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Mirzapour-Kouhdasht A, Garcia-Vaquero M, Huang JY. Algae-derived compounds: Bioactivity, allergenicity and technologies enhancing their values. BIORESOURCE TECHNOLOGY 2024; 406:130963. [PMID: 38876282 DOI: 10.1016/j.biortech.2024.130963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/02/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
As a rapidly growing source of human nutrients, algae biosynthesize diverse metabolites which have promising bioactivities. However, the potential allergenicity of algal components hinder their widespread adoption. This review provides a comprehensive review of various macro and micronutrients derived from algal biomass, with particular focus on bioactive compounds, including peptides, polyphenols, carotenoids, omega-3 fatty acids and phycocyanins. The approaches used to produce algal bioactive compounds and their health benefits (antioxidant, antidiabetic, cardioprotective, anti-inflammatory and immunomodulatory) are summarised. This review particularly focuses on the state-of-the-art of precision fermentation, encapsulation, cold plasma, high-pressure processing, pulsed electric field, and subcritical water to reduce the allergenicity of algal compounds while increasing their bioactivity and bioavailability. By providing insights into current challenges of algae-derived compounds and opportunities for advancement, this review contributes to the ongoing discourse on maximizing their application potential in the food nutraceuticals, and pharmaceuticals industries.
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Affiliation(s)
- Armin Mirzapour-Kouhdasht
- Department of Chemical Sciences, SSPC, Science Foundation Ireland Research Centre for Pharmaceuticals, Bernal Institute, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland
| | - Marco Garcia-Vaquero
- School of Agriculture and Food Science, University College Dublin, Belfield, D04V1W8 Dublin, Ireland
| | - Jen-Yi Huang
- Department of Food Science, Purdue University, West Lafayette, IN 47907, USA; Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, IN 47907, USA; Environmental and Ecological Engineering, Purdue University, West Lafayette, IN 47907, USA.
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2
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Oppenheimer J, Casale TB, Tanimoto S. Comment on "Ensuring the Efficacy and Safety of Approved Medications ". J Med Toxicol 2024; 20:330-331. [PMID: 38696066 PMCID: PMC11288218 DOI: 10.1007/s13181-024-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 03/28/2024] [Accepted: 04/18/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- J Oppenheimer
- UMDNJ Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Thomas B Casale
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sarina Tanimoto
- ARS Pharmaceuticals, Inc., 11682 El Camino Real, Suite 120, 92130, San Diego, California, USA.
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3
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Ellis AK, Casale TB, Kaliner M, Oppenheimer J, Spergel JM, Fleischer DM, Bernstein D, Camargo CA, Lowenthal R, Tanimoto S. Development of neffy, an Epinephrine Nasal Spray, for Severe Allergic Reactions. Pharmaceutics 2024; 16:811. [PMID: 38931932 PMCID: PMC11207568 DOI: 10.3390/pharmaceutics16060811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
Epinephrine autoinjectors (EAIs) are used for the treatment of severe allergic reactions in a community setting; however, their utility is limited by low prescription fulfillment rates, failure to carry, and failure to use due to fear of needles. Given that delayed administration of epinephrine is associated with increased morbidity/mortality, there has been a growing interest in developing needle-free, easy-to-use delivery devices. neffy (epinephrine nasal spray) consists of three Food and Drug Administration (FDA)-approved components: epinephrine, Intravail A3 (absorption enhancer), and a Unit Dose Spray (UDS). neffy's development pathway was established in conjunction with the FDA and the European Medicines Agency and included multiple clinical trials to evaluate pharmacokinetic and pharmacodynamic responses under a variety of conditions, such as self-administration and allergic and infectious rhinitis, as well as an animal anaphylaxis model of severe hypotension, where neffy demonstrated a pharmacokinetic profile that is within the range of approved injection products and a pharmacodynamic response that is as good or better than injections. The increased pulse rate (PR) and blood pressure (BP) observed even one minute following the administration of neffy confirm the activation of α and β adrenergic receptors, which are the key components of epinephrine's mechanism of action. The results suggest that neffy will provide a safe and effective needle-free option for the treatment of severe allergic reactions, including anaphylaxis.
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Affiliation(s)
- Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Thomas B. Casale
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Michael Kaliner
- Institute for Asthma and Allergy, Chevy Chase, MD 20815, USA
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David M. Fleischer
- Section of Allergy and Immunology, Department of Pediatrics, Children’s Hospital Colorado, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - David Bernstein
- Bernstein Clinical Research Center, Division of Immunology, Allergy and Rheumatology, College of Medicine, University of Cincinnati, Cincinnati, OH 45236, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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4
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Magen E, Merzon E, Green I, Golan-Cohen A, Magen I, Vinker S, Israel A. A case-control study for comorbidity and laboratory factors associated with food-induced anaphylaxis. Allergy Asthma Proc 2024; 45:53-60. [PMID: 38151728 DOI: 10.2500/aap.2024.45.230076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Background: Food-induced anaphylaxis (FIA) is a serious and potentially life-threatening allergic reaction triggered by food allergens. Objective: This case-control study aimed to investigate comorbidities and laboratory factors associated with FIA in the pediatric population of Israel. Methods: Retrospective data from the electronic health records of Leumit Health Care Services were used to identify 711 pediatric patients with FIA and 2560 subjects with food allergy and without anaphylaxis matched for age, gender, and ethnicity. Comorbidities were identified based on medical billing diagnosis codes, and laboratory characteristics were compared between the two groups. Results: The mean ± standard deviation age of patients with FIA was 4.1 ± 4.1 years, and 37.3% were girls. Laboratory analysis revealed increased eosinophil counts (p < 0.001), elevated immunoglobulin E (IgE) (p < 0.001), and IgA levels (p = 0.001) in the FIA group compared with the controls. With regard to comorbidities, the FIA group had higher prevalence rates of allergic diseases, including allergic rhinitis (odds ratio [OR] 1.72; p < 0.001), allergic conjunctivitis (OR 1.84; p = 0.001), asthma (OR 1.36; p < 0.001), angioedema (OR 6.37; p < 0.001), atopic dermatitis (OR 1.77; p < 0.001), and contact dermatitis (OR 1.42; p = 0.001). There was a trend toward significance for chronic spontaneous urticaria (p = 0.051). There was a significant negative association between helminthiases, particularly enterobiasis, and FIA (OR 0.76 [95% confidence interval, 0.59-0.98]; p = 0.029). Conclusion: This study provides valuable epidemiologic evidence on the associations among FIA, comorbidities, and laboratory factors in the pediatric population.
