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Hsu C, Hosakoppal S, Yong M, Gupta R, Makhija M, Singh AM. Prevalence and Characteristics of Accidental Ingestions Among Pediatric Food Allergy Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00822-5. [PMID: 39127102 DOI: 10.1016/j.jaip.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Despite a known diagnosis of food allergy, accidental ingestions continue to occur. OBJECTIVE To characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions. METHODS A prospective monthly survey developed by the Food Allergy Consortium at Northwestern University was administered to parents of food-allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. In addition, chart reviews of 100 pediatric participants from Lurie Children's Hospital of Chicago allergy clinics (typical clinical encounters) were compared with the prospective survey results. RESULTS A total of 196 survey participants and 100 retrospective review subjects were analyzed-31.1% of participants from the surveyed cohort and 19.0% of participants from the retrospective review reported at least 1 accidental ingestion over 1 year. The rate of accidental ingestions reported in the prospective survey was high: 10% to 25% of participants each month reported an accidental ingestion, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred for milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high in both the prospective and retrospective cohorts (33.1% and 16.7%, respectively). CONCLUSIONS Accidental ingestion rates were high among food-allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education on allergen avoidance and accidental exposure is imperative.
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Affiliation(s)
- Cynhia Hsu
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Shweta Hosakoppal
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Meagan Yong
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Ruchi Gupta
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Melanie Makhija
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Anne Marie Singh
- Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Ill; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis.
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Loke P, Wang X, Lloyd M, Ashley SE, Lozinsky AC, Gold M, O'Sullivan MD, Quinn P, Robinson M, Galvin AD, Orsini F, Tang MLK. Two-year post-treatment outcomes following peanut oral immunotherapy in the Probiotic and Peanut Oral Immunotherapy-003 Long-Term (PPOIT-003LT) study. Allergy 2024. [PMID: 39099231 DOI: 10.1111/all.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/15/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Few studies have examined long-term outcomes following oral immunotherapy (OIT); none have examined long-term risks and benefits associated with distinct clinical outcomes (desensitization, remission). METHODS Participants completing the probiotic and peanut oral immunotherapy (PPOIT) -003 randomized trial were enrolled in a follow-on study, PPOIT-003LT. Peanut ingestion, reactions, and health-related quality of life (HRQOL) were monitored prospectively. Outcomes at 1-year and 2-years post-treatment were examined by treatment group and by post-OIT clinical outcome (remission, desensitization without remission [DWR], allergic). RESULTS 86% (151/176) of eligible children enrolled. Post-treatment peanut ingestion at 2-years post-treatment were similar for PPOIT (86.7%) and OIT (78.7%) groups, both higher than placebo (10.3%). Reactions reduced over time for all treatment and clinical outcome groups (PPOIT 31.7% to 23.3%, OIT 37.7% to 19.7%, placebo 13.8% to 6.9%; remission 27.5% to 15.9%; DWR 57.9% to 36.8%; allergic 11.6% to 7%). At 2-years post-treatment, similar proportions of remission and allergic participants reported reactions (RD 0.09 (95%CI -0.03, 0.20), p = .127), whereas more DWR participants reported reactions than remission (remission vs DWR: RD -0.21 (95%CI -0.39; -0.03), p = .02) and allergic (DWR vs allergic: RD 0.30 (95%CI 0.13, 0.47), p = .001) participants. At 2-years post-treatment, 0% remission versus 5.3% DWR versus 2.3% allergic participants reported adrenaline injector usage. Remission participants had significantly greater HRQOL improvement (adjusted for baseline) compared with both DWR (MD -0.54 (95%CI -0.99, -0.10), p = .017) and allergic (MD -0.82 (95%CI -1.25, -0.38), p < .001). CONCLUSION By 2-years post-treatment, remission participants reported fewer reactions, less severe reactions and greater HRQOL improvement compared with DWR and allergic participants, indicating that remission is the patient-preferred treatment outcome over desensitization or remaining allergic.
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Affiliation(s)
- Paxton Loke
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Xiaofang Wang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Melanie Lloyd
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Sarah E Ashley
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Michael Gold
- Department of Paediatrics, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Michael D O'Sullivan
- Immunology Department, Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, Western Australia, Australia
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Patrick Quinn
- Department of Paediatrics, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Marnie Robinson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Audrey Dunn Galvin
- School of Applied Psychology, Cork University Hospital, University College Cork, Cork, Ireland
- Allergy Research Network, Ireland
| | - Francesca Orsini
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
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Liu Y, Zou ZB, Gu FD, Lin YF, Li Y, Chen HY, Liu H, Yang XW, Liu GM, Liu QM. Marine-Derived Alternariol Monomethyl Ether Alleviates Ovalbumin-Induced Food Allergy by Suppressing MAPK and NF-κB Signaling Pathways of Mast Cells. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:5463-5476. [PMID: 38414429 DOI: 10.1021/acs.jafc.3c08126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The prevalence of food allergies has grown dramatically over the past decade. Recently, studies have shown the potential of marine substances to alleviate food allergies. We utilized a rat basophilic leukemia (RBL)-2H3 model to evaluate the antiallergic effects of alternariol monomethyl ether (AME) extracted from marine fungi Alternaria sp. Our results showed that AME attenuated food allergy symptoms in mice and reduced histamine release in serum. The population of mast cells in the spleen and mesenteric lymph nodes was considerably reduced. Moreover, in vitro assays also revealed that AME inhibited the release of β-hexosaminidase and histamine. Transcriptomic analysis uncovered that AME regulated gene expression associated with mast cells. Additionally, Western blotting demonstrated that AME suppressed mast cell activation by modulating MAPK and NF-κB signaling pathways. Taken together, these findings provide a theoretical basis for the potential antiallergic use of marine-derived compounds in the development of functional foods.
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Affiliation(s)
- Yan Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Zheng-Biao Zou
- Key Laboratory of Marine Biogenetic Resources, Third Institute of Oceanography, Ministry of Natural Resources, 184 Daxue Road, Xiamen, Fujian 361005, China
| | - Fu-Die Gu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Yong-Feng Lin
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Yan Li
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Hui-Ying Chen
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Hong Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Xian-Wen Yang
- Key Laboratory of Marine Biogenetic Resources, Third Institute of Oceanography, Ministry of Natural Resources, 184 Daxue Road, Xiamen, Fujian 361005, China
| | - Guang-Ming Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
| | - Qing-Mei Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen, Fujian 361021, China
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Crealey M, Byrne A. Factors influencing accidental food allergic reactions in schools and preschools. Ir J Med Sci 2024; 193:313-319. [PMID: 37284946 PMCID: PMC10808491 DOI: 10.1007/s11845-023-03414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Children spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings. AIM The aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS. METHODS A prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here. RESULTS A total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6-7.0) and in preschool CCS 5% (95% CI 1.8-11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow's milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff. CONCLUSION The incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of "nut bans" remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.
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Affiliation(s)
- Miranda Crealey
- Department of Paediatric Allergy, Children's Health Ireland at Crumlin, Dublin, Ireland.
- Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Aideen Byrne
- Department of Paediatric Allergy, Children's Health Ireland at Crumlin, Dublin, Ireland
- Department of Paediatric Allergy, Children's Health Ireland at Tallaght, Dublin, Ireland
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Abrams EM, Bernstein JA, Chu DK, Horner CC, Rank MA, Stukus DR, Burrows AG, Cruickshank H, Golden DBK, Wang J, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Waserman S, Abrams EM, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt M, Horner CC, Ledford DK, Lieberman J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol 2024; 132:124-176. [PMID: 38108678 DOI: 10.1016/j.anai.2023.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/19/2023]
Abstract
This practice parameter update focuses on 7 areas in which there are new evidence and new recommendations. Diagnostic criteria for anaphylaxis have been revised, and patterns of anaphylaxis are defined. Measurement of serum tryptase is important for diagnosis of anaphylaxis and to identify underlying mast cell disorders. In infants and toddlers, age-specific symptoms may differ from older children and adults, patient age is not correlated with reaction severity, and anaphylaxis is unlikely to be the initial reaction to an allergen on first exposure. Different community settings for anaphylaxis require specific measures for prevention and treatment of anaphylaxis. Optimal prescribing and use of epinephrine autoinjector devices require specific counseling and training of patients and caregivers, including when and how to administer the epinephrine autoinjector and whether and when to call 911. If epinephrine is used promptly, immediate activation of emergency medical services may not be required if the patient experiences a prompt, complete, and durable response. For most medical indications, the risk of stopping or changing beta-blocker or angiotensin-converting enzyme inhibitor medication may exceed the risk of more severe anaphylaxis if the medication is continued, especially in patients with insect sting anaphylaxis. Evaluation for mastocytosis, including a bone marrow biopsy, should be considered for adult patients with severe insect sting anaphylaxis or recurrent idiopathic anaphylaxis. After perioperative anaphylaxis, repeat anesthesia may proceed in the context of shared decision-making and based on the history and results of diagnostic evaluation with skin tests or in vitro tests when available, and supervised challenge when necessary.
