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Jeong S, Khandokar R, Sicherer SH. The impact of peer influence and social pressure on the management of food allergy in adolescents and young adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00572-5. [PMID: 38825037 DOI: 10.1016/j.jaip.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Stephanie Jeong
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Radiah Khandokar
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
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2
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Mason AE, Benson L, Hale V, Oslund M, Robinson A. Exploring Food Allergy Management and Food-Related Social Occupations in Elementary School-Aged Children. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:287-295. [PMID: 37377178 DOI: 10.1177/15394492231181091] [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: 06/29/2023]
Abstract
RATIONALE Elementary school-aged children with food allergies face barriers to navigating safe food practices in concert with socializing while eating. Little research examines children's role in managing their health (i.e., a food allergy). OBJECTIVES This qualitative descriptive study explores the experiences of preadolescent children with food allergies relating to food allergy management and socialization in various foodscapes in the United States. METHOD Data gathering strategies included interviews, diaries, and photo elicitation. The analysis involved coding, discussion, and thematic development. FINDINGS Participants shared food allergy management with caregivers depending on the environment. They learned to educate others, respond to emergencies, and prepare daily relating to food allergies. They faced conflict with managing food allergies with peers but overall perceived food allergy management as a low burden. CONCLUSION When provided with positive social and environmental supports, school-aged children with food allergies can learn to safely manage social food environments without direct parental involvement.
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Crealey M, Byrne A. Socializing practices of Irish children and adolescents with food allergy: A prospective study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100164. [PMID: 37781675 PMCID: PMC10509833 DOI: 10.1016/j.jacig.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 10/03/2023]
Abstract
Background Food is an integral part of social activities; because of fear of accidental reaction, children with food allergy (FA) are at risk of exclusion or oversupervision at these events. The extent of adaptive exclusion behaviors is poorly defined. Families attending our service are encouraged to socialize and taught to minimize risk and avoid accidental reactions. Objective The aim of this study was to establish the social practices and eating-out habits of children and adolescents with FA who are already attending an allergy clinic. Methods Irish children, aged 2 to 16 years, with confirmed FA were recruited as part of a parallel prospective observational study titled Recording Accidental Allergic Reactions in Children and Teenagers (ReAACT). Information on social activities and eating out habits was collected prospectively. Results A total of 531 children were enrolled. The majority attended age-appropriate social activities; 97% of the 5- to 12-year-olds went to birthday parties and 85% visited friends' houses. More nonparticipators had previous anaphylaxis (relative risk [RR] = 1.44; 95% CI = 0.97-2.14; P = .06) and peanut allergy (RR = 1.19; 95% CI = 0.99-1.42; P = .06). Among adolescents, 94% visited friends' homes, but only 12% had been away from home alone. Overall, 523 participants (98.5 %) visited food establishments, whereas 4.6% did not eat out in any food establishment; these participants were significantly more likely to be adolescents (RR = 3.27; 95% CI = 1.65-7.48; P = .0001). Conclusion Overall, Irish children with FA are "living with allergy." There was a trend toward decreased participation among adolescents. Future interventions should target this group specifically.
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Affiliation(s)
- Miranda Crealey
- Department of Paediatric Allergy, Children’s Health Ireland, Dublin, Ireland
- Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aideen Byrne
- Department of Paediatric Allergy, Children’s Health Ireland, Dublin, Ireland
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Ireland
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Dominguez S, Théolier J, Lizée K, Povolo B, Gerdts J, Godefroy SB. "Vegan" and "plant-based" claims: risk implications for milk- and egg-allergic consumers in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:74. [PMID: 37620965 PMCID: PMC10464346 DOI: 10.1186/s13223-023-00836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
The market share of foods carrying labels suggesting absence of animal ingredients has significantly increased in recent years. The purpose of this study was to document the purchasing behaviour of egg- or milk-allergic consumers vis-à-vis food marketed as "vegan" and "plant-based", and to evaluate the associated allergenic risk. A survey was conducted among egg- and milk-allergic consumers and revealed that 86% (margin of error 5.4%; confidence level 95%) would buy "vegan" products, indicating this label may be perceived as a substitute for "free from milk and eggs". To assess the risk posed by these products, 87 prepackaged foods with "vegan" and/or "plant-based" claims purchased in Quebec were tested for milk proteins, and 64 for egg proteins. Overall, 5.7% and 0% occurrence of milk and egg proteins, respectively, were observed, suggesting that the analysed prepackaged foods carrying "vegan" and/or "plant-based" labels pose little risk to egg- or milk-allergic consumers. However, this is likely due to allergen management practices applied by the Canadian manufacturers of the products tested, and should not be attributed to the use of "vegan" or similar labels. Enhanced regulatory requirements for the use of these labels, and an education campaign on their meaning with respect to allergy-related risks, are necessary to better inform and protect egg- and milk-allergic consumers.
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Affiliation(s)
- Silvia Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada.
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
| | - Kamila Lizée
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
| | - Beatrice Povolo
- Food Allergy Canada, 505 Consumers Drive, Suite 507, Toronto, ON, M2J 4A2, Canada
| | - Jennifer Gerdts
- Food Allergy Canada, 505 Consumers Drive, Suite 507, Toronto, ON, M2J 4A2, Canada
| | - Samuel B Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, 2440 Hochelaga Boulevard, Quebec, QC, G1V 0A6, Canada
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5
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Stankovich GA, Warren CM, Gupta R, Sindher SB, Chinthrajah RS, Nadeau KC. Food allergy risks and dining industry – an assessment and a path forward. FRONTIERS IN ALLERGY 2023; 4:1060932. [PMID: 37064717 PMCID: PMC10090668 DOI: 10.3389/falgy.2023.1060932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023] Open
Abstract
Food allergies have increased in prevalence over the last few decades and continue to grow. Consumption of even trace amounts of common foods can cause a rapid allergic reaction (generally within minutes) which can be mild to severe to even life-threatening. Eating at restaurants poses a risk of allergic reactions for those with food allergies due to inadequate, inconsistent labeling of allergens in foods. Here, we review food labeling rules and practices in the restaurant industry and compare and contrast it with food labeling for prepackaged foods. We review global and United States trends, and provide a brief historical overview. The paper describes the key legal and economic motivations behind restaurant food labeling. Next, we describe novel risk-driven policies and new biotechnologies that have the potential to change food labeling practices worldwide. Finally, we outline desirable federal regulations and voluntary information disclosures that would positively impact the public health aspects of restaurant food labeling and improve the quality of life for people with severe food allergies.
