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Marshall HF, Leung DYM, Lack G, Sindher S, Ciaccio CE, Chan S, Nadeau KC, Brough HA. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:423-425. [PMID: 38142858 DOI: 10.1016/j.anai.2023.12.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Gideon Lack
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine and Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, Illinois
| | - Susan Chan
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Kari C Nadeau
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Helen A Brough
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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2
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Marques-Mejias A, Bartha I, Ciaccio CE, Chinthrajah RS, Chan S, Hershey GKK, Hui-Beckman JW, Kost L, Lack G, Layhadi JA, Leung DYM, Marshall HF, Nadeau KC, Radulovic S, Rajcoomar R, Shamji MH, Sindher S, Brough HA. Skin as the target for allergy prevention and treatment. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00001-2. [PMID: 38253125 DOI: 10.1016/j.anai.2023.12.030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
The fact that genetic and environmental factors could trigger disruption of the epithelial barrier and subsequently initiate a TH2 inflammatory cascade conversely proposes that protecting the same barrier and promoting adequate interactions with other organs, such as the gut, may be crucial for lowering the risk and preventing atopic diseases, particularly, food allergies. In this review, we provide an overview of structural characteristics that support the epithelial barrier hypothesis in patients with atopic dermatitis, including the most relevant filaggrin gene mutations, the recent discovery of the role of the transient receptor potential vanilloid 1, and the role involvement of the microbiome in healthy and damaged skin. We present experimental and human studies that support the mechanisms of allergen penetration, particularly the dual allergen exposure and the outside-in, inside-out, and outside-inside-outside hypotheses. We discuss classic skin-targeted therapies for food allergy prevention, including moisturizers, steroids, and topical calcineurin inhibitors, along with pioneering trials proposed to change their current use (Prevention of Allergy via Cutaneous Intervention and Stopping Eczema and ALlergy). We provide an overview of the novel therapies that enhance the skin barrier, such as probiotics and prebiotics topical application, read-through drugs, direct and indirect FLG replacement, and interleukin and janus kinases inhibitors. Last, we discuss the newer strategies for preventing and treating food allergies in the form of epicutaneous immunotherapy and the experimental use of single-dose of adeno-associated virus vector gene immunotherapy.
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Affiliation(s)
- Andreina Marques-Mejias
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Irene Bartha
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Christina E Ciaccio
- Department of Pediatrics, The University of Chicago, Chicago, Illinois; Department of Medicine, The University of Chicago, Chicago, Illinois
| | - R Sharon Chinthrajah
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Susan Chan
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laurie Kost
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Gideon Lack
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Janice A Layhadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Kari C Nadeau
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Suzana Radulovic
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Reena Rajcoomar
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Helen A Brough
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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3
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Burke Harris N, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 DOI: 10.1080/10253890.2024.2327333] [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: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma Recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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4
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Brough HA, Sindher S, Nadeau KC. Editorial comments on "Early initiation of short-term emollient use for the prevention of atopic dermatitis in high-risk infants-The STOP-AD randomized controlled trial"-Is emollient therapy enough? Allergy 2023; 78:908-911. [PMID: 36573442 DOI: 10.1111/all.15626] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford University, Stanford, California, USA
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5
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Parsons ES, Liu F, Kaushik A, Lee A, Schuetz J, Dunham D, Seastedt H, Ogulur I, Heider A, Tan G, Shah A, Cao S, Smith E, Kost L, Acharya S, Prunicki M, Rothenberg M, Sindher S, Leib R, Akdis CA, Nadeau K, Lejeune S. Detection of gut and mucosal peptides through TOMAHAQ in healthy individuals. Allergy 2023. [PMID: 36872560 DOI: 10.1111/all.15698] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Affiliation(s)
- E S Parsons
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - F Liu
- Mass Spectrometry Center, Stanford University, Palo Alto, California, USA
| | - A Kaushik
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - A Lee
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - J Schuetz
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - D Dunham
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - H Seastedt
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - I Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - A Heider
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - G Tan
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - A Shah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - S Cao
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - E Smith
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - L Kost
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - S Acharya
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - M Prunicki
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - M Rothenberg
- Department of Pediatrics, Department of Allergy and Immunology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - S Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - R Leib
