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Chong AC, Izadi N, Chwa WJ, Tam JS. Fruitful or unfruitful: strawberry and tomato specific immunoglobulin E testing at a tertiary pediatric center. FRONTIERS IN ALLERGY 2023; 4:1277631. [PMID: 37908373 PMCID: PMC10613731 DOI: 10.3389/falgy.2023.1277631] [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: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Background Suspected strawberry and tomato (S/T) food allergy (FA) can be evaluated using specific immunoglobulin E (sIgE) testing despite its low specificity and positive predictive value. Objective This study aims to understand ordering patterns for S/T sIgE testing and identify relevant factors to clinical decision-making. Methods We retrospectively reviewed 814 patients with sIgE testing available for strawberries (651), tomatoes (276), or both (113) from January 2012 to May 2022 at a tertiary pediatric hospital. Patient demographics, provider specialty, and reasons for testing were collected. Student's t-test and multiple regression analyses were performed to test the association between the S/T sIgE level and clinically relevant outcome (CRO) status. Fisher's exact test and general linear models were used to evaluate and compare potential predictive factors for CRO status. Results Allergy and immunology, gastroenterology, and general pediatrics ordered most S/T sIgE testing. Testing was ordered most frequently for non-IgE-mediated gastrointestinal symptoms, mild possible IgE-mediated reactions, and eczema. Testing was most often ordered for infants and school-age children. Mean sIgE levels were higher for S/T tests resulting in a CRO when controlling for other predictor variables (p = 0.015; p = 0.002 for S/T, respectively). Only 2.2% and 5.4% of tests resulted in a CRO for S/T, and severe allergy was rare. Testing for non-IgE-mediated GI symptoms or eczema, or in non-atopic patients, yielded no CROs. Exposure and reaction history of present illness (ERH) was associated with CROs (p < 0.001; p = 0.04) with a high negative predictive value (99.5%; 100%) and low positive predictive value (11.5%; 15.0%). ERH (p < 0.001, η2 = 0.073; p = 0.009, η2 = 0.123) was a more significant predictor than the sIgE level (p = 0.002, η2 = 0.037; p = 0.212, η2 = 0.030) for CRO status. Conclusion The diagnosis of S/T food allergy is made primarily based on clinical history. S/T sIgE testing for children and adolescents should be avoided for patients without an ERH and in the workup of non-IgE-mediated GI symptoms. Testing for eczema and non-atopic patients is likely low-yield.
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Affiliation(s)
- Albert C. Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Neema Izadi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Won Jong Chwa
- Saint Louis University School of Medicine, Saint Louis University, Saint Louis, MO, United States
| | - Jonathan S. Tam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
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Sugunasingha N, Jones FW, du Toit G, Jones CJ. Evaluating an online self-help intervention for parents of children with food allergies. Pediatr Allergy Immunol 2022; 33:e13731. [PMID: 35212055 PMCID: PMC9306710 DOI: 10.1111/pai.13731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/12/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA. METHODS In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained. RESULTS A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL. CONCLUSION While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention.
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Affiliation(s)
- Naomi Sugunasingha
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Fergal W Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - George du Toit
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Technical opinion of the Asociación Mexicana de Gastroenterología on soy plant-based beverages. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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CURRENT TRENDS IN THE PREVALENCE OF FOOD HYPERSENSITIVITY IN CHILDREN OF THE KYIV REGION. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the study. Due to the growing prevalence of food hypersensitivity worldwide and the number of dangerous food reactions, the aim was to determine the current prevalence of food hypersensitivity symptoms among children in the Kyiv region, Ukraine.
Methods. Total of 7106 children were surveyed: Group I (4 months – 5 years) had 1787 children, Group II (6–7 years) – 2080 children, Group ІІI (13–14 years) – 1909 children, Group ІV (15–17 years) – 1330 children.
