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Mendonca CE, Andreae DA. Food Allergy. Med Clin North Am 2024; 108:655-670. [PMID: 38816109 DOI: 10.1016/j.mcna.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
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Affiliation(s)
- Chelsea Elizabeth Mendonca
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77018, USA.
| | - Doerthe A Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA
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Dupont C, Burks AW, Fleischer DM, Bee KJ, Chainani S, Sampson HA. Safety and efficacy of epicutaneous immunotherapy with DBV712 (peanut patch) in peanut allergy. Expert Rev Clin Immunol 2024; 20:623-633. [PMID: 38323337 DOI: 10.1080/1744666x.2024.2315221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION DBV712 250 µg (also referred to as Viaskin Peanut or peanut patch; Viaskin is a trademark of DBV Technologies) is an innovative approach to epicutaneous immunotherapy (EPIT). The patch-based technology system facilitates peanut protein (allergen) absorption into the intact non-vascularized epidermis to promote desensitization to peanut while limiting systemic allergen exposure. AREAS COVERED Efficacy and safety in children have been evaluated in four completed phase 3 studies. Overall, the results from these studies have demonstrated the peanut patch to be superior in desensitization compared with placebo and safe for daily use over multiple years. EXPERT OPINION These findings, as well as supportive evidence from phase 2 studies, confirm the potential for an effective treatment of peanut allergy in children. The purpose of this review is to summarize the safety and efficacy of the peanut patch in the treatment of peanut allergy.
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Affiliation(s)
- Christophe Dupont
- Pediatric Gastroenterology Department, Marcel Sembat Clinic, Ramsay Group, Boulogne Billancourt, France
| | - A Wesley Burks
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David M Fleischer
- Children's Hospital Colorado, Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Hugh A Sampson
- DBV Technologies, Basking Ridge, NJ, United States
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ho S, Cooke F, Ramos A, McQuaid EL, Sharma H, Herbert LJ. Anxiety among youth with food allergy. J Pediatr Psychol 2024:jsae026. [PMID: 38679905 DOI: 10.1093/jpepsy/jsae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Anxiety is among the major psychological concerns for children living with food allergy (FA). Yet research exploring the variables driving anxiety symptoms in FA remains sparse, and most studies still utilize homogeneous samples to assess anxiety symptoms. The current study seeks to evaluate the rates of clinically significant anxiety symptoms among a diverse sample of youth with FA and examine whether a heightened risk perception of FA outcomes and FA burden (vs. FA medical history) is associated with anxiety in youth. METHODS 94 youth ages 10-14 and their parents were recruited from FA clinics at a mid-Atlantic children's hospital. Both youth and parents completed demographic and FA medical history questionnaires, the Screen for Child Anxiety Related Emotional Disorders, and the Food Allergy Independent Measure as part of a longitudinal study about FA adjustment and adherence. RESULTS Over a third (37%) of youth scored above clinical cut-offs for overall anxiety symptoms. At least 25% of youth reported clinically significant scores on panic disorder, generalized anxiety, social anxiety, separation anxiety, and school avoidance subscales. Perception of risk of adverse FA outcomes and burden-but not FA medical history-were associated with total anxiety, generalized anxiety, panic disorder, and school avoidance symptoms, but not social anxiety and separation anxiety. Having more FAs was associated with higher social anxiety scores but not with other anxiety subscales. CONCLUSIONS Youth with FA might benefit from psychosocial interventions that address FA risk perception management and promote appropriate FA vigilance to cope with anxiety symptoms.
