ 100 mg) achieved 99.3%-99.9% risk reduction when consuming ice cream. CONCLUSIONS It is concluded that an increase in threshold following immunotherapy which achieves an eliciting dose of 300 or 1000 mg peanut protein is clinically relevant for the European peanut-allergic population. Benefits of an increased threshold include a significant reduction in risk due to traces of peanut protein.
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Affiliation(s)
| | | | - Stef J Koppelman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska
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Burkhardt S, Genet P, Sabatasso S, La Harpe R. Death by anaphylactic shock in an institution: an accident or negligence? Int J Legal Med 2018; 133:561-564. [PMID: 30187123 DOI: 10.1007/s00414-018-1929-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Abstract
This is a description of a man, institutionalised for learning difficulties, known to have an allergy to seafood. After eating a pie, the patient quickly developed dyspnoea and vomiting. The staff at the institution administered epinephrine and called the emergency services. Despite cardiopulmonary resuscitation, the patient died shortly after being admitted to the emergency department of the University Hospitals of Geneva. In the light of the circumstances of the death and of a discrepancy between the information given to the police by the staff at the institution looking after the patient on the one hand, and the preliminary elements of the investigation on the other hand, it was suspected that there was failure in care of the patient and our institute was asked to carry out an autopsy. Basing on all the investigations carried out, the cause of death was anaphylactic reaction following the ingestion of seafood, contrary to what had been alleged by the staff at the home.
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Affiliation(s)
- Sandra Burkhardt
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland.
| | - Pia Genet
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
| | - Sara Sabatasso
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
| | - Romano La Harpe
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
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Mustafa SS, Russell AF, Kagan O, Kao LM, Houdek DV, Smith BM, Wang J, Gupta RS. Parent perspectives on school food allergy policy. BMC Pediatr 2018; 18:164. [PMID: 29753332 PMCID: PMC5948763 DOI: 10.1186/s12887-018-1135-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background Food allergy affects up to 8% of children in the U.S. There is minimal research to date on food allergy policies that are currently in place in schools and the opinions of parents of children with food allergy on the effectiveness of or need for these policies. Methods An electronic survey was disseminated to parents of children with food allergy. Frequencies were calculated to describe respondent characteristics and responses. Chi-square tests were performed to examine associations between school and child characteristics and outcomes. Results Of the 289 parent respondents, 27.4% were unsure or felt school was unsafe for their child with food allergy. While the majority felt that the polices in their child’s school were helpful, most also believed that implementation of additional polices was necessary, including availability of stock epinephrine (94.2%), lunch menus with allergen information (86%), ingredient labels on food items (81%), and direct food allergy education for students (86%). There were significant differences in school food allergy policy depending on the age of the student body, private versus public school, and geographic location. Conclusions While most schools reportedly have one or more food allergy policies in place, many parents have concerns over the safety of their child at school and feel that additional policies are necessary to improve the safety of the school environment for children with food allergy. The availability of stock epinephrine, improved allergen labeling of food and menus and increased food allergy education may be key policy areas on which to focus.
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Affiliation(s)
- S Shahzad Mustafa
- Rochester Regional Health, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Anne F Russell
- Food Allergy & Anaphylaxis Michigan Association, Ann Arbor, MI, USA
| | - Olga Kagan
- Molloy College, Rockville Centre, New York, USA
| | - Lauren M Kao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane V Houdek
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bridget M Smith
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. Veterans Affairs Hospital, Hines, IL, USA
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Dr., 6th Floor, Chicago, IL, 60611, USA.
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Mercer RD, Jones CJ, Smith HE. Reviewing the Content and Design of Anaphylaxis Management Plans Published in English. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1288-1294.e4. [DOI: 10.1016/j.jaip.2017.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Baumert JL, Taylor SL, Koppelman SJ. Quantitative Assessment of the Safety Benefits Associated with Increasing Clinical Peanut Thresholds Through Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:457-465.e4. [PMID: 28669889 DOI: 10.1016/j.jaip.2017.05.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peanut immunotherapy studies are conducted with the aim to decrease the sensitivity of patients to peanut exposure with the outcome evaluated by testing the threshold for allergic response in a double-blind placebo-controlled food challenge. The clinical relevance of increasing this threshold is not well characterized. OBJECTIVE We aimed to quantify the clinical benefit of an increased threshold for peanut-allergic patients. METHODS Quantitative risk assessment was performed by matching modeled exposure to peanut protein with individual threshold levels. Exposure was modeled by pairing US consumption data for various food product categories with potential contamination levels of peanut that have been demonstrated to be present on occasion in such food products. Cookies, ice cream, doughnuts/snack cakes, and snack chip mixes were considered in the risk assessment. RESULTS Increasing the baseline threshold before immunotherapy from 100 mg or less peanut protein to 300 mg peanut protein postimmunotherapy reduces the risk of experiencing an allergic reaction by more than 95% for all 4 food product categories that may contain trace levels of peanut residue. Further increase in the threshold to 1000 mg of peanut protein had an additional quantitative benefit in risk reduction for all patients reacting to 300 mg or less at baseline. CONCLUSIONS We conclude that achieving thresholds of 300 mg and 1000 mg of peanut protein by peanut immunotherapy is clinically relevant, and that the risk for peanut-allergic patients who have achieved this increased threshold to experience an allergic reaction is reduced in a clinically meaningful way.
