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Elizur A, Goldberg MR. Peanut oral immunotherapy protects a young captive in Gaza from anaphylaxis. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00290-4. [PMID: 38777121 DOI: 10.1016/j.anai.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Arnon Elizur
- The Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Israel; Department of Pediatrics, Tel Aviv University School of Medicine, Tel Aviv, Israel.
| | - Michael R Goldberg
- The Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Israel; Department of Pediatrics, Tel Aviv University School of Medicine, Tel Aviv, Israel
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Goldberg MR, Appel MY, Tobi K, Levy MB, Epstein-Rigbi N, Holmqvist M, Östling J, Nachshon L, Lidholm J, Elizur A. Validation of the NUT CRACKER Diagnostic Algorithm and Prediction for Cashew and Pistachio Co-Allergy. J Allergy Clin Immunol Pract 2024; 12:1273-1282.e5. [PMID: 38382880 DOI: 10.1016/j.jaip.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Because of the high cross-sensitization among tree nuts, the NUT CRACKER (Nut Co-reactivity-Acquiring Knowledge for Elimination Recommendations) study proposed a diagnostic algorithm to minimize the number of required oral food challenges (OFCs). OBJECTIVE To validate the algorithm for cashew and pistachio allergy and determine markers for allergic severity. METHODS Patients (n = 125) with a median age of 7.8 (interquartile range, 5.9-11.2) years with suspected tree nut allergy were evaluated prospectively with decision tree points on the basis of skin prick test (SPT), basophil activation test (BAT), and knowledge of the coincidence of allergies. Validation of allergic status was determined by OFC. Markers of clinical severity were evaluated using the combined original and prospective cohort (n = 187) in relationship to SPT, BAT, and Ana o 3-sIgE. RESULTS Reactivity to cashew in SPT, BAT, and Ana o 3-sIgE and the incidence of abdominal pain on challenge were significantly higher in dual-allergic cashew/pistachio patients (n = 82) versus single cashew allergic patients (n = 18) (P = .001). All 3 diagnostic tests showed significant inverse correlation with log10 reaction doses for positive cashew OFC. The algorithm reduced overall the total number of OFCs by 72.0%, with a positive predictive value and negative predictive value of 93.0% and 99.0%, respectively. Cashew false-positives were observed primarily in hazelnut-allergic patients (P = .026). In this population, Ana o 3-specific IgE could diagnose cashew allergy with a sensitivity of more than 90% and a specificity of more than 95%. CONCLUSIONS The NUT CRACKER diagnostic algorithm was validated and reduced the number of diagnostic OFCs required. Markers for severity phenotypes may guide oral immunotherapy protocols, improving the risk/benefit ratio for patients.
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Affiliation(s)
- Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Michael Y Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Katz Tobi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Medicine, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Elizur A, Rachel‐Jossefi S, Rachmiel M, Eisenberg E, Katz Y. Consumption of cow's milk formula in the nursery and the development of milk allergy. Clin Transl Allergy 2024; 14:e12352. [PMID: 38613160 PMCID: PMC11015055 DOI: 10.1002/clt2.12352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The effect of the amount of transient cow's milk formula (CMF) consumed during the first days of life on IgE-cow's milk allergy (IgE-CMA) is unknown. METHODS A cohort of 58 patients with IgE-CMA was identified from a large scale population-based study of 13,019 infants followed from birth. A group of 116 infants matched for sex and breastfeeding only duration (beyond the nursery period), and another random group of 259 healthy infants were used as controls. Parents were interviewed and the infants' medical records were searched to assess CMF consumption in the nursery. RESULTS While 96% of the mothers of the 174 infants (58 with Cow's milk allergy and 116 controls) reported on exclusive breastfeeding during the stay in the nursery, CMF consumption was documented in 96 (55%) of the infants. Of those, most (57; 59%) received one to three feedings, 20 (21%) received four to nine feedings, and 19 (20%) received ≥10 feedings. Fewer formula feeds (1-3) were significantly more common in the allergic group than ≥4 feeds (p = 0.0003) and no feeds at all (p = 0.02) compared to controls (n = 116). Of those exclusively breastfed in the nursery, 13/23 allergic infants (57%) introduced CMF at age 105-194 days (the period with highest-risk for IgE-CMA) compared to 33/98 (34%) from the random control group (n = 259) (p = 0.04). CONCLUSIONS Most infants end up receiving few CMF feeds in the nursery. Transient CMF in the nursery is associated with increased risk of IgE-CMA.
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Affiliation(s)
- Arnon Elizur
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
| | - Shirel Rachel‐Jossefi
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
| | - Marianna Rachmiel
- Tel Aviv University School of MedicineTel AvivIsrael
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionPediatric Endocrinology and Diabetes InstituteTzrifinIsrael
| | - Eli Eisenberg
- Tel Aviv University School of Physics and AstronomyTal AvivIsrael
| | - Yitzhak Katz
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024:S0091-6749(24)00238-0. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Oriel RC, Elizur A, Sicherer SH. Comprehensive Diagnosis, Management, and Treatment of Sesame Allergy. J Allergy Clin Immunol Pract 2024; 12:590-597. [PMID: 37952774 DOI: 10.1016/j.jaip.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
Sesame allergy prevalence varies regionally and by age, in the range of 0.1% to 0.9%. Reactions can be severe and potentially fatal. Resolution rates are in the range of 20% to 50%. The diagnosis requires a careful history and the use of tests, such as skin prick tests and serum sesame-specific IgE. The availability of serum IgE testing for the sesame protein Ses i 1 has improved diagnostic accuracy. The emerging potential for sesame basophil activation tests and additional new tests will likely improve diagnosis in coming years, further reducing the need for diagnostic oral food challenges. Although sesame proteins share homology with those in many foods, clinically relevant cross-reactivity appears uncommon. Nevertheless, sesame is a prominent allergen for those with multiple food allergies. Management may include strict avoidance, but sesame products vary dramatically in protein content. Many people with sesame allergy tolerate forms that are low in protein, such as scattered seeds, rather than sesame paste that is protein-dense. Thus, options in the approach to avoidance are possible. Studies suggest that sesame oral immunotherapy may be safe and effective, and this and additional treatment options are emerging. Here, we review the current comprehensive diagnosis, management, and treatment for sesame allergy.