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Affiliation(s)
- Sally Ho
- Center for Translational Research, Children's National Hospital, Washington, DC, United States
| | - Frances Cooke
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC, United States
| | - Ashley Ramos
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island, United States
- Departments of Psychiatry and Human Behavior and Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States
| | - Linda Jones Herbert
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, United States
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Hill SA, Nurmatov U, DunnGalvin A, Reese I, Vieira MC, Rommel N, Dupont C, Venter C, Cianferoni A, Walsh J, Yonamine G, Beauregard A, Meyer R, Vazquez-Ortiz M. Feeding difficulties in children with food allergies: An EAACI Task Force Report. Pediatr Allergy Immunol 2024; 35:e14119. [PMID: 38566436 DOI: 10.1111/pai.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
The term "feeding difficulties" refers to a spectrum of phenotypes characterized by suboptimal intake of food and/or lack of age-appropriate eating habits. While it is evident that feeding difficulties are prevalent within healthy children, no consensus has been reached for those with food allergies. The aim of this study was to systematically review all the available literature reporting the prevalence of feeding difficulties within food allergic children. We searched eight international electronic databases for all published studies until June 2022. International experts in the field were also contacted for unpublished and ongoing studies. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so narrative synthesis of quantitative data was performed. A total of 2059 abstracts were assessed, out of which 21 underwent full-text screening and 10 studies met the study criteria. In these, 12 different terms to define feeding difficulties and 11 diagnostic tools were used. Five papers included data of feeding difficulty prevalence in children with food allergies, ranging from 13.6% to 40%. Higher prevalence was associated with multiple food allergies. The current literature suggests that feeding difficulties are prevalent within food allergic children, particularly those with multiple food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging. Consensus guidelines for the diagnosis and management of feeding difficulties within food allergic children and further research on the development and perpetuation of feeding difficulties are needed to appropriately manage such patients.
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Affiliation(s)
- Sarah-Anne Hill
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Audrey DunnGalvin
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Natalie Rommel
- University Hospital Tübingen, Tübingen, Germany
- Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Christophe Dupont
- Paris Descartes University, Paris, France
- Clinique Marcel Sembat, Ramsay Group, Boulogne Billancourt, France
| | - Carina Venter
- University of Colorado/Children's Hospital Colorado, Denver, Colorado, USA
| | - Antonella Cianferoni
- Allergy and Immunology Division, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Glauce Yonamine
- Division of Nutrition, Instituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Alexia Beauregard
- Faculty, Ellyn Satter Institute, Clinical Dietetics Branch Winn Army Community Hospital, Fort Stewart, Georgia, USA
| | - Rosan Meyer
- Imperial College London, London, UK
- University of Winchester, Winchester, UK
- University of KU Leuven, Leuven, Belgium
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Koffert A, Liippo J, Löyttyniemi E, Savolainen J. Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy. Allergol Immunopathol (Madr) 2024; 52:44-59. [PMID: 38186193 DOI: 10.15586/aei.v52i1.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/07/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To evaluate the clinical outcome of lightened version of egg oral immunotherapy (OIT) and to analyze egg allergen component-specific antibody levels during short up-dosing with egg white powder and maintenance by egg in daily diet. PATIENTS AND METHODS Eighteen egg-allergic children received egg powder with short up--dosing and they maintained tolerance using egg in daily diet. Seventeen egg-allergic children served as a control group. Component-resolved analysis of serum immunoglobulin E (IgE), IgA1, IgA2, and IgG4 levels were determined at inclusion, after up-dosing and after 1 year of immunotherapy. Skin-prick tests were performed at inclusion and after 1 year of therapy. RESULTS All 18 patients in the egg OIT group were successfully desensitized. Desensitization was achieved on average in 4.5 months. In the control group, only two children tolerated egg in oral food challenge after 1 year. Of the measured immune markers, smaller wheal diameters in skin-prick testing, reduction in component-specific IgE levels, and increase in component-specific IgA1, IgA2, and IgG4 levels were associated with desensitization. CONCLUSION A lightened egg OIT is effective and safe in children with egg allergy. Increase in all egg component-specific IgA1, IgA2 and IgG4 levels and decrease in all egg component--specific IgE levels were observed after 12 months of OIT.
