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Lövquist A, Turesson A, Protudjer JLP, Zelander CF, Jonsson M. The needs of parents of children with allergic diseases in preschool and school: A focus-group study. J Pediatr Nurs 2024; 79:100-106. [PMID: 39244819 DOI: 10.1016/j.pedn.2024.08.028] [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: 04/04/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To describe the perceived physical and psychological needs of parents of children with allergic diseases and asthma regarding allergy management in preschools and schools. METHODS We conducted a semi-structured focus group study with parents of children (ages 2-13 years) with different types of allergic diseases with/without asthma living in Stockholm, Sweden. Data were analyzed qualitative with systematic text condensation. RESULTS Across 4 focus groups, involving 25 parents, four primary themes representing parents' expressed needs related to allergy management in preschools and schools emerged: (i) Well-implemented routines (to create an allergy-safe physical environment where personnel have clear responsibilities and communication); (ii) Allergy competence among personnel (basic and practical knowledge, being able to act in emergency situations); (iii) My child is to be treated equally (with equal conditions and for their child to being included); (iv) To feel trust (parents need to be understood, taken seriously and feel confident in the preschool/school personnel's ability to take care of their child in a secure way). CONCLUSION This qualitative study shows parents needs regarding general allergy management in preschool/school. These needs emphasized well implemented allergy routines, improved allergy knowledge and competence among personnel, importance of equal conditions for children with allergic disease and establishing a trustful allergy-supportive relationship with both parents and children. IMPLICATIONS IN PRACTICE The study findings provide crucial insights for school administrators, teachers, and health care professionals on how to improve allergy management in preschools and schools.
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Affiliation(s)
- Alexandra Lövquist
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Annelie Turesson
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Marina Jonsson
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Ashley SE, Bosco A, Tang MLK. Transcriptomic changes associated with oral immunotherapy for food allergy. Pediatr Allergy Immunol 2024; 35:e14106. [PMID: 38520061 DOI: 10.1111/pai.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
This review summarizes recent advances in characterizing the transcriptional pathways associated with outcomes following Oral Immunotherapy. Recent technological advances including single-cell sequencing are transforming the ways in which the transcriptional landscape is understood. The application of these technologies is still in its infancy in food allergy but here we summarize current understanding of gene expression changes following oral immunotherapy for food allergy and specific signatures underpinning the different clinical outcomes of desensitization and remission (sustained unresponsiveness). T helper 2A cells have been identified as a cell type which correlates with disease activity and is modified by treatment. Molecular features at study entry may differentiate individuals who achieve more positive outcomes during OIT. Recent findings point to T cell anergy and Type 1 interferon pathways as potential mechanisms supporting redirection of the allergen-specific immune response away from allergy towards remission. Despite these developments in our understanding of immune mechanisms following OIT, there are still significant gaps. Additional studies examining immune signatures associated with long term and well-defined clinical outcomes are required to gain a more complete understanding of the pathways leading to remission of allergy, in order to optimize treatments and gain improved outcomes for patients.
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Affiliation(s)
- Sarah E Ashley
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anthony Bosco
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
- Department of Immunobiology, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
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Figueroa-Gómez X, Oliveras-López MJ, Rodríguez Silva JM, Poyanco M, López H, Araya M. Experiences and perceptions of people with celiac disease, food allergies and food intolerance when dining out. Front Nutr 2024; 11:1321360. [PMID: 38371500 PMCID: PMC10870926 DOI: 10.3389/fnut.2024.1321360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Eating out is a common practice in modern society. Celiac disease (CeD) and food allergy (FA) are among the most common conditions responsible for adverse reactions to food. Despite their different origins, both require treatment with restrictive diets (avoidance of gluten and/or specific allergens) and this results posing similar challenges when eating out. Our objective was to learn about the experiences/perceptions of consumers with CeD and FA when dining out, as well as the challenges they face in food service environments. Methods An ad hoc questionnaire was used to record consumer perceptions, food service characteristics and resulting adverse reactions. Results 377 individuals living in Santiago, Chile, provided complete information and were analyzed (160 CeD, 105 FA). 301 participants (79.8%) declared eating out, 33.6% reported experiencing an adverse reaction at least once while eating out. 94.4% of the 377 participants believed that the serving staff had little or no knowledge about his/her condition. Consumers reporting symptoms as severe adverse reactions were more common among celiac than allergic patients (p < 0.001). Discussion The study showed no significant differences based on consumer-related characteristics (p:NS). The consequences of eating out did not vary based on individual's data, including diagnosis, age, frequency of eating out, adverse reactions experienced, or intensity. These findings suggest that the most important determinants of risk associated with eating out are characteristics of the food service, like availability of information, staff training, and establishment's facilities like equipment available, exclusive utensils for customers with special dietary needs and kitchen and bathrooms organization.
