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Çolak S, Erkoç M, Sin BA, Bavbek S. Comparison of two diagnostic criteria in the diagnosis of anaphylaxis in a tertiary adult allergy clinic. World Allergy Organ J 2023; 16:100761. [PMID: 37065906 PMCID: PMC10090707 DOI: 10.1016/j.waojou.2023.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023] Open
Abstract
Background Anaphylaxis is a very dynamic issue with its incidence and trigger profile changing over the years. We aimed to compile the characteristics of anaphylaxis cases diagnosed in our clinic prospectively and to make a comparison between diagnostic criteria proposed by National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) and World Allergy Organization (WAO). Method Three-item diagnostic criteria recommended by NIAID/FAAN (2006) were used in the diagnosis of anaphylaxis. The clinical features of the cases, risk factors, etiologies, severity of anaphylaxis, and treatment approach were determined. The same patients were also classified by current WAO diagnostic criteria. Results A total of 204 patients (158F/46 M, median age 45.3 years) were included. Drugs (65.2%), venom (9.8%) and food allergies (9.3%) were the top 3 etiologies. Among drug triggers, chemotherapeutics were the most common (17.7%), followed by antibiotics (15.3%) and non-steroidal anti-inflammatory drugs (14.2%). The patients were mostly diagnosed with the second criterion (84.8%), followed by the first criterion (11.8%) and the third criterion (3.4%) of the NIAID/FAAN criteria. In terms of WAO criteria, 82.8% of the patients were diagnosed with the first criterion, and 14.3% with the second criterion while 2.9% of the patients did not meet the WAO criteria. The severity of anaphylaxis was evaluated as grade-2, 3 and 4 in 30.9%, 64.2%, and 4.9% of the patients, respectively. Adrenaline was administered to 31.9% of the patients especially who had angioedema and bronchospasm (p = 0.04). Conclusion Our data suggest that covering more details in patient's history may prevent possible underdiagnosis and WAO diagnostic criteria seem to be insufficient in some patients. We believe that our results will contribute to the literature on anaphylaxis and would be groundwork for future studies.
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2
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Cardoso B, Moscoso T, Morais-Almeida M, Demoly P, Tanno LK. Economic burden of drug-induced anaphylaxis: what can we do better? Curr Opin Allergy Clin Immunol 2022; 22:234-241. [PMID: 35852897 DOI: 10.1097/aci.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This systematic review evaluates published data related to the economic burden of drug-induced anaphylaxis (DIA) to understand preventive cost saving measures that could reduce the burden of these conditions. RECENT FINDINGS Although DIA has a relevant societal impact, there are limited and heterogenous available data related to its cost. Direct costs related to the management of acute phase of DIA was estimated by $529.6 to $3125, depending on the number of emergency room visits/hospitalizations, emergency kits and transports in ambulance. Direct costs of investigations of DIA varied from $288 to $2292.95 and the desensitization was estimated by $6796. Main variables for this were: personnel, allergy screening procedures, medical consumables and space cost. The mean indirect cost was based on a mean absenteeism of 3 days per DIA corresponding to $381.2. SUMMARY More than reviewing the published data, we were able to identify variables that, if correctly managed, can reduce the economic burden of DIA, such as adjusting the timing of referral and etiological diagnosis, identification of potential risk and/or co-factors, correct written recommendations to patients. The evidence presented highlights the need of optimization of healthcare patients to patients suffering from DIA.
