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Fakih-Botero I, Cerchiaro-Mejia MC, Rusinque MJ, Palacios-Ariza MA, Plata-Garcia CE, Peña-Hernández S. Out-of-pocket expenses and parent reported quality of life in children with cow's milk protein allergy in Bogotá, Colombia. J Pediatr Gastroenterol Nutr 2024; 79:18-25. [PMID: 38587147 DOI: 10.1002/jpn3.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To identify the out-of-pocket expenses and parent-reported quality of life (QoL) of children with a diagnosis of cow's milk protein allergy between the ages of 0 and 5 using the Food Allergy Quality of Life Questionnaire - Parent Form. METHODS A cross-sectional study was conducted in two tertiary care centers in Bogotá. Demographic, medical information, and QoL scores were collected by parental interview. We carried out a cost-of-illness analysis based on self-reported out-of-pocket expenses attributed to the treatment as a whole and the family's monthly income. Exploratory analyses used the QoL scores and the percentage of out-of-pocket expenses attributable to treatment as outcomes. RESULTS 122 families were analyzed. Median subject age was 17 months (Q1-Q3: 11-26.75 months) and female subjects made up 71% of the sample. The median QoL score was 3.21 points (Q1-Q3: 2.43-4.34) and only differed by age groups and personal history of other food allergies. The median out-of-pocket treatment related costs was 300,000 Colombian pesos (COP) (Q1-Q3: 280,000-340,000 COP). About 17% of the families had to pay over 15% of their monthly income to purchase food and dietary products. Out-of-pocket treatment related costs differed depending on whether the treatment included formulas (Mann-Whitney test p < 0.001). Out-of-pocket treatment expenses were uncorrelated with the QoL scores. CONCLUSION Food allergy related QoL scores were not associated with out-of-pocket expenses as a whole or as a fraction of monthly income but were higher in children with additional food allergies and in older age groups, suggesting a lower QoL.
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Affiliation(s)
- Isabella Fakih-Botero
- Pediatric Residency Program, Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia
| | | | - Maria Juliana Rusinque
- Pediatric Residency Program, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Stephania Peña-Hernández
- Departamento de Gastroenterología, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
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Batac ALR, Golding MA, Merrill KA, Lê ML, Fong AT, Hsu PS, Warren CM, Dadha P, Abrams EM, Chan ES, Ben-Shoshan M, Bilaver LA, Gupta RS, Shroba JA, Kivistö JE, Greenhawt MJ, Mäkelä MJ, Muraro A, Ahlstedt S, Protudjer JLP. A scoping review protocol for evaluating cost questionnaires aimed at measuring the household financial burden of food allergy. Clin Exp Allergy 2024; 54:524-527. [PMID: 38733299 DOI: 10.1111/cea.14493] [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: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Ayel Luis R Batac
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn A Merrill
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew T Fong
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter S Hsu
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Christopher M Warren
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Priyanka Dadha
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Division of Allergy, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, Department of Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lucy A Bilaver
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ruchi S Gupta
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jodi A Shroba
- Division of Allergy and Immunology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mika J Mäkelä
- Department of Allergology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Dermatology, Allergology and Venereology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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3
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Aaneland H, Larsen MH, Helseth S, Wahl AK. Quality Appraisal of Quality of Life Research in Children and Adolescents with Food Allergy: A Systematic Review. Int Arch Allergy Immunol 2024:1. [PMID: 38885630 DOI: 10.1159/000539113] [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: 11/10/2023] [Accepted: 04/05/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Quality of life (QOL) and health-related quality of life (HRQOL) in children and adolescents with food allergies have been an important and steadily growing field of research for the past 20 years. There seem to be conceptual and methodological challenges that might influence the face validity of QOL and HRQOL research in general health research, but this has not been investigated in pediatric and adolescent food allergy research up until now. The aim of this study was to perform a systematic review of the QOL and HRQOL studies on food allergy in children and adolescents under the age of 18. METHODS The systematic review was conducted on studies purporting to measure QOL or HRQOL in children and adolescents with food allergies. The literature search was developed in Ovid MEDLINE and databases used in the review were Embase, Cochrane Database of Systematic Reviews, CINAHL, and Scopus. Studies were evaluated based on a set of face validity criteria developed by Gill and Feinstein in 1994 and refined by Moons et al. in 2004. RESULTS Out of 61 studies eligible for the review, 11 (18%) defined QOL or HRQOL and two distinguished QOL from HRQOL. The Food Allergy Quality of Life (FAQLQ) instrument series is the most frequently used HRQOL measurement among the studies included. QOL and HRQOL were employed interchangeably in half of the studies, some of them also using a third term in addition. CONCLUSION Our findings lead to the conclusion that the research field investigated contains methodological and conceptual shortcomings regarding QOL and HRQOL. An increased awareness toward the terminology as well as consideration of points to reflect upon will be beneficial, as this will also improve the validity of future studies.