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Affiliation(s)
- Eli Magen
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Eugene Merzon
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Ilan Green
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | | | - Israel Magen
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
| | - Shlomo Vinker
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Ariel Israel
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
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5
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De Miguel-Díez J, Lopez-de-Andres A, Caballero-Segura FJ, Jimenez-Garcia R, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Omaña-Palanco R, Cuadrado-Corrales N. Trends and Hospital Outcomes in HOSPITAL Admissions for Anaphylaxis in Children with and without Asthma in Spain (2016-2021). J Clin Med 2023; 12:6387. [PMID: 37835032 PMCID: PMC10574011 DOI: 10.3390/jcm12196387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: To assess and compare the temporal trends in the incidence, characteristics and hospital outcomes among children with and without asthma who were hospitalized with anaphylaxis in Spain from 2016 to 2021, and identify the variables associated with severe anaphylaxis among children with asthma. (2) Methods: An observational, retrospective study was conducted using a population-based database. The study population included pediatric patients with anaphylaxis. This population was stratified based on whether they had asthma. (3) Results: The number of hospital admissions was stable from 2016 to 2019, dropping in 2020 and raising to the highest number in 2021. A total of 60.63% of hospitalizations occurred in boys and the most common anaphylactic reactions were due to food consumption (67.28%), increasing over time. The in-hospital mortality (IHM) remained stable and under 1% in all the years studied. The incidence of anaphylaxis was 2.14 times higher in children with asthma than in those without asthma (IRR 2.14; 95% CI 1.87-2.44). Furthermore, it was 1.79 times higher in boys with asthma than in those without asthma (IRR 1.79; 95% CI 1.06-2.45) and 2.68 times higher in girls with asthma than in those without asthma (IRR 2.68; 95% CI 2.23-3.12). Asthma was not associated with severe anaphylaxis (OR 1.31; 95% CI 0.88-1.96). (4) Conclusions: The number of hospitalizations for anaphylaxis in children remained stable from 2016 to 2019, dropping in 2020 and recovering in 2021. IHM was low and remained stable during the study period. The incidence of hospitalizations for anaphylaxis was higher in asthmatic children than in non-asthmatics, but there were no differences in the occurrence of severe anaphylaxis among them.
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Affiliation(s)
- Javier De Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain; (J.D.M.-D.); (F.J.C.-S.)
| | - Ana Lopez-de-Andres
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
| | - Francisco J. Caballero-Segura
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain; (J.D.M.-D.); (F.J.C.-S.)
| | - Rodrigo Jimenez-Garcia
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - David Carabantes-Alarcon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
| | - Jose J. Zamorano-Leon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
| | - Ricardo Omaña-Palanco
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (N.C.-C.)
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Kim YH, Kim AL. Evaluating Standardized Job Competencies for Managing Students at Risk for Anaphylaxis in Elementary School Nurses. Healthcare (Basel) 2023; 11:2102. [PMID: 37510543 PMCID: PMC10379963 DOI: 10.3390/healthcare11142102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to evaluate standardized job competencies of elementary school nurses in managing the health of students at risk for anaphylaxis (SRAs). A total of 166 elementary school nurses from across Korea participated in this study. The tool utilized was a list of standardized job tasks of elementary school nurses in managing SRAs' health. Seven factors were obtained from the factor analysis, with a cumulative variance explained of 68.6%. The importance-performance analysis method was employed to suggest priority areas for training. The factors placed in quadrant II included: (1) "offering psychological support", among elementary school nurses who have been provided with clinical information on anaphylaxis, (2) "providing emergency care", among those who have not been provided with clinical information on anaphylaxis, (3) the factors "utilizing individualized healthcare plans", "conducting health education and staff training", and "evaluating the student", among those who agreed that schools need legal protection to purchase epinephrine auto-injectors, and (4) the factor "preparing a school emergency system", among those with less than five years of experience as a school nurse. When planning continuing education strategies to improve elementary school nurses' management of SRAs, factors such as career experience, access to clinical information, and beliefs regarding legal protection for schools to purchase epinephrine auto-injectors should be considered.
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Affiliation(s)
- Yeon-Ha Kim
- Department of Nursing, Korea National University of Transportation, Jeungpyeong-gun 27909, Republic of Korea
| | - Aee Lee Kim
- College of Nursing, Sungshin Women's University, Seoul 01133, Republic of Korea
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7
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Koukou Z, Papadopoulou E, Panteris E, Papadopoulou S, Skordou A, Karamaliki M, Diamanti E. The Effect of Breastfeeding on Food Allergies in Newborns and Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1046. [PMID: 37371277 PMCID: PMC10297573 DOI: 10.3390/children10061046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow's milk formula during the first week of life should be avoided. Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. The prophylactic effects of breastfeeding have been the subject of many studies, some with weak evidence. In this narrative review, we aim to provide an up-to-date account of the effects of prophylactic breastfeeding on food allergy and other common allergies in infants and children up to 5 years of age. Colostrum in particular has been shown to be prophylactic against food allergy. The American Academy of Pediatrics cautions that the relationship between duration of breastfeeding and incidence of food allergy in early childhood is unclear. The protective role of breastfeeding has a positive effect on allergy prevention, which is opposed by the early introduction of solid foods, but larger studies are needed to confirm the evidence. There is evidence that breastfeeding is effective in providing partial protection to infants.
