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Knibb RC. New insights into the incidence and prevalence of food allergy in England. Lancet Public Health 2024; 9:e640-e641. [PMID: 39214633 DOI: 10.1016/s2468-2667(24)00186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Affiliation(s)
- R C Knibb
- Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK.
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2
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Alsulaiman JW, Kheirallah KA, Alrawashdeh A, Saleh T, Obeidat M, Alawneh YJ, Abu Sanad Z, Amayreh W, Alawneh RJ. Risk Stratification of Penicillin Allergy Labeled Children: A Cross-Sectional Study from Jordan. Ther Clin Risk Manag 2024; 20:505-514. [PMID: 39188939 PMCID: PMC11346476 DOI: 10.2147/tcrm.s464511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024] Open
Abstract
Background Implementing allergy testing among children with a reported history of penicillin allergy could be challenging, particularly in developing countries with limited resources. This study screened and risk-stratified the likelihood of true penicillin allergy among children labeled with penicillin allergy in Jordan. Methods A web-based survey, completed by parents, assessed history, type, and severity of penicillin allergic reactions, including age at diagnosis, symptoms, time to the reaction, reaction's course and resolution, and received medical evaluation/testing. Low-risk allergic symptoms were defined as vomiting, diarrhea, headache, dizziness, itching, rash, cough, or runny nose without evidence of anaphylaxis or severe cutaneous reactions. Results A total of 530 parents of "penicillin allergy"-labeled children completed the survey. Of these, 86.4% reported allergic reactions to penicillin and 13.6% reported avoidance of penicillin due to family history. Among the former, 52.2% were male, 67.3% were three years old or younger when the reported reaction was established, and 68.3% experienced exclusively low-risk symptoms. Overall, skin rash was the most reported symptom (86.0%). High-risk symptoms were reported in 31.5% of children. About two-thirds (64.0%) of children were reported to have experienced symptoms after the first exposure to penicillin. The most common indication for antibiotic use was a throat infection (63.8%). Asthma comorbidity was significantly higher among high-risk (24.8%) compared low-risk group (11.5%). Conclusion In Jordan, many parent-reported penicillin allergic reactions seem to be clinically insignificant and unlikely to be verifiable, which can adversely affect patients' care and antimicrobial stewardship. An appropriate clinical history/evaluation is a key step in identifying true immunoglobulin E-mediated allergic reactions and risk stratifying patients for either de-labeling those with obviously non-immune-mediated reactions or identifying candidates for direct oral challenge test.
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Affiliation(s)
- Jomana W Alsulaiman
- Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Khalid A Kheirallah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Alrawashdeh
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Saleh
- Department of Pharmacology and Public Health, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Maha Obeidat
- Department of Pediatrics, Princess Rahma Teaching Hospital, Irbid, Jordan
| | - Yareen J Alawneh
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziydoun Abu Sanad
- Department of Pediatrics, Princess Rahma Teaching Hospital, Irbid, Jordan
| | - Wajdi Amayreh
- Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Rama J Alawneh
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Maurer M, Pereira MP, Kolkhir P. The Definition, Classification, and History of Urticaria. Immunol Allergy Clin North Am 2024; 44:407-419. [PMID: 38937006 DOI: 10.1016/j.iac.2024.03.001] [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] [Indexed: 06/29/2024]
Abstract
The term "urticaria" was first introduced by William Cullen in the eighteenth century. Urticaria is a common mast cell-mediated cutaneous disease presenting with pruritic wheals, angioedema, or both. It is classified as acute (≤6 weeks) or chronic (>6 weeks) and as spontaneous (no definite triggers) or inducible (definite and subtype-specific triggers). The international urticaria guideline on the definition, classification, diagnosis, and management of urticaria is revised every 4 years. The global network of Urticaria Centers of Reference and Excellence, the biggest and most active consortium of urticaria specialists, offers physicians and patients several research, educational, and digital care initiatives.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
| | - Manuel P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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Braun C, Mazenq J, Eigenmann P, Kalayci O, Tanno L. Editorial comments on "Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report". Pediatr Allergy Immunol 2024; 35:e14210. [PMID: 39099145 DOI: 10.1111/pai.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/08/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Camille Braun
- Department of Pediatrics, Pulmonology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, ENS de Lyon, Lyon, France
| | - Julie Mazenq
- APHM - Pediatric Pulmonology Department, Aix-Marseille University, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Omer Kalayci
- Department of Pediatric Allergy and Asthma, Hacettepe University School of Medicine, Ankara, Turkey
| | - Luciana Tanno
- University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier - INSERM, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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5