- Mass Spectrometry Center, Stanford University, Palo Alto, California, USA
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - K Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Environmental Health Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - S Lejeune
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, California, USA.,INSERM U1019, CNRS UMR 9017, Center for infection and immunity of Lille (CIIL), Univ. Lille, CHU Lille, Institut Pasteur de Lille, Lille, France
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Jia X, Chin A, Khavari N, Haija M, McGhee S, Chinthrajah S, Sindher S. Management of Eosinophilic Esophagitis in Pediatric Patients Undergoing Food Allergen Oral Immunotherapy. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.280] [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] [Indexed: 02/05/2023]
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Fernandes A, Gupta S, Cao S, Parsons E, Maysel-Auslender S, Dunham D, Lyu SC, Rogers J, Martinez K, Sindher S, Manohar M, Maecker H, Nadeau K. Cashew and Shrimp Oral Immunotherapy-Induced Changes in Allergen-Reactive CD4+ T Cells. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.735] [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] [Indexed: 02/05/2023]
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8
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Seetasith A, Sindher S, Boudreau D, Liu Y, Gupta S, Ciaccio C. Asthma-Related Healthcare Resource Use And Costs In Patients With Documented Food Allergies. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.581] [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] [Indexed: 02/05/2023]
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9
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Eun Lee AS, Suprun M, Getts R, Peck S, Sindher S, Nadeau K, Chinthrajah RS, Galli S, Sampson H. Baseline Epitope-Specific IgE Profiles are Predictive of Sustained Unresponsiveness One Year Post OIT in the POISED Trial. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.381] [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] [Indexed: 02/05/2023]
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10
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Ciaccio C, Lieberman J, Sindher S, Baran K, Creasy B, Ladonnikov R, Gupta S, Nowak-Wegrzyn A. DIAGNOSIS AND MANAGEMENT OF FOOD ALLERGIC PATIENTS ACROSS SEVERITY AND ALLERGENS: A NATIONWIDE US SURVEY. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.671] [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] [Indexed: 11/11/2022]
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11
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Warren C, Sherr J, Sindher S, Nadeau KC, Casale TB, Ward D, Gupta R, Chinthrajah RS. The impact of COVID-19 on a national sample of US adults with food allergy. J Allergy Clin Immunol Pract 2022; 10:2744-2747. [PMID: 35970447 PMCID: PMC9374594 DOI: 10.1016/j.jaip.2022.07.036] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher Warren
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Janell Sherr
- Division of Allergy and Immunology, Stanford University School of Medicine, Stanford, Calif
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Division of Allergy and Immunology, Stanford University School of Medicine, Stanford, Calif
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Division of Allergy and Immunology, Stanford University School of Medicine, Stanford, Calif
| | | | - Dana Ward
- Food Allergy Research and Education, McLean, Va
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Division of Allergy and Immunology, Stanford University School of Medicine, Stanford, Calif
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12
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Sessions J, Purington N, Wang Y, McGhee S, Sindher S, Goyal A, Khavari N. Pediatric eosinophilic esophagitis outcomes vary with co-morbid eczema and pollen food syndrome. Front Allergy 2022; 3:981961. [PMID: 36118171 PMCID: PMC9478188 DOI: 10.3389/falgy.2022.981961] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease characterized by eosinophil inflammation of the esophagus. It has been described as a component of the Allergic March and is often seen with other atopic diseases. Some atopic diseases, including asthma, are known to be heterogenous with endotypes that guide treatment. Similarly, we propose that EoE is a heterogenous disease with varying phenotypes and endotypes that might impact response to therapy. Methods A single-center retrospective review of pediatric patients ≤18 years of age diagnosed with EoE was conducted. All gastrointestinal clinic visits and esophagogastroduodenoscopies (EGD) from disease presentation through the first three years after diagnosis were reviewed. Histologic remission rate and therapies utilized [proton pump inhibitor (PPI), topical steroid, dietary elimination] were assessed. Results One hundred and thirty-seven patients were included, 80% of whom had at least one concurrent atopic condition at diagnosis, with food allergies being the most common (57%) followed by eczema (34%), and asthma (29%). The remission rate of the overall cohort was 65%, and by concurrent allergy, comorbid pollen food syndrome and eczema had the highest remission rates at 100% and 81%, respectively followed by asthma (62%), food allergies (62%), seasonal allergic rhinitis (60%), and history of anaphylaxis (56%). Kaplan-Meier curves for each atopic condition show that patients with eczema and pollen food syndrome achieve histologic remission faster than those without. All treatment modalities were more successful in patients with eczema than those without, and PPI was most effective treatment at inducing remission. Conclusions In a real-world pediatric cohort, 80% of patients with EoE had an underlying atopic condition. Patients with eczema and pollen food syndrome had a swifter response and were more likely to achieve histologic remission than patients with other atopic conditions. This study suggests that EoE, like other allergic diseases, may have heterogenous phenotypes that could affect response to treatment. There is currently a knowledge gap in classifying EoE based on endotypes and phenotypes at diagnosis and correlating responses to various treatment modalities.
