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Lyons SA, Knulst AC, Burney PGJ, Fernandez‐Rivas M, Ballmer‐Weber BK, Barreales L, Bieli C, Clausen M, Dubakiene R, Fernandez‐Perez C, Jedrzejczak‐Czechowicz M, Kowalski ML, Kummeling I, Kralimarkova T, Mustakov TB, Os‐Medendorp H, Papadopoulos NG, Popov TA, Potts J, Versteeg SA, Xepapadaki P, Welsing PMJ, Mills C, Ree R, Le T. Predicting food allergy: The value of patient history reinforced. Allergy 2021; 76:1454-1462. [PMID: 32894581 PMCID: PMC8246712 DOI: 10.1111/all.14583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/24/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/01/2023]
Abstract
Background EAACI guidelines emphasize the importance of patient history in diagnosing food allergy (FA) and the need for studies investigating its value using standardized allergy‐focused questionnaires. Objective To determine the contribution of reaction characteristics, allergic comorbidities and demographics to prediction of FA in individuals experiencing food‐related adverse reactions. Methods Adult and school‐age participants in the standardized EuroPrevall population surveys, with self‐reported FA, were included. Penalized multivariable regression was used to assess the association of patient history determinants with “probable” FA, defined as a food‐specific case history supported by relevant IgE sensitization. Results In adults (N = 844), reproducibility of reaction (OR 1.35 [95% CI 1.29‐1.41]), oral allergy symptoms (OAS) (4.46 [4.19‐4.75]), allergic rhinitis (AR) comorbidity (2.82 [2.68‐2.95]), asthma comorbidity (1.38 [1.30‐1.46]) and male sex (1.50 [1.41‐1.59]) were positively associated with probable FA. Gastrointestinal symptoms (0.88 [0.85‐0.91]) made probable FA less likely. The AUC of a model combining all selected predictors was 0.85 after cross‐validation. In children (N = 670), OAS (2.26 [2.09‐2.44]) and AR comorbidity (1.47 [CI 1.39‐1.55]) contributed most to prediction of probable FA, with a combined cross‐validation‐based AUC of 0.73. When focusing on plant foods, the dominant source of FA in adults, the pediatric model also included gastrointestinal symptoms (inverse association), and the AUC increased to 0.81. Conclusions In both adults and school‐age children from the general population, reporting of OAS and of AR comorbidity appear to be the strongest predictors of probable FA. Patient history particularly allows for good discrimination between presence and absence of probable plant FA.
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Affiliation(s)
- Sarah A. Lyons
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
| | | | | | - Barbara K. Ballmer‐Weber
- Allergy Unit Department of Dermatology University Hospital of Zürich Zürich Switzerland
- Faculty of Medicine University of Zürich Zürich Switzerland
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Laura Barreales
- Clinical Epidemiology Unit Preventive Medicine Department Hospital Clinico San Carlos IdISSC Madrid Spain
| | - Christian Bieli
- Department of Paediatric Pulmonology University Children's Hospital Zürich Switzerland
| | - Michael Clausen
- Children's Hospital Landspitali University Hospital Reykjavik Iceland
| | | | - Cristina Fernandez‐Perez
- Clinical Epidemiology Unit Preventive Medicine Department Hospital Clinico San Carlos IdISSC Madrid Spain
| | | | - Marek L. Kowalski
- Department of Immunology, Rheumatology and Allergy Faculty of Medicine Medical University of Lodz Lodz Poland
| | - Ischa Kummeling
- National Heart and Lung Institute Imperial College London London UK
| | - Tanya Kralimarkova
- Clinical Centre of Allergology of the Alexandrovska Hospital Medical University of Sofia Sofia Bulgaria
| | - Tihomir B. Mustakov
- Clinical Centre of Allergology of the Alexandrovska Hospital Medical University of Sofia Sofia Bulgaria
| | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Saxion University of Applied Sciences Deventer The Netherlands
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
- Division of Infection, Immunity and Respiratory Medicine University of Manchester Manchester UK
| | | | - James Potts
- National Heart and Lung Institute Imperial College London London UK
| | - Serge A. Versteeg
- Department of Experimental Immunology Amsterdam University Medical Center Amsterdam The Netherlands
| | | | - Paco M. J. Welsing
- Division of Internal Medicine and Dermatology University Medical Center UtrechtUtrecht University The Netherlands
| | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
| | - Ronald Ree
- Department of Experimental Immunology Amsterdam University Medical Center Amsterdam The Netherlands
- Department of Otorhinolaryngology Amsterdam University Medical Center Amsterdam The Netherlands
| | - Thuy‐My Le
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