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Maurer M, Albuquerque M, Boursiquot JN, Dery E, Giménez-Arnau A, Godse K, Guitiérrez G, Kanani A, Lacuesta G, McCarthy J, Nigen S, Winders T. A Patient Charter for Chronic Urticaria. Adv Ther 2024; 41:14-33. [PMID: 37991694 PMCID: PMC10796664 DOI: 10.1007/s12325-023-02724-6] [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: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
Chronic urticaria (CU) is the recurring development of wheals (aka "hives" or "welts"), angioedema, or both for more than 6 weeks. Wheals and angioedema occur with no definite triggers in chronic spontaneous urticaria, and in response to known and definite physical triggers in chronic inducible urticaria. Approximately 1.4% of individuals globally will have CU during their lifetime. The itching and physical discomfort associated with CU have a profound impact on daily activities, sexual function, work or school performance, and sleep, causing significant impairment in a patient's physical and mental quality of life. CU also places a financial burden on patients and healthcare systems. Patients should feel empowered to self-advocate to receive the best care. The voice of the patient in navigating the journey of CU diagnosis and management may improve patient-provider communication, thereby improving diagnosis and outcomes. A collaboration of patients, providers, advocacy organizations, and pharmaceutical representatives have created a patient charter to define the realistic and achievable principles of care that patients with CU should expect to receive. Principle (1): I deserve an accurate and timely diagnosis of my CU; Principle (2): I deserve access to specialty care for my CU; Principle (3): I deserve access to innovative treatments that reduce the burden of CU on my daily life; Principle (4): I deserve to be free of unnecessary treatment-related side-effects during the management of my CU; and Principle (5): I expect a holistic treatment approach to address all the components of my life impacted by CU. The stated principles may serve as a guide for healthcare providers who care for patients with CU and translate into better patient-physician communication. In addition, we urge policymakers and authors of CU treatment guidelines to consider these principles in their decision-making to ensure the goals of the patient are achievable.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | | | - Elaine Dery
- Canadian Chronic Urticaria Society, Quebec City, Canada
| | - Ana Giménez-Arnau
- Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Amin Kanani
- University of British Columbia, Vancouver, Canada
| | | | | | - Simon Nigen
- Montreal General Hospital, McGill University, Montreal, Canada
| | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria.
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Ryan D, Tanno LK, Angier E, Clark E, Price D, Zuberbier T, Maurer M. Clinical review: The suggested management pathway for urticaria in primary care. Clin Transl Allergy 2022; 12:e12195. [PMID: 36225262 PMCID: PMC9533216 DOI: 10.1002/clt2.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Urticaria is a common condition presenting both as acute and chronic disease within primary care. To those without specialist training it is poorly understood from the points of view of diagnosis and management. It causes a considerable disease burden to sufferers with marked impact on quality of life. Purpose of this review The recent publication of the EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria guideline prompted us to take this excellent resource and re-configure its findings and recommendations to a non-specialist audience with particular reference to the needs of the primary care team.
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Affiliation(s)
- Dermot Ryan
- Usher InstituteUniversity of EdinburghMedical SchoolEdinburghUK
| | - Luciana K. Tanno
- Department of AllergyUniversity Hospital of MontpellierMontpellierFrance
- Institut Desbrest d’Epidémiologie et de Santé PubliqueIDESPUniversity of Montpellier – INSERMMontpellierFrance
- WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Evangéline Clark
- Department of DermatologyMontpellier University HospitalMontpellierFrance
| | - David Price
- Observational and Pragmatic Research InstituteSingaporeSingapore
- Centre of Academic Primary Care, Division of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
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Ryan D, Flokstra – de Blok BMJ, Clark E, Gaudin C, Mamodaly M, Kocks J, van der Velde JL, Angier L, Romberg K, Gawlik R, Demoly P, Tanno LK. Allergic and hypersensitivity conditions in non-specialist care: Flow diagrams to support clinical practice. Allergy 2022; 77:2618-2633. [PMID: 35266160 PMCID: PMC9543313 DOI: 10.1111/all.15273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
Most patients presenting with allergies are first seen by primary care health professionals. The perceived knowledge gaps and educational needs were recently assessed in response to which the LOGOGRAM Task Force was established with the remit of constructing pragmatic flow diagrams for common allergic conditions in line with an earlier EAACI proposal to develop simplified pathways for the diagnosis and management of allergic diseases in primary care. To address the lack of accessible and pragmatic guidance, we designed flow diagrams for five major clinical allergy conditions: asthma, anaphylaxis, food allergy, drug allergy, and urticaria. Existing established allergy guidelines were collected and iteratively distilled to produce five pragmatic and accessible tools to aid diagnosis and management of these common allergic problems. Ultimately, they should now be validated prospectively in primary care settings.