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Affiliation(s)
- Anna Koffert
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland;
| | - Jussi Liippo
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Johannes Savolainen
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Hameed S, Sondhi V. Experiences and difficulties for primary caretakers of children with celiac disease - A qualitative study. Indian J Gastroenterol 2023; 42:791-799. [PMID: 37610566 DOI: 10.1007/s12664-023-01413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/06/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The purpose of this study was to understand the experiences of primary caretakers (PCTs) with a child diagnosed with celiac disease (CeD). There is paucity of research in understanding the experiences of PCTs of children with CeD in India. METHODS Purposive sampling was used to select PCTs of CeD-affected children from a tertiary hospital in New Delhi. Ten PCTs took part in the investigation. To gather the data, semi-structured interviews were held with participants. Hindi was used to administer the interviews. RESULTS The current study focused on the difficulties and worries PCTs experience in managing CeD. The main themes and sub-themes that emerged from the data were diagnosis of CeD (misdiagnosis of CeD, late diagnosis of CeD, feelings at the time of diagnosis, help from a doctor/nutritionist at the time of diagnosis); characteristics of CeD (CeD as a new disease, CeD as an allergy); attitude towards wheat (wheat as a poison, ignorance regarding negative effect of wheat); influence of significant others (making fun of the child, queries from others are a source of worry, non-acceptance of celiac disease by others and pressure to give gluten to the child); issues in following gluten-free diet (GFD) (fear of cross-contamination, distrust on GFD available outside home, GFD is expensive, making GFD is difficult, joint family, non-adherence to GFD, making non-GFD along with GFD); effect of CeD (financial effect of CeD, effect on physical and mental health of the child and PCT, effect on social life, change in family dynamics, eating restrictions); management of CeD (GFD for the whole family to manage CeD, family support to manage CeD, adhering to GFD, early diagnosis); and concerns (future marital concern for the child, cure of CeD, proper physical growth). CONCLUSION The current study gave an understanding of how PCTs dealt with a child's CeD. The difficulties and worries of caretakers should be taken into consideration and appropriate recommendations made to lessen the strain of managing the child's CeD and the daily obstacles associated with it.
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Affiliation(s)
- Sadaf Hameed
- Indian Council of Social Science Research, New Delhi, 110 029, India.
| | - Vanita Sondhi
- Vivekananda College, University of Delhi, New Delhi, 110 092, India
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Szafron V, Rana R, Anvari S. Updates in food allergen immunotherapy. Curr Opin Pediatr 2023; 35:680-685. [PMID: 37417834 DOI: 10.1097/mop.0000000000001272] [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] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW Food allergies are on the rise. Though allergen avoidance and management of acute reactions have been the backbone of therapy, complete avoidance and timely acute care is often not feasible. Food allergen immunotherapy (FAIT) is a novel and evolving treatment option intended to induce desensitization and potential sustained unresponsiveness (SU) to food allergens. This review addresses the methods, mechanisms, efficacy, and adverse effects of oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) for food allergens in the published literature. RECENT FINDINGS Single FAIT has been most extensively studied in peanut, milk, and hen's egg allergic patients and has been successful in achieving desensitization in treated individuals through various modalities. Long-term data regarding SU is limited; however, current data suggests subsets of patients may be more likely to achieve SU compared to others. Other studies are actively assessing multifood AIT and novel FAIT protocols with adjunctive therapies. SUMMARY Food allergy constitutes a prevalent problem with far-reaching consequences. The emergence of FAIT may mitigate the burden of food allergy. Current evidence is promising for specific allergens and pediatric patient populations. Future studies are needed to further assess efficacy between different modalities of immunotherapy for food allergens across an age continuum.
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Affiliation(s)
- Vibha Szafron
- Baylor College of Medicine, Department of Pediatrics, Division of Immunology, Allergy and Retrovirology
| | - Ruchit Rana
- B-Baylor College of Medicine, Department of Medicine, Section of Immunology, Allergy and Rheumatology
| | - Sara Anvari
- Baylor College of Medicine, Department of Pediatrics, Division of Immunology, Allergy and Retrovirology
- Texas Children's Hospital, William T. Shearer Center for Human Immunobiology, Houston, Texas, USA
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Hu A, Lloyd M, Loke P, Chebar Lozinsky A, O'Sullivan M, Quinn P, Gold M, Tang MLK. Association of Reaction Symptoms and Eliciting Dose With Health-Related Quality of Life in Children With Peanut Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3195-3202.e4. [PMID: 37423341 DOI: 10.1016/j.jaip.2023.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Food allergy adversely affects the health-related quality of life (HRQoL) of patients. It is unclear whether factors such as the reaction eliciting dose (ED) and the nature of allergic reaction symptoms affect HRQoL. OBJECTIVE To explore associations between reaction ED or the nature of allergic symptoms and HRQoL among children with peanut allergy. METHODS This study was a secondary analysis of baseline data from the PPOIT-003 randomized trial in 212 children aged 1 to 10 years with challenge-confirmed peanut allergy. Children's past reaction symptoms were collected by clinicians during screening. Associations between variables of interest and parent-reported child-proxy HRQoL were examined by univariable and multivariable linear regression. RESULTS Mean age of study participants was 5.9 years; 63.2% were male. Children with a low reaction ED of 80 mg peanut protein had significantly poorer HRQoL (β = -0.81; 95% CI, -1.61 to -0.00; P = .049) compared with children with a high ED of 2,500 mg peanut protein. Gastrointestinal symptoms (β = 0.45; 95% CI, 0.03-0.87; P = .037), lower airway symptoms (β = 0.46; 95% CI, 0.05-0.87; P = .030), multisystem involvement (β = 0.71; 95% CI, 0.25-1.16; P = .003), or anaphylaxis (β = 0.46; 95% CI, 0.04-0.87; P = .031) during a previous reaction were associated with worse HRQoL. CONCLUSIONS Peanut-allergic children with a lower allergen reaction threshold experienced a greater negative HRQoL impact compared with children with higher reaction thresholds. In addition, specific past allergic reaction symptoms were associated with comparatively worse HRQoL. Children experiencing these symptoms and those with lower reaction ED require increased clinical support to manage the food allergy and are likely to benefit from interventions that can improve HRQoL.