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Berger WE, Mustakov TB, Kralimarkova TZ, Christoff G, Popov TA. Treatment with azelastine hydrochloride and fluticasone propionate in a single delivery device of young children and adolescents with allergic rhinitis. Allergy Asthma Proc 2020; 41:232-239. [PMID: 32605694 DOI: 10.2500/aap.2020.41.200034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Allergic rhinitis (AR) is the most common chronic noncommunicable disease worldwide that affects any age during the human life span but raises particular concerns among the parents and caregivers of the children who are affected. H1-receptor antagonists and corticosteroids provide the most effective way of bringing the condition under control. Intranasal application of these medications has the advantage of a faster onset of action and avoids systemic unwanted adverse effects. The only combination treatment, which comprises azelastine hydrochloride and fluticasone propionate, so far in a single advanced delivery system has proven its efficacy and safety in clinical trials of adult patients with AR. Objective: To critically review and identify gaps in the existing data for children in all different strata of pediatric ages. Methods: We searched the specialized medical literature for publications on the efficacy and safety of the combined formulation of azelastine and fluticasone in a single delivery device in adolescents (ages < 18 years) and children (ages < 12 years). Results: Altogether, 12 peer-reviewed articles have been published about trials that also involved subjects in different strata of the pediatric ages, seven of the articles pooled adolescents and adults. Three articles presented the results of studies in children ages 4 to 11 years specifically designed to overcome the difficulties that children experience in expressing themselves verbally. Conclusion: All the trials with the novel combination product that involved young children and adolescents documented its efficacy, effectiveness, and safety. However, the numbers of the youngest children (ages 4 and 5 years) were low, which suggested that further data about safety and efficacy in this age group are needed.
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Affiliation(s)
| | - Tihomir B. Mustakov
- Clinic of Allergy and Asthma, University Hospital Alexandrovska, Sofia, Bulgaria
| | | | - George Christoff
- Faculty of Public Health, Medical University Sofia, Sofia, Bulgaria; and
| | - Todor A. Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
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Lyons SA, Knulst AC, Burney PGJ, Fernández-Rivas M, Ballmer-Weber BK, Barreales L, Bieli C, Clausen M, Dubakiene R, Fernández-Perez C, Jedrzejczak-Czechowicz M, Kowalski ML, Kummeling I, Mustakov TB, van Os-Medendorp H, Papadopoulos NG, Popov TA, Potts J, Xepapadaki P, Welsing PMJ, Mills ENC, van Ree R, Le TM. Predictors of Food Sensitization in Children and Adults Across Europe. J Allergy Clin Immunol Pract 2020; 8:3074-3083.e32. [PMID: 32348914 DOI: 10.1016/j.jaip.2020.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The geographical variation and temporal increase in the prevalence of food sensitization (FS) suggest environmental influences. OBJECTIVE To investigate how environment, infant diet, and demographic characteristics, are associated with FS in children and adults, focusing on early-life exposures. METHODS Data on childhood and adult environmental exposures (including, among others, sibship size, day care, pets, farm environment, and smoking), infant diet (including breast-feeding and timing of introduction to infant formula and solids), and demographic characteristics were collected from 2196 school-age children and 2185 adults completing an extensive questionnaire and blood sampling in the cross-sectional pan-European EuroPrevall project. Multivariable logistic regression was applied to determine associations between the predictor variables and sensitization to foods commonly implicated in food allergy (specific IgE ≥0.35 kUA/L). Secondary outcomes were inhalant sensitization and primary (non-cross-reactive) FS. RESULTS Dog ownership in early childhood was inversely associated with childhood FS (odds ratio, 0.65; 95% CI, 0.48-0.90), as was higher gestational age at delivery (odds ratio, 0.93 [95% CI, 0.87-0.99] per week increase in age). Lower age and male sex were associated with a higher prevalence of adult FS (odds ratio, 0.97 [95% CI, 0.96-0.98] per year increase in age, and 1.39 [95% CI, 1.12-1.71] for male sex). No statistically significant associations were found between other evaluated environmental determinants and childhood or adult FS, nor between infant diet and childhood FS, although early introduction of solids did show a trend toward prevention of FS. CONCLUSIONS Dog ownership seems to protect against childhood FS, but independent effects of other currently conceived environmental and infant dietary determinants on FS in childhood or adulthood could not be confirmed.
