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Jiang N, Xu W, Huang H, Hou X, Xiang L. Anaphylaxis in Chinese Children with Pollen Sensitization: Triggers, Clinical Presentation, and Acute Management. J Asthma Allergy 2022; 15:633-643. [PMID: 35603012 PMCID: PMC9122664 DOI: 10.2147/jaa.s363113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Pollen sensitization is increasing in children. However, there is little evidence regarding the characteristics of anaphylaxis in individuals with pollen sensitization. Patients and Methods We conducted a retrospective study of patients with anaphylaxis combined with pollen sensitization who attended an allergy department in a tertiary children’s hospital from 2014 to 2021. Results A total of 157 anaphylaxis events in 108 patients were analyzed; the mean age at the reaction was 5.8 ± 4.17 years. A total of 99.1% (107/108) of the patients came from northern China. The most common sensitizing pollen was mugwort (93.5%,101/108), followed by ragweed (68.5%, 74/108) and birch (40.7%, 44/108). A total of 76.9% (83/108) of the patients showed polysensitization to pollen. Allergic rhinitis/conjunctivitis was the most common comorbidity (87.0%, 94/108). Children with severe anaphylaxis were more likely to have a history of recurrent urticaria (16.1% vs 3.9%, p = 0.028). The most frequently implicated foods were fruits/vegetables (22.3%, 35/157), followed by wheat (8.9%, 14/157) and milk (8.3%, 13/157), and the most common fruit allergen was peach (n = 7). Of 14% (22/157) exercise-induced reactions, 63.6% (14/22) occurred in pollen season. Skin symptoms were the most frequent (86.0%, 135/157) symptoms, followed by respiratory (73.9%, 116/157) and gastrointestinal (21%, 33/157) symptoms. Regarding acute management, only 7.4% of the patients were treated with epinephrine. Conclusion Our findings revealed the characteristics of anaphylaxis in children with pollen sensitization. Fruits/vegetables accounted for a substantial percentage of anaphylaxis triggers. The suboptimal use of epinephrine highlights the need for educational programs promoting the use of epinephrine.
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Affiliation(s)
- Nannan Jiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Wei Xu
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Huijie Huang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Xiaoling Hou
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Li Xiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Correspondence: Li Xiang, Department of Allergy, Beijing Children’s Hospital, Capital Medical University, National Center for Children′s Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, People’s Republic of China, Tel +861059616934, Fax +861059616934, Email
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Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Abrams EM, Simons E, Ben-Shoshan M. Fruit-Induced Anaphylaxis: Clinical Presentation and Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2825-2830.e2. [PMID: 33727108 DOI: 10.1016/j.jaip.2021.02.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
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Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, QC, Canada
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, ON, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Moisan
- Emergency Medical Services of Outaouais, Outaouais, QC, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, 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] [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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Klingebiel C, Chantran Y, Arif‐Lusson R, Ehrenberg AE, Östling J, Poisson A, Liabeuf V, Agabriel C, Birnbaum J, Porri F, Sarrat A, Apoil P, Vivinus M, Garnier L, Chiriac AM, Caimmi D, Bourrain J, Demoly P, Guez S, Boralevi F, Lovato B, Palussière C, Leroy S, Bourrier T, Giovannini‐Chami L, Gouitaa M, Aferiat‐Derome A, Charpin D, Sofalvi T, Cabon‐Boudard I, Massabie‐Bouchat Y, Hofmann B, Bonardel N, Dron‐Gonzalvez M, Sterling B, Carsin A, Vivinus S, Poitevin B, Nicolau L, Liautard G, Soler C, Mezouar S, Annesi‐Maesano I, Mège J, Lidholm J, Vitte J. Pru p 7 sensitization is a predominant cause of severe, cypress pollen‐associated peach allergy. Clin Exp Allergy 2019; 49:526-536. [DOI: 10.1111/cea.13345] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/11/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | - Yannick Chantran
