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Corbett M, Allen A, Bobo N, Foggs MB, Fonacier LS, Gupta R, Kowalsky R, Martinez E, Begolka WS, Zachary C, Blaiss MS. Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy. Ann Allergy Asthma Immunol 2023; 130:392-396.e2. [PMID: 36538973 DOI: 10.1016/j.anai.2022.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Atopic dermatitis (AD) and food allergies are more prevalent and more severe in people with skin of color than White individuals. The American College of Allergy, Asthma, and Immunology (ACAAI) sought to understand the effects of racial disparities among patients with skin of color with AD and food allergies. The ACAAI surveyed its members (N = 200 completed), conducted interviews with health care providers and advocacy leaders, and hosted a roundtable to explore the challenges of diagnosis and management of AD and food allergies in people with skin of color and to discuss potential solutions. Most of the survey respondents (68%) agreed that racial disparities make it difficult for people with skin of color to receive adequate treatment for AD and food allergies. The interviews and roundtable identified access to care, burden of costs, policies and infrastructure that limit access to safe foods and patient education, and inadequate research involving people with skin of color as obstacles to care. Proposed solutions included identifying ways to recruit more people with skin of color into clinical trials and medical school, educating health care providers about diagnosis and treating AD and food allergy in people with skin of color, improving access to safe foods, creating and disseminating culturally appropriate materials for patients, and working toward longer appointment times for patients who need them. Challenges in AD and food allergy in persons with skin of color were identified by the ACAAI members. Solutions to these challenges were proposed to inspire actions to mitigate racial disparities in AD and food allergy.
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Affiliation(s)
| | - Abby Allen
- Peninsula Allergy & Asthma, Georgetown, Delaware
| | - Nichole Bobo
- National Association of School Nurses, Silver Spring, Maryland
| | | | - Luz S Fonacier
- Department of Medicine, NYU Langone Hospital-Long Island, Mineola, New York
| | - Ruchi Gupta
- Departments of Pediatrics and Medicine, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rachel Kowalsky
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York; Section on Minority Health Equity and Inclusion, American Academy of Pediatrics, Itasca, Illinois
| | | | | | | | - Michael S Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta, Georgia.
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Susanto NH, Lowe AJ, Salim A, Koplin JJ, Tang MLK, Suaini NHA, Ponsonby AL, Allen KJ, Dharmage SC, Erbas B. Associations between grass pollen exposures in utero and in early life with food allergy in 12-month-old infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:712-722. [PMID: 32677468 DOI: 10.1080/09603123.2020.1793920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Birth during pollen seasons may influence food allergy risk but no study has assessed pollen exposure. Using the HealthNuts population-based cohort of 5276 infants, we assessed grass pollen exposures, in utero and up to the first 6 months of life, on hen's egg, sesame and peanut allergy outcomes at 12 months. Cumulative pollen exposure in the first 7 days of life increased risk of peanut sensitization aMOR (adjusted multinomial odds ratio) = 1.21 (95% CI: 1.01-1.44). Exposure between first 4-6 months of life increased risk of hen's egg aMOR = 1.02 (95% CI: 1.004-1.04) and sensitization to all foods aMOR = 1.02 (95% CI: 1.003-1.04). Grass pollen exposure was associated with food challenge diagnosed food allergy, but only among infants with a maternal history of food allergy. Exposure to grass pollen in the intrauterine period and infancy may be important but more studies are needed to replicate these findings.
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Affiliation(s)
- Nugroho Harry Susanto
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Agus Salim
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Jennifer J Koplin
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Mimi L K Tang
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Noor H A Suaini
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Anne-Louise Ponsonby
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Katrina J Allen
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
- The Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Abstract
The risk factors for food allergy (FA) include both genetic variants and environmental factors. Advances using both candidate-gene association studies and genome-wide approaches have led to the identification of FA-associated genes involved in immune responses and skin barrier functions. Epigenetic changes have also been associated with the risk of FA. In this chapter, we outline current understanding of the genetics, epigenetics and the interplay with environmental risk factors associated with FA. Future studies of gene-environment interactions, gene-gene interactions, and multi-omics integration may help shed light on the mechanisms of FA, and lead to improved diagnostic and treatment strategies.
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Affiliation(s)
- Elisabet Johansson
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Tesfaye B Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
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Mahr TA, Lieberman JA, Haselkorn T, Damle V, Ali Y, Chidambaram A, Griffin NM, Sublett JW. Characteristics of Peanut Allergy Diagnosis in a US Health Care Claims Database (2011-2017). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1683-1694.e5. [PMID: 33346150 DOI: 10.1016/j.jaip.2020.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peanut allergy is the most common food allergy among children. Studies assessing the burden of peanut allergy in a real-world setting are limited. OBJECTIVE To estimate annual incidence and prevalence of peanut allergy cases among children aged 4 to 17 years and assess severe reaction and associated health care utilization rates. METHODS Patient longitudinal data between January 2011 and December 2017 from a geographically and payer-type representative US health care claims database were used. Peanut allergy cases were identified using diagnostic codes and/or services indicating peanut-allergy-associated severe reactions/anaphylaxis. Estimated annual incidence was defined as peanut-allergic births as a proportion of all 1-year-olds and adjusted for less than 100% data set capture, undercoding, patient underpresenting rates, and spontaneous outgrowth. Prevalence was calculated on the basis of incidence. To assess rates of severe reactions to peanut and associated health care utilization, the cohort of 720,490 peanut allergy cases identified in 2011 was evaluated over a 6-year period from 2011 to 2017. RESULTS Annual incidence increased from 1.7% to 5.2% between 2001 and 2017. Estimated prevalence in 4- to 17-year-olds was 1.25 million (2.2%) in 2017. Atopic comorbidities (asthma, 60.8%; atopic dermatitis, 61.7%) and other food allergies (35.3%) were common. Severe reactions (≥1) were observed in more than half (n = 399,806) the patients, and 37.9% were triggered by an accidental exposure. One in 5 patients (n = 144,883) visited the emergency department due to peanut exposure. CONCLUSIONS Claims data suggest that the incidence and prevalence of peanut allergy in the United States may be increasing. Estimated severe reaction rates and health care utilization were high, suggesting that the burden of peanut allergy may be considerable.
