1
|
Bingemann TA, LeBovidge J, Bartnikas L, Protudjer JLP, Herbert LJ. Psychosocial Impact of Food Allergy on Children and Adults and Practical Interventions. Curr Allergy Asthma Rep 2024; 24:107-119. [PMID: 38261244 DOI: 10.1007/s11882-023-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW IgE- and non-IgE-mediated food allergies are increasing in prevalence in children and adults worldwide. A food allergy diagnosis can be associated with a sense of overwhelm and stress and commonly has a negative impact on quality of life. RECENT FINDINGS While there is an increased recognition of the psychosocial effects of food allergy, the current research reflects the experience of mostly White, well-educated wealthier populations. Some studies have now explored the psychosocial impact among other populations; however, further study is needed. It is important that physicians and allied health professionals screen for the potentially negative psychosocial effects of food allergy and provide education to promote safety and self-efficacy at each visit; however, time may be a limiting factor. Numerous validated questionnaires are now available to help assess the psychosocial impact of food allergies. Allergy-friendly foods are typically more expensive, and thus, it is imperative that physicians screen for food insecurity as well. Educational resources should be offered regarding living well with food allergies at each visit. For patients and families experiencing anxiety or food allergy burden that is difficult to manage, referral to a mental health provider should be considered. Resources regarding programs to help accessing safe foods should also be available. Further research is needed among diverse populations focusing on interventions to best support patients and families with food allergy.
Collapse
Affiliation(s)
- Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 695, Rochester, NY, 14642, USA.
| | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa Bartnikas
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
- George Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Linda J Herbert
- Division of Psychology &, Behavioral Health, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| |
Collapse
|
2
|
Herlihy LE, Walters EM, D'Auria JP, Orgel K, Jordan KA. Early Peanut Introduction in Infants: Improving Guideline Adherence With EMR Standardization. Pediatrics 2023; 152:e2023062371. [PMID: 37873594 DOI: 10.1542/peds.2023-062371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools. METHODS Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts. RESULTS We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes. CONCLUSIONS Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.
Collapse
Affiliation(s)
- Lauren E Herlihy
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jennifer P D'Auria
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly Orgel
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine A Jordan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Bird JA. Please push the peanuts! J Allergy Clin Immunol 2023; 151:1246-1248. [PMID: 36796455 DOI: 10.1016/j.jaci.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Affiliation(s)
- J Andrew Bird
- Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
4
|
Venter C, Warren C, Samady W, Nimmagadda SR, Vincent E, Zaslavsky J, Bilaver L, Gupta R. Food allergen introduction patterns in the first year of life: A US nationwide survey. Pediatr Allergy Immunol 2022; 33:e13896. [PMID: 36564881 PMCID: PMC10107094 DOI: 10.1111/pai.13896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prevention guidelines have changed over the past decade and now recommend the earlier introduction of peanut and egg without delaying the introduction of other food allergens. This paper explored caregiver practices regarding the introduction of food allergens during infancy. METHODS A survey was administered (2021) to a US population-based sample of 3062 caregivers (children 7 months - 3.5 years). Demographics and feeding practices were collected. Weighted frequencies and proportions were calculated using the svyr package in R 4.1. Survey-weighted chi-square statistics and covariate-adjusted, survey-weighted logistic regression models were used for statistical inference. RESULTS Cow's milk, wheat, and soy were the top three allergens introduced. Peanut and egg were introduced by 17.2% and 15.5% of caregivers before 7 months and 58.8% and 66.4% before 1 year, respectively. The age of peanut and egg introduction differed significantly by race/ethnicity (p < .001) and caregiver age (p < .001). Peanut and egg introduction before 7 months was significantly associated with the increased introduction of other allergenic foods before 1 year (p = <.001; peanut and p = < .001; egg). Caregivers who introduced peanut and egg before 7 months infant age fed an additional mean of 5.4 and 4.5 food allergens, respectively, before 1 year. Few caregivers (0.9%) reported feeding an "early food allergen introduction product" ≥ 3 times, which was significantly associated with parental food allergy (OR = 2.2) and previously seen an allergist (OR = 6.7). CONCLUSION More than half of the caregivers are not introducing peanut by age of one year and one-third are not introducing egg, though an observed shift toward earlier peanut and egg introduction was seen in the past 5 years. Peanut and egg introduction seem to co-occur and are associated with increased intake of other food allergens.
