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Peters RL, Soriano VX, Allen KJ, Tang MLK, Perrett KP, Lowe AJ, Wijesuriya R, Parker KM, Loke P, Dharmage SC, Koplin JJ. The Prevalence of IgE-Mediated Food Allergy and Other Allergic Diseases in the First 10 Years: The Population-Based, Longitudinal HealthNuts Study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00277-0. [PMID: 38597846 DOI: 10.1016/j.jaip.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There are limited longitudinal data on the population prevalence of allergic conditions during childhood, and few studies have incorporated the reference standard oral food challenge to confirm food allergy. OBJECTIVE To describe the population prevalence of IgE-mediated food allergy, eczema, asthma, and rhinitis at ages 6 and 10 years in Melbourne, Australia. METHODS The HealthNuts study recruited 5,276 1-year-old infants in Melbourne, Australia, with repeat assessments at ages 6 and 10 years. At ages 6 and 10 years, carers completed a questionnaire on symptoms and doctor diagnosis of allergic conditions (International Study of Asthma and Allergies in Children). Children were invited to attend a clinic assessment including skin prick test, lung function tests, and oral food challenges when indicated. To minimize the impact of attrition bias, prevalence estimates among participants at ages 6 and 10 years were weighted to reflect characteristics of the whole cohort at recruitment. RESULTS In total, 4,455 and 4,065 families participated at ages 6 and 10 years, respectively (84% and 77% of the original cohort). Of those, 73% and 55% of participants ages 6 and 10 years, respectively, completed clinical assessments. Overall, 36.5% (95% CI, 34.8-38.2) and 38.2% (95% CI, 36.5-40.1%) of 6- and 10-year-olds had at least one current allergic disease, and around one third of those had two or more allergic diseases. Food allergy occurred in 6.4% (95% CI, 5.6-7.2) of 6-year olds and 6.3% (95% CI, 5.5-7.2) of 10-year-olds. Among infants with challenge-confirmed food allergy in infancy, 45% had persistent disease at age 10 years. The prevalence of current diagnosed asthma at ages 6 and 10 years were 12.1% (95% CI, 10.9-13.3) and 13.1% (95% CI, 11.9-14.4), respectively, current eczema decreased slightly from 15.3% (95% CI, 14.1-19.7) at age 6 years to 12.9% (95% CI, 11.7-14.2) at age 10 years, and current rhinitis increased from 15.1% (95% CI, 13.9-16.5) at age 6 years to 25.0% (95% CI, 23.4-26.7) at age 10 years. CONCLUSIONS Allergic diseases affect 40% of primary school-age children; one third have multiple allergic diagnoses. Challenge-confirmed food allergy prevalence remains high, and 45% of infants with food allergy have persistent disease to age 10 years.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Victoria X Soriano
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rushani Wijesuriya
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kayla M Parker
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paxton Loke
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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Lloyd M, Loke P, Ashley S, Lozinsky AC, Orsini F, O'Sullivan M, Gold M, Quinn P, Metcalfe J, Tang MLK. Interaction Between Baseline Participant Factors and Treatment Effects Following Peanut Oral Immunotherapy. The Journal of Allergy and Clinical Immunology: In Practice 2024; 12:1019-1028.e2. [PMID: 38154554 DOI: 10.1016/j.jaip.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The Probiotic Peanut Oral Immunotherapy-003 multicenter randomized trial found that both probiotic peanut oral immunotherapy (PPOIT) and peanut OIT alone (OIT) were effective compared with placebo in inducing clinical remission after 18 months of treatment, and improving health-related quality of life (HRQL) at 12 months after treatment. Understanding treatment effect modifiers can optimize outcomes through precision care. OBJECTIVES This post hoc study examined baseline clinical and demographic participant factors that modified treatment effects. METHODS The study sample included 201 children (aged 1-10 years) with challenge-confirmed peanut allergy. Exposure variables were baseline clinical and demographic factors. Outcomes were remission (double-blind, placebo-controlled food challenge, cumulative 4,950-mg peanut protein at 8 weeks after treatment) and HRQL (change in Food Allergy Quality of Life Questionnaire-Parent Form score). Interactions between baseline factors and treatment effects on remission and HRQL were explored with regression models. RESULTS A higher degree of peanut sensitivity (large peanut skin prick test, high peanut specific IgE, and low reaction-eliciting dose at study entry challenge) and other concurrent allergic conditions (multiple food allergies, asthma, or wheeze) were associated with the decreased likelihood of attaining remission after both PPOIT and OIT treatment. History of anaphylaxis was associated with the reduced likelihood of remission after PPOIT compared with OIT. For the HRQL outcome, there was evidence that sex, history of anaphylaxis, and age modified treatment effects. CONCLUSIONS Baseline participant factors modify PPOIT and OIT effects on remission and HRQL. Considering modifiers of treatment effect during participant selection may optimize treatment success and clinical trial design toward specific outcomes, such as the achievement of remission.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah Ashley
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adriana C Lozinsky
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Francesca Orsini
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- Department of Immunology, Perth Children's Hospital, Nedlands, Western Australia, Australia; Telethon Kid Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Gold
- Department of Paediatrics, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Patrick Quinn
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Jessica Metcalfe
- Department of Immunology, Perth Children's Hospital, Nedlands, Western Australia, Australia; Telethon Kid Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Anderson J, Imran S, Ng YY, Wang T, Ashley S, Minh Thang C, Quang Thanh L, Thi Trang Dai V, Van Thanh P, Thi Hong Nhu B, Ngoc Xuan Trang D, Thi Phuong Trinh P, Thanh Binh L, Thuong Vu N, Trong Toan N, Novakovic B, Tang MLK, Wurzel D, Mulholland K, Pellicci DG, Do LAH, Licciardi PV. Differential anti-viral response to respiratory syncytial virus A in preterm and term infants. EBioMedicine 2024; 102:105044. [PMID: 38447274 PMCID: PMC10933467 DOI: 10.1016/j.ebiom.2024.105044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Preterm infants are more likely to experience severe respiratory syncytial virus (RSV) disease compared to term infants. The reasons for this are multi-factorial, however their immature immune system is believed to be a major contributing factor. METHODS We collected cord blood from 25 preterm (gestational age 30.4-34.1 weeks) and 25 term infants (gestation age 37-40 weeks) and compared the response of cord blood mononuclear cells (CBMCs) to RSVA and RSVB stimulation using neutralising assays, high-dimensional flow cytometry, multiplex cytokine assays and RNA-sequencing. FINDINGS We found that preterm and term infants had similar maternally derived neutralising antibody titres to RSVA and RSVB. Preterm infants had significantly higher myeloid dendritic cells (mDC) RSV infection compared to term infants. Differential gene expression analysis of RSVA stimulated CBMCs revealed enrichment of genes involved in cytokine production and immune regulatory pathways involving IL-10, IL-36γ, CXCL1, CXCL2, SOCS1 and SOCS3 in term infants, while differentially expressed genes (DEGs) in preterm infants were related to cell cycle (CDK1, TTK, ESCO2, KNL1, CDC25A, MAD2L1) without associated expression of immune response genes. Furthermore, enriched genes in term infants were highly correlated suggesting an increased co-ordination of their immune response to RSVA. When comparing DEGs in preterm and term infants following RSVB stimulation, no differences in immune response genes were identified. INTERPRETATION Overall, our data suggests that preterm infants have a more restricted immunological response to RSVA compared with term infants. While further studies are required, these findings may help to explain why preterm infants are more susceptible to severe RSV disease and identify potential therapeutic targets to protect these vulnerable infants. FUNDING Murdoch Children's Research Institute Infection and Immunity theme grant.
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Affiliation(s)
- Jeremy Anderson
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Samira Imran
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yan Yung Ng
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tongtong Wang
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Ashley
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | | | - Boris Novakovic
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Mimi L K Tang
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia
| | - Danielle Wurzel
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Kim Mulholland
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel G Pellicci
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Lien Anh Ha Do
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Paul V Licciardi
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024:S0091-6749(24)00238-0. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Wai-Yan Leong O, Perrett KP, Loke P, Koplin JJ, Tang MLK, Allen KJ, Dharmage SC, Soriano VX, Lowe AJ, Peters RL. Reintroduction of peanut into the infant diet following negative peanut oral food challenges. J Allergy Clin Immunol Pract 2024; 12:779-782.e1. [PMID: 37931829 DOI: 10.1016/j.jaip.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Omega Wai-Yan Leong
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Center for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Paxton Loke
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Center for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Centre, the University of Queensland, Brisbane, Queensland, Australia
| | - Mimi L K Tang
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Center for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina J Allen
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Victoria X Soriano
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rachel L Peters
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.
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Ashley SE, Bosco A, Tang MLK. Transcriptomic changes associated with oral immunotherapy for food allergy. Pediatr Allergy Immunol 2024; 35:e14106. [PMID: 38520061 DOI: 10.1111/pai.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
This review summarizes recent advances in characterizing the transcriptional pathways associated with outcomes following Oral Immunotherapy. Recent technological advances including single-cell sequencing are transforming the ways in which the transcriptional landscape is understood. The application of these technologies is still in its infancy in food allergy but here we summarize current understanding of gene expression changes following oral immunotherapy for food allergy and specific signatures underpinning the different clinical outcomes of desensitization and remission (sustained unresponsiveness). T helper 2A cells have been identified as a cell type which correlates with disease activity and is modified by treatment. Molecular features at study entry may differentiate individuals who achieve more positive outcomes during OIT. Recent findings point to T cell anergy and Type 1 interferon pathways as potential mechanisms supporting redirection of the allergen-specific immune response away from allergy towards remission. Despite these developments in our understanding of immune mechanisms following OIT, there are still significant gaps. Additional studies examining immune signatures associated with long term and well-defined clinical outcomes are required to gain a more complete understanding of the pathways leading to remission of allergy, in order to optimize treatments and gain improved outcomes for patients.
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Affiliation(s)
- Sarah E Ashley
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anthony Bosco
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
- Department of Immunobiology, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
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7
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Rosser SA, Lloyd M, Hu A, Loke P, Tang MLK. Associations between gender and health-related quality of life in people with IgE-mediated food allergy and their caregivers: A systematic review. Clin Exp Allergy 2024; 54:93-108. [PMID: 38321912 DOI: 10.1111/cea.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Understanding factors that impact health-related quality of life (HRQL) is essential to inform personalised food allergy management. However, there are inconsistencies about the impact of gender on HRQL in food allergy. This review aimed to collate all investigations of the association between gender and total or subdomain HRQL scores of individuals with food allergy and their caregivers. DESIGN This is a narrative systematic review. We descriptively synthesised and compared HRQL outcomes by participant and parent genders according to statistical and clinical significance. Study quality was assessed using the ROBINS-I, inclusive of all domains. Sensitivity analysis of non-interventional studies was conducted using the ROBINS-E. DATA SOURCES A systematic search of Medline and Embase databases was conducted on 4 April 2022 and updated on 5 December 2023. ELIGIBILITY CRITERIA Studies were eligible for inclusion if they reported original data on the association between any sex and/or gender and HRQL, as measured with any validated instrument, in populations with IgE-mediated food allergy. Interventional and non-interventional studies were eligible. RESULTS A comparison of 34 eligible studies (10 interventional and 24 non-interventional) indicated females with food allergy (62.5% of studies of children, 83.3% of studies of adults) and mothers of children with food allergy (50% of studies of caregivers) experienced poorer self-reported baseline HRQL than their counterparts, notably in domains of physical, emotional or food anxiety-related well-being. Gender differences in child HRQL after food allergen immunotherapy were observed. However, selective reporting in included interventional studies meant the direction of this association could not be determined. The proxy-reported total HRQL of participants was not affected by caregiver gender, nor was caregiver HRQL likely impacted by child gender. CONCLUSIONS Gender should be considered an important modifier of participant HRQL outcomes in food allergy studies. Purposeful exploration of HRQL in all genders is needed to fully understand the implications of this construct on the lived experience of food allergy. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022329901).