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Affiliation(s)
- Gabriel A. Stankovich
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, United States
| | - Christopher M. Warren
- Center for Food Allergy and Asthma Research at Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research at Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sayantani B. Sindher
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, United States
| | - R. Sharon Chinthrajah
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, United States
| | - Kari C. Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Correspondence: Kari C. Nadeau
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6
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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7
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Schelly D, Ohl A, Meramo H. College students with food allergy: From hypervigilance to disclosure fatigue. J Pediatr Nurs 2022; 70:e32-e39. [PMID: 36494237 DOI: 10.1016/j.pedn.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to explore the impact of food allergy (FA) on the daily lives of young adults who recently transitioned to attending college away from home. DESIGN AND METHODS We conducted in-depth qualitative interviews using a grounded theory approach to data collection, data analysis, and theory development. For recruitment, we posted a flier on a FA Facebook group and reposted approximately monthly for one year. We completed and recorded 16 interviews that ranged in duration from 30 to 90 min. The interviews were transcribed, coded, and analyzed with the intention of developing mid-range theory. RESULTS Several interrelated themes were identified during the analytical process, including hypervigilance, misunderstood risk, and stigma management. Notably, a series of cascading effects eventually lead to what we call "disclosure fatigue," where students with FA tire of talking about their invisible disability with people who misunderstand it, and they eventually develop strategies to avoid conversations. The consequences include a narrowing of social networks and activities and even risky food behaviors. CONCLUSIONS Research is needed in other settings, for other conditions, to consider and ameliorate the negative health consequences associated with disclosure fatigue. PRACTICE IMPLICATIONS In addition to focusing on physical aspects of FA, including avoiding exposure, healthcare practitioners in pediatric settings should emphasize social aspects of FA that gain influence during the transition out of high school and away from home. Disclosure fatigue provides one explanation for why individuals with FA may choose to ignore best practices and engage in risky food behaviors.
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Affiliation(s)
- David Schelly
- Department of Occupational Therapy, Lewis School of Health Sciences, Clarkson University, Box 5883, 8 Clarkson Ave., Potsdam, NY 13699, USA.
| | - Alisha Ohl
- Department of Occupational Therapy, Lewis School of Health Sciences, Clarkson University, Box 5883, 8 Clarkson Ave., Potsdam, NY 13699, USA
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Feldman LY, Merrill K, Golding MA, Memauri T, Driedger SM, Ross NL, Protudjer JLP. Children's Perspectives on Food Allergy in Schools: A Qualitative Study. J Sch Nurs 2022:10598405221130694. [PMID: 36217767 DOI: 10.1177/10598405221130694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Approximately 7% of children live with food allergy, a condition that requires dietary avoidance to prevent an allergic reaction. In this qualitative study, we aimed to understand food allergy-related experiences, beliefs and learning preferences among children with and without food allergies, to inform a school-based, food allergy education program. Data were analysed thematically. We virtually interviewed children in Kindergarten-Grade 8 in Manitoba, Canada, with (n = 7) and without (n = 9) parent-reported, physician-diagnosed food allergies. We identified three themes: Naive reliance on peers and school staff to assist with food allergy management; Limited food allergy knowledge; and, Recommended food allergy curricula: complementary perspective. Our findings will help inform the development of a school-based, food allergy education program, with a long-term goal of minimizing food allergy-related worries and optimizing safety for children with food allergy. Ongoing, school-based food allergy education is needed.
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Affiliation(s)
| | - Kaitlyn Merrill
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tessa Memauri
- Department of Foods and Human Nutritional Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
| | - Nancy L Ross
- Children's Allergy and Asthma Education Centre, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Foods and Human Nutritional Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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9
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LeBovidge JS, Herbert LJ, Ramos A, Rotter N, Sicherer SH, Young MC, Pistiner M, Phipatanakul W, Bartnikas LM, Bingemann TA. The Development of Age-Based Food Allergy Educational Handouts for Caregivers and Patients: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2552-2558. [PMID: 36030195 PMCID: PMC9555009 DOI: 10.1016/j.jaip.2022.01.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Food allergy education is an ongoing process that must address unique safety concerns and psychosocial challenges at each developmental stage. Families require reliable information that is targeted to specific developmental stages to support the integration of food allergy management into daily life. OBJECTIVE The purpose of this project was to develop age-specific, evidence-based patient education handouts with practical recommendations for managing and coping with food allergies at different developmental stages. METHODS Handout content was based on: (1) practice guidelines for food allergy management; (2) literature addressing psychosocial and educational needs of patients with food allergy and their caregivers; and (3) clinical experience of the project team. Fifty-seven caregivers of patients (aged 0-21 years) with food allergy and 2 young adults with food allergy reviewed a draft of the handouts and completed an online survey to assess handout acceptability and usability and identify areas for improvement. Handouts were revised based on participant feedback. RESULTS The majority of participants (79%) rated the amount of information in the age-specific handouts as "just right," versus "not enough" (9%) or "too much" information (12%). Sixty-three percent reported that they would be "very likely" to use the handouts as a resource and 35% "somewhat likely." Almost all participants (88%-100% by item) agreed that the handouts used elements of plain language writing and clear communication. CONCLUSION Caregivers rated the age-based food allergy education handouts as understandable and useful. We anticipate that these handouts could be used during health care visits and directly accessed online by families.
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Affiliation(s)
- Jennifer S LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Psychiatry, Harvard Medical School, Boston, Mass.
| | - Linda J Herbert
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Nancy Rotter
- Department of Psychiatry, Harvard Medical School, Boston, Mass; Department of Pediatrics, Food Allergy Center, Massachusetts General Hospital for Children, Boston, Mass
| | - Scott H Sicherer
- Division of Allergy and Immunology, Elliot and Roslyn Jaffe Food Allergy Institute, Kravis Children's Hospital, New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael C Young
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michael Pistiner
- Department of Pediatrics, Food Allergy Center, Massachusetts General Hospital for Children, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Theresa A Bingemann
- Division of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester Medical Center, Rochester, NY; Division of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY
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10
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Turner PJ, Arasi S, Ballmer‐Weber B, Baseggio Conrado A, Deschildre A, Gerdts J, Halken S, Muraro A, Patel N, Van Ree R, de Silva D, Worm M, Zuberbier T, Roberts G. Risk factors for severe reactions in food allergy: Rapid evidence review with meta-analysis. Allergy 2022; 77:2634-2652. [PMID: 35441718 PMCID: PMC9544052 DOI: 10.1111/all.15318] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/04/2022] [Accepted: 04/17/2022] [Indexed: 02/06/2023]
Abstract
This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food-dependent exercise-induced anaphylaxis may be an exception. Some medications such as beta-blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life-threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk.