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Affiliation(s)
| | | | | | - Pascal Demoly
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP, University of Montpellier - INSERM
- Department of Allergy, University Hospital of Montpellier
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Luciana K Tanno
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP, University of Montpellier - INSERM
- Department of Allergy, University Hospital of Montpellier
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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3
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Lee MH, Roh EJ, Jung YM, Ahn Y, Chung EH. Characteristics of anaphylaxis patients who visited emergency departments in Korea: Results from a national emergency department information system. PLoS One 2022; 17:e0266712. [PMID: 35486614 PMCID: PMC9053810 DOI: 10.1371/journal.pone.0266712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Anaphylaxis is an allergic disease with fatal respiratory or cardiovascular symptoms that require immediate emergency treatment. We aimed to understand the characteristics and frequency of emergency department (ED) visits of patients with anaphylaxis in Korea. Methods Between 2007 and 2013, using data from 147 ED from the National Emergency Department Information System in Korea, we retrospectively evaluated patients with a primary diagnosis of anaphylaxis. Results During the study, a total 23,313 patients visited the ED due to anaphylaxis. The number of patients with anaphylaxis who visited the ED increased from 3.0 per 100,000 population in 2007 to 11.6 per 100,000 population in 2013 (P<0.001). Overall, the frequency of anaphylaxis emergency department visits increased by 1.24 times each year (95% CI 1.23–1.25). The risk of visiting ED due to anaphylaxis by population-based age-specific group was highest in the 60–69 years old (OR 2.30, 95% CI 1.96–2.70). Deaths from anaphylaxis increased by 1.35 times per year (95% CI 1.13–1.62). The causes of anaphylaxis were unknown (80.8%; 95% CI 80.35–81.38), drugs (8.9%; 95% CI 8.47–9.24), food (4.1%; 95% CI 3.87–4.39), bees (3.2%; 95% CI 3.02–3.48) and arthropods (2.3%; 95% CI 2.11–2.48). In 2009, drugs were the most common cause of anaphylaxis in November (35.5%), followed by food in May (15.5%) (P<0.001). Between July and September, stings from insects were the most common causes (P<0.001). By age, food was the most common cause in children aged <6 years (7.6%, <12 months; 9.0%, 1–6 years) and drugs in those aged ≥7 years. The 7-year overall mortality rate was 0.104 case per 1,000,000 population; men accounted for 77.8% of the deaths. By region, the number of cases was the highest in metropolitan areas, Gyeonggi and Seoul; however, the number of anaphylaxis cases per 100,000 population was the highest in Jeju and Gangwon. Conclusion Based on ICD-10 codes, the number of ED visits due to anaphylaxis is increasing in Korea, and the incidence of anaphylaxis varies by region, season, and age.
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Affiliation(s)
- Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Republic of Korea
| | - Eui-Jeong Roh
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yu-Mi Jung
- Medical Record Team, National Medical Center, Seoul, Republic of Korea
| | - Youngmin Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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4
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Baseggio Conrado A, Patel N, Turner PJ. Global patterns in anaphylaxis due to specific foods: A systematic review. J Allergy Clin Immunol 2021; 148:1515-1525.e3. [PMID: 33940057 PMCID: PMC8674817 DOI: 10.1016/j.jaci.2021.03.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND There are increasing global data relating to prevalence of food allergy and food-induced anaphylaxis; however, this is often based on surrogate measures of sensitization rather than objective symptoms at food challenge. In terms of protecting food-allergic consumers from reactions, to our knowledge, there has been no global survey assessing geographic differences in the proportion of anaphylaxis triggered by specific foods. OBJECTIVE We sought to identify common triggers for food-induced anaphylaxis and how these vary from country to country. METHODS Systematic review of relevant reports published between January 2010 and November 2020. Results were reported following PRISMA guidelines. Publications were screened and data extracted by 2 independent reviewers, and the risk of bias was assessed. RESULTS Sixty-five studies (encompassing 41 countries and all 6 regions as defined by the Food and Agriculture Organization of the United Nations) were included. Significant regional variations in the most common triggers of food anaphylaxis were seen; however, in general, there was good agreement between local legislative requirements for allergen disclosure and the most common allergens for each region or nation. CONCLUSIONS Local legislation for allergen disclosure generally reflects those allergens commonly responsible for food anaphylaxis. Cow's milk and crustaceans appear to cause a higher proportion of anaphylaxis compared to peanut in some regions.
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Affiliation(s)
| | - Nandinee Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
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5
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Tanno LK, Clark E, Mamodaly M, Cardona V, Ebisawa M, Asontegui I, Sanchez-Borges M, Santos AF, Fiocchi A, Worm M, Caimmi D, Latour Staffeld P, Muraro A, Pawankar R, Greenberger PA, Thong BYH, Martin B, Demoly P. Food-induced anaphylaxis morbidity: Emergency department and hospitalization data support preventive strategies. Pediatr Allergy Immunol 2021; 32:1730-1742. [PMID: 34142390 DOI: 10.1111/pai.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. METHODS We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. RESULTS A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. CONCLUSION Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.