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Affiliation(s)
- Hilde Aaneland
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Yu J, Lanoue D, Mir A, Kaouache M, Bretholz A, Clarke A, McCusker C, Protudjer JLP, Jones A, Ben-Shoshan M. Trends of Peanut-Induced Anaphylaxis Rates Before and After the 2017 Early Peanut Introduction Guidelines in Montreal, Canada. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00626-3. [PMID: 38876271 DOI: 10.1016/j.jaip.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Food allergies, particularly peanut, represent the predominant cause of anaphylaxis. Whereas early allergen introduction has emerged as a potential preventive strategy, the precise impact of recent guidelines on peanut-induced anaphylaxis rates in Canada remains unclear. OBJECTIVE To assess the impact of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy on peanut-induced anaphylaxis rates in Canada. METHODS Using a comprehensive longitudinal registry capturing pediatric anaphylaxis presentations to the Montreal's Children's Hospital, we compared children with and without known peanut allergy who presented with peanut-induced anaphylaxis between 2011 and 2019 inclusive, excluding data beyond 2019 owing to the Coronavirus disease 2019 (COVID-19) pandemic. We calculated rates of peanut-induced anaphylaxis presentations per 100,000 age-adjusted all-cause emergency department visits using 4-month intervals. Interrupted time series analysis was used to compare anaphylaxis rate trends before and after 2017 for children ages 0 to 2 and 3 to 17 years. RESULTS We examined 2,011 cases of pediatric anaphylaxis, including 429 (21%) triggered by peanuts. Compared with pre-guideline estimates, the yearly rate of change of peanut anaphylaxis rates decreased by 7.96 (95% confidence interval -14.57 to -1.36; P = .018) after 2017 among patients with new-onset anaphylaxis in children 2 years of age or younger (n = 109). No significant changes were identified for older patients ages 3 to 17, or in patients with known peanut allergy. CONCLUSIONS Early introduction guidelines in Canada are associated with a reduced risk of new-onset peanut-induced anaphylaxis in young children within a single center in Montreal. Further research is required to assess the impact on a wider population and other food allergens.
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Affiliation(s)
- Joshua Yu
- Department of Medicine, Faculty of Medicine, McMaster University, Hamilton, Ont, Canada.
| | - Derek Lanoue
- Division of Allergy and Clinical Immunology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Adhora Mir
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ont, Canada
| | - Mohammed Kaouache
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta, Canada
| | - Christine McCusker
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine; and Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Anagnostou A, Warren C, Dantzer J, Galvin AD, Phillips EJ, Khan DA, Banerji A. Patient-Reported Outcome Measures in Food and Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00461-6. [PMID: 38710408 DOI: 10.1016/j.jaip.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
A patient-reported outcome is directly reported by the patient without interpretation of the patient's response by anyone else. It refers to the patient's health (symptoms and feelings), quality of life, or functional status associated with health care or treatment. Patient-reported outcome measures (PROMs) are defined as the tools or instruments that are used to measure patient-reported outcomes. Health-related quality of life has been the most studied psychosocial PROM in food allergy, using validated questionnaires. In drug allergy, PROMs are useful in capturing patients' experiences of potential allergic reactions, including subjective symptoms such as headache, dizziness, or fatigue. Patient-reported outcome measures can also help differentiate true allergies from side effects or other nonallergic reactions and inform decisions about drug challenges and de-labeling strategies. Ensuring the chosen tool is validated for the specific allergy context is crucial for accurate data collection. Integrating patient-reported experiences alongside traditional methods can lead to more accurate assessments and personalized care.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology, and Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Christopher Warren
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University, Chicago, Ill; CFAAR, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Jennifer Dantzer
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
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6
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Braun C, Coutier L, Bégin P, Nosbaum A. Skin-centered strategies in food allergy prevention. Pediatr Allergy Immunol 2024; 35:e14130. [PMID: 38693814 DOI: 10.1111/pai.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024]
Abstract
While the early introduction of food allergens in the infant diet has been shown to be effective at preventing the development of food allergy (FA), its implementation in real life has been associated with various challenges. Interventions aimed at correcting skin barrier dysfunction have been explored in recent decades as a distinct or complementary mean to prevent allergic sensitization through the skin and subsequent development of FA. Studies assessing the application of emollient from birth have yielded conflicting results, and meta-analyses have demonstrated either no effect or only a slight positive effect on FA prevention. However, a careful review of the clinical trials reveals that different emollients were used, which may have explained some of the discrepancies between study results. Emollient application protocols also varied widely between studies. While firm conclusions cannot be drawn with regard to their overall efficacy at preventing FA, the available data provide valuable insight into the characteristics that could be associated with a more effective intervention. Namely, successful trials tended to use emollients with an acidic pH of 5.5, applied over the entire body, and combined with topical corticosteroids in affected areas. Consensus on the optimal strategy to restore skin barrier function could help improve the homogeneity and clinical relevance of future trials on this topic. In the meantime, clinicians should avoid products associated with worse outcomes.