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Affiliation(s)
- Todd A Mahr
- Division of Allergy, Asthma, and Immunology, Gundersen Health System, La Crosse, Wis.
| | - Jay A Lieberman
- Department of Pediatrics, Division of Pulmonology, Allergy, & Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
| | | | - Varsha Damle
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
| | - Yasser Ali
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
| | | | - Noelle M Griffin
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
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Longitudinal analysis of total serum IgE levels with allergen sensitization and atopic diseases in early childhood. Sci Rep 2020; 10:21278. [PMID: 33277617 PMCID: PMC7718260 DOI: 10.1038/s41598-020-78272-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022] Open
Abstract
There are few studies addressing the longitudinal analysis of serum IgE levels and its impact to the development of atopic diseases in early childhood. We investigated 170 children who regularly followed up at our clinic for 4 years in a birth cohort study with at least 3 time-points of serum samples. The pattern of total serum IgE levels from 6 months to 4 years of age was clustered using K-means method in R software. Specific immunoglobulin E antibodies against food (egg white and milk) and inhalant allergens (D. pteronyssinus and D. farinae) were measured at 0.5, 1, 1.5, 2, 3 and 4 years of age. By using K-means clustering, the dynamic changes in serum IgE levels was significantly stratified into 3 clusters (cluster A, < 100 kU/L, n = 106; cluster B, 100–200 kU/L, n = 35; cluster C, ≥ 200 kU/L, n = 29). A persistent total IgE levels higher than 100 kU/L appeared to be associated with higher prevalence of sensitization to food but not mite. However, a persistent IgE levels higher than 200 kU/L was not only remarkably related to increased prevalence of mite sensitization, but also risk of eczema at age 1 and allergic rhinitis and asthma at age 2, 3 and 4. In conclusion, a persistent total serum IgE level ≥ 200 kU/L since infancy is strongly associated with the presence of food and mite sensitization, as well as the development of eczema in infants, and rhinitis and asthma later in early childhood.
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Parent report of physician diagnosis in pediatric food allergy: An update. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:542-546.e2. [PMID: 33010522 DOI: 10.1016/j.jaip.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. RECENT FINDINGS Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.
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Affiliation(s)
- Christopher M Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
| | - Jialing Jiang
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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Herbert LJ, Jacobs M, Ramos A, DiGiacomo D, Balas K, Robbins KA. Perceived food allergy, sensitivity, or intolerance and its impact on breastfeeding practices. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:355-357.e4. [PMID: 31401132 DOI: 10.1016/j.jaip.2019.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/10/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Linda Jones Herbert
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; Division of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Marni Jacobs
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
| | - Daniel DiGiacomo
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; Division of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Katherine Balas
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
| | - Karen A Robbins
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; Division of Pediatrics, George Washington University School of Medicine, Washington, DC
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Min TK, Pyun BY, Kim HH, Park YM, Jang GC, Kim HY, Yum HY, Kim J, Ahn K, Lee S, Kim KW, Kim YH, Lee JM, Kim WK, Song TW, Kim JH, Lee YJ, Jeon YH, Lee SY. Epidemiology of food allergy in Korean children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Bok Yang Pyun
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Mean Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Hye Yung Yum
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Min Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Won Song
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, Seoul, Korea
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Soto-Ramírez N, Kar S, Zhang H, Karmaus W. Infant feeding patterns and eczema in children in the first 6 years of life. Clin Exp Allergy 2017; 47:1285-1298. [PMID: 28815821 DOI: 10.1111/cea.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/10/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Modes of infant feeding such as direct and indirect breastfeeding, and formula feeding, and their combinations may play a role in child health. OBJECTIVE The aim was to investigate which feeding patterns in the first 6 months pose risks of eczema/skin allergy in children up to 6 years compared to direct breastfeeding for at least 3 months. METHODS The Infant Feeding Practices Study II in the United States and its 6-year follow-up provided data on feeding modes in infancy and doctor's diagnosed eczema/skin allergy in the first 6 years of life (1387 infants), based on parental reports. Different feeding patterns were identified. Log-linear models were used to estimate prevalence ratios (PRs) of feeding patterns for doctor's diagnosed eczema/skin allergy in the first 6 years of life, adjusting for confounders. RESULTS Compared to "direct breastfeeding for at least 3 months" (DBF3m), the combination of "direct feeding at the breast (DBF), pumping and feeding breast milk (BM), and formula (FF) in the first months" (DBF/BM/FF) showed a statistically significant higher risk of eczema/skin allergy in the first 6 years of life (PR = 1.46), adjusting for confounders. DBF combined with BM for the first 3 months followed by mixed feeding also had an increased risk (PR = 1.26), although not statistically significant. Formula feeding introduced since birth had no effect on eczema. Among the confounders, paternal eczema and race/ethnicity (Hispanic vs White) were associated with a higher risk of eczema/skin allergy. CONCLUSIONS & CLINICAL RELEVANCE Mixed infant feeding may carry a higher risk of eczema/skin allergy compared to direct feeding at the breast. The recent epidemic of pumping and feeding in the United States and the use of mixed infant feeding modes requires additional studies to provide appropriate and renewed assessments of the risks of feeding modes for the future development of allergies.