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Affiliation(s)
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Alyssa G Burrows
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
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Ansotegui Zubeldia IJ, Fiocchi A. [Introduction to food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:208-210. [PMID: 38506857 DOI: 10.29262/ram.v70i4.1308] [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: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Food allergy is a common chronic disorder that affects infants, children, adolescents, and adults. The prevalence of food allergy has increased in recent decades throughout the world, not limited to Western countries. Since there is no treatment, this focuses on avoiding allergens, in addition to educating patients and caregivers in the emergency treatment of acute reactions, for example: application of epinephrine. Studies suggest that accidental reactions occur in about 45% of children with food allergies each year, although most reactions are mild or moderate in severity. Hospital admissions for food anaphylaxis vary from 4 to 20 per 100,000 inhabitants; Deaths are rare, with an estimated incidence of 0.03 to 0.3 per million people with food allergy. Death from food anaphylaxis is rare and appears to have remained stable, possibly due to increases in food allergen labeling, diagnostic services, rates of intramuscular epinephrine prescription, and awareness of food allergies. Omalizumab is a drug approved for several disorders (chronic hives or difficult asthma) and may help reduce symptoms associated with food allergy. The relative importance of alternative technologies, management strategies and policies for food allergy varies from one region to another, due to differences in the epidemiology, education, socioeconomic well-being, and cultural preferences of the population.
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Affiliation(s)
- Ignacio Javier Ansotegui Zubeldia
- Director Médico Ejecutivo, Expresidente de la Organización Mundial de Alergia (WAO). Jefe del Departamento de Alergia e Inmunología, Hospital Quironsalud, Bizkaia, Bilbao,
| | - Alessandro Fiocchi
- Director responsable de la S.C. de Pediatría, Hospital Materno Infantil Macedonio Melloni, Milán, Italia. Director del Departamento Materno Infantil, Hospital Fatebenefratelli-Ophthalmic de Milán, Italia. Profesor adjunto de la Escuela de Es-pecialización en Pediatría III, Universidad de Milán y Consejero de la Sociedad Italiana de Pediatría, Sección Lombarda. Pediatric Hospital Bambino Gesú IRCCS Allergy division, Roma, Italia
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Połomska J, Dydak P, Sozańska B, Sikorska-Szaflik H. Peanut Allergy and Component-Resolved Diagnostics Possibilities-What Are the Benefits? Nutrients 2023; 15:5132. [PMID: 38140391 PMCID: PMC10746123 DOI: 10.3390/nu15245132] [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: 10/30/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Peanut allergy is a widespread and potentially life-threatening condition that affects both children and adults, with a growing incidence worldwide. It is estimated to affect around 1-2% of the population in several developed countries. Component-resolved diagnostics is a modern approach to allergy diagnosis that focuses on identifying specific allergenic proteins to provide precise diagnoses and personalized treatment plans. It is a technique that enables the analysis of specific IgE antibodies against tightly defined molecules (components) that constitute the allergen. Component-resolved diagnostics is particularly valuable in peanut allergy diagnosis, helping to determine allergen components associated with severe reactions. It also aids in predicting the course of the allergy and enables the development of personalized immunotherapy plans; however, the full application of it for these purposes still requires more precise studies. In this paper, we present the current knowledge about peanut allergy and component-resolved diagnostics possibilities. We discuss the possibilities of using molecular diagnostics in the diagnosis of peanut allergy. We focus on examining and predicting the development of peanut allergy, including the risk of anaphylaxis, and describe the latest data related to desensitization to peanuts.
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Affiliation(s)
- Joanna Połomska
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
| | - Paulina Dydak
- Clinical Department of Paediatrics, Specialist Hospital No. 2, Bytom, Silesian Medical University, 40-055 Katowice, Poland;
| | - Barbara Sozańska
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
| | - Hanna Sikorska-Szaflik
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
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Anagnostou A, Rodríguez Del Río P. Food Immunotherapy: Dissecting Current Guidelines and Navigating the Gray Zone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3040-3046. [PMID: 37391019 DOI: 10.1016/j.jaip.2023.06.038] [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: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
Food allergy is a common, chronic disease that is burdensome for patients and families, with multiple dietary and social limitations and a significant psychological impact stemming from the fear of accidental exposures and potentially severe, life-threatening reactions. Until recently, the only management option consisted of strict food avoidance. Food allergen immunotherapy (food AIT) has emerged as an alternative, active intervention to strict food avoidance, with a multitude of research studies supporting its efficacy and good safety profile. Food AIT results in a raise of allergenic threshold, which provides several benefits to food-allergic patients, including protection from accidental exposures, potentially decreased severity of allergic reactions on unintentional exposures, and improvement in quality of life. In the last few years, multiple independent reports have been published proposing strategies to implement food oral immunotherapy in U.S. clinics, although formal guidelines are currently lacking. Because food immunotherapy is gaining traction, popularity, and interest among both patients and health care providers, many physicians look for guidance on how to implement this intervention in their daily practice. In other parts of the world, use of this treatment has prompted the development of various guidelines from allergy societies. This rostrum discusses currently available guidelines on food AIT from different areas of the world, describes and comments on their similarities and differences, and highlights unmet needs in this area of therapy.
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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 & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Pablo Rodríguez Del Río
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; IIS La Princesa, Madrid, Spain
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9
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Lodge CJ, Waidyatillake N, Peters RL, Netting M, Dai X, Burgess J, Hornung CJ, Perrett KP, Tang MLK, Koplin JJ, Dharmage SC. Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials. Clin Transl Allergy 2023; 13:e12268. [PMID: 37488726 PMCID: PMC10314278 DOI: 10.1002/clt2.12268] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. BODY: We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. CONCLUSION We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.
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Affiliation(s)
- Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Merryn Netting
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Xin Dai
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - John Burgess
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Allergy Immunology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Child Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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10
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Ruran HB, Bartnikas LM. Multifood allergy: More than meets the eye. Ann Allergy Asthma Immunol 2023; 130:540-541. [PMID: 37137600 DOI: 10.1016/j.anai.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Hana B Ruran
- Division of Immunology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lisa M Bartnikas
- Division of Immunology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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11
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McWilliam VL, Koplin JJ, Allen K, Robinson M, Smart J, Loke P, Peters RL, Dang T, Lee KJ, Dalziel K, Tey D, Taranto M, Perrett KP. TreEAT trial: Protocol for a randomized controlled trial investigating the efficacy and safety of early introduction of tree nuts for the prevention of tree nut allergy in infants with peanut allergy. Pediatr Allergy Immunol 2023; 34:e13930. [PMID: 36974653 DOI: 10.1111/pai.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/22/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Children with peanut allergy are at increased risk of developing tree nut allergies, which can be severe and for most lifelong. Introduction of peanut in the first year of life can reduce the risk of peanut allergy; however, prevention strategies for tree nut allergies have not been established. We aimed to test the efficacy and safety of a novel strategy, a supervised multi-nut oral food challenge (OFC) compared with standard care for tree nut allergy prevention in infants at high risk of developing tree nut allergy, TreEAT. METHODS AND ANALYSIS TreEAT is a 2-armed, open-label, randomized, controlled trial (RCT). Infants (n = 212) aged 4-11 months with peanut allergy will be randomized 1:1 at peanut allergy diagnosis to either a hospital-based multi-tree nut (almond, cashew, hazelnut, and walnut) OFC using multi-nut butter or standard care (home introduction of individual tree nuts). All infants will be assessed at age 18 months, with questionnaires and SPT to peanut and tree nuts. Peanut and tree nut OFCs will be performed as required to determine the allergy status for each nut. The primary outcome is tree nut allergy at age 18 months. Secondary outcomes include peanut allergy resolution, proportion, and severity of adverse events related to tree nut ingestion, number and frequency of tree nuts ingested, quality of life and parental anxiety, and allergy-related healthcare visits from randomization to 18 months of age. Analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION TreEAT was approved by the Royal Children's Hospital Human Research Ethics Committee (#70489). Outcomes will be presented at scientific conferences and disseminated through publication. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT04801823.