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Affiliation(s)
- Camille Braun
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
| | - Laurianne Coutier
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
| | - Philippe Bégin
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Medicine, Section of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Audrey Nosbaum
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
- Department of Allergy and Clinical Immunology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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7
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Grammatikopoulou MG, Vassilakou T. Nutrition in Pediatric Patients and Vulnerable Populations: Updates and Advances. CHILDREN (BASEL, SWITZERLAND) 2024; 11:430. [PMID: 38671646 PMCID: PMC11049479 DOI: 10.3390/children11040430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024]
Abstract
Nutrition is a modifiable factor of paramount importance for the prevention and attainment of health and the development of youngsters [...].
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Affiliation(s)
- Maria G. Grammatikopoulou
- Immunonutrition and Clinical Nutrition Unit, Department of Rheumatology and Clinical Immunology, Medical School, University of Thessaly, Biopolis Campus, GR-43100 Larissa, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, GR-11521 Athens, Greece
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Adedeji AA, Priyesh PV, Odugbemi AA. The Magnitude and Impact of Food Allergens and the Potential of AI-Based Non-Destructive Testing Methods in Their Detection and Quantification. Foods 2024; 13:994. [PMID: 38611300 PMCID: PMC11011628 DOI: 10.3390/foods13070994] [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: 02/29/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Reaction to food allergens is on the increase and so is the attending cost on consumers, the food industry, and society at large. According to FDA, the "big-eight" allergens found in foods include wheat (gluten), peanuts, egg, shellfish, milk, tree nuts, fish, and soybeans. Sesame was added to the list in 2023, making the target allergen list nine instead of eight. These allergenic foods are major ingredients in many food products that can cause severe reactions in those allergic to them if found at a dose that can elicit a reaction. Defining the level of contamination that can elicit sensitivity is a work in progress. The first step in preventing an allergic reaction is reliable detection, then an effective quantification method. These are critical steps in keeping contaminated foods out of the supply chain of foods with allergen-free labels. The conventional methods of chemical assay, DNA-PCR, and enzyme protocols like enzyme-linked immunosorbent assay are effective in allergen detection but slow in providing a response. Most of these methods are incapable of quantifying the level of allergen contamination. There are emerging non-destructive methods that combine the power of sensors and machine learning to provide reliable detection and quantification. This review paper highlights some of the critical information on the types of prevalent food allergens, the mechanism of an allergic reaction in humans, the measure of allergenic sensitivity and eliciting doses, and the conventional and emerging AI-based methods of detection and quantification-the merits and downsides of each type.
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Affiliation(s)
- Akinbode A. Adedeji
- Department of Biosystems and Agricultural Engineering, University of Kentucky, Lexington, KY 40546, USA
| | - Paul V. Priyesh
- Department of Animal and Food Science, University of Kentucky, Lexington, KY 40546, USA;
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Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults. Curr Allergy Asthma Rep 2024; 24:121-131. [PMID: 38416390 PMCID: PMC10960768 DOI: 10.1007/s11882-024-01131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades. RECENT FINDINGS The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.