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Affiliation(s)
- N Soto-Ramírez
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - S Kar
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - H Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - W Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Brotons-Canto A, Martín-Arbella N, Gamazo C, Irache JM. New pharmaceutical approaches for the treatment of food allergies. Expert Opin Drug Deliv 2016; 15:675-686. [PMID: 27732129 DOI: 10.1080/17425247.2016.1247805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Allergic diseases constitute one of the most common causes of chronic illness in developed countries. The main mechanism determining allergy is an imbalance between Th1 and Th2 response towards Th2. AREAS COVERED This review describes the mechanisms underlying the natural tolerance to food components and the development of an allergic response in sensitized individuals. Furthermore, therapeutic approaches proposed to manage these abnormal immunologic responses food are also presented and discussed. EXPERT OPINION In the past, management of food allergies has consisted of the education of patients to avoid the ingestion of the culprit food and to initiate the therapy (e.g. self-injectable epinephrine) in case of accidental ingestion. In recent years, sublingual/oral immunotherapies based on the continuous administration of small amounts of the allergen have been developed. However, the long periods of time needed to obtain significant desensitization and the generation of adverse effects, limit their use. In order to solve these drawbacks, strategies to induce tolerance are being studied, such as the use of either adjuvant immunotherapy in order to facilitate the reversion of the Th2 response towards Th1 or the use of monoclonal antibodies to block the main immunogenic elements.
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Affiliation(s)
- Ana Brotons-Canto
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
| | - Nekane Martín-Arbella
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
| | - Carlos Gamazo
- b Department of Microbiology , University of Navarra , Pamplona , Spain
| | - Juan M Irache
- a Department of Pharmacy and Pharmaceutical Technology , University of Navarra , Pamplona , Spain
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Vanga SK, Jain M, Raghavan V. Significance of fruit and vegetable allergens: Possibilities of its reduction through processing. FOOD REVIEWS INTERNATIONAL 2016. [DOI: 10.1080/87559129.2016.1239208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Sai Kranthi Vanga
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Mohit Jain
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Vijaya Raghavan
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
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Leonard SA. Debates in allergy medicine: baked milk and egg ingestion accelerates resolution of milk and egg allergy. World Allergy Organ J 2016; 9:1. [PMID: 26839628 PMCID: PMC4727383 DOI: 10.1186/s40413-015-0089-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/30/2015] [Indexed: 02/02/2023] Open
Abstract
Cow’s milk and hen’s egg are ubiquitous in diets around the world and can be important sources of protein in young children. Unfortunately, milk and egg allergies are also some of the most common food allergies in childhood. Less allergenic forms of milk and egg due to heating and interactions with a food matrix, as in baked goods, are tolerated by a majority of milk- and egg-allergic patients. Adding baked milk and egg into the diets of milk- and egg-allergic children can broaden diets, increase nutrition, and improve quality of life. Most important, regular ingestion of baked milk and egg can help children outgrow their allergies to milk and egg. This article will review our current understanding of baked milk and egg tolerance and outline how these baked forms accelerates tolerance to regular milk and egg.
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Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, University of California, San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5114, San Diego, CA 92123 USA
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Verrill L, Bruns R, Luccioli S. Prevalence of self-reported food allergy in U.S. adults: 2001, 2006, and 2010. Allergy Asthma Proc 2015; 36:458-67. [PMID: 26453524 DOI: 10.2500/aap.2015.36.3895] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Epidemiologic evidence indicates that food allergies are increasing in the population. Information on a change in self-reported food allergy (srFA) in adults over time is lacking. OBJECTIVE To report the prevalence of srFA and compare differences at three time points over a decade. METHODS We analyzed srFA and reported physician-diagnosed food allergy in >4000 U.S. adults who participated in the 2010 U.S. Food and Drug Administration Food Safety Survey. Information on causative food(s), reaction severity characteristics, and various diagnostic factors was also analyzed. We compared 2010 Food Safety Survey data with 2006 and 2001 data, and highlighted relevant differences. RESULTS SrFA prevalence increased significantly, to 13% in 2010 and 14.9% in 2006 compared with 9.1% in 2001 (p < 0.001). Physician diagnosed food allergy was 6.5% in 2010, which was not significantly different compared with 7.6% in 2006 and 5.3% in 2001. SrFA increased in both men and women, non-Hispanic white and black adults, 50-59 year olds, and in adults with a high school or lower education. In 2010, milk, shellfish, and fruits were the most commonly reported food allergens, similar to 2001. Also, in 2010, 15% of reactions reportedly required a hospital visit and 8.4% were treated with epinephrine. Minor differences in reaction severity characteristics were noted among the surveys. CONCLUSIONS Analysis of survey results indicates that the prevalence of srFA increased among U.S. adults from 2001 to 2010 and that adults are increasingly self-reporting FAs without obtaining medical diagnosis. Improved education about food allergies is needed for this risk group.