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Affiliation(s)
- Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL Research Network, Barcelona, Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Ignacio Asontegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Alexandra F Santos
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Davide Caimmi
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | | | - Paul Allen Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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6
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Muraro A, Sublett JW, Haselkorn T, Nilsson C, Casale TB. Incidence of anaphylaxis and accidental peanut exposure: A systematic review. Clin Transl Allergy 2021; 11:e12064. [PMID: 34708943 PMCID: PMC8694181 DOI: 10.1002/clt2.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Peanut allergy (PA), a common food allergy, is increasing in prevalence and is associated with high rates of anaphylaxis. Prevalence of food-related anaphylaxis is higher in children and adolescents than in adults, and the pediatric incidence is increasing. We conducted a systematic literature review and meta-analysis to determine the incidence of peanut-induced anaphylaxis in children and/or adolescents with PA. METHODS Literature searches were conducted using the PubMed database and through supplemental methods. Eligible articles for inclusion were peer-reviewed studies published in English that reported the incidence of anaphylaxis in pediatric PA using the 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria, sample size, and follow-up duration. Incidence rates were calculated as person-years at risk or a crude incidence rate was calculated. Meta-analyses of pooled data were conducted using the I2 statistic as the measure of heterogeneity. RESULTS A total of 830 citations were screened; 8 met the study inclusion criteria and were selected for review. Pooled meta-analysis estimates of the incidence of (1) anaphylaxis among children/adolescents with food allergies, (2) anaphylaxis among children/adolescents with PA, and (3) accidental exposure to peanuts among children/adolescents with PA were 3.72 cases per 100 person-years (95% confidence interval [CI] = 2.35, 5.10), 2.74 cases per 100 person-years (95% CI = 1.42, 4.05), and 12.28 cases per 100 person-years (95% CI = 11.51, 13.05), respectively. CONCLUSIONS The risks of anaphylaxis among children with food allergies and those with PA contribute to the serious overall burden of PA and food allergy for children and their families.
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Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | | | | | - Caroline Nilsson
- Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Thomas B Casale
- Food Allergy Research and Education (FARE), University of South Florida, Tampa, Florida, USA
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7
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Arasi S, Nurmatov U, Dunn-Galvin A, Daher S, Roberts G, Turner PJ, Shinder SB, Gupta R, Eigenmann P, Nowak-Wegrzyn A, Sánchez Borges MA, Ansotegui IJ, Fernandez-Rivas M, Petrou S, Tanno LK, Vazquez-Ortiz M, Vickery BP, Wong GWK, Ebisawa M, Fiocchi A. Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review. World Allergy Organ J 2021; 14:100503. [PMID: 33767801 PMCID: PMC7966874 DOI: 10.1016/j.waojou.2020.100503] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS The term "Food Allergy" refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. METHODS We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. RESULTS We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. CONCLUSIONS There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. SYSTEMATIC REVIEW REGISTRATION A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).
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Affiliation(s)
- Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
| | - Audrey Dunn-Galvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Shahd Daher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK
| | - Graham Roberts
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Paul J. Turner
- National Heart & Lung Institute, Imperial College London, London, UK
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia
| | - Sayantani B. Shinder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine, Department of Pediatrics & Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Women-Children-Teenagers Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Mario A. Sánchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | | | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, Paris, France
| | | | | | - Gary Wing-Kin Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Alessandro Fiocchi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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8
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Blumchen K, DunnGalvin A, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fisher HR, Fernández‐Rivas M. APPEAL-1: A pan-European survey of patient/caregiver perceptions of peanut allergy management. Allergy 2020; 75:2920-2935. [PMID: 32438514 DOI: 10.1111/all.14414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peanut allergy (PA) is associated with marked quality-of-life (QoL) impairment. However, data are lacking on the experience and impact of living with PA from the perspectives of persons with PA (PwPA) and their caregivers. Allergy to Peanuts imPacting Emotions And Life study 1 (APPEAL-1) was a pan-European survey investigating these perspectives. This first of two articles reports clinical characteristics of PwPA and PA management practices. METHODS APPEAL-1 was a quantitative, online survey conducted in eight European countries, developed by eight representatives of patient advocacy groups and five healthcare professionals and researchers. Eligible participants included adults with PA and parents/caregivers of PwPA who responded by self-report and provided proxy-report for the PwPA under their care. Data were summarized using nonweighted descriptive statistics. RESULTS Of 1846 completed/analysed questionnaires, 528 were from adults with PA (self-report); 437 by proxy for children with PA (34 aged 0-3 years, 287 aged 4-12 years, 116 aged 13-17 years) and 881 from parents/caregivers (self-report). Of PwPA (N = 965), 95% reported diagnosis by healthcare professionals, mostly by clinical history and peanut-specific allergy testing. Rates of allergic rhinitis, asthma and other food allergies in PwPA were 50%, 42% and 79%, respectively. Only 31% of PwPA received HCP advice/support following their worst allergic reaction, and 28% had not been prescribed an adrenaline auto-injector. Results were similar by country but varied by age group. CONCLUSIONS The APPEAL-1 findings contribute to greater understanding of PA impact on PwPA, caregivers and family members and the need for improved PA management across Europe.