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Affiliation(s)
- Eric C K Lee
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Brit Trogen
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kathryn Brady
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Lara S Ford
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Sydney Medical School, The University of Sydney, The University of Sydney, NSW, 2006, Australia.
| | - Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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10
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Gupta N, Mapondela KB. Allergy testing in lower middle income countries. Clin Exp Allergy 2024; 54:4-6. [PMID: 38233150 DOI: 10.1111/cea.14443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Neeraj Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Kassim Babu Mapondela
- Department of Pediatric Allergy (SA), Muhimbili University of Health and Medical Scineces, Upanga West, Tanzania
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11
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Ye L, Wong T, Lavine E, Cook VE, Erdle SC. Using the canadian egg ladder in children with food protein-induced enterocolitis syndrome: a case series. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:87. [PMID: 37803461 PMCID: PMC10557249 DOI: 10.1186/s13223-023-00843-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Current management of food protein-induced enterocolitis syndrome (FPIES) involves strict avoidance of the offending food for 12-18 months, followed by oral food challenge (OFC) under physician supervision. OFCs are resource-intensive and there is a lack of a universal standardized protocol for FPIES. Prolonged avoidance may increase the risk of IgE-mediated allergy, particularly in atopic patients. Food ladders have shown success in promoting accelerated tolerance in patients with IgE-mediated allergy. Our case series evaluated the safety of use of the Canadian Egg Ladder in patients with mild-to-moderate FPIES to egg. METHODS From May 2020 to November 2021, patients with mild-to-moderate FPIES to egg, defined as no history of lethargy or intravenous fluid administration, were started on the Canadian Egg Ladder. Instructions for advancing up the ladder were identical to using the Canadian Egg Ladder in patients with IgE-mediated allergy. Patients were followed every 3-6 months, at which time information was collected regarding progression up the ladder, symptoms while on treatment and interventions required. Treating allergists completed a survey to capture baseline demographic characteristics and prior tolerance to egg. Descriptive statistics were analyzed using MS Excel. RESULTS Twenty-one patients with mild-to-moderate FPIES were started on the Canadian Egg Ladder. Median age at initiation of the ladder was 10 months (IQR, 9-11). Nineteen (90.5%) patients completed the ladder, tolerating a serving size amount of cooked egg, over a median duration of 7 month (IQR, 4-9 months). Four patients (19.0%) had mild symptoms including vomiting (9.5%), pallor (9.5%), belching (4.8%), irritability (4.8%) and small spit up (4.8%). In three of the four patients, symptoms were the result of accidental exposure to a higher step of the ladder. There were no reports of lethargy. No patients required health care presentation or intravenous fluid administration. No patients discontinued the ladder. CONCLUSIONS The Canadian Egg Ladder can safely guide the dietary advancement of egg-containing foods in patients with mild-to-moderate FPIES to egg, without the need for prolonged avoidance and resource-intensive OFCs.
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Affiliation(s)
- Linlei Ye
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
| | - Tiffany Wong
- Division of Allergy, BC Children's Hospital, Vancouver, BC, Canada
| | - Elana Lavine
- Department of Pediatrics, University of Toronto, Humber River Hospital, Toronto, ON, Canada
| | - Victoria E Cook
- Division of Allergy, BC Children's Hospital, Vancouver, BC, Canada
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12
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Cook EE. Anthropological and sociological perspectives on food allergy. Clin Exp Allergy 2023; 53:989-1003. [PMID: 37649424 DOI: 10.1111/cea.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
This review explores the anthropological and sociological literature on food allergy and identifies four primary areas of research to date. The first explores the relationality and management of risk, uncertainty and stigma among parents and sufferers of food allergies. The second analyses the influence of intersectionality, specifically the effects of class, gender, race/ethnicity and disability on experiences of food allergy. The third discusses diagnostic difficulties and the impact these have on legitimacy and believability, both in the context of clinician-patient relations and in managing food allergies in public spaces. The fourth explores the ethics and uncertainties in food allergy treatments and how scientific knowledge of emerging treatments is constructed. This body of research illustrates that although an individual disease, food allergy experiences are significantly affected by socio-cultural structures, institutions, ideologies and discourses. The review concludes with four primary recommendations. First, there should be more incorporation of anthropological or sociological methodologies and perspectives into studies of food allergy. Second, studies are needed from more countries exploring lived experience of food allergy. Third, research on food allergy needs to incorporate an analysis of intersectional factors such as gender, class and race/ethnicity, and should explore the experiences of minority populations. Fourth, more research is needed on the interactions between biomedicine and local systems of knowledge, as well as the factors that shape what treatments become available, for whom it becomes available, experiences of treatment and aspects (including biases) that influence patient-clinician interactions.