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Affiliation(s)
- Joseph L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Neb.
| | - Steve L Taylor
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Neb
| | - Stef J Koppelman
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Neb
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Johnson SF, Woodgate RL. Qualitative research in teen experiences living with food-induced anaphylaxis: A meta-aggregation. J Adv Nurs 2017; 73:2534-2546. [DOI: 10.1111/jan.13325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sara F. Johnson
- College of Nursing; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg MB Canada
| | - Roberta L. Woodgate
- College of Nursing; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg MB Canada
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Jeong K, Kim J, Ahn K, Lee SY, Min TK, Pyun BY, Kim YH, Kim KW, Sohn MH, Kim KE, Jang GC, Song TW, Kim JH, Jeon YH, Lee YJ, Park YM, Yum HY, Kim HH, Kim WK, Lee S. Age-Based Causes and Clinical Characteristics of Immediate-Type Food Allergy in Korean Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:423-430. [PMID: 28677356 PMCID: PMC5500697 DOI: 10.4168/aair.2017.9.5.423] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/17/2017] [Accepted: 04/24/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Age-based causes and clinical characteristics of immediate-type food allergy (FA) have not been sufficiently studied. Therefore, we investigated age-dependent clinical profiles of FA in Korean children through an extensive multicenter investigation. METHODS Using a case report form developed by the authors, a retrospective medical record review was performed of patients (0-18 years old) diagnosed with immediate-type FA between September 2014 and August 2015 in 14 tertiary hospitals in Korea. RESULTS A total of 1,353 children and adolescents, 93% younger than 7 years, were enrolled in the present study, and 1,661 cases of immediate-type FA were recorded in these patients. The 7 major causative foods were cow's milk (28.1%), hen's eggs (27.6%), wheat (7.9%), walnuts (7.3%), peanuts (5.3%), buckwheat (1.9%), and shrimps (1.9%). Categorizing the patients into 4 age groups revealed that the most common causative food was different for each age group: cow's milk (<2 years), walnuts (2-6 years), walnuts (7-12 years), and buckwheat (13-18 years). The onset time of symptoms was less than 10 minutes in 49%, between 10 and 30 minutes in 17%, and between 30 minutes and 2 hours in 34% of cases. Food-induced anaphylaxis was reported in 506 (30.5%) out of 1,661 cases, and the 7 major causes of food-induced anaphylaxis was cow's milk (27.5%), hen's eggs (21.9%), wheat (11.3%), walnuts (10.5%), peanuts (5.9%), buckwheat (4.2%), and pine nuts (3.0%). The proportion of anaphylaxis was highest in the patients allergic to buckwheat (67.7%), followed by those allergic to pine nuts (57.7%), walnuts (43.8%), wheat (43.5%), and peanuts (34.1%). CONCLUSIONS The 5 major causative foods of immediate-type FA in Korean children were cow's milk, hen's eggs, wheat, walnuts, and peanuts. The distribution of causative foods was considerably distinctive according to different age groups. Anaphylaxis was reported in 30.5% of immediate-type FA cases.
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Affiliation(s)
- Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Bok Yang Pyun
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Earn Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Tae Won Song
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Hee Kim
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Atopy Clinic, Seoul Medical Center, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
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O'Keefe A, Clarke A, St Pierre Y, Mill J, Asai Y, Eisman H, La Vieille S, Alizadehfar R, Joseph L, Morris J, Gravel J, Ben-Shoshan M. The Risk of Recurrent Anaphylaxis. J Pediatr 2017; 180:217-221. [PMID: 27743592 DOI: 10.1016/j.jpeds.2016.09.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/10/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis. STUDY DESIGN As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions. Cox regression analysis determined factors associated with recurrence. RESULTS Among 292 children who were registered as having had medical attended anaphylaxis, 68.5% completed annual follow-up questionnaires. Forty-seven patients experienced 65 episodes of anaphylaxis during 369 patient-years of follow-up. Food was the trigger in 84.6% of cases, and epinephrine was used in 66.2%. In 50.8%, epinephrine was used outside the health care facility, and 81.7% were brought to a health care facility for treatment. Asthma, reaction triggered by food, and use of epinephrine during the index episode increased the odds of recurrent reaction. Patients whose initial reaction was triggered by peanut were less likely to have a recurrent reaction. CONCLUSIONS We report a yearly anaphylaxis recurrence rate of 17.6% in children. There is substantial underuse of epinephrine in cases of anaphylaxis. Educational programs that promote effective avoidance strategies and prompt use of epinephrine are required.
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Affiliation(s)
- Andrew O'Keefe
- Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yvan St Pierre
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Jennifer Mill
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Harley Eisman
- Montreal Children's Hospital, Emergency Department, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Reza Alizadehfar
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hospital, University of Montréal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Ilesanmi AO, Ekwe GJ, Ilesanmi RI, Ogundele DT, Akintunde JK, Olalubi OA. Prevalence of latent eosinophilia among occupational gardeners at Babcock University, Nigeria. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2015.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Herbert LJ, Lin A, Matsui E, Wood RA, Sharma H. Development of a Tool to Measure Youths’ Food Allergy Management Facilitators and Barriers. J Pediatr Psychol 2015; 41:363-72. [DOI: 10.1093/jpepsy/jsv099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
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Abstract
PURPOSE The increasing incidence of IgE-mediated food allergy has led to further study of this atopic disease. RECENT FINDINGS Food allergy represents a failure to attain oral tolerance marked by a pronounced Th2 versus T-regulatory cell response. The gold standard for the diagnosis of food allergy is a double-blind, placebo-controlled food challenge. Evidence supports breastfeeding to prevent certain atopic diseases but there is no support for delayed food introduction or maternal diet restrictions during pregnancy or lactation. There is no cure for food allergies. The mainstay of therapy is avoidance and management of severe reactions with self-injectable epinephrine. Other promising therapies include oral immunotherapy and sublingual immunotherapy. SUMMARY The mechanism of IgE-mediated food allergy is better understood but further research is needed to prevent and treat food allergies.