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Affiliation(s)
- Zoi Koukou
- School of Health Sciences, International Hellenic University (IHU), Sindos, 57400 Thessaloniki, Greece; (S.P.); (A.S.); (M.K.)
| | | | - Eleftherios Panteris
- Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Styliani Papadopoulou
- School of Health Sciences, International Hellenic University (IHU), Sindos, 57400 Thessaloniki, Greece; (S.P.); (A.S.); (M.K.)
| | - Anna Skordou
- School of Health Sciences, International Hellenic University (IHU), Sindos, 57400 Thessaloniki, Greece; (S.P.); (A.S.); (M.K.)
| | - Maria Karamaliki
- School of Health Sciences, International Hellenic University (IHU), Sindos, 57400 Thessaloniki, Greece; (S.P.); (A.S.); (M.K.)
| | - Elisavet Diamanti
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Broas E, Lowe AA, Ivich K, Garcia M, Ward J, Hollister J, Gerald LB. The Implementation and Evaluation of a Stock Epinephrine for Schools Program in Maricopa County, Arizona. J Sch Nurs 2023:10598405231172957. [PMID: 37157790 DOI: 10.1177/10598405231172957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The increasing rate of food allergies in children, combined with the role of food as an integral part of the school day has led to the emergence of anaphylaxis as a daily threat to students, regardless of prior allergy diagnosis. Stock epinephrine-non-patient specific epinephrine auto-injectors that may be used during emergencies-is a means for schools to prepare for anaphylactic events and protect children with allergies. The Maricopa County Department of Public Health initiated the School Surveillance and Medication Program (SSMP), a data capture program, to facilitate the process of stocking epinephrine in schools. Spearheaded by the implementation efforts of the Kyah Rayne Foundation, program enrollment increased 146% between the 2020-2021 and 2021-2022 school years. The increased proportion of schools enrolled in the SSMP and the number of school personnel trained to administer epinephrine demonstrates the feasibility of school-centered stock epinephrine programs and validates strategies for increasing program uptake.
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Affiliation(s)
- Erin Broas
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ashley A Lowe
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA
| | - Kimberly Ivich
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - Melissa Garcia
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - Jackie Ward
- Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - James Hollister
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Lynn B Gerald
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, IL, USA
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Chernikova DA, Zhao MY, Jacobs JP. Microbiome Therapeutics for Food Allergy. Nutrients 2022; 14:5155. [PMID: 36501184 PMCID: PMC9738594 DOI: 10.3390/nu14235155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022] Open
Abstract
The prevalence of food allergies continues to rise, and with limited existing therapeutic options there is a growing need for new and innovative treatments. Food allergies are, in a large part, related to environmental influences on immune tolerance in early life, and represent a significant therapeutic challenge. An expanding body of evidence on molecular mechanisms in murine models and microbiome associations in humans have highlighted the critical role of gut dysbiosis in the pathogenesis of food allergies. As such, the gut microbiome is a rational target for novel strategies aimed at preventing and treating food allergies, and new methods of modifying the gastrointestinal microbiome to combat immune dysregulation represent promising avenues for translation to future clinical practice. In this review, we discuss the intersection between the gut microbiome and the development of food allergies, with particular focus on microbiome therapeutic strategies. These emerging microbiome approaches to food allergies are subject to continued investigation and include dietary interventions, pre- and probiotics, microbiota metabolism-based interventions, and targeted live biotherapeutics. This exciting frontier may reveal disease-modifying food allergy treatments, and deserves careful study through ongoing clinical trials.
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Affiliation(s)
- Diana A. Chernikova
- Department of Pediatrics, Division of Immunology, Allergy, and Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
- The Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Matthew Y. Zhao
- The Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jonathan P. Jacobs
- The Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
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De Filippo M, Votto M, Albini M, Castagnoli R, De Amici M, Marseglia A, Pizzo A, Marseglia GL, Licari A. Pediatric Anaphylaxis: A 20-Year Retrospective Analysis. J Clin Med 2022; 11:jcm11185285. [PMID: 36142932 PMCID: PMC9502364 DOI: 10.3390/jcm11185285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaphylaxis is a steadily increasing global problem defined as an acute hypersensitivity multisystem reaction that is potentially fatal. In the pediatric age, the leading cause is food. In other allergic diseases, intrinsic heterogeneity has been reported in the clinical presentation, severity, and triggers of anaphylaxis. This study analyzes the features and management approach of the anaphylactic reactions in children evaluated at the pediatric clinic in Pavia. MATERIALS AND METHODS A retrospective study was conducted on patients with anaphylaxis between 2001 and 2021. RESULTS A total of 148 patients with a median age of 5 years were enrolled, and 80% of the patients had other atopic comorbidities that were correlated with the severity of anaphylaxis. The main trigger of anaphylaxis was food. Most reactions involved mucocutaneous, respiratory, and gastrointestinal systems, and occurred at home. Adrenaline was administered only in a minority of cases. CONCLUSIONS Considering that anaphylaxis is a potentially life-threatening condition requiring prompt management, the use of adrenaline should be implemented. Our data also suggest the importance of educating and spreading awareness of anaphylactic management within the medical community.