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Affiliation(s)
- Paul J. Turner
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Stefania Arasi
- Translational Research in Paediatric Specialities AreaDivision of AllergyBambino Gesù Children's HospitalIRCCSRomeItaly
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and AllergologyKantonsspital St. GallenSt. GallenSwitzerland,Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
| | | | - Antoine Deschildre
- CHU Lille, Univ. LillePediatric Pulmonology and Allergy DepartmentHôpital Jeanne de FlandreLilleFrance
| | | | - Susanne Halken
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark
| | | | - Nandinee Patel
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Ronald Van Ree
- Departments of Experimental Immunology and of OtorhinolaryngologyAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | | | - Margitta Worm
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité, Universitätsmedizin BerlinBerlinGermany
| | - Torsten Zuberbier
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité, Universitätsmedizin BerlinBerlinGermany
| | - Graham Roberts
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustFaculty of MedicineUniversity of SouthamptonSouthamptonUK,The David Hide Asthma and Allergy Research CentreSt Mary's HospitalIsle of WightUK
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11
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Newman KL, Chater A, Knibb RC. Beliefs about food allergies in adolescents aged 11–19 years: A systematic review. Clin Transl Allergy 2022; 12:e12142. [PMID: 35414890 PMCID: PMC8984676 DOI: 10.1002/clt2.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Research suggests of people with food allergy (FA), adolescents have the highest risk of fatal allergic reactions to food, yet understanding of this population and how they manage their condition is limited. Understanding beliefs and how they affect behaviour could inform ways to reduce risk taking behaviour and fatal reactions in adolescents. This systematic review aimed to explore beliefs adolescents hold about their FA, and how these may be associated with FA management. Demographics Adolescents aged 11–19 years with FA. Methodology A systematic search of seven databases was conducted. Papers of any design were included that reported on the beliefs about FA in adolescents aged 11–19 years. Data was systemised by narrative thematic analysis. Findings 20 studies were included. Themes included navigating FA in different environments, carriage and use of adrenaline auto‐injectors, management of the risk of anaphylaxis, behaviour and understanding of others, and food‐allergic identity. Implications Adolescents with FA hold a variety of condition beliefs; some beliefs were related to behaviour that could lead to an allergic reaction, while other beliefs were related to protective behaviours. Further research into understanding adolescent beliefs in order to inform clinical management and reduce the risk of potential fatal reactions is essential.
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Affiliation(s)
- Kristina L. Newman
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
- Department of Psychology School of Social Sciences Nottingham Trent University Nottingham UK
| | - Angel Chater
- Department for Sport Science and Physical Activity University of Bedfordshire Bedford UK
| | - Rebecca C. Knibb
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
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12
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Ravert RD, Russell LT. College students' intentions to assist peers with chronic medical conditions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:355-362. [PMID: 32343192 DOI: 10.1080/07448481.2020.1751170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/27/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Objective This study identified influences on college students' intentions to assist peers with chronic medical conditions. Participants: A panel of 293 U.S. full-time college students completed online surveys in July, 2017. Methods: Participants reported the number of people they knew with chronic medical conditions, and completed measures of general empathy, stigma toward chronic conditions, self-efficacy to provide support, and expected likelihood of assisting a peer with a chronic medical condition. Path Analysis and mediation tests were performed. Results: Low stigma, and high confidence in providing support were directly associated with intentions to assist student peers if needed. Empathy and number of people known with chronic conditions were additional indirect predictors. Conclusions: Peer support is important for students with chronic medical conditions. Intention to provide assistance if needed is partially explained by holding low stigma and high confidence in providing support, both of which may be enhanced through education and intervention.
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Affiliation(s)
- Russell D Ravert
- Human Development & Family Science, University of Missouri, Columbia, Missouri, USA
| | - Luke T Russell
- Family and Consumer Sciences, Illinois State University, Normal, Illinois, USA
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13
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Piercy H, Nutting C, Yap S. "It's Just Always Eating": The Experiences of Young People Growing up Medium Chain Acyl-coA Dehydrogenase Deficiency. Glob Qual Nurs Res 2021; 8:23333936211032203. [PMID: 34423075 PMCID: PMC8375334 DOI: 10.1177/23333936211032203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is a rare metabolic disorder, and commonly now part of newborn screening programs. Those diagnosed at birth are now progressing from childhood to adulthood. The study aim was to explore young people’s experiences of living with MCADD and managing their condition. A descriptive qualitative study design involving semi-structured interviews with 12 participants aged 10 to 15 years, recruited from one regional pediatric metabolic disorder service in England. Data were analyzed using thematic analysis. The two major themes were “Eating for energy” and “Growing into a self-management role.” Self-monitoring and self-management skills had been nurtured from early childhood by parents and healthcare providers. Young people’s anxieties concerned having to maintain adequate energy input to stay safe and the associated burden of responsibility. Growing up with MCADD presents specific challenges. Self-management and ongoing support are important for dealing with those challenges.
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Affiliation(s)
| | | | - Sufin Yap
- Sheffield Children's Hospital NHS Foundation Trust, UK
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McLaughlin AM, Macaulay T, Peterson CC. College students' knowledge and management of food allergies. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:610-616. [PMID: 31944900 DOI: 10.1080/07448481.2019.1705832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 09/10/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
This study explored predictors of food allergy management in college students, including participants' reported allergy severity, history of allergic reactions, and allergy knowledge. Further, we compared allergy knowledge in participants with food allergy to a matched sample of college students without food allergy. Method: Participants were recruited from a larger nationwide study of knowledge and attitudes toward food allergy in college students, with purposeful oversampling of students with food allergies. Participants completed measures assessing their food allergy(ies), symptoms, history of reactions, and current allergy management behaviors. Participants with food allergies and control participants without food allergies completed a measure of food allergy knowledge. Results: Hierarchical regression revealed that food allergy knowledge accounted for an additional 20% of variance in students' allergy management behaviors, above and beyond severity and allergic reactions, R2=.39, F(3,48)=10.09, p<.001. There was not a statistically significant difference in food allergy knowledge between participants with food allergy and matched controls, t(49)=-1.85, p=.07, 95% CI=-1.42 to 0.06. Conclusions: This study suggests allergy knowledge is an important factor in food allergy management. Knowledge significantly predicted food allergy management behaviors above and beyond food allergy severity and recent food allergy reactions. College students with food allergies did not demonstrate greater knowledge than controls, suggesting a need for psychoeducational intervention to target college students' allergy knowledge as they transition to independent allergy management.
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Affiliation(s)
- Alix M McLaughlin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Taylor Macaulay
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
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Manny E, La Vieille S, Dominguez SA, Kos G, Barrère V, Théolier J, Touma J, Godefroy SB. Probabilistic risk assessment for milk in dark chocolate, cookies and other baked goods with PAL sold in Canada. Food Chem Toxicol 2021; 152:112196. [PMID: 33862120 DOI: 10.1016/j.fct.2021.112196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
The risk of having an allergic reaction in milk-allergic individuals consuming products with precautionary allergen labelling (PAL) for milk has been rarely studied in products such as dark chocolate, cookies, and other baked goods. A probabilistic risk assessment model was developed to estimate potential risks. Milk occurrence and contamination levels were reported in a previous article from our group. Dose-response curves for milk were constructed using values (n = 1078) from published double-blind placebo-controlled food challenges. Canadian consumption data was extracted from a national survey, and a homemade survey involving food-allergic Canadians. Milk eliciting doses (ED) were 0.23 (ED01), 1.34 (ED05), 3.42 (ED10), and 16.3 (ED25) mg of milk protein (Log-Normal distribution). Average exposures, per eating occasion, were 24 mg (dark chocolate), 3.9 mg (baked goods), and 0.20 mg (cookies) of milk proteins. The estimated risk of having a milk-induced allergic reaction by consuming foods with PAL for milk was higher for dark chocolate (16%; 15,881/100,000) than baked goods (3.8%; 3802/100,000) or cookies (0.6%; 646/100,000) in milk-allergic Canadians. Dark chocolate, cookies, and baked goods with PAL for milk, should be avoided by milk-allergic Canadians (consuming or not products with PAL) to prevent allergic reactions.