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Affiliation(s)
- Linda Verrill
- Center for Food Safety and Applied Nutrition, Division of Public Health, Informatics, and Analytics, Consumer Studies Branch, U.S. Food and Drug Administration, College Park, Maryland, USA
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Luccioli S, Zhang Y, Verrill L, Ramos-Valle M, Kwegyir-Afful E. Infant feeding practices and reported food allergies at 6 years of age. Pediatrics 2014; 134 Suppl 1:S21-8. [PMID: 25183751 PMCID: PMC4258844 DOI: 10.1542/peds.2014-0646e] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The goal of this study was to identify the frequency of physician-diagnosed food allergies among 6-year-old US children and study the impact of exclusive breastfeeding and complementary food introduction on this frequency. METHODS Data were analyzed from children who participated in the Infant Feeding Practices Study II Year 6 Follow-Up Study (Y6FU). Children with probable food allergy (pFA) were defined as children with report of physician-diagnosed food allergy at age 6 years. Subgroups of pFA included children who were not diagnosed before 1 year of age (new pFA) and those with atopic risk factors (high risk). RESULTS Prevalence of total pFA in the Y6FU was 6.34%. The majority of these children had new pFA and high-risk factors. Higher maternal education, higher family income, family history of food allergy, and reported eczema before 1 year of age were significantly associated with higher odds of total or new pFA. Exclusive breastfeeding duration and timing of complementary food introduction were not significantly associated with total pFA. However, exclusive breastfeeding of ≥4 months compared with no breastfeeding was marginally associated with lower odds of new pFA (adjusted odds ratio: 0.51; P = .07); this effect was not observed with high-risk children. CONCLUSIONS Analysis of infant and maternal variables in the Y6FU cohort of US children revealed that socioeconomic and atopic factors were the main predictors of pFA at age 6 years. Exclusive breastfeeding of ≥4 months may have a preventive effect on development of pFA after 1 year of age in non high-risk children.
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Affiliation(s)
| | - Yuanting Zhang
- Analytics and Outreach, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland
| | - Linda Verrill
- Analytics and Outreach, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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Gupta RS, Lau CH, Dyer AA, Sohn MW, Altshuler BA, Kaye BA, Necheles J. Food allergy diagnosis and management practices among pediatricians. Clin Pediatr (Phila) 2014; 53:524-30. [PMID: 24419266 DOI: 10.1177/0009922813518425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our goals were to (1) estimate the rates of parent-reported versus physician-diagnosed food allergy, (2) determine pediatrician adherence to national guidelines, and (3) obtain pediatricians' perspectives on guideline nonadherence. A mixed method approach was used, including survey, chart review, and qualitative methods. Overall, 10.9% of parents reported having a child with food allergy and two thirds of these cases were detected by the pediatrician. Chart reviews revealed high rates of guideline adherence with respect to allergist referral (67.3%), but less consistent adherence regarding documentation of reaction history (38.8%), appropriate use of diagnostic tests (34.7%), prescription of epinephrine autoinjectors (44.9%), and counseling families in food allergy management (24.5%). Pediatricians suggested that poor adherence was due to lack of documentation, familiarity with guidelines, and clarity regarding the pediatrician's role in managing food allergy. Findings emphasize the need to better establish the role of the pediatrician and to improve awareness and adherence to guidelines.
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Affiliation(s)
- Ruchi S Gupta
- 1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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18
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Keet CA, Savage JH, Seopaul S, Peng RD, Wood RA, Matsui EC. Temporal trends and racial/ethnic disparity in self-reported pediatric food allergy in the United States. Ann Allergy Asthma Immunol 2014; 112:222-229.e3. [PMID: 24428971 PMCID: PMC3950907 DOI: 10.1016/j.anai.2013.12.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/19/2013] [Accepted: 12/06/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of food allergy is thought to be increasing, but data from the United States have not been systematically synthesized. OBJECTIVE To summarize the data on prevalence of food allergy in the US pediatric population and to estimate the effects of time, race/ethnicity, and method of assessing food allergy on the estimated prevalence. METHODS Embase, MEDLINE, bibliographies of identified reports, and data from publically available data sets were searched. Studies were limited to those in English with data from the general pediatric US population. Study synthesis was performed by meta-analysis and meta-regression to estimate the effect of study- and participant-level covariates. Meta-regression was limited to nationally representative surveys conducted by the Centers for Disease Control and Prevention. RESULTS A total of 10,090 publications were identified, from which 27 different survey administrations, representing 452,237 children, were identified, covering the period of 1988 to 2011. Because of heterogeneity among surveys in the estimated food allergy prevalence, a summary estimate of food allergy prevalence was not possible. Meta-regression was performed using 20 of these surveys. Temporal trends were pronounced, with an estimated increased prevalence of self-reported food allergy of 1.2 percentage points per decade (95% confidence interval [CI], 0.7-1.6). The increase per decade varied by race/ethnicity: 2.1% among non-Hispanic blacks (95% CI, 1.5%-2.7%), 1.2% among Hispanics (95% CI, 0.7%-1.7%), and 1.0% among non-Hispanic whites (95% CI, 0.4%-1.6%). CONCLUSION Self-report of food allergy among US children has sharply increased in the past 2 decades. The increase has been greatest among non-Hispanic black children, a disparity that needs to be investigated.