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Affiliation(s)
- Roxanne C Oriel
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Tel Aviv, Israel; Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
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Nachshon L, Schwartz N, Levy MB, Goldberg M, Epstein-Rigbi N, Katz Y, Elizur A. Reply to "Intense allergic reactions to personalized oral immunotherapy treatments for food allergies at home". J Allergy Clin Immunol Pract 2024; 12:797-798. [PMID: 38458704 DOI: 10.1016/j.jaip.2023.11.014] [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: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 03/10/2024]
Affiliation(s)
- Liat Nachshon
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel; Department of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Michael B Levy
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | - Michael Goldberg
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel; Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Landau T, Gamrasni K, Barlev Y, Elizur A, Benor S, Mimouni F, Brandwein M. A machine learning approach for stratifying risk for food allergies utilizing electronic medical record data. Allergy 2024; 79:499-502. [PMID: 37555336 DOI: 10.1111/all.15839] [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: 05/30/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Tamar Landau
- MYOR Diagnostics Ltd., Zichron Yaakov, Israel
- Department of Statistics, University of Haifa, Haifa, Israel
| | | | - Yotam Barlev
- MYOR Diagnostics Ltd., Zichron Yaakov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Tel Aviv, Israel
| | - Shira Benor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Francis Mimouni
- Leumit Health Services, Leumit Research Institute, Tel Aviv, Israel
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Nachshon L, Westerhout J, Blom WM, Remington B, Levy MB, Goldberg MR, Epstein-Rigbi N, Katz Y, Elizur A. Sesame eliciting and safe doses in a large sesame allergic population. Allergy 2023; 78:3212-3220. [PMID: 37606275 DOI: 10.1111/all.15863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited. METHODS All sesame oral food challenges (OFCs), performed either for diagnosis or for threshold identification before the beginning of sesame oral immunotherapy (OIT) between November 2011 and July 2021 in Shamir medical center were analyzed for reaction threshold distribution. Safe-dose challenges with 90-120 min intervals were also analyzed. RESULTS Two hundred and fifty patients underwent 338 positive OFCs, and additional 158 safe-dose OFCs were performed. The discrete and cumulative protein amounts estimated to elicit an objective reaction in 1% (ED01) of the entire cohort (n = 250) were 0.8 mg (range 0.3-6.3) and 0.7 mg (range 0.1-7.1), respectively, and those for 5% of the population (ED05) were 3.4 mg (range 1.2-20.6) and 4.5 mg (range 1.2-28.8), respectively. Safe-dose OFCs showed similar values of ED01 (0.8, 0.4-7.5 mg) and ED05 (3.4, 1.2-22.9 mg). While doses of ≤1 mg sesame protein elicited oral pruritus in 11.6% of the patients, no objective reaction was documented to this amount in any of the challenges, including safe-dose OFCs. CONCLUSIONS This study provides data on sesame reaction threshold distribution in the largest population of allergic patients studied, with no right or left censored data, and with validation using a safe-dose OFC. It further supports the current methods for ED determination as appropriate for establishing safety precautions for the food industry.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joost Westerhout
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - W Marty Blom
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Benjamin Remington
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shalem T, Cohen DL, Epstein-Rigbi N, Elizur A, Eindor-Abarbanel A, Broide E, Richter V. Proton pump inhibitors in eosinophilic esophagitis (EoE) related to oral immunotherapy: is it as effective as in other EoE? Eur J Pediatr 2023; 182:5409-5416. [PMID: 37750913 DOI: 10.1007/s00431-023-05228-1] [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: 07/09/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
Oral immunotherapy (OIT) may induce eosinophilic esophagitis (EoE). Proton pump inhibitors (PPIs) are an effective treatment for EoE. However, the effect of PPI treatment is not well established in patients with EoE induced by OIT. Our primary aim was to compare the clinical, endoscopic, and histological response rates to PPIs in children with EoE induced by OIT (EoE+OIT) versus EoE patients without OIT (EoE-OIT). The secondary aims are to describe the clinical and histological features of EoE+OIT. Demographic, clinical, endoscopic, and histological findings of patients with EoE in the gastroenterology clinic at Shamir Medical Center between March 2015 and December 2022 were collected. Comparisons were performed between EoE+OIT and EoE-OIT patients. The study included 42 children (74% male, mean age 11.2), of whom 31 had EoE-OIT and 11 had EoE+OIT. There were no significant differences between groups regarding sex, comorbidities, symptoms, or endoscopic and histological characteristics at diagnosis. All 42 children were treated with PPIs after diagnosis with or without diet changes. The rates of any clinical response were 83.9% and 90.1% in the EoE-OIT group and EoE+OIT group, respectively (p = 1.0). The rate of any endoscopic response was 74.2% for EoE-OIT and 81.8% for EoE+OIT (p = 0.54). Histologically, PPIs were even more effective in the EoE+OIT group, where only 18.2% had no histological response at all compared to 51.6% in the EoE-OIT group (p = 0.1). CONCLUSION PPI treatment is as effective in EoE with OIT as it is in EoE due to other etiologies. WHAT IS KNOWN • Proton pump inhibitor (PPI) treatment is effective for achieving clinical response and histologic remission in some patients with eosinophilic esophagitis (EoE). • EoE has also been reported to be triggered by oral immunotherapy (OIT). WHAT IS NEW • PPI treatment in EoE with OIT is as effective as treatment for EoE due to other etiologies.
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Affiliation(s)
- Tzippora Shalem
- The Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel
| | - Daniel L Cohen
- The Gonczarowski Family Institute of Gastroenterology and Liver Disease, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel
| | - Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Eindor-Abarbanel
- The Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel
| | - Efrat Broide
- The Jecheskiel Sigi Gonczarowski Pediatric Gastroenterology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel
- The Gonczarowski Family Institute of Gastroenterology and Liver Disease, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Richter
- The Gonczarowski Family Institute of Gastroenterology and Liver Disease, Shamir (Assaf Harofeh) Medical Center, Zerifin, 70300, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Goldberg MR, Epstein-Rigbi N, Elizur A. Eosinophil-Associated Gastrointestinal Manifestations During OIT. Clin Rev Allergy Immunol 2023; 65:365-376. [PMID: 37957456 DOI: 10.1007/s12016-023-08974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Gastrointestinal adverse events are common during oral immunotherapy (OIT) for food allergy and range from immediate IgE-mediated reactions to non-anaphylactic clinical presentations. This review aims to summarize recent findings on non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT. Two clinical presentations of non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT are identified, each with a different paradigm for treatment, and distinguished by their time of onset. In the first clinical entity, characterized by its onset early in the course of treatment, patients present with abdominal pain, nausea, and/or vomiting. The symptoms become evident typically within weeks to months of starting OIT. These symptoms, however, are not temporally related to the time of dose administration, as in the case of immediate IgE-mediated anaphylactic reactions. While esophageal biopsies, when performed, can demonstrate eosinophilic esophagitis (EoE), baseline esophageal eosinophilia has also been observed in food allergic patients prior to OIT. A potential non-invasive biomarker, the peripheral absolute eosinophil count (AEC), often rises during these reactions and subsides after dose reduction and subsequent resolution of symptoms. OIT can usually then be resumed, albeit at a slower pace, without a recurrence of symptoms. Risk factors for development of symptoms early during OIT include a high starting dose and a baseline AEC of greater than 600. The second, and much less frequently encountered, non-anaphylactic gastrointestinal adverse event related to OIT, presents months to years after initiating OIT. In this latter group, patients present with the classical clinical symptoms and endoscopic findings of EoE. In contrast to the acute onset group, peripheral eosinophilia is usually not observed in these cases. This OIT-associated EoE has shown good response to standard EoE treatment approaches of proton pump inhibitors or swallowed steroids. Most patients with eosinophil-associated adverse reactions are able to continue OIT and remain desensitized. Treatment approaches depend on the specific subtype of these reactions and relate to the stages of OIT treatment.
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Affiliation(s)
- Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel.
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, 70300, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shtossel O, Turjeman S, Riumin A, Goldberg MR, Elizur A, Bekor Y, Mor H, Koren O, Louzoun Y. Recipient-independent, high-accuracy FMT-response prediction and optimization in mice and humans. Microbiome 2023; 11:181. [PMID: 37580821 PMCID: PMC10424414 DOI: 10.1186/s40168-023-01623-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/14/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Some microbiota compositions are associated with negative outcomes, including among others, obesity, allergies, and the failure to respond to treatment. Microbiota manipulation or supplementation can restore a community associated with a healthy condition. Such interventions are typically probiotics or fecal microbiota transplantation (FMT). FMT donor selection is currently based on donor phenotype, rather than the anticipated microbiota composition in the recipient and associated health benefits. However, the donor and post-transplant recipient conditions differ drastically. We here propose an algorithm to identify ideal donors and predict the expected outcome of FMT based on donor microbiome alone. We also demonstrate how to optimize FMT for different required outcomes. RESULTS We show, using multiple microbiome properties, that donor and post-transplant recipient microbiota differ widely and propose a tool to predict the recipient post-transplant condition (engraftment success and clinical outcome), using only the donors' microbiome and, when available, demographics for transplantations from humans to either mice or other humans (with or without antibiotic pre-treatment). We validated the predictor using a de novo FMT experiment highlighting the possibility of choosing transplants that optimize an array of required goals. We then extend the method to characterize a best-planned transplant (bacterial cocktail) by combining the predictor and a generative genetic algorithm (GA). We further show that a limited number of taxa is enough for an FMT to produce a desired microbiome or phenotype. CONCLUSIONS Off-the-shelf FMT requires recipient-independent optimized FMT selection. Such a transplant can be from an optimal donor or from a cultured set of microbes. We have here shown the feasibility of both types of manipulations in mouse and human recipients. Video Abstract.
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Affiliation(s)
- Oshrit Shtossel
- Department of Mathematics, Bar-Ilan University, Ramat Gan, 52900, Israel.
| | - Sondra Turjeman
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alona Riumin
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Michael R Goldberg
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Arnon Elizur
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yarin Bekor
- Department of Mathematics, Bar-Ilan University, Ramat Gan, 52900, Israel
| | - Hadar Mor
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Omry Koren
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar-Ilan University, Ramat Gan, 52900, Israel.