- UPMC Univ Paris 06 INSERM UMRS 938 Centre de Recherche Saint‐Antoine, team “Immune System, Neuroinflammation and Neurodegenerative Diseases” Hôpital Saint‐Antoine Sorbonne Universités Paris France
- Immunology Department AP‐HP Saint‐Antoine Hospital Paris France
| | - Rihane Arif‐Lusson
- Aix‐Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France
| | | | | | - Alain Poisson
- Service de Pneumo‐Allergologie Hôpital Saint Joseph Marseille France
| | - Valérie Liabeuf
- Aix‐Marseille Univ APHM, Hôpital Timone Service de Dermatologie‐Vénéréologie Marseille France
| | - Chantal Agabriel
- Aix‐Marseille Univ APHM, Hôpital Timone Service de Pédiatrie Multidisciplinaire Marseille France
| | - Joëlle Birnbaum
- Service de Pneumologie et Allergologie CH du Pays d'Aix Aix‐en‐Provence France
| | - Françoise Porri
- Service de Pneumo‐Allergologie Hôpital Saint Joseph Marseille France
| | - Anne Sarrat
- Laboratoire d'Immunologie et Immunogénétique GH Pellegrin CHU Bordeaux Bordeaux France
| | - Pol‐André Apoil
- Institut Fédératif de Biologie Hôpital Purpan, CHU Toulouse Toulouse France
| | - Mylène Vivinus
- Laboratoire d'Immunologie Hôpital de l'Archet CHU Nice Nice France
| | - Lorna Garnier
- Laboratoire d'Immunologie CH Lyon Sud CHU Lyon Pierre‐Bénite France
| | - Anca Mirela Chiriac
- Département de pneumologie et addictologie CHU Montpellier Hôpital Arnaud‐de‐Villeneuve Univ Montpellier Montpellier France
- Sorbonne Universités INSERM UMRS 1136 IPLESP, team EPAR Paris France
| | - Davide‐Paolo Caimmi
- Département de pneumologie et addictologie CHU Montpellier Hôpital Arnaud‐de‐Villeneuve Univ Montpellier Montpellier France
- Sorbonne Universités INSERM UMRS 1136 IPLESP, team EPAR Paris France
| | - Jean‐Luc Bourrain
- Département de pneumologie et addictologie CHU Montpellier Hôpital Arnaud‐de‐Villeneuve Univ Montpellier Montpellier France
| | - Pascal Demoly
- Département de pneumologie et addictologie CHU Montpellier Hôpital Arnaud‐de‐Villeneuve Univ Montpellier Montpellier France
- Sorbonne Universités INSERM UMRS 1136 IPLESP, team EPAR Paris France
| | - Stéphane Guez
- Unité d'allergologie, GH Pellegrin, CHU Bordeaux Bordeaux France
| | - Franck Boralevi
- Unité de Dermatologie Pédiatrique Hôpital Pellegrin‐Enfants, CHU Bordeaux Bordeaux France
| | | | | | - Sylvie Leroy
- Service de Pneumologie Hôpital Pasteur CHU Nice Nice France
| | | | | | - Marion Gouitaa
- Aix‐Marseille Univ APHM, Hôpital Nord Service de Pneumologie Marseille France
| | | | - Denis Charpin
- Aix‐Marseille Univ APHM, Hôpital Timone Unité de Pneumologie Marseille France
| | - Tünde Sofalvi
- Aix‐Marseille Univ APHM, Hôpital Nord Service de Pneumologie Marseille France
| | - Isabelle Cabon‐Boudard
- Aix‐Marseille Univ APHM, Hôpital Timone Service de Chirurgie Pédiatrique Marseille France
| | | | | | | | | | - Benoît Sterling
- Medical Office Marseille France
- Aix‐Marseille Univ APHM, Hôpital Timone Service de Pneumo‐Pédiatrie Marseille France
| | - Ania Carsin
- Aix‐Marseille Univ APHM, Hôpital Timone Service de Pneumo‐Pédiatrie Marseille France
| | - Serge Vivinus
- Service de Pneumologie Hôpital Pasteur CHU Nice Nice France
| | | | | | | | | | - Soraya Mezouar
- Aix‐Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France
| | | | - Jean‐Louis Mège
- Aix‐Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France
| | | | - Joana Vitte
- Aix‐Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France
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Liang S, Wu X, Jin F. Gut-Brain Psychology: Rethinking Psychology From the Microbiota-Gut-Brain Axis. Front Integr Neurosci 2018; 12:33. [PMID: 30271330 PMCID: PMC6142822 DOI: 10.3389/fnint.2018.00033] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