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Affiliation(s)
- Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Maria Albini
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Mara De Amici
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Laboratory of Immuno-Allergology of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessia Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Pizzo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382-502-629
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11
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Chow Wei L, Yazid MB, Norhayati MN, Md Noh AY, Rahman A. Patient Ability to Use Old versus New/Modified Model Adrenaline Autoinjection Emergency Medical Devices for Anaphylaxis in Prehospital Setting: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:183. [PMID: 35206798 PMCID: PMC8872424 DOI: 10.3390/healthcare10020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The goal of this study was to determine the individual's ability to use new/modified model AAI compared to old model AAIs devices for anaphylaxis. METHODS The protocol was established a priori and published on PROSPERO (CRD42021229691) and was conducted based on PRISMA guidelines. MEDLINE and CENTRAL were searched until 31 January 2021. Only RCTs were included in this review. Primary studies comparing old model AAI to new/modified model AAI emergency medical devices were included. Primary outcomes included number of successful administrations, and number of individuals to complete all steps. Secondary outcomes included successful removal of device safety guards, placement of correct end of the device against the thigh and holding of the device in place for adequate time after administration; the frequency of an adverse event (digital injection); individual preferences in terms of size, individual preference in terms of ease for carrying, overall patient preference; and the mean time of delivery. RESULTS Overall, seven trials consisting of 1359 patients were analyzed. Reporting of adverse events was limited to digital injection, which was significantly higher in the old model AAI (RR 6.90, 95% CI 3.27 to 14.57; I2 statistic = 0%; p < 0.001; four trials, 610 participants; high quality evidence). No significant difference was found regarding successful administration between the old model AAI and new/modified model AAI (RR 0.76, 95% CI 0.52 to 1.11; I2 statistic = 96%; p = 0.16; seven trials, 2196 participants; low quality evidence). CONCLUSIONS We cannot make any new recommendations on the effectiveness of different models of AAIs regarding successful administration. However, considering the aspect of safety, we think that mew/modified model AAI can be chosen as the old model AAI was associated with a higher frequency of the adverse event (digital injection).
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Affiliation(s)
- Leong Chow Wei
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (L.C.W.); (A.Y.M.N.); (A.R.)
| | - Mohd Boniami Yazid
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (L.C.W.); (A.Y.M.N.); (A.R.)
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Abu Yazid Md Noh
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (L.C.W.); (A.Y.M.N.); (A.R.)
| | - Andey Rahman
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (L.C.W.); (A.Y.M.N.); (A.R.)
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12
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Xiang Q, Huangfu L, Dong S, Ma Y, Li K, Niu L, Bai Y. Feasibility of atmospheric cold plasma for the elimination of food hazards: Recent advances and future trends. Crit Rev Food Sci Nutr 2021:1-19. [PMID: 34761962 DOI: 10.1080/10408398.2021.2002257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent decades, food safety has emerged as a worldwide public health issue with economic and political implications. Pesticide residues, mycotoxins, allergens, and antinutritional factors are the primary concerns associated with food products due to their potential adverse health effects. Although various conventional processing methods (such as washing, peeling, and cooking) have been used to reduce or eliminate these hazards from agricultural food materials, the results obtained are not quite satisfactory. Recently, atmospheric cold plasma (ACP), an emerging low -temperature and green processing technology, has shown great potential for mitigating food hazards. However, detailed descriptions of the effects of ACP treatment on food hazards are still not available. Thus, the current review aims to highlight recent studies on the efficacy and application of ACP in the reduction or elimination of pesticide residues, mycotoxins, allergens, and antinutritional factors in various food products. The possible working mechanisms of ACP and its effect on food quality, and the toxicity of degradation products are emphatically discussed. In addition, multiple factors affecting the efficacy of ACP are summarized in detail. At the same time, the major technical challenges for practical application and future development prospects of this emerging technology are also highlighted.
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Affiliation(s)
- Qisen Xiang
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Lulu Huangfu
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Shanshan Dong
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Yunfang Ma
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Ke Li
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Liyuan Niu
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
| | - Yanhong Bai
- College of Food and Bioengineering, Zhengzhou University of Light Industry, Zhengzhou, PR China.,Henan Key Laboratory of Cold Chain Food Quality and Safety Control, Zhengzhou, PR China
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13
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Jurich EK. ‘Do you think this is normal?’: risk, temporality, and the management of children’s food allergies through online support groups. HEALTH, RISK & SOCIETY 2021. [DOI: 10.1080/13698575.2021.1914824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ebru Kayaalp Jurich
- Department of New Media and Communication, Ankara Bilim University, Ankara, Turkey
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14
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Abstract
Immediate administration of intramuscular epinephrine to a patient experiencing anaphylaxis is the first-line therapy for this life-threatening allergic reaction. Alhough anaphylaxis is generally a rare occurrence, it has dire consequences if left untreated. In infants, anaphylaxis is typically triggered by exposure to egg, cow's milk, or peanuts. The rapid onset of symptoms in multiple organ systems makes an accurate diagnosis in infants difficult because there are numerous ways in which anaphylaxis may present. The symptoms of infant anaphylaxis are often underrecognized or misdiagnosed for less serious illnesses or even normal findings, including drooling, loose stools, and irritability. Because infants are mostly nonverbal-and most pediatric emergency department visits for anaphylaxis cases are the first diagnosis-ascertaining potential exposure to common allergens is difficult; this further complicates diagnosis in these youngest patients for whom the clinical presentation of anaphylaxis varies widely. A key factor in diagnosing anaphylaxis is the temporal profile of symptom development following allergen exposure; however, some children with anaphylaxis develop symptoms that reoccur hours or days after an initial anaphylactic reaction, making diagnosis challenging. Advanced practice nurses are often the first health care provider to encounter a patient who may be experiencing anaphylaxis. Although diagnostic criteria exist for anaphylaxis, specific criteria for the diagnosis of anaphylaxis in infants have not been developed. As such, it is important to understand and recognize the variable presentation of anaphylaxis in infants and to rapidly diagnose and treat with epinephrine.