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Affiliation(s)
- Julia Sessions
- Stanford School of Medicine, Stanford Medicine, Stanford, CA, United States
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
- Correspondence: Julia Sessions,
| | - Natasha Purington
- Stanford Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Yiwen Wang
- Stanford Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Sean McGhee
- Division of Allergy, Immunology, & Rheumatology, Stanford Medicine, Stanford, CA, United States
| | - Sayantani Sindher
- Division of Allergy, Immunology, & Rheumatology, Stanford Medicine, Stanford, CA, United States
| | - Alka Goyal
- Pediatric Gastroenterology, Hepatology, & Nutrition, Stanford Medicine, Stanford, CA, United States
| | - Nasim Khavari
- Pediatric Gastroenterology, Hepatology, & Nutrition, Stanford Medicine, Stanford, CA, United States
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13
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O'Rourke E, Tang H, Chin A, Long A, Sindher S, Chinthrajah RS. Current insights: a systemic review of therapeutic options for peanut allergy. Curr Opin Allergy Clin Immunol 2022; 22:188-193. [PMID: 35660711 PMCID: PMC9178908 DOI: 10.1097/aci.0000000000000824] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW With increasing prevalence of peanut allergy (PA) globally and the greater risk of potential reactions occurring due to the leading role of nuts in food products, PA has become a significant public health concern over the past decade, affecting up to 5 million of the US adult population. This review details updates and advances in prevalence, diagnosis, and immunotherapies that have occurred over the past year. RECENT FINDINGS Therapeutic and diagnostic advances remain at the forefront of research and have continued to push the food allergy (FA) field forward to provide a promising role in the detection and treatment of PA. The FA field has researched significant advances in peanut immunotherapy, biomarker diagnosis, and quality of life (QoL) improvement. SUMMARY Given the burden and consequences for individuals with PA, these advances delivered in clinical practice can significantly improve the QoL of individuals with PA and their caregivers. Ongoing studies will continue to investigate long-term outcome measures of desensitisation and effective management plans tailored to the families' needs.
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Affiliation(s)
- Eimear O'Rourke
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
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14
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Quake AZ, Liu TA, D’Souza R, Jackson KG, Woch M, Tetteh A, Sampath V, Nadeau KC, Sindher S, Chinthrajah RS, Cao S. Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study. Nutrients 2022; 14:nu14040737. [PMID: 35215387 PMCID: PMC8879339 DOI: 10.3390/nu14040737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/26/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/09/2023] Open
Abstract
The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4-6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.
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15
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Gajare P, Cao S, Anderson B, Lloret MG, Zedeck SS, Kost L, Nadeau K, Chinthrajah S, Sindher S, Long A. Dose-related allergic adverse events during multi-food oral immunotherapy. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.143] [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] [Indexed: 10/19/2022]
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Shah A, Parsons E, Smith E, Kost L, Ögülür I, Heider A, Tan G, Hamilton R, Sindher S, Liu F, Akdis C, Lieb R, Nadeau K, Lejeune S. Understanding the Association of IgE and Gut and Mucosal Proteins in Atopic Disorders. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.745] [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] [Indexed: 12/01/2022]
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Fernandes A, Gupta S, Cao S, Maysel-Auslender S, Dunham D, Lyu SC, Sindher S, Manohar M, Maecker H, Nadeau K. Studies on Cashew and Shrimp-Oral Immunotherapy-Induced Changes in Allergen-Reactive CD4+ T Cells. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.163] [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] [Indexed: 11/16/2022]
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18
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Fast K, Lee A, Hampton Q, Chinthrajah S, Sindher S, Jia X, Collins W, Nadeau K, Cao S. SARS-CoV-2 and Perceived Physical, Mental and Social Health in Northern California. J Allergy Clin Immunol 2022. [PMCID: PMC8804478 DOI: 10.1016/j.jaci.2021.12.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Collins W, Adlou B, Rodriguez A, Albarran M, O'Neal E, Weiss T, Hsu K, Sindher S, Bailenson J, Caruso T, Chinthrajah S. Feasibility of Virtual Reality Technology to Improve Experience During Pediatric Oral Food Challenge. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.375] [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] [Indexed: 11/26/2022]
