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Allen KJ, Chiavaroli N, Reid KJ. Successful return to work in anaesthesia after maternity leave: a qualitative study. Anaesthesia 2024. [PMID: 38177064 DOI: 10.1111/anae.16231] [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] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
Returning to work after maternity leave poses significant challenges, with potential long-term implications including decreased engagement or attrition of clinicians. Many quantitative studies have identified challenges and supports for women during pregnancy, maternity leave and re-entry to clinical practice. This qualitative study explored the experiences of anaesthetists returning to clinical work after maternity leave, to identify influential factors with the aim of providing a framework to assist planning re-entry. We conducted semi-structured interviews with 15 anaesthetists. Attendees of a re-entry programme were invited to participate, with purposive sampling and snowball recruitment to provide diversity of location and training stage, until data saturation was reached at 13 interviews. Five themes were identified: leave duration; planning re-entry; workplace culture; career impact and emotional impact. Leave duration was influenced by concerns about deskilling, but shorter periods of leave had logistical challenges, including fatigue. Most participants started planning to return to work with few or no formal processes in the workplace. Workplace culture, including support for breastfeeding, was identified as valuable, but variable. Participants also experienced negative attitudes on re-entry, including difficulty accessing permanent work, with potential career impacts. Many participants identified changes to professional and personal identity influencing the experience with emotional sequelae. This research describes factors which may be considered to assist clinicians returning to work after maternity leave and identifies challenges, including negative attitudes, which may pose significant barriers to women practising in anaesthesia and may contribute to lack of female leadership in some workplaces.
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Affiliation(s)
- K J Allen
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - N Chiavaroli
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Australian Council for Educational Research, Melbourne, Australia
| | - K J Reid
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Vaios EJ, Shenker RF, Hendrickson P, Wan Z, Niedzwiecki D, Winter SF, Dietrich J, Salama AKS, Clarke J, Allen KJ, Mullikin TC, Floyd SR, Kirkpatrick JP, Reitman ZJ. Intracranial Control with Combined Dual Immune-Checkpoint Blockade and SRS for Melanoma and NSCLC Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:S171-S172. [PMID: 37784428 DOI: 10.1016/j.ijrobp.2023.06.637] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) It is unknown whether the use of dual immune-checkpoint inhibition (D-ICI) combined with stereotactic radiosurgery (SRS) affects local control of brain metastases (BMs). We sought to characterize the efficacy of SRS and D-ICI in patients with BMs in a large, single-institution cohort. MATERIALS/METHODS Patients with melanoma and non-small cell lung cancer (NSCLC) BMs treated with SRS from January 1, 2016 to August 1, 2022 were evaluated. Patients were stratified by treatment with D-ICI versus single ICI (S-ICI). Concurrent ICI was defined as ICI given within four weeks of SRS. Local recurrence (LR), intracranial progression (IP), and overall survival (OS) were estimated using competing risk and Kaplan-Meier analyses. IP included both local and distant intracranial recurrence. RESULTS One thousand seven hundred four SRS-treated BMs from 288 patients met inclusion criteria. 55% of patients were symptomatic from their BMs at presentation. Median age, KPS, number of lesions, and SRS courses were 64 (Q1Q3:56-70.5), 90 (80-90), 2 (1-4), and 1 (1-2), respectively. One hundred twenty-eight (44%) melanoma and 160 (56%) NSCLC patients were included. 82 (28.5%), 129 (44.8%), and 77 (26.7%) patients were treated with D-ICI, S-ICI, or SRS alone. Median SRS dose, fractions, and PTV were 20 (Q1Q3:20-25), 1 (1-5), and 0.3cc3 (0.1-1.2). The median follow-up was 14.3 months. One hundred twenty-seven (7.45%) BMs recurred post-SRS and the median time to LR was 4.8 months (Q1Q3:3.0-9.2). On competing risk analysis, LR was significantly reduced with D-ICI (HR: 0.452, p = 0.0024), but not with S-ICI (HR: 0.693, p = 0.0596) compared to SRS alone. The 1-year LR was 3.77% (95% CI = 2.19-6.00), 6.8% (5.19-8.70), and 8.96% (6.48-11.93) with D-ICI, S-ICI, and SRS alone. The median time to IP was 4.1 months (Q1Q3 = 2.9-9.5). On competing risk analysis, IP was significantly reduced with D-ICI (HR = 0.638, p = 0.031), but not with S-ICI (HR = 0.756, p = 0.106) compared to SRS alone. 1-year IP was 40.05% (95% CI = 29.14-50.70), 51.86% (42.78-60.19), and 58.49% (46.30-68.84) with D-ICI, S-ICI, and SRS alone. Concurrent delivery of D-ICI and SRS significantly reduced IP (HR = 0.463, p = 0.0071), whereas other combinations of timing and ICI did not reach significance. Median OS was 11.9 months after SRS. On Kaplan Meier analysis, OS was significantly improved with D-ICI (HR = 0.616, 95% CI = 0.412-0.923, p = 0.019), but not with S-ICI (HR = 0.877, 95% CI = 0.633-1.217, p = 0.433) compared to SRS alone. Hospitalizations (p = 0.021) and immune-related adverse events (irAEs) (p<0.001) were increased with D-ICI. Any grade radiation necrosis (RN) was also increased with D-ICI (p = 0.013), but neurologic adverse events were comparable across cohorts (p = 0.572). CONCLUSION D-ICI combined with SRS was associated with improved local control, intracranial control, and overall survival compared to SRS alone, whereas S-ICI was not associated with an improvement in these outcomes. However, D-ICI was also associated with increased risks of irAEs and RN.
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Affiliation(s)
- E J Vaios
- Duke University, Durham, NC; Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - R F Shenker
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - P Hendrickson
- Department of Radiation Oncology, Duke University, Durham, NC
| | - Z Wan
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - D Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - S F Winter
- Massachusetts General Hospital, Boston, MA
| | - J Dietrich
- Massachusetts General Hospital, Boston, MA
| | | | - J Clarke
- Duke University, Department of Medical Oncology, Durham, NC
| | - K J Allen
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - T C Mullikin
- Department of Radiation Oncology, Duke University, Rochester, MN
| | - S R Floyd
- Duke University Medical Center, Durham, NC
| | - J P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Z J Reitman
- Harvard Radiation Oncology Program, Boston, MA
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Bull KE, Allen KJ, Hodgkinson JE, Peachey LE. The first report of macrocyclic lactone resistant cyathostomins in the UK. Int J Parasitol Drugs Drug Resist 2023; 21:125-130. [PMID: 36940551 PMCID: PMC10036890 DOI: 10.1016/j.ijpddr.2023.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 10/27/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
In recent years, resistance to the benzimidazole (BZ) and tetrahydropyrimidine (PYR) anthelmintics in global cyathostomin populations, has led to reliance on the macrocyclic lactone drugs (ML-of which ivermectin and moxidectin are licensed in horses) to control these parasites. Recently, the first confirmed case of resistance to both ivermectin (IVM) and moxidectin (MOX) was reported in the USA in yearlings imported from Ireland. This suggests that ML resistance in cyathostomins has emerged, and raises the possibility that regular movement of horses may result in rapid spread of ML resistant cyathostomins. Resistance may go undetected due to a lack of surveillance for ML efficacy. Here, we report anthelmintic efficacies in cyathostomins infecting UK Thoroughbreds on four studs. Faecal egg count reduction tests (FECRT) were performed to define resistance (resistance = FECR <95% lower credible interval (LCI) < 90%). Stud A yearlings had FECRs of 36.4-78.6% (CI:15.7-86.3) after three IVM treatments, 72.6% (CI: 50.8-85.2) after MOX, and 80.8% (CI: 61.9-90.0) after PYR. Mares on stud A had a FECR of 97.8% (CI: 93.3-99.9) and 98% (95.1-99.4) after IVM and MOX treatment, respectively. Resistance to MLs was not found in yearlings or mares on studs B, C or D with FECR after MOX OR IVM treatment ranging from 99.8 to 99.9% (95.4-100); although yearlings on studs B, C and D all had an egg reappearance period (ERP) of six weeks for MOX and stud C had a four-week ERP for IVM. This study describes the first confirmed case of resistance to both licensed ML drugs on a UK Thoroughbred stud and highlights the urgent need for a) increased awareness of the threat of ML resistant parasites infecting horses, and b) extensive surveillance of ML efficacy against cyathostomin populations in the UK, to gauge the extent of the problem.
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Affiliation(s)
- K E Bull
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, UK.
| | - K J Allen
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, UK
| | - J E Hodgkinson
- Department of Infection Biology, Institute of Infection & Global Health, University of Liverpool, L3 5RF, UK
| | - L E Peachey
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, UK
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Fitzharris LE, Franklin SH, McConnell AK, Hezzell MJ, Allen KJ. Inspiratory muscle training for the treatment of dynamic upper airway collapse in racehorses: A preliminary investigation. Vet J 2021; 275:105708. [PMID: 34147643 DOI: 10.1016/j.tvjl.2021.105708] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 05/01/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022]
Abstract
Exercise-induced upper airway collapse (UAC) probably occurs when the stabilising muscles of the upper airway are unable to withstand the dramatic changes in airflow and pressure that occurs during exercise. In racehorses, the mainstay of treatment is surgical intervention. In human athletes, exercise-induced laryngeal obstruction has been treated successfully with inspiratory muscle training (IMT). The aims of this study were: (1) to assess the feasibility of IMT in racehorses; and (2) describe the exercising endoscopy findings pre- and post-IMT in racehorses diagnosed with dynamic UAC. Horses undergoing IMT wore a mask with an attached threshold-valve to apply an additional load during inspiration, creating a training stimulus with the purpose of increasing upper airway muscle strength. Each horse underwent IMT once daily, while standing in the stable, 5-6 days/week for 10 weeks. Endoscopy recordings were analysed in a blinded manner using an objective grading scheme and subjective pairwise analysis. Seventeen horses successfully completed the IMT protocol, with full information available for 10 horses. Objective grading analysis showed a lower grade of vocal fold collapse (6/9 horses), palatal instability (7/10 horses) and intermittent dorsal displacement of the soft palate (5/7 horses) post-IMT. Pairwise subjective analysis suggested better overall airway function post-IMT in 3/10 horses. The main limitations of this preliminary investigation were the low number of horses examined and lack of a control population. Further research is required to investigate the effects of IMT on upper airway muscle strength and to evaluate its efficacy for prevention and treatment of UAC.