Results. The prevalence of food hypersensitivity among the surveyed children is 26.5 % (95 % CI: 25.5–27.6) – this is 1888 children out of 7106. Highest prevalence of food hypersensitivity (FHS) is observed in the Group I, which is 32 % (95 % CI: 29.8–34.2) – 571/1787, Groups II – 27.2 % (95 % CI: 25.7–29.8) – 566/2080, Groups III – 27.7 % (95 % CI: 14.7–18.0) – 529/1909, in the Group IV – 16.7 % (95 % CI: 25.3-29.2) – 222/1330). FHS in children is most often manifested by skin symptoms, followed by gastrointestinal manifestations, and acute urticaria/angioneurotic edema is at the third place. Respiratory manifestations possess 5 % in the structure of FHS symptoms. An anaphylactic reaction was observed in 4 children out of 7106 respondents.
Conclusions. The prevalence of food hypersensitivity among Ukrainian children is high. There is an increase in the prevalence of urticaria/angioedema in preschool children.
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Vázquez-Frias R, Icaza-Chávez ME, Ruiz-Castillo MA, Amieva-Balmori M, Argüello-Arévalo GA, Carmona-Sánchez RI, Flores-Bello MV, Hernández-Rosiles V, Hernández-Vez G, Medina-Vera I, Montijo-Barrios E, Núñez-Barrera I, Pinzón-Navarro BA, Sánchez-Ramírez CA. Technical opinion of the Asociación Mexicana de Gastroenterología on soy plant-based beverages. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:461-471. [PMID: 32863095 DOI: 10.1016/j.rgmx.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
There has been a recent increase in the consumption of cow's milk substitutes, specifically plant-based beverages, which have erroneously been named "plant milks". Plant-based beverages do not have a standard of identity, and so their nutritional composition can vary from one brand to another, even within the same category. The aim of the present narrative review was to produce a technical opinion to serve as a frame of reference for sustaining the recommendation of soy plant-based beverages. Nutrition and gastroenterology experts that belong to the Asociación Mexicana de Gastroenterología jointly commented on and analyzed themes on plant-based beverages, and on soy drinks in particular, including their nutritional characteristics, consumption in children, and potential growth and development alterations, as well as soy drink consumption in adults and its association with gastrointestinal alterations and other conditions. Plant-based beverages, including those made from soy, are not a replacement for breastmilk or breastmilk substitutes. Soy beverages are considered safe and can enrich the varied diet of its consumers, as long as they are considered an additional liquid portion of the diet. They can be ingested by adults and children above two years of age that present with cow's milk protein allergy or lactose intolerance.
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Affiliation(s)
- R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México.
| | | | - M A Ruiz-Castillo
- Servicio de Gastroenterología Pediátrica, Hospital del Niño DIF Hidalgo, Pachuca, Hidalgo, México
| | - M Amieva-Balmori
- Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, México
| | - G A Argüello-Arévalo
- Departamento de Gastroenterología y Nutrición Pediátrica, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - R I Carmona-Sánchez
- Unidad de Medicina Ambulatoria, Christus Muguerza, San Luis Potosí, San Luis Potosí, México
| | - M V Flores-Bello
- Instituto Tecnológico y de Estudios Superiores de Monterrey, Campus Ciudad de México, Ciudad de México, México
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México
| | | | - I Medina-Vera
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - E Montijo-Barrios
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - I Núñez-Barrera
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Ciudad de México, México
| | - B A Pinzón-Navarro
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
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Azdad O, Mejrhit N, El Kabbaoui M, Chda A, Ouahidi I, Tazi A, Bencheikh R, Aarab L. Effect of heating and enzymatic hydrolysis on casein cow milk sensitivity in Moroccan population. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1391179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ouarda Azdad
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Najlae Mejrhit
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed El Kabbaoui
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Alae Chda
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ibtissam Ouahidi
- High Institute of Nursing and Technical Health (ISPITS Fez), Ministry of Health, Fez, Morocco
| | - Abdelali Tazi
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Rachid Bencheikh
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Lotfi Aarab
- Laboratory of Bioactive Molecules (LBM), Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Brandström J, Vetander M, Lilja G, Johansson SGO, Sundqvist AC, Kalm F, Nilsson C, Nopp A. Individually dosed omalizumab: an effective treatment for severe peanut allergy. Clin Exp Allergy 2017; 47:540-550. [DOI: 10.1111/cea.12862] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Brandström
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - M. Vetander
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Center for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - G. Lilja
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - S. G. O. Johansson
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A.-C. Sundqvist
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - F. Kalm
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Division of Proteomics and Nanobiotechnology; School of Biotechnology; Royal Institute of Technology; Stockholm Sweden
| | - C. Nilsson
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Center for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - A. Nopp
- Department of Medicine; Immunology and Allergy Unit; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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8