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Fernandes A, Gupta S, Cao S, Maysel-Auslender S, Dunham D, Lyu S, Sindher S, Manohar M, Maecker H, Nadeau K. P032 STUDIES ON CASHEW AND SHRIMP-ORAL IMMUNOTHERAPY-INDUCED CHANGES IN ALLERGEN-REACTIVE CD4+ T CELLS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.077] [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] [Indexed: 11/17/2022]
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21
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Sindher S, Raimundo K, Liu Y, Shah A, Rajput Y, Gupta S. P115 RATES OF FOOD ALLERGY CARE IN THE US AMONG THE INSURED. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.133] [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] [Indexed: 10/19/2022]
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22
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Cao S, Borro M, Alonzi S, Sindher S, Nadeau K, Chinthrajah RS. Improvement in Health-Related Quality of Life in Food-Allergic Patients: A Meta-analysis. J Allergy Clin Immunol Pract 2021; 9:3705-3714. [PMID: 34089927 DOI: 10.1016/j.jaip.2021.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Food allergy (FA) is a growing global problem that can affect patients' health-related quality of life (HRQoL) owing to increased anxiety as well as social and economic restrictions. Interventions such as oral food challenges (OFCs) and oral immunotherapy (OIT) have been shown to improve HRQoL. However, meta-analyses and systematic synthesis of these data are lacking. OBJECTIVE To review and quantitatively synthesize potential benefits of interventions (OIT and OFC) systematically to address FA to a variety of foods. METHODS We conducted a systematic search through PubMed and Cochrane Medical Library databases and performed a meta-analysis focusing on studies assessing changes in HRQoL after OIT and/or OFCs in FA participants and caregivers from 2010 to July 2020. Random effects model and I2 statistics were used to assess overall intervention effects and heterogeneity across studies. RESULTS We included 13 publications in this meta-analysis (OIT = 7; OFCs = 6). Mean change in HRQoL scores after OIT and OFCs was -1.25 (P < .001) and -0.78 (P = .052), with a significant I2 of 87% (P < .001) and 90% (P < .001), respectively. Five OIT studies found significant improvements in HRQoL in the OIT group compared with the placebo group, with an overall standardized mean difference of -0.56 (P = .007; I2 = 42%, P = .099). CONCLUSIONS This meta-analysis showed that in FA patients, both OIT and OFCs are associated with an improvement in HRQoL. Well-designed and long-term HRQoL studies are necessary to ascertain sustained benefits of OIT and OFCs.
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Affiliation(s)
- Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif
| | - Matteo Borro
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine, San Paolo Hospital, Savona, Italy
| | - Sarah Alonzi
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Department of Psychology, Loyola University, New Orleans, La
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif.
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Sindher S, Kumar D, Fitzpatrick J, Cao S, Long A, Woch M, Conn T, Nadeau K, Chinthrajah S. A positive perception of treatment and continued adherence to dosing in a long-term follow-up study in food allergic participants undergoing multi-food oral immunotherapy. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.407] [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] [Indexed: 10/22/2022]
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24
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Chinthrajah S, Cao S, Tsai M, Mukai K, Tibshirani R, Sindher S, Nadeau K, Galli S. Basophil activation tests identify a peanut OIT subgroup with improved safety and outcomes. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.589] [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] [Indexed: 10/22/2022]
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25
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Sindher S, Long AJ, Purington N, Chollet M, Slatkin S, Andorf S, Tupa D, Kumar D, Woch MA, O'Laughlin KL, Assaad A, Pongracic J, Spergel JM, Tam J, Tilles S, Wang J, Galli SJ, Nadeau KC, Chinthrajah RS. Corrigendum: Analysis of a Large Standardized Food Challenge Data Set to Determine Predictors of Positive Outcome Across Multiple Allergens. Front Immunol 2020; 11:625796. [PMID: 33329616 PMCID: PMC7734876 DOI: 10.3389/fimmu.2020.625796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2018.02689.].