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Shanahan L, Zucker N, Copeland WE, Costello EJ, Angold A. Are children and adolescents with food allergies at increased risk for psychopathology? J Psychosom Res 2014; 77:468-73. [PMID: 25454290 PMCID: PMC4307934 DOI: 10.1016/j.jpsychores.2014.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Living with food allergy is a unique and potentially life-threatening stressor that requires constant vigilance to food-related stimuli, but little is known about whether adolescents with food allergies are at increased risk for psychopathology-concurrently and over time. METHODS Data came from the prospective-longitudinal Great Smoky Mountains Study. Adolescents (N=1420) were recruited from the community, and interviewed up to six times between ages 10 and 16 for the purpose of the present analyses. At each assessment, adolescents and one parent were interviewed using the Child and Adolescent Psychiatric Assessment, resulting in N=5165 pairs of interviews. RESULTS Cross-sectionally, food allergies were associated with more symptoms of separation and generalized anxiety, disorder, attention deficit and hyperactivity disorder, and anorexia nervosa. Longitudinally, adolescents with food allergy experienced increases in symptoms of generalized anxiety disorder and depression from one assessment to the next. Food allergies were not, however, associated with a higher likelihood of meeting diagnostic criteria for a psychiatric disorder. CONCLUSION The unique constellation of adolescents' increased symptoms of psychopathology in the context of food allergy likely reflects an adaptive increase in vigilance rather than cohesive syndromes of psychopathology. Support and guidance from health care providers is needed to help adolescents with food allergies and their caregivers achieve an optimal balance between necessary vigilance and hypervigilance and unnecessary restriction.
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Affiliation(s)
- Lilly Shanahan
- University of North Carolina at Chapel Hill, United States.
| | - Nancy Zucker
- Developmental Epidemiology Program, Duke University Medical Center
,Duke Center for Eating Disorders
| | | | - E. Jane Costello
- Developmental Epidemiology Program, Duke University Medical Center
| | - Adrian Angold
- Developmental Epidemiology Program, Duke University Medical Center
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 545] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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Muraro A, Agache I, Clark A, Sheikh A, Roberts G, Akdis CA, Borrego LM, Higgs J, Hourihane JO, Jorgensen P, Mazon A, Parmigiani D, Said M, Schnadt S, van Os-Medendorp H, Vlieg-Boerstra BJ, Wickman M. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community. Allergy 2014; 69:1046-57. [PMID: 24905609 DOI: 10.1111/all.12441] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 12/14/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.
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Affiliation(s)
- A. Muraro
- Department of Mother and Child Health; The Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region; Padua General University Hospital; Padua Italy
| | - I. Agache
- Theramed Medical Center; Brasov Romania
| | - A. Clark
- Allergy Department; Addenbrookes NHS Foundation Trust; Cambridge UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- Human Development in Health and Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
- Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - L. M. Borrego
- Centro de Alergia; Hospital CUF Descobertas and Departamento de Imunologia; NOVA Medical School; Lisboa Portugal
| | - J. Higgs
- Health Education Trust; Greens Norton; Northamptonshire UK
| | | | | | - A. Mazon
- Pediatric Allergy and Pneumology Unit; Children's Hospital La Fe; Instituto de Investigacion Sanitaria La Fe; Valencia Spain
| | - D. Parmigiani
- Association for Teacher Education in Europe; Bruxelles Belgium
- Department of Education; University of Genoa; Genoa Italy
| | - M. Said
- Allergy & Anaphylaxis Australia; Hornsby NSW Australia
| | - S. Schnadt
- Deutscher Allergie- und Asthmabund e.V.; Mönchengladbach Germany
| | - H. van Os-Medendorp
- Department of Dermatology & Allergology; UMC Utrecht; Utrecht The Netherlands
| | - B. J. Vlieg-Boerstra
- Department of Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - M. Wickman
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics; Sachs’ Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
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Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011. Allergy Asthma Clin Immunol 2014; 10:38. [PMID: 25670935 PMCID: PMC4322510 DOI: 10.1186/1710-1492-10-38] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Examining deaths caused by anaphylaxis may help identify factors that may decrease the risk of these unfortunate events. However, information on fatal anaphylaxis is limited. The objectives of our study were to examine all cases of fatal anaphylaxis in Ontario to determine cause of death, associated features, co factors and trends in mortality. The identification of these factors is important for developing effective strategies to overcome gaps in monitoring and treatment of patients with food allergies and risk for anaphylaxis. Methods This was a retrospective case-series analysis of all causes of anaphylaxis-related deaths using data from the Ontario Coroner’s database between 1986 and 2011. Quantitative data (e.g. demographic) were analyzed using descriptive statistics and frequency analysis using SPSS. Qualitative data were analyzed using content analysis of grounded theory methodology. Results We found 92 deaths in the last 26 years related to anaphylaxis. Causes of death, in order of decreasing frequency, included food (40 cases), insect venom (30 cases), iatrogenic (16 cases), and idiopathic (6 cases). Overall, there appears to be a decline in the frequency of food related deaths, but an increase in iatrogenic causes of fatalities. We found factors associated with fatal anaphylaxis included: delayed epinephrine administration, asthma, allergy to peanut, food ingestion outside the home, and teenagers with food allergies. Conclusions Our findings indicate the need to improve epinephrine auto-injector use in acute reactions, particularly for teens and asthmatics with food allergies. In addition, education can be improved among food service workers and food industry in order to help food allergic patients avoid potentially fatal allergens. The increasing trend in iatrogenic related anaphylaxis is concerning, and requires monitoring and more investigation.