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Affiliation(s)
- Emma E Cook
- Modern Japanese Studies, Hokkaido University, Sapporo, Japan
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Arámburo-Gálvez JG, Figueroa-Salcido OG, Ramírez-Torres GI, Terán-Cabanillas E, Gracia-Valenzuela MH, Arvizu-Flores AA, Sánchez-Cárdenas CA, Mora-Melgem JA, Valdez-Zavala L, Cárdenas-Torres FI, Ontiveros N. Prevalence of Parent-Reported Food Allergy in a Mexican Pre-School Population. J Clin Med 2023; 12:5095. [PMID: 37568497 PMCID: PMC10420166 DOI: 10.3390/jcm12155095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
The magnitude and relevance of food allergies in the preschool population remain unknown in most regions of Mexico and Latin America. Thus, our aim was to estimate the parent-reported prevalence of food allergies in a Mexican preschool population and to characterize their clinical diagnosis and presentation. A cross-sectional survey was conducted in Culiacán City. A validated questionnaire was utilized. A total of 810 parents responded to the questionnaire (valid response rate, 40.7%). The estimated prevalence rates (95% CI) were: "physician-diagnosed Food Allergy (FA), ever" 5.30% (3.86-7.08); "immediate-type FA, ever" 2.96% (1.91-4.38); "immediate-type FA, current" 1.60% (0.86-2.73); and food-dependent anaphylaxis 1.11% (0.51-2.01). The main food allergens were milk (0.49%), strawberries (0.37%), egg, and soy (0.25% each). Atopic diseases and a family history of allergies were significantly associated with immediate-type FA. Among "immediate-type FA, current" cases, 76.9% required emergency room visits, but the prescription of epinephrine autoinjectors was reported in one case only. The food reactions occurred at home (92.35%), in a relative's house (38.5), and at restaurants (23%). Immediate-type FA reactions requiring emergency room visits are not uncommon among the studied population. Actions like proper anaphylaxis management and the prevention of cross-contamination of foods should be encouraged.
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Affiliation(s)
- Jesús Gilberto Arámburo-Gálvez
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - Oscar Gerardo Figueroa-Salcido
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
- Integral Postgraduate Program in Biotechnology, Faculty of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan 80010, Mexico
| | | | - Elí Terán-Cabanillas
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - Martina Hilda Gracia-Valenzuela
- Department of Engineering, Technological National of Mexico, Technological Institute of the Yaqui Valley, Bacum 85276, Mexico;
| | - Aldo Alejandro Arvizu-Flores
- Postgraduate Program in Health Sciences, Faculty of Biological and Health Sciences, University of Sonora, Hermosillo 83000, Mexico;
| | - Cesar Antonio Sánchez-Cárdenas
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - José Antonio Mora-Melgem
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - Luisamaria Valdez-Zavala
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - Feliznando Isidro Cárdenas-Torres
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80010, Mexico; (J.G.A.-G.); (O.G.F.-S.); (E.T.-C.); (C.A.S.-C.); (J.A.M.-M.); (L.V.-Z.)