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Affiliation(s)
- Sophie A Rosser
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia
| | - Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Alice Hu
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
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Lange K, Pham C, Fedyszyn IE, Cook F, Burgner DP, Olsson CA, Downes M, Priest N, Mansell T, Tang MLK, Ponsonby AL, Symeonides C, Loughman A, Vuillermin P, Kerr JA, Gray L, Sly PD, Lycett K, Carlin JB, Saffery R, Wake M, O'Connor M. Emotional symptoms and inflammatory biomarkers in childhood: Associations in two Australian birth cohorts. J Affect Disord 2024; 344:356-364. [PMID: 37832736 DOI: 10.1016/j.jad.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND An increasing body of evidence supports associations between inflammation and mental health difficulties, but the onset and directionality of these relationships are unclear. METHODS Data sources: Barwon Infant Study (BIS; n = 500 4-year-olds) and Longitudinal Study of Australian Children (LSAC; n = 1099 10-13-year-olds). MEASURES Strengths and Difficulties Questionnaire emotional symptoms at 4, 10-11 and 12-13 years, and circulating levels of two inflammatory biomarkers, high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA), at 4 and 11-12 years. ANALYSIS Adjusted quantile regression models examining cross-sectional associations between emotional symptoms and inflammation in 4-year-olds (BIS), and cross-lagged associations in 10-13-year-olds (LSAC). RESULTS We identified a small association between higher emotional symptoms at 10-11 years and higher GlycA levels a year later (standardised coefficient β = 0.09; 95%CI: 0.02 to 0.15). Sex-stratified analyses revealed this association was stronger for boys (β = 0.13; 95%CI: 0.04 to 0.21) than girls (β = 0.01; 95%CI: -0.09 to 0.11). These associations were not observed for hsCRP. There was little evidence of an association between higher GlycA or hsCRP at 11-12 years and emotional symptoms a year later, or cross-sectional associations between emotional symptoms and hsCRP or GlycA at 4 years. LIMITATIONS A single time-point of biomarker collection in late childhood precluded adjustment for baseline inflammatory biomarkers. CONCLUSIONS Our results support the direction of association from emotional symptoms to inflammation in late childhood, with potential sex differences. This adds to the body of evidence that addressing emotional symptoms in childhood is a major priority in optimising overall health throughout the life course.
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Affiliation(s)
- Katherine Lange
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia.
| | - Cindy Pham
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
| | - Izabela E Fedyszyn
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, Parkville, VIC, Australia
| | - Fallon Cook
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; Monash University, Department of Paediatrics, Clayton, VIC, Australia
| | - Craig A Olsson
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; Deakin University, Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Burwood, VIC, Australia
| | - Marnie Downes
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Naomi Priest
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Australian National University, Centre for Social Research and Methods, Canberra, ACT, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, Parkville, VIC, Australia; University of Melbourne, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Christos Symeonides
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Royal Children's Hospital, Parkville, VIC, Australia; Minderoo Foundation, Perth, WA, Australia
| | - Amy Loughman
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, VIC, Australia
| | - Peter Vuillermin
- Deakin University, School of Medicine, Geelong, VIC, Australia; Barwon Health, Child Health Research Unit, Geelong, VIC, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; University of Otago, Department of Psychological Medicine, Christchurch, New Zealand
| | - Lawrence Gray
- Deakin University, School of Medicine, Geelong, VIC, Australia; Barwon Health, Child Health Research Unit, Geelong, VIC, Australia
| | - Peter D Sly
- University of Queensland, Child Health Research Centre, South Brisbane, QLD, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; Deakin University, Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Burwood, VIC, Australia
| | - John B Carlin
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; University of Auckland, Liggins Institute, Grafton, Auckland, New Zealand
| | - Meredith O'Connor
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia; University of Melbourne, Melbourne Graduate School of Education, Parkville, VIC, Australia
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Vilcins D, Blake TL, Sly PD, Saffery R, Ponsonby AL, Burgner D, Tang MLK, Reid N. Effects of prenatal alcohol exposure on infant lung function, wheeze, and respiratory infections in Australian children. Alcohol Clin Exp Res (Hoboken) 2023; 47:2278-2287. [PMID: 38151787 DOI: 10.1111/acer.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is a known risk factor for a range of adverse outcomes, such as facial dysmorphism, adverse birth outcomes, and neurodevelopmental changes. Preclinical research shows that PAE also inhibits lung development, lowers surfactant protein expression, has detrimental effects on alveolar macrophages, and decreases both T and B cell numbers. However, clinical evidence of respiratory impacts from PAE is limited. This study explored whether lung function, wheeze, and incidence of respiratory infections differ in children with PAE compared with unexposed children. METHODS Data from the Barwon Infant Study (n = 1074) were examined. PAE data were extracted from maternal questionnaires at trimesters 1 and 2 (combined), and trimester 3, and included as "total standard drinks" during each trimester and total pregnancy intake, a binary yes/no for PAE, and binge drinking (>5 standard drinks in one session). Respiratory outcomes were parent-reported wheeze, lung function (measured by multiple breath washout), and parent report and medical record indicators of health service attendances for respiratory conditions. Linear and logistic regressions were performed to quantify relationships between PAE and respiratory outcomes, controlling for socioeconomic status, birthweight, sex, gestational age, and maternal smoking. RESULTS Binge drinking was associated with increased health service attendance for respiratory condition(s) in the first 12 months of life (OR = 5.0, 95% CI (1.7, 20.7), p = 0.008). We did not find a relationship between binary PAE and binge drinking with lung function at 4 weeks of age or wheeze at 12 months. The number of standard drinks consumed in trimester two was associated with a lower lung clearance index (β = -0.011 turnovers, 95% CI (-0.0200, -0.0013), p = 0.03), and a small increase in functional residual capacity (β = 0.34 mL, 95% CI (0.02, 0.66), p = 0.04). CONCLUSIONS We found an association between binge drinking and health service utilization for respiratory conditions in infancy, but no evidence that low-level PAE was associated with adverse respiratory outcomes.
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Affiliation(s)
- Dwan Vilcins
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Tamara L Blake
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Hu A, Lloyd M, Loke P, Chebar Lozinsky A, O'Sullivan M, Quinn P, Gold M, Tang MLK. Association of Reaction Symptoms and Eliciting Dose With Health-Related Quality of Life in Children With Peanut Allergy. J Allergy Clin Immunol Pract 2023; 11:3195-3202.e4. [PMID: 37423341 DOI: 10.1016/j.jaip.2023.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Food allergy adversely affects the health-related quality of life (HRQoL) of patients. It is unclear whether factors such as the reaction eliciting dose (ED) and the nature of allergic reaction symptoms affect HRQoL. OBJECTIVE To explore associations between reaction ED or the nature of allergic symptoms and HRQoL among children with peanut allergy. METHODS This study was a secondary analysis of baseline data from the PPOIT-003 randomized trial in 212 children aged 1 to 10 years with challenge-confirmed peanut allergy. Children's past reaction symptoms were collected by clinicians during screening. Associations between variables of interest and parent-reported child-proxy HRQoL were examined by univariable and multivariable linear regression. RESULTS Mean age of study participants was 5.9 years; 63.2% were male. Children with a low reaction ED of 80 mg peanut protein had significantly poorer HRQoL (β = -0.81; 95% CI, -1.61 to -0.00; P = .049) compared with children with a high ED of 2,500 mg peanut protein. Gastrointestinal symptoms (β = 0.45; 95% CI, 0.03-0.87; P = .037), lower airway symptoms (β = 0.46; 95% CI, 0.05-0.87; P = .030), multisystem involvement (β = 0.71; 95% CI, 0.25-1.16; P = .003), or anaphylaxis (β = 0.46; 95% CI, 0.04-0.87; P = .031) during a previous reaction were associated with worse HRQoL. CONCLUSIONS Peanut-allergic children with a lower allergen reaction threshold experienced a greater negative HRQoL impact compared with children with higher reaction thresholds. In addition, specific past allergic reaction symptoms were associated with comparatively worse HRQoL. Children experiencing these symptoms and those with lower reaction ED require increased clinical support to manage the food allergy and are likely to benefit from interventions that can improve HRQoL.
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Affiliation(s)
- Alice Hu
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, Monash University Clayton, Victoria, Australia
| | | | - Michael O'Sullivan
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia; Paediatrics Division, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Patrick Quinn
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Michael Gold
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
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11
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Chang CL, Ali GB, Pham J, Dharmage SC, Lodge CJ, Tang MLK, Lowe AJ. Childhood body mass index trajectories and asthma and allergies: A systematic review. Clin Exp Allergy 2023; 53:911-929. [PMID: 37401045 DOI: 10.1111/cea.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships. OBJECTIVE To systematically synthesise the association between BMI trajectories in childhood (0-18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes). DESIGN We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS-E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta-analysis. DATA SOURCES A search was performed on PubMed and EMBASE databases on 4th January 2023. ELIGIBILITY CRITERIA Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included. RESULTS Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma. CONCLUSIONS Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer-term follow-up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed.
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Affiliation(s)
- Chia-Lun Chang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gulshan Bano Ali
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Pham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Asthma, Allergy and Clinical Immunology Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Allergy Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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12
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Gao Y, Stokholm J, O'Hely M, Ponsonby AL, Tang MLK, Ranganathan S, Saffery R, Harrison LC, Collier F, Gray L, Burgner D, Molloy J, Sly PD, Brix S, Frøkiær H, Vuillermin P. Gut microbiota maturity mediates the protective effect of siblings on food allergy. J Allergy Clin Immunol 2023; 152:667-675. [PMID: 37150361 DOI: 10.1016/j.jaci.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The mechanisms underlying the protective effect of older siblings on allergic disease remain unclear but may relate to the infant gut microbiota. OBJECTIVE We sought to investigate whether having older siblings decreases the risk of IgE-mediated food allergy by accelerating the maturation of the infant gut microbiota. METHODS In a birth cohort assembled using an unselected antenatal sampling frame (n = 1074), fecal samples were collected at 1 month, 6 months, and 1 year, and food allergy status at 1 year was determined by skin prick test and in-hospital food challenge. We used 16S rRNA gene amplicon sequencing to derive amplicon sequence variants. Among a random subcohort (n = 323), microbiota-by-age z scores at each time point were calculated using fecal amplicon sequence variants to represent the gut microbiota maturation over the first year of life. RESULTS A greater number of siblings was associated with a higher microbiota-by-age z score at age 1 year (β = 0.15 per an additional sibling; 95% CI, 0.05-0.24; P = .003), which was in turn associated with decreased odds of food allergy (odds ratio, 0.45; 95% CI, 0.33-0.61; P < .001). Microbiota-by-age z scores mediated 63% of the protective effect of siblings. Analogous associations were not observed at younger ages. CONCLUSIONS The protective effect of older siblings on the risk of developing IgE-mediated food allergy during infancy is substantially mediated by advanced maturation of the gut microbiota at age 1 year.
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Affiliation(s)
- Yuan Gao
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia; Child Health Research Unit, Barwon Health, Geelong, Australia; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Martin O'Hely
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Developing Brain Division, The Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Leonard C Harrison
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Fiona Collier
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia
| | - Lawrence Gray
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia; Child Health Research Unit, Barwon Health, Geelong, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - John Molloy
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia; Child Health Research Unit, Barwon Health, Geelong, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia; Faculty of Health, Deakin University, Geelong, Australia
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Hanne Frøkiær
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vuillermin
- Institute for Physical and Mental Health and Clinical Transformation, Deakin University, Geelong, Australia; Child Health Research Unit, Barwon Health, Geelong, Australia.