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Wagner CW. Anaphylaxis in the pediatric patient: optimizing management and prevention. J Pediatr Health Care 2013; 27:S5-17; quiz S18-9. [PMID: 23419548 DOI: 10.1016/j.pedhc.2012.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/05/2012] [Accepted: 12/14/2012] [Indexed: 01/13/2023]
Abstract
Recent reports describing a rise in serious allergies and life-threatening reactions have prompted the need for pediatric nurse practitioners to re-evaluate and hone their clinical skills with regard to the recognition of anaphylaxis. An accredited symposium entitled, "Anaphylaxis in the Pediatric Patient: Optimizing Management and Prevention" was held in conjunction with the 2012 Annual Conference of the National Association of Pediatric Nurse Practitioners. This article is an accredited enduring activity from that symposium. Goals of this activity are to (a) provide participants with information regarding current trends in serious allergies and anaphylaxis, (b) discuss recommendations from clinical guidelines designed to standardize practice, and (c) address medical and educational needs of patients with anaphylaxis. This article focuses on the point of care where pediatric nurse practitioners require the diagnostic skills to determine whether a patient's acute symptoms are consistent with a diagnosis of anaphylaxis and whether epinephrine should be used to treat those symptoms. The rationale for the use of intramuscular epinephrine, insights into the development and execution of an emergency action plan, and patient education also are discussed.
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Affiliation(s)
- Christine W Wagner
- Department of Pulmonary Medicine, Children’s Medical Center,Dallas, TX 75235, USA.
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Anaphylaxis in the community setting: determining risk factors for admission. Ann Allergy Asthma Immunol 2012; 109:133-6. [PMID: 22840255 DOI: 10.1016/j.anai.2012.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/20/2012] [Accepted: 06/01/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the identification and management of anaphylaxis in an emergency department setting has been well studied, our understanding of the risk factors for admission in a community-based hospital is lacking. OBJECTIVE To determine the demographics and the predictors of hospitalization, in patients presenting with anaphylaxis to a community-based emergency department (ED). METHODS We performed a five-year retrospective chart review of all patients seen in the ED of Winthrop University Hospital, a community-based institution, with an International Classification of Diseases, 9(th)Edition code related to anaphylaxis. RESULTS Fifty-eight visits met inclusion criteria, of which 34% resulted in hospital admission (95% CI: 22-48%). Univariate predictors for admission included (1) the involvement of 2, 3, and 4 organ systems (26%, 55%, and 75%, respectively; P < .02); (2) gastrointestinal symptoms vs no symptoms (59% vs 24%, P < .02); (3) non-sting (ingested and other allergens) vs insect sting allergen (50% vs 12.5%, P < .005); and (4) a history of an ED visit for anaphylaxis vs none (67% vs 30%, P < .05). Multivariate analysis (logistic regression) confirmed non-sting allergens (p < 0.02) and number of organ systems involved (P < .05) as independent predictors of hospitalization. CONCLUSION In our study population, the involvement of multiple organ systems, particularly gastrointestinal involvement, a history of ED visits for anaphylaxis, and involvement of ingested or other allergens (non-sting) demonstrated higher admission rates.
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Ashraf S, Qadri S, al-Ramadi B, Haik Y. Nanoparticles rapidly assess specific IgE in plasma. NANOTECHNOLOGY 2012; 23:305101. [PMID: 22782087 DOI: 10.1088/0957-4484/23/30/305101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Allergy is the sixth leading cause of chronic disease in the world. This study demonstrates the feasibility of detecting allergy indicators in human plasma, noninvasively, at the point of care and with a comparable efficiency and reduced turnaround time compared with the gold standard. Peanut allergy was utilized as a model due to its widespread occurrence among the US population and fatality if not treated. The detection procedure utilized magnetic nanoparticles that were coated with an allergen layer (peanut protein extract). Peanut immunoglobulin E (IgE) was detected in concentrations close to the minimum detection range of CAP assay. The results were obtained in minutes compared with the CAP assay which requires more than 3 h.
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Affiliation(s)
- Sarmadia Ashraf
- Center for Research Excellence in Nanobiosciences, University of North Carolina, 321 McIver Street Greensboro, NC 27412, USA
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Branum AM, Simon AE, Lukacs SL. Among children with food allergy, do sociodemographic factors and healthcare use differ by severity? Matern Child Health J 2012; 16 Suppl 1:S44-50. [PMID: 22450958 PMCID: PMC4741090 DOI: 10.1007/s10995-012-1009-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Among children with food allergy, we aim to describe differences in allergy severity by sociodemographic characteristics and potential differences in healthcare characteristics according to food allergy severity. Using the 2007 National Survey of Children's Health, we identified children with food allergies based on parental report (n = 4,657). Food allergic children were classified by the severity of their food allergy, as either mild (n = 2,333) or moderate/severe (n = 2,285). Using logistic regression, we estimated the odds of having moderate/severe versus mild food allergy by sociodemographic characteristics and the odds of having selected healthcare characteristics by food allergy severity. Among children with food allergy, those who were older (ages 6 through 17 years) and those who had siblings were more likely to have moderate/severe allergy compared to their younger and only-child counterparts. There were no significant differences in severity by other sociodemographic characteristics. Children with a moderate/severe food allergy were more likely to report use of an Individual Education Plan (OR = 1.88 [1.31, 2.70]) and to have seen a specialist than those with mild food allergy. Among younger children with food allergy, those with moderate/severe food allergy were more likely to require more services than is usual compared with those with mild allergy. Associations between allergy severity and health care-related variables did not differ significantly by race/ethnicity, income level, or maternal education. We report few differences in allergy severity by sociodemographic characteristics of food allergic children. In addition, we found that associations between allergy severity and use of health related services did not differ significantly by race/ethnicity or poverty status among children with food allergy. Given the importance of food allergy as an emerging public health issue, further research to confirm these findings would be useful.