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Kianifar HR, Pourreza A, Jabbari Azad F, Yousefzadeh H, Masomi F. Sensitivity Comparison of the Skin Prick Test and Serum and Fecal Radio Allergosorbent Test (RAST) in Diagnosis of Food Allergy in Children. Rep Biochem Mol Biol 2016; 4:98-103. [PMID: 27536703 PMCID: PMC4986269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Diagnosis of food allergy is difficult in children. Food allergies are diagnosed using several methods that include medical histories, clinical examinations, skin prick and serum-specific immunoglobulin E (IgE) tests, radio-allergosorbent test (RAST), food challenge, and supervised elimination diets. In this study we evaluated allergies to cow's milk, egg, peanut, and fish in children with suspected food allergies with skin prick tests and serum and feces RAST. METHODS Forty-one children with clinical symptoms of food allergies were enrolled in the study. Skin prick tests and serum and fecal RAST were performed and compared with challenge tests. RESULTS The most common sites of food allergy symptoms were gastrointestinal (82.9%) and skin (48.8%). 100% of the patients responded to the challenge tests with cow's milk, egg, peanut, and fish. 65% of the patients tested positive with the skin prick test, 12.1% tested positive with serum RAST, and 29.2% tested positive with fecal RAST. CONCLUSION The skin prick test was more sensitive than serum or fecal RAST, and fecal RAST was more than twice as sensitive as serum RAST.
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Affiliation(s)
- Hamid Reza Kianifar
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Pourreza
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farahzad Jabbari Azad
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadis Yousefzadeh
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Masomi
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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A retrospective analysis of allergic reaction severities and minimal eliciting doses for peanut, milk, egg, and soy oral food challenges. Food Chem Toxicol 2015; 80:92-100. [DOI: 10.1016/j.fct.2015.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
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Hochwallner H, Schulmeister U, Swoboda I, Spitzauer S, Valenta R. Cow's milk allergy: from allergens to new forms of diagnosis, therapy and prevention. Methods 2013; 66:22-33. [PMID: 23954566 PMCID: PMC3969108 DOI: 10.1016/j.ymeth.2013.08.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 12/22/2022] Open
Abstract
The first adverse reactions to cow's milk were already described 2,000 years ago. However, it was only 50 years ago that several groups started with the analysis of cow's milk allergens. Meanwhile the spectrum of allergy eliciting proteins within cow's milk is identified and several cow's milk allergens have been characterized regarding their biochemical properties, fold and IgE binding epitopes. The diagnosis of cow's milk allergy is diverse ranging from fast and cheap in vitro assays to elaborate in vivo assays. Considerable effort was spent to improve the diagnosis from an extract-based into a component resolved concept. There is still no suitable therapy available against cow's milk allergy except avoidance. Therefore research needs to focus on the development of suitable and safe immunotherapies that do not elicit severe side effect.
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Affiliation(s)
- Heidrun Hochwallner
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria.
| | - Ulrike Schulmeister
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Ines Swoboda
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
| | - Susanne Spitzauer
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
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Brown J, Tuthill D, Alfaham M, Spear E. A randomized maternal evaluation of epinephrine autoinjection devices. Pediatr Allergy Immunol 2013; 24:173-7. [PMID: 23448513 DOI: 10.1111/pai.12048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intramuscular epinephrine (adrenaline) is the first-line therapy for anaphylaxis and prompt administration improves outcome. In 2011, two epinephrine autoinjectors existed in the United Kingdom, differing in their users' administration method: EpiPen(®) and Anapen(®) . We routinely train all families who receive these devices. AIM To evaluate: Maternal competence in using epinephrine autoinjectors following our standard anaphylaxis training package. Which device mothers found easier to use. METHODS Mothers with no previous epinephrine autoinjector experience were approached to participate. One clinician provided a standardized demonstration on using a randomly assigned autoinjector device. She immediately evaluated the mothers' performance using ten predetermined criteria. Four criteria were device specific and six were common criteria to both devices. RESULTS One hundred mothers participated: 50 EpiPen(®) and 50 Anapen(®) . A substantial proportion of mothers (15% overall) were not able to successfully 'fire' these training devices: Anapen(®) 4% and EpiPen(®) 26% (OR 8.43, p = 0.005). Only 22% of mothers overall were able to perform all ten procedures completely successfully: Anapen(®) 32% and EpiPen(®) 12%. Chi-squared analysis showed a significantly higher proportion of mothers correctly performing all Anapen(®) specific procedures than EpiPen(®) (OR 14.24, p < 0.0001). CONCLUSION It is concerning that 15% of mothers overall could not 'fire' these devices correctly despite a one-to-one demonstration, identifying a need for more user friendly devices and training. Mothers found the Anapen(®) device significantly easier to use, which may have implications for future prescribing. Evaluation of the next generation of autoinjectors and their training packages needs to be performed as important practical differences may be found.