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13
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Peters RL, Soriano VX, Lycett K, Flynn C, Idrose NS, Tang MLK, Wijesuriya R, Allen KJ, Ranganathan S, Lowe AJ, Perrett KP, Lodge CJ, Koplin JJ, Dharmage SC. Infant food allergy phenotypes and association with lung function deficits and asthma at age 6 years: a population-based, prospective cohort study in Australia. Lancet Child Adolesc Health 2023; 7:636-647. [PMID: 37506717 DOI: 10.1016/s2352-4642(23)00133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Food allergy is considered a precursor to asthma in the context of the atopic march, but the relationship between infant food allergy phenotypes and lung function and asthma in childhood is unclear. We aimed to examine the association between food sensitisation and challenge-confirmed food allergy in infancy, as well as persistent and resolved food allergy up to age 6 years, and the risk of lung function deficits and asthma at age 6 years. METHODS The longitudinal, population-based HealthNuts cohort study in Melbourne, VIC, Australia, recruited 5276 infants children aged 1 year who attended council-run immunisation sessions between Sept 28, 2007, and Aug 5, 2011. At age 1 year, all children completed skin prick testing to four food allergens (egg, peanut, sesame, and either shrimp or cow's milk) and an oral food challenge (egg, peanut, and sesame) at the Royal Children's Hospital in Melbourne. Parents completed questionnaires about their infant's allergy history, demographic characteristics, and environmental exposures. At age 6 years, children were invited for a health assessment that included skin prick testing for ten foods (milk, egg, peanut, wheat, sesame, soy, shrimp, cashew, almond, and hazelnut) and eight aeroallergens (alternaria, cladasporum, house dust mite, cat hair, dog hair, bermuda grass, rye grass, and birch mix), oral food challenges, and lung function testing by spirometry. Questionnaires completed by parents (different to those completed at age 1 year) captured the child's allergy and respiratory history and demographics. We investigated associations between food allergy phenotypes (food-sensitised tolerance or food allergy; and ever, transient, persistent, or late-onset food allergy), lung function spirometry measures (forced expiratory volume in 1 sec [FEV1] and forced vital capacity [FVC] z-scores, FEV1/FVC ratio, forced expiratory flow at 25% and 75% of the pulmonary volume [FEF25-75%], and bronchodilator responsiveness), and asthma using regression methods. Only children with complete data on the exposure, outcome, and confounders were included in models. Infants without food sensitisation or food allergy at age 1 year and 6 years served as the reference group. FINDINGS Of 5276 participants, 3233 completed the health assessment at age 6 years and were included in this analysis. Food allergy, but not food-sensitised tolerance, at age 1 year was associated with reduced FEV1 and FVC (aβ -0·19 [95% CI -0·32 to -0·06] and -0·17 [-0·31 to -0·04], respectively) at age 6 years. Transient egg allergy was associated with reduced FEV1 and FVC compared with never having egg allergy (-0·18 [95% CI -0·33 to -0·03] and -0·15 [-0·31 to 0·00], respectively), whereas persistent egg allergy was not (FEV1 -0·09 [-0·48 to 0·31]; FVC -0·20 [-0·62 to 0·21]). Transient peanut allergy was associated with reduced FEV1 and FVC (FEV1 aβ -0·37 [-0·79 to 0·04] and FVC aβ -0·55 [-0·98 to -0·12]), in addition to persistent peanut allergy (FEV1 aβ -0·30 [-0·54 to -0·06] and FVC aβ-0·30 [-0·55 to -0·05]), and late-onset peanut allergy (FEV1 aβ -0·62 [-1·06 to -0·18] and FVC aβ-0·49 [-0·96 to -0·03]). Estimates suggested that food-sensitised tolerance and food allergy were associated with reduced FEF25-75%, although some estimates were imprecise. Food allergy phenotypes were not associated with an FEV1/FVC ratio. Late-onset peanut allergy was the only allergy phenotype that was possibly associated with increased risk of bronchodilator responsiveness (2·95 [95% CI 0·77 to 11·38]). 430 (13·7%) of 3135 children were diagnosed with asthma before age 6 years (95% CI 12·5-15·0). Both food-sensitised tolerance and food allergy at age 1 year were associated with increased asthma risk at age 6 years (adjusted odds ratio 1·97 [95% CI 1·23 to 3·15] and 3·69 [2·81 to 4·85], respectively). Persistent and late-onset peanut allergy were associated with higher asthma risk (3·87 [2·39 to 6·26] and 5·06 [2·15 to 11·90], respectively). INTERPRETATION Food allergy in infancy, whether it resolves or not, is associated with lung function deficits and asthma at age 6 years. Follow-up studies of interventions to prevent food allergy present an opportunity to examine whether preventing these food allergies improves respiratory health. FUNDING National Health & Medical Research Council of Australia, Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program.
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Affiliation(s)
- Rachel L Peters
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Victoria X Soriano
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Deakin University, Burwood, VIC, Australia
| | - Catherine Flynn
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Nur Sabrina Idrose
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Rushani Wijesuriya
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Adrian J Lowe
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Caroline J Lodge
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Child Health Research Centre, University of Queensland, South Brisbane, QLD, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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14
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Greenhawt M, Dribin TE, Abrams EM, Shaker M, Chu DK, Golden DBK, Akin C, Anagnostou A, ALMuhizi F, Alqurashi W, Arkwright P, Baldwin JL, Banerji A, Bégin P, Ben-Shoshan M, Bernstein J, Bingemann TA, Bindslev-Jensen C, Blumenthal K, Byrne A, Cahill J, Cameron S, Campbell D, Campbell R, Cavender M, Chan ES, Chinthrajah S, Comberiati P, Eastman JJ, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Garvey LH, Grayson MH, Isabwe GAC, Hartog N, Hendron D, Horner CC, Hourihane JO, Iglesia E, Kan M, Kaplan B, Katelaris CH, Kim H, Kelso JM, Khan DA, Lang D, Ledford D, Levin M, Lieberman JA, Loh R, Mack DP, Mazer B, Mody K, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Nathan R, Oppenheimer J, Otani IM, Park M, Pawankar R, Perrett KP, Peter J, Phillips EJ, Picard M, Pitlick M, Ramsey A, Rasmussen TH, Rathkopf MM, Reddy H, Robertson K, Rodriguez Del Rio P, Sample S, Sheshadri A, Sheik J, Sindher SB, Spergel JM, Stone CA, Stukus D, Tang MLK, Tracy JM, Turner PJ, Vander Leek TK, Wallace DV, Wang J, Wasserman S, Weldon D, Wolfson AR, Worm M, Yacoub MR. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. J Allergy Clin Immunol 2023; 152:309-325. [PMID: 37295474 PMCID: PMC10247143 DOI: 10.1016/j.jaci.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K Chu
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada; Evidence in Allergy Group, McMaster University Medical Centre, Hamilton, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Bethesda
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Akterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Arabia
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - James L Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Philippe Bégin
- Centre Hospital Universitaire Sainte-Justine, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa A Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | - Kim Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Aideen Byrne
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Cahill
- University of Alberta, Faculty of Medicine, Calgary, Canada
| | - Scott Cameron
- Allergy Victoria, Victoria, British Columbia, Canada
| | | | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester
| | | | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jacqueline J Eastman
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guys's and St Tomas's Hospital National Health Service Foundation Trust, London, Mass
| | - Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Nicholas Hartog
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - David Hendron
- Access Health Care Physicians LLC, New Port Richey, Fla
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | | | - Edward Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, New York, NY
| | | | - Harold Kim
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, St Joseph's Health Care, London (Canada), Mass
| | - John M Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David A Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada; Halton Pediatric Allergy, Burlington, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Ketan Mody
- Elite Sports Medicine Institute Ltd, Westmont, Ill
| | - Gisele Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, Mass
| | - S Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex; Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Tex
| | | | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Kirsten P Perrett
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill; Population Allergy Group and the Centre for Food and Allergy Research, Murdoch Children's Research Institute, University of Melbourne, University of Melbourne, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | | | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Trine Holm Rasmussen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | | | - Hari Reddy
- Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St Joseph's Health Care, London (Canada), Mass; Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care, London (Canada), Mass
| | | | | | - Ajay Sheshadri
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Javed Sheik
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - James M Tracy
- Allergy, Asthma, and Immunology Associates PC, Omaha, Neb; Department of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J Turner
- Imperial College Healthcare National Health Service Trust, London, Mass; Royal Brompton and Harefield National Health Service Foundation Trust, London, Mass
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Dana V Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Wasserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - David Weldon
- Baylor Scott and White Clinic, College Station, Tex
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mona-Rita Yacoub
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Segrate, Milan, Italy
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15
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Lodge CJ, Waidyatillake N, Peters RL, Netting M, Dai X, Burgess J, Hornung CJ, Perrett KP, Tang MLK, Koplin JJ, Dharmage SC. Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials. Clin Transl Allergy 2023; 13:e12268. [PMID: 37488726 PMCID: PMC10314278 DOI: 10.1002/clt2.12268] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. BODY: We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. CONCLUSION We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.
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Affiliation(s)
- Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Merryn Netting
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Xin Dai
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - John Burgess
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Allergy Immunology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Child Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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16
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Shanthikumar S, Chen K, Soriano VX, Nguyen L, Koplin JJ, Tang MLK, Lowe AJ, Lodge CJ, Idrose NS, Ranganathan S, Thompson B, Dharmage SC, Peters RL. Comparing definitions of bronchodilator response in a population-based cohort of 6-year-old children. Pediatr Pulmonol 2023. [PMID: 37154521 DOI: 10.1002/ppul.26456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Shivanthan Shanthikumar
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine Chen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Lily Nguyen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Victoria, Australia
| | - Caroline J Lodge
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Victoria, Australia
| | - Nur Sabrina Idrose
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Bruce Thompson
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Victoria, Australia
| | - Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
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17
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Burgner D, Tang MLK, Campbell KJ. Understanding the pathways between prenatal and postnatal factors and overweight outcomes in early childhood: a pooled analysis of seven cohorts. Int J Obes (Lond) 2023:10.1038/s41366-023-01301-9. [PMID: 37012427 DOI: 10.1038/s41366-023-01301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND/OBJECTIVES Childhood overweight and obesity are influenced by a range of prenatal and postnatal factors. Few studies have explored the integrative pathways linking these factors and childhood overweight. This study aimed to elucidate the integrative pathways through which maternal pre-pregnancy body mass index (BMI), infant birth weight, breastfeeding duration, and rapid weight gain (RWG) during infancy are associated with overweight outcomes in early childhood from ages 3 to 5 years. SUBJECTS/METHODS Pooled data from seven Australian and New Zealand cohorts were used (n = 3572). Generalized structural equation modelling was used to examine direct and indirect associations of maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration, and RWG during infancy with child overweight outcomes (BMI z-score and overweight status). RESULTS Maternal pre-pregnancy BMI was directly associated with infant birth weight (β 0.01, 95%CI 0.01, 0.02), breastfeeding duration ≥6 months (OR 0.92, 95%CI 0.90, 0.93), child BMI z-score (β 0.03, 95%CI 0.03, 0.04) and overweight status (OR 1.07, 95%CI 1.06, 1.09) at ages 3-5 years. The association between maternal pre-pregnancy BMI and child overweight outcomes was partially mediated by infant birth weight, but not RWG. RWG in infancy exhibited the strongest direct association with child overweight outcomes (BMI z-score: β 0.72, 95%CI 0.65, 0.79; overweight status: OR 4.49, 95%CI 3.61, 5.59). Infant birth weight was implicated in the indirect pathways of maternal pre-pregnancy BMI with RWG in infancy, breastfeeding duration, and child overweight outcomes. The associations between breastfeeding duration (≥6 months) and lower child overweight outcomes were fully mediated by RWG in infancy. CONCLUSIONS Maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration and RWG in infancy act in concert to influence early childhood overweight. Future overweight prevention interventions should target RWG in infancy, which showed the strongest association with childhood overweight; and maternal pre-pregnancy BMI, which was implicated in several pathways leading to childhood overweight.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - Jodie Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Li Ming Wen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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18
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Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Kandane‐Rathnayake R, Aldakheel FM, Erbas B, Hamilton GS, Thomas PS, Hew M, Tang MLK, Abramson MJ, Perret JL, Dharmage SC. Biomarkers of asthma relapse and lung function decline in adults with spontaneous asthma remission: A population-based cohort study. Allergy 2023; 78:957-967. [PMID: 36301194 PMCID: PMC10953440 DOI: 10.1111/all.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The extent to which biomarkers of asthma activity persist in spontaneous asthma remission and whether such markers are associated with future respiratory outcomes remained unclear. We investigated the association between sub-clinical inflammation in adults with spontaneous asthma remission and future asthma relapse and lung function decline. METHODS The Tasmanian Longitudinal Health Study is a population-based cohort (n = 8583). Biomarkers of systemic inflammation were measured on participants at age 45, and latent profile analysis was used to identify cytokine profiles. Bronchial hyperresponsiveness (BHR) and nitric oxide products in exhaled breath condensate (EBC NOx) were measured at age 50. Participants with spontaneous asthma remission at ages 45 (n = 466) and 50 (n = 318) were re-evaluated at age 53, and associations between baseline inflammatory biomarkers and subsequent asthma relapse and lung function decline were assessed. RESULTS We identified three cytokine profiles in adults with spontaneous asthma remission: average (34%), Th2-high (42%) and Th2-low (24%). Compared to the average profile, a Th2-high profile was associated with accelerated decline in post-BD FEV1 /FVC (MD -0.18% predicted per-year; 95% CI -0.33, -0.02), while a Th2-low profile was associated with accelerated decline in both post-BD FEV1 (-0.41%; -0.75, -0.06) and post-BD FVC (-0.31%; -0.62, 0.01). BHR and high TNF-α during spontaneous remission were associated with an increased risk of asthma relapse. In contrast, we found no evidence of association between EBC NOx and either asthma relapse or lung function decline. CONCLUSION BHR and serum inflammatory cytokines have prognostic value in adults with spontaneous asthma remission. At-risk individuals with BHR, Th2-high or Th2-low cytokine profiles may benefit from closer monitoring and on-going follow-up.