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Nachshon L, Schwartz N, Levy MB, Goldberg M, Epstein-Rigbi N, Katz Y, Elizur A. Severe Anaphylactic Reactions to Home Doses of Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract 2023; 11:2524-2533.e3. [PMID: 36925102 DOI: 10.1016/j.jaip.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Severe anaphylactic reactions to home doses may occur during food allergy oral immunotherapy (OIT). OBJECTIVE To study the rate and risk factors for such reactions. METHODS We studied all patients aged greater than 3.5 years who completed OIT in a single center between April 2010 and January 2020. All home epinephrine-treated reactions (HETRs) were identified. High-grade HETRs (HG-HETRs) were defined as HETRs involving respiratory (SpO2 of 94% or less), cardiovascular (low blood pressure), or central nervous system impairment (loss of consciousness). We investigated the rate and risk factors for HG-HETRs. RESULTS A total of 1,637 OIT treatments were studied: milk (880), peanut (346), tree nuts (221), sesame (115), and egg (75). Of 390 identified HETRs, 30 HG-HETRs occurred during 27 treatments (1.65% of all treatments). Nearly all (26 of 30) were during milk OIT in patients with house dust mite (HDM) sensitization and asthma (26 of 30 each). Of the 30 patients with HG-HETRs, 21 recovered with one or two epinephrine treatments, but nine (0.55% of all treatments) did not respond to a second dose of epinephrine and were deemed to have refractory anaphylaxis. Three patients required intensive care unit admission and three received epinephrine drip, but none required ventilatory support. Risk factors for HG-HETRs included milk OIT (P = .031), asthma (P = .02) and HDM sensitization (P = .02). No specific triggers for HG-HETR were identified. Of patients with HG-HETRs, 25.9% were fully desensitized, including the four non-milk treated patients; 22.2% were partially desensitized; and 51.9% failed. CONCLUSIONS High-grade HETRs are uncommon, particularly refractory anaphylactic reactions to home OIT doses. Although milk OIT, asthma, and HDM sensitization are the main risk factors for such reactions, identification of patients who are at risk is challenging.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel
| | - Michael Goldberg
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Nachshon L, Schwartz N, Levy MB, Goldberg MR, Epstein-Rigbi N, Katz Y, Elizur A. Factors associated with home epinephrine-treated reactions during peanut and tree-nut oral immunotherapy. Ann Allergy Asthma Immunol 2023; 130:340-346.e5. [PMID: 36509409 DOI: 10.1016/j.anai.2022.12.001] [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: 05/29/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Home reactions requiring epinephrine administration, a marker of their severity, restrict the widespread use of oral immunotherapy (OIT), but their risk factors are largely not known. OBJECTIVE To identify risk factors for such reactions during OIT to most allergenic foods. METHODS All patients who began OIT for peanut, tree nuts, sesame, or egg allergy at the Shamir Medical Center between April 2010 and January 2020 were enrolled. The patients were instructed to use their epinephrine autoinjectors during reactions consisting of severe abdominal pain, significant shortness of breath, or lethargy, or whenever in uncertainty of reaction severity. Patients with and without home epinephrine-treated reactions (HETRs) were compared. RESULTS A total of 757 OIT treatments for peanut (n = 346), tree nuts (n = 221; walnut n = 147, cashew n = 57, hazelnut n = 16, almond n = 1), sesame (n = 115), and egg (n = 75) allergies were administered to 644 patients. Eighty-three (10.9%) patients experienced HETRs. The highest rate of HETRs was experienced during walnut (20.4%) or hazelnut (25%) OIT, followed by peanut (9.8%), sesame (6.1%), egg (6.7%), and cashew (5.3%) OIT. Risk factors for HETRs included a reaction treated in an emergency department (ER) (P = .005) before starting OIT and a reaction treated with epinephrine during in-clinic induction (P < .001). Significantly fewer patients with (73.6%) than without (88.3%) HETRs achieved full desensitization (P = .001), but only a few patients with HETRs (8.4%) failed treatment. CONCLUSION Previous reaction severity is the main predictor for HETRs during OIT. These reactions are more frequent during walnut and hazelnut OIT than during OIT for other foods studied. Most patients experiencing HETRs achieved desensitization.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Schwartz
- School of Public Health-University of Haifa, Haifa, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Epstein-Rigbi N, Levy MB, Nachshon L, Koren Y, Katz Y, Goldberg MR, Elizur A. Efficacy and safety of food allergy oral immunotherapy in adults. Allergy 2023; 78:803-811. [PMID: 36190349 DOI: 10.1111/all.15537] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 06/29/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is an emerging method for treating food allergy in children. However, data regarding adults undergoing this process are lacking. METHODS We retrospectively analyzed the medical records of patients with food allergy aged ≥17 years who completed OIT treatment between April 2010 and December 2020 at Shamir Medical Center. Data were compared with that of children aged 4 to <11 years and adolescents aged ≥11 to 17 treated during the same time period. RESULTS A total of 96 adults at a median age of 22.3 years who underwent OIT for milk (n = 53), peanut (n = 18), sesame (n = 7), egg (n = 5), and tree nuts (n = 13) were analyzed and compared with 1299 children and 309 adolescents. Adults experienced more adverse reactions requiring injectable epinephrine, both during in-clinic up-dosing (49% vs. 15.9% and 26.5% for children and adolescents, respectively, p < 0.0001) and during home treatment (22.9% vs. 12.4%, p = 0.007 for children, and 17.5%, p = 0.23 for adolescents). Most adults (61.5%) were fully desensitized, but the rates of full desensitization were significantly lower than children (73.4%, p = 0.013). Significantly more adults (28.3%) undergoing milk OIT failed treatment than children (14.3%, p = 0.015) and adolescents (14.1%, p = 0.022), while failure rates in adults undergoing OIT for other foods were low (9.3%) and comparable with children and adolescents. CONCLUSIONS OIT is successful in desensitizing most adults with IgE-mediated food allergy. Adults undergoing milk OIT are at increased risk for severe reactions and for OIT failure while failure rates in adults undergoing OIT for other foods are low.
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Affiliation(s)
- Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Koren
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Epstein-Rigbi N, Elizur A, Levy MB, Nachshon L, Koren Y, Shalem Z, Broide E, Goldberg MR. Treatment of oral immunotherapy-associated eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology: In Practice 2022; 11:1303-1305.e2. [PMID: 36423867 DOI: 10.1016/j.jaip.2022.11.010] [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: 07/04/2022] [Revised: 10/28/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yael Koren
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Zippi Shalem
- Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Efrat Broide
- Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Pediatric Gastroenterology Unit, Shamir Medical Center, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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16
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Katz Y, Melchior M, Elizur A, Nachshon L, Remington BC, Leshno M. Informing risk management for patients with cow’s milk allergy based on threshold dose distributions using low dose food challenges. The Journal of Allergy and Clinical Immunology: In Practice 2022; 11:1116-1122. [PMID: 36379407 DOI: 10.1016/j.jaip.2022.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The safe consumption of foods depends on their allergen content in relation to patients' lowest observed adverse effect level (LOAEL) and no observed adverse effect level (NOAEL), as well as other factors. In the case of milk, data on LOAEL and NOAEL are limited and conflicting. OBJECTIVE To determine the threshold dose distribution and the lowest individual eliciting dose (ED) for milk in a large group of milk-allergic patients METHODS: Individuals with confirmed cow's milk allergy who underwent a diagnostic or pre-oral immunotherapy open milk oral food challenge at the Institute of Allergy, Immunology, and Pediatric Pulmonology at Shamir Medical Center between 2010 and 2015 were included. A subgroup of patients with severe milk allergy underwent a modified challenge with a 90- to 120-minute interval after a starting dose of 0.3 mg cow's milk protein. RESULTS A total of 866 participants (193 with diagnostic challenges and 673 with pre-oral immunotherapy challenges) were included in the study. The discrete ED01 and ED05, or values derived in which 1% or 5% of the respective allergic population would be predicted to experience an allergic reaction, were 1.1 to 1.9 and 4.7 to 5.6 mg milk protein, respectively, and values for cumulative doses for ED01 and ED05 were 0.9 to 1.8 and 5.2 to 6.2 mg milk protein, respectively. No patients, including the most severely milk-allergic individuals who underwent the modified challenge, reacted to the first 0.3 mg protein dose. CONCLUSION This report provides valuable information about milk NOAELs, LOAELs, and EDs that might assist regulators in decisions about food labeling in general, and milk in particular.