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Affiliation(s)
- Ximena Figueroa-Gómez
- PhD Student of the Nutrition and Food Science Doctoral Program, Department of Nutrition and Bromatology, Faculty of Pharmacy, University of Granada, Granada, Spain
- PhD Student of the Nutrition and Food Science Doctoral Program, Human Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - María Jesus Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Sevilla, Spain
| | | | - Marcelo Poyanco
- Faculty of Economic and Administrative Sciences, University of Valparaíso, Valparaíso, Chile
| | - Herminia López
- Department of Nutrition and Bromatology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Magdalena Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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Caner N, Efe YS, Söyünmez S, Bayat M. Managing food allergies at school: A qualitative study. J Pediatr Nurs 2023; 73:58-66. [PMID: 37647789 DOI: 10.1016/j.pedn.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The prevalence of childhood allergic diseases, including food allergies, has increased globally. Parents and children have experienced psychosocial and financial difficulties, decreased quality of life, anxiety, and depression in the management of food allergies in schools. PURPOSE The aim of the study was to determine the challenges experienced by mothers of children with food allergies during their children's school life. DESIGN A qualitative phenomenological study design was used. METHODS Online interviews were conducted with 9 mothers who have children with food allergies between June-August 2022. The data were analyzed using the content analysis method. The COREQ checklist was used in the study. RESULTS The ages of the mothers participating in the study ranged from 28 to 40. Four themes were generated from 75 codes: 1) Problems experienced in the process of utilizing health services, 2) Burden of care, 3) Coming out of the shell: The school process, and 4) Environmental and social perspective. CONCLUSIONS Mothers carried the burden of food allergy management during the school process, and the increased burden of care negatively impacted mothers emotionally, physically, and socially. Also, mothers were anxious about the safety of their school-age children with food allergies and their experiences with school administration, teachers, and other parents made it difficult for food allergy management in the school environment. CLINICAL RELEVANCE Children with chronic health problems such as food allergies need to be closely monitored by a health professional in school to ensure their safety. Nurses have a pivotal role in supporting families to address their child's food allergies competently, hence fostering positive health outcomes. This study showed that there was a need for the development of school health policies to ensure the safety of children with food allergies and to reduce anxiety and care burden among mothers.
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Affiliation(s)
- Nuray Caner
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Yağmur Sezer Efe
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Selin Söyünmez
- Erciyes University, Institute of Health Sciences, Child Health and Disease Nursing Department, Kayseri, Turkey.
| | - Meral Bayat
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
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Sanagavarapu P, Dadich A, Hussain W. Interventions to Promote Food Allergy Literacy in Childhood: A Systematic Scoping Review. THE JOURNAL OF SCHOOL HEALTH 2023. [PMID: 36861668 DOI: 10.1111/josh.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This article introduces the concept, food allergy literacy (FAL), which encompasses the knowledge, behaviors, and skills needed to manage a food allergy and is thus critical to child safety. Yet, there is limited clarity on how to promote FAL in children. METHODS Twelve academic databases were systematically searched to identify publications on interventions to promote FAL in children. Five publications met the inclusion criteria, which involved children (3 to 12 years), their parents, or educators and tested the efficacy of an intervention. FINDINGS Four interventions were for parents and educators, while 1 intervention was for parents with their children. The interventions were educational and focused on promoting participant knowledge and skills of food allergy, and/or psychosocial in nature, promoting coping, confidence, and self-efficacy in managing children's allergies. All interventions were deemed effective. Only 1 study used a control group, and none assessed the long-term benefits of the interventions. IMPLICATIONS FOR SCHOOL POLICY, PRACTICE, AND EQUITY The results can enable health service providers and educators to design evidence-based interventions to promote FAL. This might involve designing, implementing, and evaluating curricula and play-based activities, therein, that award greater attention to food allergy-its consequences, risks, skills to prevent risk, and managing food allergy in educational settings. CONCLUSIONS There is limited evidence on child-focused interventions that promote FAL. There is, therefore, considerable opportunity to co-design and test interventions with children.