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Affiliation(s)
- Daniel J. Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Eugene Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- School of Medicine, University of TasmaniaHobartTasmaniaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Dinh S. Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Basic Sciences, Faculty of Allied Health SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | | | - Fahad M. Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Bircan Erbas
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- Violet Vines Marshman Centre for Rural Health ResearchLa Trobe UniversityBendigoVictoriaAustralia
| | - Garun S. Hamilton
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
| | - Paul S. Thomas
- Prince of Wales' Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mark Hew
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- The Alfred HospitalMelbourneVictoriaAustralia
| | - Mimi L. K. Tang
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
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Coelho GLDH, Lloyd M, Tang MLK, DunnGalvin A. Food allergy satisfaction with life scale: A complementary measure to health‐related quality of life. Clin Transl Allergy 2023; 13:e12233. [PMID: 36973959 PMCID: PMC9987026 DOI: 10.1002/clt2.12233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
| | - Melanie Lloyd
- School of Public Health and Preventative MedicineMonash UniversityParkvilleVictoriaAustralia
- Allergy Immunology GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Mimi L. K. Tang
- Allergy Immunology GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Allergy and ImmunologyThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
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20
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Coelho GLDH, Lloyd M, Tang MLK, DunnGalvin A. The Short Food Allergy Quality of Life Questionnaire (FAQLQ-12) for Adults. J Allergy Clin Immunol Pract 2023; 11:1522-1527.e5. [PMID: 36868474 DOI: 10.1016/j.jaip.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The Food Allergy Quality of Life Questionnaire (FAQLQ) is the most widely used measure to assess health-related quality of life in food allergy. However, its length can lead to a series of disadvantages, such as reduced or incomplete participation and boredom and disengagement, affecting data quality, reliability, and validity. OBJECTIVE We shortened the well-known FAQLQ for adults and propose the FAQLQ-12. METHODS We applied reference-standard statistical analyses, mixing classic test theory and item response theory to identify relevant items for the new short form and confirm its structure fit and reliability. More specifically, we employed discrimination, difficulty, and information levels (item response theory), confirmatory factor analysis, Pearson's correlations, and reliability analysis (McDonald ω and Cronbach α). RESULTS We chose items with the highest discrimination values to compose the shortened FAQLQ because they were among the ones with the best difficulty levels and the highest amount of individual information. We retained three items per factor because this number allowed for acceptable reliability levels, resulting in 12 items. The FAQLQ-12 presented a better model fit compared with the complete version. The correlation patterns and reliability levels were similar for both the 29 and 12 versions. CONCLUSIONS Although the full version of the FAQLQ remains a reference standard to assess food allergy quality of life, the FAQLQ-12 is introduced as a powerful and beneficial alternative. It can help participants, researchers, and clinicians in specific settings, such as dealing with time and budget limitations, and provides high-quality and reliable responses.
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Affiliation(s)
| | - Melanie Lloyd
- Health Economics and Outcomes Research, Murdoch Children's Research Institute and Monash University, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
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21
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Lloyd M, Loke P, Mack DP, Sicherer SH, Perkin MR, Boyle R, Yin Leung AS, Lee BW, Levin M, Blumchen K, Fiocchi A, Ebisawa M, Oliveira LCLD, Tang MLK. Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World. J Allergy Clin Immunol Pract 2023; 11:1010-1027.e6. [PMID: 36805346 DOI: 10.1016/j.jaip.2023.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael R Perkin
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Robert Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Hub of Paediatric Excellence, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Lucila Camargo Lopes de Oliveira
- Department of Paediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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22
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Lloyd M, Patel N, Munblit D, Tang MLK. Endpoints and Outcomes After Immunotherapy for Food Allergy: What Is Meaningful for Patients? J Allergy Clin Immunol Pract 2023; 11:998-1007. [PMID: 36736959 DOI: 10.1016/j.jaip.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
Multiple novel interventions for food allergy are currently at various stages of development with the goal of reducing or eliminating allergic reactions. However, the relative success of these therapeutics in achieving meaningful, long-term improvements to patients' lives is difficult to determine as there is currently very limited understanding of the degree of alignment between clinical trial efficacy endpoints and patient-centered outcomes. Furthermore, outcome measures used in clinical trials of food allergy immunotherapies vary widely, are often misinterpreted, and not necessarily consistent with what patients expect to achieve through treatment. This review aims to assist clinicians in critically interpreting outcomes reported in clinical trials and accurately communicating risks and outcomes to patients when practicing shared decision-making.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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23
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Zeleke BM, Lowe AJ, Dharmage SC, Lopez DJ, Koplin JJ, Peters RL, Soriano VX, Tang MLK, Walters EH, Varigos GA, Lodge CJ, Perret JL, Abramson MJ. Epidemiology of eczema in South-Eastern Australia. Australas J Dermatol 2023; 64:e41-e50. [PMID: 36533890 PMCID: PMC10952653 DOI: 10.1111/ajd.13966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Eczema is a common chronic debilitating skin condition in childhood. Data on the epidemiology and natural history of eczema across the life course are lacking. This analysis aimed to describe these epidemiological features in Australian children and adults. METHODS Data collected on eczema from four Australian cohort studies were analysed: namely HealthNuts, Melbourne Atopic Cohort Study (MACS), Tasmanian Longitudinal Health Study (TAHS) and the Australian arm of the European Community Respiratory Health Survey (ECRHS). RESULTS Among children aged under 6 years, 28.8%-35.6% have ever-had eczema, and 16.7%-26.6% had 'current eczema'. Among those aged 6-12 years, 14.6%-24.7% had 'current eczema' with 12.0%-18.5% of those at ages of 6 and 10 years classified as having moderate-to-severe eczema according to the Scoring of Atopic Dermatitis (SCORAD) index. In adults, the prevalence of 'eczema ever' ranged between 13.8% and 48.4%. The 12-month period prevalence of eczema was 15.1% at age 18, while current eczema was 8.5% at an average age of 51, and 8.8% at an average age 53 years. Eczema was more common among young boys, but this difference became non-significant for older children and early adolescents. In contrast, eczema was more common for adult women than men. CONCLUSIONS Eczema is common both in children and adults. The proportion of severe eczema in children was substantial.
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Affiliation(s)
- Berihun M. Zeleke
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Diego J. Lopez
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Jennifer J. Koplin
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Rachel L. Peters
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Victoria X. Soriano
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Mimi L. K. Tang
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - E. Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- School of Medicine, University of TasmaniaHobartAustralia
| | - George A. Varigos
- Department of DermatologyThe Royal Melbourne HospitalMelbourne, ParkvilleVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
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24
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Turner PJ, Tang MLK, Wood RA. Food Allergy and Eosinophilic Gastrointestinal Diseases-The Next 10 Years. J Allergy Clin Immunol Pract 2023; 11:72-78. [PMID: 36371062 DOI: 10.1016/j.jaip.2022.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
The first report of food allergy desensitization was in 1908, at least a few years before the first published description of a diagnostic test for food allergy. It has taken almost 100 years for food allergy to move from passive management of avoidance to a more proactive approach including prevention and treatment. In parallel, this has been matched by recognition of eosinophil gastrointestinal diseases, which were first described in the 1980s (although eosinophilic esophagitis was itself described in 1978). As we celebrate 10 years of The Journal of Allergy and Clinical Immunology: In Practice, we take the opportunity to look into the future and speculate how our practice may develop over the next decade.
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Affiliation(s)
- Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
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25
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Hua X, Dalziel K, Brettig T, Dharmage SC, Lowe A, Perrett KP, Peters RL, Ponsonby AL, Tang MLK, Koplin J. Out-of-hospital health care costs of childhood food allergy in Australia: A population-based longitudinal study. Pediatr Allergy Immunol 2022; 33:e13883. [PMID: 36433856 PMCID: PMC9828422 DOI: 10.1111/pai.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Australia has one of the highest prevalence of childhood food allergy in the world, but there are no data on its economic burden in Australia. METHODS We used data from the HealthNuts study, a population-based longitudinal study undertaken in Melbourne, Australia. Infants were recruited at age 12 months between Sept 2007 and Aug 2011 with food allergy diagnosed using oral food challenges. Health care costs of out-of-hospital services were collected through data linkage to Australia's universal health insurance scheme Medicare. Two-part model was used to compare costs after controlling for potential confounders. RESULTS 2919 children were included, and 390 (13.4%) had challenge-confirmed food allergy at age 1 year. Compared with children without food allergy, children with food allergy had significantly higher costs for GP visits, specialist visits, tests, and prescriptions in the first four years of life. The total Medicare cost associated with food allergy from age 1 to 4 years was estimated to be AUD$889.7 (95% CI $566.1-$1188.3) or €411.0 (95% CI €261.5-€549.0) per child. This was projected into an annual Medicare cost of AUD$26.1 million (95% CI $20.1-$32.3 million) or €12.1 (95% CI €9.3-€14.9 million) based on population size in 2020. CONCLUSIONS Childhood food allergy causes considerable Medicare costs for out-of-hospital services in the first four years after birth in Australia. These findings can help anticipate the financial impact on the health care system associated with childhood food allergy, act as a useful costing resource for future evaluations, and inform management of childhood food allergy internationally.