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15
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Missed Registration of Disease Codes for Pediatric Anaphylaxis at the Emergency Department. Emerg Med Int 2019; 2019:4198630. [PMID: 31485351 PMCID: PMC6710778 DOI: 10.1155/2019/4198630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background It is important to register anaphylaxis codes correctly to study the exact prevalence of anaphylaxis. The purpose of this study was to analyze the clinical characteristics and disease codes of inaccurately registered groups in pediatric anaphylaxis patients. Methods This study reviewed the medical records of all pediatric patients who presented to the university hospital emergency department over a 5-year period. Study subjects were divided into 2 groups: the accurate group, including those registered under anaphylaxis codes, and the inaccurate coding group, including those registered under other codes. Results From a total of 79,676 pediatric patients, 184 (0.23%) had anaphylaxis. Of these, 23 (12.5%) and 161 (87.5%) patients were classified to the accurate and inaccurate coding groups, respectively. Average age, time from symptom onset to emergency department presentation, past history of allergy, and penicillin and cephalosporin as causes of anaphylaxis differed between the 2 groups. Cardiovascular (39.1% vs. 5.6%, p=0.001) and respiratory symptoms (65.2% vs. 42.2%, p=0.038) manifested more frequently in the accurate group, while gastrointestinal symptoms (68.3% vs. 26.1%, p=0.001) were more frequently observed in the inaccurate coding group. Fluid administration (82.6% vs. 28.0%, p=0.001), steroid use (60.9% vs. 23.0%, p=0.001), and epinephrine use (65.2% vs. 13.0% p=0.001) were more common treatments for anaphylaxis in the emergency department in the accurate group. Anaphylaxis patients with cardiovascular symptoms, steroid use, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes. Conclusions In the case of pediatric anaphylaxis, more patients were registered inaccurately under other allergy-related codes and simple symptom codes, rather than under anaphylaxis codes. Therefore, future research on anaphylaxis should consider inaccurately registered anaphylactic patients, as shown in this study.
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16
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Atanaskovic-Markovic M, Gomes E, Cernadas JR, du Toit G, Kidon M, Kuyucu S, Mori F, Ponvert C, Terreehorst I, Caubet JC. Diagnosis and management of drug-induced anaphylaxis in children: An EAACI position paper. Pediatr Allergy Immunol 2019; 30:269-276. [PMID: 30734362 DOI: 10.1111/pai.13034] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/27/2022]
Abstract
Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life-threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug-induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non-steroidal anti-inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate-onset drug-induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children.
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Affiliation(s)
| | - Eva Gomes
- Allergy and Clinical Immunology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Josefina Rodrigues Cernadas
- Department of Allergy and Clinical Immunology, Head of Drug Allergy Clinic - Centro Hospitalar Universitário, Hospital S.João, Porto, Portugal
| | - George du Toit
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Mona Kidon
- Angioedema and Allergy Unit, Pediatric Allergy Clinic, Safra Children's Hospital and the Clinical Immunology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Faculty of Pediatric Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Semanur Kuyucu
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, Mersin University, Mersin, Turkey
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Claude Ponvert
- Pulmonology and Allergy Unit, Department of Paediatrics, Hôpital des Enfants Malades, Paris, France.,Faculty of Medicine, Paris Descartes University, Paris, France
| | - Ingrid Terreehorst
- Department of ENT, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
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17
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Sachs B, Dubrall D, Fischer‐Barth W, Schmid M, Stingl J. Drug-induced anaphylactic reactions in children: A retrospective analysis of 159 validated spontaneous reports. Pharmacoepidemiol Drug Saf 2019; 28:377-388. [PMID: 30706619 PMCID: PMC6590409 DOI: 10.1002/pds.4726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The main objective of this study was to analyze validated cases of drug-induced anaphylactic reactions in children with regard to incriminated drugs, clinical characteristics, and associated factors. A further objective was to compare differences in incriminated drugs and characteristics between validated cases and a reference excluding anaphylactic reaction cases (basic dataset). METHODS Spontaneous reports of anaphylactic reactions in children (0-17 years) registered between January 2000 to December 2016 were extracted from the adverse drug reaction database of the German Federal Institute for Drugs and Medical Devices. These reports were restricted to drugs for which at least four cases were found. After case validation, 159 reports remained (validated dataset) and were compared with the basic dataset (n = 12.168 reports) using inferential statistics. RESULTS Estimated yearly increase of reports (36.8 vs 0.1), most frequently incriminated drugs (antibiotics 30.2% vs 11%, analgesics/antipyretics 22.0% vs 5.6%; P values less than 0.001) and route of administration (38.4% vs 6.7%) differed between the validated dataset and the basic dataset. Validated cases differed in severity (higher with atracurium), reported symptoms (urticaria leading with analgesics), and associated factors (atopy/allergy rarely reported with antibiotics) depending on the incriminated drug class. In 13.8% (11.3% if excluding repeated readministration in one person) of the cases, the drug had not been tolerated before. CONCLUSIONS A heterogeneous clinical phenotype with differences in associated factors was observed, suggesting different underlying mechanisms triggered by the different drug groups. Occurrence of serious drug-induced anaphylactic reactions in children could be reduced by carefully considering patient history.