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Affiliation(s)
- Vicki L McWilliam
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katie Allen
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Marnie Robinson
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joanne Smart
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paxton Loke
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Monash Children's Hospital, Clayton, Victoria, Australia
| | - Rachel L Peters
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Thanh Dang
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology & Biostatistics Unit (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Dean Tey
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Taranto
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre Food & Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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12
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Lloyd M, Loke P, Mack DP, Sicherer SH, Perkin MR, Boyle R, Yin Leung AS, Lee BW, Levin M, Blumchen K, Fiocchi A, Ebisawa M, Oliveira LCLD, Tang MLK. Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1010-1027.e6. [PMID: 36805346 DOI: 10.1016/j.jaip.2023.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael R Perkin
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Robert Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Hub of Paediatric Excellence, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Lucila Camargo Lopes de Oliveira
- Department of Paediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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13
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Food allergy in adolescents: validation of the food allergy independent measure and the EuroPrevall food allergy quality of life questionnaire into Spanish. Allergol Immunopathol (Madr) 2023; 51:71-81. [PMID: 36916090 DOI: 10.15586/aei.v51i2.617] [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: 02/24/2022] [Accepted: 11/12/2022] [Indexed: 03/09/2023]
Abstract
BACKGROUND Different questionnaires have been developed globally to assess and compare the impact of food allergy on the quality of life. The aim of this study was to validate a Spanish translation of the Food Allergy Independent Measure (FAIM) and the EuroPrevall Food Allergy-Quality of Life Questionnaire-Teenage Form (FAQLQ-TF) for adolescents aged 13-17 years. METHODS Sixty adolescents diagnosed with immunoglobulin E-mediated allergy to food completed the questionnaires. Cronbach's alpha was used to assess internal consistency; correlation between FAQLQ-TF and FAIM was used to test construct validity. The discriminant validity was evaluated by comparison with the number of offending foods, the perceived impact on social life, the diagnosis of anaphylaxis, and the previous prescription of adrenaline auto--injectors (AAI). RESULTS No question fulfilled criteria to be removed from the questionnaire. For FAIM, Cronbach's alpha = 0.763, and for the four domains of FAQLQ-TF, Cronbach's alpha = 0.797-0.847. A significant correlation existed between FAQLQ-TF and FAIM, and of both of them with anaphylaxis and the prescription of AAI (P ˂ 0.05 for all comparisons). CONCLUSIONS This Spanish translation of FAIM and FAQLQ-TF for adolescents had good internal consistency and construct validity as well as ability to discriminate patients according to the number of foods to avoid, impact on social life, diagnosis of anaphylaxis, and AAI prescription.
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14
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Alshajarah HA, Alghamdi HA, Alberi ZA, AlAam FA, Alshajarah AA, AlKhunaizi MF. Peanut-Induced Anaphylaxis in Children: A Literature Review. Cureus 2022; 14:e32946. [PMID: 36578844 PMCID: PMC9792142 DOI: 10.7759/cureus.32946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
Peanut allergy has become more common among children and is considered one of the most common triggers for fatal anaphylaxis. Treatment of symptoms during a reaction is only one aspect of managing anaphylaxis; other elements include rigorous dietary avoidance and education about settings that could put the patient at a high risk of unintentional exposure. We aimed to review the prevalence, mechanism, diagnosis, treatment, and emergency action of peanut-induced anaphylaxis among children. We used a web-based literature search using the advanced features of databases such as PubMed, Scopus, Directory of Open Access Journals (DOAJ), Embase, Google Scholar, and Cochrane electronic databases. The most common food to cause fatal anaphylaxis and a common cause of food allergies is peanuts. Over the past two years, our knowledge improved more about peanut allergens, their prevalence, causes, diagnoses, and treatments. The research cited in this review demonstrates that the peanut allergens are most closely associated with disease differ across cultures, that early oral peanut exposure may reduce the occurrence of peanut allergy while early non-oral exposure may have the opposite effect, that complement activation by peanut constituents appears to promote peanut-induced anaphylaxis, and that oral immunotherapy, anti-IgE antibody, and a herbal formulation are all demonstrating promise as treatments. To conclude, peanut allergies have increased frequently during the past 10 years, especially in Westernized nations. Given that peanut allergy poses a danger for fatal anaphylaxis, response management is crucial. The current standard of care for those with nut allergies comprises complete food avoidance and the administration of injectable epinephrine to treat systemic symptoms.
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Affiliation(s)
- Hawra A Alshajarah
- School of Medicine, Xi'an Jiaotong University, Xi'an, CHN
- Medicine, King Fahad Medical City, Riyadh, SAU
| | - Hamza A Alghamdi
- Allergy and Immunology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, SAU
| | - Zainab A Alberi
- School of Medicine, Xi'an Jiaotong University, Xi'an, CHN
- Medicine, King Fahad University Hospital, Khobar, SAU
| | - Fatima A AlAam
- School of Medicine, Xi'an Jiaotong University, Xi'an, CHN
- Medicine, King Khalid University Hospital, Riyadh, SAU
| | - Abeer A Alshajarah
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland - Medical University of Bahrain, Muharraq, BHR
| | - Maha F AlKhunaizi
- School of Medicine, Xi'an Jiaotong University, Xi'an, CHN
- Medicine, King Khalid University Hospital, Riyadh, SAU
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15
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Roche I, Vale SL, Hornung CJ, Zurzolo GA, Netting MJ, Dharmage SC, Gray C, Lee NA, Lacis-Lee J, Jorgensen PF, Smith J, Freeman W, Perrett KP, Voukelatos S, McWilliam VL, Grinter K, Koplin JJ, Said M, Campbell DE. An International First: Stakeholder Consensus Statement for Food Allergen Management in Packaged Foods and Food Service for Australia and New Zealand. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2056-2065. [PMID: 35381394 DOI: 10.1016/j.jaip.2022.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Food-allergic consumers encounter inadequate, confusing, and ambiguous allergen information for packaged and unpackaged foods. Key Australian and New Zealand allergy organizations convened multiple forums to facilitate discussions among consumers, food manufacturers, food retailers, regulatory bodies, researchers, and health professionals to develop a unified approach to improving food allergen management. The following stakeholder consensus statement provides a foundation for advocacy for improved food allergen management and safety. It is the responsibility of consumers to: 1. declare their food allergies and read food labels (including ingredient lists and allergen declaration statements), and 2. ultimately make their own judgment about the foods they choose to consume. We consider that to enable consumers to make informed decisions about their safety, It is the responsibility of packaged food manufacturers to: 1. follow robust allergen management practices including quantitative risk assessment, and 2. use clear, consistent labeling to inform consumers about that food's allergen content, including the possible presence of unintended allergens. It is the responsibility of food service establishments and providers to: 1. follow robust allergen management practices, and 2. ensure that staff understand and can inform consumers about the allergen content of the food they provide, including the possible presence of unintended allergens.
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Affiliation(s)
- Ingrid Roche
- Perth Children's Hospital, Perth, Western Australia, Australia; Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Sandra L Vale
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia.
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Giovanni A Zurzolo
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Merryn J Netting
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nanju A Lee
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | | | - Jill Smith
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Wendy Freeman
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sally Voukelatos
- National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Vicki L McWilliam
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Jennifer J Koplin
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Said
- National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; The Children's Hospital at Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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16
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Brettig T, Dalziel K, Koplin JJ, Dang T, Lange L, McWilliam V, Sato S, Savvatianos S, Perrett KP. Ana o 3 sIgE and diagnostic algorithms reduce cost of cashew allergy diagnosis in children compared with skin prick test: A cost comparison analysis. Pediatr Allergy Immunol 2022; 33. [PMID: 36003046 DOI: 10.1111/pai.13839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the absence of a clear clinical history of reaction, diagnosis of cashew allergy using skin prick tests (SPT) or cashew-specific IgE requires a high number of oral food challenges (OFC). By using Ana o 3 sIgE alone, or a two-step diagnostic algorithm using cashew sIgE followed by Ana o 3 sIgE, there is a reduced need for OFC. We aimed to perform a cost comparison for both of these approaches compared with cashew SPT alone. METHODS Pooled individual-level data from 6 studies were used to determine diagnostic accuracy and OFC rate. Two studies used cashew SPT (n = 567, 198 allergic), with 95% positive and negative predictive values of ≥12 mm and <3 mm. Four studies were included in the pathways for Ana o 3 sIgE alone or a 2-step algorithm incorporating cashew and Ana o 3 sIgE (n = 271, 156 allergic). Cut-offs used were ≥8.5kUA/L and ≤0.1kUA/L for cashew sIgE and ≥0.35kUA/L and ≤0.1kUA/L for Ana o 3 sIgE. Costs were constructed based on unit prices from hospital inpatient admissions, expenses incurred by families, individual patient data on allergic reaction types and rates, and adrenaline autoinjector carriage, applying a health system perspective. RESULTS Modeled data through the Ana o 3 pathway resulted in a 46.43% cost reduction (€307,406/1000 patients) compared with using cashew SPT alone (€573,854/1000 patients). The 2-step algorithm resulted in a 44.94% cost reduction compared with SPT alone (€315,952.82/1000 patients). Both the Ana o 3 pathway and 2-step algorithm resulted in a 79%-80% reduction in OFCs compared with SPT. CONCLUSIONS Using Ana o 3 as a standalone test for cashew allergy diagnosis or a 2-step algorithm incorporating cashew sIgE and Ana o 3 sIgE is accurate and results in a large reduction in both OFCs and health system costs compared with cashew SPT alone.