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Affiliation(s)
- Josephine Brown
- Children's Hospital for Wales, University Hospital for Wales, Cardiff, UK.
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12
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Money AG, Barnett J, Kuljis J, Lucas J. Patient perceptions of epinephrine auto-injectors: exploring barriers to use. Scand J Caring Sci 2012; 27:335-44. [DOI: 10.1111/j.1471-6712.2012.01045.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Sugiura K, Sugiura M. Criteria for prick test using soy sauce. Int J Dermatol 2011; 51:542-56. [PMID: 21972818 DOI: 10.1111/j.1365-4632.2011.05050.x] [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: 11/29/2022]
Abstract
BACKGROUND We previously reported four cases of soy sauce allergy and noted that new criteria are necessary for the prick test. Soy sauce contains histamine and often causes false-positive reactions in the skin tests. It is important to discuss how to interpret the results of prick tests. MATERIALS AND METHODS Eight female patients with soy sauce allergy and four female volunteers as controls were given the prick test using 15 sauces and were evaluated according to nine criteria. The volume of histamine in 15 sauces was determined by high-performance liquid chromatography. RESULTS The conventional criteria resulted in nine different reactions. Some of the control subjects showed false-positive reactions according to the conventional criteria. Histamine was detected in 11 sauces and was not detected in four sauces. The positive ratios of these four sauces were low; there were no positive reactions in controls according to the new criteria. Regardless of patients or controls, the positive ratio evaluated using the conventional criteria was higher than that evaluated using the new criteria in the sauces containing histamine. DISCUSSION It is difficult to evaluate the results of the prick test using soy sauce with the conventional criteria because the results were different depending on each criterion. Our new criteria are more suitable for evaluating the results of the prick test using soy sauce than the conventional criteria, and they could decrease the number of false-positive reactions. Common diagnostic criteria are needed for prick testing using pseudoallergens.
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Affiliation(s)
- Keiji Sugiura
- Department of Environmental Dermatology and Allergology, Daiichi Clinic, Nakaku, Nagoya, Japan.
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14
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Dunkin D, Berin MC, Mayer L. Allergic sensitization can be induced via multiple physiologic routes in an adjuvant-dependent manner. J Allergy Clin Immunol 2011; 128:1251-1258.e2. [PMID: 21762973 DOI: 10.1016/j.jaci.2011.06.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND Oral exposure to food allergens may be limited in infancy, and the initial site of antigen exposure likely plays an important role in food allergy induction. OBJECTIVE To examine the impact of different routes of exposure by using milk allergens, with and without adjuvant, on sensitization. METHODS C3H/HeJ mice were repeatedly exposed to the milk allergen α-lactalbumin (ALA), with or without cholera toxin (CT). Sensitization routes used were intragastric, cutaneous, intranasal, and sublingual. Anaphylaxis severity was assessed by symptoms and body temperature in response to oral challenge. Antigen-specific serum antibodies were measured by ELISA. The mechanism of adjuvant activity of cutaneous CT was also determined. RESULTS Sensitization to ALA as measured by allergen-specific IgE occurred by all routes of sensitization and was maximal in response to cutaneous exposure. Sensitization was dependent on CT and did not occur to antigen alone by any route. Mucosal, but not cutaneous, exposure resulted in a robust allergen-specific IgA response. Anaphylaxis occurred in all sensitized groups when orally challenged with ALA. Topical CT induced migration of langerin(neg) dermal dendritic cells to the lymph node, resulting in enhanced proliferation and T(H)2 cytokine production from responder T cells. CONCLUSIONS Sensitization can occur via all physiologic routes when adjuvant is present. The skin is a potent and likely important physiologic route of sensitization whereby adjuvant induces an efflux of antigen-bearing dermal dendritic cells to the lymph node that generate a proallergic T(H)2 response.