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Affiliation(s)
- Emilie Manny
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada.
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada; Health Canada, 251 Sir F. Banting Driveway, Ottawa, Ontario, H1A 0K9, Canada
| | - Silvia A Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Gregor Kos
- Department of Chemistry & Biochemistry, 7141 Sherbrooke Street West, Concordia University, Montreal, Quebec, H4B 1R6, Canada
| | - Virginie Barrère
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Joseph Touma
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
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Rubeiz CJ, Ernst MM. Psychosocial Aspects of Food Allergy: Resiliency, Challenges and Opportunities. Immunol Allergy Clin North Am 2021; 41:177-188. [PMID: 33863478 DOI: 10.1016/j.iac.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Food allergy is a public health concern and has been found to be increasing in prevalence; however, psychosocial factors differentiate challenges related to management throughout the lifespan. Resilience has been found to improve quality of life in other chronic diseases, but little has been published regarding increasing resilience in food allergy. The psychosocial impacts of food allergy vary by age group and developmental stage. This article reviews developmental milestones within the context of food allergy in infancy, school-age children, adolescents, and adults. Recommendations for promoting resilience in patients with food allergy are provided.
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Affiliation(s)
- Christine J Rubeiz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michelle M Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Herbert L, Cooke F, Ramos A, Amatya K, Sharma HP. Assessing daily food allergy self-management among adolescents using a 24-hour recall interview. Ann Allergy Asthma Immunol 2021; 127:206-213. [PMID: 33722785 DOI: 10.1016/j.anai.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe food allergic reactions can be life-threatening or fatal and are experienced by up to 40% of children with food allergies, with adolescents at greatest risk. There are no comprehensive measures to assess food allergy management behaviors that could prevent allergic reactions. OBJECTIVE To describe food allergy self-management behaviors as reported by adolescents on a 24-hour recall measure and identify related factors. METHODS Adolescents aged 10 to 14 years with immunoglobulin E-mediated food allergy completed the Food Allergy Management 24-Hour Recall as an interview. Participants answered questions on each food they ate on the previous day and food allergy self-management behaviors. RESULTS Participants were a diverse sample (28% White) of 101 adolescents (mean age = 11.80 years; 53% male sex). Most meals and snacks (76%) were observed by adults. Epinephrine autoinjectors (EAIs) were reportedly available for almost all meals and snacks (93%). Almost all foods had been eaten before (95%) and were verified as allergen free (92%). Furthermore, 35% of the time, past experience with the food was the only method used to verify safety. Child age, number of food allergies, or time since allergic reaction was not related to self-management behavior. EAI availability and ingredient verification were most common at home and in school; adult observation was least likely in the home. CONCLUSION Adolescents reported that EAIs were frequently available, but they relied on past experience with food to determine safety. Appropriate assessment of food safety should be a primary intervention target. The Food Allergy Management 24-Hour Recall may be a useful tool to assess and track food allergy self-management.
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Affiliation(s)
- Linda Herbert
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Frances Cooke
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Kaushalendra Amatya
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC
| | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
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Miles LM, Ratnarajah K, Gabrielli S, Abrams EM, Protudjer JLP, Bégin P, Chan ES, Upton J, Waserman S, Watson W, Gerdts J, Ben-Shoshan M. Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2321-2333. [PMID: 33549844 DOI: 10.1016/j.jaip.2021.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. OBJECTIVES A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis. METHODS Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis. RESULTS Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P = .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine. CONCLUSION The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.
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Affiliation(s)
- Laura May Miles
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
| | - Kayadri Ratnarajah
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Philippe Bégin
- Division of Clinical Immunology and Allergy, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Wade Watson
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, ON, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
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Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
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Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
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Ist das Konzept einer "erdnussfreien Schule" für das Alltagsmanagement von Erdnuss-allergischen Kindern mit Anaphylaxie-Risiko sinnvoll? ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-2579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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23
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Gabrielli S, Clarke A, Morris J, Eisman H, Gravel J, Enarson P, Chan ES, Gerdts J, O'Keefe A, Porter R, Lim R, Yanishevsky Y, Adatia A, Ben-Shoshan M. Teenagers and those with severe reactions are more likely to use their epinephrine autoinjector in cases of anaphylaxis in Canada. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1073-1075.e3. [PMID: 30170165 DOI: 10.1016/j.jaip.2018.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Ann Clarke
- Division of Rheumatology, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Harley Eisman
- Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Paul Enarson
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, Newfoundland & Labrador, Canada
| | - Robert Porter
- Division of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland & Labrador, Canada
| | - Rodrick Lim
- Division of Pediatrics and Emergency Medicine, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Yarden Yanishevsky
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Adil Adatia
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Robinson M, Koplin JJ, Field MJ, Sasaki M, Peters RL, McWilliam V, Sawyer SM, Patton GC, Vuillermin PJ, Douglass J, Gurrin LC, Tang MLK, Dharmage SC, Allen KJ. Patterns of Carriage of Prescribed Adrenaline Autoinjectors in 10- to 14-Year-Old Food-Allergic Students: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:437-443. [PMID: 30031901 DOI: 10.1016/j.jaip.2018.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescence is well recognized as a period of increased risk for severe and fatal food-induced anaphylaxis. Current Australian adrenaline autoinjector (AAI) prescription guidelines therefore suggest that consideration be given to AAI prescription in all adolescents with a food allergy. To date, however, few studies have assessed the AAI carriage behavior of adolescents prescribed AAI devices. OBJECTIVE To determine the carriage behavior of prescribed AAI devices in a population-based sample of young Australian adolescents. METHODS Students aged 10 to 14 years (and their parents) from randomly selected schools in metropolitan Melbourne completed self-administered questionnaires regarding the history and management of food allergy, including prescription and carriage of AAI device in different domains of school and social life. RESULTS A total of 9816 students completed the questionnaire (46% response): 620 students were assessed to have likely IgE-mediated food allergy and 234 (38%) of these had been prescribed an AAI. Most students (93%; 95% CI, 89%-96%) who were prescribed AAIs reported that they provided their AAI and anaphylaxis action plan to their school. Adherence to AAI carriage in other domains of social life was poor, with 49% (95% CI, 42%-56%) never carrying their AAI in 1 or more locations. Carriage of the AAI device was particularly poor when students were independent of parental supervision: 32% (95% CI, 25%-39%) never carried it when they were by themselves, 28% (95% CI, 22%-36%) never carried it while out with friends, and 36% (95% CI, 30%-43%) never carried their AAI to sporting activities. CONCLUSIONS Carriage of AAI devices is suboptimal in young adolescents prescribed AAIs, particularly when young adolescents are independent of parental supervision.