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Affiliation(s)
- Tim Brettig
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia.,Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Thanh Dang
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Vicki McWilliam
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sakura Sato
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Savvas Savvatianos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Kirsten P Perrett
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
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17
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Kabasser S, Pratap K, Kamath S, Taki AC, Dang T, Koplin J, Perrett K, Hummel K, Radauer C, Breiteneder H, Lopata AL, Bublin M. Identification of vicilin, legumin and antimicrobial peptide 2a as macadamia nut allergens. Food Chem 2022; 370:131028. [PMID: 34525424 PMCID: PMC7614219 DOI: 10.1016/j.foodchem.2021.131028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022]
Abstract
Macadamia nut is an increasingly popular food item of a healthy diet. However, macadamia nut is also a potent allergenic food. To date, there is little information about the allergenic proteins involved. In this study, using sera from macadamia nut allergic individuals, four IgE-binding proteins were detected. Their identities were determined by tandem mass spectrometry with de novo sequencing. Three IgE-reactive proteins, the vicilin Mac i 1, the legumin Mac i 2 and the antimicrobial peptide 2a/Mac i 1 (28-76) were purified from the nut while the non-specific lipid transfer protein was produced as a recombinant in Pichia pastoris. IgE-binding assays using sera from well-characterized groups of tree nut and/or peanut allergic patients revealed that the allergens were mainly recognized by sera from macadamia nut allergic individuals. Hence, these newly discovered allergens will enable molecular diagnostics to identify patients at high risk of macadamia nut allergy.
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Affiliation(s)
- Stefan Kabasser
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Kunal Pratap
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia
| | - Sandip Kamath
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia
| | - Aya C. Taki
- School of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Thanh Dang
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Jennifer Koplin
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Kirsten Perrett
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Karin Hummel
- VetCore Facility for Research, University of Veterinary Medicine, Vienna, Austria
| | - Christian Radauer
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Andreas L. Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia,Corresponding authors: Merima Bublin, PhD, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. ; Andreas L. Lopata, PhD, Pharmacy and Medical Research Building, James Cook University, Townsville, QLD, Australia,
| | - Merima Bublin
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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18
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Zurzolo GA, Campbell DE, Said M, Peters RL, Dharmage SC. Anaphylaxis to foods purchased from food establishments in Australia. J Paediatr Child Health 2022; 58:77-82. [PMID: 34260784 DOI: 10.1111/jpc.15651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
AIM Food establishments that sell non-packaged foods are not required to have a food label directly on the food product detailing the ingredients. This practice could increase the risk of anaphylaxis among individuals with food allergy. The aim of the study is to understand whether anaphylaxis occurs commonly in individuals with food allergy as a consequence of eating food products purchased from food establishments. METHODS We undertook an anonymous on-line cross-sectional survey of food allergic individuals over a 9-month period. Anaphylaxis was defined as reported symptoms consistent with the Australasian Society of Clinical Immunology and Allergy definition of anaphylaxis. RESULTS A total of 268 responses were received over the study period and 264 consented and completed the questionnaire. Among our survey participants, the rate of anaphylaxis to food purchased from establishments was 27% (n = 67/246, 95% confidence interval 21.8-33.3%). Of those who reported an anaphylaxis (n = 67), 87% reported informing staff of their/their dependents food allergy/s. Most (81%) reported that they would like to see additional information, such as listing of allergen information next to dishes on the menu and 61% reported that staff pro-actively asking about food allergies would be beneficial. CONCLUSION Anaphylaxis from food purchased at food establishments is not uncommon despite a high proportion of individuals declaring their food allergy to staff. Consumers with food allergy would like to see allergen information listed on the menus and for staff to proactively enquire about food allergies. A food allergen matrix that is regularly checked/updated so staff and consumers have easy access to information on menu items and common allergens is required.
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Affiliation(s)
- Giovanni A Zurzolo
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research (CFAR), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dianne E Campbell
- Centre for Food & Allergy Research (CFAR), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Maria Said
- Allergy & Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Rachel L Peters
- Centre for Food & Allergy Research (CFAR), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
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19
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Baseggio Conrado A, Patel N, Turner PJ. Global patterns in anaphylaxis due to specific foods: A systematic review. J Allergy Clin Immunol 2021; 148:1515-1525.e3. [PMID: 33940057 PMCID: PMC8674817 DOI: 10.1016/j.jaci.2021.03.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND There are increasing global data relating to prevalence of food allergy and food-induced anaphylaxis; however, this is often based on surrogate measures of sensitization rather than objective symptoms at food challenge. In terms of protecting food-allergic consumers from reactions, to our knowledge, there has been no global survey assessing geographic differences in the proportion of anaphylaxis triggered by specific foods. OBJECTIVE We sought to identify common triggers for food-induced anaphylaxis and how these vary from country to country. METHODS Systematic review of relevant reports published between January 2010 and November 2020. Results were reported following PRISMA guidelines. Publications were screened and data extracted by 2 independent reviewers, and the risk of bias was assessed. RESULTS Sixty-five studies (encompassing 41 countries and all 6 regions as defined by the Food and Agriculture Organization of the United Nations) were included. Significant regional variations in the most common triggers of food anaphylaxis were seen; however, in general, there was good agreement between local legislative requirements for allergen disclosure and the most common allergens for each region or nation. CONCLUSIONS Local legislation for allergen disclosure generally reflects those allergens commonly responsible for food anaphylaxis. Cow's milk and crustaceans appear to cause a higher proportion of anaphylaxis compared to peanut in some regions.
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Affiliation(s)
| | - Nandinee Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
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20
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Hikisz P, Bernasinska-Slomczewska J. Beneficial Properties of Bromelain. Nutrients 2021; 13:4313. [PMID: 34959865 PMCID: PMC8709142 DOI: 10.3390/nu13124313] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/21/2022] Open
Abstract
Bromelain is a major sulfhydryl proteolytic enzyme found in pineapple plants, having multiple activities in many areas of medicine. Due to its low toxicity, high efficiency, high availability, and relative simplicity of acquisition, it is the object of inexhaustible interest of scientists. This review summarizes scientific reports concerning the possible application of bromelain in treating cardiovascular diseases, blood coagulation and fibrinolysis disorders, infectious diseases, inflammation-associated diseases, and many types of cancer. However, for the proper application of such multi-action activities of bromelain, further exploration of the mechanism of its action is needed. It is supposed that the anti-viral, anti-inflammatory, cardioprotective and anti-coagulatory activity of bromelain may become a complementary therapy for COVID-19 and post-COVID-19 patients. During the irrepressible spread of novel variants of the SARS-CoV-2 virus, such beneficial properties of this biomolecule might help prevent escalation and the progression of the COVID-19 disease.
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Affiliation(s)
- Pawel Hikisz
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, ul. Pomorska 141/143, 90-236 Lodz, Poland;
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21
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Imran S, Neeland MR, Koplin J, Dharmage S, Tang MLK, Sawyer S, Dang T, McWilliam V, Peters R, Perrett KP, Novakovic B, Saffery R. Epigenetic programming underpins B-cell dysfunction in peanut and multi-food allergy. Clin Transl Immunology 2021; 10:e1324. [PMID: 34466226 PMCID: PMC8384135 DOI: 10.1002/cti2.1324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/07/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Rates of IgE-mediated food allergy (FA) have increased over the last few decades, and mounting evidence implicates disruption of epigenetic profiles in various immune cell types in FA development. Recent data implicate B-cell dysfunction in FA; however, few studies have examined epigenetic changes within these cells. METHODS We assessed epigenetic and transcriptomic profiles in purified B cells from adolescents with FA, comparing single-food-allergic (peanut only), multi-food-allergic (peanut and ≥1 other food) and non-allergic (control) individuals. Adolescents represent a phenotype of persistent and severe FA indicative of a common immune deviation. RESULTS We identified 144 differentially methylated probes (DMPs) and 116 differentially expressed genes (DEGs) that distinguish B cells of individuals with FA from controls, including differential methylation of the PM20D1 promoter previously associated with allergic disorders. Subgroup comparisons found 729 DMPs specific to either single-food- or multi-food-allergic individuals, suggesting epigenetic distinctions between allergy groups. This included two regions with increased methylation near three S100 genes in multi-food-allergic individuals. Ontology results of DEGs specific to multi-food-allergic individuals revealed enrichment of terms associated with myeloid cell activation. Motif enrichment analysis of promoters associated with DMPs and DEGs showed differential enrichment for motifs recognised by transcription factors regulating B- and T-cell development, B-cell lineage determination and TGF-β signalling pathway between the multi-food-allergic and single-food-allergic groups. CONCLUSION Our data highlight epigenetic changes in B cells associated with peanut allergy, distinguishing features of the epigenome between single-food- and multi-food-allergic individuals and revealing differential developmental pathways potentially underpinning these distinct phenotypes.