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Turner PJ, Gretzinger M, Patel N, Brough HA, Chinthrajah RS, Ebisawa M, Elizur A, Koplin JJ, Peters RL, Purington N, Nowak‐Wegrzyn A, Saf S, Sampson HA, Westerhout J, Blom WM, Baumert JL, Houben GF, Remington BC. Updated threshold dose-distribution data for sesame. Allergy 2022; 77:3124-3162. [PMID: 35531634 PMCID: PMC9790362 DOI: 10.1111/all.15364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Paul J. Turner
- National Heart & Lung InstituteImperial College LondonLondonUK
| | | | - Nandinee Patel
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Helen A. Brough
- Children's Allergy ServiceEvelina Children's Hospital, Guy's and St. Thomas' NHS Foundation HospitalLondonUK,Department of Paediatric AllergyKing's College LondonLondonUK
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma ResearchStanford University School of MedicineStanfordCAUSA
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and RheumatologyNational Hospital Organization Sagamihara National HospitalSagamiharaJapan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric PulmonologyYitzhak Shamir Medical CenterZerifinIsrael,Department of Pediatrics, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Jennifer J. Koplin
- Population HealthThe Murdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rachel L. Peters
- Population HealthThe Murdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Natasha Purington
- Department of Medicine, Quantitative Sciences UnitStanford University School of MedicineStanfordCAUSA
| | - Anna Nowak‐Wegrzyn
- Allergy and Immunology, Department of PediatricsNew York University Langone HealthNew YorkNYUSA,Department of Pediatrics, Gastroenterology and Nutrition, Collegium MedicumUniversity of Warmia and MazuryOlsztynPoland
| | - Sarah Saf
- Division of Pediatric Allergy and ImmunologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Allergology‐Centre de l'Asthme et des AllergiesHôpital d'Enfants Armand TrousseauParisFrance
| | - Hugh A. Sampson
- Division of Pediatric Allergy and ImmunologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Joost Westerhout
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
| | - W. Marty Blom
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
| | - Joseph L. Baumert
- Food Allergy Research and Resource ProgramUniversity of NebraskaLincolnNebraskaUSA
| | - Geert F. Houben
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
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18
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Elizur A, Appel MY, Nachshon L, Levy MB, Epstein‐Rigbi N, Koren Y, Holmqvist M, Porsch H, Lidholm J, Goldberg MR. Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study). Allergy 2022; 77:1863-1872. [PMID: 35000223 DOI: 10.1111/all.15212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/12/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, and peanut allergy, but data on the efficacy and safety of cashew OIT are limited. METHODS A cohort of 50 cashew-allergic patients aged ≥4 years, who were consecutively enrolled into cashew OIT (target dose 4000 mg protein) between 4/2016 and 12/2019. Fifteen cashew-allergic patients who continued cashew elimination served as observational controls. Co-allergy to pistachio and walnut was determined. Full desensitization rate and associated immunological changes in both groups were compared. Patients fully desensitized to cashew were instructed to consume a dose of 1200 mg cashew protein for 6 months and were then challenged to a full dose. Patients with co-allergy to pistachio or walnut were challenged to the respective nut. RESULTS Forty-four of 50 OIT-treated patients (88%) compared to 0% in controls tolerated a dose of 4000 mg cashew protein at the end of the study (odds ratio 8.3, 95% CI 3.9-17.7, p < 0.001). An additional three patients were desensitized to 1200 mg cashew protein, and three patients stopped treatment. Three patients (6%) were treated with injectable epinephrine for home reactions. Desensitized patients had decreased SPT, sIgE, basophil reactivity, and increased sIgG4, following treatment. Following cashew desensitization, all pistachio (n = 35) and four of eight walnut co-allergic patients were cross-desensitized to the respective nut. All (n = 44) patients consuming a low cashew dose for ≥6 months following desensitization passed a full-dose cashew OFC. CONCLUSIONS Cashew OIT desensitizes most cashew-allergic patients and cross-desensitizes to pistachio. Safety is similar to OIT for other foods.
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Affiliation(s)
- Arnon Elizur
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Y. Appel
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | - Liat Nachshon
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Medicine Sackler Faculty of Medicine Tel Aviv University Israel
| | - Michael B. Levy
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | - Naama Epstein‐Rigbi
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Koren
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | | | | | | | - Michael R. Goldberg
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Nachshon L, Levy MB, Goldberg MR, Epstein-Rigbi N, Schwartz N, Katz Y, Elizur A. Triggers for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract 2022; 10:1070-1076.e2. [PMID: 34982978 DOI: 10.1016/j.jaip.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Home reactions requiring epinephrine treatment represent a significant obstacle to oral immunotherapy (OIT) and impair treatment outcome. OBJECTIVE To identify potential triggers for such reactions for improvement of patient safety. METHODS All patients aged older than 3.7 years who began an open-label OIT treatment program to milk, peanut, egg, sesame, or tree nuts in the Institute of Allergy, Immunology, and Pediatric Pulmonology at Shamir Medical Center between April 2010 and March 2018 were enrolled. Information on home epinephrine-treated reactions (HETRs) during the up-dosing phase of OIT was collected from the documentation in patients' files and the reports were transmitted by email and via a web reporting system. RESULTS A total 1,270 OIT treatments were included (milk 780; peanut 256; egg 63; sesame 72; and tree nuts 99). Home epinephrine was administered in 200 treatments (15.7%) and in 70 of them a second epinephrine-treated reaction occurred. The leading identified triggers for HETRs were physical exercise temporally associated with administration of home dose (20%), and dose consumption during infectious disease (16.7%), or when fatigued (13.8%). The rate of first HETRs was highest (10.1%) to doses of 500 mg protein or less and particularly to 300 mg or less. The occurrence of first HETRs was highest (35.5%) during the first and decreased to 13.8% by the last of the 4-week home-treatment phase. Second HETRs occurred in a similar rate throughout these 4 weeks. The incidence of HETRs was highest during pollen season and vacation months. CONCLUSIONS The identification of factors, some protocol-dependent, that trigger HETRs should assist in improving OIT safety.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael B Levy
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yankov, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Perrett KP, Sindher SB, Begin P, Shanks J, Elizur A. Advances, Practical Implementation, and Unmet Needs Regarding Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract 2022; 10:19-33. [PMID: 34785391 DOI: 10.1016/j.jaip.2021.10.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Treatment of food allergy is a rapidly changing landscape, with arguably, the most significant advancement in recent years, the transition of oral immunotherapy (OIT) to clinical practice. As an innovation, OIT is a phase of rapidly increasing demand, particularly for some allergens such as peanut, egg, and milk, which have substantial evidence of efficacy. However, significant questions remain about how to best treat multiple food allergies and less common food allergies and how to optimize long-term safety and efficacy. This review summarizes the currently available resources for integrating food allergy OIT into clinical practice and focuses on the multiple remaining unmet needs such as providing an approach for OIT to food allergens for which there is no or limited evidence; practical issues related to food allergy treatment particularly when it is not going well; long-term outcomes and follow-up after OIT; and strategies to help meet the impending increase in demand.
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Affiliation(s)
- Kirsten P Perrett
- Population Allergy, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford, California
| | - Philippe Begin
- Division of Allergy, Immunology and Rheumatology, CHU Sainte-Justine, Montréal, Canada
| | - Josiah Shanks
- Population Allergy, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Kessel A, Bamberger E, Nachshon L, Rosman Y, Confino‐Cohen R, Elizur A. Safe administration of the Pfizer-BioNtTech COVID-19 vaccine following an immediate reaction to the first dose. Allergy 2021; 76:3538-3540. [PMID: 34370884 PMCID: PMC8441877 DOI: 10.1111/all.15038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Aharon Kessel
- Division of Allergy & Clinical Immunology Bnai Zion Medical Center, Haifa Rappaport Faculty of Medicine Technion Haifa Israel
| | - Ellen Bamberger
- Division of Allergy & Clinical Immunology Bnai Zion Medical Center, Haifa Rappaport Faculty of Medicine Technion Haifa Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Yitzhak Shamir Medical Center Zerifin Israel
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
| | - Yossi Rosman
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Allergy and Clinical Immunology Unit Meir Medical Center Kfar Saba Israel
| | - Ronit Confino‐Cohen
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Allergy and Clinical Immunology Unit Meir Medical Center Kfar Saba Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Yitzhak Shamir Medical Center Zerifin Israel
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
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22
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Goldberg MR, Appel MY, Nachshon L, Holmqvist M, Epstein-Rigbi N, Levy MB, Lidholm J, Elizur A. Combinatorial advantage of Ses i 1-specific IgE and basophil activation for diagnosis of sesame food allergy. Pediatr Allergy Immunol 2021; 32:1482-1489. [PMID: 33955090 DOI: 10.1111/pai.13533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of sesame food allergy (SFA) is increasing worldwide with the potential of anaphylactic reactions upon exposure. Utility of specific component IgE testing as an alternative to the oral food challenge (OFC), the diagnostic standard, is being investigated. METHODS Patients (n = 42) with suspected SFA completed an open OFC to sesame. Diagnostic testing included serum levels of Ses i 1-specific IgE, skin prick test with high-protein extract, and basophil reactivity (% induced CD63 expression) for each patient. The diagnostic utility of these tests was evaluated at a 95% sensitivity, with the outcome measure being the number of OFCs required. RESULTS Twenty-seven patients (64%) were diagnosed with SFA. Ses i 1 IgE differed significantly between allergic and tolerant patients (p = .0001). ROC curve analysis for Ses i 1 IgE yielded an AUC of 0.88 ± 0.05. Levels of Ses i 1 IgE correlated to induced CD63+ expression on basophils (p = .0001). Ses i 1 IgE was not sufficiently robust as a single step for diagnosis. Used concurrently, BAT and Ses i 1 IgE yielded correct positive classifications for 25 of 27 sesame-allergic patients with two false positives (93% PPV). Both tests were negative in 5 non-allergic patients. Patients with divergent Ses i 1 IgE and BAT results required OFC (n = 10, 24% of patients). Alternatively, sequential use of BAT, ruling in SFA followed by Ses i 1 IgE diagnosing non-allergic patients, yielded a 89% PPV, with 19% requiring OFC. CONCLUSION Ses i 1 IgE and BAT used together can decrease the need for OFC in most SFA patients. A prospective cohort trial is necessary to validate these results.