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Affiliation(s)
- Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew J Long
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Madeleine Chollet
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sara Slatkin
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Dana Tupa
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Kumar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Margaret A Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Katherine L O'Laughlin
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Amal Assaad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, United States
| | - Jacqueline Pongracic
- Division of Allergy and Immunology, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Tam
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen Tilles
- ASTHMA Inc. Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, WA, United States
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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Sindher S, Alkotob SS, Shojinaga MN, Brough HA, Bahnson HT, Chan S, Lack G, Leung DYM, Nadeau KC. Pilot study measuring transepidermal water loss (TEWL) in children suggests trilipid cream is more effective than a paraffin-based emollient. Allergy 2020; 75:2662-2664. [PMID: 32176320 DOI: 10.1111/all.14275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of Medicine Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
| | - Shifaa S. Alkotob
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of Medicine Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
| | - Melanie N. Shojinaga
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of Medicine Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
| | - Helen A. Brough
- Paediatric Allergy Group Department of Women and Children's Health School of Life Course Sciences King's College LondonSt. Thomas' Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King's College London Guys' Hospital London UK
- Children's Allergy Service Evelina Children's Hospital Guy's and St. Thomas' Hospital NHS Foundation Trust London UK
| | - Henry T. Bahnson
- Immune Tolerance Network Benaroya Research Institute Seattle WA USA
| | - Susan Chan
- Paediatric Allergy Group Department of Women and Children's Health School of Life Course Sciences King's College LondonSt. Thomas' Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King's College London Guys' Hospital London UK
- Children's Allergy Service Evelina Children's Hospital Guy's and St. Thomas' Hospital NHS Foundation Trust London UK
| | - Gideon Lack
- Paediatric Allergy Group Department of Women and Children's Health School of Life Course Sciences King's College LondonSt. Thomas' Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King's College London Guys' Hospital London UK
- Children's Allergy Service Evelina Children's Hospital Guy's and St. Thomas' Hospital NHS Foundation Trust London UK
| | - Donald Y. M. Leung
- Department of Pediatrics National Jewish Health Denver CO USA
- Department of Pediatrics University of Colorado at Denver Health Sciences Center Aurora CO USA
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of Medicine Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
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27
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Sindher S, Alkotob SS, Shojinaga MN, Hamilton R, Chan S, Cao S, Bahnson HT, Brough HA, Lack G, Leung DYM, Nadeau KC. Increases in plasma IgG4/IgE with trilipid vs paraffin/petrolatum-based emollients for dry skin/eczema. Pediatr Allergy Immunol 2020; 31:699-703. [PMID: 32372469 PMCID: PMC8078833 DOI: 10.1111/pai.13253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Shifaa S Alkotob
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Melanie N Shojinaga
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Robert Hamilton
- Divisions of Allergy and Clinical Immunology, Departments of Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Chan
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, St. Thomas' Hospital, King's College London, London, UK
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St.Thomas' Hospital NHS Foundation Trust, London, UK
- Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, Guys' Hospital, King's College London, London, UK
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Henry T Bahnson
- Benaroya Research Institute and Immune Tolerance Network, Seattle, WA, USA
| | - Helen A Brough
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, St. Thomas' Hospital, King's College London, London, UK
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St.Thomas' Hospital NHS Foundation Trust, London, UK
- Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, Guys' Hospital, King's College London, London, UK
| | - Gideon Lack
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, St. Thomas' Hospital, King's College London, London, UK
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St.Thomas' Hospital NHS Foundation Trust, London, UK
- Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, Guys' Hospital, King's College London, London, UK
| | - Donald Y M Leung
- Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
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Chinthrajah S, Johansson J, Woch M, Conn T, Chen E, Long A, Lyu SC, Kumar D, Sindher S, Nadeau K. Protein Composition Changes in Manufactured Penaeus aztecus Shrimp Powder. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.189] [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] [Indexed: 11/28/2022]
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29