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Affiliation(s)
- L E Fitzharris
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, UK.
| | - S H Franklin
- University of Adelaide, School of Animal and Veterinary Sciences, Roseworthy Campus, Mudla Wirra Rd, Roseworthy, SA 5371, Australia
| | | | - M J Hezzell
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, UK
| | - K J Allen
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, UK
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Allen KJ, Tennant KV, Franklin SH. Effect of inclusion or exclusion of epithelial cells in equine respiratory cytology analysis. Vet J 2019; 254:105405. [PMID: 31836172 DOI: 10.1016/j.tvjl.2019.105405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/11/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/25/2022]
Abstract
Published studies vary as to whether epithelial cells are included in differential counts for tracheal wash (TW) and bronchoalveolar lavage (BAL) cytology in horses. The aim of this study was to determine whether inclusion or exclusion of epithelial cells affects interpretation of airway cytology. Using criteria of >20% TW neutrophils, >10% BAL neutrophils and/or >5% BAL mast cells to indicate airway inflammation, there was a change in categorisation from 'normal' to 'abnormal' in 21%, 4% and 8% horses, respectively, when epithelial cells were excluded from differential counts. It is recommended that future equine respiratory research studies explicitly state whether epithelial cells are included or excluded in differential counts. A consensus on epithelial cell inclusion during cytology reporting is required.
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Affiliation(s)
- K J Allen
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK.
| | - K V Tennant
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
| | - S H Franklin
- Equine Health and Performance Centre, School of Animal and Veterinary Science, University of Adelaide, Roseworthy, South Australia 5371, Australia
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Allen KJ, Hull JH. Active or passive laryngeal closure. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. J. Allen
- Equine Hospital Bristol Vet School University of Bristol LangfordUK
| | - J. H. Hull
- Department of Respiratory Medicine Respiratory Biomedical Research Unit Royal Brompton and Harefield National Health Service Foundation Trust London UK
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Affiliation(s)
- L J Scrivens
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - J M R Goulding
- Department of Dermatology, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - K J Allen
- Health Services Management Centre, University of Birmingham, Birmingham, U.K
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Muraro A, Fernandez-Rivas M, Beyer K, Cardona V, Clark A, Eller E, Hourihane JO, Jutel M, Sheikh A, Agache I, Allen KJ, Angier E, Ballmer-Weber B, Bilò MB, Bindslev-Jensen C, Camargo CA, Cianferoni A, DunnGalvin A, Eigenmann PA, Halken S, Hoffmann-Sommergruber K, Lau S, Nilsson C, Poulsen LK, Rueff F, Spergel J, Sturm G, Timmermans F, Torres MJ, Turner P, van Ree R, Wickman M, Worm M, Mills ENC, Roberts G. The urgent need for a harmonized severity scoring system for acute allergic reactions. Allergy 2018; 73:1792-1800. [PMID: 29331045 DOI: 10.1111/all.13408] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 12/28/2017] [Indexed: 11/29/2022]
Abstract
The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three-grade-based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.
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Waidyatillake NT, Dharmage SC, Allen KJ, Bowatte G, Boyle RJ, Burgess JA, Koplin JJ, Garcia-Larsen V, Lowe AJ, Lodge CJ. Association between the age of solid food introduction and eczema: A systematic review and a meta-analysis. Clin Exp Allergy 2018; 48:1000-1015. [PMID: 29570230 DOI: 10.1111/cea.13140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/23/2017] [Revised: 02/25/2018] [Accepted: 03/03/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed. METHODS PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure. RESULTS A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, 2 case-controls, 1 cross-sectional study and 2 randomized controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema. CONCLUSIONS The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema.
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Affiliation(s)
- N T Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - K J Allen
- Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - G Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - R J Boyle
- Section of Paediatrics, Imperial College London, London, UK
| | - J A Burgess
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J J Koplin
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - V Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - C J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
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Waidyatillake NT, Dharmage SC, Allen KJ, Lodge CJ, Simpson JA, Bowatte G, Abramson MJ, Lowe AJ. Association of breast milk fatty acids with allergic disease outcomes-A systematic review. Allergy 2018; 73:295-312. [PMID: 28869762 DOI: 10.1111/all.13300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Dietary polyunsaturated fatty acids (PUFAs) have immunoregulatory properties. Breast milk is rich in PUFA, and it has been hypothesized that these PUFAs may be important in the aetiology of allergic diseases. Despite a growing body of evidence, the associations between breast milk PUFA and allergic disease have not previously been systematically reviewed. METHODS The search was performed in PubMed and EMBASE databases using breastfeeding, fatty acid and allergic disease terms. Two authors were involved in selecting papers for review according to the inclusion criteria and extracting information on study characteristics and measures of association. Only studies that reported numeric associations between concentration of breast milk fatty acids and allergic disease outcomes were included. RESULTS A total of 18 papers met the inclusion criteria, reporting results from 15 study populations. The majority were cohort studies (n=11), with data from only two case-control and two cross-sectional studies. Sample size varied between 30 and 352 participants, and follow-up time of the cohorts varied between 3 months and 14 years. Nine studies reported on eczema, seven reported on sensitization, and only five reported on asthma/wheeze. There was heterogeneity among studies in terms of presenting the association between PUFA and allergy; therefore, estimates could not be pooled. Only a few studies observed associations between n-3 and n-6 PUFAs and allergic disease, and the magnitude of this effect varied greatly. CONCLUSIONS There is insufficient evidence to suggest that colostrum or breast milk polyunsaturated fatty acids influence the risk of childhood allergic diseases.
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Affiliation(s)
- N. T. Waidyatillake
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Melbourne VIC Australia
| | - C. J. Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
| | - J. A. Simpson
- Biostatistics Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
| | - G. Bowatte
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
| | - M. J. Abramson
- School of Public Health & Preventive Medicine; Monash University; Melbourne VIC Australia
| | - A. J. Lowe
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
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Ashley SE, Tan HTT, Vuillermin P, Dharmage SC, Tang MLK, Koplin J, Gurrin LC, Lowe A, Lodge C, Ponsonby AL, Molloy J, Martin P, Matheson MC, Saffery R, Allen KJ, Ellis JA, Martino D. The skin barrier function gene SPINK5 is associated with challenge-proven IgE-mediated food allergy in infants. Allergy 2017; 72:1356-1364. [PMID: 28213955 DOI: 10.1111/all.13143] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 02/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND A defective skin barrier is hypothesized to be an important route of sensitization to dietary antigens and may lead to food allergy in some children. Missense mutations in the serine peptidase inhibitor Kazal type 5 (SPINK5) skin barrier gene have previously been associated with allergic conditions. OBJECTIVE To determine whether genetic variants in and around SPINK5 are associated with IgE-mediated food allergy. METHOD We genotyped 71 "tag" single nucleotide polymorphisms (tag-SNPs) within a region spanning ~263 kb including SPINK5 (~61 kb) in n=722 (n=367 food-allergic, n=199 food-sensitized-tolerant and n=156 non-food-allergic controls) 12-month-old infants (discovery sample) phenotyped for food allergy with the gold standard oral food challenge. Transepidermal water loss (TEWL) measures were collected at 12 months from a subset (n=150) of these individuals. SNPs were tested for association with food allergy using the Cochran-Mantel-Haenszel test adjusting for ancestry strata. Association analyses were replicated in an independent sample group derived from four paediatric cohorts, total n=533 (n=203 food-allergic, n=330 non-food-allergic), mean age 2.5 years, with food allergy defined by either clinical history of reactivity, 95% positive predictive value (PPV) or challenge, corrected for ancestry by principal components. RESULTS SPINK5 variant rs9325071 (A⟶G) was associated with challenge-proven food allergy in the discovery sample (P=.001, OR=2.95, CI=1.49-5.83). This association was further supported by replication (P=.007, OR=1.58, CI=1.13-2.20) and by meta-analysis (P=.0004, OR=1.65). Variant rs9325071 is associated with decreased SPINK5 gene expression in the skin in publicly available genotype-tissue expression data, and we generated preliminary evidence for association of this SNP with elevated TEWL also. CONCLUSIONS We report, for the first time, association between SPINK5 variant rs9325071 and challenge-proven IgE-mediated food allergy.
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Molloy J, Koplin JJ, Allen KJ, Tang MLK, Collier F, Carlin JB, Saffery R, Burgner D, Ranganathan S, Dwyer T, Ward AC, Moreno-Betancur M, Clarke M, Ponsonby AL, Vuillermin P. Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study. Allergy 2017; 72:1222-1231. [PMID: 28042676 DOI: 10.1111/all.13122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 12/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. OBJECTIVE To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. METHODS In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25(OH)D3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. RESULTS Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. CONCLUSIONS There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.
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Affiliation(s)
- J. Molloy
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - J. J. Koplin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - F. Collier
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - J. B. Carlin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
| | - R. Saffery
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - D. Burgner
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Paediatrics; Monash University; Clayton VIC Australia
| | - S. Ranganathan
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Respiratory Medicine; Royal Children's Hospital; Parkville VIC Australia
| | - T. Dwyer
- The George Institute for Global Health; University of Oxford; Oxford UK
| | - A. C. Ward
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
| | - M. Moreno-Betancur
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - M. Clarke
- Biological and Molecular Mass Spectrometry Facility; Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth Western Australia 6009
| | - A. L. Ponsonby
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - P. Vuillermin
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
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13
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Waidyatillake NT, Stoney R, Thien F, Lodge CJ, Simpson JA, Allen KJ, Abramson MJ, Erbas B, Svanes C, Dharmage SC, Lowe AJ. Breast milk polyunsaturated fatty acids: associations with adolescent allergic disease and lung function. Allergy 2017; 72:1193-1201. [PMID: 28027401 DOI: 10.1111/all.13114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND It has been hypothesized that n-3 PUFA in breast milk may assist immune and lung development. There are very limited data on possible long-term effects on allergic disease and lung function. The aim was to investigate associations of n-3 and n-6 PUFA levels in colostrum and breast milk with allergic disease and lung function at ages 12 and 18 years. METHODS Polyunsaturated fatty acids were measured in 194 colostrum samples and in 118 three-month expressed breast milk samples from mothers of children enrolled in the Melbourne Atopy Cohort (MACS) Study, a high-risk birth cohort study. Associations with allergic diseases, skin prick tests and lung function assessed at 12 and 18 years were estimated using multivariable regression. RESULTS Higher levels of n-3 but not n-6 PUFAs in colostrum were associated with a trend towards increased odds of allergic diseases, with strong associations observed for allergic rhinitis at 12 (OR = 5.69[95% CI: 1.83,17.60] per weight%) and 18 years (4.43[1.46,13.39]) and eczema at 18 years (9.89[1.44, 68.49]). Higher levels of colostrum n-3 PUFAs were associated with reduced sensitization (3.37[1.18, 9.6]), mean FEV1 (-166 ml [-332, -1]) and FEV1 /FVC ratio (-4.6%, [-8.1, -1.1]) at 12 years. CONCLUSION Higher levels of colostrum n-3 PUFAs were associated with increased risks of allergic rhinitis and eczema up to 18 years, and sensitization and reduced lung function at 12 years. As residual confounding may have caused these associations, they should be replicated, but these results could indicate that strategies that increase maternal n-3 PUFA intake may not aid in allergic disease prevention.