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Affiliation(s)
- Dermot Ryan
- Usher InstituteUniversity of EdinburghEdinburghUK
| | - Bertine M. J. Flokstra – de Blok
- General Practitioners Research Institute (GPRI)GroningenThe Netherlands,University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands,Department of Pediatric Pulmonology and Pediatric AllergologyUniversity of GroningenUniversity Medical Center GroningenBeatrix Children's HospitalGroningenThe Netherlands
| | | | | | | | - Janwillem Kocks
- General Practitioners Research Institute (GPRI)GroningenThe Netherlands,Observational and Pragmatic Research InstituteSingaporeSingapore,University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands
| | - Jantina Lucia van der Velde
- University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands,Department of General PracticeUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Liz Angier
- Primary Care and Population SciencesUniversity of SouthamptonSouthamptonUK
| | - Kerstin Romberg
- Health Care CentreNäsets LäkargruppHöllvikenSweden,Respiratory Medicine and AllergologyClinical Sciences LundLund UniversityLundSweden
| | - Radek Gawlik
- Department of Internal Medicine, Allergology and Clinical ImmunologySilesian University of MedicineKatowicePoland
| | - Pascal Demoly
- University Hospital of MontpellierMontpellierFrance,IDESP, INSERM – UniversityMontpellierFrance,WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
| | - Luciana Kase Tanno
- University Hospital of MontpellierMontpellierFrance,IDESP, INSERM – UniversityMontpellierFrance,WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
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Saleem SS, Khan A, Aman R, Saleem SS, Bibi A, Ahmad N, Mushtaq S, Mehsud S, Green IR, Rashid SA, Khan A, Shah KU. Impact of pharmacist-led educational intervention on knowledge of self-management among asthmatic patients: a prospective cohort study. BMJ Open 2022; 12:e058861. [PMID: 35705337 PMCID: PMC9204400 DOI: 10.1136/bmjopen-2021-058861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Poor control of asthma in the majority of patients could be partly due to their lack of knowledge concerning disease management, its triggering agents and when to seek advice from the healthcare provider. This study aims to assess the impact of pharmacist-led educational intervention on knowledge of self-management among asthmatic patients. DESIGN A pre-post cohort study. SETTING Outpatient department of a tertiary care hospital affiliated with Quaid-i-Azam University, Pakistan. PARTICIPANTS Approximately 265 adult asthmatic patients selected through a spirometry process, aged ≥18 years, were approached. 240 patients gave consent to participate in the study and were divided into control and treatment groups. INTERVENTIONS The educational intervention consisted of individual patient counselling using educational material with time varied according to each patient's comprehension and previous knowledge. PRIMARY AND SECONDARY OUTCOME MEASURES Assessment consisted of a 14-item Asthma Self-Management Knowledge Questionnaire (ASMQ) quantifying a patient's self-management knowledge through an ASMQ score and its change following an educational intervention. RESULTS Disease self-management knowledge was low with an average raw ASMQ score of 4.1 (max 14); which equates to a transformed score of 29.34 (max 100) and the proportion of patients who correctly answered more than 50% of questions were 16.7% preintervention. More than half of the participants (55%) did not know that asthma cannot be cured. The administration of educational intervention protocols resulted in significantly improved level of knowledge of asthma self-management (<0.001) in the treatment group (mean ASMQ score improved from 4.20 to 9.77). CONCLUSION On baseline visit, patients possessed a poor knowledge about asthma self-management. Educational intervention protocols had a positive impact on improving patients' knowledge about disease self-management. This would suggest that education and self-management skills should be seen as an integral component of asthma management and should be incorporated in structured patient care to achieve optimal asthma control.