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Nadeau K, Sindher S, Berdyshev E, Shojinaga M, Alkotob S, Alonzi S, Varadharajulu S, Chandra S, Chinthrajah S, Brough H, Chan S, Lack G, Leung D. Skin TEWL results show significant improvements with Trilipid emollient compared to controls in infants and young children. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.136] [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] [Indexed: 11/24/2022]
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30
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Sindher S, Kumar D, Purington N, Tupa D, Long A, Cao S, Woch M, Tan T, Lloret MG, Chinthrajah S, Nadeau K. A Phase 2 Study of Multi Oral Immunotherapy in Multi Food Allergic Patients to Test Immune Markers after Minimum Maintenance Dose using Xolair. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.534] [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] [Indexed: 10/24/2022]
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31
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Sindher S, Kumar D, Purington N, Tupa D, Long A, Cao S, Woch M, Tan T, Skura S, Garcia-Lloret M, Chinthrajah S. P312 EFFICACY OF A FIXED DOSE OF OMALIZUMAB DURING MULTI-ALLERGEN ORAL-IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Eiwegger T, Anagnostou K, Arasi S, Bégin P, Ben-Shoshan M, Beyer K, Blumchen K, Brough H, Caubet JC, Chan ES, Chen M, Chinthrajah S, Davis CM, Des Roches A, Du Toit G, Elizur A, Galli SJ, Håland G, Hoffmann-Sommergruber K, Kim H, Leung DYM, Long A, Muraro A, Nurmatov UB, Pajno GB, Sampath V, Saxena J, Sindher S, Upton J, Worm M, Nadeau KC. Conflicting verdicts on peanut oral immunotherapy from the Institute for Clinical and Economic Review and US Food and Drug Administration Advisory Committee: Where do we go from here? J Allergy Clin Immunol 2019; 145:1153-1156. [PMID: 31678426 DOI: 10.1016/j.jaci.2019.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Eiwegger
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Research Institute, Translational Medicine, Hospital for Sick Children, Toronto, Canada; Department of Immunology, University of Toronto, Toronto, Canada
| | - Katherine Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Stefania Arasi
- Department of Pediatric Medicine, Pediatric Allergology Unit, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Philippe Bégin
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada; Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helen Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Meng Chen
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Carla M Davis
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Anne Des Roches
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center and Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Department of Pathology and Department of Microbiology and Immunology, Stanford, Calif
| | - Geir Håland
- Department of Paediatric Allergy and Pulmonology, Oslo University Hospital, Oslo, Norway
| | | | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, and the Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colo
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Antonella Muraro
- Food Allergy Centre-Veneto Region, Department of Woman and Child Health Padua University Hospital, Padua, Italy
| | - Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, National Centre for Population Health and Wellbeing Research, Swansea, United Kingdom
| | - Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Jamie Saxena
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif; Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, Calif.
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Eiwegger T, Anagnostou K, Arasi S, Bégin P, Ben-Shoshan M, Beyer K, Blumchen K, Brough H, Caubet JC, Chan ES, Chinthrajah S, Davis CM, Roches AD, Du Toit G, Elizur A, Galli SJ, Håland G, Hoffmann-Sommergruber K, Kim H, Leung DYM, Muraro A, Nurmatov UB, Pajno GB, Sindher S, Szepfalusi Z, Torres MJ, Upton J, Worm M, Nadeau K. ICER report for peanut OIT comes up short. Ann Allergy Asthma Immunol 2019; 123:430-432. [PMID: 31513908 DOI: 10.1016/j.anai.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Thomas Eiwegger
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Research Institute, The Hospital for Sick Children, Translational Medicine, Toronto, Canada; Department of Immunology, The University of Toronto, Toronto, Canada
| | - Katherine Anagnostou
- Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Stefania Arasi
- Department of Pediatric Medicine, Pediatric Allergology Unit, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Philippe Bégin
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada; Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helen Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Carla M Davis
- Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Anne Des Roches
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Arnon Elizur
- The Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center and Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Department of Pathology and Department of Microbiology and Immunology, Stanford University, Stanford, California
| | - Geir Håland
- Department of Paediatric Allergy and Pulmonology, Oslo University Hospital, Oslo, Norway
| | | | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, and the Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colorado
| | - Antonella Muraro
- Food Allergy Centre -Veneto Region, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, The National Centre for Population Health and Wellbeing Research, Wales, United Kingdom
| | - Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Zsolt Szepfalusi
- Division of Ped. Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolecent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Jose Torres
- Allergy Unit, National Network ARADyAL, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Germany
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA; Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California.