| | - Noé Ontiveros
- Clinical and Research Laboratory (LACIUS, U.N.), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Faculty of Biological and Health Sciences, University of Sonora, Navojoa 85880, Mexico
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Venter C, Groetch M, Protudjer JLP. Diet Diversity and Rising Food Prices: An Allergy Conundrum. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2345-2347. [PMID: 37116792 DOI: 10.1016/j.jaip.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Carina Venter
- Children's Hospital Colorado Anschutz Medical Campus, Aurora, Colo
| | - Marion Groetch
- Elliot and Roslyn Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer L P Protudjer
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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15
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Dhanjal R, Dine K, Gerdts J, Merrill K, Frykas TLM, Protudjer JL. An online, peer-mentored food allergy education program improves children's and parents' confidence. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:47. [PMID: 37248523 DOI: 10.1186/s13223-023-00800-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Children with food allergy, and their families experience substantial burdens because of efforts necessary to minimize the risk of anaphylaxis. To this end, peer-to-peer education is paramount. Food Allergy Canada offers an online, peer-to-peer mentoring program. However, the impact of this program has not previously been formally evaluated. OBJECTIVE To determine if Allergy Pals, an online, peer-to-peer mentoring program, for children aged 7-11 years, increased child and parental food allergy competency, and confidence. Our secondary aim was to qualitatively describe the experiences of the program. METHODS From May 2020-May 2021, children and their parents were invited to participate in an online, anonymous survey about Allergy Pals, at pre-program, and post-program. Primary outcomes, which were described and compared using chi2 or t-tests, as appropriate for the respective variables, included food allergy competence (epinephrine carriage, signs and symptoms of anaphylaxis) and food allergy confidence (e.g. comfort asking other for food allergy-related support). Secondary outcomes included child and parent perceptions of the program, which were analysed thematically. RESULTS Overall, 17 children completed the pre-program, and 11 completed the post-program survey. Corresponding numbers for parents were 25 and 23. Food allergy competence was high pre-program, and remained so post-program. Food allergy confidence improved from pre-program to post-program. E.g. Children tended to feel less left out (5/12, 41.7%; 3/10; 30.0%, respectively), a finding that was reflected also in parents' scores. Themes identified for child and parent perceptions further supported improved food allergy confidence. CONCLUSION Although food allergy competence was high pre-program, Allergy Pals improved food allergy confidence.
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Affiliation(s)
| | - Kyle Dine
- Food Allergy Canada, Toronto, ON, Canada
| | | | - Kaitlyn Merrill
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tara Lynn M Frykas
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Lp Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
- Department of Foods and Human Nutritional Sciences, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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16
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Golding MA, Roos LE, Abrams EM, Gerdts JD, Protudjer JLP. Temporal examination of adult food insecurity amongst Canadian families managing food allergy. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:45. [PMID: 37245046 DOI: 10.1186/s13223-023-00802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pediatric food allergy is associated with excess familial food costs compared to families without allergy. Since the start of the COVID-19 pandemic, food prices have increased substantially. OBJECTIVE To understand the temporal pattern of food insecurity amongst Canadian families with food allergy from the year prior to the pandemic, through May 2022. METHODS Using data collected electronically from families reporting food allergy using a validated food security questionnaire, we estimated food insecurity, including categories of food insecurity (marginal, moderate, secure) in the year prior to the pandemic (2019; Wave 1), and the first (2020; Wave 2) and second years of the pandemic (2022; Wave 3). RESULTS Participants in all waves were commonly in 2 + adult, 2 child households. Less than half of participants (Waves 1-3: 45.7%, 31.0%, and 22.9%, respectively) reported household incomes below the median Canadian. Common allergies were milk, eggs, peanuts and tree nuts. In Wave 1, 22.9% of families reported food insecurity; corresponding numbers at Waves 2 and 3 were 30.6% and 74.4%, respectively, representing an overall increase of 225.6%, including notable increases in severe food insecurity. CONCLUSION Canadian families with pediatric food allergy report higher rates of food insecurity compared to the general Canadian population, especially during the pandemic.
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Affiliation(s)
- Michael A Golding
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
| | - Leslie E Roos
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
- University of British Columbia, Vancouver, BC, Canada
| | | | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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17
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Pilot Study of the Applicability, Usability, and Accuracy of the Nutricate© Online Application, a New Dietary Intake Assessment Tool for Managing Infant Cow's Milk Allergy. Nutrients 2023; 15:nu15041045. [PMID: 36839403 PMCID: PMC9960076 DOI: 10.3390/nu15041045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND/OBJECTIVES The mainstay treatment of cow's milk allergy (CMA) is to remove cow's milk proteins from children's dietary intake. In this context, dietary intake of children with CMA should be particularly checked and monitored. The objective of this study was to assess the applicability, usability, and accuracy of a new dietary intake (DI) assessment online tool (Nutricate© online application) for managing CMA in children. SUBJECTS/METHODS This study used a pre-existing database of DI from the Nutricate© online application. DIs from 30 CMA children were used to compare micro/macronutrients (energy, protein, calcium, and iron intakes) calculated by Nutricate© and NutriLog© as the reference method. Comparisons were performed using the Pearson correlation analysis and the Bland-Altman plot. The Nutricate© tool usability was assessed via a System Usability Scale questionnaire (SUSq). RESULTS Correlation coefficient between the levels of micro/macronutrients obtained by Nutrilog© and Nutricate© software were highly significant (p = 0.0001) and were well-correlated (R coefficient > 0.6), indicating a very good concordance between the two methods. This observation was reinforced by the Bland-Altman plot, indicating the absence of proportional or fixed bias for energy, protein, calcium, and iron intakes. The mean SUSq score obtained was 81 ± 14, which is considered to be an excellent score. CONCLUSIONS Nutricate© online application is a reliable method to assess micro/macronutrient (energy, protein, calcium, and iron intakes) intake in CMA children. Applicability and usability of this new dietary intake assessment online tool is excellent.