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Affiliation(s)
- Corinne A. Keet
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology, and Graduate Student, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Jessica H. Savage
- Brigham and Women's Hospital, Division of Rheumatology, Immunology, and Allergy, Boston, MA
| | - Shannon Seopaul
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology, Baltimore, MD
| | - Roger D. Peng
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD
| | - Robert A. Wood
- Johns Hopkins University School of Medicine, Division of Allergy and Immunology, Department of Pediatrics, Baltimore, MD
| | - Elizabeth C. Matsui
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology, Baltimore, MD
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Kaya A, Erkoçoğlu M, Civelek E, Çakır B, Kocabaş CN. Prevalence of confirmed IgE-mediated food allergy among adolescents in Turkey. Pediatr Allergy Immunol 2013; 24:456-62. [PMID: 23772635 DOI: 10.1111/pai.12097] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although food allergy is an important health problem in Western countries, the prevalence varies among geographic regions. There is limited data on the prevalence of food allergy especially for adolescent age group, and the data from Turkey and Mediterranean region are even scarce. METHODS The study is a cross-sectional survey including a questionnaire followed by phone survey with families that have reported food allergy and clinical evaluation of children having a history compatible with food allergy after phone survey. The sample number of students has been calculated 9096 of a total of 210.000 students at the second stage (6th, 7th, and 8th grades) of state elementary schools in the metropolitan counties of Ankara province with the assumption of food allergy prevalence (P) = 1% and a δ value = 0.2 (α < 0.05, β = 0.8). RESULTS Of 11,233 questionnaires distributed at 34 schools, 10,096 (89.4%) have been returned. The number of reported food allergy was 1139 (11.2%), and it was reduced to 133 (1.3%) after phone survey. After clinical evaluation by skin test, specific IgE and double-blind placebo-controlled food challenge (DBPCFC), proven IgE-mediated food allergy was determined in 15 (0.15%) children. The foods most commonly resulting food allergy were peanut 0.05% and treenuts 0.05%. CONCLUSION The prevalence of food allergy among adolescent age group has been confirmed to be comparatively low in Turkey. Peanuts and treenuts were determined to be the most common causes of IgE-mediated food allergy.
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Affiliation(s)
- Ayşenur Kaya
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey
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20
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Greenhawt M, Weiss C, Conte ML, Doucet M, Engler A, Camargo CA. Racial and ethnic disparity in food allergy in the United States: a systematic review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:378-86. [PMID: 24565543 DOI: 10.1016/j.jaip.2013.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/11/2013] [Accepted: 04/17/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy. OBJECTIVE We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States. METHODS We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment. RESULTS Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect. CONCLUSION Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies.
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Affiliation(s)
- Matthew Greenhawt
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, The University of Michigan Medical School and the University of Michigan Health System, Ann Arbor, Mich.
| | | | - Marisa L Conte
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Mich
| | - Marlie Doucet
- Oak Ridge Institute for Science and Education Fellow, Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Amy Engler
- Human Biology Department, Stanford University, Palo Alto, Calif
| | - Carlos A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Ben-Shoshan M, Turnbull E, Clarke A. Food allergy: temporal trends and determinants. Curr Allergy Asthma Rep 2013; 12:346-72. [PMID: 22723032 DOI: 10.1007/s11882-012-0274-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This review summarizes studies discussing temporal trends in the prevalence of food allergy as well as potential factors associated with the development of food allergy. In addition, we will address the potential hypotheses accounting for the apparent increase in food allergy prevalence. Studies suggest increased prevalence of food allergy. However, relatively little is known about its pathogenesis. This review aims to assess temporal trends in the prevalence of food allergy and discuss potential genetic, environmental, and demographic determinants. The search strategy examined the medical literature database MEDLINE (using PubMed) for the time period of January 1, 2002 to January 31, 2012. In recent decades, the prevalence of food allergy in general has increased by 0.60 % [95 % confidence interval (CI), 0.59 %-0.61 %] and the prevalence of peanut allergy by 0.027 % (95 % CI, 0.026 %-0.028 %), but it has now likely stabilized in developed countries. Genes, the environment, and demographic characteristics play a role in the pathogenesis of food allergy. Numerous environmental and demographic factors as well as gene-environment interactions may account for this increase in prevalence, but further studies are required to tease out their relative contribution.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
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22
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Soto-Ramírez N, Karmaus W, Zhang H, Davis S, Agarwal S, Albergottie A. Modes of infant feeding and the occurrence of coughing/wheezing in the first year of life. J Hum Lact 2013; 29:71-80. [PMID: 22914756 DOI: 10.1177/0890334412453083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Controversies regarding infant feeding and childhood wheezing may result from insufficient differentiation among various feeding modes. OBJECTIVES We conducted prospective analyses of associations between the repeated ascertainment of feeding mode and wheezing in infancy. METHODS The Infant Feeding Practices Study II (2833 infants) provided data on coughing/wheezing episodes (CWEs) at 8 time points and feeding modes at 9 time points from months 1 to 12. Feeding modes were defined as direct breastfeeding, indirect breastfeeding (IBF, bottled breast milk), formula feeding (FF), and their combinations. In concurrent and delayed models using repeated measurements, the relative risks (RR) and their 95% confidence intervals (95% CI) of different feeding modes for CWEs were estimated. In the delayed models, only infants without symptoms were considered at risk for consequent CWE. RESULTS In a model with a 1-month delay, compared to direct breastfeeding, any other feeding mode showed a statistically significant risk for CWEs (IBF: RR = 1.69, 95% CI [1.05, 2.72]; FF: RR = 1.26, 95% CI [1.08, 1.47]; mixed breast feeding plus FF: RR = 1.25, 95% CI [1.01, 1.55]; and FF and direct breastfeeding: RR = 1.38, 95% CI [1.14, 1.68]). In a concurrent effect model, FF, the combination of FF and IBF, and mixed breastfeeding plus formula were risk factors (RR = 1.38, 95% CI [1.19, 1.59], RR = 1.83, 95% CI [1.27, 2.63], and RR=1.35, 95% CI [1.11, 1.65]; respectively). CONCLUSIONS Any mode of feeding that includes formula or bottled breast milk seems to be a moderate risk for cough or wheezing episodes in the first 12 months of life.