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Affiliation(s)
- Samira Imran
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Melanie R Neeland
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Jennifer Koplin
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Shyamali Dharmage
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
- Allergy and Lung Health UnitMelbourne School of Population and Global HealthUniversity of MelbourneCarltonVICAustralia
| | - Mimi LK Tang
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
- Department of Allergy and ImmunologyRoyal Children's HospitalMelbourneVICAustralia
| | - Susan Sawyer
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
- Centre for Adolescent HealthRoyal Children's HospitalMelbourneVICAustralia
| | - Thanh Dang
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Vicki McWilliam
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
- Department of Allergy and ImmunologyRoyal Children's HospitalMelbourneVICAustralia
| | - Rachel Peters
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Kirsten P Perrett
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
- Department of Allergy and ImmunologyRoyal Children's HospitalMelbourneVICAustralia
| | - Boris Novakovic
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
| | - Richard Saffery
- Murdoch Children’s Research Institute, and Department of PaediatricsUniversity of MelbourneRoyal Children's HospitalParkvilleVICAustralia
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22
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Waserman S, Cruickshank H, Hildebrand KJ, Mack D, Bantock L, Bingemann T, Chu DK, Cuello-Garcia C, Ebisawa M, Fahmy D, Fleischer DM, Galloway L, Gartrell G, Greenhawt M, Hamilton N, Hourihane J, Langlois M, Loh R, Muraro A, Rosenfield L, Schoessler S, Tang MLK, Weitzner B, Wang J, Brozek JL. Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines. J Allergy Clin Immunol 2021; 147:1561-1578. [PMID: 33965093 DOI: 10.1016/j.jaci.2021.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022]
Abstract
Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.
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Affiliation(s)
- Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kyla J Hildebrand
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Mack
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Bantock
- Department of Primary Medical Services, Sun Peaks Community Health Centre, Sun Peaks, British Columbia, Canada
| | - Theresa Bingemann
- Department of Allergy and Immunology, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, University of Rochester, Rochester, NY
| | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Cuello-Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Quality in Health Care Residency Program, Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - David Fahmy
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David M Fleischer
- Department of Pediatrics-Allergy/Immunology, University of Colorado School of Medicine, Aurora, Colo; Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Lisa Galloway
- School District No. 73, Kamloops, British Columbia, Canada
| | - Greg Gartrell
- School District No. 73, Kamloops, British Columbia, Canada
| | - Matthew Greenhawt
- Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Nicola Hamilton
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Langlois
- District School Board of Niagara, St Catharines, Ontario, Canada
| | - Richard Loh
- Department of Immunology, Princess Margaret Hospital for Children, Subiaco, Australia
| | | | - Lana Rosenfield
- Section of Allergy and Clinical Immunology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mimi L K Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Brenda Weitzner
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Wang
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jan L Brozek
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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23
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Lieberman JA, Gupta RS, Knibb RC, Haselkorn T, Tilles S, Mack DP, Pouessel G. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy 2021; 76:1367-1384. [PMID: 33216994 PMCID: PMC8247890 DOI: 10.1111/all.14666] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self‐management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%–14% of patients with PA experience accidental peanut exposure annually, and one‐third to one‐half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health‐related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.
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Affiliation(s)
- Jay A. Lieberman
- University of Tennessee Health Science Center/Le Bonheur Children’s Hospital Memphis TN USA
| | - Ruchi S Gupta
- Institute for Public Health and Medicine Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern School of Medicine Chicago IL USA
| | | | | | | | - Douglas P. Mack
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Guillaume Pouessel
- Pneumology and Allergology Unit Children's HospitalLille University Hospital Jeanne de Flandre France
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24
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Fasola S, Ferrante G, Malizia V, Bommarito N, Del Giacco S, Bonini M, Baiardini I, Bellafiore M, La Grutta S. Validity and repeatability of the Pediatric Allergy Questionnaire for Athletes (AQUAped) for the screening of atopy. Pediatr Allergy Immunol 2021; 32:437-444. [PMID: 33202069 DOI: 10.1111/pai.13410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND High atopy prevalence has been reported in athletes. Having an age-specific questionnaire for predicting atopy is important for an optimal management of young athletes. The study objectives were as follows: (i) developing a scoring system for the Pediatric Allergy Questionnaire for Athletes (AQUAped); (ii) identifying the optimal age target within the range 7-14 years; (iii) assessing AQUAped validity and repeatability in the identified target population. METHODS A total of 133 young athletes (age 7-14 years) were recruited. Following a screening visit, the participants filled AQUAped at baseline (T0) and after 7 days (T1), concomitantly undergoing skin prick testing. Using atopy as the gold standard (positivity to ≥1 aeroallergen), the 12 core items were scored based on their likelihood ratios, and a total score was calculated. The optimal cut-off was identified based on the Youden's criterion. The repeatability of AQUAped was assessed through the intra-cluster correlation coefficient (ICC). The optimal age target was identified as the largest age range associated with an acceptable cross-validated area under the receiver operating characteristic curve (AUC ≥ 0.70) and an excellent ICC (≥0.75). RESULTS Forty (30%) children were atopic; the optimal age target was 10-14 years (cross-validated AUC = 0.70, ICC = 0.81). AQUAped total score ranged from -26 to 75, and only 5% of non-atopic children had AQUAped ≥ 24. AQUAped ≥ 2 had 82% specificity, 60% sensitivity, and 74% overall accuracy. CONCLUSION Developing and testing a scoring system for AQUAped showed that it is a valid and reliable tool for the screening of atopy in young athletes aged 10-14 years.
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Affiliation(s)
- Salvatore Fasola
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Velia Malizia
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Noemi Bommarito
- Sport and Exercise Science Research Unit, Department of Psychological, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Internal Medicine, Respiratory Unit for Continuity of Care-University Hospital IRCCS San Martino, University of Genoa, Genoa, Italy
| | - Marianna Bellafiore
- Sport and Exercise Science Research Unit, Department of Psychological, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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25
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Neeland MR, Andorf S, Dang TD, McWilliam VL, Perrett KP, Koplin JJ, Saffery R. Altered immune cell profiles and impaired CD4 T-cell activation in single and multi-food allergic adolescents. Clin Exp Allergy 2021; 51:674-684. [PMID: 33626189 DOI: 10.1111/cea.13857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Approximately 5% of adolescents have a food allergy, with peanut and tree nut allergies the most common. Having two or more food allergies in adolescence also doubles the risk of any adverse food reaction, and is associated with increased dietary and social burden. Investigations of immune function in persistently food allergic children are rare. OBJECTIVE In the present study, we aimed to investigate the immune mechanisms that underlie food allergy in adolescence. METHODS We used high-dimensional flow cytometry, unsupervised computational analysis and functional studies to comprehensively phenotype a range of non-antigen-specific immune parameters in a group of well-characterized adolescents with clinically defined single peanut allergy, multi-food allergy and aged-matched non-food allergic controls. RESULTS We show that food allergic adolescents have higher circulating proportions of dendritic cells (p = .0084, FDR-adjusted p = .087, median in no FA: 0.63% live cells, in FA: 0.93%), and higher frequency of activated, memory-like Tregs relative to non-food allergic adolescents (p = .011, FDR-adjusted p = .087, median in no FA: 0.49% live cells, in FA: 0.65%). Cytokine profiling revealed that CD3/CD28 stimulated naïve CD4 T cells from food allergic adolescents produced less IL-6 (p = .0020, FDR-adjusted p = .018, median log2 fold change [stimulated/unstimulated] in no FA: 3.03, in FA: 1.92) and TNFα (p = .0044, FDR-adjusted p = .020, median in no FA: 9.16, in FA: 8.64) and may secrete less IFNγ (p = .035, FDR-adjusted p = .11, median in no FA: 6.29, in FA: 5.67) than naïve CD4 T cells from non-food allergic controls. No differences between clinical groups were observed for LPS-stimulated monocyte secretion of cytokines. CONCLUSIONS These results have important implications for understanding the evolution of the immune response in food allergy throughout childhood, revealing that dendritic cell and T-cell signatures previously identified in early life may persist through to adolescence.