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Trends and determinants of epinephrine prescriptions: a proxy of anaphylaxis epidemiology? Curr Opin Allergy Clin Immunol 2022; 22:441-449. [PMID: 36165443 DOI: 10.1097/aci.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Epinephrine autoinjectors (EAIs) are recommended to all patients previously experiencing anaphylaxis reaction in order to prevent further reactions and fatalities. Under that perspective, EAI prescription could be considered as a proxy of anaphylaxis epidemiology. Nevertheless EAI prescription rates are still unacceptably low. RECENT FINDINGS The review focuses on potential determinants, in addition to clinical indications, which might impact EAI prescription rates by exploring the scientific literature published within the past 18 months, wherever available. Although some controversial results, age, sex, ethnicity, geographical setting and socioeconomic conditions might influence both physician prescription behaviour and EAIs' accessibility from the patient's side, which hampers the accuracy of EAI prescription as a proxy of anaphylaxis. Low EAI prescription and refill rates have been recorded even in the absence of significant socioeconomic barriers, suggesting that economical limitations only partially account for the issue, and cultural restrictions have also to be considered and addressed. SUMMARY In addition to providing the same opportunities in terms of EAI availability in all countries worldwide, implementing the resources for anaphylaxis management in terms of practical knowledge, education, and allergy specialist networks is an urgent need, even in the absence of socioeconomic barriers.
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Wood RA, Chinthrajah RS, Eggel A, Bottoli I, Gautier A, Woisetschlaeger M, Tassinari P, Altman P. The rationale for development of ligelizumab in food allergy. World Allergy Organ J 2022; 15:100690. [PMID: 36185545 PMCID: PMC9483652 DOI: 10.1016/j.waojou.2022.100690] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Food allergy (FA) is a growing healthcare problem worldwide and the rising prevalence in many countries can be attributed to lifestyle, environmental, and nutritional changes. Immunoglobulin E (IgE)-mediated FA is the most common form of FA affecting approximately 3%-10% of adults and 8% of children across the globe. Food allergen-induced immediate hypersensitivity reactions mediated by IgE and high-affinity IgE receptor (FcεRI) complexes on mast cells and basophils are a major hallmark of the disease. FA can affect several aspects of health-related quality of life and impose a substantial financial burden on patients and healthcare systems. Although currently there is one United States Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatment for peanut allergy (Palforzia), the main treatment approaches are based on allergen avoidance and symptom management. Thus, there is an urgent need for more effective and ideally disease-modifying strategies. Given the crucial role of IgE in FA, anti-IgE monoclonal antibodies are considered promising therapeutic agents. Talizumab was the first humanized anti-IgE antibody to demonstrate substantial protection against allergic reactions from accidental peanut exposure by substantially increasing the peanut reactivity threshold on oral food challenge. However, development of talizumab was discontinued and further trials were performed using omalizumab. In double-blind, Phase 2, placebo-controlled trials in patients with multi-FAs, sustained dosing with omalizumab, or omalizumab in combination with oral immunotherapy, enabled rapid desensitization to multiple trigger foods. In this review, we describe the development of ligelizumab (a derivative of talizumab), a next generation, humanized monoclonal anti-IgE antibody, its existing clinical evidence, and its potential in the management of FA. When compared with omalizumab, ligelizumab binds with ∼88-fold higher affinity for human IgE and recognizes a different epitope that substantially overlaps with the binding site of FcεRI. These properties translate into a high potency to block IgE/FcεRI signaling in both in vitro and in vivo studies. Given its efficient suppression of IgE levels, good safety and pharmacokinetic/pharmacodynamic profile, ligelizumab clearly warrants further studies for the potential management of FA.
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Affiliation(s)
- Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Alexander Eggel
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | | | | | | | | | - Pablo Altman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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