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Affiliation(s)
- Alice Hu
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, Monash University Clayton, Victoria, Australia
| | | | - Michael O'Sullivan
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia; Paediatrics Division, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Patrick Quinn
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Michael Gold
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
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Chang F, Eng L, Chang C. Food Allergy Labeling Laws: International Guidelines for Residents and Travelers. Clin Rev Allergy Immunol 2023; 65:148-165. [PMID: 37160543 PMCID: PMC10169132 DOI: 10.1007/s12016-023-08960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
The prevalence of food allergies varies by country, as does each country's food allergen labeling. While labeling laws may vary by country, most follow the Codex Alimentarius. Even developing countries have some degree of labeling guidelines for food allergies, but it is highly developed countries that tend to implement stricter labeling regulations to protect their citizens and tourists. Different organizations, both domestic and international, such as Food Allergy Research and Education (FARE), work to advance food allergen labeling laws around the globe. Eating out and traveling can be anxiety-provoking for people with food allergies, especially when traveling to international destinations. Furthermore, experiences that young children, teenagers, and parents have with food allergies can have psychosocial and social impacts. To evaluate food allergen labeling laws across the globe, official legal documents outlining the laws pertaining to foods and allergen food labeling were reviewed for each respective country or region. These were organized according to continent, then region or country. The majority of countries require that major food groups be listed on food labels, including milk, egg, soy, wheat, peanuts, treenuts, fish, and shellfish. There are individual variations across regions depending on staples in respective diets. With increasing rates of food allergies worldwide, legislative action is needed to ensure that people living with food allergies can more safely purchase and consume foods. Until then, the work of avoiding accidental ingestions and anaphylaxis remains primarily with the individual, who must educate themselves on labeling laws and implement other protective measures.
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Affiliation(s)
- Francesca Chang
- Northumbria University, Ellison Place, Newcastle Upon Tyne, NE1 8ST UK
| | - Lauren Eng
- Amherst College, Keefe Campus Center, AC# 1285, 16 Barrett Hill Drive, Amherst, MA 01002-5000 USA
| | - Christopher Chang
- Division of Immunology, Allergy and Pediatric Rheumatology, Joe DiMaggio Children’s Hospital, Memorial Healthcare System, 1131 N 35Th Avenue, Suite 220, Hollywood, FL 33021 USA
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Kılıç N, Kaya Ş, Taşçı G, Özsoy F, Kılıç M. Quality of life in children with food allergies, psychiatric symptoms, and caregiving burden of their mothers. Allergol Immunopathol (Madr) 2023; 51:48-56. [PMID: 37695230 DOI: 10.15586/aei.v51i5.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The present study aimed to evaluate the quality of life in children with food allergies, the accompanying depression and anxiety disorders, and caregiving burden of their mothers. MATERIAL AND METHODS A total of 168 children with food allergy visiting our clinic and their mothers were included in the study group. The control group included 152 children who visited the healthy child follow-up clinic of our hospital and their mothers. Studying mothers' opinions, the Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) was used for evaluating children, and the Beck's Depression Inventory, Beck's Anxiety Inventory, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, and Zarit Caregiver Burden Scales were used for evaluating mothers. RESULTS No differences were noticed between the study and control group regarding mean age and gender distribution (P > 0.05). In the study, the FAQLQ-PF total and subscale scores of children with food allergies were determined according to the opinions of their mothers, and scores tended to increase with age (P < 0.0001). In addition, it was determined that mothers of children with food allergies had higher levels of anxiety, depression, and caregiving burden than mothers of the control group (P < 0.0001). CONCLUSION In order to develop a multidisciplinary approach for children with food allergies, we conceived as appropriate to inform their families about the difficulties of caregiving and psychosocial disorders that could develop over time. They also must be informed to take preventive measures as well as the medical aspects of their children's disease.