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Affiliation(s)
- Melanie R Neeland
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Sandra Andorf
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Divisions of Biomedical Informatics and Allergy & Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thanh D Dang
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Vicki L McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
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26
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Midun E, Radulovic S, Brough H, Caubet JC. Recent advances in the management of nut allergy. World Allergy Organ J 2021; 14:100491. [PMID: 33510829 PMCID: PMC7811165 DOI: 10.1016/j.waojou.2020.100491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Peanut/tree nut allergy is common and has been associated with particularly severe reactions. Epidemiological data have shown that the prevalence ranges between 0.05% and 4.9% for tree nut and between 0.5% and 3% for peanut. These large variations can be explained by differences in the age of included patients and the geographical region. In addition, the food consumption modality (ie, raw versus roasted) plays a major role, as heat treatment has the capacity to modify the allergenicity of nuts and legumes. Nut allergies tend to persist into adulthood and consequently have a high impact on quality of life. Recently, it has been demonstrated that a significant proportion of nut allergic patients are able to tolerate other nuts. As opposed to the avoidance of all nuts, this approach is currently proposed in several tertiary allergy centers. However, diagnosis of nut allergy is particularly difficult due to co-sensitization leading to high rate of false positive skin prick tests and/or specific IgE to whole allergen extracts. The use of component resolved diagnosis leads to major improvement of diagnosis, particularly to distinguish between primary and secondary nut allergies. The basophil activation test has been suggested to be useful but is still used mainly as a research tool. Thus, diagnosis remains mainly based on the oral food challenge, which is considered as the gold standard. Regarding treatment, avoidance remains the cornerstone of management of nut allergy. Oral immunotherapy is increasingly proposed as an alternative management strategy.
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Key Words
- Component-resolved diagnostic, CRD
- Cross reactivity
- Double-blind, placebo-controlled, food challenge, DBPCFC
- Food allergy
- Lipid transfer protein, LTP
- Oral allergy syndrome, OAS
- Oral food challenge, OFC
- Oral immunotherapy
- Oral induction tolerance, OIT
- Pathogenesis related protein type 10, PR-10
- Peanut
- Platelet-activating factor, PAF
- Pollen-food syndrome, PFS
- Precautionary Allergen Labels, (PAL)
- Skin prick test, SPT
- Tree nut
- Tree nut, TN
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Affiliation(s)
- Elise Midun
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205 Geneva, Switzerland, University Lyon 1 Claude Bernard, 43 Boulevard Du 11-Novembre-1918, 69100, Villeurbanne, France
- Corresponding author.
| | - Suzana Radulovic
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Helen Brough
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205, Geneva, Switzerland
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Community-Based Adverse Food Reactions and Anaphylaxis in Children with IgE-Mediated Food Allergy at Age 6 Years: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3515-3524. [DOI: 10.1016/j.jaip.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/11/2023]
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Blumchen K, DunnGalvin A, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fisher HR, Fernández‐Rivas M. APPEAL-1: A pan-European survey of patient/caregiver perceptions of peanut allergy management. Allergy 2020; 75:2920-2935. [PMID: 32438514 DOI: 10.1111/all.14414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peanut allergy (PA) is associated with marked quality-of-life (QoL) impairment. However, data are lacking on the experience and impact of living with PA from the perspectives of persons with PA (PwPA) and their caregivers. Allergy to Peanuts imPacting Emotions And Life study 1 (APPEAL-1) was a pan-European survey investigating these perspectives. This first of two articles reports clinical characteristics of PwPA and PA management practices. METHODS APPEAL-1 was a quantitative, online survey conducted in eight European countries, developed by eight representatives of patient advocacy groups and five healthcare professionals and researchers. Eligible participants included adults with PA and parents/caregivers of PwPA who responded by self-report and provided proxy-report for the PwPA under their care. Data were summarized using nonweighted descriptive statistics. RESULTS Of 1846 completed/analysed questionnaires, 528 were from adults with PA (self-report); 437 by proxy for children with PA (34 aged 0-3 years, 287 aged 4-12 years, 116 aged 13-17 years) and 881 from parents/caregivers (self-report). Of PwPA (N = 965), 95% reported diagnosis by healthcare professionals, mostly by clinical history and peanut-specific allergy testing. Rates of allergic rhinitis, asthma and other food allergies in PwPA were 50%, 42% and 79%, respectively. Only 31% of PwPA received HCP advice/support following their worst allergic reaction, and 28% had not been prescribed an adrenaline auto-injector. Results were similar by country but varied by age group. CONCLUSIONS The APPEAL-1 findings contribute to greater understanding of PA impact on PwPA, caregivers and family members and the need for improved PA management across Europe.
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Affiliation(s)
- Katharina Blumchen
- Division of Allergology, Pneumology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund, (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSCARADyAL Madrid Spain
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DunnGalvin A, Blumchen K, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fernández‐Rivas M, Fisher HR. APPEAL-1: A multiple-country European survey assessing the psychosocial impact of peanut allergy. Allergy 2020; 75:2899-2908. [PMID: 32400915 PMCID: PMC7689848 DOI: 10.1111/all.14363] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
Background Peanut allergy (PA) is a common, potentially life‐threatening and typically lifelong condition with a significant burden of illness. However, information is lacking on how persons with PA (PwPA) and their caregivers perceive the psychosocial impact of living with PA. The Allergy to Peanuts imPacting Emotions And Life 1 (APPEAL‐1) survey, conducted across Europe, investigated the experience and impact of living with PA. Here, we report data evaluating the psychosocial impact of PA on PwPA and their caregivers. Methods Allergy to Peanuts imPacting Emotions And Life study 1 was an online survey conducted in eight European countries. Representatives of eight patient advocacy groups and five healthcare‐research specialists developed the survey. Eligible respondent groups included the following: adults diagnosed with PA (self‐report); parent/nonparent caregivers (proxy‐report for a child with PA); and parent/nonparent caregivers (self‐report of PA impact on themselves). Results Of 1846 total study respondents, 419 were adults with PA (self‐report); 546 were parents/caregivers (proxy‐report); and 881 were parents/caregivers (self‐report). Most respondents reported lifestyle restrictions regarding food (84%‐93%) and additional domains including parties and socializing, holiday activities and destinations, and taking public transport (53%‐89%). Approximately 40% rated themselves as “very” frustrated and “very” stressed. Two‐thirds (65%) felt socially isolated; 43% were bullied. Less than half felt confident in knowing when to use an adrenaline autoinjector. Several intercountry differences were observed such as high levels of uncertainty and stress in respondents from Ireland, highest rates of anxiety in respondents from Germany, and social exclusion and isolation most common in respondents from France. Conclusions Peanut allergy imposes an adverse psychosocial impact on patients and caregivers, leading to frustration, stress and isolation. Attention to the impact of PA is needed in research and clinical practice to improve PA healthcare and public education programmes.
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Affiliation(s)
- Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Katharina Blumchen
- Division of Pneumology, Allergology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSC, ARADyAL Madrid Spain
| | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
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Kaur N, Mehr S, Katelaris C, Wainstein B, Altavilla B, Saad R, Valerio C, Codarini M, Burton P, Perram F, Baumgart K, Barnes EH, Campbell DE. Added Diagnostic Value of Peanut Component Testing: A Cross-Sectional Study in Australian Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:245-253.e4. [PMID: 32942048 DOI: 10.1016/j.jaip.2020.08.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Peanut components are widely used in clinical practice; however, their utility to predict challenge outcome in the Australian children, outside of infants, is not well studied. OBJECTIVE Can peanut component testing predict outcome of challenge in peanut-allergic children. METHODS All children attending peanut challenges, regardless of previous allergic reactions to peanut or sensitization (skin prick test or peanut IgE) alone, were recruited. Serum collected before the challenge was analyzed for peanut IgE and Ara h 1, 2, 3, 6, 8, and 9 (ImmunoCap). RESULTS Of the 222 children recruited, 89 (40%) were allergic on oral food challenge. Ara h 2 and 6 performed similarly to peanut IgE and skin prick test in predicting challenge outcome (area under the curve, 0.84-0.87). No baseline clinical characteristics, including past history, predicted challenge outcome. By logistic regression, degree of polysensitization to Ara h 1, 2, or 3 increased the odds of allergic reaction at oral food challenge at 0.35 and 1.0 kUA/L cutoff levels (P < .001 for both). All 11 children sensitized (>0.35 kUA/L) to Ara h 1, 2, and 3 reacted to peanut challenge. Degree of polysensitization at more than 1.0 kUA/L was associated with a lower cumulative eliciting dose (P = .016) and with severity of allergic reaction on challenge (P = .007). CONCLUSIONS In our cohort, sensitization to the combination of Ara h 1, 2, and 3 was highly predictive of peanut allergy. Overall, only Ara h 2 as individual component most correlated with severity of reaction at challenge and adrenaline use. Ara h 8 and 9 were not useful in predicting challenge outcome.