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Affiliation(s)
- Amy M Branum
- National Center for Health Statistics, Office of Analysis and Epidemiology, Infant, Child and Women's Health Statistics Branch, Hyattsville, MD 20782, USA.
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Kalogeromitros D, Makris MP, Chliva C, Sergentanis TN, Church MK, Maurer M, Psaltopoulou T. An internet survey on self-reported food allergy in Greece: clinical aspects and lack of appropriate medical consultation. J Eur Acad Dermatol Venereol 2012; 27:558-64. [PMID: 22348258 DOI: 10.1111/j.1468-3083.2012.04482.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Food allergy (FA) represents a common and worldwide disorder but in publications referring to FA the reported diagnosis is rarely confirmed. Consequently, the subjectively assessed FA may negatively affect the quality of life of patients and their families. OBJECTIVE We have conducted this internet survey in order to estimate the self-reported perception of FA in Greece. METHODS A standard anonymous questionnaire was posted for a 3-month period on http://www.in.gr, a Greek popular Internet portal. Each individual could participate only once. Participants were screened for the presence or history of FA by a key question and were then asked to provide information on symptoms, course and management. RESULTS A total of 3673 adult subjects (mean age 34.2 years, range 18-74, females 61.3%), reporting FA were included in analysis. Most reported reactions were related to fruits (14.9%), seafood (10.7%) and nuts (9.2%). The first episode occurred principally during the second (29.2%) and third (30.9%) decade within 3 h from consumption (82.2%). Predominant symptoms were urticaria and oral allergy syndrome (almost 25% each one). Nearly half of the participants sought no medical advice, while 31.4% asked for an allergist's consultation. Almost 21% of reactors were hospitalized; nuts, severity of symptoms (lower respiratory and/or cardiovascular), onset in lower age, previous exercise and concomitant alcohol and/or aspirin intake were positively associated with hospitalization. CONCLUSION Although FA causes severe anaphylactic episodes, almost 50% of individuals who experience symptoms perceived as FA do not seek medical advice. Awareness programmes must be carried out in order to increase consciousness about this potentially fatal medical condition.
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Affiliation(s)
- D Kalogeromitros
- Allergy Unit, 2nd Department Dermatology and Venereology, 'Attikon' University Hospital, Medical School, University of Athens, Athens, Greece
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The natural history of persistent peanut allergy. Ann Allergy Asthma Immunol 2011; 108:326-331.e3. [PMID: 22541403 DOI: 10.1016/j.anai.2011.11.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/27/2011] [Accepted: 11/28/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peanut allergy affects 1% of children, and for those with persistent disease, few data have been published on trends in peanut-specific immunoglobulin E (P-IgE) levels or the value of P-IgE in predicting reaction severity. OBJECTIVE The primary outcome was the frequency of inadvertent peanut exposure. Secondary outcomes included clinical characteristics, trends in P-IgE, characteristics of accidental exposures, and predictors of reaction severity in patients with persistent peanut allergy. METHODS Records of patients with persistent peanut allergy were reviewed. Other allergic conditions, P-IgE levels, and peanut exposures were documented. RESULTS Seven hundred eighty-two patients were studied, 524 of them male. The median age at initial observation was 1.4 years; the median duration of follow-up was 5.3 years. Of the 782 patients, 93.1% were avoiding other foods, 70.8% had atopic dermatitis, 57.3% allergic rhinitis, and 55.8% asthma. The median initial P-IgE was 28.0 kU/L, and the median peak P-IgE was 68.1. Six hundred eighty-five exposures were seen among 455 patients: 75.9% ingestion, 13.6% contact, 4.5% airborne. 73.7% resulted in urticaria/angioedema, 22.2% lower respiratory symptoms, 21.2% gastrointestinal symptoms, and 7.7% oral erythema/pruritus. Treatment included antihistamines (33.4%), emergency department visits (16.5%), epinephrine (13.1%), corticosteroids (7.7%), albuterol (3.2%), no treatment (26.3%), and not recorded (29.6%). The rate of postdiagnosis ingestion was 4.7%/year; exposures with severe reactions, 1.6%/year; reactions treated with epinephrine, 1.1%/year. Reaction severity did not change with repeated exposure. Severe reactions were associated with higher P-IgE, but not with age, sex, or asthma. CONCLUSION In this referral population, the rates of accidental peanut exposures and severe reactions were low. There was a strong association between higher P-IgE levels and reaction severity.
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Barnett J, Muncer K, Leftwich J, Shepherd R, Raats MM, Gowland MH, Grimshaw K, Lucas JS. Using 'may contain' labelling to inform food choice: a qualitative study of nut allergic consumers. BMC Public Health 2011; 11:734. [PMID: 21943285 PMCID: PMC3195759 DOI: 10.1186/1471-2458-11-734] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022] Open
Abstract
Background Precautionary 'may contain' warnings are used to indicate possible allergen contamination. Neither food safety nor foods labelling legislation address this issue. The aim of this study is to understand how peanut and nut allergic adults interpret 'may contain' labelling and how they use this information when purchasing food. Methods Qualitative methods were used to explore both behaviour and attitudes. The behaviour and 'thinking aloud' of 32 participants were recorded during their normal food shop. A semi-structured interview also explored participants' views about 13 potentially problematic packaged foods. Transcribed data from these tasks were analysed to explore the interpretation of 'may contain' labelling and how this influenced food choice decisions. Results Peanut and nut allergic individuals adopt a complex range of responses and strategies to interpret 'may contain' labelling. Many claimed such labelling was not credible or desirable; many ignored it whilst some found it helpful and avoided products with all such labelling. Interpretation and consequent decisions were not only based on the detail of the labelling but also on external factors such as the nature of the product, the perceived trustworthiness of the producer and on the previous experience of the nut allergic individual. Conclusions 'May contain' labelling was interpreted in the light of judgements about the product, producer and previous personal experience. It is vital that these interpretation strategies are taken into account by those responsible for labelling itself and for the provision of advice to nut allergic individuals. Suggestions to improve labelling and advice to the allergic individual are considered.