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Affiliation(s)
- Nelís Soto-Ramírez
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.
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23
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Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy 2013; 3:3-14. [PMID: 23403837 PMCID: PMC3563019 DOI: 10.5415/apallergy.2013.3.1.3] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/07/2013] [Indexed: 11/04/2022] Open
Abstract
Asia is a populous and diverse region and potentially an important source of information on food allergy. This review aims to summarize the current literature on food allergy from this region, comparing it with western populations. A PubMed search using strategies "Food allergy AND Asia", "Food anaphylaxis AND Asia", and "Food allergy AND each Asian country" was made. Overall, 53 articles, published between 2005 and 2012, mainly written in English were reviewed. The overall prevalence of food allergy in Asia is somewhat comparable to the West. However, the types of food allergy differ in order of relevance. Shellfish is the most common food allergen from Asia, in part due to the abundance of seafood in this region. It is unique as symptoms vary widely from oral symptoms to anaphylaxis for the same individual. Data suggest that house dust mite tropomysin may be a primary sensitizer. In contrast, peanut prevalence in Asia is extremely low compared to the West for reasons not yet understood. Among young children and infants, egg and cow's milk allergy are the two most common food allergies, with prevalence data comparable to western populations. Differences also exist within Asia. Wheat allergy, though uncommon in most Asian countries, is the most common cause of anaphylaxis in Japan and Korea, and is increasing in Thailand. Current food allergy data from Asia highlights important differences between East and West, and within the Asian region. Further work is needed to provide insight on the environmental risk factors accounting for these differences.
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Affiliation(s)
- Alison Joanne Lee
- Department of Paediatrics, Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore 119228, Singapore
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24
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Parent report of physician diagnosis in pediatric food allergy. J Allergy Clin Immunol 2013; 131:150-6. [DOI: 10.1016/j.jaci.2012.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/26/2012] [Accepted: 07/19/2012] [Indexed: 11/20/2022]
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25
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Dowhower Karpa K, Paul IM, Leckie JA, Shung S, Carkaci-Salli N, Vrana KE, Mauger D, Fausnight T, Poger J. A retrospective chart review to identify perinatal factors associated with food allergies. Nutr J 2012; 11:87. [PMID: 23078601 PMCID: PMC3493351 DOI: 10.1186/1475-2891-11-87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/16/2012] [Indexed: 01/22/2023] Open
Abstract
Background Gut flora are important immunomodulators that may be disrupted in individuals with atopic conditions. Probiotic bacteria have been suggested as therapeutic modalities to mitigate or prevent food allergic manifestations. We wished to investigate whether perinatal factors known to disrupt gut flora increase the risk of IgE-mediated food allergies. Methods Birth records obtained from 192 healthy children and 99 children diagnosed with food allergies were reviewed retrospectively. Data pertaining to delivery method, perinatal antibiotic exposure, neonatal nursery environment, and maternal variables were recorded. Logistic regression analysis was used to assess the association between variables of interest and subsequent food allergy diagnosis. Results Retrospective investigation did not find perinatal antibiotics, NICU admission, or cesarean section to be associated with increased risk of food allergy diagnosis. However, associations between food allergy diagnosis and male gender (66 vs. 33; p=0.02) were apparent in this cohort. Additionally, increasing maternal age at delivery was significantly associated with food allergy diagnosis during childhood (OR, 1.05; 95% CI, 1.017 to 1.105; p=0.005). Conclusions Gut flora are potent immunomodulators, but their overall contribution to immune maturation remains to be elucidated. Additional understanding of the interplay between immunologic, genetic, and environmental factors underlying food allergy development need to be clarified before probiotic therapeutic interventions can routinely be recommended for prevention or mitigation of food allergies. Such interventions may be well-suited in male infants and in infants born to older mothers.