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Affiliation(s)
- Michael R Goldberg
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Y Appel
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | - Liat Nachshon
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Naama Epstein-Rigbi
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | | | - Arnon Elizur
- Yitzhak Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Epstein Rigbi N, Schwartz N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy. Pediatr Allergy Immunol 2021; 32:1029-1037. [PMID: 33452829 DOI: 10.1111/pai.13445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined. METHODS Children aged 4-12 years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied. Children in the same age range starting OIT without the support of a MC served as controls. Parents of all children completed the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF), and children aged 8-12 years completed the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF). QOL scores of parents and children with and without a MC support were compared. RESULTS Children with (n = 88) and without (n = 212) the support of a MC were comparable in demographics and clinical characteristics. The study group had a significantly lower single highest tolerated dose compared to controls (57 ± 83 vs 162 ± 274 mg protein, respectively, P < .001). Parental perception of the QOL of children was not associated with a MC support (P = .81) but rather with previous reaction severity (P < .01). In contrast, the QOL of children aged 8-12 years (n = 119) was positively associated primarily with a MC support, total score 3.7 ± 1.1 vs 4.6 ± 1.3 (P < .001). CONCLUSIONS While the perception of QOL of parents of children with food allergy at OIT initiation is mainly associated with previous reaction severity, the QOL of the children themselves is primarily positively associated with MC support.
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Affiliation(s)
- Naama Epstein Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Schwartz
- School of Public Health, Haifa University, Haifa, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Nachshon L, Goldberg MR, Levy MB, Epstein-Rigbi N, Koren Y, Elizur A. Home epinephrine-treated reactions in food allergy oral immunotherapy: Lessons from the coronavirus disease 2019 lockdown. Ann Allergy Asthma Immunol 2021; 127:451-455.e1. [PMID: 34010698 PMCID: PMC9338684 DOI: 10.1016/j.anai.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
Background Oral immunotherapy (OIT) is effective in desensitizing patients with food allergy but adverse reactions limit its use. Objective To study the effect of the coronavirus disease 2019 lockdown in Israel between March 15, 2020, and April 30, 2020, on the incidence of home epinephrine-treated reactions. Methods All patients who were in the up-dosing phase of OIT for greater than or equal to 1 month during the lockdown, or a respective period in years 2015 to 2019, were studied. The incidence of home-epinephrine treated reactions during the 2020 lockdown was compared with that in the respective period in 2015 to 2019 and to periods before and after the lockdown. Results A total of 1163 OIT treatments were analyzed. Two epinephrine injections occurred during 2020 (0.7%) compared with 29 injections (3.28%) during 2015 to 2019 (P = .03). Patients treated in 2020 were older (8.1 vs 7 years, P < .01) and had a significantly lower single highest tolerated dose (12 vs 20 mg protein, P < .01). The rate of milk-OIT was lower (P = .01), but the total number of milk treatments was higher (99 vs 71 to 82) in 2020 compared with 2015 to 2019. On multivariate analysis, treatments during the 2020 lockdown were performed in older patients (P = .001), primarily for nonmilk (P = .03), began with a lower single highest tolerated dose (P = .006), and were associated with significantly less home epinephrine-treated reactions (P = .05) compared with those in 2015 to 2019. Patients treated in 2020 experienced more epinephrine-treated reactions in adjacent periods before (n = 8) and after (n = 6) the lockdown. Conclusion The lower rate of home epinephrine-treated reactions during the coronavirus disease 2019 lockdown in Israel suggests that potentially avoidable triggers contribute significantly to the rate of adverse reactions during OIT.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Koren
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Nachshon L, Schwartz N, Goldberg MR, Schon Y, Cheryomukhin M, Katz Y, Elizur A. Characteristics and associated morbidities of young adults with misconceived food allergy: A cross-sectional study. EClinicalMedicine 2021; 33:100766. [PMID: 33718851 PMCID: PMC7933257 DOI: 10.1016/j.eclinm.2021.100766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with self-reported food allergy are not allergic but suffer from similar burdens. We aimed to characterize young adults with misconceived food allergy. METHODS A cross-sectional study of individuals (n = 12,592) aged 17-18 years, recruited to the Israel Defense Forces (IDF) at a single urban-area recruitment center over a six month-period. All participants underwent a comprehensive medical and psychological evaluation. Cognitive tests were performed and a Combined Intellectual-Education score assigned. Participants who reported food elimination due to allergy were skin-tested and underwent oral food challenges, when indicated. The characteristics, psychological evaluation and cognitive tests of individuals with no reported food allergy (n = 12,444), misconceived food allergy (n = 64) and true food allergy (n = 84) were compared. FINDINGS The prevalence of atopic co-morbidities was higher in recruits reporting compared to those not reporting food allergy while the rate of other co-morbidities was comparable. Anxiety disorder was diagnosed significantly more in individuals who reported food allergy (4·1%) compared to those who did not (1·7%) (p = 0·04). Further analysis revealed that this diagnosis was concentrated in individuals with misconceived (8/64, 12·5%) compared to true food allergy (2/84, 2·4%), (p = 0·02). Patients with misconceived food allergy were mostly of female sex, had lower Combined Intellectual-Education scores compared to patients with true (p = 0·001) and no reported food allergy (p = 0·01), and required the longest mean evaluation time (147·6 ± 109·4 days). INTERPRETATION Patients with misconceived food allergy have higher rates of anxiety disorder and are often from a lower educational level and of female sex. Medical and educational attention is required to improve care of this specific population. FUNDING The research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D).
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Affiliation(s)
- Liat Nachshon
- Allergy clinic, Israel Defense Forces Medical Corps, Israel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Corresponding author.
| | | | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Yitzhak Katz
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
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26
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Nachshon L, Zipper O, Levy MB, Goldberg MR, Epstein-Rigby N, Elizur A. Subjective oral symptoms are insufficient predictors of a positive oral food challenge. Pediatr Allergy Immunol 2021; 32:342-348. [PMID: 33040398 DOI: 10.1111/pai.13392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Subjective oral symptoms, especially if recurrent, might lead to termination of an oral food challenge (OFC) for fear of a subsequent severe reaction. METHODS In a single-center retrospective cohort study, oral food challenges to milk, egg, peanut, sesame, or tree nuts performed between January 2016 and January 2018 in patients aged ≥3 years, at the Institute of Allergy, Immunology and Pediatric Pulmonology in Shamir Medical Center, were analyzed. Subjective oral symptoms during the challenge were documented, and their association with the challenge outcome was examined. RESULTS A total of 323 patients underwent 652 oral food challenges to the investigated foods (milk, 71; egg, 22; peanut, 48; sesame, 24; and tree nuts, 487). Subjective oral symptoms were experienced in 237 (36.3%) of all OFCs performed, and their rate was comparable across most foods tested. The rate of positive challenges was significantly higher when subjective oral symptoms were experienced during the challenge than when they were not (69.6% vs 30.4%, respectively, P < .001). However, the false-positive rate of such symptoms in predicting a positive food challenge was 30.3% for all foods; peanut, 40%; sesame, 27.3%; milk, 35.5%; egg, 33%; and tree nuts, 28.4%. Overall, subjective oral symptoms (SOS) provided sensitivity of 56.7, specificity 80.4, PPV 69.6, and NPV 69.0 for predicting OFC outcome. Importantly, reactions during positive challenges with and without subjective oral symptoms were comparable to severity. CONCLUSIONS Continuing OFCs with subjective oral symptoms is recommended for it will prevent false-positive results in a third of cases without increasing patients' risk.
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Affiliation(s)
- Liat Nachshon
- Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Zipper
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | - Michael R Goldberg
- Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigby
- Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | - Arnon Elizur
- Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Morag I, Barkai E, Wazana Y, Elizur A, Levkovitz Stern O, Staretz-Chacham O, Pinchevski-Kadir S, Ofek Shlomai N. Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia. Front Pediatr 2021; 9:780518. [PMID: 34912762 PMCID: PMC8667805 DOI: 10.3389/fped.2021.780518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD). Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use. Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency. Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.