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Affiliation(s)
- Xinyang Hua
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Kim Dalziel
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia
| | - Tim Brettig
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Adrian Lowe
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Anne-Louise Ponsonby
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jennifer Koplin
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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26
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Royce SG, Licciardi PV, Beh RC, Bourke JE, Donovan C, Hung A, Khurana I, Liang JJ, Maxwell S, Mazarakis N, Pitsillou E, Siow YY, Snibson KJ, Tobin MJ, Ververis K, Vongsvivut J, Ziemann M, Samuel CS, Tang MLK, El-Osta A, Karagiannis TC. Sulforaphane prevents and reverses allergic airways disease in mice via anti-inflammatory, antioxidant, and epigenetic mechanisms. Cell Mol Life Sci 2022; 79:579. [DOI: 10.1007/s00018-022-04609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/30/2022]
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27
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Imran S, Neeland MR, Peng S, Vlahos A, Martino D, Dharmage SC, Tang MLK, Sawyer S, Dang TD, McWilliam V, Peters RL, Koplin JJ, Perrett KP, Novakovic B, Saffery R. Immuno-epigenomic analysis identifies attenuated interferon responses in naïve CD4 T cells of adolescents with peanut and multi-food allergy. Pediatr Allergy Immunol 2022; 33:e13890. [PMID: 36433861 DOI: 10.1111/pai.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND IgE-mediated food allergies have been linked to suboptimal naïve CD4 T (nCD4T) cell activation in infancy, underlined by epigenetic and transcriptomic variation. Similar attenuated nCD4T cell activation in adolescents with food allergy have also been reported, but these are yet to be linked to specific epigenetic or transcriptional changes. METHODS We generated genome-wide DNA methylation data in purified nCD4 T cells at quiescence and following activation in a cohort of adolescents (aged 10-15 years old) with peanut allergy (peanut only or peanut + ≥1 additional food allergy) (FA, n = 29), and age-matched non-food allergic controls (NA, n = 18). Additionally, we assessed transcriptome-wide gene expression and cytokine production in these cells following activation. RESULTS We found widespread changes in DNA methylation in both NA and FA nCD4T cells in response to activation, associated with the T cell receptor signaling pathway. Adolescents with FA exhibit unique DNA methylation signatures at quiescence and post-activation at key genes involved in Th1/Th2 differentiation (RUNX3, RXRA, NFKB1A, IL4R), including a differentially methylated region (DMR) at the TNFRSF6B promoter, linked to Th1 proliferation. Combined analysis of DNA methylation, transcriptomic data and cytokine output in the same samples identified an attenuated interferon response in nCD4T cells from FA individuals following activation, with decreased expression of several interferon genes, including IFN-γ and a DMR at a key downstream gene, BST2. CONCLUSION We find that attenuated nCD4T cell responses from adolescents with food allergy are associated with specific epigenetic variation, including disruption of interferon responses, indicating dysregulation of key immune pathways that may contribute to a persistent FA phenotype. However, we recognize the small sample size, and the consequent restraint on reporting adjusted p-value statistics as limitations of the study. Further study is required to validate these findings.
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Affiliation(s)
- Samira Imran
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Melanie R Neeland
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen Peng
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Vlahos
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Martino
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Telethon Kids Institute, University of Western, Perth, Nedlands, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Sawyer
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Thanh D Dang
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel L Peters
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Boris Novakovic
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
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Dharmage SC, Lowe AJ, Tang MLK. Revisiting the Atopic March Current Evidence. Am J Respir Crit Care Med 2022; 206:925-926. [PMID: 35816436 PMCID: PMC9802002 DOI: 10.1164/rccm.202206-1219ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Shyamali C. Dharmage
- Allergy and Lung Health UnitMelbourne School of Population and Global HealthMelbourne, Australia
| | - Adrian J. Lowe
- Allergy and Lung Health UnitMelbourne School of Population and Global HealthMelbourne, Australia
| | - Mimi L. K. Tang
- Allergy ImmunologyMurdoch Children’s Research instituteMelbourne, Australia,Allergy ImmunologyThe Royal Children’s HospitalMelbourne, Australia
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Idrose NS, Lodge CJ, Peters RL, Douglass JA, Koplin JJ, Lowe AJ, Perrett KP, Tang MLK, Newbigin EJ, Abramson MJ, Erbas B, Vicendese D, Dharmage SC. The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children. Pediatr Allergy Immunol 2022; 33:e13862. [PMID: 36282135 PMCID: PMC9828461 DOI: 10.1111/pai.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children. METHODS We investigated 1- (n = 1108) and 6-year-old (n = 675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1 year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers. RESULTS Grass pollen at lag 0-3 (every 20 grains/m3 increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only. CONCLUSION Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.
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Affiliation(s)
- Nur Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed J Newbigin
- School of Biosciences, The University of Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
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30
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Sly PD, Tang MLK, Campbell KJ. Determinants of rapid infant weight gain: A pooled analysis of seven cohorts. Pediatr Obes 2022; 17:e12928. [PMID: 35510714 PMCID: PMC9540679 DOI: 10.1111/ijpo.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG. METHODS Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z-score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta-analysis was conducted to obtain pooled effect sizes. RESULTS Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native-born versus overseas-born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre-pregnancy BMI. CONCLUSION Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG.
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Affiliation(s)
- Miaobing Zheng
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | - Kylie D. Hesketh
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | | | - Jodie Dodd
- Discipline of Obstetrics and GynaecologyThe Robinson Research Institute, The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Li Ming Wen
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Louise A. Baur
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Rachael Taylor
- Department of MedicineUniversity of OtagoDunedinNew Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of MedicineHealth and Human Sciences, Macquarie UniversitySydneyNew South WalesAustralia
| | - Peter D. Sly
- Children's Health and Environment ProgramThe University of QueenslandBrisbaneAustralia
| | | | - Karen J. Campbell
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
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31
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Ashley SE, Jones AC, Anderson D, Holt PG, Bosco A, Tang MLK. Remission of peanut allergy is associated with rewiring of allergen-driven T helper 2-related gene networks. Allergy 2022; 77:3015-3027. [PMID: 35615783 PMCID: PMC9790273 DOI: 10.1111/all.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/27/2022] [Accepted: 03/15/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The immunological changes underpinning acquisition of remission (also called sustained unresponsiveness) following food immunotherapy remain poorly defined. Limited access to effective therapies and biosamples from treatment responders has prevented progress. Probiotic peanut oral immunotherapy is highly effective at inducing remission, providing an opportunity to investigate immune changes. METHODS Using a systems biology approach, we examined gene co-expression network patterns in peanut-specific CD4+ T cell responses before and after probiotic and peanut oral immunotherapy in subjects enrolled in the PPOIT-001 randomized trial: Responders who attained remission (n = 16), placebo-treated who remained allergic (n = 16). RESULTS Acquisition of remission was associated with rewiring of gene network patterns, which was characterized by integration of T helper 2 and interferon signalling modules, markedly reduced T helper 2 gene connectivity, and shutdown in co-expression activity between T helper 2 effectors and cell cycle regulators. CONCLUSION The immunological changes underlying remission following peanut oral immunotherapy are mediated by reprogramming of T helper 2-associated gene networks in the CD4+ T cell compartment. Findings provide insight into immune mechanisms driving the acquisition of remission following oral immunotherapy, paving the way for the development of improved approaches to induce remission/sustained unresponsiveness in patients with food allergy.
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Affiliation(s)
- Sarah E. Ashley
- Allergy ImmunologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,The Royal Children’s HospitalMelbourneVictoriaAustralia
| | - Anya C. Jones
- Telethon Kids InstitutePerthWestern AustraliaAustralia,The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Denise Anderson
- Telethon Kids InstitutePerthWestern AustraliaAustralia,The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Patrick G. Holt
- Telethon Kids InstitutePerthWestern AustraliaAustralia,The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Anthony Bosco
- Telethon Kids InstitutePerthWestern AustraliaAustralia,The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Mimi L. K. Tang
- Allergy ImmunologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,The Royal Children’s HospitalMelbourneVictoriaAustralia
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Gao Y, O’Hely M, Quinn TP, Ponsonby AL, Harrison LC, Frøkiær H, Tang MLK, Brix S, Kristiansen K, Burgner D, Saffery R, Ranganathan S, Collier F, Vuillermin P. Maternal gut microbiota during pregnancy and the composition of immune cells in infancy. Front Immunol 2022; 13:986340. [PMID: 36211431 PMCID: PMC9535361 DOI: 10.3389/fimmu.2022.986340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Preclinical studies have shown that maternal gut microbiota during pregnancy play a key role in prenatal immune development but the relevance of these findings to humans is unknown. The aim of this prebirth cohort study was to investigate the association between the maternal gut microbiota in pregnancy and the composition of the infant’s cord and peripheral blood immune cells over the first year of life. Methods The Barwon Infant Study cohort (n=1074 infants) was recruited using an unselected sampling frame. Maternal fecal samples were collected at 36 weeks of pregnancy and flow cytometry was conducted on cord/peripheral blood collected at birth, 6 and 12 months of age. Among a randomly selected sub-cohort with available samples (n=293), maternal gut microbiota was characterized by sequencing the 16S rRNA V4 region. Operational taxonomic units (OTUs) were clustered based on their abundance. Associations between maternal fecal microbiota clusters and infant granulocyte, monocyte and lymphocyte subsets were explored using compositional data analysis. Partial least squares (PLS) and regression models were used to investigate the relationships/associations between environmental, maternal and infant factors, and OTU clusters. Results We identified six clusters of co-occurring OTUs. The first two components in the PLS regression explained 39% and 33% of the covariance between the maternal prenatal OTU clusters and immune cell populations in offspring at birth. A cluster in which Dialister, Escherichia, and Ruminococcus were predominant was associated with a lower proportion of granulocytes (p=0.002), and higher proportions of both central naïve CD4+ T cells (CD4+/CD45RA+/CD31−) (p<0.001) and naïve regulatory T cells (Treg) (CD4+/CD45RA+/FoxP3low) (p=0.02) in cord blood. The association with central naïve CD4+ T cells persisted to 12 months of age. Conclusion This birth cohort study provides evidence consistent with past preclinical models that the maternal gut microbiota during pregnancy plays a role in shaping the composition of innate and adaptive elements of the infant’s immune system following birth.
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Affiliation(s)
- Yuan Gao
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
- Faculty of Science, Copenhagen University, København, Denmark
| | - Martin O’Hely
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
| | | | - Anne-Louise Ponsonby
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- The Early Brain Science Department, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Leonard C. Harrison
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Hanne Frøkiær
- Faculty of Science, Copenhagen University, København, Denmark
| | - Mimi L. K. Tang
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Dave Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Richard Saffery
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarath Ranganathan
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Collier
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
- *Correspondence: Peter Vuillermin,
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33
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McWilliam V, Venter C, Greenhawt M, Perrett KP, Tang MLK, Koplin JJ, Peters RL. A pragmatic approach to infant feeding for food allergy prevention. Pediatr Allergy Immunol 2022; 33:e13849. [PMID: 36156814 PMCID: PMC9540872 DOI: 10.1111/pai.13849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022]
Abstract
Early introduction of allergenic foods into an infant's diet is currently the most promising strategy to prevent food allergy, with infant guidelines around the world shifting from promoting avoidance to actively encourage the introduction of allergenic foods in the infant diet. Infant feeding guidelines vary according to regional public health priorities, and knowledge gaps remain, resulting in ongoing challenges for clinicians and families to translate guidelines into practical strategies for the introduction of complementary foods for food allergy prevention. Evidence from Australia demonstrates high community support and uptake of revised guidelines with most parents introducing allergenic foods in the first year of life, although this has not had the expected impact on substantially reducing food allergy prevalence. To uptake of guidelines from other countries is less clear, and several barriers have been noted in infant feeding RCTs, which may warrant intervention strategies. Further research is needed to understand additional strategies for food allergy prevention, particularly in infants who develop food allergy prior to when they are developmentally ready to commence solids. Several RCTs are underway investigating preventative strategies that target the window before allergen ingestion, such as vitamin D supplementation, emollient use, and immunizations that prime the immune response away from a Th2-driven allergic phenotype. Further research is also needed to understand the role of the environment and the host environment in the development of tolerance to foods.