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Affiliation(s)
- N. T. Waidyatillake
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Australia
| | - R. Stoney
- Department of Nutrition and Dietetics; Redland Hospital and Wynnum Health Service; Metro South Health; Brisbane Australia
| | - F. Thien
- Respiratory Medicine; Eastern Health Box Hill Hospital; Monash University; Melbourne Australia
| | - C. J. Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
| | - J. A. Simpson
- Biostatistics Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Melbourne Australia
- Department of Allergy; Royal Childrens Hospital; Melbourne Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Australia
| | - M. J. Abramson
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - B. Erbas
- School of Psychology and Public Health; La Trobe University; Melbourne Australia
| | - C. Svanes
- Centre for International Health; University of Bergen; Bergen Norway
- Department of Occupational Medicine; Haukeland University Hospital; Bergen Norway
| | - S. C. Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
| | - A. J. Lowe
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Australia
- Murdoch Childrens Research Institute; Melbourne Australia
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14
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Ashley SE, Tan HTT, Peters R, Allen KJ, Vuillermin P, Dharmage SC, Tang MLK, Koplin J, Lowe A, Ponsonby AL, Molloy J, Matheson MC, Saffery R, Ellis JA, Martino D. Genetic variation at the Th2 immune gene IL13 is associated with IgE-mediated paediatric food allergy. Clin Exp Allergy 2017; 47:1032-1037. [PMID: 28544327 DOI: 10.1111/cea.12942] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/20/2017] [Accepted: 03/01/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Food allergies pose a considerable world-wide public health burden with incidence as high as one in ten in 12-month-old infants. Few food allergy genetic risk variants have yet been identified. The Th2 immune gene IL13 is a highly plausible genetic candidate as it is central to the initiation of IgE class switching in B cells. OBJECTIVE Here, we sought to investigate whether genetic polymorphisms at IL13 are associated with the development of challenge-proven IgE-mediated food allergy. METHOD We genotyped nine IL13 "tag" single nucleotide polymorphisms (tag SNPs) in 367 challenge-proven food allergic cases, 199 food-sensitized tolerant cases and 156 non-food allergic controls from the HealthNuts study. 12-month-old infants were phenotyped using open oral food challenges. SNPs were tested using Cochran-Mantel-Haenszel test adjusted for ancestry strata. A replication study was conducted in an independent, co-located sample of four paediatric cohorts consisting of 203 food allergic cases and 330 non-food allergic controls. Replication sample phenotypes were defined by clinical history of reactivity, 95% PPV or challenge, and IL13 genotyping was performed. RESULTS IL13 rs1295686 was associated with challenge-proven food allergy in the discovery sample (P=.003; OR=1.75; CI=1.20-2.53). This association was also detected in the replication sample (P=.03, OR=1.37, CI=1.03-1.82) and further supported by a meta-analysis (P=.0006, OR=1.50). However, we cannot rule out an association with food sensitization. Carriage of the rs1295686 variant A allele was also associated with elevated total plasma IgE. CONCLUSIONS AND CLINICAL RELAVANCE We show for the first time, in two independent cohorts, that IL13 polymorphism rs1295686 (in complete linkage disequilibrium with functional variant rs20541) is associated with challenge-proven food allergy.
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Affiliation(s)
- S E Ashley
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,The Hudson Institute, Monash Translational Health Precinct (MTHP), Monash University, Clayton, Australia
| | - H-T T Tan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - R Peters
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - K J Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia.,Institute of Inflammation and Repair, University of Manchester, UK
| | - P Vuillermin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Barwon Health, Child Health Research Unit, Geelong, Australia.,Deakin University, Waurn Ponds, Australia
| | - S C Dharmage
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - M L K Tang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - J Koplin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - A Lowe
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - A-L Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - J Molloy
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Barwon Health, Child Health Research Unit, Geelong, Australia.,Deakin University, Waurn Ponds, Australia
| | - M C Matheson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - R Saffery
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,The Hudson Institute, Monash Translational Health Precinct (MTHP), Monash University, Clayton, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - J A Ellis
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Australia
| | - D Martino
- Murdoch Childrens Research Institute, Royal Children's Hospital, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,University of Western Australia, Department of Paediatrics, Australia
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15
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Zurzolo GA, Peters RL, Koplin JJ, de Courten M, Mathai ML, Tye-Din JA, Tang MLK, Campbell DE, Ponsonby AL, Prescott SL, Gurrin L, Dharmage S, Allen KJ. The practice and perception of precautionary allergen labelling by the Australasian food manufacturing industry. Clin Exp Allergy 2017; 47:961-968. [DOI: 10.1111/cea.12923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
- G. A. Zurzolo
- Centre for Chronic Disease; College of Health and Biomedicine; Victoria University; Melbourne Australia
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
| | - R. L. Peters
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
| | - J. J. Koplin
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
| | - M. de Courten
- Centre for Chronic Disease; College of Health and Biomedicine; Victoria University; Melbourne Australia
| | - M. L. Mathai
- Centre for Chronic Disease; College of Health and Biomedicine; Victoria University; Melbourne Australia
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
| | - J. A. Tye-Din
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Immunology Division; The Walter and Eliza Hall Institute of Medical Research; Melbourne Australia
| | - M. L. K. Tang
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Australia
| | - D. E. Campbell
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Department of Allergy and Immunology; The Children's Hospital at Westmead; Westmead Australia
| | - A-L. Ponsonby
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
| | - S. L. Prescott
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- School of Paediatrics and Child Health; University of Western Australia; Perth Australia
| | - L. Gurrin
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
| | - S.C. Dharmage
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
| | - K. J. Allen
- Centre for Food & Allergy Research; Murdoch Childrens Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Australia
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
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16
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Martino DJ, Ashley S, Koplin J, Ellis J, Saffery R, Dharmage SC, Gurrin L, Matheson MC, Kalb B, Marenholz I, Beyer K, Lee Y, Hong X, Wang X, Vukcevic D, Motyer A, Leslie S, Allen KJ, Ferreira MAR. Genomewide association study of peanut allergy reproduces association with amino acid polymorphisms in
HLA
‐
DRB
1. Clin Exp Allergy 2017; 47:217-223. [DOI: 10.1111/cea.12863] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Affiliation(s)
- D. J. Martino
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
| | - S. Ashley
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
- Hudson Institute of Medical Research Clayton Vic. Australia
| | - J. Koplin
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
- School of Population and Global Health The University of Melbourne Melbourne Vic. Australia
| | - J. Ellis
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
| | - R. Saffery
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
| | - S. C. Dharmage
- School of Population and Global Health The University of Melbourne Melbourne Vic. Australia
| | - L. Gurrin
- School of Population and Global Health The University of Melbourne Melbourne Vic. Australia
| | - M. C. Matheson
- School of Population and Global Health The University of Melbourne Melbourne Vic. Australia
| | - B. Kalb
- Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Berlin Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center of MDC Charité Berlin Germany
- Max‐Delbrück‐Center for Molecular Medicine (MDC) Berlin Germany
| | - I. Marenholz
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center of MDC Charité Berlin Germany
- Max‐Delbrück‐Center for Molecular Medicine (MDC) Berlin Germany
| | - K. Beyer
- Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Berlin Germany
| | - Y.‐A. Lee
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center of MDC Charité Berlin Germany
- Max‐Delbrück‐Center for Molecular Medicine (MDC) Berlin Germany
| | - X. Hong
- Department of Population, Family and Reproductive Health Center on the Early Life Origins of Disease Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | - X. Wang
- Department of Population, Family and Reproductive Health Center on the Early Life Origins of Disease Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | - D. Vukcevic
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
- Centre for Systems Genomics Schools of Mathematics and Statistics and Biosciences The University of Melbourne Melbourne Vic. Australia
| | - A. Motyer
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
- Centre for Systems Genomics Schools of Mathematics and Statistics and Biosciences The University of Melbourne Melbourne Vic. Australia
| | - S. Leslie
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
- Centre for Systems Genomics Schools of Mathematics and Statistics and Biosciences The University of Melbourne Melbourne Vic. Australia
| | - K. J. Allen
- Department of Paediatrics Murdoch Childrens Research Institute The Royal Children's Hospital The University of Melbourne Melbourne Vic. Australia
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17
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Panjari M, Koplin JJ, Dharmage SC, Peters RL, Gurrin LC, Sawyer SM, McWilliam V, Eckert JK, Vicendese D, Erbas B, Matheson MC, Tang MLK, Douglass J, Ponsonby AL, Dwyer T, Goldfeld S, Allen KJ. Nut allergy prevalence and differences between Asian-born children and Australian-born children of Asian descent: a state-wide survey of children at primary school entry in Victoria, Australia. Clin Exp Allergy 2016; 46:602-9. [PMID: 26728850 DOI: 10.1111/cea.12699] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/30/2015] [Accepted: 01/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asian infants born in Australia are three times more likely to develop nut allergy than non-Asian infants, and rates of challenge-proven food allergy in infants have been found to be unexpectedly high in metropolitan Melbourne. To further investigate the risk factors for nut allergy, we assessed the whole-of-state prevalence distribution of parent-reported nut allergy in 5-year-old children entering school. METHODS Using the 2010 School Entrant Health Questionnaire administered to all 5-year-old children in Victoria, Australia, we assessed the prevalence of parent-reported nut allergy (tree nut and peanut) and whether this was altered by region of residence, socio-economic status, country of birth or history of migration. Prevalence was calculated as observed proportion with 95% confidence intervals (CI). Risk factors were evaluated using multivariable logistic regression and adjusted for appropriate confounders. RESULTS Parent-reported nut allergy prevalence was 3.1% (95% CI 2.9-3.2) amongst a cohort of nearly 60 000 children. It was more common amongst children of mothers with higher education and socio-economic index and less prevalent amongst children in regional Victoria than in Melbourne. While children born in Australia to Asian-born mothers (aOR 2.67, 95% CI 2.28-3.27) were more likely to have nut allergy than non-Asian children, children born in Asia who subsequently migrated to Australia were at decreased risk of nut allergy (aOR 0.1, 95% CI 0.03-0.31). CONCLUSION Migration from Asia after the early infant period appears protective for the development of nut allergy. Additionally, rural regions have lower rates of nut allergy than urban areas.