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Affiliation(s)
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Rubina Aman
- Department of Pulmonology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | - Ayesha Bibi
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Saifullah Mehsud
- Department of Pharmaceutical Sciences, Abbottabad University of Science and Technology, Havelian, Khyber Pakhtunkhwa, Pakistan
| | - Ivan R Green
- Department of Chemistry and Polymer Science, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
| | - Sheikh Abdur Rashid
- Gomal Center of Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, Dera Ismail Khan, Pakistan
| | - Ahmad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Cabrera M, Ryan D, Angier E, Losappio L, Flokstra ‐ de Blok BMJ, Gawlik R, Purushotam D, Bosnic‐Anticevich S. Current allergy educational needs in primary care. Results of the EAACI working group on primary care survey exploring the confidence to manage and the opportunity to refer patients with allergy. Allergy 2022; 77:378-387. [PMID: 34498282 DOI: 10.1111/all.15084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/12/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
The aim of this survey was to explore the specific educational needs of a cohort of European GPs with regards to allergy training so that future educational initiatives may better support the delivery of allergy services in primary care. METHOD This study took the form of a cross-sectional observational study in which a structured electronic questionnaire was distributed to primary care providers, in eight languages, across 8 European countries between September 2019 and November 2019. Data associated with demographic parameters, professional qualifications, type of employment, level of confidence regarding competencies for diagnosis and treatment of allergic diseases, referral of patients to allergist and preferred method of learning and assessment were collected. A 5-point Likert scale was used to assess level of confidence. Exploratory analysis was carried out. RESULTS A total of 687 responses were available for analysis, with 99.3% of responders working within Europe. 70.1% of participants were female; and 48.0% and 48.0% of participants respectively had received some undergraduate and/or postgraduate allergy education. Confidence in dealing with different aspect of allergy management differed between countries. The main reason for specialist referral was a perceived need for tertiary assessment (54.3%), and the main barrier for referral was the consideration that the patient's condition could be appropriately diagnosed and treated in a primary care facility. Up to 44.7% and 55.3% of participants reported that they preferred e-Learning over traditional learning. CONCLUSIONS This study identified the specific areas of skills training and educational needs of GPs in managing allergic conditions in primary care, and provided insights into possible strategies for more feasible and cost-effective approaches.
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Affiliation(s)
- Martha Cabrera
- Allergy Department Hospital los Madroños Brunete, Madrid Spain
| | | | - Elisabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Laura Losappio
- Allergy and Immunology Unit ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Bertine M. J. Flokstra ‐ de Blok
- General Practitioners Research Institute Groningen the Netherlands
- GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology University Medical Center Groningen Beatrix Children's Hospital University of Groningen Groningen The Netherlands
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology Silesian University of Medicine Katowice Poland
| | | | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicines Group Woolcock Institute of Medical Research University of Sydney NSW Australia
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Usefulness of the drug allergy passport in the drug allergy management. Postepy Dermatol Alergol 2021; 38:433-439. [PMID: 34377124 PMCID: PMC8330863 DOI: 10.5114/ada.2021.107930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Nowadays, the number of people with drug hypersensitivity has been increasing and it has become a major problem for the healthcare system. Unfortunately, not everyone is aware of which medications they can safely use. Aim To assess the suitability of a drug allergy passport in patients with drug hypersensitivity in order to increase knowledge about medicines that can be safely used. Material and methods The study was conducted in 54 hospitalized patients with confirmed hypersensitivity to drugs by issuing a drug passport at discharge. The study was carried out with the questionnaire method. The questionnaire was conducted by phone 3, 6 and 12 months after the patients received the drug passport. Results Fifty-eight people were contacted by phone. The survey was conducted in 54 people (42 women (77%), mean age: 48, range: 19-71), which gives a response rate of 98%. The application of the drug allergy passport by patients increased with time and the number of patients who did not use their passport decreased. With time, patients showed the drug allergy passport to a larger number of doctors, most often to general practitioners and dentists. In the following months, the number of doctors who followed passport recommendations and patients who adhered to the passport recommendations increased. Conclusions The analysis of drug allergy passport shows that patients are better informed about medicines they can use and have a greater sense of security. By showing the passport to specialists, they choose the safest and adequate treatment.