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Affiliation(s)
- Marnie Robinson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michael J Field
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mari Sasaki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Peter J Vuillermin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Jo Douglass
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lyle C Gurrin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.
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Duncan SE, Annunziato RA. Barriers to self-management behaviors in college students with food allergies. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:331-339. [PMID: 29405879 DOI: 10.1080/07448481.2018.1431898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study examined barriers to engagement in self-management behaviors among food-allergic college students (1) within the frameworks of the health belief model (HBM) and common sense self-regulation model (CS-SRM) and (2) in the context of overall risky behaviors. PARTICIPANTS Undergraduate college students who reported having a physician-diagnosed food allergy (N = 141). Research was conducted from February 2015 through May 2016. METHODS Participants were recruited from college campuses through email and social media. The frequency of adherence to self-management behaviors was measured along with HBM, CS-SRM, and risk-taking behaviors through a self-report survey. RESULTS Among all participants, HBM and CS-SRM constructs and Tobacco Use explained 30.6% of the variance in adherence. CS-SRM constructs and Tobacco Use explained 44.8% of the variance for participants with self-injectable epinephrine (SIE). CONCLUSIONS Food-allergic college students demonstrate inconsistent adherence, and interventions designed to improve adherence should take both SIE prescription status and contextual factors into consideration.
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Affiliation(s)
- Sarah E Duncan
- a Department of Psychology , Fordham University , Bronx , New York , USA
| | - Rachel A Annunziato
- a Department of Psychology , Fordham University , Bronx , New York , USA
- b Department of Pediatrics , Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital , New York , New York , USA
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Dyer AA, O'Keefe A, Kanaley MK, Kao LM, Gupta RS. Leaving the nest: Improving food allergy management on college campuses. Ann Allergy Asthma Immunol 2018; 121:82-89.e5. [PMID: 29679763 DOI: 10.1016/j.anai.2018.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies. OBJECTIVE The study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. METHODS Key informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions. RESULTS The convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the student's campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions-collectively called Spotlight-were developed. CONCLUSION The use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders-including pediatricians that care for adolescents-can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.
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Affiliation(s)
- Ashley A Dyer
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Lauren M Kao
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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27
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DunnGalvin A, Polloni L, Le Bovidge J, Muraro A, Greenhawt M, Taylor S, Baumert J, Burks W, Trace A, DunnGalvin G, Forristal L, McGrath L, White J, Vasquez M, Allen K, Sheikh A, Hourihane J, Tang ML. Preliminary Development of the Food Allergy Coping and Emotions Questionnaires for Children, Adolescents, and Young People: Qualitative Analysis of Data on IgE-Mediated Food Allergy from Five Countries. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Allen KJ, Taylor SL. The Consequences of Precautionary Allergen Labeling: Safe Haven or Unjustifiable Burden? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.12.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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29
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Food Allergy: What's on the Menu in 2018? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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30
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Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, Peters RL, Gurrin LC, Vuillermin PJ, Douglass J, Pezic A, Brewerton M, Tang ML, Patton GC, Allen KJ. Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study. J Allergy Clin Immunol 2018; 141:391-398.e4. [DOI: 10.1016/j.jaci.2017.05.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
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31
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Vetander M, Protudjer JLP, Lilja G, Kull I, Hedlin G, van Hage M, Östblom E, Bergström A, Wickman M. Anaphylaxis to foods in a population of adolescents: incidence, characteristics and associated risks. Clin Exp Allergy 2017; 46:1575-1587. [PMID: 27790764 DOI: 10.1111/cea.12842] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Information about severe reactions to foods in adolescence is limited. OBJECTIVE To describe reactions to foods, including anaphylaxis, with regard to incidence, characteristics and associated risks, among 16-year-olds (adolescents) in a large, population-based birth cohort. METHODS Parent-reported questionnaire data from ages 2-3 months, and 1, 2 and 16 years were used (N = 3153). Anaphylaxis at age 16 years was defined per NIAID/FAAN criteria. Immunoglobulin E (IgE) antibodies to 14 common food and inhalant allergens were analysed at ages 4 (n = 2283) and 16 years (n = 2510). Among adolescents with food-related symptoms (FRS) and for whom blood was available (n = 221), 25 additional food allergen extracts or allergen components were analysed. Associations between reactions to foods, and sensitization and allergic multimorbidity were investigated. RESULTS In the 12 months prior to the 16-year assessment, 8.5% of adolescents had FRS. This included 0.8% (n = 24) adolescents who were classified as having anaphylaxis, yielding an incidence rate of 761/100 000 person-years. One-third of adolescents accessed health care during anaphylaxis. Allergic multimorbidity in infancy, as well as sensitization to foods and airborne allergens at age 4 years, was associated with an increased risk for FRS in adolescence. Peanuts and tree nuts were the most common culprit foods for anaphylaxis, and fruits and vegetables for non-anaphylactic reactions. Adolescents with anaphylaxis were significantly more likely to be sensitized to storage proteins (Ara h 2, Cor a 9, Cor a 14) and to be polysensitized to foods (P < 0.001 vs. non-anaphylactic reactions). CONCLUSIONS AND CLINICAL RELEVANCE The incidence of food-induced anaphylaxis during adolescence in our population-based birth cohort is higher than previously reported. Adolescents with anaphylaxis differ from adolescents with non-anaphylactic FRS with regard to culprit foods and sensitization. Adolescents with previous anaphylaxis are likely to be polysensitized to foods, particularly tree nut and peanut storage proteins, and which warrants consideration at follow-up.