Collapse
Affiliation(s)
- Carina Venter
- Children's Hospital Colorado/University of Colorado, Aurora, Colorado, USA
| | - Christopher Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Waheeda Samady
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Sai R Nimmagadda
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Eileen Vincent
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin Zaslavsky
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lucy Bilaver
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| |
Collapse
|
5
|
Dantzer J, Wood RA. Can Peanut Allergy Prevention Be Translated to the Pediatric Population? JAMA 2022; 328:25-26. [PMID: 35788815 DOI: 10.1001/jama.2022.6263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer Dantzer
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
6
|
Cox AL, Shah A, Groetch M, Sicherer SH. Allergic reactions in infants using commercial early allergen introduction products. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3517-3520.e1. [PMID: 34022446 DOI: 10.1016/j.jaip.2021.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Amanda L Cox
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Ami Shah
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
7
|
Abrams EM, Shaker M, Greenhawt M, Mack DP. International Peanut Allergy Prevention, 6 Years After the Learning Early About Peanut Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:71-77. [PMID: 34311123 DOI: 10.1016/j.jaip.2021.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
Six years ago, the Learning Early About Peanut (LEAP) trial findings helped fundamentally shift the paradigm of peanut allergy prevention. Although the results of LEAP are well accepted, policy-makers, caregivers, and clinicians struggle with how best to implement and apply the study's key findings in clinical practice. Differences in guidelines highlight issues related to peanut allergy prevention implementation, including caregiver acceptability, cost, fidelity, feasibility, appropriateness, and adoption. The goals of this rostrum are to review how the LEAP study has informed international peanut allergy prevention policy, as well as to review the strengths and ongoing controversies in peanut allergy prevention implementation.
Collapse
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth, Hanover, NH
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Halton Pediatric Allergy, Burlington, Ontario, Canada
| |
Collapse
|
8
|
Chang A, Cabana MD, LaFlam TN, Patel S, Okumura M. Early Peanut Introduction and Testing: A Framework for General Pediatrician Beliefs and Practices. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2021; 34:53-59. [PMID: 34143689 PMCID: PMC8329693 DOI: 10.1089/ped.2020.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022]
Abstract
Background: Peanut introduction guidelines have undergone significant reversal since 2001 from recommending delayed introduction to rescinding the recommendations in 2008 to actively recommending early introduction of peanut between 4 and 11 months of age in high-risk infants in 2015. This qualitative study aims to explore pediatrician beliefs, practices, facilitators, and barriers regarding peanut introduction and testing. Methods: General pediatricians from academic, private, large group, and underserved practices in Northern California underwent individual semi-structured interviews in 2017. We asked about experiences surrounding infant peanut introduction, strategies for staying up-to-date with current recommendations, and barriers and facilitators to the new peanut introduction and testing recommendations. The data were coded, and using grounded theory methodology, a conceptual framework was developed around early peanut introduction and testing in infants. Results: Eighteen general pediatricians participated. We identified barriers that may contribute to pediatrician reluctance to recommending early peanut introduction or testing including lack of awareness, lack of agreement, lack of resources, and lack of outcome expectancy. A framework was created that suggests that pediatricians need to be knowledgeable about new recommendations, agree with the recommendations, have resources to carry out the counseling and testing, and have buy-in from the parents in order for successful uptake of peanut introduction guidelines. Conclusion: Recommending early peanut introduction or testing causes significant apprehension in some pediatricians, and there are many barriers to following recent early peanut introduction recommendations. A potential limitation of the study is that it was conducted right after the addendum guidelines were changed, leaving the possibility that attitudes and practices may have evolved since 2017. It is still likely that a multifaceted approach that addresses primary care provider guideline awareness, limited primary care resources for education and testing, and includes support and collaboration from subspecialty practices is more likely to lead to improved early peanut introduction uptake.