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Sharma V, Jobrack J, Cerenzia W, Tilles S, Ryan R, Sih-Meynier R, Zeitler S, Manning M. A study to assess current approaches of allergists in European countries diagnosing and managing children and adolescents with peanut allergy. PLoS One 2020; 15:e0241648. [PMID: 33270629 PMCID: PMC7714149 DOI: 10.1371/journal.pone.0241648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Food allergy is documented to result in considerable morbidity, negative impact on quality of life, and substantial medical care costs. Although anecdotal data suggest widely varying practices in the diagnosis and management of food allergies, the diversity and relative frequency of these practices have not been documented. METHODS A questionnaire was developed evaluating allergists' management approaches of individuals with peanut allergy (PA) in Germany (DE), France (FR), and the United Kingdom (UK). RESULTS Here, we report the survey results from a total of 109 allergists from DE, FR and the UK. They reported to confirm PA at initial diagnosis using skin prick test (≥60%), while allergists from DE and FR reported using allergen-specific IgE testing more (>86%) compared to the UK (<50%). At initial diagnosis, oral food challenge was used less in DE (13%) and FR (14%) and very rarely in the UK (3%) to confirm diagnosis. Recognition of acute reactions, use of adrenaline auto-injectors and allergen avoidance were reported to be discussed with the patient/caregiver at the initial office visit by most allergists (>75%). Half of the responders reported assessing the patient's quality of life. 63% allergists reported retesting for PA resolution at a later date, with 45% allergists indicated to recommend ingestion of a normal serving of peanut regularly upon resolution. Lack of effective PA treatment was reported to be a 'very significant' barrier for optimal PA treatment, with allergists being less than 'moderately familiar' with data from clinical trials testing new treatments options for PA. Lastly, allergists stated that the severity of patient's PA ranked as the most important factor in their decision to recommend oral immunotherapy for PA treatment. CONCLUSIONS This survey provides essential insights into the practice of allergists and highlights some areas that would inform strategies for education and improving PA healthcare.
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Affiliation(s)
- Vibha Sharma
- Lydia Becker Institute of Immunology and Inflammation University of Manchester and Royal Manchester Children’s Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Stephen Tilles
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
- University of Washington, Seattle, WA, United States of America
| | - Robert Ryan
- Aimmune Therapeutics, London, United Kingdom
| | - Regina Sih-Meynier
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
| | | | - Michael Manning
- Medical Research of Arizona, Scottsdale, AZ, United States of America
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Dramburg S, Marchante Fernández M, Potapova E, Matricardi PM. The Potential of Clinical Decision Support Systems for Prevention, Diagnosis, and Monitoring of Allergic Diseases. Front Immunol 2020; 11:2116. [PMID: 33013892 PMCID: PMC7511544 DOI: 10.3389/fimmu.2020.02116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022] Open
Abstract
Clinical decision support systems (CDSS) aid health care professionals (HCP) in evaluating large sets of information and taking informed decisions during their clinical routine. CDSS are becoming particularly important in the perspective of precision medicine, when HCP need to consider growing amounts of data to create precise patient profiles for personalized diagnosis, treatment and outcome monitoring. In allergy care, several CDSS are being developed and investigated, mainly for respiratory allergic diseases. Although the proposed solutions address different stakeholders, the majority aims at facilitating evidence-based and shared decision-making, incorporating guidelines, and real-time clinical data. We offer here an overview on existing tools, new developments and novel concepts and discuss the potential of digital CDSS in improving prevention, diagnosis and monitoring of allergic diseases.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - María Marchante Fernández
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Delabelling Antibiotic Hypersensitivity in Children Is Critical for Future Treatments. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Demoly P. Development of algorithms for the diagnosis and management of acute allergy in primary practice. World Allergy Organ J 2019; 12:100022. [PMID: 30937144 PMCID: PMC6439400 DOI: 10.1016/j.waojou.2019.100022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 12/02/2022] Open
Abstract
Most patients presenting with allergies are first seen in the primary care setting. However, inadequacies in training and available guidance for general practitioners (GP) have been identified as significantly impacting the quality of care for these patients, resulting in inefficient use of healthcare resources. To address the lack of available guidance, a working group of French allergists has developed a series of online tools aimed at GPs. The expert panel developed algorithms for the diagnosis and treatment of common allergies by incorporating deliberations based on clinical guidelines and experience. In addition, they developed tables of common symptoms and detailed clinical cases that guide GPs through the typical decisions they are faced with in line with current best practice. These tools translate evidence-based recommendations from international clinical guidelines, outlining the key steps involved and assisting the physician in making decisions at each step. In addition to targeting improvements in diagnosis and standard of primary care, the tools also aim to reduce the burden on specialist allergy services by enabling GPs to diagnose and treat mild and moderate allergies, referring only severe and/or atypical cases to secondary care. The tools are adapted to the high primary care workload, enabling the physician to access essential information rapidly without unnecessary referrals to specialist allergy services.