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Affiliation(s)
- Iris Morag
- The Edmond and Lily Safra Children Hospital, Shebe Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Barkai
- Faculty of Management, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Wazana
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Shamir Medical Center, Institute of Allergy, Immunology and Pediatric Pulmonology, Zerifin, Israel
| | - Orly Levkovitz Stern
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
| | - Orna Staretz-Chacham
- Metabolic Clinic, Pediatric Division, Soroka Medical Center, Ben-Gurion University, Be'er Sheva, Israel
| | - Shiran Pinchevski-Kadir
- The Edmond and Lily Safra Children Hospital, Shebe Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
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28
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Goldberg MR, Mor H, Magid Neriya D, Magzal F, Muller E, Appel MY, Nachshon L, Borenstein E, Tamir S, Louzoun Y, Youngster I, Elizur A, Koren O. Microbial signature in IgE-mediated food allergies. Genome Med 2020; 12:92. [PMID: 33109272 PMCID: PMC7592384 DOI: 10.1186/s13073-020-00789-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Multiple studies suggest a key role for gut microbiota in IgE-mediated food allergy (FA) development, but to date, none has studied it in the persistent state. METHODS To characterize the gut microbiota composition and short-chain fatty acid (SCFAs) profiles associated with major food allergy groups, we recruited 233 patients with FA including milk (N = 66), sesame (N = 38), peanut (N = 71), and tree nuts (N = 58), and non-allergic controls (N = 58). DNA was isolated from fecal samples, and 16S rRNA gene sequences were analyzed. SCFAs in stool were analyzed from patients with a single allergy (N = 84) and controls (N = 31). RESULTS The gut microbiota composition of allergic patients was significantly different compared to age-matched controls both in α-diversity and β-diversity. Distinct microbial signatures were noted for FA to different foods. Prevotella copri (P. copri) was the most overrepresented species in non-allergic controls. SCFAs levels were significantly higher in the non-allergic compared to the FA groups, whereas P. copri significantly correlated with all three SCFAs. We used these microbial differences to distinguish between FA patients and non-allergic healthy controls with an area under the curve of 0.90, and for the classification of FA patients according to their FA types using a supervised learning algorithm. Bacteroides and P. copri were identified as taxa potentially contributing to KEGG acetate-related pathways enriched in non-allergic compared to FA. In addition, overall pathway dissimilarities were found among different FAs. CONCLUSIONS Our results demonstrate a link between IgE-mediated FA and the composition and metabolic activity of the gut microbiota.
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Affiliation(s)
- Michael R Goldberg
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Hadar Mor
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Dafna Magid Neriya
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Faiga Magzal
- MIGAL-Galilee Research Institute, Kiryat Shmona, Israel
- Tel-Hai College, Upper Galilee, Israel
| | - Efrat Muller
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Michael Y Appel
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Liat Nachshon
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Borenstein
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Santa Fe Institute, Santa Fe, NM, USA
| | - Snait Tamir
- MIGAL-Galilee Research Institute, Kiryat Shmona, Israel
- Tel-Hai College, Upper Galilee, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar-Ilan University, Ramat-Gan, Israel
| | - Ilan Youngster
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Arnon Elizur
- Yitzhak Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Omry Koren
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Epstein‐Rigbi N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Quality of life of children aged 8-12 years undergoing food allergy oral immunotherapy: Child and parent perspective. Allergy 2020; 75:2623-2632. [PMID: 32350869 DOI: 10.1111/all.14350] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 01/11/2020] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) for food allergy improves the quality of life (QOL) of children from parental perspective but little is known about the child perception. METHODS The Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) was administered to children aged 8-12 years, and the FAQLQ-Parent Form (FAQLQ-PF) was administered to their parents at the start of OIT for milk, egg, peanut, sesame, or tree nuts, at the end of up-dosing, and after 6 months of follow-up. Food-allergic children not undergoing OIT served as controls. Children QOL scores were compared to their parents. RESULTS The total FAQLQ-CF score of 103 children undergoing OIT improved significantly from start of OIT (median (IQR); 4.8, 3.8-5.7) to end of up-dosing (3.9, 3-5.2) (P < .001). A greater improvement was noted in the 56 children who reached a follow-up visit, from 5.0 (3.7-5.8) at OIT start to 3.1 (1.8-5.0) on follow-up, (P < .001). In contrast, FAQLQ-CF scores of control patients improved mildly and nonsignificantly between the two time points from 5.3 (4.3-5.7) to 4.8 (3.6-6.0), (P = .13). The improvement in the total FAQLQ-CF scores from OIT start to follow-up was significantly greater compared to the change in control patients during observation (P = .015). Parents reported better QOL scores compared to their children at all stages of OIT (start 4.0, 3.2-5, P = .004; end of up-dosing 2.9, 1.9-4.7, P = .04; follow-up 2.2, 1.6-3.6, P = .003). CONCLUSIONS QOL of food-allergic children undergoing OIT improves significantly compared to controls. Parents perceive QOL to be better than the perception of the children.
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Affiliation(s)
- Na'ama Epstein‐Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
| | - Michael R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Pediatrics Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Medicine Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Pediatrics Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Nachshon L, Schwartz N, Tsviban L, Levy MB, Goldberg MR, Epstein-Rigby N, Katz Y, Elizur A. Patient Characteristics and Risk Factors for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract 2020; 9:185-192.e3. [PMID: 32750430 DOI: 10.1016/j.jaip.2020.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is effective in desensitizing food-allergic patients but adverse events limit its applicability. OBJECTIVE To identify risk factors for home epinephrine-treated reactions during the build-up phase of OIT. METHODS A retrospective cohort study of patients older than 3.7 years undergoing OIT for food allergy at Shamir Medical Center between April 2010 and March 2019. All patients with a final disposition of full desensitization, partial desensitization, or failure were analyzed. Risk factors and outcome of home epinephrine-treated reactions were examined. RESULTS A total of 1037 patients (mean age, 8.4 years) who underwent 1100 OIT treatments (milk, n = 710; peanut, n = 213; egg, n = 50; sesame, n = 57; and tree nuts, n = 70) reached a final disposition and were analyzed. Full desensitization was achieved in 763 (69.4%) treatments, partial desensitization in 219 (19.9%), and 118 (10.7%) failed. Epinephrine was administered to 121 patients (11.7%) during 10.8% of treatments. Milk OIT was a significant risk factor both for epinephrine-treated reactions (odds ratio, 2.15; 95% CI, 1.25-3.68) and for low rate of full desensitization following such reactions compared with nonmilk OIT (18.2% vs 73.9%, respectively; P < .0001). Risk factors during milk OIT included asthma, pre-OIT reaction severity, lower tolerated dose, and epinephrine-treated reactions during clinic updosing, whereas risk factors during nonmilk OIT were male sex and lower tolerated dose. CONCLUSIONS Milk OIT poses a significant risk for home epinephrine-treated reactions during OIT and for poor outcome following such reactions. Together with the additional risk factors described for both milk and nonmilk OIT, this information may assist in patient selection for treatment.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Lior Tsviban
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigby
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Elizur A, Goldberg MR. Pro: Skin prick testing with fresh foods. Ann Allergy Asthma Immunol 2020; 124:441-442. [PMID: 32336464 DOI: 10.1016/j.anai.2019.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
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Levy M, Goldberg M, Nachshon L, Epstein-Rigbi N, Appel M, Katz Y, Elizur A. Experience with Omalizumab in Patients with Severe Cow's Milk Allergy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.445] [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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Goldberg M, Appel M, Nachshon L, Huang PH, Epstein-Rigbi N, Levy M, Lidholm J, Elizur A. The Diagnostic Utility of IgE to Ses i 1 Singly, and In Combination with Basophil Activation and Skin Prick Testing For the Diagnosis Of Sesame Food Allergy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.163] [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: 11/29/2022]
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Affiliation(s)
- George du Toit
- Division of Asthma, Allergy, and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St Thomas' NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Arnon Elizur
- Institute of Allergy, Department of Pediatrics, Immunology and Pediatric Pulmonology, Sackler School of Medicine, Tel Aviv University, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California.,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California.,Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California