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Affiliation(s)
- Julie Barnett
- Department of Information Systems and Computing, Brunel University, Uxbridge, Middlesex, UK.
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Namork E, Fæste CK, Stensby BA, Egaas E, Løvik M. Severe allergic reactions to food in Norway: a ten year survey of cases reported to the food allergy register. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:3144-55. [PMID: 21909296 PMCID: PMC3166732 DOI: 10.3390/ijerph8083144] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/15/2011] [Accepted: 07/18/2011] [Indexed: 01/27/2023]
Abstract
The Norwegian Food Allergy Register was established at the Norwegian Institute of Public Health in 2000. The purpose of the register is to gain information about severe allergic reactions to food in Norway and to survey food products in relation to allergen labelling and contamination. Cases are reported on a voluntary basis by first line doctors, and submitted together with a serum sample for specific IgE analysis. The register has received a total of 877 reports from 1 July, 2000 to 31 December, 2010. Two age groups, small children and young adults are over-represented, and the overall gender distribution is 40:60 males-females. The legumes lupine and fenugreek have been identified as two "new" allergens in processed foods and cases of contamination and faults in production of processed foods have been revealed. The highest frequency of food specific IgE is to hazelnuts and peanuts, with a marked increase in reactions to hazelnuts during the last three years. The Food Allergy Register has improved our knowledge about causes and severity of food allergic reactions in Norway. The results show the usefulness of population based national food allergy registers in providing information for health authorities and to secure safe food for individuals with food allergies.
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Affiliation(s)
- Ellen Namork
- Division of Environmental Medicine, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, Oslo NO-0403, Norway; E-Mails: (B.A.S.); (M.L.)
| | - Christiane K. Fæste
- National Veterinary Institute, Oslo N-0106, Norway; E-Mails: (C.K.F.); (E.E.)
| | - Berit A. Stensby
- Division of Environmental Medicine, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, Oslo NO-0403, Norway; E-Mails: (B.A.S.); (M.L.)
| | - Eliann Egaas
- National Veterinary Institute, Oslo N-0106, Norway; E-Mails: (C.K.F.); (E.E.)
| | - Martinus Løvik
- Division of Environmental Medicine, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, Oslo NO-0403, Norway; E-Mails: (B.A.S.); (M.L.)
- Norwegian University of Science and Technology, Trondheim NO-7491, Norway
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Goossens NJ, Flokstra-de Blok BMJ, Vlieg-Boerstra BJ, Duiverman EJ, Weiss CC, Furlong TJ, Dubois AEJ. Online version of the food allergy quality of life questionnaire-adult form: validity, feasibility and cross-cultural comparison. Clin Exp Allergy 2011; 41:574-81. [PMID: 21395879 DOI: 10.1111/j.1365-2222.2011.03711.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Food-allergic reactions occur in 3-4% of the adult population in Western countries. It has been shown that food allergy may impair health-related quality of life (HRQL). Food allergy quality of life questionnaires (FAQLQs) have been developed and validated, including an adult form (FAQLQ-AF). These questionnaires may be particularly useful for cross-cultural comparisons. OBJECTIVES The aims of this study were to translate the FAQLQ-AF from Dutch into English and validate an online version in the United States. Additionally, HRQL of American and Dutch food-allergic adults was compared. METHODS The Dutch FAQLQ-AF was translated into English as set out by the World Health Organization and converted to an electronic online format. Participants (food allergic American adults) were recruited through the 'Food Allergy and Anaphylaxis Network' website and completed the questionnaire online. Construct validity, internal consistency, discriminative ability and feasibility were analysed. A cross-cultural comparison was made using the Dutch FAQLQ-AF scores. RESULTS Data from 180 American participants were analysed. The online FAQLQ-AF had a good construct validity (correlation with FAIM: ρ=0.72; P<0.001), internal consistency (Cronbach's α=0.95) and was discriminative for 'anaphylaxis' vs. 'no anaphylaxis' and 'number of food allergies'. The most striking finding was a significantly greater impairment in HRQL in the American participants, as compared with their Dutch counterparts (the total FAQLQ-AF scores were 4.3 vs. 3.5, respectively; P<0.001, where 1 signifies no impairment and 7 signifies extreme impairment in HRQL). CONCLUSIONS AND CLINICAL RELEVANCE The online American FAQLQ-AF is a valid instrument to measure HRQL in food-allergic patients in the United States. Additionally, HRQL of American food-allergic adults may be more impaired than Dutch food-allergic adults. The FAQLQ-AF can now be used to determine the HRQL in American food-allergic adults and can assist clinicians in optimizing management strategies for food-allergic patients.
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Affiliation(s)
- N J Goossens
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
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Fiocchi A, Schünemann HJ, Brozek J, Restani P, Beyer K, Troncone R, Martelli A, Terracciano L, Bahna SL, Rancé F, Ebisawa M, Heine RG, Assa'ad A, Sampson H, Verduci E, Bouygue GR, Baena-Cagnani C, Canonica W, Lockey RF. Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report. J Allergy Clin Immunol 2011; 126:1119-28.e12. [PMID: 21134569 DOI: 10.1016/j.jaci.2010.10.011] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 09/30/2010] [Accepted: 10/01/2010] [Indexed: 01/28/2023]
Abstract
The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge.