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Affiliation(s)
- M Panjari
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - J J Koplin
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - S C Dharmage
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - R L Peters
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - L C Gurrin
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - S M Sawyer
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Vic., Australia
| | - V McWilliam
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia
| | - J K Eckert
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - D Vicendese
- La Trobe University, Bundoora, Vic., Australia
| | - B Erbas
- La Trobe University, Bundoora, Vic., Australia
| | - M C Matheson
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - M L K Tang
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia
| | - J Douglass
- The Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - A-L Ponsonby
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - T Dwyer
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,George Institute for Global Health, United Kingdom School of Psychology and Public Health, University of Oxford, Oxford, UK
| | - S Goldfeld
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia
| | - K J Allen
- The Murdoch Childrens Research Institute, Parkville, Vic., Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia.,Institute of Inflammation and Repair, University of Manchester, Manchester, UK
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18
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Marchisotto MJ, Harada L, Blumenstock JA, Bilaver LA, Waserman S, Sicherer S, Boloh Y, Regent L, Said M, Schnadt S, Allen KJ, Muraro A, Taylor SL, Gupta RS. Global perceptions of food allergy thresholds in 16 countries. Allergy 2016; 71:1081-5. [PMID: 27176492 DOI: 10.1111/all.12933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - L. Harada
- Food Allergy Canada (formerly Anaphylaxis Canada); Toronto ON Canada
| | | | - L. A. Bilaver
- Department of Public Health; Northern Illinois University; DeKalb IL USA
- Chapin Hall at the University of Chicago; Chicago IL USA
| | - S. Waserman
- Division of Allergy and Clinical Immunology; McMaster University; Hamilton ON Canada
| | - S. Sicherer
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Y. Boloh
- Philéas Info; St Mars d'Outillé France
| | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - M. Said
- Allergy & Anaphylaxis Australia; Castle Hill NSW Australia
| | - S. Schnadt
- Deutscher Allergie- und Asthmabund e.V. (DAAB); Mönchengladbach Germany
| | - K. J. Allen
- Centre of Food and Allergy Research; Murdoch Children's Research Institute; The Royal Children's Hospital; Parkville Australia
- Department of Allergy and Clinical Immunology; The Royal Children's Hospital; Parkville Australia
- Department of Gastroenterology and Clinical Nutrition; The Royal Children's Hospital; Parkville Australia
- Department of Paediatrics; The Royal Children's Hospital; Parkville Australia
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | - A. Muraro
- Department of Pediatrics; University of Padua; Padua Italy
| | - S. L. Taylor
- Food Allergy Research & Resource Program (FARRP); University of Nebraska; Lincoln NE USA
| | - R. S. Gupta
- Northwestern University Feinberg School of Medicine; Chicago IL USA
- Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago IL USA
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19
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Kiraly N, Koplin JJ, Crawford NW, Bannister S, Flanagan KL, Holt PG, Gurrin LC, Lowe AJ, Tang MLK, Wake M, Ponsonby AL, Dharmage SC, Allen KJ. Timing of routine infant vaccinations and risk of food allergy and eczema at one year of age. Allergy 2016; 71:541-9. [PMID: 26707796 DOI: 10.1111/all.12830] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological evidence suggests that routine vaccinations can have nontargeted effects on susceptibility to infections and allergic disease. Such effects may depend on age at vaccination, and a delay in pertussis vaccination has been linked to reduced risk of allergic disease. We aimed to test the hypothesis that delay in vaccines containing diphtheria-tetanus-acellular pertussis (DTaP) is associated with reduced risk of food allergy and other allergic diseases. METHODS HealthNuts is a population-based cohort in Melbourne, Australia. Twelve-month-old infants were skin prick-tested to common food allergens, and sensitized infants were offered oral food challenges to determine food allergy status. In this data linkage study, vaccination data for children in the HealthNuts cohort were obtained from the Australian Childhood Immunisation Register. Associations were examined between age at the first dose of DTaP and allergic disease. RESULTS Of 4433 children, 109 (2.5%) received the first dose of DTaP one month late (delayed DTaP). Overall, delayed DTaP was not associated with primary outcomes of food allergy (adjusted odds ratio (aOR) 0.77; 95% CI: 0.36-1.62, P = 0.49) or atopic sensitization (aOR: 0.66; 95% CI: 0.35-1.24, P = 0.19). Amongst secondary outcomes, delayed DTaP was associated with reduced eczema (aOR: 0.57; 95% CI: 0.34-0.97, P = 0.04) and reduced use of eczema medication (aOR: 0.45; 95% CI: 0.24-0.83, P = 0.01). CONCLUSIONS There was no overall association between delayed DTaP and food allergy; however, children with delayed DTaP had less eczema and less use of eczema medication. Timing of routine infant immunizations may affect susceptibility to allergic disease.
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Affiliation(s)
- N. Kiraly
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
| | - J. J. Koplin
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - N. W. Crawford
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
- SAEFVIC; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
| | - S. Bannister
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
| | - K. L. Flanagan
- Department of Immunology; Monash University; Prahran VIC Australia
| | - P. G. Holt
- Telethon Institute for Child Health Research; University of Western Australia; Perth, WA Australia
- Queensland Children's Medical Research Institute; University of Queensland; Brisbane QLD Australia
| | - L. C. Gurrin
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - A. J. Lowe
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - M. L. K. Tang
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Allergy & Immune Disorders; Murdoch Childrens Research Institute; Manchester UK
- Department of Allergy and Immunology; The Royal Children's Hospital; Manchester UK
| | - M. Wake
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Community Health Services Research; Murdoch Childrens Research Institute; Manchester UK
- The Centre for Community Child Health; The Royal Children's Hospital; Manchester UK
| | - A.-L. Ponsonby
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Environmental & Genetic Epidemiology Research; Murdoch Childrens Research Institute; Manchester UK
| | - S. C. Dharmage
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; The Royal Children's Hospital; Manchester UK
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
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20
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Peters RL, Allen KJ, Dharmage SC, Lodge CJ, Koplin JJ, Ponsonby AL, Wake M, Lowe AJ, Tang MLK, Matheson MC, Gurrin LC. Differential factors associated with challenge-proven food allergy phenotypes in a population cohort of infants: a latent class analysis. Clin Exp Allergy 2016; 45:953-963. [PMID: 25523199 DOI: 10.1111/cea.12478] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 11/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Food allergy, eczema and wheeze are early manifestations of allergic disease and commonly co-occur in infancy although their interrelationship is not well understood. Data from population studies are essential to determine whether there are differential drivers of multi-allergy phenotypes. We aimed to define phenotypes and risk factors of allergic disease using latent class analysis (LCA). METHODS The HealthNuts study is a prospective, population-based cohort of 5276 12-month-old infants in Melbourne, Australia. LCA was performed using the following baseline data collected at age 12 months: food sensitization (skin prick test ≥ 2 mm) and allergy (oral food challenge) to egg, peanut and sesame; early (< 4 months) and late-onset eczema; and wheeze in the first year of life. Risk factors were modelled using multinomial logistic regression. RESULTS Five distinct phenotypes were identified: no allergic disease (70%), non-food-sensitized eczema (16%), single egg allergy (9%), multiple food allergies (predominantly peanut) (3%) and multiple food allergies (predominantly egg) (2%). Compared to the baseline group of no allergic disease, shared risk factors for all allergic phenotypes were parents born overseas (particularly Asia), delayed introduction of egg, male gender (except for single egg allergy) and family history of allergic disease, whilst exposure to pet dogs was protective for all phenotypes. Other factors including filaggrin mutations, vitamin D and the presence of older siblings differed by phenotype. CONCLUSIONS AND CLINICAL RELEVANCE Multiple outcomes in infancy can be used to determine five distinct allergy phenotypes at the population level, which have both shared and separate risk factors suggesting differential mechanisms of disease.
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Affiliation(s)
- R L Peters
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - K J Allen
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia.,School of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - S C Dharmage
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - C J Lodge
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - J J Koplin
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - A-L Ponsonby
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - M Wake
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - A J Lowe
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - M L K Tang
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia
| | - M C Matheson
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - L C Gurrin
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
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21
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Alduraywish SA, Lodge CJ, Campbell B, Allen KJ, Erbas B, Lowe AJ, Dharmage SC. The march from early life food sensitization to allergic disease: a systematic review and meta-analyses of birth cohort studies. Allergy 2016; 71:77-89. [PMID: 26466117 DOI: 10.1111/all.12784] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [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: 10/02/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is growing evidence for an increase in food allergies. The question of whether early life food sensitization, a primary step in food allergies, leads to other allergic disease is a controversial but important issue. Birth cohorts are an ideal design to answer this question. OBJECTIVES We aimed to systematically investigate and meta-analyse the evidence for associations between early food sensitization and allergic disease in birth cohorts. METHODS MEDLINE and SCOPUS databases were searched for birth cohorts that have investigated the association between food sensitization in the first 2 years and subsequent wheeze/asthma, eczema and/or allergic rhinitis. We performed meta-analyses using random-effects models to obtain pooled estimates, stratified by age group. RESULTS The search yielded fifteen original articles representing thirteen cohorts. Early life food sensitization was associated with an increased risk of infantile eczema, childhood wheeze/asthma, eczema and allergic rhinitis and young adult asthma. Meta-analyses demonstrated that early life food sensitization is related to an increased risk of wheeze/asthma (pooled OR 2.9; 95% CI 2.0-4.0), eczema (pooled OR 2.7; 95% CI 1.7-4.4) and allergic rhinitis (pooled OR 3.1; 95% CI 1.9-4.9) from 4 to 8 years. CONCLUSION Food sensitization in the first 2 years of life can identify children at high risk of subsequent allergic disease who may benefit from early life preventive strategies. However, due to potential residual confounding in the majority of studies combined with lack of follow-up into adolescence and adulthood, further research is needed.
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Affiliation(s)
- S. A. Alduraywish
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
- Department of Family and Community Medicine; King Saud University; Riyadh Saudi Arabia
| | - C. J. Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
- Murdoch Children's Research Institute; Melbourne Vic. Australia
| | - B. Campbell
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
| | - K. J. Allen
- Murdoch Children's Research Institute; Melbourne Vic. Australia
- Department of Allergy; Royal Children Hospital; Melbourne Vic. Australia
| | - B. Erbas
- Department of Public Health; School of Psychology & Public Health; La Trobe University; Melbourne Vic. Australia
| | - A. J. Lowe
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
- Murdoch Children's Research Institute; Melbourne Vic. Australia
| | - S. C. Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; University of Melbourne; Melbourne Vic. Australia
- Murdoch Children's Research Institute; Melbourne Vic. Australia
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22
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Judd LM, Heine RG, Menheniott TR, Buzzelli J, O'Brien-Simpson N, Pavlic D, O'Connor L, Al Gazali K, Hamilton O, Scurr M, Collison AM, Mattes J, Allen KJ, Giraud AS. Elevated IL-33 expression is associated with pediatric eosinophilic esophagitis, and exogenous IL-33 promotes eosinophilic esophagitis development in mice. Am J Physiol Gastrointest Liver Physiol 2016; 310:G13-25. [PMID: 26514775 DOI: 10.1152/ajpgi.00290.2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Received: 08/24/2015] [Accepted: 10/08/2015] [Indexed: 01/31/2023]
Abstract
We tested whether the T helper (Th) type 2 (Th2) cell agonist and allergenic ligand IL-33 was associated with eosinophilic esophagitis (EoE) development in a pediatric cohort and whether IL-33 protein could induce disease symptoms in mice. Biopsies from EoE patients or controls were used to measure IL-33 mRNA and protein expression. Increased expression of IL-33 mRNA was found in the esophageal mucosa in EoE. IL-33 protein was detected in cells negative for CD45, mast cells, and epithelial cell markers near blood vessels. Circulating levels of IL-33 were not increased. The time course for IL-33 gene expression was quantified in an established Aspergillus fumigatus allergen mouse model of EoE. Because IL-33 induction was transient in this model and chronicity of IL-33 expression has been demonstrated in humans, naive mice were treated with recombinant IL-33 for 1 wk and esophageal pathology was evaluated. IL-33 application produced changes consistent with phenotypically early EoE, including transmural eosinophilia, mucosal hyperproliferation, and upregulation of eosinophilic genes and chemokines. Th2 cytokines, including IL-13, along with innate lymphoid cell group 2, Th1/17, and M2 macrophage marker genes, were increased after IL-33 application. IL-33-induced eosinophilia was ablated in IL-13 null mice. In addition, IL-33 induced a profound inhibition of the regulatory T cell gene signature. We conclude that IL-33 gene expression is associated with pediatric EoE development and that application of recombinant protein in mice phenocopies the early clinical phase of the human disease in an IL-13-dependent manner. IL-33 inhibition of esophageal regulatory T cell function may induce loss of antigenic tolerance, thereby providing a mechanistic rationale for EoE development.