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Affiliation(s)
- Nülüfer Kılıç
- Elazığ Mental Health and Diseases Hospital, Elazığ, Turkey;
| | - Şuheda Kaya
- Elazığ Mental Health and Diseases Hospital, Elazığ, Turkey
| | - Gülay Taşçı
- Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Filiz Özsoy
- Faculty of Medicine, Department of Psychiatry, Gaziosmanpasa University, Tokat/Turkey
| | - Mehmet Kılıç
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of Firat, Elazığ, Turkey
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Pasioti M, Savva M, Lakoumentas J, Kompoti E, Makris M, Xepapadaki P, Papadopoulos NG. Impact of Presumed Tree Nut and Peanut Allergy on Quality of Life at Different Ages. J Clin Med 2023; 12:jcm12103472. [PMID: 37240577 DOI: 10.3390/jcm12103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Tree nut and/or peanut allergy impairs patients' quality of life, but data on the impact of age and the type of nut or peanut on the quality of life are lacking. To evaluate the impact at different ages, age-appropriate survey questionnaires accompanied by FAQLQ and FAIM were distributed to patients with suspected tree nut and/or peanut allergy who presented at the allergy departments of three hospitals in Athens. Out of 200 questionnaires distributed, 106 met the inclusion criteria (46 children, 26 teenagers, 34 adults). The median score of each age group for FAQLQ was 4.6 (3.3-5.1), 4.7 (3.9-5.5), and 3.9 (3.2-5.1) and for FAIM was 3.7 (3.0-4.0), 3.4 (2.8-4.0), and 3.2 (2.7-4.1), respectively. FAQLQ and FAIM scores were correlated with the reported probability of using the rescue anaphylaxis set upon reaction (15.4%, p = 0.04 and 17.8%, p = 0.02, respectively) and pistachio allergy (FAQLQ: 4.8 vs. 4.0, p = 0.04; FAIM: 3.5 vs. 3.2, p = 0.03). Patients with additional food allergies reported worse FAQLQ scores (4.6 vs. 3.8, p = 0.05). Worse FAIM scores were associated with younger age (-18.2%, p = 0.01) and the number of life-threatening allergic reactions (25.3%, p < 0.001). The overall impact of tree nut and/or peanut allergy on patients' quality of life is moderate but differs with age, the type of nut, the use of adrenaline, and the number of previous reactions. The aspects of life affected and contributed factors also vary across age groups.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Fidippidou Street, 4th Floor, Goudi, 115 27 Athens, Greece
| | - Maria Savva
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Evangelia Kompoti
- Allergology Department, "Laikon" General Hospital, 115 27 Athens, Greece
| | - Michael Makris
- Allergy Unit 'D. Kalogeromitros', 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 124 62 Chaidari, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Post hoc analysis examining symptom severity reduction and symptom absence during food challenges in individuals who underwent oral immunotherapy for peanut allergy: results from three trials. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:21. [PMID: 36915184 PMCID: PMC10009988 DOI: 10.1186/s13223-023-00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Peanut allergy and its current management, involving peanut avoidance and use of rescue medication during instances of accidental exposure, are burdensome to patients and their caregivers and can be a source of stress, uncertainty, and restriction. Physicians may also be frustrated with a lack of effective and safe treatments other than avoidance in the current management of peanut allergy. Efficacy, determined using double-blind, placebo-controlled food challenges (DBPCFCs), of oral immunotherapy with peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Palforzia®) was demonstrated versus placebo in children and adolescents aged 4 to 17 years in multiple phase 3 trials; continued benefit of PTAH was shown in a follow-on trial. The DBPCFC is a reproducible, rigorous, and clinically meaningful assessment accepted by regulatory authorities to evaluate the level of tolerance as an endpoint for accidental exposures to peanut in real life. It also provides useful clinical