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Affiliation(s)
- Kelly Dowhower Karpa
- Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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26
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Rinaldi M, Harnack L, Oberg C, Schreiner P, St Sauver J, Travis LL. Peanut allergy diagnoses among children residing in Olmsted County, Minnesota. J Allergy Clin Immunol 2012; 130:945-50. [PMID: 22944484 PMCID: PMC3553546 DOI: 10.1016/j.jaci.2012.07.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 06/28/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peanut allergy is a major health concern, particularly in developed countries. Research indicates that as many as 2% of children are allergic to peanuts, which represents a 3-fold increase in diagnoses over the past 2 decades. OBJECTIVE This population-based descriptive study used the Rochester Epidemiology Project to estimate the prevalence in 2007 and annual incidence rates of peanut allergy diagnoses from 1999 to 2007 among children residing in Olmsted County, Minnesota. METHODS Residents of Olmsted County from January 1, 1999, through December 31, 2007, who received medical care at a Rochester Epidemiology Project facility and provided research authorization were eligible for the study. A medical chart review of 547 potential diagnoses resulted in 244 prevalent and 170 incident cases. Annual rates, crude and adjusted for age and sex, were standardized with the use of the indirect method to the Olmsted County population data in 1999. Incidence rate ratios were estimated with Poisson regression. RESULTS The prevalence in 2007 was 0.65%. Female children were less likely to be diagnosed than male children (incidence rate ratio = 0.18; 95% CI, 0.07-0.48). Children aged birth to 2 years were significantly more likely to be diagnosed than older children aged 3-17 years (incidence rate ratio = 0.001; 95% CI, 0.0004-0.004). A significant 3-fold increasing trend was observed in diagnoses over time from 2.05 cases per 10,000 children in 1999 to 6.88 cases per 10,000 in 2007. CONCLUSIONS Peanut allergies are an increasing concern in Olmsted County, Minnesota, as indicated by a 3-fold increase in diagnoses from 2.05 per 10,000 children in 1999 to 6.88 per 10,000 children in 2007.
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Affiliation(s)
- Maria Rinaldi
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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27
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Duncker SC, Philippe D, Martin-Paschoud C, Moser M, Mercenier A, Nutten S. Nigella sativa (black cumin) seed extract alleviates symptoms of allergic diarrhea in mice, involving opioid receptors. PLoS One 2012; 7:e39841. [PMID: 22768141 PMCID: PMC3387213 DOI: 10.1371/journal.pone.0039841] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/27/2012] [Indexed: 12/12/2022] Open
Abstract
The incidence of food hypersensitivity and food allergies is on the rise and new treatment approaches are needed. We investigated whether N. sativa, one of its components, thymoquinone, or synthetic opioid receptor (OR)-agonists can alleviate food allergy. Hence, ovalbumin (OVA)-sensitized BALB/c-mice were pre-treated either with a hexanic N. sativa seed extract, thymoquinone, kappa-(U50'4889) or mu-OR-agonists (DAMGO) and subsequently challenged intra-gastrically with OVA. All 4 treatments significantly decreased clinical scores of OVA-induced diarrhea. N. sativa seed extract, thymoquinone, and U50'488 also decreased intestinal mast cell numbers and plasma mouse mast cell protease-1 (MMCP-1). DAMGO, in contrast, had no effect on mast cell parameters but decreased IFNγ, IL-4, IL-5, and IL-10 concentration after ex vivo re-stimulation of mesenteric lymphocytes. The effects on allergy symptoms were reversible by OR-antagonist pre-treatment, whereas most of the effects on immunological parameter were not. We demonstrate that N. sativa seed extract significantly improves symptoms and immune parameters in murine OVA-induced allergic diarrhea; this effect is at least partially mediated by thymoquinone. ORs may also be involved and could be a new target for intestinal allergy symptom alleviation. N. sativa seed extract seems to be a promising candidate for nutritional interventions in humans with food allergy.
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MESH Headings
- Animals
- Benzoquinones/pharmacology
- Benzoquinones/therapeutic use
- Biomarkers/metabolism
- Chymases/metabolism
- Diarrhea/complications
- Diarrhea/drug therapy
- Diarrhea/immunology
- Food Hypersensitivity/complications
- Food Hypersensitivity/drug therapy
- Food Hypersensitivity/immunology
- Ligands
- Male
- Mice
- Mice, Inbred BALB C
- Nigella sativa/chemistry
- Ovalbumin/immunology
- Phytotherapy
- Plant Extracts/pharmacology
- Plant Extracts/therapeutic use
- Receptors, Opioid/agonists
- Receptors, Opioid/metabolism
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/metabolism
- Seeds/chemistry
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Affiliation(s)
- Swantje C Duncker
- Nestlé Research Center, Nestec Ltd., Vers-chez-les-Blancs, Lausanne, Switzerland.
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Abstract
PURPOSE OF REVIEW Cow's milk is a leading cause of food allergy especially in infants and children. 'Diagnosis and Rationale for Action against Cow's Milk Allergy' published by the World Allergy Organization has underlined that there is not enough information concerning geographical trends in cow's milk allergy (CMA) in children or adults. Experts from Australia, Asia, North America, Latin America, the Middle East and Europe have gathered together in a 2-day meeting in order to present various regional approaches to CMA. This report is a summary of the information that was presented at this meeting. RECENT FINDINGS Even though there seems to be uniformity concerning the diagnosis and treatment of CMA, the diagnostic approach to CMA shows variations among different regions. Common concerns were inadequate applications of challenge tests for the diagnosis and inadequate supply of the cow's milk substitute formulas. SUMMARY CMA is a global challenge and collaboration of the national and international scientific communities is essential to produce and update practical guidelines for CMA.