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Affiliation(s)
- Prathyusha Sanagavarapu
- School of Education, Western Sydney University, Locked Bag 1797, Sydney, NSW, 2751, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Sydney, NSW, 2751, Australia
| | - Wajiha Hussain
- School of Education, Western Sydney University, Locked Bag 1797, Sydney, NSW, 2751, Australia
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The Need for Required Stock Epinephrine in All Schools: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1068-1082.e1. [PMID: 36716997 DOI: 10.1016/j.jaip.2022.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/30/2023]
Abstract
Epinephrine is the first line of treatment for anaphylaxis that can occur outside a medical setting in community environments such as schools. Patients with diagnosed IgE-mediated food allergy at risk of anaphylaxis are prescribed self-injectable epinephrine and given an individualized anaphylaxis action plan. As students, such patients/families provide their school with completed medication forms, a copy of their anaphylaxis plan, and additional student-specific epinephrine. However, students approved to self-carry prescribed self-injectable epinephrine may forget to do so or have other reasons for lacking prescribed epinephrine such as familial inability to fill the prescription due to cost or other access barriers. Undiagnosed students lacking prescribed epinephrine may also experience anaphylaxis at school. The presence of non-student-specific school stock epinephrine allows school nurses and other staff the ability to treat anaphylaxis onsite while awaiting Emergency Medical Services. Notably, not all states legally mandate K-12 schools to stock epinephrine. In states with laws only voluntarily allowing schools to stock epinephrine, it provides the ability to opt-out. Herein, we present a comprehensive review of barriers to school stock epinephrine, related improvement strategies, and workgroup recommendations supporting the need for mandated stock epinephrine in all schools in every state. Proposed solutions include ensuring legal immunity from liability for prescribers; advocacy for legislation to stabilize cost of self-injectable epinephrine; educational initiatives to schools promoting merits and safety of epinephrine and related anaphylaxis training; and partnerships between patient advocacy groups, medical and nursing organizations, public health departments and other health professionals to promote laws and district policies addressing need for stock epinephrine and school nurses to train and supervise school staff.
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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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: 4] [Impact Index Per Article: 2.0] [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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How primary care providers can help prevent food allergies. Curr Opin Pediatr 2022; 34:430-437. [PMID: 35797492 DOI: 10.1097/mop.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW IgE-mediated food allergy rates have increased in recent decades, yet treatment options remain limited. Prevention strategies are thus essential. We will review recent research and consensus guidelines for food allergy prevention. RECENT FINDINGS Research has continued to support that early introduction of allergens via the gastrointestinal tract induces tolerance and prevents development of food allergy. In contrast, allergen sensitization may occur via transcutaneous allergen exposure. This is supported by research that shows a decreased risk of food allergy with aggressive treatment of atopic dermatitis. More recent research suggests that transcutaneous sensitization could also be facilitated by frequent emollient use in the absence of atopic dermatitis but definitive research is lacking. Murine models have shown a likely role of dysbiosis, or disruption of the body's normal healthy microbiome, in development of food allergy, yet human studies have yet to show a conclusive benefit of probiotics in the prevention of food allergy. SUMMARY Important approaches for food allergy prevention are: introduction of peanut and cooked egg at 4-6 months, early introduction of other allergenic foods, and early diagnosis and treatment of atopic dermatitis (because of a predisposition to food sensitization through the damaged skin barrier). More research is needed to clarify the role, if any, of emollient use and probiotics.