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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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Nachshon L, Goldberg MR, Levy MB, Epstein-Rigbi N, Appel MY, Katz Y, Elizur A. Cross-desensitization to goat and sheep milk following cow's milk oral immunotherapy. J Allergy Clin Immunol Pract 2019; 8:358-360.e3. [PMID: 31425836 DOI: 10.1016/j.jaip.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael Y Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Nachshon L, Goldberg MR, Levy MB, Appel MY, Epstein-Rigbi N, Lidholm J, Holmqvist M, Katz Y, Elizur A. Efficacy and Safety of Sesame Oral Immunotherapy-A Real-World, Single-Center Study. J Allergy Clin Immunol Pract 2019; 7:2775-2781.e2. [PMID: 31150789 DOI: 10.1016/j.jaip.2019.05.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presence of sesame in Western diet is increasing, making its avoidance by sesame-allergic patients more challenging. OBJECTIVE To report the efficacy and safety of sesame oral immunotherapy (OIT). METHODS Sixty patients aged 4 years or older, diagnosed as sesame-allergic on the basis of a positive oral food challenge, were consecutively enrolled into OIT between November 2014 and November 2017. Fifteen patients with sesame allergy, based on a positive oral food challenge or a recent immediate reaction, and a positive skin prick test result or specific IgE, continued sesame elimination and served as observational controls. Immunologic parameters were measured in a subset (OIT, n = 16; controls, n = 11) at the start and end of the study. Fully desensitized patients continued daily consumption of 1200 mg sesame protein and challenged with 4000 mg after more than 6 months. RESULTS Fifty-three OIT-treated patients (88.4%) were fully desensitized to sesame, compared with 0% of controls. Four additional patients (total 57 of 60 = 95%) were desensitized to more than 1000 mg protein. Reactions occurred in 4.7% of hospital doses and 1.9% of home doses. Epinephrine-treated reactions occurred in 16.7% of patients for hospital and 8.3% for home doses. Significant decreases in rSes i 1 IgE (P = .007) and basophil reactivity (P = .001) and increases in sesame and rSes i 1 IgG4 (P = .001) occurred in OIT-treated patients but not in controls. Forty-seven patients desensitized to 4000 mg were evaluated more than 6 months after reaching maintenance. Only mild reactions were reported during maintenance, and all passed the 4000-mg challenge. CONCLUSIONS Sesame-OIT is an effective alternative to sesame avoidance in allergic patients. The potential for adverse events necessitates its performance in specialized centers.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael Y Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | | | | | - Yitzhak Katz
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Pontoppidan B, Lidholm J, Goldberg MR. Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study. Lancet Child Adolesc Health 2019; 3:312-321. [PMID: 30926371 DOI: 10.1016/s2352-4642(19)30029-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND The safety and efficacy of oral immunotherapy for tree nut allergy has not been demonstrated to date, and its effectiveness is complicated by the high prevalence of co-allergies to several nuts. This study aimed to investigate the use of walnut oral immunotherapy in the desensitisation of walnut and additional tree nuts in patients who are co-allergic to several nuts. METHODS In a single-centre, prospective cohort study (the Nut Co-Reactivity ACquiring Knowledge for Elimination Recommendations study) at the Institute of Allergy, Immunology, and Paediatric Pulmonology at the Yitzhak Shamir Medical Centre, we recruited patients aged 4 years or older who were allergic to walnut, with or without co-allergy to pecan, hazelnut, and cashew. The diagnosis of each food allergy was based on a positive skin prick test or specific serum IgE (≥0·35 kUA/L) to the corresponding nut together with a positive oral food challenge, unless an immediate (within 2 h of exposure) reaction in the past year had been documented. Patients with uncontrolled asthma or a medical contraindication to receive adrenaline were excluded. Patients were assigned to walnut oral immunotherapy or the control group (observation and strict dietary exclusion) on the basis of the order of presentation to the clinic. Oral immunotherapy began with a 4-day dose-escalation phase to establish the single highest tolerated dose, which was consumed daily at home for 24 days; subsequent monthly dose escalations were repeated until 4000 mg walnut protein was achieved. Patients who were desensitised to walnut continued to consume 1200 mg walnut protein daily for 6 months as maintenance. The primary outcome was walnut desensitisation (passing an oral food challenge with 4000 mg of walnut protein) at the end of the study, analysed by intention to treat. In patients who were co-allergic to pecan, hazelnut, and cashew, the proportion who achieved cross-desensitisation to these nuts in addition to walnut desensitisation was examined. FINDINGS 73 patients with a walnut allergy were enrolled between May 15, 2016, and Jan 14, 2018. 49 (89%) of 55 patients in the oral immunotherapy group were desensitised to walnut compared with none of 18 patients in the control group (odds ratio 9·2, 95% CI 4·3-19·5; p<0·0001). Following walnut desensitisation, all patients who were co-allergic to pecan (n=46) were also desensitised to pecan. Additionally, 18 (60%) of 30 patients who were co-allergic to hazelnut or cashew, and 14 (93%) of 15 patients who were co-allergic to hazelnut alone, were either fully desensitised or responded to treatment. 47 (85%) of 55 patients had an adverse reaction (mostly grade 1 or 2) during up-dosing in the clinic; eight patients required intramuscular epinephrine in response to a dose at home. Of 45 patients who had follow-up data for the maintenance phase, all maintained walnut desensitisation and one patient required epinephrine during this period. INTERPRETATION Walnut oral immunotherapy can induce desensitisation to walnut as well as cross-desensitisation to pecan and hazelnut in patients who have tree nut co-allergies, with a reasonable safety profile. A low daily dose of the allergen maintains desensitisation. FUNDING None.
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Affiliation(s)
- Arnon Elizur
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel; Department of Paediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael Y Appel
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel
| | - Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel
| | | | | | - Michael R Goldberg
- Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel
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Elizur A, Appel M, Nachshon L, Levy MB, Epstein-Rigbi N, Pontoppidan B, Lidholm J, Goldberg M. Deciphering the Walnut-Pecan Allergy Paradigm Using Component Resolved Diagnostics. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.785] [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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Goldberg M, Gershon H, Appel M, Nachshon L, Levy MB, Youngster I, Elizur A, Koren O. Distinctive Gut Microbiota Signature in Persistent IgE-mediated Food Allergy. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Sinai T, Goldberg MR, Nachshon L, Amitzur-Levy R, Yichie T, Katz Y, Monsonego-Ornan E, Elizur A. Reduced Final Height and Inadequate Nutritional Intake in Cow's Milk-Allergic Young Adults. J Allergy Clin Immunol Pract 2018; 7:509-515. [PMID: 30529059 DOI: 10.1016/j.jaip.2018.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Growth impairment was previously described in milk-allergic children but was not examined in adults on reaching final height. OBJECTIVES To investigate the dietary intake and final stature of young adults with IgE-mediated cow's milk allergy (IgE-CMA) as compared with nonallergic controls. METHODS Eighty-seven patients with IgE-CMA, median age 19.5 years (interquartile range [IQR], 17.3-22.7), and 36 control participants without food allergies, median age 22.7 years (IQR, 18.9-26.1), were studied. Anthropometric and nutritional data were collected. Age and gender z-scores were determined according to the Centers for Disease Control and Prevention growth charts. Nutrient intake assessment was based on dietary records. Individuals with conditions or treatments affecting bone metabolism or growth, other than asthma, were excluded. RESULTS Mean values of height z-scores were significantly reduced in CMA subjects compared with controls (-0.64 ± 0.9 vs -0.04 ± 0.7, P = .001). In contrast, no differences were found between the 2 groups in weight and body mass index z-scores. Patients with CMA had significantly lower intake of protein, and several essential vitamins (A, B12, and riboflavin) and minerals (calcium, potassium, phosphorus, magnesium, and zinc) compared with controls (P < .05), but the intakes of calories, carbohydrate, and fat were not significantly different between the 2 groups. Differences between actual and expected (based on midparental height) height z-scores were comparable in CMA subjects with or without asthma and between those with and without additional food allergies. CONCLUSIONS Young adults who have CMA from infancy are at risk of not reaching their growth potential. Growth and nutritional monitoring and appropriate dietary intervention are of particular importance in these at-risk individuals.
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Affiliation(s)
- Tali Sinai
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Roni Amitzur-Levy
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Tamar Yichie
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Efrat Monsonego-Ornan
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel.
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Goldberg MR, Nachshon L, Sinai T, Epstein-Rigbi N, Oren Y, Eisenberg E, Katz Y, Elizur A. Risk factors for reduced bone mineral density measurements in milk-allergic patients. Pediatr Allergy Immunol 2018; 29:850-856. [PMID: 30099766 DOI: 10.1111/pai.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Earlier studies noted that young adults with IgE-mediated cow's milk allergy (IgE-CMA) have significantly lower bone mineral density (BMD) than age- and gender-matched controls. We sought to identify additional risk factors contributing to the low BMD in IgE-CMA patients. METHODS Postpubertal (defined by Tanner stage V) IgE-CMA patients (n = 78; 16- to 30-year-old females and 17.5- to 30-year-old males) were evaluated prospectively for BMD using a DXA scan, serum values of bone turnover factor, and dietary and lifestyle questionnaires. Patients receiving > 2 short courses of systemic steroid treatments were excluded. RESULTS Abnormal BMD measurements (T- or Z-scores < -1.0) of the lumbar vertebrae, femoral neck, or hip were noted in 60 patients, while normal BMD values were present in 18 patients, despite similarly decreased calcium intakes between the groups (P = 0.92). Patients with abnormal BMD were more likely to be asthmatic (P = 0.014), have a lower weight z-score (P = 0.007), have a decreased percent caloric intake derived from fat (P = 0.01), and have an increased carbohydrate intake (P = 0.03), in comparison with the normal-BMD group. Serum values of bone turnover were similar between the groups. On multivariate regression analysis, only asthma significantly (P = 0.006) increased the risk for osteopenia and osteoporosis (OR 38.5, 95% CI 2.8-500). Fitting continuous z-scores into a regression model, both asthma and weight z-score were significant (adjusted r2 = 0.272). Asthma was significantly overrepresented in osteopenic and osteoporotic subpopulations while decreased weight only in patients with osteoporosis. CONCLUSIONS In the context of a low calcium intake, asthma and weight are independent risk factors for decreased BMD in IgE-CMA patients.