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Abstract
Food allergy (FA) is perceived as a common problem, especially during childhood. Accurate assessment of incidence and prevalence of FA has been difficult to establish, however, due to lack of universally accepted diagnostic criteria. Although many foods are reported to cause IgE-mediated FA, most studies focus on 4 common food groups: cow's milk, hen's egg, peanut/tree nuts, and fish/shellfish. There may be variation in the prevalence of FA in regions of the world and a likely increase in prevalence has been observed in recent decades. This cannot be stated with confidence, however, without the use of consistent methodology and diagnostic criteria.
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30
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Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FER, Teach SJ, Yawn BP, Schwaninger JM. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2011; 126:1105-18. [PMID: 21134576 DOI: 10.1016/j.jaci.2010.10.008] [Citation(s) in RCA: 1001] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 12/11/2022]
Abstract
Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.
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Affiliation(s)
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- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
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31
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Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127:594-602. [PMID: 21236480 DOI: 10.1016/j.jaci.2010.11.044] [Citation(s) in RCA: 451] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 11/29/2010] [Indexed: 11/17/2022]
Abstract
Adverse reactions to foods can occur for a variety of reasons, but a food allergy is caused by a specific immune response. Challenges to determine the prevalence of food allergy include misclassification, biased participation, lack of simple diagnostic tests, rapid evolution of disease, large numbers of potential triggers, and varied clinical phenotypes. Nonetheless, it is clear that this is a common disorder, with studies suggesting a cumulative prevalence of 3% to 6%, representing a significant impact on quality of life and costs. The inclusion of mild reactions to fruits and vegetables could result in calculation of prevalence exceeding 10% in some regions. There are data from numerous studies to suggest an increase in prevalence, but methodologic concerns warrant caution. Prevalence varies by age, geographic location, and possibly race/ethnicity. Many childhood food allergies resolve. Population-based epidemiologic studies have generated numerous novel theories regarding risks, including modifiable factors such as components of the maternal and infant diet, obesity, and the timing of food introduction. Recent and ongoing studies provide insights on risk factors, prevalence, and natural course that may inform clinical trials to improve diagnosis, prevention, and treatment.
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Affiliation(s)
- Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Cho HN, Hong S, Lee SH, Yum HY. Nutritional status according to sensitized food allergens in children with atopic dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:53-7. [PMID: 21217926 PMCID: PMC3005320 DOI: 10.4168/aair.2011.3.1.53] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 10/15/2010] [Indexed: 01/10/2023]
Abstract
PURPOSE Food allergies can affect the growth and nutritional status of children with atopic dermatitis (AD). This study was conducted to determine the association between the number of sensitized food allergens and the growth and nutritional status of infants and young children with AD. METHODS We studied 165 children with AD, aged 5 to 47 months, and who visited the Atopy Clinic of the Seoul Medical Center. We recorded the birth weight, time at which food weaning began, scoring of atopic dermatitis (SCORAD) index, eosinophil counts in peripheral blood, and total serum IgE and specific IgE to six major allergens (egg white, cow's milk, soybean, peanut, wheat, and fish). The height and weight for age and weight for height were converted to z-scores to evaluate their effects on growth and nutritional status. Specific IgE levels ≥0.7 kUA/L, measured via the CAP assay, were considered positive. RESULTS As the number of sensitized food allergens increased, the mean z-scores of weight and height for age decreased (P=0.006 and 0.018, respectively). The number directly correlated with the SCORAD index (r=0.308), time at which food weaning began (r=0.332), eosinophil counts in peripheral blood (r=0.266), and total serum IgE (r=0.394). Inverse correlations were observed with the z-scores of weight for age (r=-0.358), height for age (r=-0.278), and weight for height (r=-0.224). CONCLUSIONS A higher number of sensitized food allergens was associated with negative effects on the growth and nutritional status of infants and young children with AD. Therefore, a thorough evaluation of both growth and nutritional status, combined with adequate patient management, is crucial in pediatric AD patients presenting with numerous sensitized food allergies.
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Affiliation(s)
- Ha-Na Cho
- Atopy Clinic, Seoul Medical Center, Seoul, Korea
| | - Soyoung Hong
- Atopy Research Institute, Seoul Medical Center, Seoul, Korea
| | | | - Hye-Yung Yum
- Atopy Clinic, Seoul Medical Center, Seoul, Korea
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Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FER, Teach SJ, Yawn BP, Schwaninger JM. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1-58. [PMID: 21134576 PMCID: PMC4241964 DOI: 10.1016/j.jaci.2010.10.007] [Citation(s) in RCA: 534] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 12/14/2022]
Abstract
Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.
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Fein SB, Grummer-Strawn LM, Raju TNK. Infant feeding and care practices in the United States: results from the Infant Feeding Practices Study II. Pediatrics 2008; 122 Suppl 2:S25-7. [PMID: 18829827 DOI: 10.1542/peds.2008-1315b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sara B Fein
- Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Pkwy, HFS 020, College Park, MD 20740, USA.
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