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Affiliation(s)
- L M Judd
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - R G Heine
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - T R Menheniott
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - J Buzzelli
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - N O'Brien-Simpson
- Oral Health Cooperative Research Center, Melbourne Dental School, University of Melbourne, Parkville, Victoria, Australia; and
| | - D Pavlic
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - L O'Connor
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - K Al Gazali
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - O Hamilton
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - M Scurr
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - A M Collison
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - J Mattes
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - K J Allen
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - A S Giraud
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia;
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23
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Allen KJ, Koplin JJ. Does LEAP change the screening paradigm for food allergy in infants with eczema? Clin Exp Allergy 2015; 46:42-7. [DOI: 10.1111/cea.12685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K. J. Allen
- Centre for Food and Allergy Research; Murdoch Childrens Research Institute; Royal Children's Hospital; Parkville Vic. Australia
- Department of Allergy and Immunology; The University of Melbourne; Royal Children's Hospital; Parkville Vic. Australia
- Department of Paediatrics; The University of Melbourne; Royal Children's Hospital; Parkville Vic. Australia
- Institute of Inflammation and Repair; The University of Manchester; Manchester UK
| | - J. J. Koplin
- Centre for Food and Allergy Research; Murdoch Childrens Research Institute; Royal Children's Hospital; Parkville Vic. Australia
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24
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Bowatte G, Tham R, Allen KJ, Tan DJ, Lau MXZ, Dai X, Lodge CJ. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr 2015; 104:85-95. [PMID: 26265016 DOI: 10.1111/apa.13151] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [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: 05/13/2015] [Revised: 07/03/2015] [Accepted: 08/05/2015] [Indexed: 12/28/2022]
Abstract
AIM To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM). METHODS Systematic review and meta-analysis following searching of PubMed, CINAHL and EMBASE electronic databases. RESULTS Twenty-four studies, all from the USA or Europe, met the inclusion criteria. In the pooled analyses, any form of breastfeeding was found to be protective for AOM in the first 2 years of life. Exclusive breastfeeding for the first 6 months was associated with the greatest protection (OR 0.57 95% CI 0.44, 0.75), followed by 'more vs less' breastfeeding (OR 0.67; 0.59, 0.76) and 'ever vs never' breastfeeding (OR 0.67; 0.56, 0.80). CONCLUSION This systematic review and meta-analysis provides evidence that breastfeeding protects against AOM until 2 years of age, but protection is greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, there is no evidence that breastfeeding protects against AOM; however, there were few studies and the evidence quality was low.
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Affiliation(s)
- G Bowatte
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - R Tham
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - KJ Allen
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Vic. Australia
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | - DJ Tan
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease; School of Medicine; University of Tasmania; Hobart TAS Australia
| | - MXZ Lau
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - X Dai
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - CJ Lodge
- Allergy and Lung Health Unit; Centre of Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Vic. Australia
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Lodge CJ, Tan DJ, Lau MXZ, Dai X, Tham R, Lowe AJ, Bowatte G, Allen KJ, Dharmage SC. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr 2015; 104:38-53. [PMID: 26192405 DOI: 10.1111/apa.13132] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [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: 05/13/2015] [Revised: 06/29/2015] [Accepted: 07/14/2015] [Indexed: 02/06/2023]
Abstract
AIM To systematically review the association between breastfeeding and childhood allergic disease. METHODS Predetermined inclusion/exclusion criteria identified 89 articles from PubMed, CINAHL and EMBASE databases. Meta-analyses performed for categories of breastfeeding and allergic outcomes. Meta-regression explored heterogeneity. RESULTS More vs. less breastfeeding (duration) was associated with reduced risk of asthma for children (5-18 years), particularly in medium-/low-income countries and with reduced risk of allergic rhinitis ≤5 years, but this estimate had high heterogeneity and low quality. Exclusive breastfeeding for 3-4 months was associated with reduced risk of eczema ≤2 years (estimate principally from cross-sectional studies of low methodological quality). No association found between breastfeeding and food allergy (estimate had high heterogeneity and low quality). Meta-regression found differences between study outcomes may be attributable to length of breastfeeding recall, study design, country income and date of study inception. Some of the protective effect of breastfeeding for asthma may be related to recall bias in studies of lesser methodological quality. CONCLUSION There is some evidence that breastfeeding is protective for asthma (5-18 years). There is weaker evidence for a protective effect for eczema ≤2 years and allergic rhinitis ≤5 years of age, with greater protection for asthma and eczema in low-income countries.
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Affiliation(s)
- CJ Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
| | - DJ Tan
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease; School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - MXZ Lau
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - X Dai
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - R Tham
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - AJ Lowe
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
| | - G Bowatte
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - KJ Allen
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
- Institute of Inflammation and Repair; University of Manchester; UK
| | - SC Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
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Abstract
AIM To synthesise the current evidence for the associations between breastfeeding and dental caries, with respect to specific windows of early childhood caries risk. METHODS Systematic review, meta-analyses and narrative synthesis following searches of PubMed, CINAHL and EMBASE databases. RESULTS Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding), had a reduced risk of caries (OR 0.50; 95%CI 0.25, 0.99, I(2) 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed <12 months (seven studies (OR 1.99; 1.35, 2.95, I(2) 69.3%). Amongst children breastfed >12 months, those fed nocturnally or more frequently had a further increased caries risk (five studies, OR 7.14; 3.14, 16.23, I(2) 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed, bottle-fed and children not bottle or breastfed, alongside specific breastfeeding practices, consuming sweet drinks and foods, and oral hygiene practices limiting our ability to tease out the risks attributable to each. CONCLUSION Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months.
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Affiliation(s)
- R Tham
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - G Bowatte
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - SC Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital; Parkville Vic. Australia
| | - DJ Tan
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease; School of Medicine; University of Tasmania; Hobart TAS Australia
| | - MXZ Lau
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - X Dai
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - KJ Allen
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital; Parkville Vic. Australia
- Institute of Inflammation and Repair; University of Manchester; UK
| | - CJ Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital; Parkville Vic. Australia
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27
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Affiliation(s)
- S C Dharmage
- Allergy & Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia; Murdoch Childrens Research Institute, Parkville, Vic., Australia
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Martin PE, Eckert JK, Koplin JJ, Lowe AJ, Gurrin LC, Dharmage SC, Vuillermin P, Tang MLK, Ponsonby AL, Matheson M, Hill DJ, Allen KJ. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin Exp Allergy 2015; 45:255-64. [PMID: 25210971 DOI: 10.1111/cea.12406] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/01/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relationship between early onset eczema and food allergy among infants has never been examined in a population-based sample using the gold standard for diagnosis, oral food challenge. OBJECTIVE We characterised the risk of challenge-proven food allergy among infants with eczema in the general population. METHODS One-year-old infants (n = 4453 meeting criteria for this analysis) were assessed for history of eczema, received a nurse-administered eczema examination and underwent skin prick testing to peanut, egg and sesame. Those with a detectable wheal to one of the test foods underwent an oral food challenge irrespective of wheal size. The risk of food allergy, stratified by eczema severity and age of onset, was estimated using multivariate logistic regression with population sampling weights. RESULTS One in five infants with eczema were allergic to peanut, egg white or sesame, compared to one in twenty-five infants without eczema (OR 6.2, 95% CI 4.9, 7.9, P < 0.001). The prevalence of peanut allergy was low in the absence of eczema (0.7% 95% CI 0.4, 1.1). Infants with eczema were 11.0 times more likely to develop peanut allergy (95% CI 6.6, 18.6) and 5.8 times more likely to develop egg allergy (95% CI 4.6, 7.4) by 12 months than infants without eczema. 50.8% of infants (95% CI 42.8, 58.9) with early eczema onset (<3 months) who required doctor-prescribed topical corticosteroid treatment developed challenge-proven food allergy. CONCLUSION AND CLINICAL RELEVANCE Eczema, across the clinical severity spectrum in infancy, is a strong risk factor for IgE-mediated food allergy. Infants with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12 months than infants without eczema. Our data suggest that a heightened awareness of food allergy risk among healthcare practitioners treating infants with eczema, especially if early onset and severe, is warranted.
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Affiliation(s)
- P E Martin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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DunnGalvin A, Chan CH, Crevel R, Grimshaw K, Poms R, Schnadt S, Taylor SL, Turner P, Allen KJ, Austin M, Baka A, Baumert JL, Baumgartner S, Beyer K, Bucchini L, Fernández-Rivas M, Grinter K, Houben GF, Hourihane J, Kenna F, Kruizinga AG, Lack G, Madsen CB, Clare Mills EN, Papadopoulos NG, Alldrick A, Regent L, Sherlock R, Wal JM, Roberts G. Precautionary allergen labelling: perspectives from key stakeholder groups. Allergy 2015; 70:1039-51. [PMID: 25808296 DOI: 10.1111/all.12614] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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: 03/16/2015] [Indexed: 01/22/2023]
Abstract
Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the possibility of reaction from the unintended presence of allergens in foods. However, in its current form, PAL is counterproductive for consumers with food allergies. This review aims to summarize the perspectives of all the key stakeholders (including clinicians, patients, food industry and regulators), with the aim of defining common health protection and risk minimization goals. The lack of agreed reference doses has resulted in inconsistent application of PAL by the food industry and in levels of contamination that prompt withdrawal action by enforcement officers. So there is a poor relationship between the presence or absence of PAL and actual reaction risk. This has led to a loss of trust in PAL, reducing the ability of consumers with food allergies to make informed choices. The result has been reduced avoidance, reduced quality of life and increased risk-taking by consumers who often ignore PAL. All contributing stakeholders agree that PAL must reflect actual risk. PAL should be transparent and consistent with rules underpinning decision-making process being communicated clearly to all stakeholders. The use of PAL should indicate the possible, unintended presence of an allergen in a consumed portion of a food product at or above any proposed action level. This will require combined work by all stakeholders to ensure everyone understands the approach and its limitations. Consumers with food allergy then need to be educated to undertake individualized risk assessments in relation to any PAL present.