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Affiliation(s)
- Sarah A Lyons
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - André C Knulst
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Barbara K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland; Clinic for Dermatology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Laura Barreales
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | - Christian Bieli
- Department of Paediatric Pulmonology, University Children's Hospital, Zürich, Switzerland
| | - Michael Clausen
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Cristina Fernández-Perez
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology, and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Ischa Kummeling
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tihomir B Mustakov
- Clinical Centre of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Harmieke van Os-Medendorp
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Saxion University of Applied Sciences, Deventer, The Netherlands
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thuy-My Le
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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4
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Lyons SA, Clausen M, Knulst AC, Ballmer-Weber BK, Fernandez-Rivas M, Barreales L, Bieli C, Dubakiene R, Fernandez-Perez C, Jedrzejczak-Czechowicz M, Kowalski ML, Kralimarkova T, Kummeling I, Mustakov TB, Papadopoulos NG, Popov TA, Xepapadaki P, Welsing PMJ, Potts J, Mills ENC, van Ree R, Burney PGJ, Le TM. Prevalence of Food Sensitization and Food Allergy in Children Across Europe. J Allergy Clin Immunol Pract 2020; 8:2736-2746.e9. [PMID: 32330668 DOI: 10.1016/j.jaip.2020.04.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND For adults, prevalence estimates of food sensitization (FS) and food allergy (FA) have been obtained in a standardized manner across Europe. For children, such estimates are lacking. OBJECTIVES To determine the prevalence of self-reported FA, FS, probable FA (symptoms plus IgE sensitization), and challenge-confirmed FA in European school-age children. METHODS Data on self-reported FA were collected through a screening questionnaire sent to a random sample of the general population of 7- to 10-year-old children in 8 European centers in phase I of the EuroPrevall study. Data on FS and probable FA were obtained in phase II, comprising an extensive questionnaire on reactions to 24 commonly implicated foods, and serology testing. Food challenge was performed in phase III. RESULTS Prevalence (95% CI) of self-reported FA ranged from 6.5% (5.4-7.6) in Athens to 24.6% (22.8-26.5) in Lodz; prevalence of FS ranged from 11.0% (9.7-12.3) in Reykjavik to 28.7% (26.9-30.6) in Zurich; and prevalence of probable FA ranged from 1.9% (0.8-3.5) in Reykjavik to 5.6% (3.6-8.1) in Lodz. In all centers, most food-sensitized subjects had primary (non-cross-reactive) FS. However, FS due to birch pollen related cross-reactivity was also common in Central-Northern Europe. Probable FA to milk and egg occurred frequently throughout Europe; to fish and shrimp mainly in the Mediterranean and Reykjavik. Peach, kiwi, and peanut were prominent sources of plant FA in most countries, along with notably hazelnut, apple, carrot, and celery in Central-Northern Europe and lentils and walnut in the Mediterranean. CONCLUSIONS There are large geograhical differences in the prevalence of FS and FA in school-age children across Europe. Both primary and cross-reactive FS and FA occur frequently.