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Ross N, Dalke S, Filuk S, Kulbaba B, Marks D, St-Vincent JA, Simons E. It takes a village: perceptions of Winnipeg parents, students, teachers and school staff regarding the impact of food allergy on school-age students and their families. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:47. [PMID: 35689271 PMCID: PMC9188203 DOI: 10.1186/s13223-022-00682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/03/2022] [Indexed: 11/21/2022]
Abstract
Background The entire school community contributes to the safety of students with food allergy. We sought to determine the food allergy perceptions and education needs of parents, students and school staff, with the goal of enhancing food allergy education in schools. Methods With ethics approval from the University of Manitoba and participating school divisions, elementary school principals emailed SurveyMonkey® Questionnaire Links to their parent/caregiver contact list and school staff. We compared anonymous responses of parents of children with and without food allergy, students with and without food allergy, and parents and school staff using chi-squared tests. Results Participants included 561 parents of school-age children (ages 7–12 years, 19% with food allergy), 61 students (23% with food allergy), and 203 school staff (62% teachers, 88% with experience managing food allergies in the classroom). Parents of children with and without food allergy considered food allergy when sending food to school (98% vs. 96%, p = 0.39). More parents of children with food allergy thought that greater information and awareness about food allergy was needed (74% vs. 44%, p < 0.0001). Students with food allergy were most interested (100%) in having other students learn not to bully and how to help during a reaction. Students without food allergy were most interested in learning how to prevent a reaction (70%). Fewer parents than school staff thought that food allergies in the classroom impacted teachers’ time (2.1% vs. 21%, p < 0.0001) and that teachers knew how to treat allergic reactions to foods (34% vs. 94%, p < 0.0001). More parents than school staff thought that banning foods from classrooms kept allergic students safe (65% vs. 34%, p = 0.006) and that having a Food Allergy Educator speak at school would be helpful (99% vs. 67%, p < 0.0001). Conclusions Food allergy education is necessary for the entire school community and should include parents of school-aged children with and without food allergy, students with and without food allergy, and teachers and school staff. These members of the school community recognized their own and others’ needs for increased food allergy education and awareness in the school setting. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00682-2.
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Affiliation(s)
- Nancy Ross
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Sandra Dalke
- Unified Referral and Intake Service, Manitoba Health, 300 Carlton Street, Winnipeg, MB, R3B 3M9, Canada
| | - Shauna Filuk
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Bev Kulbaba
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Diane Marks
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Jo-Anne St-Vincent
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Elinor Simons
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada. .,Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, 504B-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
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Kanter AB, Yasik AE, Zaccario ML, Saviano JC. Self-Reported Anxiety Ratings in Children With and Without Food Allergies and Teacher Knowledge of Food Allergies. THE JOURNAL OF SCHOOL HEALTH 2022; 92:541-549. [PMID: 35411602 DOI: 10.1111/josh.13181] [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: 05/29/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Researchers have found a relationship between having food allergies and anxiety in children. Anxiety may relate to others' lack of food allergy knowledge. This study investigated the relationship between having a food allergy and self-reported anxiety among children. Furthermore, knowledge of food allergies among children without food allergies and teachers was explored. METHODS Children with food allergies and their parents each completed a perceived food allergy severity questionnaire. Children without food allergies completed a food allergy knowledge measure. All children completed a self-reported anxiety measure. Teachers completed a questionnaire investigating knowledge, attitudes, and beliefs about food allergies. Correlational analyses and analyses of variance were conducted. RESULTS Overall anxiety was significantly higher in children with food allergies than in children without food allergies. When controlling for the effects of sex and age, children with food allergies had significantly higher social phobia and school phobia. Teachers correctly answered 69.7% of knowledge-based questions about food allergies; children without food allergies correctly answered 62.7%. CONCLUSIONS Findings highlight the need for an integrated approach in which families, school personnel, psychologists and other mental health professionals, and medical professionals work together to increase awareness about the multifaceted needs of children with food allergies.
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12
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Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management. Ann Allergy Asthma Immunol 2022; 129:430-439. [PMID: 35568300 DOI: 10.1016/j.anai.2022.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.
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Affiliation(s)
- Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts.
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Vollmer RL, Girsch V, Foster JS. A Qualitative Investigation of Parent and Child Perceptions of School Food Allergy Policies in the United States. THE JOURNAL OF SCHOOL HEALTH 2022; 92:185-193. [PMID: 34806178 DOI: 10.1111/josh.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many schools implement well-intentioned food allergy policies; however, may not ease parents'/children's worry and concern. The purpose of this study was to (1) explore children's and parents' perceptions their school's food allergy policy and (2) compare these perceptions to the documented school policy. METHODS Children ages 8 to 18 with a food allergy and their parents (N = 18 pairs) across the US completed one-on-one semi-structured, audio-recorded phone interviews. School food allergy policies were collected from school websites. Content analysis was applied to the transcriptions by two investigators to identify themes among parents and children. RESULTS Parents and children described policies may impact the child's social and/or emotional well-being. Many opportunities for improvement were provided by parents and children. There is a wide variation in food allergy policies across the schools in this study, and overall, parents and children thought that policy enforcement needs to be improved. CONCLUSIONS With so much variation in food allergy policies in schools coupled with inconsistent enforcement, parents and children may feel unsafe or unsupported by the school. Schools should adopt a team- or whole-school approach to develop and enforce policies that help protect children with food allergies.