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Affiliation(s)
- A. DunnGalvin
- Department of Paediatrics and Child Health; School of Applied Psychology; University College Cork; Cork Ireland
| | - C.-H. Chan
- Food Allergy Branch; Food Standards Agency; Bedford UK
| | - R. Crevel
- Safety and Environmental Assurance Centre; Unilever; Colworth Science Park Sharnbrook Bedford UK
| | - K. Grimshaw
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | | | - S. Schnadt
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
| | - S. L. Taylor
- Food Allergy Research & Resource Program; University of Nebraska; Lincoln NE USA
| | - P. Turner
- Section of Paediatrics (Allergy and Infectious Diseases); MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | - K. J. Allen
- Centre of Food and Allergy Research; Murdoch Children's Research Institute; Melbourne Vic. Australia
- Department of Paediatrics; Royal Children's Hospital; Melbourne Vic. Australia
| | - M. Austin
- Anaphylaxis Campaign; Farnborough UK
| | - A. Baka
- ILSI Europe; Brussels Belgium
| | - J. L. Baumert
- Food Allergy Research & Resource Program; University of Nebraska; Lincoln NE USA
| | - S. Baumgartner
- Center for Analytical Chemistry; University of Natural Resources and Life Sciences; Vienna Austria
| | - K. Beyer
- Department of Paediatric Pneumology & Immunology; Charité University Medical Centre; Berlin Germany
| | | | | | - K. Grinter
- Allergen Bureau & Nestle; Rhodes New South Wales Australia
| | | | - J. Hourihane
- Paediatrics and Child Health; University College Cork; Cork Ireland
| | - F. Kenna
- Anaphylaxis Ireland; Cork Ireland
| | | | - G. Lack
- Division of Asthma, Allergy and Lung Biology; King's College London; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - C. B. Madsen
- National Food Institute; Technical University of Denmark; Søborg Denmark
| | - E. N. Clare Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - N. G. Papadopoulos
- Centre for Pediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | | | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - R. Sherlock
- Allergen Bureau & DTS Facta; Hobart Australia
| | | | - G. Roberts
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust
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30
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Affiliation(s)
- S. H. Franklin
- School of Animal and Veterinary Sciences; University of Adelaide; Roseworthy Australia
| | - K. J. Allen
- Equine Sports Medicine Centre; University of Bristol; UK
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31
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Affiliation(s)
- K. J. Allen
- Equine Sports Medicine Centre; University of Bristol; Langford UK
| | - L. E. Young
- Specialist Equine Cardiology Services; Moat End Suffolk UK
| | - S. H. Franklin
- School of Animal and Veterinary Sciences; University of Adelaide; Roseworthy Australia
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Affiliation(s)
- K. J. Allen
- Equine Sports Medicine Centre; University of Bristol; Langford UK
| | | | - S. H. Franklin
- School of Animal and Veterinary Sciences; University of Adelaide; Roseworthy South Australia Australia
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Offord S, Tulloch LK, Franklin SH, Tremaine WH, Woodford N, Allen KJ. The effect of the laryngeal tie-forward procedure and soft palate cautery on nasopharyngeal diameter in horses. Vet Rec 2015; 176:19. [DOI: 10.1136/vr.102509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. Offord
- School of Veterinary Science; University of Bristol; Langford Bristol BS40 5DU UK
| | | | - S. H. Franklin
- School of Animal and Veterinary Sciences; University of Adelaide; Adelaide Australia
| | - W. H. Tremaine
- School of Veterinary Science; University of Bristol; Langford Bristol BS40 5DU UK
| | - N.S. Woodford
- Endell Veterinary Group; Salisbury Wiltshire SP5 3DG UK
| | - K. J. Allen
- Equine Sports Medicine Centre; School of Veterinary Science; University of Bristol; Langford Bristol BS40 5DU UK
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Koplin JJ, Peters RL, Ponsonby AL, Gurrin LC, Hill D, Tang MLK, Dharmage SC, Allen KJ. Increased risk of peanut allergy in infants of Asian-born parents compared to those of Australian-born parents. Allergy 2014; 69:1639-47. [PMID: 25041549 DOI: 10.1111/all.12487] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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: 07/10/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Asian infants appear to be over-represented among patients with clinical food allergy in Australia, but this has not been formally examined at the population level. Any difference in prevalence according to parental country of birth may be secondary to modifiable lifestyle factors. We aimed to quantify (i) differences in the prevalence of peanut allergy by parental country of birth and (ii) contribution of measured environmental exposures to these differences. METHODS The population-based HealthNuts study in Melbourne, Australia, screened 5276 infants (74% participation) with skin prick tests and sensitized infants underwent food challenge. Of these, 535 had a parent born in East Asia and 574 in UK/Europe. Associations between parents' country of birth and offspring peanut allergy were examined using multiple logistic regression. RESULTS Compared to infants with two Australian-born parents, peanut allergy was more common among infants with parent/s born in East Asia (OR 3.4, 95% CI 2.2-5.1) but not those with parent/s born in the UK/Europe (OR 0.8, 95% CI 0.4-1.5). Paradoxically rates of allergic disease were lower among Asian parents. A higher prevalence of eczema among infants of Asian parents explained around 30% of the increase in peanut allergy, while differences in dog ownership explained around 18%. CONCLUSIONS The high peanut allergy prevalence among infants of Asian-born parents appears to have occurred in a single generation and was not present among infants with parents migrating from other countries, suggesting gene-environment interactions are important. The role of eczema and microbial exposure in food allergy prevention warrants exploration.
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Affiliation(s)
- J. J. Koplin
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Parkville Vic. Australia
| | - R. L. Peters
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
| | - A.-L. Ponsonby
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
| | - L. C. Gurrin
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Parkville Vic. Australia
| | - D. Hill
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
| | - S. C. Dharmage
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Parkville Vic. Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Royal Children's Hospital; University of Melbourne; Parkville Vic. Australia
- University of Manchester; Manchester UK
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35
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Fitzharris LE, Franklin SH, Allen KJ. The prevalence of abnormal breathing patterns during exercise and associations with dynamic upper respiratory tract obstructions. Equine Vet J 2014; 47:553-6. [PMID: 25056992 DOI: 10.1111/evj.12325] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY There is very limited published information on the prevalence and significance of abnormal breathing patterns adopted during canter/gallop. OBJECTIVES The aim of this study was to report the prevalence of abnormal breathing patterns during canter/gallop and to investigate whether these may be associated with dynamic upper respiratory tract (URT) obstructions. STUDY DESIGN Retrospective analysis of clinical records. METHODS Simultaneous audio and URT videoendoscopy recordings from 365 horses referred for treadmill evaluation were analysed. RESULTS Thirty percent of horses had an abnormal breathing pattern at canter or gallop, of which 23% had a 2:1 breathing pattern (i.e. one breath is taken over two strides). The prevalence of abnormal breathing patterns was higher at low canter speeds than during strenuous exercise. There was a significant association between breathing pattern during strenuous exercise and the presence of an URT obstruction. CONCLUSIONS This study suggests that abnormal breathing patterns during canter and gallop may be associated with dynamic URT obstructions; therefore, horses identified by owners or veterinary surgeons to have an abnormal breathing pattern during exercise, in particular a 2:1 breathing pattern, may warrant investigations for diagnosis of respiratory tract disease.
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Affiliation(s)
- L E Fitzharris
- Langford House Equine Hospital, University of Bristol, UK
| | - S H Franklin
- School of Animal and Veterinary Sciences, University of Adelaide, South Australia, Australia
| | - K J Allen
- Langford House Equine Hospital, University of Bristol, UK
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36
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Lodge CJ, Lowe AJ, Allen KJ, de Silva D, Roberts G, Halken S, Høst A, Grimshaw K, Venter C, Panesar S, Sheikh A, Muraro A. Primary prevention of food allergy in children and adults. Allergy 2014; 69:971-2. [PMID: 24898677 DOI: 10.1111/all.12417] [Citation(s) in RCA: 3] [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: 11/30/2022]
Affiliation(s)
- C. J. Lodge
- School of Population and Global Health; University of Melbourne; Parkville Vic. Australia
| | - A. J. Lowe
- School of Population and Global Health; University of Melbourne; Parkville Vic. Australia
- Murdoch Children's Research Institute; Royal Children's Hospital; Parkville Vic. Australia
| | - K. J. Allen
- Murdoch Children's Research Institute; Royal Children's Hospital; Parkville Vic. Australia
- Department of Allergy and Clinical Immunology; Royal Children's Hospital; Parkville Vic. Australia
- Department of Paediatrics; University of Melbourne; Parkville Vic. Australia
| | | | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; UK
| | - S. Halken
- Odense University Hospital; Odense C Denmark
| | - A. Høst
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - K. Grimshaw
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - C. Venter
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
| | - S. Panesar
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| | - A. Muraro
- Department of Mother and Child Health Referral Centre Food Allergy Diagnosis and Treatment, Veneto Region; University of Padua; Padua Italy
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Abstract
There have been dramatic changes in timing of first exposure to solid foods for children over the last 40 years, ranging from exposure prior to 4 months of age for most infants in the 1960s, to guidelines recommending delaying solids until after 6 months of age introduced in the 1990s. Infant diet, specifically age of weaning and age at introduction of allergenic foods, has long been thought to play a role food allergy. However, controversy surrounding the relationship between timing of introduction of foods and development of food allergy has lead to a plethora of inconsistent infant feeding guidelines both between and within countries. The aims of this article were to discuss the history of changing guidelines for optimal timing of introduction of solids in general and allergenic solids in particular and the evidence (or lack thereof) underpinning recommendations at each of these time-points. We present the current clinical equipoise with regards to recently revised guidelines published almost simultaneously in the UK, US and Australia and argue that guideline modification about timing of introduction (both for high risk infants but also for the general population) will require careful review of emerging literature to provide a true evidence base to inform public health practice such as infant feeding guidelines.