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Affiliation(s)
- Sarah A Lyons
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Michael Clausen
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Barbara K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland; Clinic for Dermatology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Laura Barreales
- Servicio de Medicina Preventiva, Epidemiology Unit, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | - Christian Bieli
- Department of Paediatric Pulmonology, University Children's Hospital, Zürich, Switzerland
| | | | - Cristina Fernandez-Perez
- Servicio de Medicina Preventiva, Epidemiology Unit, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | | | - Marek L Kowalski
- Department of Allergy and Immunology, Medical University of Lodz, Lodz, Poland
| | - Tanya Kralimarkova
- Clinical Centre of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ischa Kummeling
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tihomir B Mustakov
- Clinical Centre of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | | | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Kraft M, Knop MP, Renaudin J, Scherer Hofmeier K, Pföhler C, Bilò MB, Lang R, Treudler R, Wagner N, Spindler T, Hourihane JO, Maris I, Koehli A, Bauer A, Lange L, Müller S, Papadopoulos NG, Wedi B, Moeser A, Ensina LF, Fernandez‐Rivas M, Cichocka‐Jarosz E, Christoff G, Garcia BE, Poziomkowska‐Gęsicka I, Cardona V, Mustakov TB, Rabe U, Mahler V, Grabenhenrich L, Dölle‐Bierke S, Worm M. Secondary prevention measures in anaphylaxis patients: Data from the anaphylaxis registry. Allergy 2020; 75:901-910. [PMID: 31584692 DOI: 10.1111/all.14069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/01/2019] [Revised: 08/09/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. METHODS Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. RESULTS The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, mastocytosis as comorbidity, severity of the reaction, and reimbursement/availability of the autoinjector influence physician's decision to prescribe one. CONCLUSIONS Based on the low implementation of guidelines concerning secondary prevention measures outside of specialized allergy centers, our findings highlight the importance of these specialized centers and the requirement of better education for primary healthcare and emergency physicians.
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Affiliation(s)
- Magdalena Kraft
- Division of Allergy and Immunology Department of Dermatology Venerology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Macarena Pia Knop
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | | | - Kathrin Scherer Hofmeier
- Division of Allergy Department of Dermatology University Hospital Basel University of Basel Basel Switzerland
| | - Claudia Pföhler
- Department of Dermatology The Saarland University Medical Center Homburg/Saar Germany
| | - Maria Beatrice Bilò
- Allergy Unit Department of Internal Medicine University Hospital Ospedali Riuniti di Ancona Ancona Italy
- Department of Clinical and Molecular Sciences Polytechnic University of Marche Ancona Italy
| | - Roland Lang
- Department of Dermatology University Hospital Salzburg Paracelsus Medical University Salzburg Austria
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology Leipzig Interdisciplinary Allergy Center (LICA)‐Comprehensive Allergy Center University Hospital Leipzig Germany
| | - Nicola Wagner
- Department of Dermatology University Hospital of Erlangen‐Nürnberg Erlangen Germany
| | | | | | - Ioana Maris
- Bon Secours Hospital Cork/Department of Paediatrics and Child Health University College Cork Cork Ireland
| | - Alice Koehli
- Division of Allergology University Children's Hospital Zurich Zurich Switzerland
| | - Andrea Bauer
- University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Lars Lange
- Department for Pediatrics St. Marien‐Hospital Bonn Germany
| | - Sabine Müller
- Department of Dermatology Medical Center‐University of Freiburg Freiburg Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic, National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy CenterHannover Medical SchoolHannover Germany
| | - Anne Moeser
- Institute for Infectious Diseases and Infection Control Jena University Hospital Jena Germany
| | - Luis F. Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Montserrat Fernandez‐Rivas
- Department of Allergy Hospital Clinico San Carlos Universidad Complutense, IdISSC Madrid Spain
- ARADyAL Research Network
| | - Ewa Cichocka‐Jarosz
- Department of Pediatrics, Pulmonology, Allergy and Dermatology Clinic Jagiellonian University Medical College Krakow Poland
| | - George Christoff
- Faculty of Public Health Medical University‐Sofia Sofia Bulgaria
- Allergy Out‐patient Department Acibadem CityClinic Tokuda Medical Centre Sofia Bulgaria
| | - Blanca E. Garcia
- Service of Allergology Complejo Hospitalario de Navarra Pamplona Spain
| | | | - Victoria Cardona
- ARADyAL Research Network
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron Barcelona Spain
| | | | - Uta Rabe
- Department for Allergy and Asthma Johanniter Hospital Treuenbrietzen Germany
| | | | - Linus Grabenhenrich
- Division of Allergy and Immunology Department of Dermatology Venerology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Department for Infectious Disease Epidemiology Robert Koch‐Institut Berlin Germany
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology Venerology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology Venerology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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6