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Affiliation(s)
- Bernhardt Sachs
- Research DivisionFederal Institute for Drugs and Medical Devices (BfArM)BonnGermany
- Department for Dermatology and AllergyUniversity Hospital AachenAachenGermany
| | - Diana Dubrall
- Research DivisionFederal Institute for Drugs and Medical Devices (BfArM)BonnGermany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE)University Hospital BonnBonnGermany
| | - Wilma Fischer‐Barth
- Research DivisionFederal Institute for Drugs and Medical Devices (BfArM)BonnGermany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE)University Hospital BonnBonnGermany
| | - Julia Stingl
- Research DivisionFederal Institute for Drugs and Medical Devices (BfArM)BonnGermany
- Centre for Translational Medicine, Medical FacultyUniversity Hospital BonnBonnGermany
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18
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Cardinale F, Amato D, Mastrototaro MF, Caffarelli C, Crisafulli G, Franceschini F, Liotti L, Caimmi S, Bottau P, Saretta F, Mori F, Bernardini R. Drug-induced anaphylaxis in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:30-35. [PMID: 30830059 PMCID: PMC6502178 DOI: 10.23750/abm.v90i3-s.8172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 12/03/2022]
Abstract
Anaphylaxis represents one of the most frequent medical emergencies in childhood. However, as compared to adults, drugs are less common triggers of anaphylaxis in children, with a frequency which is increasing from infancy to adolescence. Deaths seldom occur, maybe because of the paucity of comorbidities in children. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the main elicitors in drug-induced anaphylaxis in children. Both immune-mediated (mainly IgE-mediated) and non immune-mediated may be involved. IgG-mediated and complement-mediated mechanisms has been also hypothesized. Correct management relies on a right diagnosis and prompt therapy. A proper work-up is also important to prevent further potentially fatal re-exposures to the same drug or other structurally similar molecules but also unnecessary avoidance of medications not representing the culprit of the episode.
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Affiliation(s)
- Fabio Cardinale
- UOC di Pediatria, Servizio di Allergologia e Pneumologia Pediatrica, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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19
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Abstract
Anaphylaxis is a dramatic expression of systemic allergy. The lifetime prevalence of anaphylaxis is currently estimated at 0.05-2 % in the USA and ~3 % in Europe. Several population-specific studies have noted a rise in the incidence, particularly in the hospitalizations and ER visits due to anaphylaxis. The variable signs and symptoms that constitute the diagnostic criteria for anaphylaxis, the differences in diagnostic algorithms, and the limitations in the current coding systems have made summarizing epidemiologic data and comparing study results challenging. Nevertheless, across all studies, the most common triggers continue to be medications, food, and venom. Various risk factors for more severe reactions generally include older age, history of asthma, and having more comorbid diseases. Interesting seasonal, geographic, and latitude differences have been observed in anaphylaxis prevalence and incidence rates, suggesting a possible role of vitamin D and sun exposure in modifying anaphylaxis risk. While the incidence and prevalence of anaphylaxis appear to be increasing in certain populations, the overall fatality rate remains relatively low.
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Affiliation(s)
- Joyce E Yu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
| | - Robert Y Lin
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
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20
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Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities. J Asthma Allergy 2018; 11:143-151. [PMID: 29950873 PMCID: PMC6016581 DOI: 10.2147/jaa.s159400] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Epinephrine is the only effective treatment for anaphylaxis but studies routinely show underutilization. This is especially troubling given the fact that fatal anaphylaxis has been associated with delayed administration of epinephrine. Many potential barriers exist to the proper use of epinephrine during an anaphylactic reaction. This article will explore both patient-and physician-related factors, as well as misconceptions that all contribute to the underuse of epinephrine for the treatment of anaphylaxis.
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Affiliation(s)
- Benjamin T Prince
- Division of Allergy and Immunology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Irene Mikhail
- Division of Allergy and Immunology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
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21
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Lee YJ, Yang HJ, Yoon JS, Han MY, Kim CK, Kim JT. Proper allergen selection for serum specific IgE test in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.5.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yong Ju Lee
- Department of Pedaitrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University, Seoul, Korea
| | - Man-Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Bundang, Korea
| | - Chang Keun Kim
- Department of Pediatircs, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University, Seoul, Korea
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22
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Approach to food allergy diagnosis and management by nonspecialty practitioners. Ann Allergy Asthma Immunol 2017; 116:585-8. [PMID: 27264566 DOI: 10.1016/j.anai.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/21/2022]
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23
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Hohler SE. Keeping children with latex allergies safe. Nursing 2017; 47:1-5. [PMID: 28953705 DOI: 10.1097/01.nurse.0000524760.51000.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Sharon E Hohler
- Sharon E. Hohler is a team coordinator and CN IV at Saint Francis Medical Center in Cape Girardeau, Mo
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24
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Vella C, Sammut P. Anaphylaxis secondary to Parietaria judaica (wall pellitory). BMJ Case Rep 2017; 2017:bcr-2017-220309. [PMID: 28710239 DOI: 10.1136/bcr-2017-220309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aeroallergens are an unusual cause of anaphylaxis with sparse reports in the literature. We describe a case of suspected anaphylaxis to Parietaria judaica pollen and the difficulties encountered in confirming this diagnosis.
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Affiliation(s)
- Chiara Vella
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
| | - Patrick Sammut
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
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25
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Robinson M, Greenhawt M, Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Ann Allergy Asthma Immunol 2017; 119:164-169. [PMID: 28711194 DOI: 10.1016/j.anai.2017.06.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel. OBJECTIVE To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). METHODS We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013. RESULTS A total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30-0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21-0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37-0.86; P = .01). CONCLUSION This study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management.