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Affiliation(s)
- Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel
| | - Tali Sinai
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel
| | - Yael Oren
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel
| | - Eli Eisenberg
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Beer Yaakov, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Taylor A, Mills D, Wang T, Ntalamagka N, Cummins SF, Elizur A. A Sperm Spawn-Inducing Pheromone in the Silver Lip Pearl Oyster (Pinctada maxima). Mar Biotechnol (NY) 2018; 20:531-541. [PMID: 29705863 DOI: 10.1007/s10126-018-9824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Pheromones are considered to play an important role in broadcast spawning in aquatic animals, facilitating synchronous release of gametes. In oysters, the sperm has been implicated as a carrier for the spawn-inducing pheromone (SIP). In hatchery conditions, male pearl oysters (Pinctata maxima) can be stimulated to spawn through a variety of approaches (e.g. rapid temperature change), while females can only be induced to spawn through exposure to conspecific sperm, thus limiting development of targeted pairing, required for genetic research and management. The capacity for commercial production and improvement of genetic lines of pearl oysters could be greatly improved with access to a SIP. In this study, we prepared and sequenced crude and semi-purified P. maxima sperm extracts that were used in bioassays to localise the female SIP. We report that the P. maxima SIP is proteinaceous and extrinsically associated with the sperm membrane. Bioactivity from pooled RP-HPLC fractions, but not individual fractions, suggests that the SIP is multi-component. We conclude that crude sperm preparations, as described in this study, can be used as a sperm-free inducer of female P. maxima spawning, which enables for a more efficient approach to genetic breeding.
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Affiliation(s)
- A Taylor
- Darwin Aquaculture Centre, Channel Island, Darwin, Northern Territory, 0800, Australia
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, 4558, Australia
| | - D Mills
- Darwin Aquaculture Centre, Channel Island, Darwin, Northern Territory, 0800, Australia
| | - T Wang
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, 4558, Australia
| | - N Ntalamagka
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, 4558, Australia
| | - S F Cummins
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, 4558, Australia
| | - A Elizur
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, 4558, Australia.
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Nachshon L, Goldberg MR, Katz Y, Levy MB, Elizur A. Long-term outcome of peanut oral immunotherapy-Real-life experience. Pediatr Allergy Immunol 2018; 29:519-526. [PMID: 29698554 DOI: 10.1111/pai.12914] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is currently recommended as a treatment option for peanut-allergic patients. Data regarding its long-term compliance and efficacy in real life are required. METHODS Peanut-allergic patients aged ≥4 years were enrolled in a single-center clinical OIT program. Buildup to 3000 mg peanut protein was performed. Patients reaching this dose before or after 12/2014 were instructed to consume 3000 or 1200 mg daily, respectively. Patients were followed ≥6 months after reaching maintenance and rechallenged to 3000 mg. RESULTS Of the 145 patients studied, 113 (77.9%) were fully desensitized to 3000 mg and 133 (91.7%) were desensitized to ≥300 mg. 21/145 patients (14.5%) required adrenaline for home-dose reactions during buildup. Non-anaphylactic gastrointestinal symptoms, experienced by 9 patients (6.2%), reversed with dose reduction. Of the 111 patients available for analysis 6 months after reaching 3000 mg, 97 (87.4%) continued regular peanut consumption. Only 2/111 patients (1.8%) required adrenaline over the long-term (median, range; 18, 6-75 months) follow-up. Adherence to treatment was significantly higher in patients consuming 1200 mg (73/76, 96.1%) vs those consuming 3000 mg (24/35, 72.2%), (P = .001). A higher maintenance dosage and home adrenaline requirement during buildup predicted adherence cessation (OR 12.5, P = .001; and OR 7.8, P = .02, respectively). 63/64 patients (98.4%) consuming 1200 mg maintenance dose were successfully rechallenged to 3000 mg. CONCLUSIONS This real-life experience demonstrates the efficacy of peanut OIT long-term. A lower maintenance dose minimized treatment cessation while maintaining desensitization. OIT should be performed in qualified centers given the prevalence of adverse reactions, particularly during buildup.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Appel MY, Nachshon L, Elizur A, Levy MB, Katz Y, Goldberg MR. Reply to “On the reliability of the
CD
123‐endowed basophil activation test (
BAT
) and its application in food allergy”. Clin Exp Allergy 2018; 48:1071-1072. [DOI: 10.1111/cea.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Michael Y. Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - Yitzhak Katz
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
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Epstein-Rigbi N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Quality of Life of Food-Allergic Patients Before, During, and After Oral Immunotherapy. J Allergy Clin Immunol Pract 2018; 7:429-436.e2. [PMID: 30129441 DOI: 10.1016/j.jaip.2018.06.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/13/2018] [Accepted: 06/14/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) for food allergy is demanding but data on patients' quality of life (QOL) throughout the process are limited. OBJECTIVE To characterize changes in QOL of food-allergic patients during and after OIT. METHODS In a prospective cohort study, the Food Allergy Quality of Life Questionnaire-Parental Form (FAQLQ-PF) was administered to parents of 191 consecutive children aged 4 to 12 years undergoing OIT for food allergy. Questionnaires were administered at OIT initiation, mid up-dosing, upon reaching maintenance, and after 6 months of follow-up. Age- and sex-matched food-allergic children (n = 48) not undergoing OIT served as controls. RESULTS FAQLQ-PF scores had significantly improved (decreased) from OIT initiation to reaching full maintenance (emotional impact [EI], 3.66-3.32, P = .001; food anxiety [FA], 3.90-3.32, P < .001; social and dietary limitation [SDL], 3.50-2.94, P < .001; and total score, 3.69-3.19, P < .001) and partial maintenance, whereas no change was noted in control patients. Worse baseline QOL, single food allergy, and a younger age predicted greater QOL improvement. Of the 85 (88.5%) patients who completed the FAQLQ-PF at mid up-dosing and for whom QOL deteriorated, a significant improvement was noted upon reaching maintenance. Additional significant improvement in QOL was observed in the 95 (88.8%) patients who completed the FAQLQ-PF 6 months after reaching maintenance (EI, 3.414-2.993, P = 0.049; FA, 3.37-2.593, P = .001; SDL, 2.989-2.264, P = .001; and total score, 3.266-2.614, P = .001). CONCLUSION The QOL of food-allergic children improves significantly upon reaching OIT maintenance, with additional improvement 6 months later. The detrimental effect of OIT on some patients' QOL during up-dosing is reversed upon reaching maintenance.
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Affiliation(s)
- Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf Harofeh Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Appel MY, Nachshon L, Elizur A, Levy MB, Katz Y, Goldberg MR. Evaluation of the basophil activation test and skin prick testing for the diagnosis of sesame food allergy. Clin Exp Allergy 2018; 48:1025-1034. [DOI: 10.1111/cea.13174] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Y. Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - L. Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - A. Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - M. B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - Y. Katz
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - M. R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
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Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Golobov K, Goldberg MR. NUT Co Reactivity - ACquiring Knowledge for Elimination Recommendations (NUT CRACKER) study. Allergy 2018; 73:593-601. [PMID: 29127694 DOI: 10.1111/all.13353] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ambiguities exist regarding the diagnosis of tree-nut allergy, necessitating either their elimination or the performance of oral food challenges (OFCs). OBJECTIVE To examine the coincidences of allergies among tree-nuts and improve diagnostic testing to minimize the need for OFC. METHODS Eighty-three patients prospectively evaluated for walnut, pecan, cashew, pistachio, hazelnut, and almond allergy. A history of previous reactions was obtained, and standardized skin prick tests (SPTs) using finely ground tree-nut solution and basophil activation tests (BAT) were performed. Patients underwent OFC for each tree-nut they eliminated and to which a reaction in the previous 2 years was not documented. RESULTS While most patients were sensitized to 5-6 tree-nuts, over 50% were allergic to only 1-2 tree-nuts. The highest rate of allergy in sensitized patients was observed for walnut (74.6%) and cashew (65.6%). The rate of co-allergy for most tree-nuts was <30%. Two-thirds of walnut- and cashew-allergic patients were also allergic to pecan and pistachio, respectively, while all pecan- and pistachio-allergic patients were allergic to walnut and cashew, respectively. Receiver-operating characteristic analysis for SPT and BAT was tree-nut dependent and yielded area under the curve (AUC) values ranging from 0.75 to 0.94. Knowledge of coincident allergies in these pairs along with the combination of SPT and BAT correctly distinguished allergic from tolerant patients for walnut (87%), pecan (66%), cashew (71%), and pistachio (79%). CONCLUSION The data presented here should assist in differentiating between allergic and tolerant patients, decrease the need for OFC, and allow for appropriate elimination recommendations.
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Affiliation(s)
- A. Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Zerifin Israel
| | - M. Y. Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - L. Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - N. Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - K. Golobov
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
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Nachshon L, Goldberg MR, Levy MB, Epstein-Rigbi N, Elizur A. Long Term outcome of Peanut Oral Immunotherapy (OIT) in Patients Unable to Reach Maintenance Goal. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.755] [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: 10/18/2022]
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