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Versluis A, Knulst AC, Michelsen-Huisman AD, Houben GF, Blom WM, Le TM, van Os-Medendorp H. Accidental food-allergic reactions are associated with higher costs and more sick leave but not with quality of life. Clin Exp Allergy 2021; 51:627-630. [PMID: 33523539 PMCID: PMC8048496 DOI: 10.1111/cea.13839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Astrid Versluis
- Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andre C Knulst
- Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Geert F Houben
- Netherlands Organization for Applied Scientific Research, TNO, Utrecht, The Netherlands
| | - W Marty Blom
- Netherlands Organization for Applied Scientific Research, TNO, Utrecht, The Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
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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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Saleh-Langenberg J, Dubois AEJ, Groenhof F, Kocks JWH, van der Molen T, Flokstra-de Blok BMJ. Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands. Allergy Asthma Clin Immunol 2015; 11:28. [PMID: 26472961 PMCID: PMC4607246 DOI: 10.1186/s13223-015-0094-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/23/2015] [Indexed: 01/22/2023] Open
Abstract
Background The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands. Methods Patients aged 12–23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI. Results One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP. Conclusions This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care.
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Affiliation(s)
- Jacquelien Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands ; GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands ; GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Groenhof
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J W H Kocks
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T van der Molen
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - B M J Flokstra-de Blok
- GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Versluis A, Knulst AC, Kruizinga AG, Michelsen A, Houben GF, Baumert JL, van Os-Medendorp H. Frequency, severity and causes of unexpected allergic reactions to food: a systematic literature review. Clin Exp Allergy 2015; 45:347-67. [PMID: 24766413 DOI: 10.1111/cea.12328] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Food allergic patients have to deal with an avoidance diet. Confusing labelling terms or precautionary labels can result in misinterpretation and risk-taking behaviour. Even those patients that strictly adhere to their diet experience (sometimes severe) unexpected allergic reactions to food. The frequency, severity and causes of such reactions are unknown. The objective of this review was to describe the frequency, severity and causes of unexpected allergic reactions to food in food allergic patients aged > 12 years, in order to develop improved strategies to deal with their allergy. A systematic review was carried out by two researchers, in six electronic databases (CINAHL, Cochrane, EMBASE, Medline, Psychinfo and Scopus). The search was performed with keywords relating to the frequency, severity and causes of unexpected allergic reactions to food. This resulted in 24 studies which met the inclusion criteria; 18 observational and six qualitative studies. This review shows that knowledge about the frequency of unexpected reactions is limited. Peanut, nuts, egg, fruit/vegetables and milk are the main causal foods. Severe reactions and even fatalities occur. Most reactions take place at home, but a significant number also take place when eating at friends' houses or in restaurants. Labelling issues, but also attitude and risky behaviour of patients can attribute to unexpected reactions. We conclude that prospective studies are needed to get more insight in the frequency, severity, quantity of unintended allergen ingested and causes of unexpected allergic reactions to food, to be able to optimize strategies to support patients in dealing with their food allergy. Although the exact frequency is not known, unexpected reactions to food occur in a significant number of patients and can be severe. For clinical practice, this means that patient education and dietary instructions are necessary.
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Goossens NJ, Flokstra-de Blok BMJ, van der Meulen GN, Arnlind MH, Asero R, Barreales L, Burney P, Cerecedo I, Clausen M, Fernandéz-Rivas M, Frewer L, de la Hoz Caballer B, Jansson SA, Jedrzejczak-Czechowicz M, Knulst AC, Kowalski ML, Papadopoulos NG, Purohit A, Rokicka E, Starosta P, Vásquez-Cortés S, Duiverman EJ, Dubois AEJ. Health-related quality of life in food-allergic adults from eight European countries. Ann Allergy Asthma Immunol 2014; 113:63-68.e1. [PMID: 24795291 DOI: 10.1016/j.anai.2014.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/07/2014] [Accepted: 04/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Food allergy can impair health-related quality of life (HRQL). Food Allergy Quality of Life Questionnaires (FAQLQs) have been developed and validated, including an adult form (FAQLQ-AF). HRQL has not, to date, been measured across different European countries using a uniform methodology. OBJECTIVE To translate and validate the FAQLQ-AF for use in 8 European countries (Iceland, The Netherlands, Poland, France, Spain, Italy, Greece, and Sweden). METHODS The English FAQLQ-AF was translated, back-translated, and compared for use in the 8 relevant European languages. Adults with a perceived food allergy were recruited from outpatient departments and through a community survey. Participants completed the FAQLQ-AF, the Food Allergy Independent Measure, and questions concerning participants' characteristics. Validity of the FAQLQ-AF was analyzed for use in the 8 countries. RESULTS The FAQLQ-AF had strong construct validity (r > 0.59) and an excellent internal consistency (Cronbach α > 0.95) in all countries. Total FAQLQ-AF scores (range 3.2-5.0) were significantly different across participating countries. CONCLUSION The FAQLQ-AF is a suitable and valid instrument for measuring HRQL in food-allergic adults in Iceland, The Netherlands, Poland, France, Spain, Italy, Greece, and Sweden. The impact of food allergy on HRQL seems to differ among adults from the 8 participating European countries.
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Affiliation(s)
- Nicole J Goossens
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Bertine M J Flokstra-de Blok
- GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerbrich N van der Meulen
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Department of Pediatric Allergy, Martini Hospital, Groningen, The Netherlands
| | - Marianne H Arnlind
- Centre for Allergy Research and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ricardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Laura Barreales
- Department of Preventive Medicine, Research Unit, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Peter Burney
- Department of Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Imnaculada Cerecedo
- Sección de Alergología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Michael Clausen
- Department of Allergy, Landspitali, University Hospital, Reykjavík, Iceland
| | | | - Lynn Frewer
- Food Safety and Consumer Behaviour, Marketing and Consumer Behaviour Group, Wageningen, The Netherlands; CRE, SAFRD, Newcastle University, Newcastle, United Kingdom
| | | | - Sven-Arne Jansson
- Centre for Allergy Research and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - André C Knulst
- Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Ashok Purohit
- Division of Allergy, Department of Chest Diseases, University Hospitals, University of Strasbourg, Strasbourg, France
| | - Ewa Rokicka
- Faculty of Economics and Sociology, Lodz University, Poland
| | - Pawel Starosta
- Faculty of Economics and Sociology, Lodz University, Poland
| | | | - Eric J Duiverman
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anthony E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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