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Affiliation(s)
- Alessandro Fiocchi
- Department of Child and Maternal Medicine, Melloni Hospital, Milan, Italy.
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Abstract
Managing food allergy in school and camp environments involves creating an individualized plan that addresses safety, and supports growth and development of the food-allergic child. The result is a dynamic strategy that meets the needs of a food-allergic child and promotes the development of a food-allergic adolescent.
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Affiliation(s)
- Kim Mudd
- Johns Hopkins Division of Pediatric Allergy and Immunology, Johns Hopkins Hospital, 600 North Wolfe Street, CMSC 1105, Baltimore, MD 21287, USA.
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Springston EE, Smith B, Shulruff J, Pongracic J, Holl J, Gupta RS. Variations in quality of life among caregivers of food allergic children. Ann Allergy Asthma Immunol 2011; 105:287-294. [PMID: 20934628 DOI: 10.1016/j.anai.2010.08.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/30/2010] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric food allergy is a serious health problem in the United States. As the number of affected children increases, more caregivers are charged with the responsibility of managing their child's food allergy. OBJECTIVE To better understand the impact of pediatric food allergy on caregiver quality of life. METHODS As part of a larger project examining the knowledge, attitudes, and beliefs of caregivers with food allergic children, the Food Allergy Quality of Life-Parental Burden questionnaire was administered to a large sample of caregivers across the United States from January 1, 2008, to January 31, 2009. Findings were analyzed to describe caregiver quality of life and to examine the impact of the manifestation of food allergy on participant response. RESULTS Data were collected from 1,126 caregivers. The impact of food allergy on caregiver quality of life varied widely with 1 exception: caregivers consistently reported being troubled by social limitations resulting from their child's food allergy. Poor quality of life was significantly more likely on a number of survey items among caregivers more knowledgeable about food allergy and among caregivers whose children had been to the emergency department for food allergy in the past year, had multiple food allergies, or were allergic to specific foods. CONCLUSIONS Previous research has emphasized the negative impact of food allergy on caregiver quality of life. This study illustrates the diverse experience of caring for a child with food allergy and the importance of considering the manifestation of disease when evaluating parental burden.
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Affiliation(s)
- Elizabeth E Springston
- Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Banerji A, Rudders SA, Corel B, Garth AP, Clark S, Camargo CA. Predictors of hospital admission for food-related allergic reactions that present to the emergency department. Ann Allergy Asthma Immunol 2011; 106:42-8. [PMID: 21195944 DOI: 10.1016/j.anai.2010.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 09/30/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND guidelines do not provide specific hospitalization criteria for patients presenting to the emergency department (ED) with food-related allergic reactions. OBJECTIVE to determine predictors of hospital admission for ED patients with food-related allergic reactions. METHODS we performed a medical record review at 3 academic centers of patients presenting to the ED for food-related allergic reactions (International Classification of Diseases, Ninth Revision, Clinical Modification codes 693.1, 995.0, 995.1, 995.3, 995.7, 995.60-995.69, 558.3, 692.5, and 708.X) between January 1, 2001, and December 31, 2006. We focused on patient demographics, medical history, food triggers, clinical presentation, pre-ED and ED management with a specific focus on epinephrine treatment, and disposition. Predictors of hospital admission were determined using multivariable logistic regression. RESULTS through random sampling and appropriate weighting, the 1,112 cases reviewed represented a study cohort of 2,583 patients. Most patients (80%) were discharged from the ED. The age and sex of patients admitted to the hospital and those discharged were similar. Multivariable analysis identified 3 factors associated with a higher likelihood of hospital admission: meeting the criteria for food-related anaphylaxis (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.23-4.33), pre-ED epinephrine treatment (OR, 6.65; 95% CI, 3.04-14.57), and epinephrine treatment within 1 hour of ED triage (OR, 3.78; 95% CI, 1.68-8.50). Patients with food-related allergic reactions triggered by shellfish were less likely to be admitted to the hospital (OR, 0.23; 95% CI, 0.08-0.68). CONCLUSIONS most patients presenting to the ED with food-related allergic reactions are discharged. Several patient factors were independently associated with hospital admission in ED patients with food-related allergic reactions.
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Affiliation(s)
- Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Lee JM, Kim EJ, Kwon DG, Lee SY. Clinical Characteristics of Walnut Allergy and Evaluation of Cross-Reactivity between Walnut and Peanut in Children Under 4 Years of Age. ACTA ACUST UNITED AC 2011. [DOI: 10.7581/pard.2011.21.4.261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jeong-Min Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Eun-Jin Kim
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Duck-Guen Kwon
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Soo-Young Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Leftwich J, Barnett J, Muncer K, Shepherd R, Raats MM, Hazel Gowland M, Lucas JS. The challenges for nut-allergic consumers of eating out. Clin Exp Allergy 2010; 41:243-9. [PMID: 21121977 DOI: 10.1111/j.1365-2222.2010.03649.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For individuals with a nut allergy, the avoidance of allergens is particularly challenging in situations where they are not preparing their own food. Many allergic reactions occur when eating outside the home. OBJECTIVE To identify and explore the challenges faced by nut-allergic individuals (NAIs) when they are eating in restaurants and other eating establishments. METHODS A qualitative interview study was conducted with 32 adults with a clinical history of allergy to peanuts and/or tree nuts. RESULTS The main strategies that participants adopted to manage the risk of allergic reactions when eating outside the home were avoidance and communication. They avoided types of restaurants, meal courses or particular foods. Seeking familiarity was a key strategy that enabled NAIs to reduce uncertainty and anxiety. Language differences were a major barrier to confident communication about food content. The need to check whether the food on offer may contain nuts was a source of social embarrassment for many participants and the desire to avoid this sometimes led to increased risk taking. Some did not disclose their allergy to restaurant staff as they feared a conservative reaction that would further constrain food choices. NAIs often have to plan where to eat out. The consequent lack of spontaneity was a source of regret to some. CONCLUSION AND CLINICAL RELEVANCE Communication patterns of nut-allergic adults are often grounded in legitimate everyday social considerations around embarrassment, choice and spontaneity. Education and training strategies are needed that recognize and take account of this. Focusing on communication deficits of NAIs may be unhelpful; responsibility for food safety must be shared with the food industry.