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Affiliation(s)
- Rachel L Vollmer
- Bradley University, 1501 West Bradley Avenue, Peoria, IL, 61625, USA
| | - Virginia Girsch
- Bradley University, 1501 West Bradley Avenue, Peoria, IL, 61625, USA
| | - Jaime S Foster
- Yale-Griffin Prevention Research Center, 130 Division Street, Derby, CT, 06418, USA
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Poza-Guedes P, González-Pérez R. Implementing information and communication technology education on food allergy and anaphylaxis in the school setting. Clin Transl Allergy 2021; 11:e12039. [PMID: 34262693 PMCID: PMC8254581 DOI: 10.1002/clt2.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Every year, 1/10,000 children experiences a food‐anaphylactic reaction. Most of these events, including attack‐related deaths, may happen during the school hours. In the current study, we assessed the influence of information and communication technologies (ICT) in the school‐staff's education on food allergy and anaphylaxis (FAA). Methods The target population of this intervention was non‐university teaching centers from the local Regional Education Council, including both state and private institutions. The digital intervention was supported by the free‐of‐charge and open‐source learning‐management Aulatic Educational Platform. Structured questionnaires were developed to evaluate the educators' knowledge, feelings, and self‐efficacy on FAA, in addition to a satisfaction and quality survey of the training program. Results A total of 1748 school‐educators were virtually enrolled from May 2016 to June 2020 in one of the 8‐week course editions, with 80.6% of attendees successfully completing the full training. All scores concerning school‐staff's basic knowledge and self‐efficacy on FAA significantly improved after the educational intervention, reaching a high level of satisfaction among participants (98.5%) over the 4‐year educational program. Conclusion Our results highlighted the effectiveness of a focused e‐learning activity to improve teachers and school caretakers in the management of food allergic scholars and anaphylactic reactions during the school hours. The use of ICTs tools should become an integrated part of curricular frameworks in non‐university education, leading to a better care of FAA school children.
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Affiliation(s)
- Paloma Poza-Guedes
- Allergy Department Hospital Universitario de Canarias Tenerife Spain.,Severe Asthma Unit Hospital Universitario de Canarias Tenerife Spain
| | - Ruperto González-Pérez
- Allergy Department Hospital Universitario de Canarias Tenerife Spain.,Severe Asthma Unit Hospital Universitario de Canarias Tenerife Spain
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15
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Brough HA, Gourgey R, Radulovic S, Caubet JC, Lack G, Anagnostou A. Latest Developments in the Management of Nut Allergies. CURRENT TREATMENT OPTIONS IN ALLERGY 2021; 8:97-110. [PMID: 34150446 PMCID: PMC8203721 DOI: 10.1007/s40521-021-00290-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length and administration devices have been recently debated considering the risk of bone penetration vs subcutaneous administration, and autoinjectors seem to deliver higher peak concentrations than syringes. Selective nut introduction has gained momentum in the last 5 years, demonstrating improved quality of life but with the need for motivated parents for continued consumption and available resources for challenges. Immunotherapy to nuts is also a rapidly developing field, with the balance of efficacy and safety being important considerations in the differing modes of administration. Summary The management of nut allergies is a rapidly developing field, and dietary and medical management have progressed significantly in the last 5 years. Future research directions include improving safety and efficacy of food immunotherapy and examining patients’ goals for therapy and treatment outcomes.
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Affiliation(s)
- H A Brough
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - R Gourgey
- Department of Paediatric Allergy, The Royal London Children's Hospital, Barts Health NHS Trust, E1 1FR, London, UK
| | - S Radulovic
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - J C Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé, Geneva, Switzerland
| | - G Lack
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - A Anagnostou
- Section of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, TX USA.,Department of Pediatrics, Section of Allergy, Immunology and Retrovirology, Texas Children's Hospital, Houston, TX USA
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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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