Collapse
Affiliation(s)
- Angela Chang
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Michael D. Cabana
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Taylor N. LaFlam
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Saharsh Patel
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Megumi Okumura
- Department of Pediatrics and UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
9
|
Perkin MR, Togias A, Koplin J, Sicherer S. Food Allergy Prevention: More Than Peanut. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1-13. [PMID: 31950900 DOI: 10.1016/j.jaip.2019.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 12/28/2022]
Abstract
Given an apparent increase in food allergies worldwide, the focus on prevention strategies has intensified. Following the Learning Early About Peanut study, there is now a widespread acceptance that peanut should be introduced promptly into the diet of high-risk infants. However, most food allergies are caused by triggers other than peanut and additional prevention strategies are being evaluated. The appreciation of the role of an impaired skin barrier in the process of food sensitization and subsequent allergy has led to a spectrum of dermatologically orientated studies. Other prevention strategies address the role of the microbiome, dietary components, and other modifiable risk factors. With regard to early introduction of foods other than peanut, studies are heterogeneous in design and governmental and professional society response to the early introduction trials has varied, ranging from new guidelines confining advice specifically to peanut, to ones recommending prompt introduction of a broad spectrum of allergenic foods. Much remains to be determined with regard to the acceptability and uptake of the new guidelines and their impact on infant feeding behavior and food allergy outcomes. This review discusses the panoply of prevention approaches, their promise, and limitations.
Collapse
Affiliation(s)
- Michael R Perkin
- Population Health Research Institute, St George's, University of London, London, United Kingdom.
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jennifer Koplin
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Scott Sicherer
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
10
|
Groetch M, Czerkies L, Quann E, Boccella J, Hampton J, Anater A, Nowak-Wegrzyn A. Evaluation of the introduction of allergen-containing foods: Feeding Infants and Toddlers Study 2016. Ann Allergy Asthma Immunol 2021; 126:555-561.e2. [PMID: 33561539 DOI: 10.1016/j.anai.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Guidelines on the early introduction of allergen-containing foods are evolving; however, little national data exist defining current allergen-feeding practices. OBJECTIVE To investigate the consumption rates of foods containing egg and peanut among infants and toddlers before the guideline changes in 2017. METHODS The Feeding Infants and Toddlers Study 2016 was conducted nationally among 3235 caregivers with a child under 4 years of age. The 24-hour dietary recalls were reviewed for peanut or egg ingredients. Participants were categorized as "consuming peanut or egg-containing foods" or "not consuming peanut or egg-containing foods." Data on physician-diagnosed food allergies and avoidance were collected. RESULTS The consumption rates of peanut- and egg-containing foods were low. For the age group of 4 to 5.9 months, 0.3% reported peanut consumption and 2.4% reported egg consumption. For the age group of 6 to 8.9 months, 0.9% reported eating peanut-containing foods and 13.0% egg, and for the age group of 9 to 11.9 months, 5.5% were consuming peanut-containing foods and 33.2% egg-containing foods. Peanut or egg ingredients were identified in the diet of children whose caregivers reported avoidance. CONCLUSION Before the publication of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy, there were low rates of reported peanut consumption across the study population with less than 1% of any age group before 9 months of age and less than 6% in any age group before 12 months of age consuming peanut on the 24-hour recall day. In addition, reported egg consumption was low and increased with age. These results serve as an important baseline comparison for future studies evaluating the implementation and impact of early peanut and egg introduction.