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Affiliation(s)
- Pascal Demoly
- Corresponding author. Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
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15
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Cvetkovski B, Tan R, Kritikos V, Yan K, Azzi E, Srour P, Bosnic-Anticevich S. A patient-centric analysis to identify key influences in allergic rhinitis management. NPJ Prim Care Respir Med 2018; 28:34. [PMID: 30213945 PMCID: PMC6137238 DOI: 10.1038/s41533-018-0100-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
Allergic rhinitis (AR) is increasingly becoming a patient self-managed disease. Just under 70% of patients purchasing pharmacotherapy self-select their treatment with no health-care professional intervention often resulting in poor choices, leading to suboptimal management and increased burden of AR on the individual and the community. However, no decision is made without external, influencing forces. This study aims to determine the key influences driving patients’ decision-making around AR management. To accomplish this aim, we utilised a social network theory framework to map the patient’s AR network and identify the strength of the influences within this network. Adults who reported having AR were interviewed and completed an AR network map and AR severity and quality of life questionnaires. Forty one people with AR completed the study. The AR networks of the participants had a range of 1–11 influences (alters), with an average number of 4 and a median of 5. The larger the impact of AR on their quality of life, the greater the number of alters within their network. The three most commonly identified alters were, general practitioners, pharmacists and the participants’ ‘own experience’. The strength of the influence of health-care professionals (HCPs) was varied. The proportion of HCPs within the AR network increased as the impact of AR on their quality of life increased. By mapping the AR network, this study demonstrated that there are multiple influences behind patient’s decisions regarding AR management but the role of the HCP cannot be dismissed. In-depth interviews with allergy sufferers about their treatment decisions highlights a need for healthcare professionals to help optimize allergy management. Allergic rhinitis (AR), a set of conditions including hayfever, is often poorly managed by patients, partly due to the growing availability of over-the-counter medications. However, little is known about what influences patients’ self-management decisions. Biljana Cvetkovski at the University of Sydney, Australia, and co-workers interviewed 41 adults with AR. The participants also completed quality of life questionnaires and created network maps of key influencers. Cvetkovski found that patients followed many different influences when making treatment decisions, including online resources, family, friends and healthcare professionals. Three of the key influencers were general practitioners, pharmacists and patients’ own experience. Those with severe AR had a larger, more diverse network of influences and often reported treatment fatigue.
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Affiliation(s)
- Biljana Cvetkovski
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.
| | - Rachel Tan
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Kwok Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Elizabeth Azzi
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Pamela Srour
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Central Sydney Local Area Health District, Level 11, KGV Building, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
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16
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Parental confusion may result when primary health care professionals show heterogeneity in their knowledge, attitudes, and perceptions regarding infant nutrition, food allergy, and atopic dermatitis. Allergol Immunopathol (Madr) 2018; 46:326-333. [PMID: 29496234 DOI: 10.1016/j.aller.2017.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Whether the guidelines on infant nutrition, food allergy and atopic dermatitis confer real health benefits in practice at the population level has not been deeply studied. We aimed here to characterize the knowledge, attitudes, and perceptions regarding these issues among primary health care professionals. In addition, we surveyed available parent-reported information sources and the incidence of food-related symptoms, dietary restrictions, food allergy, and atopic dermatitis among one-year-old children in the general population. MATERIALS AND METHODS An online questionnaire was designed for public health nurses and general practitioners. In addition, parents of one-year-old children were recruited to a separate survey at the time of their regular check-up visit. RESULTS Altogether, 80 professionals took part. The median overall knowledge score was 77% and significantly higher among the general practitioners than among the nurses (p=0.004). However, only 35% of all the professionals recognized either severe airway or cardiovascular symptoms as potential food allergy-related symptoms. Moisturizers and emollients were thought to be adequate treatment for atopic dermatitis by 56%. Among 248 one-year-old children, the incidence of food allergy was 4% and atopic dermatitis 13%. During this period, parents intentionally avoided giving at least one food to 23% of the children, yet more than 80% of these restrictions can be regarded as unnecessary. CONCLUSION The knowledge, attitudes and beliefs regarding infant feeding, food allergy, and atopic dermatitis varied significantly among the primary care professionals. This will likely result in heterogeneous guidance practices and confusion among the families at the population level.