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Affiliation(s)
- M Vetander
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - J L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - G Lilja
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - G Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - M van Hage
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - E Östblom
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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32
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Alvarez-Perea A, Tanno LK, Baeza ML. How to manage anaphylaxis in primary care. Clin Transl Allergy 2017; 7:45. [PMID: 29238519 PMCID: PMC5724339 DOI: 10.1186/s13601-017-0182-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/16/2017] [Indexed: 12/13/2022] Open
Abstract
Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different combinations of symptoms and apparently mild signs and can progress to fatal anaphylactic shock unpredictably. The difficulty in recognizing anaphylaxis is due, in part, to the variability of diagnostic criteria, which in turn leads to a delay in administration of appropriate treatment, thus increasing the risk of death. The use of validated clinical criteria can facilitate the diagnosis of anaphylaxis. Intramuscular epinephrine (adrenaline) is the medication of choice for the emergency treatment of anaphylaxis. Administration of corticosteroids and H1-antihistamines should not delay the administration of epinephrine, and the management of a patient with anaphylaxis should not end with the acute episode. Long-term management of anaphylaxis should include avoidance of triggers, following confirmation by an allergology study. Etiologic factors suspected in the emergency department often differ from the real causes of anaphylaxis. Evaluation of patients with a history of anaphylaxis should also include an assessment of personal data, such as age and comorbidities, which may increase the risk of severe reactions. Special attention should also be paid to co-factors, as these may easily confound the cause of the anaphylaxis. Patients experiencing anaphylaxis should administer epinephrine as soon as possible. Education (including the use of Internet and social media), written personalized emergency action plans, and self-injectable epinephrine have proven useful for the treatment of further anaphylaxis episodes.
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Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France
- Pierre and Marie Curie Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - María L. Baeza
- Allergy Service, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
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33
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Begen FM, Barnett J, Barber M, Payne R, Gowland MH, Lucas JS. Parents' and caregivers' experiences and behaviours when eating out with children with a food hypersensitivity. BMC Public Health 2017; 18:38. [PMID: 28728569 PMCID: PMC5520367 DOI: 10.1186/s12889-017-4594-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background For parents and caregivers of food hypersensitive (FH) children, accommodating their child’s dietary needs when eating out can be a challenging experience. This study explored caregivers’ experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences. Methods A cross-sectional, qualitative design was used. In depth, semi-structured interviews were carried out with 15 caregivers of children with FH. Interviews were analysed using framework analysis. Results Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of ‘family context’, ‘child-focused concerns’, and ‘venue issues’, caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members. Conclusions Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians and support charities can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4594-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona M Begen
- Department of Psychology, University of Bath, Claverton Down, Bath, UK.
| | - Julie Barnett
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Miriam Barber
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Ros Payne
- Creative Research Ltd, Bishops Castle, UK
| | | | - Jane S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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34
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Stensgaard A, DunnGalvin A, Nielsen D, Munch M, Bindslev-Jensen C. Green, Yellow, and Red risk perception in everyday life - a communication tool. Allergy 2017; 72:1114-1122. [PMID: 27886390 DOI: 10.1111/all.13095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents have the highest risk for food allergy-related fatalities. Our main aim was to investigate the level of risk in everyday social situations as perceived by adolescents/young adults with peanut allergy, their families, and their friends. METHODS The web-based 'Colours Of Risks' (COR) questionnaire was completed by 70 patients (aged 12-23 years), 103 mothers and fathers, 31 siblings (aged 12-26 years), and 42 friends (aged 12-24 years). COR deals with six main contexts (home, school/university, work, visiting/social activities, special occasions/parties, and vacations), each with 1-12 items. Response categories are green (I feel safe), yellow (I feel uncertain), or red (I feel everything is risky). RESULTS There was a high level of agreement between participants in defining situations as safe, uncertain, or risky, but female patients and mothers rated fewer situations as safe compared to male patients and fathers. Being with close friends and family, and attending planned parties without alcohol were perceived as situations of low risk. While 94% of patients took an epinephrine auto-injector (EAI) into risky situations, only 65% took it into safe situations. In contrast to the close family, 31% of the friends did not know the patient had an EAI, and fewer knew how to administer the EAI. CONCLUSION Young adults with peanut allergy face challenges when moving from the safe home with ready assistance if needed, to independence with unpredictable surroundings and less certain help. Perceived 'safe' situations may in fact be the riskiest, as patients often do not take the EAI with them.
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Affiliation(s)
- A. Stensgaard
- Odense Research Center for Anaphylaxis (ORCA); Department of Dermatology and Allergy Center; Odense University Hospital; Odense Denmark
| | - A. DunnGalvin
- School of Applied Psychology; University College Cork; Cork Ireland
| | - D. Nielsen
- Migrant Health Clinic; Odense University Hospital; Odense C Denmark
| | - M. Munch
- Research Unit of General Practice; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - C. Bindslev-Jensen
- Odense Research Center for Anaphylaxis (ORCA); Department of Dermatology and Allergy Center; Odense University Hospital; Odense Denmark
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35
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Johnson SF, Woodgate RL. Qualitative research in teen experiences living with food-induced anaphylaxis: A meta-aggregation. J Adv Nurs 2017; 73:2534-2546. [DOI: 10.1111/jan.13325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sara F. Johnson
- College of Nursing; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg MB Canada
| | - Roberta L. Woodgate
- College of Nursing; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg MB Canada
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36
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Lambert R, Grimshaw KEC, Ellis B, Jaitly J, Roberts G. Evidence that eating baked egg or milk influences egg or milk allergy resolution: a systematic review. Clin Exp Allergy 2017; 47:829-837. [PMID: 28516451 DOI: 10.1111/cea.12940] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been proposed that the frequent ingestion of baked hen's egg or cow's milk accelerates the resolution of hen's egg or cow's milk allergy. This practice is being introduced into clinical practice. OBJECTIVE To systematically review the evidence to determine whether the introduction of baked hen's egg or cow's milk into the diet of children with hen's egg or cow's milk allergies respectively leads to a larger proportion of children outgrowing these allergies than expected. METHODS A systematic review of the literature was conducted in Medline, Embase and CINAHL. The inclusion criteria were as follows: randomized control trials, case-control or cohort studies; children aged 0-18 years with hen's egg or cow's milk allergy; baked hen's egg or cow's milk intervention with or without a comparator; and resolution of the hen's egg or cow's milk allergy as determined by food challenge as the outcome. Studies were critically appraised using the quality assessment tool for quantitative studies. PROSPERO reference CRD42015026029. RESULTS We identified 851 and 2816 hen's egg and cow's milk articles respectively. Only three hen's egg and three cow's milk studies fulfilled our pre-specified inclusion criteria. The studies concluded that baked products either increased the likelihood of the resolution of allergy or accelerated resolution. However, when critiqued, all studies were classified as weak because they were observational, lacking an appropriate control group; this brings into doubt the study's conclusions. There were a number of examples of severe reactions to baked products. CONCLUSION There is little evidence to address the hypothesis that the ingestion of baked hen's egg or cow's milk results in more patients outgrowing their hen's egg or cow's milk allergy respectively. Data are required from a trial comparing the resolution rates of baked-tolerant participants who are randomized to ingest or avoid baked products to assess the accuracy of this hypothesis.