Collapse
Affiliation(s)
- Marion Groetch
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Erin Quann
- Gerber, Nestlé Nutrition, Arlington, Virginia
| | | | - Joel Hampton
- RTI International, Research Triangle Park, North Carolina
| | - Andrea Anater
- RTI International, Research Triangle Park, North Carolina
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Langone Health, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
11
|
Jin H, Sifers T, Cox AL, Kattan JD, Bunyavanich S, Oriel RC, Tsuang A, Wang J, Groetch M, Sicherer SH, Nowak-Wegrzyn A. Peanut oral food challenges and subsequent feeding of peanuts in infants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1756-1758.e1. [PMID: 33290919 DOI: 10.1016/j.jaip.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Hope Jin
- Department of Pediatrics, NYU Langone Health, New York, NY
| | - Travis Sifers
- Center for Allergy and Immunology, Kansas City Physician Partners, Kansas City, Mo
| | - Amanda L Cox
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob D Kattan
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Supinda Bunyavanich
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roxanne C Oriel
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angela Tsuang
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie Wang
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Langone Health, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| |
Collapse
|
12
|
Sharma V, Jobrack J, Cerenzia W, Tilles S, Ryan R, Sih-Meynier R, Zeitler S, Manning M. A study to assess current approaches of allergists in European countries diagnosing and managing children and adolescents with peanut allergy. PLoS One 2020; 15:e0241648. [PMID: 33270629 PMCID: PMC7714149 DOI: 10.1371/journal.pone.0241648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Food allergy is documented to result in considerable morbidity, negative impact on quality of life, and substantial medical care costs. Although anecdotal data suggest widely varying practices in the diagnosis and management of food allergies, the diversity and relative frequency of these practices have not been documented. METHODS A questionnaire was developed evaluating allergists' management approaches of individuals with peanut allergy (PA) in Germany (DE), France (FR), and the United Kingdom (UK). RESULTS Here, we report the survey results from a total of 109 allergists from DE, FR and the UK. They reported to confirm PA at initial diagnosis using skin prick test (≥60%), while allergists from DE and FR reported using allergen-specific IgE testing more (>86%) compared to the UK (<50%). At initial diagnosis, oral food challenge was used less in DE (13%) and FR (14%) and very rarely in the UK (3%) to confirm diagnosis. Recognition of acute reactions, use of adrenaline auto-injectors and allergen avoidance were reported to be discussed with the patient/caregiver at the initial office visit by most allergists (>75%). Half of the responders reported assessing the patient's quality of life. 63% allergists reported retesting for PA resolution at a later date, with 45% allergists indicated to recommend ingestion of a normal serving of peanut regularly upon resolution. Lack of effective PA treatment was reported to be a 'very significant' barrier for optimal PA treatment, with allergists being less than 'moderately familiar' with data from clinical trials testing new treatments options for PA. Lastly, allergists stated that the severity of patient's PA ranked as the most important factor in their decision to recommend oral immunotherapy for PA treatment. CONCLUSIONS This survey provides essential insights into the practice of allergists and highlights some areas that would inform strategies for education and improving PA healthcare.
Collapse
Affiliation(s)
- Vibha Sharma
- Lydia Becker Institute of Immunology and Inflammation University of Manchester and Royal Manchester Children’s Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Stephen Tilles
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
- University of Washington, Seattle, WA, United States of America
| | - Robert Ryan
- Aimmune Therapeutics, London, United Kingdom
| | - Regina Sih-Meynier
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
| | | | - Michael Manning
- Medical Research of Arizona, Scottsdale, AZ, United States of America
| |
Collapse
|
13
|
Practical Challenges and Considerations for Early Introduction of Potential Food Allergens for Prevention of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:44-56.e1. [PMID: 33127520 DOI: 10.1016/j.jaip.2020.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 01/26/2023]
Abstract
Recent randomized controlled trials aimed at the prevention of food allergy have led to sweeping changes in food allergy prevention guidelines. Emphasis is now on the introduction of potential food allergens, particularly peanut and egg, rather than avoidance. Although guidelines recommend against delaying the introduction of other potential allergens, there remains little or no evidence of the benefit of their early introduction. Parents and physicians alike report a need for greater guidance and resources on early potential allergen introduction in the complementary feeding period. A thorough understanding of early introduction literature, current prevention guidelines, and infant nutrition will empower physicians to address patient needs and concerns both when advice is established as effective and where uncertainty remains. We discuss the state of the science, compare recommendations between guidelines, and provide practical options to introduce allergenic foods, alongside other complementary foods, within the first year of life. We include a review of the available literature, including review and suggestions of potential doses of food allergens, and the first published comparison of commercially available products and homemade early introduction foods to help clinicians support their patients. We address the nutritional, dietary, and practical considerations of introducing food allergens in the first year of life while adhering to infant feeding guidelines. Finally, given the limitations of existing guidelines, we review the need for shared decision-making between physicians and parents regarding early allergen introduction.