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Affiliation(s)
- J J Koplin
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia
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38
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Martin PE, Koplin JJ, Eckert JK, Lowe AJ, Ponsonby AL, Osborne NJ, Gurrin LC, Robinson MN, Hill DJ, Tang MLK, Dharmage SC, Allen KJ. The prevalence and socio-demographic risk factors of clinical eczema in infancy: a population-based observational study. Clin Exp Allergy 2014; 43:642-51. [PMID: 23711126 DOI: 10.1111/cea.12092] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/10/2012] [Accepted: 01/11/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Socio-demographic predictors for the development of clinically observed, infantile eczema have not been formally examined in a large population-based study. Few studies of eczema risk factors have included current, objective eczema outcomes as well as parent-reported history. OBJECTIVES We aimed to measure the population prevalence of infantile eczema using novel sampling methodology, and identify socio-demographic risk factors for eczema in the first year of life. METHODS A population-based cross-sectional study of infantile allergy (the HealthNuts study, n = 4972, response rate 74.1%) was conducted from 2008-2011 in Melbourne, Australia. Infants were examined for current eczema at age 12 months (mean 12.7, SD 0.7). Parents provided information about the infants' history of eczema and demographic factors. Factors associated with eczema were modelled using multinomial logistic regression. RESULTS The population prevalence of observed eczema at 12 months was 20.3% (95% CI 19.0, 21.5), while cumulative prevalence for parent-reported eczema was 28.0% (95% CI 26.7, 29.4). The strongest predictors of eczema were maternal eczema and asthma (multinomial (M)-OR 1.7, P < 0.001, and M-OR 1.4, P = 0.007), male sex (M-OR 1.4, P < 0.001), and East Asian ethnicity (M-OR 1.6, P < 0.001) with over 80% of infants with all risk factors exhibiting eczema. East Asian parents, particularly recent migrants, reported fewer allergies than other parents. CONCLUSIONS AND CLINICAL RELEVANCE Approximately, one in three infants developed eczema by 12 months of age. East Asian infants are at increased risk of eczema despite their parents having lower rates of allergy than non-Asian parents. Gene-environment interactions may explain the differential effect seen in this minority group.
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Affiliation(s)
- P E Martin
- Murdoch Childrens Research Institute, Parkville
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Vuillermin PJ, Ponsonby AL, Kemp AS, Allen KJ. Potential links between the emerging risk factors for food allergy and vitamin D status. Clin Exp Allergy 2014; 43:599-607. [PMID: 23711121 DOI: 10.1111/cea.12048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A variety of hypotheses have been proposed to explain the recently described increase in food allergy among children living in developed countries. In this study, we summarize the emerging risk factors for IgE-mediated food allergy in early life, and then review the evidence for and against an association between low vitamin status (VDS) and food allergy. We consider whether each of the epidemiological variables that have been associated with food allergy may also be associated with VDS; and argue that future studies must adequately account for the potential relationships between risk factors for food allergy and VDS, and must also discriminate between vitamin D derived by sun exposure, diet and oral supplementation.
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Affiliation(s)
- P J Vuillermin
- Child Health Research Unit, Barwon Health, Geelong, Australia
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Abstract
Atopic dermatitis (AD) has become a significant public health problem because of increasing prevalence, together with increasing evidence that it may progress to other allergic phenotypes. While it is now acknowledged that AD commonly precedes other allergic diseases, a link termed 'the atopic march', debate continues as to whether this represents a causal relationship. An alternative hypothesis is that this association may be related to confounding by familial factors or phenotypes that comanifest, such as early-life wheeze and sensitization. However, there is increasing evidence from longitudinal studies suggesting that the association between AD and other allergies is independent of confounding by comanifest allergic phenotypes. The hypotheses on plausible biological mechanisms for the atopic march focus on defective skin barrier function and overexpression of inflammatory mediators released by the skin affected by AD (including thymic stromal lymphopoietin). Both human and animal studies have provided evidence supporting these potential biological mechanisms. Evidence from prevention trials is now critical to establishing a causal nature of the atopic march. An emerging area of research is investigation into environmental modifiers of the atopic march. Such information will assist in identifying secondary prevention strategies to arrest the atopic march. Despite much research into the aetiology of allergies, little progress has been made in identifying effective strategies to reduce the burden of allergic conditions. In this context, the atopic march remains a promising area of investigation.
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Affiliation(s)
- S. C. Dharmage
- Centre for Molecular, Environmental, Genetic & Analytic (MEGA) Epidemiology; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- Murdoch Childrens Research Institute & Royal Children's Hospital; Parkville Vic. Australia
| | - A. J. Lowe
- Centre for Molecular, Environmental, Genetic & Analytic (MEGA) Epidemiology; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
- Murdoch Childrens Research Institute & Royal Children's Hospital; Parkville Vic. Australia
| | - M. C. Matheson
- Centre for Molecular, Environmental, Genetic & Analytic (MEGA) Epidemiology; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - J. A. Burgess
- Centre for Molecular, Environmental, Genetic & Analytic (MEGA) Epidemiology; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute & Royal Children's Hospital; Parkville Vic. Australia
| | - M. J. Abramson
- School of Public Health & Preventive Medicine; Monash University; Melbourne Vic. Australia
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Dang TD, Tang MLK, Koplin JJ, Licciardi PV, Eckert JK, Tan T, Gurrin LC, Ponsonby AL, Dharmage SC, Allen KJ. Characterization of plasma cytokines in an infant population cohort of challenge-proven food allergy. Allergy 2013; 68:1233-40. [PMID: 24033562 DOI: 10.1111/all.12215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 05/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sensitization to food allergens indicates the production of food-specific IgE; however, sensitization is not a definite indicator of allergic reaction upon ingestion (N Engl J Med, 344, 2001, 30: J Allergy Clin Immunol, 120, 2007, 491). Currently, food challenge is the best approach to identify the presence or absence of allergy. While 95% positive predictive values (PPVs) thresholds for sIgE can assist with identifying increased likelihood of allergy among those who are sensitized, there are no specific biological markers that differentiate between allergic and sensitized individuals. OBJECTIVES To determine whether plasma serum cytokine profiles predict (i) sensitization to peanut and egg and (ii) food allergy among sensitized infants. METHODS Peanut-sensitized (PT) and egg-sensitized 14-month-old infants and nonsensitized controls enrolled in HealthNuts, a population-based study of food allergy, underwent an oral food challenge (OFC). Blood was collected within 1 h after OFC. Serum levels of Th1, Th2 and regulatory cytokines were determined in allergic (n = 79), sensitized (n = 40) and nonsensitized, nonallergic (n = 37) infants by multiplex assay. RESULTS Food-sensitized infants had significantly higher plasma IL-4, IL-13, IL-12p70 and lower IL-10 levels compared to nonsensitized infants. IL-10 and IL-6 levels were significantly higher in sensitized compared with allergic infants. Egg-allergic infants had significantly higher IL-13 and IL-12p70 levels compared to peanut-allergic (PA) infants. CONCLUSION Levels of Th2-related cytokines in plasma are higher in food-sensitized infants, irrespective of clinical food allergy status. In contrast, IL-10 levels appear to predict food allergy among sensitized infants. Differences in IL-13 and IL-12p70 between egg- and peanut-allergic infants could help explain the different resolution rates of the allergies.
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Affiliation(s)
| | | | | | | | - J. K. Eckert
- Murdoch Childrens Research Institute; Parkville; Vic.; Australia
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Kiraly N, Benn CS, Biering-Sørensen S, Rodrigues A, Jensen KJ, Ravn H, Allen KJ, Aaby P. Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood: long-term follow-up of a randomized controlled trial. Allergy 2013; 68:1168-76. [PMID: 23991838 DOI: 10.1111/all.12216] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recent evidence suggests that immunogenic interventions such as vaccines and micronutrients may affect atopic sensitization and atopic disease. We aimed to determine whether neonatal BCG vaccination, vitamin A supplementation and other vaccinations affect atopy in childhood. METHODS In Guinea-Bissau, low-birthweight infants were randomized to early (intervention) or delayed (usual policy) BCG. A subgroup was also randomly assigned vitamin A supplementation or placebo in a two-by-two factorial design. Participants were followed up at age 3-9 years. The main outcome was atopy defined as skin prick test reaction ≥3 mm. Secondary outcomes were symptoms of eczema, asthma and food allergy. RESULTS Two hundred eighty-one children had valid skin prick tests performed, and 14% (39/281) were atopic. There was no significant difference in atopy between the early and delayed BCG groups (OR, 0.71; 95% CI, 0.34-1.47). Atopy was significantly reduced in children who had responded to BCG with a scar (OR, 0.42; 0.19-0.94). Vitamin A supplementation was associated with increased atopy (OR, 2.88; 1.26-6.58), especially in those who received simultaneous BCG (5.99; 1.99-18.1, P = 0.09 for interaction between vitamin A supplementation and BCG). Early vs delayed BCG was not associated with symptoms of atopic disease, but vitamin A supplementation increased odds of wheeze within the past 12 months (OR, 2.45; 1.20-4.96). CONCLUSIONS There were no statistically significant effects of early vs delayed BCG on atopy or symptoms of atopic disease. Having a BCG scar was associated with reduced atopy, whereas neonatal vitamin A supplementation was associated with increased atopy. STUDY REGISTRATION Clinicaltrials.gov NCT 01420705.
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Affiliation(s)
| | | | | | - A. Rodrigues
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - K. J. Jensen
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - H. Ravn
- Research Center for Vitamins and Vaccines (CVIVA); Bandim Health Project; Statens Serum Institute; Copenhagen; Denmark
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville; VIC; Australia
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Erbas B, Lowe AJ, Lodge CJ, Matheson MC, Hosking CS, Hill DJ, Vicendese D, Allen KJ, Abramson MJ, Dharmage SC. Persistent pollen exposure during infancy is associated with increased risk of subsequent childhood asthma and hayfever. Clin Exp Allergy 2013; 43:337-43. [PMID: 23414542 DOI: 10.1111/cea.12071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 11/10/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Few studies have focused on pollen exposure and asthma in children. None have examined associations between persistent exposure to pollen in infancy and aeroallergen sensitisation and asthma in childhood. OBJECTIVES To examine the association between higher ambient levels of pollen in the first 3-6 months of life and risk of eczema, sensitization to food and aeroallergens at 2 years and asthma or hayfever at age 6-7 years combined. METHODS Using a birth cohort of 620 infants with a family history of allergic disease born between 1990 and 1994, we examined risk of eczema or allergic sensitization (SPT > 3 mm to at least one of cow's milk, egg white, peanut, house dust-mite, rye grass, and cat dander) by age 2 and asthma or hayfever at age 6-7. Daily ambient levels of pollen were measured during this period. RESULTS Cumulative exposure to pollen concentrations up to 6 months was associated with aeroallergen sensitization with the highest risk occurring at 3 months (aOR = 1.34, 95% CI 1.06-1.72). Cumulative exposure to pollen up to 3 months was also associated with hayfever (aOR = 1.14, 95% CI 1.009-1.29) and between 4 and 6 months exposure with asthma only (aOR=1.35, 95% CI 1.07-1.72). CONCLUSION Persistent pollen exposure in infancy appears to increase the risk of asthma and hayfever in children. These results support the hypothesis that there is a critical window of opportunity in early development which may be important for modification of allergic outcomes.