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Lyons SA, Burney PGJ, Ballmer-Weber BK, Fernandez-Rivas M, Barreales L, Clausen M, Dubakiene R, Fernandez-Perez C, Fritsche P, Jedrzejczak-Czechowicz M, Kowalski ML, Kralimarkova T, Kummeling I, Mustakov TB, Lebens AFM, van Os-Medendorp H, Papadopoulos NG, Popov TA, Sakellariou A, Welsing PMJ, Potts J, Mills ENC, van Ree R, Knulst AC, Le TM. Food Allergy in Adults: Substantial Variation in Prevalence and Causative Foods Across Europe. J Allergy Clin Immunol Pract 2019; 7:1920-1928.e11. [PMID: 30898689 DOI: 10.1016/j.jaip.2019.02.044] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND According to the community-based EuroPrevall surveys, prevalence of self-reported food allergy (FA) in adults across Europe ranges from 2% to 37% for any food and 1% to 19% for 24 selected foods. OBJECTIVE To determine the prevalence of probable FA (symptoms plus specific IgE-sensitization) and challenge-confirmed FA in European adults, along with symptoms and causative foods. METHODS In phase I of the EuroPrevall project, a screening questionnaire was sent to a random sample of the general adult population in 8 European centers. Phase II consisted of an extensive questionnaire on reactions to 24 preselected commonly implicated foods, and measurement of specific IgE levels. Multiple imputation was performed to estimate missing symptom and serology information for nonresponders. In the final phase, subjects with probable FA were invited for double-blind placebo-controlled food challenge. RESULTS Prevalence of probable FA in adults in Athens, Reykjavik, Utrecht, Lodz, Madrid, and Zurich was respectively 0.3%, 1.4%, 2.1%, 2.8%, 3.3%, and 5.6%. Oral allergy symptoms were reported most frequently (81.6%), followed by skin symptoms (38.2%) and rhinoconjunctivitis (29.5%). Hazelnut, peach, and apple were the most common causative foods in Lodz, Utrecht, and Zurich. Peach was also among the top 3 causative foods in Athens and Madrid. Shrimp and fish allergies were relatively common in Madrid and Reykjavik. Of the 55 food challenges performed, 72.8% were classified as positive. CONCLUSIONS FA shows substantial geographical variation in prevalence and causative foods across Europe. Although probable FA is less common than self-reported FA, prevalence still reaches almost 6% in parts of Europe.
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Affiliation(s)
- Sarah A Lyons
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Peter G J Burney
- Population Health & Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Clinic for Dermatology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Laura Barreales
- Servicio de Medicina Preventiva, Epidemiology Unit, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Michael Clausen
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Cristina Fernandez-Perez
- Servicio de Medicina Preventiva, Epidemiology Unit, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Philipp Fritsche
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Marek L Kowalski
- Department of Allergy and Immunology, Medical University of Lodz, Lodz, Poland
| | - Tanya Kralimarkova
- Clinical Center of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ischa Kummeling
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tihomir B Mustakov
- Clinical Center of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ans F M Lebens
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | | | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James Potts
- Population Health & Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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Mustakov TB, Dubuske L, Popov TA. Specific Patterns of Sensitization in Children Assessed Using an Assay of Allergen Components. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.542] [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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Mustakov TB, Popov TA, Kralimarkova TZ, Staevska MT, Dimitrov VD. Clinical characteristics of patients seeking medical advice for nasal symptoms in Bulgaria with special focus on children. World Allergy Organ J 2016; 9:11. [PMID: 27092204 PMCID: PMC4819277 DOI: 10.1186/s40413-016-0103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background In an attempt to circumvent low response rates and high cost of classical epidemiological trials, we carried out a real-life survey among practicing physicians consulting patients for nasal symptoms. In this fragment of our work we analyze similarities and differences between children and adults and within the different strata of pediatric age. Methods A survey was carried out by 69 physicians across Bulgaria (general practitioners, allergists and otorhinolaryngologists) and made possible calculation of the proportion of subjects with nasal symptoms from all other patients seen. Its structure allowed classification of rhinitis according the ARIA guidelines. Results Out of the 1685 completed survey forms, 506 pertained to the age group below 18 years. The gender predominance differed in children and adults: 57.3 % vs. 42.8 % of males respectively, P < 0.001. The prevalence of persistent rhinitis in children was 55.7 %, lower than in adults, 63.3 %, P = 0.004. In both pediatric and adult patients moderately severe and severe forms of rhinitis prevailed, 93.7 % vs. 94.6 %, with nasal obstruction as leading symptom: 59.9 % vs. 58.8 %. Cough was significantly more prevalent among children, 72.5 %, gradually decreasing until reaching adulthood, 58.7 %, P < 0.001. Prevalence of doctor diagnosed asthma was also higher among children, 25.1 %, than in adults, 19.5 %, P = 0.011. A gradient for characteristics, which were different in children, emerged across the pediatric age strata. Discussion Our study uses an unorthodox design targeting the patient population visiting physicians’ offices because of nasal symptoms, achieving a much higher level of credibility of the results at minimal expense. As we base our survey on international guidelines, we believe this approach demonstrates the applicability of such consensus documents for practical purposes when in the hands of qualified physicians. Conclusions Moderate and severe rhinitis symptoms motivate patients and their guardians to seek medical advice. While nasal congestion is a leading bothersome symptom in both adults and children, specific other features characterize the pediatric age and differ across its strata.