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Affiliation(s)
- Vicki McWilliam
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Carina Venter
- Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Boulder, Colorado, USA
| | - Matthew Greenhawt
- Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Boulder, Colorado, USA
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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Fanning L, Woods E, Hornung CJ, Perrett KP, Tang MLK, Dalziel K. Author Reply. Value Health 2022; 25:1460-1462. [PMID: 35292193 DOI: 10.1016/j.jval.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Laura Fanning
- Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Ekaterina Woods
- Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Kirsten P Perrett
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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35
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Currell A, Koplin JJ, Lowe AJ, Perrett KP, Ponsonby AL, Tang MLK, Dharmage SC, Peters RL. Mode of Birth Is Not Associated With Food Allergy Risk in Infants. J Allergy Clin Immunol Pract 2022; 10:2135-2143.e3. [PMID: 35597762 DOI: 10.1016/j.jaip.2022.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between mode of delivery and the risk of food allergy remains unclear due to the absence of studies with both challenge-proven food allergy outcomes and detailed information on the type of caesarean delivery. OBJECTIVE We assessed whether emergency or elective caesarean, or caesarean delivery in the presence or absence of labor initiation, is associated with the risk of food allergy. METHODS The HealthNuts study recruited 5276 12-month-old infants who underwent skin prick testing and oral food challenge to ascertain food allergy status, and linked the child's study data to additional birth data from the Victorian Perinatal Data Collection. RESULTS Parents of 3006 children consented to data linkage, and birth data were obtained on 2045. In this subgroup, 30% were born by caesarean and 13% had food allergy. Caesarean delivery, compared with vaginal birth, was not associated with the risk of food allergy (adjusted odds ratio [aOR]: 0.95, 95% confidence interval [CI]: 0.70, 1.30). Neither caesarean delivery before the onset of labor, nor after the onset of labor, was associated with the risk of food allergy (aOR: 0.83, 95% CI: 0.55-1.23 and aOR: 1.13, 95% CI: 0.75-1.72, respectively). Delivery by elective or emergency caesarean, compared with vaginal delivery, was not associated with risk of food allergy (aOR: 1.05, 95% CI: 0.71-1.55 and aOR: 0.86, 95% CI: 0.56-1.31). There was no evidence of effect modification by breastfeeding, older siblings, pet dog ownership, or maternal allergy. CONCLUSION Caesarean delivery, either with or without labor, or elective or emergency, was not associated with the risk of food allergy in a population-based cohort of 12-month-old infants.
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Affiliation(s)
- Anne Currell
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer J Koplin
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Adrian J Lowe
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kirsten P Perrett
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Anne-Louise Ponsonby
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Neuroepidemiology Group, The Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Mimi L K Tang
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Shyamali C Dharmage
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Rachel L Peters
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Pham C, Bekkering S, O'Hely M, Burgner D, Thomson S, Vuillermin P, Collier F, Marx W, Mansell T, Symeonides C, Sly PD, Tang MLK, Saffery R, Ponsonby AL. Infant inflammation predicts childhood emotional and behavioral problems and partially mediates socioeconomic disadvantage. Brain Behav Immun 2022; 104:83-94. [PMID: 35618227 DOI: 10.1016/j.bbi.2022.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Emotional and behavioral problems (EBP) are common in children. Environmental factors like socioeconomic disadvantage influence EBP pathogenesis and can trigger inflammation. However, the link between early inflammation-EBP in children is unclear. We investigated the associations between i) infant inflammatory biomarkers and subsequent EBP and ii) early life environmental factors and EBP and assessed whether infant inflammation mediated these associations. METHODS Inflammatory biomarkers glycoprotein acetyls (GlycA) and high-sensitivity C-reactive protein (hsCRP) were quantified at birth and 12 months in a population-derived birth cohort, the Barwon Infant Study. Early life factors including demographic, prenatal, and perinatal factors were collected from antenatal to the two-year period. Internalizing and externalizing problems at age two were measured by the Child Behavior Checklist. Prospective associations were examined by multivariable regression analyses adjusted for potential confounders. Indirect effects of early life factors on EBP through inflammation were identified using mediation analyses. RESULTS Elevated GlycA levels at birth (GlycAbirth) were associated with greater internalizing problems at age two (β = 1.32 per SD increase in GlycA; P = 0.001). Inflammation at birth had a stronger magnitude of effect with later EBP than at 12 months. GlycAbirth partially mediated the associations between lower household income (6%), multiparity (12%) and greater number of older siblings (13%) and EBP. Patterns were less evident for hsCRP or externalizing problems. CONCLUSIONS GlycAbirth was positively associated with EBP at age two and partially mediated the association between several indicators of socioeconomic disadvantage and EBP. Prenatal and perinatal inflammation may be relevant to early neurodevelopment and emotional health.
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Affiliation(s)
- Cindy Pham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Siroon Bekkering
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, GA 6625, the Netherlands
| | - Martin O'Hely
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Sarah Thomson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; Barwon Health, Geelong, VIC 3220, Australia
| | - Fiona Collier
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; Barwon Health, Geelong, VIC 3220, Australia
| | - Wolfgang Marx
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Christos Symeonides
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia.
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Lloyd M, Dunn Galvin A, Tang MLK. Measuring the Impact of Food Immunotherapy on Health-Related Quality of Life in Clinical Trials. Front Allergy 2022; 3:941020. [PMID: 35910858 PMCID: PMC9326481 DOI: 10.3389/falgy.2022.941020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Food allergy is a common, and often lifelong, disorder with considerable negative impact on the quality of life of those affected and their families. While several promising immunotherapies for food allergy have either been approved or are in late-phase clinical trials based on demonstrated effectiveness at inducing desensitization, evidence of benefit in terms of improving patient-centered outcomes is inconsistent. Historically, health-related quality of life has not been prioritized as an endpoint in food immunotherapy trials and, even when included, findings have been undermined by methodological limitations of the measurement instruments used and issues with data interpretation. This review highlights the importance of measuring health-related quality of life as an endpoint in food immunotherapy trials and discusses the strengths and limitations of available evidence in this regard, with a focus on the appropriate use of assessment instruments and interpretation of findings. There remains much to learn regarding the impact of food immunotherapies on patient wellbeing, both during treatment and over the longer term. Our aim is to assist clinicians, researchers, policy makers and consumers in their interpretation of the existing literature, and to promote greater scientific rigor in the design and selection of outcome measurement frameworks for future studies evaluating the efficacy of immunotherapy treatments for food allergy.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Audrey Dunn Galvin
- School of Applied Psychology, Cork University Hospital, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mimi L. K. Tang
- Allergy Immunology Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- *Correspondence: Mimi L. K. Tang
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Soriano VX, Peters RL, Moreno-Betancur M, Ponsonby AL, Gell G, Odoi A, Perrett KP, Tang MLK, Gurrin LC, Allen KJ, Dharmage SC, Koplin JJ. Association Between Earlier Introduction of Peanut and Prevalence of Peanut Allergy in Infants in Australia. JAMA 2022; 328:48-56. [PMID: 35788795 PMCID: PMC9257582 DOI: 10.1001/jama.2022.9224] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Randomized clinical trials showed that earlier peanut introduction can prevent peanut allergy in select high-risk populations. This led to changes in infant feeding guidelines in 2016 to recommend early peanut introduction for all infants to reduce the risk of peanut allergy. OBJECTIVE To measure the change in population prevalence of peanut allergy in infants after the introduction of these new guidelines and evaluate the association between early peanut introduction and peanut allergy. DESIGN Two population-based cross-sectional samples of infants aged 12 months were recruited 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Infants were recruited from immunization centers around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate (eligible age range, 11-15 months), regardless of history of peanut exposure or allergy history. EXPOSURES Questionnaires collected data on demographics, food allergy risk factors, peanut introduction, and reactions. MAIN OUTCOME AND MEASURES All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time. RESULTS This study included 7209 infants (1933 in 2018-2019 and 5276 in 2007-2011). Of the participants in the older vs more recent cohort, 51.8% vs 50.8% were male; median (IQR) ages were 12.5 (12.2-13.0) months vs 12.4 (12.2-12.9) months. There was an increase in infants of East Asian ancestry over time (16.5% in 2018-2019 vs 10.5% in 2007-2011), which is a food allergy risk factor. After standardizing for infant ancestry and other demographics changes, peanut allergy prevalence was 2.6% (95% CI, 1.8%-3.4%) in 2018-2019, compared with 3.1% in 2007-2011 (difference, -0.5% [95% CI, -1.4% to 0.4%]; P = .26). Earlier age of peanut introduction was significantly associated with a lower risk of peanut allergy among infants of Australian ancestry in 2018-2019 (age 12 months compared with age 6 months or younger: adjusted odds ratio, 0.08 [05% CI, 0.02-0.36]; age 12 months compared with 7 to less than 10 months: adjusted odds ratio, 0.09 [95% CI, 0.02-0.53]), but not significant among infants of East Asian ancestry (P for interaction = .002). CONCLUSIONS AND RELEVANCE In cross-sectional analyses, introduction of a guideline recommending early peanut introduction in Australia was not associated with a statistically significant lower or higher prevalence of peanut allergy across the population.
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Affiliation(s)
- Victoria X. Soriano
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Rachel L. Peters
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Margarita Moreno-Betancur
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Anne-Louise Ponsonby
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Grace Gell
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Alexsandria Odoi
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Kirsten P. Perrett
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Mimi L. K. Tang
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Lyle C. Gurrin
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | | | - Shyamali C. Dharmage
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J. Koplin
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Food and Allergy Research (CFAR), Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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Ponsonby AL, Collier F, O'Hely M, Tang MLK, Ranganathan S, Gray L, Morwitch E, Saffery R, Burgner D, Dwyer T, Sly PD, Harrison LC, Vuillermin P. Household size, T regulatory cell development, and early allergic disease: a birth cohort study. Pediatr Allergy Immunol 2022; 33:e13810. [PMID: 35754137 PMCID: PMC9545943 DOI: 10.1111/pai.13810] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children born to larger households have less allergic disease. T regulatory cell (Treg) development may be a relevant mechanism, but this has not been studied longitudinally. OBJECTIVE We aim to (i) describe how prenatal and postnatal environmental factors are associated with Treg development and (ii) investigate whether serial Treg measures predict allergic outcomes at 1 year of age. METHODS A birth cohort (n = 1074) with information on prenatal and postnatal early life factors. Both naïve Treg (nTreg) and activated Treg (aTreg) cell populations (as a proportion of CD4+ T cells) were available in 463 infants at birth (cord blood), 600 at 6 months, and 675 at 12 months. 191 infants had serial measures. Measures of allergic status at 12 months were polysensitization (sensitization to 2 or more allergens), clinically proven food allergy, atopic eczema, and atopic wheeze. RESULTS Infants born to larger households (3 or more residents) had higher longitudinal nTreg proportions over the first postnatal year with a mean difference (MD) of 0.67 (95% CI 0.30-1.04)%. Higher nTreg proportions at birth were associated with a reduced risk of infant allergic outcomes. Childcare attendance and breastfeeding were associated with higher longitudinal nTreg proportions (MD 0.48 (95% CI 0.08-0.80)%. CONCLUSION Multiple prenatal and postnatal microbial factors are associated with nTreg and aTreg development. Larger household size was associated with higher nTreg at birth which in turn was associated with reduced allergic sensitization and disease at 12 months of age.