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Affiliation(s)
- J Leftwich
- Department of Psychology, University of Surrey, Surrey, UK
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Stutius LM, Sheehan WJ, Rangsithienchai P, Bharmanee A, Scott JE, Young MC, Dioun AF, Schneider LC, Phipatanakul W. Characterizing the relationship between sesame, coconut, and nut allergy in children. Pediatr Allergy Immunol 2010; 21:1114-8. [PMID: 21073539 PMCID: PMC2987573 DOI: 10.1111/j.1399-3038.2010.00997.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sesame and coconut are emerging food allergens in the United States. We sought to examine whether children allergic to peanuts and tree nuts are at increased risk of having an allergy to sesame or coconut. We performed a retrospective chart review of children who underwent skin prick testing (SPT) to sesame and coconut and identified 191 children who underwent SPT to sesame and 40 to coconut. Sensitization to sesame was more likely in children with positive SPT to peanuts (odds ratio [OR] = 6.7, 95% confidence interval [CI] [2.7-16.8], p < 0.001) and tree nuts (OR = 10.5, 95% CI [4.0-27.7], p < 0.001). Children with histories of both peanut and tree nut reaction were more likely to have a history of sesame reaction (OR = 10.2, 95% CI [2.7-38.7], p < 0.001). Children with sensitization or allergy to peanuts or tree nuts were not more likely to be sensitized or allergic to coconut. In conclusion, children with peanut or tree nut sensitization were more likely to be sensitized to sesame but not coconut. Children with clinical histories of both peanut and tree nut allergy were more likely to be allergic to sesame.
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Ben-Shoshan M, Kagan R, Primeau MN, Alizadehfar R, Turnbull E, Harada L, Dufresne C, Allen M, Joseph L, St Pierre Y, Clarke A. Establishing the diagnosis of peanut allergy in children never exposed to peanut or with an uncertain history: a cross-Canada study. Pediatr Allergy Immunol 2010; 21:920-6. [PMID: 20444161 DOI: 10.1111/j.1399-3038.2010.00994.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnosis of peanut allergy (PA) can be complex especially in children never exposed to peanut or with an uncertain history. The aim of the study is to determine which diagnostic algorithms are used by Canadian allergists in such children. Children 1-17 yrs old never exposed to peanut or with an uncertain history having an allergist-confirmed diagnosis of PA were recruited from the Montreal Children's Hospital (MCH) and allergy advocacy organizations. Data on their clinical history and confirmatory testing were compared to six diagnostic algorithms: I. Skin prick test (SPT) >or=8 mm or specific IgE >or=5 kU/l or positive food challenge (+FC); II. SPT >or=8 or IgE >or=15 or +FC; III. SPT >or=13 or IgE >or=5 or +FC; IV. SPT >or=13 or IgE >or=15 or +FC; V. SPT >or=3 and IgE >or=5 or IgE >or=5 or +FC; VI. SPT >or=3 and IgE >or=15 or IgE >or=15 or +FC. Multivariate logistic regression analysis was used to identify factors associated with the use of each algorithm. Of 497 children recruited, 70% provided full data. The least stringent algorithm, algorithm I, was applied in 81.6% (95% CI, 77-85.6%) of children and the most stringent, algorithm VI, in 42.6% (95% CI, 37.2-48.1%).The factor most associated with the use of all algorithms was diagnosis made at the MCH in those never exposed to peanut. Other factors associated with the use of specific diagnostic algorithms were higher paternal education, longer disease duration, and the presence of hives, asthma, eczema, or other food allergies. Over 18% (95% CI, 14.4-23.0%) of children were diagnosed with PA without fulfilling even the least stringent diagnostic criteria.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada.
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O'Neil CE, Zanovec M, Nicklas TA. A Review of Food Allergy and Nutritional Considerations in the Food-Allergic Adult. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610378348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In the United States, the prevalence of adults with food allergies is approximately 2% to 3%. Theoretically, any food can cause an allergic reaction; however, some foods are clearly more allergenic than others. In adults, peanuts, tree nuts, finned fish, crustaceans, fruit, and vegetables account for 85% of the food-allergic reactions. Currently, the only ways to manage food allergies are to avoid the allergen and initiate therapy for an allergic reaction if ingestion does occur. The presence of homologous proteins among animal or plant foods and between foods and certain airborne allergens may account for cross-sensitization that may be clinically relevant. For inpatients or outpatients with food allergies, nutrient and fluid requirements are the same as for individuals without food allergies. Since patients with adverse reactions to food may self-restrict intake or have been counseled on food avoidance, it is particularly important to determine dietary adequacy and to provide patients with appropriate food substitutions to provide nutrients that may be missing from a patient’s diet. This is of particular concern for individuals with multiple food allergies. Eating away from home and traveling also pose special problems for those with food allergies.
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Affiliation(s)
- Carol E. O'Neil
- Louisiana State University AgCenter, Baton Rouge, Louisiana,
| | | | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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Current World Literature. Curr Opin Allergy Clin Immunol 2010; 10:267-70. [DOI: 10.1097/aci.0b013e32833aa149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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