Collapse
|
14
|
Abrams EM, Brough HA, Keet C, Shaker MS, Venter C, Greenhawt M. Pros and cons of pre-emptive screening programmes before peanut introduction in infancy. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:526-535. [PMID: 32562634 DOI: 10.1016/s2352-4642(20)30029-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/29/2022]
Abstract
Peanut allergy is an important public health concern and causes substantial psychosocial comorbidity. Although fatal anaphylaxis is rare (occurring at 0·03-0·3 per million person-years in the general population), peanuts are one of the most frequent causes of food allergy mortality. The Learning Early About Peanut study transformed prevention of peanut allergy by showing that early introduction of peanut into the diet of children at high risk (ie, those with an egg allergy or severe eczema) reduced the relative risk of peanut allergy at age 5 years by 81%. Following publication of this study, the US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, convened an expert panel, which recommended that, for infants with severe eczema or egg allergy, health professionals should strongly consider evaluation with peanut-specific serological IgE or skin prick test (or both) and, if necessary, an oral food challenge before peanut introduction. In the USA, depending on test results, peanut-containing foods are recommended to be introduced from age 4-6 months in infants with severe eczema or egg allergy. Early introduction to peanuts is also advocated for children with either mild to moderate or no eczema, and in children who are not allergic to egg, but without screening before peanut introduction. However, the NIAID addendum guidelines contrast with other international approaches that do not advocate for allergy screening at a population level before introducing peanuts into infants' diets. In this Review, we evaluate the advantages and disadvantages of a pre-emptive screening approach before the early introduction of peanuts in infants at high risk of peanut allergy.
Collapse
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Helen A Brough
- School of Life Course Sciences, King's College London, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Corinne Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, and Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Marcus S Shaker
- Department of Pediatrics, Section of Allergy, Asthma and Clinical Immunology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA; Department of Pediatrics, Section of Allergy, Asthma and Clinical Immunology, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
| |
Collapse
|
15
|
Implementation of the Addendum Guidelines for Peanut Allergy Prevention by US allergists, a survey conducted by the NIAID, in collaboration with the AAAAI. J Allergy Clin Immunol 2020; 146:875-883. [PMID: 32745556 DOI: 10.1016/j.jaci.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2017, the Addendum Guidelines for the Prevention of Peanut Allergy were published with recommendations on early introduction of peanut-containing foods based on infants' clinical history. OBJECTIVE We sought to conduct a nationwide US survey to assess Guidelines implementation among allergists and immunologists who manage infants for food allergy. METHODS Survey invitations were delivered to 3281 nonretired, US members of the American Academy of Asthma, Allergy & Immunology, board certified in allergy and immunology. The survey assessed awareness and implementation of the Guidelines and barriers to implementation. Descriptive statistics were generated. RESULTS Twenty-nine percent (946 of 3281) of surveyed allergists/immunologists responded, and 87.1% (825 of 946) of responders met eligibility criteria. Among eligible responders, 97.1% were aware of the Guidelines. Of these, 64.5% reported full implementation of the Guidelines as published, 34.4% reported partial implementation, and 1.1% reported using none of the Guidelines. Barriers to Guidelines use included parental (47.6%) and self (21.8%) concerns about allergic reactions, lack of referrals (33.6%), parents uninterested in early feeding (28.2%), and lack of clinic time (20.9%). The 2 most common deviations from the Guidelines were considering additional factors not specified in the Guidelines such as family history (50.2%) and conducting skin prick testing in non-high-risk children (43.9%). Of respondents using the Guidelines, 45.7% indicated they needed more education or training. CONCLUSIONS Essentially all allergists/immunologists who responded to the survey reported full or partial Guidelines implementation. Parental concerns and lack of referrals are major identifiable barriers. Improved Guidelines messaging to parents and referring physicians is warranted.
Collapse
|
16
|
Kelbel T, Kampfschulte A, Hartog N. Institution of clinic scheduling guidelines for early introduction of peanut in high risk infants. Ann Allergy Asthma Immunol 2019; 123:602-603. [PMID: 31520772 DOI: 10.1016/j.anai.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Theodore Kelbel
- Helen DeVos Children's Hospital Allergy and Immunology Department, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | | | - Nicholas Hartog
- Helen DeVos Children's Hospital Allergy and Immunology Department, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| |
Collapse
|