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Affiliation(s)
- Narinder Kaur
- Department of Allergy and Immunology, The Children's Hospital at Westmead, SCHN, Sydney, NSW, Australia; Sydney Child Health Program, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Sam Mehr
- Department of Allergy and Immunology, The Children's Hospital at Westmead, SCHN, Sydney, NSW, Australia
| | - Constance Katelaris
- Camden and Campbelltown Hospital, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Brynn Wainstein
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Betina Altavilla
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Rebecca Saad
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Carolina Valerio
- Department of Allergy and Immunology, The Children's Hospital at Westmead, SCHN, Sydney, NSW, Australia
| | - Miriam Codarini
- Camden and Campbelltown Hospital, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Pamela Burton
- Camden and Campbelltown Hospital, Sydney, NSW, Australia
| | - Fiona Perram
- Camden and Campbelltown Hospital, Sydney, NSW, Australia
| | - Karl Baumgart
- Immunology, Douglass Hanly Moir Pathology, Sydney, NSW, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Sydney Medical School, Sydney University, Sydney, NSW, Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, The Children's Hospital at Westmead, SCHN, Sydney, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Abrams EM, Simons E, Gerdts J, Nazarko O, Povolo B, Protudjer JLP. "I want to really crack this nut": an analysis of parent-perceived policy needs surrounding food allergy. BMC Public Health 2020; 20:1194. [PMID: 32738893 PMCID: PMC7395383 DOI: 10.1186/s12889-020-09309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Orla Nazarko
- Participant Advisory Committee to J Protudjer, Winnipeg, MB, Canada
| | - Beatrice Povolo
- Advocacy and Media Relations, Food Allergy Canada, Toronto, ON, Canada
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Protudjer JLP, Mikkelsen A. Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring. BMC Pediatr 2020; 20:341. [PMID: 32650748 PMCID: PMC7350184 DOI: 10.1186/s12887-020-02236-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Vegan diets - defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).
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Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
| | - Andrea Mikkelsen
- Paediatric Primary Health Care Clinics of Västra Götaland, Västra Götaland, Sweden
- Research and Development Primary Health Care, Gothenburg and Södra Bohuslän, Region Västra Götaland, Sweden
- Institute of Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chan ES, Dinakar C, Gonzales-Reyes E, Green TD, Gupta R, Jones D, Wang J, Winders T, Greenhawt M. Unmet needs of children with peanut allergy: Aligning the risks and the evidence. Ann Allergy Asthma Immunol 2020; 124:479-486. [PMID: 32007568 DOI: 10.1016/j.anai.2020.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/05/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventive measures. OBJECTIVE To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. METHODS Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions after unintentional peanut exposures. RESULTS The following key unmet needs in the prevention and management of peanut allergy were identified: (1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy, (2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice, and (3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for unintentional exposures that provoke severe reactions. Practitioners should help educate caregivers about the actual risks associated with peanut allergy and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. CONCLUSION There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.
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Affiliation(s)
- Edmond S Chan
- BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | | | | | - Todd D Green
- UPMC Children's Hospital of Pittsburgh, Pennsylvania; DBV Technologies, Montrouge, France
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern Medicine Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H Lurie Children's Hospital of Chicago, Illinois
| | | | - Julie Wang
- The Mount Sinai Hospital, New York, New York
| | | | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
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McWilliam V, Peters RL, Allen KJ, Dharmage SC, Ponsonby AL, Tang ML, Smart J, Perrett K, Tey D, Robinson M, Taranto M, Koplin JJ, Gurrin LC, Dwyer T, Lowe A, Wake M, Robertson C, Sawyer S, Patton G, Douglass J, Vuillermin P. Skin Prick Test Predictive Values for the Outcome of Cashew Challenges in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:141-148.e2. [DOI: 10.1016/j.jaip.2019.05.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
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The Prevalence of Food Allergy in Young Israeli Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2782-2789.e4. [DOI: 10.1016/j.jaip.2019.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023]
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Protudjer JLP, Middelveld R, Dahlén SE, Ahlstedt S. Food allergy-related concerns during the transition to self-management. Allergy Asthma Clin Immunol 2019; 15:54. [PMID: 31507642 PMCID: PMC6727333 DOI: 10.1186/s13223-019-0370-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background Compared to non-allergic individuals, food allergic individuals have impaired health-related quality of life (HRQL). However, effects of gender and age are unclear. The objective of our study was to describe associations between allergies to common foods and HRQL with consideration to gender and age. Methods Adolescents and adults (N = 137; 49.6% males) with specialist-diagnosed allergy to milk, egg and/or wheat completed age-appropriate versions of the Food Allergy Quality of Life Questionnaire (FAQLQ). We pooled common questions and calculated overall- and domain-specific HRQL in association with number and severity of symptoms and time elapse since worst reaction. Results In the entire study population, HRQL was not affected by gender or age, whereas gender-specific age categories affected HRQL among males only. For example, males 18–39 years had worse overall- (β = 0.77; 95% CI 0.08–1.45) and domain-specific HRQL vs. males < 18 years. Among participants with 1–3 food allergy symptoms, no associations were found. Among participants with 4–6 symptoms, the domain allergen avoidance and dietary restrictions was worse among older participants (e.g. 40+ years: β = 0.71; 95% CI 0.05–1.37 vs. < 18 years), and males 18–39 vs. < 18 years. Among participants with severe symptoms, females vs. males, and participants 18–39 vs. < 18 years had worse HRQL. At least 4 years since worst reaction was associated with worse HRQL for participants 40+ years vs. < 18 years, and older males vs. males < 18 years. Nearly all differences exceeded the clinical relevance threshold of ≥ 0.5. Conclusions Associations between allergies to common foods and HRQL are affected by gender and age. Most affected are males 18–39 years. Among females, HRQL is more stable across age groups.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,2Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,4The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Roelinde Middelveld
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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The many flavors of pineapple reactions. Ann Allergy Asthma Immunol 2019; 123:519-521. [PMID: 31400465 DOI: 10.1016/j.anai.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
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Miller RL, Shtessel M, Robinson LB, Banerji A. Advances in drug allergy, urticaria, angioedema, and anaphylaxis in 2018. J Allergy Clin Immunol 2019; 144:381-392. [PMID: 31247266 DOI: 10.1016/j.jaci.2019.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Maria Shtessel
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lacey B Robinson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
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Bedolla-Pulido T, Bedolla-Barajas M, Morales-Romero J, Bedolla-Pulido T, Domínguez-García M, Hernández-Colín D, Flores-Merino M. Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors. Allergol Immunopathol (Madr) 2019; 47:246-253. [PMID: 30503670 DOI: 10.1016/j.aller.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/16/2018] [Accepted: 09/04/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The prevalence of food allergy is on the rise on a global scale. OBJECTIVE To determine the prevalence of food hypersensitivity (FHS) and probable food allergy (PFA), as well as the foods and factors associated with these occurrences. METHODS A cross-sectional study was carried out among 1992 adolescents (aged 15-18 years). Each adolescent answered a structured questionnaire. A multivariate analysis was used to identify the association between the variables. RESULTS The prevalence of FHS was 10.6% (the most commonly associated foods were shrimp, cow's milk and avocado) and the PFA was 7.8% (shrimp, cow's milk and pecan). The prevalences of oral allergy syndrome, food-associated urticaria and systemic reaction were 4.9%, 3.6% and 1.5%, respectively. The following factors were associated with FHS: personal history of asthma (OR 1.63; 95% CI: 1.11-2.41), allergic rhinitis (OR 2.60; 95% CI: 1.75-3.87), atopic dermatitis (OR 2.07; 95% CI: 1.25-3.43), maternal history of asthma (OR 1.80; 95% CI: 1.02-3.16), atopic dermatitis (OR 6.11; 95% CI: 2.45-15.29), and female sex (OR 1.89; 95% CI: 1.38-2.59). PFA was associated with a personal history of asthma (OR 1.65; 95% CI: 1.06-2.56), allergic rhinitis (OR 2.46; 95% CI: 1.56-3.88), atopic dermatitis (OR 2.02; 95% CI: 1.15-3.54), paternal allergic rhinitis (OR 2.52; 95% CI: 1.15-5.51), maternal atopic dermatitis (OR 7.46; 95% CI: 2.93-19.00), and female sex (OR 1.89; 95% CI: 1.31-2.72). CONCLUSION The adverse reactions associated with foods among late adolescents are a frequent occurrence, and the most commonly associated factor is atopy.
