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Abstract
Anaphylaxis is a systemic allergic reaction that may be severe and life-threatening. With more than a dozen anaphylaxis definitions proposed over the past several decades and several diagnostic criteria in circulation, there is a need for a multinational consensus definition to simplify management across specialties. Anaphylaxis diagnostic criteria are more alike than they are different, and approaches of the National Institute of Allergy and Infectious Disease, World Allergy Organization, and Brighton Collaborative help to add granularity and perspective to patient management. Anaphylaxis occurs across a spectrum of severity within populations, although, among individual patients, there is some evidence to suggest more consistency for an individual allergen. Still, severity is influenced by a number of factors that demonstrate variability: factors that relate to allergen triggers, patient characteristics, and treatments received. Severity of anaphylaxis impacts management, and recent guidelines provide approaches that consider individual factors to inform both strong and conditional recommendations. Conditional recommendations serve as navigational signals for shared decision-making when patient expertise is leveraged to inform individual preferences and values together with clinician expertise in anaphylaxis management to provide patient care bespoke to each patient. As novel approaches to both prevention and treatment of anaphylaxis emerge, an understanding of the significance of strong and conditional recommendations becomes critical to providing individualized and appropriate care for patients at risk for anaphylaxis.
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Affiliation(s)
- Marcus S Shaker
- From the Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; and
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Santos AF, Worm M, Kurita S, Wong T, Contato D, Pirillo E, Esteban AE, Tassinari P, Perna F, Chinthrajah RS. Living with food allergies: the experiences of adult patients and caregivers. FRONTIERS IN ALLERGY 2023; 4:1272851. [PMID: 38026132 PMCID: PMC10658712 DOI: 10.3389/falgy.2023.1272851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Few studies have addressed how food allergy may impact differently on the daily lives of adults with food allergies and caregivers for food-allergic dependents. Objective To explore similarities and differences in life experiences and unmet needs between individuals caring for a child with food allergy and adults with food allergy world-wide. Methods Two multinational, virtual, interactive, moderated discussions of specific questions between respectively people with food allergies and caregivers for people with food allergies, with experienced clinicians participating. Results Sixteen individuals living with food allergies and nine caregivers took part in the two roundtables. Food avoidance and antihistamines were the most common treatments for food-allergic reactions in both groups. Caregivers reported greater burden of disease on affected individuals and families than did adult patients. Adult panelists considered autoinjectors easy to use but caregivers reported additional emotional stress thinking about autoinjector use. Caregivers described an ever-present fear of inattention and of overlooking a risk factor for a severe reaction, whereas adult panelists showed a determination not to let their food allergies interfere with living their lives. Both groups had safety-conscious attitudes to treatments, but adult patients emphasized convenience while caregivers prioritized reduced severity of reactions and eliminated fear. Both groups confirmed the need for improved, trusted sources of information, and for resources and training programs for any new therapies. Conclusion The interactive exchange provided insights into differences between adult patients and caregivers, notably in fear and confidence in daily life, severity of disease impact, and unmet needs for treatments.