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Sindher S, Long AJ, Purington N, Chollet M, Slatkin S, Andorf S, Tupa D, Kumar D, Woch MA, O'Laughlin KL, Assaad A, Pongracic J, Spergel JM, Tam J, Tilles S, Wang J, Galli SJ, Nadeau KC, Chinthrajah RS. Analysis of a Large Standardized Food Challenge Data Set to Determine Predictors of Positive Outcome Across Multiple Allergens. Front Immunol 2018; 9:2689. [PMID: 30538699 PMCID: PMC6277531 DOI: 10.3389/fimmu.2018.02689] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Double-blind placebo-controlled food challenges (DBPCFCs) remain the gold standard for the diagnosis of food allergy; however, challenges require significant time and resources and place the patient at an increased risk for severe allergic adverse events. There have been continued efforts to identify alternative diagnostic methods to replace or minimize the need for oral food challenges (OFCs) in the diagnosis of food allergy. Methods: Data was extracted for all IRB-approved, Stanford-initiated clinical protocols involving standardized screening OFCs to a cumulative dose of 500 mg protein to any of 11 food allergens in participants with elevated skin prick test (SPT) and/or specific IgE (sIgE) values to the challenged food across 7 sites. Baseline population characteristics, biomarkers, and challenge outcomes were analyzed to develop diagnostic criteria predictive of positive OFCs across multiple allergens in our multi-allergic cohorts. Results: A total of 1247 OFCs completed by 427 participants were analyzed in this cohort. Eighty-five percent of all OFCs had positive challenges. A history of atopic dermatitis and multiple food allergies were significantly associated with a higher risk of positive OFCs. The majority of food-specific SPT, sIgE, and sIgE/total IgE (tIgE) thresholds calculated from cumulative tolerated dose (CTD)-dependent receiver operator curves (ROC) had high discrimination of OFC outcome (area under the curves > 0.75). Participants with values above the thresholds were more likely to have positive challenges. Conclusions: This is the first study, to our knowledge, to not only adjust for tolerated allergen dose in predicting OFC outcome, but to also use this method to establish biomarker thresholds. The presented findings suggest that readily obtainable biomarker values and patient demographics may be of use in the prediction of OFC outcome and food allergy. In the subset of patients with SPT or sIgE values above the thresholds, values appear highly predictive of a positive OFC and true food allergy. While these values are relatively high, they may serve as an appropriate substitute for food challenges in clinical and research settings.
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Affiliation(s)
- Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew J Long
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Madeleine Chollet
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sara Slatkin
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Dana Tupa
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Kumar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Margaret A Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Katherine L O'Laughlin
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Amal Assaad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, United States
| | - Jacqueline Pongracic
- Division of Allergy and Immunology, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Tam
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen Tilles
- ASTHMA Inc. Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, WA, United States
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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Long A, Sindher S, Purington N, Andorf S, Tupa D, Nadeau K, Chinthrajah R. DOSE-DEPENDENT BIOMARKER CUT-OFFS PREDICTIVE OF ORAL FOOD CHALLENGE OUTCOMES. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.183] [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] [Indexed: 11/30/2022]
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36
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Sindher S, Long A, Purington N, Tupa D, Andorf S, Nadeau K, Chinthrajah R. INCREASED SEVERITY UPON REPEAT ORAL FOOD CHALLENGES IN MULTI-FOOD ALLERGIC INDIVIDUALS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.182] [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] [Indexed: 10/27/2022]
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Purington N, Chinthrajah RS, Long A, Sindher S, Andorf S, O'Laughlin K, Woch MA, Scheiber A, Assa'ad A, Pongracic J, Spergel JM, Tam J, Tilles S, Wang J, Galli SJ, Desai M, Nadeau KC. Eliciting Dose and Safety Outcomes From a Large Dataset of Standardized Multiple Food Challenges. Front Immunol 2018; 9:2057. [PMID: 30298065 PMCID: PMC6160556 DOI: 10.3389/fimmu.2018.02057] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Food allergy prevalence has continued to rise over the past decade. While studies have reported threshold doses for multiple foods, large-scale multi-food allergen studies are lacking. Our goal was to identify threshold dose distributions and predictors of severe reactions during blinded oral food challenges (OFCs) in multi-food allergic patients. Methods: A retrospective chart review was performed on all Stanford-initiated clinical protocols involving standardized screening OFCs to any of 11 food allergens at 7 sites. Interval-censoring survival analysis was used to calculate eliciting dose (ED) curves for each food. Changes in severity and ED were also analyzed among participants who had repeated challenges to the same food. Results: Of 428 participants, 410 (96%) had at least one positive challenge (1445 standardized OFCs with 1054 total positive challenges). Participants undergoing peanut challenges had the highest ED50 (29.9 mg), while those challenged with egg or pistachio had the lowest (7.07 or 1.7 mg, respectively). The most common adverse event was skin related (54%), followed by gastrointestinal (GI) events (33%). A history of asthma was associated with a significantly higher risk of a severe reaction (hazard ratio [HR]: 2.37, 95% confidence interval [CI]: 1.36, 4.13). Higher values of allergen-specific IgE (sIgE) and sIgE to total IgE ratio (sIgEr) were also associated with higher risk of a severe reaction (1.49 [1.19, 1.85] and 1.84 [1.30, 2.59], respectively). Participants undergoing cashew, peanut, pecan, sesame, and walnut challenges had more severe reactions as ED increased. In participants who underwent repeat challenges, the ED did not change (p = 0.66), but reactions were more severe (p = 0.02). Conclusions: Participants with a history of asthma, high sIgEr, and/or high values of sIgE were found to be at higher risk for severe reactions during food challenges. These findings may help to optimize food challenge dosing schemes in multi-food allergic, atopic patients, specifically at lower doses where the majority of reactions occur. Trials Registration Number: ClinicalTrials. gov number NCT03539692; https://clinicaltrials.gov/ct2/show/NCT03539692.