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Ziyab AH. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: A cross-sectional study. World Allergy Organ J 2019; 12:100024. [PMID: 30976380 PMCID: PMC6441753 DOI: 10.1016/j.waojou.2019.100024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/25/2018] [Accepted: 03/11/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Food allergy (FA) is a common public health problem that affects both children and adults. Empirical knowledge of the burden of FA in Kuwait is limited. This study sought to estimate the prevalence of FA among schoolchildren in Kuwait and assess associations between FA and the coexistence and severity of asthma, rhinitis, and eczema. METHODS Schoolchildren aged 11-14 years (n = 3,864) were enrolled in a cross-sectional study. Parents completed questionnaires regarding their children's early life exposures and clinical history of FA and allergic diseases. Study-defined FA was ascertained by a convincing clinical history. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. RESULTS The 12-month prevalence of study-defined FA was estimated to be 4.1% (154/3,738), with more girls being affected than boys (aPR = 1.44, 95% CI: 1.04-1.99). Egg (2.7%), fish (1.6%), shellfish (1.3%), peanut (1.3%), and tree nut (1.2%) were the most reported offending food allergens. Underweight and adiposity, cesarean section delivery, exposure to household dogs during infancy, and parental history of doctor-diagnosed FA were associated with an increased prevalence of study-defined FA. However, later birth order was associated with a reduced prevalence of study-defined FA. The prevalence of eczema only was higher in children with study-defined FA than in those without study-defined FA (aPR = 3.49, 95% CI: 2.37-5.14). In contrast, this association was not pronounced for children who had asthma only (aPR = 1.56, 95% CI: 0.94-2.57) or rhinitis only (aPR = 1.40, 95% CI: 0.86-2.28). Study-defined FA was associated with a 9.20-fold (95% CI: 4.50-18.78) higher prevalence of coexisting asthma, rhinitis, and eczema. Moreover, study-defined FA was associated with increased severity of symptoms of asthma, rhinitis, and eczema. CONCLUSIONS FA affects a considerable proportion of schoolchildren in Kuwait, and the most reported offending food allergens are similar to those reported in Western countries. Study-defined FA was associated with the coexistence and increased severity of asthma, rhinitis, and eczema, indicating that FA may link the comanifestations of allergic diseases and contribute to their chronicity and severity.
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Kim YH, Kim KW, Lee SY, Koo KO, Kwon SO, Seo JH, Suh DI, Shin YH, Ahn K, Oh SY, Lee S, Sohn MH, Hong SJ. Maternal Perinatal Dietary Patterns Affect Food Allergy Development in Susceptible Infants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2337-2347.e7. [PMID: 30930272 DOI: 10.1016/j.jaip.2019.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The increasing incidence of food allergy (FA) can be attributed to interactions between genes and the environment, but these interactions are not yet fully clear. OBJECTIVE We aimed to evaluate the interaction between infant genetic variations and maternal dietary patterns to identify risk factors in the development of FA. METHODS We used the Cohort for Childhood Origin of Asthma and allergic diseases birth cohort of 1628 infants, born between 2007 and 2015. Maternal dietary intakes were assessed at 26 weeks of pregnancy using a food frequency questionnaire and grouped according to 5 dietary patterns. Infant cord blood samples were genotyped at 12 loci. RESULTS Among 1628 infants, 147 (9.0%) were diagnosed with FA based on history. A maternal confectionery diet characterized by a higher intake of baked and sugary products during pregnancy was associated with a higher prevalence of FA (adjusted odds ratio [OR] = 1.517, P = .02); this dietary pattern tended to be higher in trans fat (r = 0.498, P < .001). Development of FA was associated with longer periods of breastfeeding (adjusted OR = 1.792, P = .03), and this dietary pattern was more significantly related to the development of FA in infants with the homozygous TT genotype of CD14 (rs2569190) and more than 1 copy of GSTM1 and GSTT1. CONCLUSIONS A maternal confectionery diet during pregnancy that majorly consists of baked and sugary products, combined with a longer ensuing period of breastfeeding, may lead to the development of FA, suggesting a harmful effect of trans fats in the infant. Polymorphisms in CD14 and GST in the infant influence FA susceptibility.
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Affiliation(s)
- Yoon Hee Kim
- Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea; Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea; Department of Pediatrics, Severance Hospital, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeong Ok Koo
- Department of Food and Nutrition, Research Institute of Human Ecology, Kyung Hee University, Seoul, Korea
| | - Sung-Ok Kwon
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dangook University Hospital, Cheonan, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Young Oh
- Department of Food and Nutrition, Research Institute of Human Ecology, Kyung Hee University, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Myung Hyun Sohn
- Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea; Department of Pediatrics, Severance Hospital, Seoul, Korea.
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Elegbede CF, Papadopoulos A, Just J, Moneret-Vautrin DA, Deschildre A, Crépet A. Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey. Clin Exp Allergy 2019; 49:677-689. [PMID: 30689235 DOI: 10.1111/cea.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach. OBJECTIVE To develop a threshold dose distribution curve model from routinely collected data. METHODS The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach. RESULTS Patients were mainly children (mean age: 9 years [IQR: 6-11]; 87% < 16 years) and males (62%). Median Ara h2 s IgE was of 8kUA/L [IQR: 1-55] and median skin prick test size of 10 mm [IQR: 7-13]. OFC was positive in 204 patients (86%). The median threshold dose was of 67 mg of peanut protein [IQR: 16-244]. The dose at which 1% of the patients are likely to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein. Gender, size of the skin prick test (SPT) and Ara h 2 specific IgE level had a significant impact on the threshold dose distribution curve. The Cox model was the most effective to predict threshold doses with this combination of factors. Girls react to lower doses than boys with a beta coefficient associated to the risk and a 95% credible interval of 0.44 [0.04; 0.77]. The higher the size of the SPT and the Ara h 2 specific IgE level are, the higher the risk of reacting to a small amount of peanut, with beta coefficients associated to the risk and 95% credible intervals of 0.05 [0.02; 0.08] and 0.01 [0.01; 0.02], respectively. CONCLUSION AND CLINICAL RELEVANCE According to the model, routinely collected data could be used to estimate the threshold dose. The consequences could be the identification of high-risk patients who are susceptible to react to small amounts of peanut and a personalized management of peanut allergy integrating the risk of allergic reaction. Limitations of this study are that assessors of OFC outcome were aware of SPT and Arah2 results, and a further validation study is required to confirm the predictive value of these parameters.
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Affiliation(s)
- Chabi Fabrice Elegbede
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France.,French National Institute for Agricultural Research (INRA), Paris Institute of Technology for Life, Food and Environmental Sciences (AgroParisTech), UMR Economie Publique INRA-AgroParisTech, Thiverval-Grignon, France
| | - Alexandra Papadopoulos
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
| | - Jocelyne Just
- Asthma and Allergy Center, Hôpital d'Enfants Armand-Trousseau, Paris, France.,INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - Denise Anne Moneret-Vautrin
- Allergy Department, Centre Hospitalier E Durckheim, Epinal, France.,Allergyvigilance Network, Vandoeuvre les Nancy, France.,Lorraine University, Nancy, France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | - Amélie Crépet
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
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Vale S, Netting MJ, Ford LS, Tyquin B, McWilliam V, Campbell DE. Anaphylaxis management in Australian schools: Review of guidelines and adrenaline autoinjector use. J Paediatr Child Health 2019; 55:143-151. [PMID: 30523652 DOI: 10.1111/jpc.14307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022]
Abstract
Food allergy and anaphylaxis is increasing in Australian children, and anaphylaxis is relatively common in Australian schools. This review aims to provide an overview of current policies and practices for anaphylaxis management in Australian schools, including approaches to risk mitigation and anaphylaxis training. We reviewed literature related to anaphylaxis training in the school setting published between 2010 and 2018. Current anaphylaxis policies/guidelines were obtained from Australian education and health departments, and reports of suspected anaphylaxis and adrenaline autoinjector (AAI) use for 2016-2017 were obtained from education departments where available. Our review of policies/guidelines across Australian jurisdictions indicates inconsistent approaches to anaphylaxis management training. Almost half of Australian school anaphylaxis events required a general-use AAI, administered to students not identified as at risk of anaphylaxis. Development of clear, evidence-based, consistent guidelines related to anaphylaxis management and training in the school setting is imperative to minimise risk.
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Affiliation(s)
- Sandra Vale
- National Allergy Strategy, Sydney, New South Wales, Australia.,Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Merryn J Netting
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia.,Healthy Mothers Babies and Children's Theme, South Australian Health Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Nutrition Department, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Lara S Ford
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia.,Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Briony Tyquin
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW This review aims to provide an update of recent advances in the epidemiology, clinical features and diagnosis, and management of food-induced anaphylaxis (FIA). RECENT FINDINGS Food allergy prevalence and FIA rates continue to rise, but FIA fatalities are stable. Basophil and mast cell activation tests promise more accurate identification of food triggers. Oral, sublingual, and epicutaneous immunotherapy can desensitize a significant portion of subjects. Epinephrine use for FIA remains sub-optimal. As the burden of food allergy continues to increase, it appears that the corresponding increase in research focused on this epidemic is beginning to bear fruit. The stable number of FIA fatalities in the face of an ongoing epidemic indicates lives have already been saved. The emergence of new diagnostic tests and interventional therapies may transform the management of FIA in the coming years.
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Affiliation(s)
- Christopher P Parrish
- Department of Pediatrics and Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9063, USA.
| | - Heidi Kim
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
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