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Affiliation(s)
- Katharina Blumchen
- Division of Allergology, Pneumology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund, (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSCARADyAL Madrid Spain
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9
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DunnGalvin A, Blumchen K, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fernández‐Rivas M, Fisher HR. APPEAL-1: A multiple-country European survey assessing the psychosocial impact of peanut allergy. Allergy 2020; 75:2899-2908. [PMID: 32400915 PMCID: PMC7689848 DOI: 10.1111/all.14363] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
Background Peanut allergy (PA) is a common, potentially life‐threatening and typically lifelong condition with a significant burden of illness. However, information is lacking on how persons with PA (PwPA) and their caregivers perceive the psychosocial impact of living with PA. The Allergy to Peanuts imPacting Emotions And Life 1 (APPEAL‐1) survey, conducted across Europe, investigated the experience and impact of living with PA. Here, we report data evaluating the psychosocial impact of PA on PwPA and their caregivers. Methods Allergy to Peanuts imPacting Emotions And Life study 1 was an online survey conducted in eight European countries. Representatives of eight patient advocacy groups and five healthcare‐research specialists developed the survey. Eligible respondent groups included the following: adults diagnosed with PA (self‐report); parent/nonparent caregivers (proxy‐report for a child with PA); and parent/nonparent caregivers (self‐report of PA impact on themselves). Results Of 1846 total study respondents, 419 were adults with PA (self‐report); 546 were parents/caregivers (proxy‐report); and 881 were parents/caregivers (self‐report). Most respondents reported lifestyle restrictions regarding food (84%‐93%) and additional domains including parties and socializing, holiday activities and destinations, and taking public transport (53%‐89%). Approximately 40% rated themselves as “very” frustrated and “very” stressed. Two‐thirds (65%) felt socially isolated; 43% were bullied. Less than half felt confident in knowing when to use an adrenaline autoinjector. Several intercountry differences were observed such as high levels of uncertainty and stress in respondents from Ireland, highest rates of anxiety in respondents from Germany, and social exclusion and isolation most common in respondents from France. Conclusions Peanut allergy imposes an adverse psychosocial impact on patients and caregivers, leading to frustration, stress and isolation. Attention to the impact of PA is needed in research and clinical practice to improve PA healthcare and public education programmes.
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Affiliation(s)
- Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Katharina Blumchen
- Division of Pneumology, Allergology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSC, ARADyAL Madrid Spain
| | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
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Pouessel G, Dubus JC, Lejeune S, Béhal H, Noël G, Beaudouin E, Deschildre A, Corriger J. Description of two anaphylaxis phenotypes in children: The utility of a clustering analysis approach. Allergy 2020; 75:2671-2674. [PMID: 32306398 DOI: 10.1111/all.14328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Guillaume Pouessel
- Department of Pediatrics Children's Hospital Roubaix France
- Pediatric Pulmonology and Allergy Department CHU Lille Lille University Lille France
| | - Jean Christophe Dubus
- Pediatric Pneumology and Allergology Departement La Timone Hospital Aix‐Marseille University Marseille France
| | - Stéphanie Lejeune
- Pediatric Pulmonology and Allergy Department CHU Lille Lille University Lille France
| | - Hélène Béhal
- CHU Lille EA 2694 – Santé publique: épidémiologie et qualité des soins Unité de biostatistiques Lille University Lille France
| | - Guilhem Noël
- Pediatric Emergency Department Nord Hospital Aix‐Marseille University Aix‐Marseille France
| | | | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department CHU Lille Lille University Lille France
| | - Jérémy Corriger
- IRPAIEC Mercy Hospital Ars‐Laquenexy France
- Department of Dermatology and Allergy University Hospital of Nancy Vandoeuvre‐lès‐Nancy France
- CECITA Team IMOPA UMR7365 University of Lorraine/CNRS Vandoeuvre‐lès‐Nancy France
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Abstract
PURPOSE OF REVIEW Information on the natural history of hypersensitivity reactions is helpful for deciding which patient urgently needs a venom immunotherapy (VIT). RECENT FINDINGS The frequency of self-reported systemic allergic reactions (SAR) to Hymenoptera stings is approximately 3-7% in the Northern Hemisphere. About 25% of SAR are severe (anaphylactic shock). Fatal sting reactions are very rare. The most important risk factor for severe insect sting anaphylaxis is mast cell disease. Other risk factors are higher age, vespid venom allergy (in contrast to honeybee venom allergy), repeated stings, male sex, and treatment with ACE inhibitors. Preceding large local reactions seem not to play a risk factor for subsequent SAR. SUMMARY The majority of risk factors for severe anaphylaxis are not modifiable. For patients presenting with well defined risk factors for a very severe or even fatal anaphylaxis, VIT is of utmost importance, and they should be performed for the rest of their life. Sting challenge tests are required to identify patients in whom treatment was ineffective. Those patients, who did not receive VIT although presenting with a firm indication, or in whom VIT was stopped, require yearly monitoring to teach preventive measures and to renew the emergency kit.
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Anaphylaxis Attended in Emergency Departments: a Reliable Picture of Real-world Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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