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Affiliation(s)
- Melissa Robinson
- Section of Allergy and Immunology, National Jewish Hospital, Denver, Colorado
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital of Colorado, University of Colorado Denver School of Medicine, Denver, Colorado
| | - David R Stukus
- Department of Pediatrics, Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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26
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Steffens C, Clement B, Fales W, Chehade AEH, Putman K, Swor R. Evaluating the Cost and Utility of Mandating Schools to Stock Epinephrine Auto-injectors. PREHOSP EMERG CARE 2017; 21:563-566. [DOI: 10.1080/10903127.2017.1308610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Cho YJ, Kim SH, Lee H, Choi B, Kim MJ, Hong JS. Accuracy for registration of disease codes in pediatric anaphylaxis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.3.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yeon Joo Cho
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyeji Lee
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Mi Jin Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Seok Hong
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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28
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Schellpfeffer NR, Leo HL, Ambrose M, Hashikawa AN. Food Allergy Trends and Epinephrine Autoinjector Presence in Summer Camps. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:358-362. [PMID: 27923649 DOI: 10.1016/j.jaip.2016.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/04/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric campers with food allergies are at greater risk for exposure and anaphylaxis. A diagnosis of asthma increases risk for anaphylaxis. Epidemiological investigations of food-allergic children at high risk for allergic reactions requiring intervention in camp settings are lacking. OBJECTIVE The objectives of this study were to estimate the prevalence of food allergies among otherwise healthy campers in summer camps throughout the United States and Canada, and to assess asthma comorbidity and determine rates of epinephrine autoinjector prescriptions present in this population. METHODS We partnered with CampDoc.com, a web-based camp electronic health record system. Deidentified data were abstracted from 170 camps representing 122,424 campers. Only food allergies with a parental report of symptoms requiring intervention or with a camp prescription for an epinephrine autoinjector were included, whereas gluten, lactose intolerance, and food dyes were excluded. Asthma status and epinephrine presence on the camp medication list were assessed. RESULTS Overall, 2.5% of campers (n = 3055) had documented food allergies. Of these campers, 22% had multiple food allergies. Median age was 11 years; 52% were female. Nuts (81%), seafood (17.4%), egg (8.5%), fruit (8.1%), and seeds (7.2%) were the top 5 food allergies reported. Of food-allergic campers, 44.3% had concurrent asthma and 34.7% of those campers were taking multiple asthma medications. Less than half (39.7%) of food-allergic children brought an epinephrine autoinjector to the camp. CONCLUSIONS Life-saving epinephrine is not necessarily available for food-allergic children in camp settings. A substantial proportion of food-allergic campers are at higher risk for anaphylaxis based on concurrent asthma status.
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Affiliation(s)
| | - Harvey L Leo
- Department of Health Behavior and Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Michael Ambrose
- Department of Pediatrics, St. Joseph Mercy Hospital, Ann Arbor, Mich
| | - Andrew N Hashikawa
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich
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Dinakar C. Updated epinephrine autoinjector labeling. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1020-1. [PMID: 27406970 DOI: 10.1016/j.jaip.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Chitra Dinakar
- Division of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Mo.
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Tanner A, Clarke C. Epinephrine Policies and Protocols Guidance for Schools: Equipping School Nurses to Save Lives. NASN Sch Nurse 2016; 31:13-22. [PMID: 26739930 DOI: 10.1177/1942602x15607604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In response to limited direction given by legislative bodies to school nurses about how to implement state-mandated or recommended stock epinephrine programs in their schools, NASN convened a workgroup of invested stakeholders. This workgroup was challenged to equip school nurses with the necessary tools to develop policies and protocols regarding stock epinephrine in their school districts. The dynamic workgroup subcommittees focused on policies, procedures, and reporting tools. This article reviews the results of the subcommittees' work and the overall collaboration within the workgroup. This article provides clear, nationally recognized guidance on the best practice for establishing stock epinephrine policies and protocols with reporting tools at the local school district level.
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Affiliation(s)
- Andrea Tanner
- School Nurse, Coordinator of Health Services, New Albany-Floyd County Schools, New Albany, IN
| | - Carrie Clarke
- School Nurse, Sioux Falls School, District, Sioux Falls, SD
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Carrillo E, Hern HG, Barger J. Prehospital Administration of Epinephrine in Pediatric Anaphylaxis. PREHOSP EMERG CARE 2015; 20:239-44. [DOI: 10.3109/10903127.2015.1086843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jones CJ, Llewellyn CD, Frew AJ, Du Toit G, Mukhopadhyay S, Smith H. Factors associated with good adherence to self-care behaviours amongst adolescents with food allergy. Pediatr Allergy Immunol 2015; 26:111-8. [PMID: 25586900 DOI: 10.1111/pai.12333] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our understanding of factors which affect adherence to health sustaining self-care behaviours in adolescents with food allergy is limited. This study used the Health Belief Model to explore the relationship between food allergic adolescents' health beliefs, demographic, structural and social psychological factors with adherence to self-care behaviours, including allergen avoidance and carrying emergency medication. METHODS A cross-sectional study of 188 13- to 19- olds identified from hospital prescribed auto-injectable epinephrine for food allergy. Data were collected on demographics, structural factors, social psychological factors, health beliefs and current adherence behaviour using a postal questionnaire. RESULTS Full adherence was reported by 16% of participants. Multivariate analysis indicated that adherence was more likely to be reported if the adolescents belonged to a support group (OR = 2.54, (1.04, 6.20) 95% CI), had an anaphylaxis management plan (OR = 3.22, (1.18, 8.81) 95% CI), perceived their food allergy to be more severe (OR = 1.24, (1.01, 1.52) 95% CI) and perceived fewer barriers to disease management (OR = 0.87, (0.79, 0.96) 95% CI). CONCLUSIONS Membership of a patient support group and having an anaphylaxis management plan were associated with good adherence to self-care behaviours in adolescents with food allergy. Our results suggest that interventions to improve provision and utilisation of management plans, address adolescents' perceptions of the severity of anaphylaxis and reduce barriers to disease management may facilitate good adherence behaviours than focussing on knowledge-based interventions.