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Affiliation(s)
- Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona Collier
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Martin O'Hely
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Lawrence Gray
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Barwon Health, Geelong, Victoria, Australia
| | - Ellen Morwitch
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,National Centre of Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.,The George Institute for Global Health, Oxford University, Oxford, UK
| | - Peter D Sly
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.,University of Queensland, South Brisbane, Queensland, Australia
| | | | - Peter Vuillermin
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia.,Barwon Health, Geelong, Victoria, Australia
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Loke P, Hsiao KC, Lozinsky AC, Ashley SE, Lloyd M, Pitkin S, Axelrad CJ, Jayawardana KS, Tey D, Su EL, Robinson M, Leung ASY, Dunn Galvin A, Tang MLK. Probiotic peanut oral immunotherapy is associated with long-term persistence of 8-week sustained unresponsiveness and long-lasting quality-of-life improvement. Clin Exp Allergy 2022; 52:806-811. [PMID: 35485166 DOI: 10.1111/cea.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
Affiliation(s)
- Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kuang-Chih Hsiao
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Immunology, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | | | - Sarah E Ashley
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sigrid Pitkin
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christine Jean Axelrad
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kaushala S Jayawardana
- Centre for Biostatistics and Epidemiology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dean Tey
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ee Lyn Su
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Marnie Robinson
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Agnes S Y Leung
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Audrey Dunn Galvin
- School of Applied Psychology, University College Cork, Cork City, Ireland
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
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O'Connor M, Moreno-Betancur M, Goldfeld S, Wake M, Patton G, Dwyer T, Tang MLK, Saffery R, Craig JM, Loke J, Burgner D, Olsson CA. Data Resource Profile: Melbourne Children's LifeCourse initiative (LifeCourse). Int J Epidemiol 2022; 51:e229-e244. [PMID: 35536352 PMCID: PMC9557929 DOI: 10.1093/ije/dyac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/07/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Meredith O'Connor
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Margarita Moreno-Betancur
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sharon Goldfeld
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Liggins Institute, University of Auckland, Grafton, Auckland, New Zealand
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Terence Dwyer
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Jeffrey M Craig
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Jane Loke
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - David Burgner
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Inflammatory Origins Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, Monash University, Melbourne, Australia
| | - Craig A Olsson
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Australia
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Mansell T, Saffery R, Burugupalli S, Ponsonby AL, Tang MLK, O'Hely M, Bekkering S, Smith AAT, Rowland R, Ranganathan S, Sly PD, Vuillermin P, Collier F, Meikle P, Burgner D. Early life infection and proinflammatory, atherogenic metabolomic and lipidomic profiles in infancy: a population-based cohort study. eLife 2022; 11:75170. [PMID: 35535496 PMCID: PMC9090335 DOI: 10.7554/elife.75170] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/24/2022] [Indexed: 01/03/2023] Open
Abstract
Background: The risk of adult onset cardiovascular and metabolic (cardiometabolic) disease accrues from early life. Infection is ubiquitous in infancy and induces inflammation, a key cardiometabolic risk factor, but the relationship between infection, inflammation, and metabolic profiles in early childhood remains unexplored. We investigated relationships between infection and plasma metabolomic and lipidomic profiles at age 6 and 12 months, and mediation of these associations by inflammation. Methods: Matched infection, metabolomics, and lipidomics data were generated from 555 infants in a pre-birth longitudinal cohort. Infection data from birth to 12 months were parent-reported (total infections at age 1, 3, 6, 9, and 12 months), inflammation markers (high-sensitivity C-reactive protein [hsCRP]; glycoprotein acetyls [GlycA]) were quantified at 12 months. Metabolic profiles were 12-month plasma nuclear magnetic resonance metabolomics (228 metabolites) and liquid chromatography/mass spectrometry lipidomics (776 lipids). Associations were evaluated with multivariable linear regression models. In secondary analyses, corresponding inflammation and metabolic data from birth (serum) and 6-month (plasma) time points were used. Results: At 12 months, more frequent infant infections were associated with adverse metabolomic (elevated inflammation markers, triglycerides and phenylalanine, and lower high-density lipoprotein [HDL] cholesterol and apolipoprotein A1) and lipidomic profiles (elevated phosphatidylethanolamines and lower trihexosylceramides, dehydrocholesteryl esters, and plasmalogens). Similar, more marked, profiles were observed with higher GlycA, but not hsCRP. GlycA mediated a substantial proportion of the relationship between infection and metabolome/lipidome, with hsCRP generally mediating a lower proportion. Analogous relationships were observed between infection and 6-month inflammation, HDL cholesterol, and apolipoprotein A1. Conclusions: Infants with a greater infection burden in the first year of life had proinflammatory and proatherogenic plasma metabolomic/lipidomic profiles at 12 months of age that in adults are indicative of heightened risk of cardiovascular disease, obesity, and type 2 diabetes. These findings suggest potentially modifiable pathways linking early life infection and inflammation with subsequent cardiometabolic risk. Funding: The establishment work and infrastructure for the BIS was provided by the Murdoch Children’s Research Institute (MCRI), Deakin University, and Barwon Health. Subsequent funding was secured from National Health and Medical Research Council of Australia (NHMRC), The Shepherd Foundation, The Jack Brockhoff Foundation, the Scobie & Claire McKinnon Trust, the Shane O’Brien Memorial Asthma Foundation, the Our Women’s Our Children’s Fund Raising Committee Barwon Health, the Rotary Club of Geelong, the Minderoo Foundation, the Ilhan Food Allergy Foundation, GMHBA, Vanguard Investments Australia Ltd, and the Percy Baxter Charitable Trust, Perpetual Trustees. In-kind support was provided by the Cotton On Foundation and CreativeForce. The study sponsors were not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication. Research at MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program. This work was also supported by NHMRC Senior Research Fellowships to ALP (1008396); DB (1064629); and RS (1045161) , NHMRC Investigator Grants to ALP (1110200) and DB (1175744), NHMRC-A*STAR project grant (1149047). TM is supported by an MCRI ECR Fellowship. SB is supported by the Dutch Research Council (452173113).
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Affiliation(s)
- Toby Mansell
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Satvika Burugupalli
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Royal Children's Hospital, Parkville, Australia
| | - Martin O'Hely
- Murdoch Children's Research Institute, Parkville, Australia.,Deakin University, Geelong, Australia
| | - Siroon Bekkering
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | | | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Royal Children's Hospital, Parkville, Australia
| | - Peter D Sly
- Murdoch Children's Research Institute, Parkville, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Peter Vuillermin
- Murdoch Children's Research Institute, Parkville, Australia.,Deakin University, Geelong, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia
| | - Fiona Collier
- Deakin University, Geelong, Australia.,Child Health Research Unit, Barwon Health, Geelong, Australia
| | - Peter Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David Burgner
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
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Peters RL, Guarnieri I, Tang MLK, Lowe AJ, Dharmage SC, Perrett KP, Gurrin LC, Koplin JJ. The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study. J Allergy Clin Immunol 2022; 150:657-665.e13. [PMID: 35597613 DOI: 10.1016/j.jaci.2022.04.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prospectively collected data on the natural history of food allergy are lacking. OBJECTIVE We examined the natural history of egg and peanut allergy in children from age 1 to 6 years and assessed whether a skin prick test (SPT) result or other clinical factors at diagnosis are associated with the persistence or resolution of food allergy in early childhood. METHODS The HealthNuts cohort consists of 5276 children who were recruited at age 1 year and have been followed prospectively. Children with food allergy at age 1 year (peanut [n = 156] or raw egg [n = 471] allergy ) and children who developed new sensitizations or food reactions after age 1 year were assessed for food sensitization and allergy (confirmed by oral food challenge when indicated) at the 6-year follow-up. RESULTS New-onset food allergy developed by age 6 years was more common for peanut (0.7% [95% CI = 0.5%-1.1%]) than egg (0.09% [95% CI = 0.03%-0.3%]). Egg allergy resolved more commonly (89% [95% CI = 85%-92%]) than peanut allergy (29% [95% CI = 22%-38%]) by age 6 years. The overall weighted prevalence of peanut allergy at age 6 years was 3.1% (95% CI = 2.6-3.7%) and that of egg allergy was 1.2% (95% = CI 0.9%-1.6%). The factors at age 1 year associated with persistence of peanut allergy were peanut SPT result of 8 mm or larger (odds ratio [OR] = 2.35 [95% CI 1.08-5.12]), sensitization to tree nuts (adjusted OR [aOR] = 2.51 [95% CI = 1.00-6.35]), and early-onset severe eczema (aOR = 3.23, [95% CI 1.17-8.88]). Factors at age 1 associated with persistence of egg allergy at age 6 were egg SPT result of 4 mm or larger (OR = 2.98 [95% CI 1.35-6.36]), other (peanut and/or sesame) food sensitizations (aOR = 2.80 [95% CI = 1.11-7.03]), baked egg allergy (aOR = 7.41 [95% CI = 2.16-25.3]), and early-onset severe eczema (aOR = 3.77 [95% CI = 1.35-10.52]). CONCLUSION Most egg allergy and nearly one-third of peanut allergy resolves naturally by age 6 years. The prevalence of peanut allergy at age 6 years was similar to that observed at age 1 year, largely owing to new-onset food peanut allergy after age 1 year. Infants with early-onset eczema, larger SPT wheals, or multiple food sensitizations and/or allergies were less likely to acquire tolerance to either peanut or egg.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
| | - Imma Guarnieri
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Lyle C Gurrin
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
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Pham C, Vryer R, O’Hely M, Mansell T, Burgner D, Collier F, Symeonides C, Tang MLK, Vuillermin P, Gray L, Saffery R, Ponsonby AL. Shortened Infant Telomere Length Is Associated with Attention Deficit/Hyperactivity Disorder Symptoms in Children at Age Two Years: A Birth Cohort Study. Int J Mol Sci 2022; 23:ijms23094601. [PMID: 35562991 PMCID: PMC9104809 DOI: 10.3390/ijms23094601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Environmental factors can accelerate telomere length (TL) attrition. Shortened TL is linked to attention deficit/hyperactivity disorder (ADHD) symptoms in school-aged children. The onset of ADHD occurs as early as preschool-age, but the TL-ADHD association in younger children is unknown. We investigated associations between infant TL and ADHD symptoms in children and assessed environmental factors as potential confounders and/or mediators of this association. Relative TL was measured by quantitative polymerase chain reaction in cord and 12-month blood in the birth cohort study, the Barwon Infant Study. Early life environmental factors collected antenatally to two years were used to measure confounding. ADHD symptoms at age two years were evaluated by the Child Behavior Checklist Attention Problems (AP) and the Attention Deficit/Hyperactivity Problems (ADHP). Associations between early life environmental factors on TL or ADHD symptoms were assessed using multivariable regression models adjusted for relevant factors. Telomere length at 12 months (TL12), but not at birth, was inversely associated with AP (β = −0.56; 95% CI (−1.13, 0.006); p = 0.05) and ADHP (β = −0.66; 95% CI (−1.11, −0.21); p = 0.004). Infant secondhand smoke exposure at one month was independently associated with shorter TL12 and also higher ADHD symptoms. Further work is needed to elucidate the mechanisms that influence TL attrition and early neurodevelopment.
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Affiliation(s)
- Cindy Pham
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
| | - Regan Vryer
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Martin O’Hely
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Toby Mansell
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - David Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Fiona Collier
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Christos Symeonides
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Mimi L. K. Tang
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter Vuillermin
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Lawrence Gray
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Richard Saffery
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Correspondence:
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Hsiao KC, Ponsonby AL, Ashley S, Lee CYY, Jindal L, Tang MLK. Longitudinal antibody responses to peanut following probiotic and peanut oral immunotherapy (PPOIT) in children with peanut allergy. Clin Exp Allergy 2022; 52:735-746. [PMID: 35403286 DOI: 10.1111/cea.14146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Probiotic and Peanut Oral Immunotherapy (PPOIT) is effective at inducing sustained unresponsiveness (SU) at end-of-treatment and this effect persists up to four years post-treatment, referred to as persistent SU. We sought to evaluate (i) how PPOIT altered peanut-specific humoral immune indices, and (ii) how such longitudinal indices relate to persistent SU. METHODS Longitudinal serum/plasma levels of whole peanut- and peanut component- (Ara-h1, -h2, -h3, -h8, -h9) specific-IgE (sIgE) and specific-IgG4 (sIgG4) antibodies were measured by ImmunoCAP and salivary peanut-specific-IgA (sIgA) by ELISA in children (n=62) enrolled in the PPOIT-001 randomised trial from baseline (T0) to 4-years post-treatment (T5). Multivariate regression analyses of log-transformed values were used for point-in-time between group comparisons. Generalised estimating equations (GEE) were used for longitudinal comparisons between groups. RESULTS PPOIT was associated with changes in sIgE and sIgG4 over time. sIgE levels were significantly reduced post-treatment [T5, PPOIT v.s. Placebo ratio of geometric mean (GM): Ara-h1 0.07, p=0.008; Ara-h2 0.08, p=0.007; Ara-h3 0.15, p=0.021]. sIgG4 levels were significantly increased by end-of-treatment (T1, PPOIT v.s. Placebo ratio of GM: Ara-h1 3.77, p=0.011; Ara-h2 17.97, p<0.001; Ara-h3 10.42, p<0.001) but levels in PPOIT group decreased once treatment was stopped and returned to levels comparable with Placebo group by T5. Similarly, salivary peanut sIgA increased during treatment, as early as 4 months of treatment (PPOIT v.s. Placebo, ratio of GM: 2.04, p=0.014), then reduced post-treatment. CONCLUSION PPOIT was associated with broad reduction in peanut specific humoral responses which may mediate the clinical effects of SU that persists to 4-years post-treatment.