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17
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Flokstra-de Blok BMJ, Brakel TM, Wubs M, Skidmore B, Kocks JWH, Oude Elberink JNG, Schuttelaar MLA, van der Velde JL, van der Molen T, Dubois AEJ. The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care. Clin Transl Allergy 2018; 8:18. [PMID: 29872524 PMCID: PMC5972447 DOI: 10.1186/s13601-018-0206-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background The allergy management support system (AMSS) was developed to assist general practitioners (GPs) to handle the increasing burden of allergic diseases and facilitates the diagnosis and management of allergy. The aim of this cluster-randomized controlled pilot study was to test the feasibility of this AMSS for primary care. Methods GPs received diagnostic and management recommendations generated by the AMSS in addition to sIgE-test results (intervention) or GPs received sIgE-test results only (control). The AMSS recommendations are based on the previously developed patient-completed AMSS questionnaire and sIgE-test results. The AMSS was considered feasible when > 70% of the AMSS recommendations were sent to the GP within ten working days of sIgE-testing. GPs completed a questionnaire on their diagnosis and management before (T1) and after (T2) receiving sIgE test results. Agreement and disagreement concerning diagnosis, medication and referrals between GPs and AMSS was investigated at T1 and T2. A total agreement score between GPs and AMSS was calculated. GPs in the intervention group completed a questionnaire to evaluate the utility of the AMSS. Semi-structured interviews were used to explore the motivation of GPs who did not include patients in this pilot study. Results Twenty-seven GPs included 101 patients. Forty-two patients (72%) completed the AMSS questionnaire in the intervention group. The majority of the AMSS recommendations (93%) were returned to the GP within 10 working days after sIgE-test results were known [mean (SD) 4.7 (4.0) working days]. GPs in the intervention group reported largely following the AMSS recommendations in 71% of cases. The total agreement scores concerning diagnosis were significantly higher (p < 0.001) in the intervention group than the control group [mean (SD); 0.9 (1.8) vs − 0.8 (1.0)]. The agreement concerning medication or referral between GPs and AMSS did not differ between the intervention and the control group. GPs in the intervention group were reasonably positive about the AMSS. Not enrolling patients was not caused by anticipated ineffectiveness of the AMSS. Conclusion The AMSS can be considered to be feasible for primary care. GPs tend to follow the AMSS recommendations. The AMSS may contribute to the empowerment of GPs to better manage allergy patients in primary care. Trial registration ISRCTN ISRCTN36780877. Registered 23 November 2017 (retrospectively registered)
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Affiliation(s)
- Bertine M J Flokstra-de Blok
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Thecla M Brakel
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands.,3University of Groningen, Teaching Unit, Department of Social Psychology, Groningen, The Netherlands
| | - Marian Wubs
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Ben Skidmore
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Janwillem W H Kocks
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Joanne N G Oude Elberink
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Allergology, Groningen, The Netherlands
| | - Marie-Louise A Schuttelaar
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, The Netherlands
| | - Jantina L van der Velde
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Thys van der Molen
- University of Groningen, University Medical Center Groningen, Department of General Practice, Internal Postcode FA21, PO Box 196, 9700 AD Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Anthony E J Dubois
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, Groningen, The Netherlands
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18
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Doña I, Caubet JC, Brockow K, Doyle M, Moreno E, Terreehorst I, Torres MJ. An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity. Clin Transl Allergy 2018; 8:16. [PMID: 29760877 PMCID: PMC5944153 DOI: 10.1186/s13601-018-0202-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/04/2018] [Indexed: 01/20/2023] Open
Abstract
Adverse drug reactions include drug hypersensitivity reactions (DHRs), which can be immunologically mediated (allergy) or non-immunologically mediated. The high number of DHRs that are unconfirmed and often self-reported is a frequent problem in daily clinical practice, with considerable impact on future prescription choices and patient health. It is important to distinguish between hypersensitivity and non-hypersensitivity reactions by adopting a structured diagnostic approach to confirm or discard the suspected drug, not only to avoid life-threatening reactions, but also to reduce the frequent over-diagnosis of DHRs. Primary care physicians are often the first point of contact for the sufferer of a reaction, as such they have a key role in deciding whether to discard the diagnosis or send the patient for further investigation. In this review, we highlight the importance of diagnosing DHRs, analysing in detail the role of primary care physicians. We describe the common patterns of DHRs and signs of its progression, as well as the indications and contraindications for referring the patient to an allergist. The diagnostic process is described and the possible tests are discussed, which often depend on the drug involved and the type of DHR suspected. We also describe recommendations regarding the avoidance of medication suspected to have caused the reaction and the use of alternatives.