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Affiliation(s)
- David Dunkin
- Division of Pediatric Gastroenterology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Monks H, Gowland MH, MacKenzie H, Erlewyn-Lajeunesse M, King R, Lucas JS, Roberts G. How do teenagers manage their food allergies? Clin Exp Allergy 2010; 40:1533-40. [PMID: 20682004 DOI: 10.1111/j.1365-2222.2010.03586.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The peak incidence of deaths from anaphylaxis associated with nut allergy occurs in teenagers and young adults. During adolescence, the management of food allergy shifts from being the responsibility of parents to that of the young person. This is a group who therefore need special attention in the clinic. OBJECTIVE This study aimed to understand the practical challenges that teenagers with food allergy experience using a qualitative approach and generate potential interventions for tackling these. METHODS Teenagers aged 1118 years with food allergy completed a questionnaire about their food allergy and underwent a focused, semi-structured interview with open questions guided by a priori topic areas. Interviews were recorded, transcribed and analysed using a thematic approach. RESULTS The study enrolled 18 teenagers with a median age of 15 years (10 females); the most common food allergens were peanuts and tree nuts. Three key themes emerged: avoidance of allergens, preparation for reactions and the treatment of reactions. The majority of teenagers reported eating foods labelled as 'may contain' an allergen as they perceive that they are actually very unlikely to contain an allergen. Many of the teenagers only carried their self-injectable adrenaline when they thought they are particularly at risk of a reaction. Some do not know how to appropriately treat an allergic reaction. More than half believed that educating other students at school about the seriousness of food allergies would make it easier to live with their food allergy. CONCLUSIONS A significant number of teenagers demonstrate risk-taking behaviour in the management of their food allergies. Teenagers also felt it would be helpful for their peers to be educated about food allergy. This novel strategy might help them to avoid trigger foods and enable teenagers to access help more readily if they suffer a reaction.
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Affiliation(s)
- H Monks
- University of Southampton School of Medicine, Southampton, UK
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16
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Muñoz-Furlong A, Weiss CC. Characteristics of food-allergic patients placing them at risk for a fatal anaphylactic episode. Curr Allergy Asthma Rep 2009; 9:57-63. [PMID: 19063826 DOI: 10.1007/s11882-009-0009-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Food allergy is a growing public health and food safety concern. Twelve million Americans-4% of the population-suffer from the disease, and the prevalence is increasing. There is no cure for food allergy; strict avoidance is the only way to prevent a reaction. Food allergy is a major cause of anaphylaxis, a severe, potentially life-threatening allergic reaction that results in an estimated 30,000 emergency department visits and 100 to 150 deaths annually. Factors that place food-allergic patients at greater risk for a fatal anaphylactic episode include asthma; being a teen or young adult; peanut, tree nut, and seafood allergy; not carrying epinephrine; restaurant food; spending time in schools and child care settings; and lack of information from health care providers. Better education of patients and their families about managing their food allergy and high-risk situations can help to prevent future fatalities.