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Affiliation(s)
- Alexandra F. Santos
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Children’s Allergy Service, Evelina London Children’s Hospital, London, United Kingdom
| | - Margitta Worm
- Division of Allergology and Dermatology, Charité, Berlin, Germany
| | - Shoko Kurita
- Japanese Mother’s Society for Allergy Care (JMSAC), Kanagawa, Japan
| | - Tania Wong
- Allergy & Anaphylaxis Australia, Castle Hill, NSW, Australia
| | | | | | - A. Esther Esteban
- Spanish Association for People with Food and Latex Allergy (AEPNAA), Madrid, Spain
| | | | | | - R. Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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Vickers AJ, Assel M, Hannon M, Desai P, Carlsson SV, McCready T, Cracchiolo J, Simon B. A comparison of brief versus explicit descriptors for verbal rating scales: interrupted time series design. Health Qual Life Outcomes 2023; 21:105. [PMID: 37705045 PMCID: PMC10498613 DOI: 10.1186/s12955-023-02184-0] [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: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Verbal rating scales (VRS) are widely used in patient-reported outcome (PRO) measures. At our institution, patients complete an online instrument using VRSs with a five-point brief response scale to assess symptoms as part of routine follow-up after ambulatory cancer surgery. We received feedback from patients that the brief VRS descriptors such as "mild" or "somewhat" were vague. We added explicit descriptors to our VRSs, for instance, "Mild: I can generally ignore my pain" for pain severity or "Somewhat: I can do some things okay, but most of my daily activities are harder because of fatigue" for fatigue interference. We then compared responses before and after this change was made. METHODS The symptoms investigated were pain, fatigue and nausea. Our hypothesis was that the explicit descriptors would reduce overall variance. We therefore compared the coefficient of variation of scores and tested the association between symptoms scores and known predictors thereof. We also compared time to completion between questionnaires with and without the additional descriptors. RESULTS A total of 17,500 patients undergoing 21,497 operations were assigned questionnaires in the period before the descriptors were added; allowing for a short transition period, 1,417 patients having 1436 operations were assigned questionnaires with the additional descriptors. Symptom scores were about 10% lower with the additional descriptors but the coefficient of variation was slightly higher. Moreover, the only statistically significant difference between groups for association with a known predictor favored the item without the additional language for nausea severity (p = 0.004). Total completion time was longer when the instrument included the additional descriptors, particularly the first and second time that the questionnaire was completed. CONCLUSIONS Adding descriptors to a VRS of post-operative symptoms did not improve scale properties in patients undergoing ambulatory cancer surgery. We have removed the additional descriptors from our tool. We recommend further comparative psychometric research using data from PROs collected as part of routine clinical care.
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Affiliation(s)
- Andrew J Vickers
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA.
| | - Melissa Assel
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Michael Hannon
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Priyanka Desai
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Sigrid V Carlsson
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
- Department of Urology, (SC) Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Taylor McCready
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Jennifer Cracchiolo
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Brett Simon
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
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Höfer V, Martini M, Dölle-Bierke S, Worm M, Bilò MB. Health-related quality of life in food and venom induced anaphylaxis and role of influencing factors. Clin Exp Allergy 2023; 53:295-306. [PMID: 36565032 DOI: 10.1111/cea.14268] [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: 08/09/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/25/2022]
Abstract
The impact on health-related quality of life (HRQL) plays a key role for patients suffering from allergies and anaphylaxis. In this narrative review we review the HRQL in allergic patients suffering from food and venom allergy, both being the most frequent elicitors of severe allergic, potential life-threatening reactions and provide an overview on the current knowledge and identified gaps. The data show that for food and venom allergy standardized assessment tools to measure HRQL are available and have been successfully applied. Our analysis shows that multiple factors can modulate HRQL in these patient groups. These include sociodemographic data like patients' age and sex, fear of accidental reactions but also external factors like the social environment and the appreciation of the seriousness of the condition by others. External factors may have a significant impact on HRQL and should be considered in patient-related outcome assessments to avoid biased measurements possibly affecting the results. The assessment of the quality of life in the context of specific immunotherapy should consider lifestyle factors and ideally, the individual change in HRQL should be measured. Although there are many data indicating a negative impact on HRQL in food allergic children and their caregivers, limited data are existing from adults with food allergy and venom allergic patients from all age groups. Also, the use of standardized questionnaires should be extended to allow for a better comparability of results between studies. Therefore, translation to additional languages is necessary. Taken together, the eliciting allergen, the severity of the allergic disease but moreover multiple external factors impact the outcome in HRQL and should be considered in HRQL assessment.
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Affiliation(s)
- Veronika Höfer
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matteo Martini
- Allergy Unit, Ospedali Riuniti Marche Nord, Fano, Italy.,Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.,Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
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