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Affiliation(s)
- R Lambert
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
| | - K E C Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Ellis
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
| | - J Jaitly
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
| | - G Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
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Health-related quality of life in food allergy : Impact, correlates, and predictors. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:841-8. [PMID: 27329076 DOI: 10.1007/s00103-016-2368-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In food allergy, since the likelihood of a fatal reaction is low but fear, uncertainty, and lifestyle restrictions high, health-related quality of life (HRQL) may be a more meaningful measure of outcome in research and practice. HRQL is influenced by physiological, psychological, and environmental variables and can be best understood by considering the interactions of factors that cut across multiple levels. In this article we review both quantitative and qualitative research findings to provide an in-depth picture of the impact of food allergy on the concerns and the everyday lives of children, teens, adults, and parents. Research on factors that are related to, and impact on, HRQL is also discussed. We conclude by exploring some methodological and design issues in relation to the measurement of HRQL in food allergy and offer some recommendations for research and practice.
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38
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Stensgaard A, Bindslev-Jensen C, Nielsen D. Peanut allergy as a family project: social relations and transitions in adolescence. J Clin Nurs 2017; 26:3371-3381. [DOI: 10.1111/jocn.13696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anette Stensgaard
- Odense Research Center for Anaphylaxis (ORCA); Department of Dermatology and Allergy Center; Odense University Hospital; Odense C Denmark
| | - Carsten Bindslev-Jensen
- Odense Research Center for Anaphylaxis (ORCA); Department of Dermatology and Allergy Center; Odense University Hospital; Odense C Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic; Odense University Hospital; Odense C Denmark
- Health Sciences Research Center; University College Lillebaelt; Denmark
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39
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Warren CM, Dyer AA, Otto AK, Smith BM, Kauke K, Dinakar C, Gupta RS. Food Allergy-Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:381-390.e13. [PMID: 28132799 DOI: 10.1016/j.jaip.2016.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear. OBJECTIVE To characterize FA-related risk-taking and self-management behaviors of AYA with FA. METHODS A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership. RESULTS Two distinct FA behavioral risk classes were identified, representing less (N = 120) and more (N = 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.
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Affiliation(s)
| | - Ashley A Dyer
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alana K Otto
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Bridget M Smith
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Edward J. Hines Jr VA Hospital, Center for Management of Complex Chronic Care, Hines, Ill
| | | | | | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
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40
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Lee E, Jeong K, Lee JY, Min TK, Kim M, Yang HK, Lee HW, Kim J, Ahn K, Pyun BY, Lee S. Clinical characteristics and causative food types of immediate-type cow's milk and egg white allergy in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.6.351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eunjoo Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Ji Young Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Minji Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hea-Kyoung Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Won Lee
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bok Yang Pyun
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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41
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Herbert L, Shemesh E, Bender B. Clinical Management of Psychosocial Concerns Related to Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:205-13; quiz 214. [PMID: 26968959 DOI: 10.1016/j.jaip.2015.10.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 12/30/2022]
Abstract
Current estimates indicate that 4% to 8% of children in the United States are diagnosed with food allergy, and more than 40% of US children with food allergy experience severe allergic reactions. Families trying to avoid foods that may trigger an allergic reaction and ensure adequate treatment of allergic reactions that do occur face numerous challenges. The rise in the number of children diagnosed with food allergies underscores the importance of food allergy-related interventions to address elevated psychosocial concerns, such as parenting stress, anxiety, and worries about bullying. This review provides an overview of common psychosocial concerns among children with food allergy and their families across the developmental spectrum, and offers guidance to medical providers regarding the identification and treatment of food allergy-related psychosocial challenges.
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Affiliation(s)
- Linda Herbert
- Center for Translational Science, Division of Allergy and Immunology, Children's National Health System, Washington, DC.
| | - Eyal Shemesh
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bruce Bender
- Center for Health Promotion, National Jewish Health, Denver, Colo
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42
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Protudjer JLP, Jansson SA, Middelveld R, Östblom E, Dahlén SE, Arnlind MH, Bengtsson U, Kallström-Bengtsson I, Marklund B, Rentzos G, Sundqvist AC, Åkerström J, Ahlstedt S. Impaired health-related quality of life in adolescents with allergy to staple foods. Clin Transl Allergy 2016; 6:37. [PMID: 27733903 PMCID: PMC5045620 DOI: 10.1186/s13601-016-0128-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background Cow’s milk, hen’s egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall’s disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. Methods In this cross-sectional study, 58 adolescents aged 13–17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow’s milk, hen’s egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of ≥0.5. Results Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30–5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. Conclusions As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL. Electronic supplementary material The online version of this article (doi:10.1186/s13601-016-0128-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Arne Jansson
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Roelinde Middelveld
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Östblom
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Heibert Arnlind
- Swedish Council on Health Technology Assessment, SBU, Stockholm, Sweden ; Department of Learning, Informatics, Management and Ethics, and Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Bengtsson
- Allergy Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Birgitta Marklund
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Georgios Rentzos
- Allergy Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Staffan Ahlstedt
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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43
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Dean J, Fenton NE, Shannon S, Elliott SJ, Clarke A. Disclosing food allergy status in schools: health-related stigma among school children in Ontario. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e43-e52. [PMID: 25939442 DOI: 10.1111/hsc.12244] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
In 2006, 3 years after the tragic death of 13-year-old Sabrina Shannon, the Province of Ontario (Canada) passed Sabrina's Law ushering in a new era of focus and concern for severe food allergic children at risk of anaphylaxis. Questions were raised at the time regarding the potential of doing more harm than good with the new legislation. This paper reports the experiences of health-related stigma among food allergic children at risk of anaphylaxis who were required to disclose their health status under this new legislation. In 2008, in-depth interviews were conducted with 20 children and youth and their parents in order to explore the experiences living with a severe food allergy. This particular study explores their experiences of felt and enacted stigma in the school setting as a result of the disclosure process. Interviews were tape recorded with permission and transcribed for subsequent thematic analysis using NVIVO, a qualitative analysis software package. Results indicate that participants were stigmatised as a result of protective school policies under the law, and that created tension between their physical safety and social well-being. Sabrina's Law also led to a cultural shift in awareness of food allergies that resulted in some participants normalising their health status, offering promising directions for the future.
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Affiliation(s)
| | | | | | | | - Ann Clarke
- University of Calgary, Calgary, AB, Canada
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44
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Turner PJ, Baumert JL, Beyer K, Boyle RJ, Chan CH, Clark AT, Crevel RWR, DunnGalvin A, Fernández-Rivas M, Gowland MH, Grabenhenrich L, Hardy S, Houben GF, O'B Hourihane J, Muraro A, Poulsen LK, Pyrz K, Remington BC, Schnadt S, van Ree R, Venter C, Worm M, Mills ENC, Roberts G, Ballmer-Weber BK. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy 2016; 71:1241-55. [PMID: 27138061 DOI: 10.1111/all.12924] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 12/31/2022]
Abstract
Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.