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Kvenshagen B, Halvorsen R, Jacobsen M. Is there an increased frequency of food allergy in children delivered by caesarean section compared to those delivered vaginally? Acta Paediatr 2009; 98:324-7. [PMID: 18976354 DOI: 10.1111/j.1651-2227.2008.01074.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Allergic diseases are increasing. At the same time an increasing number of children are delivered by caesarean section. These children do not get the same contact with their mother's gut flora as babies delivered vaginally. Theoretically, lack of exposure to maternal vaginal and perineal bacteria might change the gut flora, with secondary changes in the immune system. The aim of this study was to investigate whether children delivered by caesarean section were more prone to develop food allergy. METHODS Six hundred and nine children were included at birth. At 2-year follow-up, 512 children participated, 171 delivered by caesarean section, 341 born vaginally. The children reported to have symptoms consistent with possible food allergy, were examined at the outpatient clinic. The diagnosis was based on the history, skin prick test (SPT), specific IgE, elimination/challenge test and double blind placebo controlled challenge. RESULTS Thirty-five (6.8%) children were diagnosed with adverse reactions to food, 27 with non-IgE-mediated and eight with IgE-mediated allergy. There was no over representation of children born by caesarean section. CONCLUSION In this study there seems to be no increased risk for food allergy in the first 2 years of life in children delivered by caesarean section.
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Affiliation(s)
- Bente Kvenshagen
- Department of Pediatrics, Oestfold Hospital Trust, Fredrikstad, Norway.
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Mine Y, Yang M. Recent advances in the understanding of egg allergens: basic, industrial, and clinical perspectives. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2008; 56:4874-4900. [PMID: 18543935 DOI: 10.1021/jf8001153] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The emergence of egg allergy has had both industrial and clinical implications. In industrialized countries, egg allergy accounts for one of the most prevalent food hypersensitivities, especially in children. Atopic dermatitis represents the most common clinical manifestation in infancy; however, the range of clinical signs is broad and encompasses life-threatening anaphylaxis. The dominant egg allergens are proteins and are mainly present in the egg white, for example, ovalbumin, ovomucoid, ovotransferrin, and lysozyme. However, egg yolk also displays low-level allergenicity, for example, alpha-livetin. Strict avoidance of the offending food remains the most common recommendation for egg-allergic individuals. Nevertheless, the omnipresence of egg-derived components in prepackaged or prepared foods makes it difficult. Therefore, more efficient preventive approaches are investigated to protect consumers from inadvertent exposure and ensuing adverse reactions. On the one hand, commercial kits have become readily available that allow for the detection of egg contaminants at trace levels. On the other hand, attempts to produce hypoallergenic egg-containing products through food-processing techniques have met with promising results, but the approach is limited due to its potentially undesirable effects on the unique functional and sensory attributes of egg proteins. Therefore, the development of preventive or curative strategies for egg allergy remains strongly warranted. Pilot studies have suggested that oral immunotherapy (IT) with raw or cooked preparations of egg may represent a safe alternative, immediately available to allergic subjects, but remains applicable to only nonanaphylactic patients. Due to the limitations of conventional IT, novel forms of immunotherapy are sought based on information obtained from the molecular characterization of major egg allergens. In the past decade, promising approaches to the treatment and prevention of egg allergy have been explored and include, among others, the production of hypoallergenic recombinant egg proteins, the development of customized peptides, and bacterial-mediated immunotherapy. Nonspecific approaches have also been evaluated, and preliminary trials with the use of probiotic bacteria have yielded encouraging results. The current understanding of egg allergens offers novel approaches toward the making of food products safe for human consumption and the development of efficient immunotherapeutic strategies.
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Affiliation(s)
- Yoshinori Mine
- Department of Food Science, University of Guelph, Guelph, Ontario N1G2W1, Canada.