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Affiliation(s)
- Tihomir B Mustakov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Todor A Popov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Tanya Z Kralimarkova
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Maria T Staevska
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Vasil D Dimitrov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
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Kralimarkova TZ, Popov TA, Staevska M, Mincheva R, Lazarova C, Racheva R, Mustakov TB, Filipova V, Koleva M, Bacheva K, Dimitrov VD. Objective approach for fending off the sublingual immunotherapy placebo effect in subjects with pollenosis: double-blinded, placebo-controlled trial. Ann Allergy Asthma Immunol 2014; 113:108-13. [PMID: 24745701 DOI: 10.1016/j.anai.2014.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/07/2014] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Symptom scoring for the assessment of allergen immunotherapy is associated with a substantial placebo effect. OBJECTIVE To assess the ability of exhaled breath temperature (EBT), a putative marker of airway inflammation, to evaluate objectively the efficacy of grass pollen sublingual immunotherapy in a proof-of-concept study. METHODS This was a double-blinded, placebo-controlled clinical trial in 56 subjects (mean ± SD 30 ± 12 years old, 33 men) sensitized to grass pollen. The objective measurements were EBT, spirometry, and periostin and high-sensitivity C-reactive protein in blood. Overall discomfort scored on a visual analog scale was used as a proxy for subjective symptoms. Evaluations were performed before, during, and after the grass pollen season. RESULTS Fifty-one subjects (25 and 26 in the active treatment and placebo groups, respectively) were assessed before and during the pollen season. The mean pre- vs in-season increase in EBT was significantly smaller (by 59.1%) in the active treatment than in the placebo group (P = .030). Of the other objective markers, only the blood periostin level increased significantly during the pollen season (P = .047), but without intergroup differences. Subjectively, the mean pre- vs in-season increase in the visual analog scale score was 32.3% smaller in the active treatment than in the placebo group, although this difference did not reach statistical significance (P = .116). CONCLUSION These results suggest that the efficacy of grass pollen sublingual immunotherapy can be assessed by EBT, a putative quantitative measurement of airway inflammation, which is superior in its power to discriminate between active and placebo treatment than a subjective assessment of symptoms assessed on a visual analog scale. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01785394.
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MESH Headings
- Administration, Sublingual
- Adolescent
- Adult
- Allergens/administration & dosage
- Biomarkers/analysis
- C-Reactive Protein/metabolism
- Cell Adhesion Molecules/blood
- Conjunctivitis, Allergic/complications
- Conjunctivitis, Allergic/immunology
- Conjunctivitis, Allergic/pathology
- Conjunctivitis, Allergic/therapy
- Double-Blind Method
- Exhalation
- Female
- Humans
- Male
- Placebos
- Poaceae/adverse effects
- Pollen/adverse effects
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Rhinitis, Allergic, Seasonal/therapy
- Sublingual Immunotherapy
- Temperature
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Affiliation(s)
| | - Todor A Popov
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria.
| | - Maria Staevska
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - Roxana Mincheva
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | | | - Rumyana Racheva
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | | | - Violina Filipova
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - Margarita Koleva
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - Kalina Bacheva
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - Vasil D Dimitrov
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
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