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Affiliation(s)
- P. J. Turner
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | - J. L. Baumert
- Food Allergy Research and Resource Program; Department of Food Science and Technology; University of Nebraska; Lincoln NE USA
| | - K. Beyer
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - R. J. Boyle
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | | | - A. T. Clark
- Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - R. W. R. Crevel
- Safety and Environmental Assurance Centre; Unilever; Colworth Science Park; Sharnbrook Bedford UK
| | - A. DunnGalvin
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | | | - L. Grabenhenrich
- Institute for Social Medicine; Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Hardy
- Food Standards Agency; London UK
| | | | - J. O'B Hourihane
- Paediatrics and Child Health; University College Cork; Cork Ireland
| | - A. Muraro
- Department of Paediatrics; Centre for Food Allergy Diagnosis and Treatment; University of Padua; Veneto Italy
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte; Copenhagen Denmark
| | - K. Pyrz
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | - S. Schnadt
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
| | - M. Worm
- Allergy-Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust and Human Development and Health Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; University Zürich; Zürich Switzerland
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45
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Abstract
Food allergy has increased in developed countries and can have a dramatic effect on quality of life, so as to provoke fatal reactions. We aimed to outline the socioeconomic impact that food allergy exerts in this kind of patients by performing a complete review of the literature and also describing the factors that may influence, to a greater extent, the quality of life of patients with food allergy and analyzing the different questionnaires available. Hitherto, strict avoidance of the culprit food(s) and use of emergency medications are the pillars to manage this condition. Promising approaches such as specific oral or epicutaneous immunotherapy and the use of monoclonal antibodies are progressively being investigated worldwide. However, even that an increasing number of centers fulfill those approaches, they are not fully implemented enough in clinical practice. The mean annual cost of health care has been estimated in international dollars (I$) 2016 for food-allergic adults and I$1089 for controls, a difference of I$927 (95 % confidence interval I$324–I$1530). A similar result was found for adults in each country, and for children, and interestingly, it was not sensitive to baseline demographic differences. Cost was significantly related to severity of illness in cases in nine countries. The constant threat of exposure, need for vigilance and expectation of outcome can have a tremendous impact on quality of life. Several studies have analyzed the impact of food allergy on health-related quality of life (HRQL) in adults and children in different countries. There have been described different factors that could modify HRQL in food allergic patients, the most important of them are perceived disease severity, age of the patient, peanut or soy allergy, country of origin and having allergy to two or more foods. Over the last few years, several different specific Quality of Life questionnaires for food allergic patients have been developed and translated to different languages and cultures. It is important to perform lingual and cultural translations of existent questionnaires in order to ensure its suitability in a specific region or country with its own socioeconomic reality and culture. Tools aimed at assessing the impact of food allergy on HRQL should be always part of the diagnostic work up, in order to provide a complete basal assessment, to highlight target of intervention as well as to evaluate the effectiveness of interventions designed to cure food allergy. HRQL may be the only meaningful outcome measure available for food allergy measuring this continuous burden.
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46
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Saleh-Langenberg J, Flokstra-de Blok BMJ, Goossens NJ, Kemna JC, van der Velde JL, Dubois AEJ. The compliance and burden of treatment with the epinephrine auto-injector in food-allergic adolescents. Pediatr Allergy Immunol 2016; 27:28-34. [PMID: 26269417 DOI: 10.1111/pai.12458] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food-allergic patients at high risk of potential fatal anaphylaxis should carry an epinephrine auto-injector (EAI) at all times. This treatment may be perceived as burdensome and this may affect compliance and health-related quality of life (HRQL). The aims of the study were (1) to determine the burden of treatment (BoT) of an EAI, (2) to examine the relationship between this burden and compliance, and (3) to analyze which factors contribute to the BoT of the EAI as perceived by food-allergic adolescents and their parents. METHODS Dutch food-allergic adolescents prescribed an EAI, and their parents completed a questionnaire package (n = 55). Relationships between BoT and HRQL, illness severity and perception, and anxiety measures were investigated. RESULTS Food-allergic adolescents and their parents were (extremely) positive about the EAI (54.5%; 72.7%, respectively) (=low BoT). The BoT measure showed a significantly greater burden in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times than adolescents who reported they did. The BoT scores of both adolescents and their parents were not associated with HRQL, illness severity and perception, or trait anxiety. CONCLUSIONS The majority of food-allergic adolescents and their parents were positive about the EAI (=low BoT). However, the BoT was significantly associated with self-reported compliance with carrying the EAI. The BoT was higher in food-allergic adolescents prescribed an EAI who reported not carrying the EAI at all times. The BoT measure seems to be a useful tool to study compliance with carrying an EAI. The BoT of an EAI is not associated with HRQL. The BoT measures a distinct concept related to compliance behavior.
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Affiliation(s)
- J Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B M J Flokstra-de Blok
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - N J Goossens
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J C Kemna
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J L van der Velde
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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47
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Walker MJ, Burns DT, Elliott CT, Gowland MH, Mills ENC. Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs. Analyst 2016; 141:24-35. [DOI: 10.1039/c5an01457c] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Food allergy is an increasing problem. If we fail to realise the promise of current risk assessment and risk management of food allergens through lack of ability to measure them reproducibly and with traceability to an international unit of measurement, the analytical community will have failed a significant societal challenge.
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Affiliation(s)
| | - D. T. Burns
- Institute for Global Food Security
- The Queen's University of Belfast
- Belfast
- UK
| | - C. T. Elliott
- Institute for Global Food Security
- The Queen's University of Belfast
- Belfast
- UK
| | | | - E. N. Clare Mills
- Institute of Inflammation and Repair
- Manchester Academic Health Sciences Centre
- Manchester Institute of Biotechnology
- University of Manchester
- Manchester M1 7DN
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48
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Leibel S, Fenton N. Building Trust: Children Experiences with Food Allergies at Summer Camp. Health (London) 2016. [DOI: 10.4236/health.2016.814143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Pistiner M, Devore CD, Schoessler S. School Food Allergy and Anaphylaxis Management for the Pediatrician--Extending the Medical Home with Critical Collaborations. Pediatr Clin North Am 2015; 62:1425-39. [PMID: 26456441 DOI: 10.1016/j.pcl.2015.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community pediatricians, working in consultation with allergists, create a medical home that is the central focus of care for the child with life-threatening food allergies. They participate in coordinating mutual and critical collaborations within schools that support families and children. They can provide leadership and guidance to both families and schools to safeguard children and adolescents, thereby extending the medical home goals into the school setting.
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Affiliation(s)
- Michael Pistiner
- Harvard Vanguard Medical Associates, 133 Brookline Ave, Boston, MA 02215, USA.
| | | | - Sally Schoessler
- Allergy & Asthma Network, 8229 Boone Boulevard, Suite 260, Vienna, VA 22182, USA; National Association of School Nurses, 1100 Wayne Ave, Suite 925, Silver Spring, MD 20910, USA
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50
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Herbert LJ, Lin A, Matsui E, Wood RA, Sharma H. Development of a Tool to Measure Youths’ Food Allergy Management Facilitators and Barriers. J Pediatr Psychol 2015; 41:363-72. [DOI: 10.1093/jpepsy/jsv099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
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