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Roth-Walter F, Berin MC, Arnaboldi P, Escalante CR, Dahan S, Rauch J, Jensen-Jarolim E, Mayer L. Pasteurization of milk proteins promotes allergic sensitization by enhancing uptake through Peyer's patches. Allergy 2008; 63:882-90. [PMID: 18588554 DOI: 10.1111/j.1398-9995.2008.01673.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The underlying mechanisms responsible for allergic sensitization to food proteins remain elusive. To investigate the intrinsic properties (as well as the effect of pasteurization) of the milk proteins alpha-lactalbumin, beta-lactoglobulin and casein that promote the induction of milk allergy. METHODS Alteration of structure and immune-reactivity of native and pasteurized proteins was assessed by gel filtration and ELISA. Uptake of these proteins was compared in vitro and in vivo. The biological effect was assessed by orally sensitizing C3H/HeJ mice with milk proteins followed by a graded oral challenge. Required dose to induce anaphylaxis, symptoms and mean body temperature was recorded. Antigen-specific antibodies and cytokine production by splenocytes were analyzed. RESULTS Soluble beta-lactoglobulin and alpha-lactalbumin but not insoluble casein were readily transcytosed through enterocytes in vitro and in vivo. Pasteurization caused aggregation of beta-lactoglobulin and alpha-lactalbumin inhibiting uptake by intestinal epithelial cells in vitro and in vivo. Furthermore, aggregation redirected uptake to Peyer's patches, which promoted significantly higher Th2-associated antibody and cytokine production in mice than their native counterparts. Despite this only the soluble forms of beta-lactoglobulin and alpha-lactalbumin elicited anaphylaxis (following priming) when allergens were administered orally. Aggregated beta-lactoglobulin and alpha-lactalbumin as well as casein required systemic administration to induce anaphylaxis. CONCLUSIONS These results indicate that triggering of an anaphylactic response requires two phases (1) sensitization by aggregates through Peyer's patches and (2) efficient transfer of soluble protein across the epithelial barrier. As the majority of common food allergens tend to form aggregates, this may be of clinical importance.
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Affiliation(s)
- F Roth-Walter
- Center of Immunobiology, Mount Sinai School of Medicine, New York, NY 10029, USA
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Cocco RR, Camelo-Nunes IC, Pastorino AC, Silva L, Sarni ROS, Rosário Filho NA, Solé D. Abordagem laboratorial no diagnóstico da alergia alimentar. REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Revisar os exames laboratoriais disponíveis utilizados no diagnóstico da alergia alimentar mediada ou não por IgE. FONTES DE DADOS: Artigos publicados em base de dados PubMed e Embase (língua inglesa e portuguesa) nos últimos dez anos. As palavras-chave utilizadas como fonte de busca foram "alergia alimentar", "diagnóstico" e "laboratório", isolados e/ou associados. SÍNTESE DOS DADOS: A abordagem diagnóstica das reações alérgicas a alimentos inclui história clínica completa, estudos laboratoriais, dietas de eliminação e desencadeamentos cegos com alimentos. Recentemente, a medida quantitativa de anticorpos IgE específicos a alimentos tem mostrado ser mais preditiva de alergia alimentar sintomática mediada por IgE. Níveis séricos de IgE específica a alimento que excedam os valores diagnósticos indicam que o paciente tem chance maior que 95% de apresentar uma reação alérgica se ingerir o alimento em questão. Estes "valores de decisão" foram definidos para alguns alimentos e resultados inconsistentes são obtidos ao se estudar diferentes populações. Os desencadeamentos com alimento, especialmente o duplo-cego controlado por placebo (DADCCP), representa a maneira mais confiável de estabelecer ou descartar o diagnóstico de hipersensibilidade alimentar. CONCLUSÕES: Número crescente de aquisições tem melhorado o valor preditivo de alguns testes laboratoriais empregados no diagnóstico de alergias alimentares. Entretanto, até hoje, não há teste in vitro ou in vivo que mostre correlação completa com a clínica da alergia alimentar. O DADCCP continua sendo o padrão-ouro no diagnóstico definitivo de alergia alimentar específica. São necessárias, urgentemente, novas abordagens diagnósticas válidadas em pacientes com alergia alimentar confirmada por DADCCP positivo.