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Affiliation(s)
- B Erbas
- School of Public Health, La Trobe University, Melbourne, VIC, Australia
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Tey D, Dharmage SC, Robinson MN, Allen KJ, Gurrin LC, Tang MLK. Frequent baked egg ingestion was not associated with change in rate of decline in egg skin prick test in children with challenge confirmed egg allergy. Clin Exp Allergy 2013. [PMID: 23181794 DOI: 10.1111/j.1365-2222.2012.04061.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is controversial whether egg-allergic children should strictly avoid all forms of egg, or if regular ingestion of baked egg will either delay or hasten the resolution of egg allergy. OBJECTIVE This is the first study to examine the relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size in egg-allergic children. METHODOLOGY This was a retrospective clinical cohort study. All children with challenge-proven egg allergy who attended the Royal Children's Hospital Allergy Department 1996-2005 and had at least two egg skin prick tests performed in this period were included (n = 125). Frequency of baked egg ingestion was assessed by telephone questionnaire as follows: (a) frequent (> once per week), (b) regular (> once every 3 months, up to ≤ once per week) or (c) strict avoidance (≤ once every 3 months). The relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size was examined by multiple linear regression, adjusting for potential confounders. RESULTS Mean rate of decline in egg skin prick test size in all children was 0.7 mm/year (95% CI 0.5-1.0 mm/year). There was no evidence (P = 0.57) that the rate of decline in egg skin prick test size differed between children who undertook frequent ingestion (n = 21, mean 0.4 mm/year, 95% CI -0.3-1.2 mm/year), regular ingestion (n = 37, mean 0.9 mm/year, 95% CI 0.4-1.4 mm/year) or strict avoidance (n = 67, mean 0.7 mm/year, 95% CI 0.4-1.1 mm/year) of baked egg. CONCLUSIONS Compared with strict dietary avoidance, frequent consumption of baked egg was not associated with a different rate of decline in egg skin prick test size in egg-allergic children. CLINICAL RELEVANCE Given that dietary restrictions can adversely impact on the family, it is reasonable to consider liberalizing baked egg in the diet of egg-allergic children.
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Affiliation(s)
- D Tey
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
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Kiraly N, Dharmage SC, Allen KJ. Reduced Risk of Pertussis Among Persons Ever Vaccinated With Whole-Cell Pertussis Vaccine Compared to Recipients of Acellular Pertussis Vaccines May Have Been Confounded by Age. Clin Infect Dis 2013; 57:770. [DOI: 10.1093/cid/cit351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lodge CJ, Lowe AJ, Gurrin LC, Matheson MC, Balloch A, Axelrad C, Hill DJ, Hosking CS, Rodrigues S, Svanes C, Abramson MJ, Allen KJ, Dharmage SC. Pets at birth do not increase allergic disease in at-risk children. Clin Exp Allergy 2013; 42:1377-85. [PMID: 22925324 DOI: 10.1111/j.1365-2222.2012.04032.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature is contradictory concerning pet exposure and risk of allergic disease in childhood especially among those with a family history of allergy. OBJECTIVE To investigate the relationship between cat and dog exposure at birth and allergic outcomes over the first 12 years in a birth cohort selected for familial allergy. METHODS A prospective birth cohort of 620 infants with a family history of allergic diseases was recruited. Data on pet keeping, family demographics and cord blood samples were collected at birth. Information on childhood wheeze, eczema and hay fever was collected 18 times in the first 2 years, at 7 years and at 12 years. Skin prick tests were conducted at 2, 7 and 12 years, and in parents. Regression analyses were used to investigate the relevant associations while adjusting for potential confounders. RESULTS Exposure to cats or dogs at birth showed a moderate reduction in risk of wheeze (aOR = 0.76; 95% CI 0.53, 1.09) and hay fever (aOR = 0.71; 0.49, 1.02) after 7 years of age. Protective effects were stronger in children of non-sensitized fathers (aOR wheeze 0.55; 0.31, 0.98; aOR hay fever 0.33; 0.15, 0.77 on exposure to cats alone, or cats or dogs at birth). Pet keeping was not related to cord blood IgE or sensitization from 2 to 12 years. CONCLUSIONS AND CLINICAL RELEVANCE Pets at birth either decreased or had no effect on allergic disease up to age 12. We found no evidence that exposure to cats or dogs at birth increases the risk of allergic disease in high-risk children.
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Affiliation(s)
- C J Lodge
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Vic., Australia.
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Abstract
The relationship between breastfeeding and allergic disease risk has been controversial. This article reviews the current evidence for the role of breastfeeding in the prevention of allergic disease. We found considerable methodological limitations inherent in most studies evaluating the effect of breastfeeding in allergic disease. Nevertheless, since randomized control trials in breast feeding research would be considered unethical, the evidence remains limited to poorer quality observational studies where participation and recall bias can severely affect the objectivity of the data collected. Furthermore, reporting of type of breastfeeding (exclusive, full or partial) may be biased by a participant's inherent belief system of what they think they should be doing. Current evidence is inconclusive regarding the effect of breastfeeding on the development of eczema, with the most recent systemic review reporting no protective effect. There is insufficient data regarding the effects of breastfeeding on objective measures of food allergy at any age. Studies show a paradoxical effect of breastfeeding on the prevention of asthma, with an apparent protective effect against early wheezing illness in the first years of life yet an increased risk of asthma in later life; however, these findings must be interpreted with caution. Existing studies fail to adequately adjust for confounders, including the critical issues of protection against early life respiratory illnesses and reverse causation. Therefore, it is possible that the effect of breastfeeding on early wheezing illness reflects protection against respiratory infection, the predominant trigger of wheezing in early childhood, rather than a true reduction in risk of asthma. In summary, future research that takes into account the potential contribution of confounding factors and effect modifiers is needed to clarify the role of breastfeeding in development of allergic disease and to inform current clinical guidelines on the prevention of allergic disease.
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Affiliation(s)
- M C Matheson
- Centre for MEGA Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia
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Delatycki MB, Wolthuizen M, Aitken MA, Hickerton C, Metcalfe SA, Allen KJ. To tell or not to tell - what to do about p.C282Y heterozygotes identified by HFE screening. Clin Genet 2012; 84:286-9. [PMID: 23121079 DOI: 10.1111/cge.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/28/2012] [Revised: 10/30/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
Abstract
Hereditary hemochromatosis (HH) is a common preventable disorder of iron overload that can result in liver cirrhosis and reduced lifespan. Most HH is due to homozygosity for the HFE p.C282Y substitution. We conducted a study of screening for p.C282Y in high schools where p.C282Y heterozygotes (CY) individuals were informed of their genotype by letter. We studied whether these individuals understood the implications of their genotype, whether this resulted in anxiety or reduced health perception and whether cascade testing was higher in families of CY than wild-type homozygous (CC) individuals. We found 586 of 5757 (1 in 10) screened individuals were CY. One month after receiving their result, 83% correctly answered that they have one copy of p.C282Y. There was no adverse change in anxiety or health perception from prior to screening to 1 month after receiving results. Significantly more family members of CY individuals than CC individuals were informed about HH and had testing for HH. In conclusion, we found that informing CY individuals of their genotype does not increase anxiety and the implications are generally well understood. This leads to cascade testing in a minority of families. CY individuals should be informed of their genetic status when identified by population screening.
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Affiliation(s)
- M B Delatycki
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Koplin JJ, Dharmage SC, Ponsonby AL, Tang MLK, Lowe AJ, Gurrin LC, Osborne NJ, Martin PE, Robinson MN, Wake M, Hill DJ, Allen KJ. Environmental and demographic risk factors for egg allergy in a population-based study of infants. Allergy 2012; 67:1415-22. [PMID: 22957661 DOI: 10.1111/all.12015] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although egg allergy is the most common food allergy in infants and young children, risk factors for egg allergy remain largely unknown. This study examined the relationship between environmental and demographic factors and egg allergy in a population-based infant cohort. METHODS In a study of 5276 infants (HealthNuts), infants underwent skin prick testing (SPT) to egg white at 12 months of age. Questionnaire data on relevant exposures were obtained. 699/873 (80%) infants eligible for oral food challenge (detectable wheal on SPT) attended for formal assessment of egg allergy status; 453 had confirmed egg allergy (positive challenge and SPT ≥ 2 mm). Associations between environmental and demographic factors and egg allergy were investigated using multivariable logistic regression. RESULTS Children with older siblings and those with a pet dog at home were less likely to develop egg allergy by 1 year of age (adjusted OR [aOR], 0.72; 95% CI, 0.62, 0.83 per sibling; and aOR, 0.72; 95% CI, 0.52, 0.99, respectively). Caesarean section delivery, antibiotic use in infancy, childcare attendance and maternal age were not associated with egg allergy. History of allergic disease in an immediate family member and having parents born in East Asia were strong risk factors for infantile egg allergy (aOR, 1.82; 95% CI, 1.40, 2.36; and aOR, 3.30; 95% CI, 2.45, 4.45, respectively). CONCLUSIONS Exposure in the first year of life to siblings and dogs may decrease the risk of subsequent egg allergy. Infants with a family history of allergy and those with parents born in East Asia are at increased risk of egg allergy.
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Affiliation(s)
| | | | - A.-L. Ponsonby
- Murdoch Childrens Research Institute; Parkville; Vic.; Australia
| | | | | | | | | | | | | | | | - D. J. Hill
- Murdoch Childrens Research Institute; Parkville; Vic.; Australia
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Madsen CB, Hattersley S, Allen KJ, Beyer K, Chan CH, Godefroy SB, Hodgson R, Mills ENC, Muñoz-Furlong A, Schnadt S, Ward R, Wickman M, Crevel R. Can we define a tolerable level of risk in food allergy? Report from a EuroPrevall/UK Food Standards Agency workshop. Clin Exp Allergy 2012; 42:30-7. [PMID: 22093016 DOI: 10.1111/j.1365-2222.2011.03868.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/14/2011] [Accepted: 08/15/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is an emerging consensus that, as with other risks in society, zero risk for food-allergic people is not a realistic or attainable option. Food allergy challenge data and new risk assessment methods offer the opportunity to develop quantitative limits for unintended allergenic ingredients which can be used in risk-based approaches. However, a prerequisite to their application is defining a tolerable level of risk. This requires a value judgement and is ultimately a 'societal' decision that has to involve all relevant stakeholders. OBJECTIVE The aim of the workshop was to bring together key representatives from the stakeholders (regulators, food industry, clinical researchers and patients), and for the first time ever discuss the definition of a tolerable level of risk with regard to allergic reactions to food. RESULTS The discussions revealed a consensus that zero risk was not a realistic option and that it is essential to address the current lack of agreed action levels for cross-contamination with allergens if food allergen management practice is to be improved. The discussions also indicated that it was difficult to define and quantify a tolerable level of risk, although both the clinical and the industry groups tried to do so. A consensus emerged that doing nothing was not a viable option, and there was a strong desire to take action to improve the current situation. CONCLUSIONS AND CLINICAL RELEVANCE Two concrete actions were suggested: (1) Action levels should be derived from the data currently available. Different scenarios should be examined and further developed in an iterative process. On the basis of this work, a tolerable level of risk should be proposed. (2) 'One-dose' clinical trial with a low challenge dose should be performed in multiple centres to provide additional information about the general applicability of dose-distribution models and help validate the threshold levels derived.
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Affiliation(s)
- C B Madsen
- Department for Toxicology and Risk Assessment, National Food Institute, Technical University of Denmark, Søborg, Denmark.
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