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Affiliation(s)
- I. Doña
- Allergy Unit (Pavilion C), Regional University Hospital of Malaga, UMA, IBIMA, National Network ARADyAL, Plaza del Hospital Civil, 29009 Malaga, Spain
| | - J. C. Caubet
- Department of Child and Adolescent, Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - K. Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - M. Doyle
- Indigo Medical, Saint Helier, Jersey
| | - E. Moreno
- Allergy Service, University Hospital of Salamanca, National Network ARADyAL, Salamanca, Spain
- Biosanitary Institute of Salamanca, Salamanca, Spain
- Department of Biomedical and Diagnostics Sciences, Salamanca Medical School, Salamanca, Spain
| | - I. Terreehorst
- Department of ENT, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - M. J. Torres
- Allergy Unit (Pavilion C), Regional University Hospital of Malaga, UMA, IBIMA, National Network ARADyAL, Plaza del Hospital Civil, 29009 Malaga, Spain
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19
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Ryan D, Gerth van Wijk R, Angier E, Kristiansen M, Zaman H, Sheikh A, Cardona V, Vidal C, Warner A, Agache I, Arasi S, Fernandez-Rivas M, Halken S, Jutel M, Lau S, Pajno G, Pfaar O, Roberts G, Sturm G, Varga EM, Van Ree R, Muraro A. Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy. Allergy 2018; 73:827-836. [PMID: 28850687 DOI: 10.1111/all.13264] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. METHODS We undertook a mixed-methods, situational analysis. This involved a purposeful literature search and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe. RESULTS The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence-based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32%-48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers. CONCLUSIONS Successful working with primary care providers is essential to scaling-up AIT provision in Europe, but to achieve this, the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.
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Affiliation(s)
- D. Ryan
- Asthma UK Centre for Applied Research; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh Medical School; Edinburgh UK
| | - R. Gerth van Wijk
- Allergy Section; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - E. Angier
- GPwSI in Allergy; Department of Clinical Immunology and Allergy; Northern General Hospital; Sheffield UK
| | - M. Kristiansen
- Section for Health Services Research; Department of Public Health; University of Copenhagen; Copenhagen K Denmark
| | - H. Zaman
- Senior Lecturer in Pharmacy Practice; Faculty of Life Sciences; School of Pharmacy and Medical Sciences; University of Bradford; Bradford UK
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh Medical School; Edinburgh UK
| | - V. Cardona
- Allergy Section; Department of Internal Medicine; Hospital Vall d'Hebron; Barcelona Spain
| | - C. Vidal
- Allergy Department and Faculty of Medicine; Complejo Hospitalario Universitario de Santiago; Santiago de Compostela University; Santigo Spain
| | - A. Warner
- Head of Clinical Services, Allergy UK; Planwell House; LEFA Business Park; Sidcup Kent UK
| | - I. Agache
- Faculty of Medicine; Department of Allergy and Clinical Immunology; Transylvania University Brasov; Brasov Romania
| | - S. Arasi
- Allergy Unit; Department of Pediatrics; University of Messina; Messina Italy
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | | | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - M. Jutel
- Wroclaw Medical University; ALL-MED Medical Research Institute; Wrocław Poland
| | - S. Lau
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - G. Pajno
- Allergy Unit; Department of Pediatrics; University of Messina; Messina Italy
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Faculty of Medicine; University of Southampton; Southampton UK
| | - G. Sturm
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
- Outpatient Allergy Clinic Reumannplatz; Vienna Austria
| | - E. M. Varga
- Department of Paediatric and Adolescent Medicine; Respiratory and Allergic Disease Division; Medical University of Graz; Graz Austria
| | - R. Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - A. Muraro
- Department of Mother and Child Health; The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region; University of Padua; Padua Italy
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