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Hourihane JO, Aiken R, Briggs R, Gudgeon LA, Grimshaw KEC, DunnGalvin A, Roberts SR. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007; 119:1197-202. [PMID: 17353036 DOI: 10.1016/j.jaci.2006.12.670] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 12/21/2006] [Accepted: 12/22/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND In June 1998, the United Kingdom government suggested that atopic pregnant and breast-feeding mothers and their infants should avoid peanuts. OBJECTIVE We report the prevalence of peanut sensitization in the first school cohort (2003-2005) to have been conceived after the advice was issued. METHOD A total of 1072 mother-child pairs were studied in school. Children with positive peanut skin prick test results to peanut had peanut challenges. RESULTS Overall, 61% of 957 mothers recalled hearing the advice about peanuts in 1998. This figure was unaffected by maternal atopic status. Only 36 mothers (3.8%) followed the Government's advice by stopping the consumption of peanuts while pregnant. Maternal atopy had no effect on peanut consumption while breast-feeding. Mothers were less likely to change their diet if having a second or subsequent child compared with mothers having their first child (odds ratio 0.635, 95% Cis, 0.543-0.743; P < .01). Thirty children (2.8%; 95% CIs, 1.8% to 3.8%) had a positive peanut skin prick test result. Twenty children (1.8%; 95% CIs, 1.1% to 2.7%) were shown to have peanut allergy. This is the highest prevalence for peanut allergy recorded to date. CONCLUSIONS The prevalence of peanut sensitization in this cohort is 2.8%, and peanut allergy now affects 1.8% of British children at school entry. It is difficult to ascertain any impact (either positive or negative) of the United Kingdom government advice on the prevalence of peanut allergy in British children aged 4-5 years from 2003 to 2005. CLINICAL IMPLICATIONS It remains uncertain if peanut avoidance during pregnancy and breast-feeding has any effect on the prevalence of peanut allergy in children.
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Abstract
The numbers of deaths from food allergy are small and not all are preventable. Allan Colver believes that the increasing prescription of emergency prophylaxis to children fuels anxiety rather than saving lives, but Jonathan Hourihane argues that there are no data to show that prescription of autoinjectors increases anxiety and their provision, as part of an integrated care plan, is justified
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Affiliation(s)
- Allan Colver
- School of Clinical Medical Sciences (Child Health), University of Newcastle upon Tyne, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP.
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Liu T, Wang BQ, Zheng PY, He SH, Yang PC. Rhinosinusitis derived Staphylococcal enterotoxin B plays a possible role in pathogenesis of food allergy. BMC Gastroenterol 2006; 6:24. [PMID: 16919166 PMCID: PMC1559701 DOI: 10.1186/1471-230x-6-24] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 08/18/2006] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Staphylococcal enterotoxin B (SEB) is a potent immunomodulator and implicated with pathogenesis of inflammatory diseases mediated by Th1 or Th2 dominant immune responses. The objective of this study is to determine a possible association between rhinosinusitis derived SEB and pathogenesis of food allergy (FA). METHODS The study included chronic rhinosinusitis (CRS) patients with FA (N = 46) or without FA (N = 33). Controls included FA patients without CRS (N = 26) and healthy volunteers (N = 25). In CRS patients, we assessed the parameters associated with FA including prick skin test (PST) reactivity to food allergens, serum levels of allergen-specific IgE and cytokines (IL-4, IL-13, IFN-I3), and the number/reactivity of food-allergen specific Th1/Th2 cells in the peripheral blood before and 2 months after sinus surgery. Changes of these parameters were evaluated in comparison with changes in SEB concentration in the sinus lavage and stool samples and also in vitro reactivity to SEB. In CRS patients with FA, we also assessed changes in reactivity to oral challenge of offending food before and after sinus surgery. RESULTS Two months following sinus surgery, we observed statistically significant reduction in PST and oral challenge reactivity in CRS patients with FA in parallel to decrease in serum levels of Th2 cytokines (IL-4 and IL-13) and allergen specific IgE. Improvement of reactivity to food allergens was positively associated with decline in SEB concentrations in the sinus lavage and stool samples. In vitro study results also indicated a role of SEB in aggravation of Th2 skewed responses to food allergens. Such changes were not observed in CRS-non FA patients or control FA patients. CONCLUSION The rhinosinusitis derived SEB plays a certain role in the pathogenesis of FA by augmenting and/or maintaining polarized Th2 responses. Removal of SEB-producing pathogens from the rhinosinuses may be beneficial for attenuating the FA symptoms in patients with CRS-FA.
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Affiliation(s)
- Tao Liu
- Institute of Allergy and Department of Otolaryngology, the First Hospital, Shanxi Medical University, Taiyuan, China
| | - Bin-Quan Wang
- Institute of Allergy and Department of Otolaryngology, the First Hospital, Shanxi Medical University, Taiyuan, China
| | - Peng-Yuan Zheng
- Department of Gastroenterology, the Second Hospital, Zhengzhou University, Zhengzhou, China
| | - Shao-Heng He
- Clinical Experimental Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping-Chang Yang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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