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Affiliation(s)
- Kuang-Chih Hsiao
- Department of Immunology, Starship Children's Hospital, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Allergy Immunology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Ashley
- Allergy Immunology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | | | | | - Mimi L K Tang
- Allergy Immunology Research, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
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46
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Collier F, Chau C, Mansell T, Faye-Chauhan K, Vuillermin P, Ponsonby AL, Saffery R, Tang MLK, O'Hely M, Carlin J, Gray LEK, Bekkering S, Burgner D. Innate Immune Activation and Circulating Inflammatory Markers in Preschool Children. Front Immunol 2022; 12:830049. [PMID: 35211111 PMCID: PMC8860896 DOI: 10.3389/fimmu.2021.830049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
Early childhood is characterised by repeated infectious exposures that result in inflammatory responses by the innate immune system. In addition, this inflammatory response to infection is thought to contribute to the epidemiological evidence linking childhood infection and adult non-communicable diseases. Consequently, the relationship between innate immune responses and inflammation during early life may inform prevention of NCDs later in life. In adults, non-genetic host factors such as age, sex, and obesity, strongly impact cytokine production and circulating mediators, but data in children are lacking. Here, we assessed cytokine responses and inflammatory markers in a population of healthy preschool children (mean age 4.2 years). We studied associations between cytokines, plasma inflammatory markers and non-genetic host factors, such as sex, age, adiposity, season, and immune cell composition. Similar to adults, boys had a higher inflammatory response than girls, with IL-12p70 and IL-10 upregulated following TLR stimulation. Adiposity and winter season were associated with increased circulating inflammatory markers but not cytokine production. The inflammatory markers GlycA and hsCRP were positively associated with production of a number of cytokines and may therefore reflect innate immune function and inflammatory potential. This dataset will be informative for future prospective studies relating immune parameters to preclinical childhood NCD phenotypes.
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Affiliation(s)
- Fiona Collier
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
| | - Cerys Chau
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | | | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Anne-Louise Ponsonby
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Neuroepidemiology, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Neuroepidemiology, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
| | - Martin O'Hely
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - John Carlin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
| | | | - Siroon Bekkering
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Internal Medicine and Radboud Institute for Molecular Life Science (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
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Idrose NS, Vicendese D, Peters RL, Koplin JJ, Douglass JA, Walters EH, Perret JL, Lowe AJ, Tang MLK, Newbigin EJ, Erbas B, Lodge CJ, Dharmage SC. Children With Food Allergy Are at Risk of Lower Lung Function on High-Pollen Days. J Allergy Clin Immunol Pract 2022; 10:2144-2153.e10. [PMID: 35398553 DOI: 10.1016/j.jaip.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Grass pollen exposure is a risk factor for childhood asthma hospital attendances. However, its short-term influence on lung function, especially among those with other allergic conditions, has been less well-studied. OBJECTIVE To investigate this association in a population-based sample of children. METHODS Within the HealthNuts cohort, 641 children performed spirometry during the grass pollen season. Grass pollen concentration was considered on the day of testing (lag 0), up to 3 days before (lag 1-lag 3), and cumulatively (lag 0-3). We used linear regression to assess the relevant associations and examined potential interactions with current asthma, hay fever or eczema, and food allergy. RESULTS Associations were observed only in children with allergic disease (P value for interaction ≤ 0.1). In children with food allergy, grass pollen concentration was associated with a lower ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) and lower mid-forced expiratory flows (FEF25%-75%) at all lags (eg, at lag 2, FEV1/FVC z-score = -0.50 [95% CI -0.80 to -0.20] and FEF25%--75% z-score = -0.40 [-0.60 to -0.04] per 20 grains/m3 pollen increase), and increased bronchodilator responsiveness (BDR) at lag 2 and lag 3 (eg, at lag 2, BDR = (31 [95% CI -0.005 to 62] mL). In children with current asthma, increasing grass pollen concentration was associated with lower FEF25%-75% and increased BDR, whereas children with current hay fever or eczema had increased BDR only. CONCLUSIONS A proactive approach needs to be enforced to manage susceptible children, especially those with food allergy, before high-grass pollen days.
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Affiliation(s)
- N Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia; Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia; Department of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed J Newbigin
- School of BioSciences, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.
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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. Int J Environ Health Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chang CL, Ali GB, Lodge CJ, Abramson MJ, Erbas B, Tang MLK, Svanes C, Bui DS, Dharmage SC, Lowe AJ. Associations between Body Mass Index Trajectories in the first two years of life and Allergic Rhinitis, Eczema and Food Allergy outcomes up to early adulthood. Pediatr Allergy Immunol 2022; 33:e13765. [PMID: 35338730 DOI: 10.1111/pai.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early life body mass index (BMI) trajectories influence the risk of asthma at 18 years of age. However, it is unclear if these are also associated with other allergic diseases. OBJECTIVES We investigated the associations between BMI trajectories and subsequent allergic rhinitis, eczema and food sensitisation/allergies. METHODS Parent-reported anthropometric data were collected 18 times in the first two years of life from a cohort of 620 participants in a high-risk cohort. Group-based trajectory modelling was applied to develop BMI trajectories. Associations between trajectories and allergic rhinitis, eczema and food sensitisation at 6, 12 and 18 years of age were assessed using logistic regression models. Potential effect modifications by parental allergic disease, sex and allocated infant formula were assessed. RESULTS We identified five BMI trajectories: average, below average, persistently low, early low and catch up, and persistently high. None showed an association with allergic rhinitis. In participants with maternal allergic rhinitis, 'early-low and catch-up' (OR = 2.83;95%CI 1.34-5.96, Pint = 0.05) and 'below average' trajectories (OR = 2.39; 1.18-7.23, Pint = 0.02) were associated with allergic rhinitis at 18 years of age compared with the average trajectory. No associations were observed with eczema or food sensitisation. CONCLUSION Infants with early-low and catch-up, or below average BMI growth, were at increased risk of allergic rhinitis at 18 years if they had a mother with allergic rhinitis. These results require replication, but suggest that interactions between poor intrauterine growth, failure to thrive and maternal allergies may influence the risk of allergic rhinitis.
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Affiliation(s)
- Chia-Lun Chang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gulshan Bano Ali
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Allergy Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dinh Son Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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Loke P, Orsini F, Lozinsky AC, Gold M, O'Sullivan MD, Quinn P, Lloyd M, Ashley SE, Pitkin S, Axelrad C, Metcalfe JR, Su EL, Tey D, Robinson MN, Allen KJ, Prescott SL, Galvin AD, Tang MLK. Probiotic peanut oral immunotherapy versus oral immunotherapy and placebo in children with peanut allergy in Australia (PPOIT-003): a multicentre, randomised, phase 2b trial. Lancet Child Adolesc Health 2022; 6:171-184. [PMID: 35123664 DOI: 10.1016/s2352-4642(22)00006-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Oral immunotherapy is effective at inducing desensitisation to allergens and induces sustained unresponsiveness (ie, clinical remission) in a subset of patients, but causes frequent reactions. We aimed to investigate whether addition of a probiotic adjuvant improved the efficacy or safety of peanut oral immunotherapy. METHODS PPOIT-003, a multicentre, randomised, phase 2b trial, was conducted in three tertiary hospitals in Australia (Adelaide [SA], Melbourne [VIC], and Perth [WA]) in children aged 1-10 years, weighing more than 7 kg, with peanut allergy confirmed by a double-blind placebo-controlled food challenge (cumulative 4950 mg dose of peanut protein) and positive peanut skin prick test (≥3 mm) or peanut-specific IgE (≥0·35 kU/L). Children were randomly assigned (2:2:1) to receive probiotic and peanut oral immunotherapy (PPOIT), placebo probiotic and peanut oral immunotherapy (OIT), or placebo probiotic and placebo OIT (placebo) for 18 months, and were followed up until 12 months after completion of treatment. Oral immunotherapy consisted of increasing doses of peanut protein (commercially available food-grade 12% defatted peanut flour [50% peanut protein]) until a 2000 mg daily maintenance dose was reached. The probiotic adjuvant was a daily dose of 2 × 1010 colony-forming units of the probiotic Lactobacillus rhamnosus ATCC 53103. Placebo immunotherapy comprised maltodextrin, brown food colouring, and peanut essence, and placebo probiotic was maltodextrin. Dual primary outcomes were 8-week sustained unresponsiveness, defined as no reaction to a cumulative dose of 4950 mg peanut protein at treatment completion and 8 weeks after treatment completion, in the PPOIT versus placebo groups and the PPOIT versus OIT groups, analysed by intention to treat. Safety endpoints were adverse events during the treatment phase, and peanut ingestion and reactions in the 12-month post-treatment period. This study is registered with the Australian New Zealand Clinical Trials Registry, 12616000322437. FINDINGS Between July 4, 2016, and Sept 21, 2020, 201 participants were enrolled and included in the intention-to-treat analysis. 36 (46%) of 79 children in the PPOIT group and 42 (51%) of 83 children in the OIT group achieved sustained unresponsiveness compared with two (5%) of 39 children in the placebo group (risk difference 40·44% [95% CI 27·46 to 53·42] for PPOIT vs placebo, p<0·0001), with no difference between PPOIT and OIT (-5·03% [-20·40 to 10·34], p=0·52). Treatment-related adverse events were reported in 72 (91%) of 79 children in the PPOIT group, 73 (88%) of 83 children in the OIT group, and 28 (72%) of 39 children in the placebo group. Exposure-adjusted incidence of adverse events was 10·58 in the PPOIT group, 11·36 in the OIT, and 2·09 in the placebo group (ratio 0·92 [95% CI 0·85 to 0·99] for PPOIT vs OIT, p=0·042; 4·98 [4·11-6·03] for PPOIT vs placebo, p<0·0001; 5·42 [4·48-6·56] for OIT vs placebo, p<0·0001), with differences seen primarily in gastrointestinal symptoms and in children aged 1-5 years. During the 12-month post-treatment period, 60 (85%) of 71 participants in the PPOIT group, 60 (86%) of 70 participants in the OIT group, and six (18%) of 34 participants in the placebo group were eating peanut; rescue epinephrine use was infrequent (two [3%] of 71 in the PPOIT group, four [6%] of 70 in the OIT group, and none in the placebo group). INTERPRETATION Both PPOIT and OIT were effective at inducing sustained unresponsiveness. Addition of a probiotic did not improve efficacy of OIT, but might offer a safety benefit compared with OIT alone, particularly in preschool children. FUNDING National Health and Medical Research Council Australia and Prota Therapeutics.
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Affiliation(s)
- Paxton Loke
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia; Monash Children's Hospital, Clayton, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Francesca Orsini
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Adriana C Lozinsky
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Michael Gold
- Department of Paediatrics, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Women's and Children's Hospital Adelaide, North Adelaide, SA, Australia
| | - Michael D O'Sullivan
- Immunology Department, Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, WA, Australia; Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Patrick Quinn
- Department of Paediatrics, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Women's and Children's Hospital Adelaide, North Adelaide, SA, Australia
| | - Melanie Lloyd
- Murdoch Children's Research Institute, Parkville, VIC, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Sarah E Ashley
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Sigrid Pitkin
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Monash Children's Hospital, Clayton, VIC, Australia
| | | | - Jessica R Metcalfe
- Immunology Department, Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, WA, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Ee Lyn Su
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Dean Tey
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Marnie N Robinson
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Susan L Prescott
- Immunology Department, Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, WA, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia; NOVA Institute for Health, Baltimore, MD, USA; Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Audrey Dunn Galvin
- School of Applied Psychology, Cork University Hospital, University College Cork, Cork, Ireland; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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