Mental disorders and neurological diseases are becoming a rapidly increasing medical burden. Although extensive studies have been conducted, the progress in developing effective therapies for these diseases has still been slow. The current dilemma reminds us that the human being is a superorganism. Only when we take the human self and its partner microbiota into consideration at the same time, can we better understand these diseases. Over the last few centuries, the partner microbiota has experienced tremendous change, much more than human genes, because of the modern transformations in diet, lifestyle, medical care, and so on, parallel to the modern epidemiological transition. Existing research indicates that gut microbiota plays an important role in this transition. According to gut-brain psychology, the gut microbiota is a crucial part of the gut-brain network, and it communicates with the brain via the microbiota-gut-brain axis. The gut microbiota almost develops synchronously with the gut-brain, brain, and mind. The gut microbiota influences various normal mental processes and mental phenomena, and is involved in the pathophysiology of numerous mental and neurological diseases. Targeting the microbiota in therapy for these diseases is a promising approach that is supported by three theories: the gut microbiota hypothesis, the "old friend" hypothesis, and the leaky gut theory. The effects of gut microbiota on the brain and behavior are fulfilled by the microbiota-gut-brain axis, which is mainly composed of the nervous pathway, endocrine pathway, and immune pathway. Undoubtedly, gut-brain psychology will bring great enhancement to psychology, neuroscience, and psychiatry. Various microbiota-improving methods including fecal microbiota transplantation, probiotics, prebiotics, a healthy diet, and healthy lifestyle have shown the capability to promote the function of the gut-brain, microbiota-gut-brain axis, and brain. It will be possible to harness the gut microbiota to improve brain and mental health and prevent and treat related diseases in the future.
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Affiliation(s)
- Shan Liang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xiaoli Wu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Feng Jin
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Zhou X, Du L, Shi R, Chen Z, Zhou Y, Li Z. Early-life food nutrition, microbiota maturation and immune development shape life-long health. Crit Rev Food Sci Nutr 2018; 59:S30-S38. [PMID: 29874476 DOI: 10.1080/10408398.2018.1485628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current knowledge about early-life nutrition and environmental factors that affect the interaction between the symbiotic microbiota and the host immune system has demonstrated novel regulatory target for treating allergic diseases, autoimmune disorders and metabolic syndrome. Various kinds of food nutrients (such as dietary fiber, starch, polyphenols and proteins) can provide energy resources for both intestinal microbiota and the host. The indigestible food components are fermented by the indigenous gut microbiota to produce diverse metabolites, including short-chain fatty acids, bile acids and trimethylamine-N-oxide, which can regulate the host metabolized physiology, immunity homeostasis and health state. Therefore it is commonly believed early-life perturbation of the microbial community structure and the dietary nutrition interference on the child mucosal immunity contribute to the whole life susceptibility to chronic diseases. In all, the combined interrelationship between food ingredients nutrition, intestinal microbiota configurations and host system immunity provides new therapeutic targets to treat various kinds of pathogenic inflammations and chronic diseases.
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Affiliation(s)
- Xiaoli Zhou
- a Shanghai Institute of Technology , Shanghai , China
| | - Lina Du
- a Shanghai Institute of Technology , Shanghai , China
| | - Ronghua Shi
- a Shanghai Institute of Technology , Shanghai , China
| | - Zhidong Chen
- a Shanghai Institute of Technology , Shanghai , China
| | - Yiming Zhou
- a Shanghai Institute of Technology , Shanghai , China
| | - Zongjie Li
- a Shanghai Institute of Technology , Shanghai , China
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