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Affiliation(s)
- Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacy, Lucile Packard Children's Hospital Stanford, CA, United States
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Katherine O'Laughlin
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Margaret A Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra Scheiber
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, United States
| | - Jacqueline Pongracic
- Division of Allergy and Immunology, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Tam
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen Tilles
- ASTHMA Inc. Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, WA, United States
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Manisha Desai
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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Abstract
Food allergies continue to increase in prevalence. Standard care is a strict elimination diet, but life-threatening reactions still occur. Allergen immunotherapy has the most potential in treating food allergy. Subcutaneous immunotherapy has not been adopted into food allergy therapy. Oral immunotherapy has a high rate of adverse reactions. Sublingual immunotherapy (SLIT) uses the tolerogenic environment of the oral mucosa and epicutaneous immunotherapy (EPIT) uses the immune cells of the epidermis to transport antigens to afferent lymph nodes to activate immune responses. SLIT and EPIT can successfully desensitize patients. More research is needed to define optimal doses and administration protocols.
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Affiliation(s)
- Sayantani Sindher
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
| | - David M Fleischer
- Section of Allergy, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, 13123 East 16th Avenue, B518, Aurora, CO 80045, USA
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
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Gupta M, Sindher S, Saltzman R, Heimall J. Evaluation and subsequent safe administration of rabies vaccine to a child presumably allergic to the gelatin content of PCECV Rabavert. J Allergy Clin Immunol Pract 2015; 3:281-282. [PMID: 25609331 DOI: 10.1016/j.jaip.2014.10.005] [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: 07/29/2014] [Revised: 09/23/2014] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Malika Gupta
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Sayantani Sindher
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Rushani Saltzman
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jennifer Heimall
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa.
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Jariwala S, Toh J, Shum M, de Vos G, Zou K, Sindher S, Patel P, Geevarghese A, Tavdy A, Rosenstreich D. The association between asthma-related emergency department visits and pollen and mold spore concentrations in the Bronx, 2001-2008. J Asthma 2013; 51:79-83. [PMID: 24131032 DOI: 10.3109/02770903.2013.853779] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence of asthma morbidity and mortality is highest among minority inner-city populations. Among New York City's five boroughs, the Bronx has the highest rate of asthma-related hospitalizations and mortality. Outdoor air pollutants have been associated with increased asthma-related ED visits (AREDV) in this borough. OBJECTIVE To better understand the contribution of pollen and mold to asthma severity in the Bronx. METHODS The numbers of daily adult and pediatric AREDV and asthma-related hospitalizations (ARH) from 2001 to 2008 were obtained from two Bronx hospitals. AREDV and ARH data were acquired retrospectively through the Clinical Looking Glass data analysis software. Daily counts for tree, grass and weed pollen and mold spore counts from March 2001 to October 2008 were obtained from the Armonk counting station. All data were statistically analyzed and graphed as daily values. RESULTS There were a total of 42 065 AREDV and 10 132 ARH at both Bronx hospitals. There were spring and winter peaks of increased AREDV. Tree pollen counts significantly correlated with total AREDV (rho = 0.3639, p < 0.001), and pediatric (rho = 0.33, p < 0.001) and adult AREDV (rho = 0.28, p < 0.001). ARH positively correlated with tree pollen counts (Spearman rho = 0.2389, p < 0.001). CONCLUSIONS There exists a significant association between spring AREDV and ARH and tree pollen concentrations in a highly urbanized area such as the Bronx. Early anticipation of spring pollen peaks based on ongoing surveillance could potentially guide clinical practice and minimize asthma-related ED visits in the Bronx.
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Patel S, Sindher S, Jariwala S, Hudes G. Chronic urticaria with monoclonal IgG gammopathy: a clinical variant of Schnitzler syndrome? Ann Allergy Asthma Immunol 2012; 109:147-8. [PMID: 22840258 DOI: 10.1016/j.anai.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/22/2012] [Accepted: 06/01/2012] [Indexed: 11/19/2022]
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