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Affiliation(s)
- Christina J Jones
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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Ott H. Nahrungsmittelanaphylaxie im Kindesalter. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Allergic emergencies in children are now more frequent and unpredictable and can cause death by anaphylactic shock, bronchospasm, and airway angioedema. Despite the publication of recent guidelines, many studies show that caregivers are still not at ease with the management of anaphylaxis and intramuscular administration of adrenaline. The prognosis depends on the early diagnosis of anaphylaxis and adrenaline administration before cardiorespiratory failure. The biphasic course of anaphylaxis requires systematic hospitalization of at least 6–24 hours depending on severity. To prevent recurrence, each child with anaphylaxis should permanently be in possession of two unexpired self-injectable adrenaline devices with a demonstration and written instructions on its use. Close collaboration between emergency departments, allergist, and family is essential to adapt therapeutic education and allergen avoidance to the allergen identified. This article focuses on opportunities to improve the skills of caregivers and standardize the management of anaphylaxis by proposing a practical definition and a therapeutic strategy based on Ring grading of severity.
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35
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Mawardi H. Oral Contact Allergy to Suture Material Resulting in Connective Tissue Graft Failure: A Case Report. Clin Adv Periodontics 2014. [DOI: 10.1902/cap.2013.120108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ahrens B, Quarcoo D, Buhner S, Reese G, Vieths S, Hamelmann E. Development of an animal model to evaluate the allergenicity of food allergens. Int Arch Allergy Immunol 2014; 164:89-96. [PMID: 24903216 DOI: 10.1159/000363109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 04/18/2014] [Indexed: 11/19/2022] Open
Abstract
SCOPE Considering the increasing numbers of patients suffering from food allergy (FA) as well as the great variety of novel foods and food compositions, an unmet need exists for the development of preclinical approaches to characterize the allergenic potential of proteins. The aim of our study was to evaluate the allergenicity of different food allergens in a rat model. METHODS Brown Norway rats were sensitized to protein extracts (RuBisCO, apple, soy, peanut, garden pea) or ovalbumin (OVA) combined with Bordetella pertussis and aluminium hydroxide, followed by oral allergen challenges. RESULTS Allergen-specific serum immunoglobulin production and the proliferation of mononuclear cells from spleen confirmed sensitization. To assess functional alterations in the gut, intestinal permeability was measured, which increased in sensitized and challenged animals compared to non-sensitized controls. Allergens with high allergenic potential (peanut, OVA, soy) caused a stronger immunological response than allergens with low allergenic potential, such as RuBisCO and apple. Moreover, the immunological responses were reduced when using boiled instead of raw soy and pea proteins. CONCLUSION This model mimics key features of FA and facilitates investigating the allergenicity of allergens in novel food or food compositions in vivo.
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Affiliation(s)
- Birgit Ahrens
- Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
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Schoessler S, Albert L, Levasseur S, Owens C. Saving lives at school: school nurses face the challenge of anaphylaxis in the school setting. NASN Sch Nurse 2014; 29:67-70. [PMID: 24707654 DOI: 10.1177/1942602x13516866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Although most cases of anaphylaxis are treated in the emergency department (ED), personnel may not immediately recognize anaphylaxis based on presenting symptoms because it has a wide range of clinical manifestations and variable progression. When symptoms happen to be atypical or mild and when no trigger is identified, the diagnosis of anaphylaxis can be challenging. Underdiagnosis of anaphylaxis can lead to delayed use of appropriate first-line epinephrine in favor of treatments that should be used as adjunctive only. Even when anaphylaxis is recognized, the choice between an epinephrine autoinjector or epinephrine ampule can still present a challenge. Treatment of anaphylaxis in the ED should include a combination of intramuscular epinephrine, supplemental oxygen, and intravenous fluids. If there is an incomplete response to the initial dose of epinephrine, additional doses or other measures may be considered. The most important management consideration is avoiding treatment delays, because symptoms can progress rapidly. Upon discharge from the ED, all patients with anaphylaxis should be given a prescription for at least 2 epinephrine autoinjectors, an initial emergency action plan, education about avoidance of triggers, and a referral to an allergist. A significant limitation of current studies is that clinical outcomes in anaphylaxis associated with established poor rates of diagnosis and use of recommended treatments are unclear; such trials must be conducted as supporting evidence for ED management guidelines for anaphylaxis.
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Affiliation(s)
- Richard M Nowak
- Henry Ford Health System, Detroit, Mich; Wayne State University School of Medicine, Detroit, Mich; University of Michigan Medical School, Ann Arbor, Mich.
| | - Charles G Macias
- Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
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Schoessler S, White MV. Recognition and treatment of anaphylaxis in the school setting: the essential role of the school nurse. J Sch Nurs 2013; 29:407-15. [PMID: 24062364 DOI: 10.1177/1059840513506014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Since anaphylaxis is unpredictable, rapid in onset, and potentially life threatening, it is critical for school staff to recognize and respond to its symptoms quickly. The symptoms of anaphylaxis can be challenging to differentiate, particularly in school-age children who may have trouble explaining what they are experiencing. School staff must understand the distinctive ways in which children describe and manifest anaphylactic symptoms, and the school nurse has a key leadership role in providing this training. The school nurse should create and coordinate individualized emergency care/action plans for students with known allergies, as well as a comprehensive care plan for all students, to ensure a safe environment and a rapid response to any life-threatening allergic reaction. This should include having epinephrine stocked and readily accessible so that it can be given promptly in the case of an anaphylactic emergency.
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40
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Current World Literature. Curr Opin Allergy Clin Immunol 2013. [DOI: 10.1097/aci.0b013e3283619e49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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