and patient-relevant information, including the amount of peanut protein an individual with peanut allergy can consume without experiencing dose-limiting symptoms, severity of symptoms, and organs affected upon ingestion of peanut protein. We explored symptoms of peanut exposure during DBPCFCs from phase 3 and follow-on trials of PTAH to further characterize treatment efficacy from a perspective relevant to patients, caregivers, and clinicians. METHODS Symptom data recorded during screening and/or exit DBPCFCs from participants aged 4 to 17 years receiving PTAH or placebo were examined post hoc across three PTAH trials (PALISADE [ARC003], ARC004 [PALISADE follow-on], and ARTEMIS [ARC010]). The maximum peanut protein administered as a single dose during DBPCFCs was 1000 mg (PALISADE and ARTEMIS) and 2000 mg (ARC004). Symptoms were classified by system organ class (SOC) and maximum severity. Endpoints were changes in symptom severity and freedom from symptoms (ie, asymptomatic) during DBPCFC. Relative risk (RR) was calculated for symptom severity by SOC and freedom from symptoms between groups; descriptive statistics were used to summarize all other data. RESULTS The risk of any respiratory (RR 0.42 [0.30-0.60], P < 0.0001), gastrointestinal (RR 0.34 [0.26-0.44], P < 0.0001), cardiovascular/neurological (RR 0.17 [0.08-0.39], P < 0.001), or dermatological (RR 0.33 [0.22-0.50], P < 0.0001) symptoms was significantly lower in participants treated with PTAH versus placebo upon exposure to peanut at the end of the PALISADE trial (ie, exit DBPCFC). Compared with placebo-treated participants (23.4%), the majority (76.3%) of PTAH-treated participants had no symptoms at the exit DBPCFC when tested at the peanut protein dose not tolerated (ie, reactive dose) during the screening DBPCFC. Significantly higher proportions of PTAH-treated participants were asymptomatic at doses ≤ 100 mg in the exit DBPCFC compared with placebo-treated participants (PALISADE: 69.35% vs 12.10%, RR 5.73 [95% confidence interval (CI) 3.55-9.26]; P < 0.0001; ARTEMIS: 67.42% vs 13.95%, RR 4.83 [95% CI 2.28-10.25]; P < 0.0001); findings were similar at peanut protein doses ≤ 1000 mg (PALISADE: RR 15.56 [95% CI 5.05-47.94]; P < 0.0001; ARTEMIS: RR 34.74 [95% CI 2.19-551.03]; P < 0.0001). In ARC004, as the period of PTAH maintenance became longer, greater proportions of participants were asymptomatic at doses of peanut protein ≤ 1000 mg in the exit DBPCFC (from 37.63% after ~ 6 months of maintenance treatment [exit DBPCFC of PALISADE] to 45.54% after ~ 13 months and 58.06% after ~ 20 months of overall PTAH maintenance treatment). CONCLUSIONS PTAH significantly reduced symptom severity due to exposure to peanut, which is clinically relevant. When exposed to peanut, participants with peanut allergy treated with PTAH rarely had moderate or severe respiratory or cardiovascular/neurological symptoms. Oral immunotherapy with PTAH appears to reduce frequency and severity of allergic reactions in individuals with peanut allergy after accidental exposure to peanut and may enable them and their families to have an improved quality of life. Trial registration ClinicalTrials.gov, NCT02635776, registered 17 December 2015, https://clinicaltrials.gov/ct2/show/NCT02635776?term=AR101&draw=2&rank=7 ; ClinicalTrials.gov, NCT02993107, registered 08 December 2016, https://clinicaltrials.gov/ct2/show/NCT02993107?term=AR101&draw=2&rank=6 ; ClinicalTrials.gov, NCT03201003, registered 22 June 2017, https://clinicaltrials.gov/ct2/show/NCT03201003 ? term = AR101&draw = 2&rank = 9.
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Casale TB, Irani AM. Peanut ( Arachis hypogaea) allergen powder-dnfp for the mitigation of allergic reactions to peanuts in children and adolescents. Expert Rev Clin Immunol 2023; 19:253-265. [PMID: 36524617 DOI: 10.1080/1744666x.2023.2159812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peanut allergy can result in severe, sometimes fatal hypersensitivity reactions that place a considerable burden on the lives of patients. This article reviews the first approved immunotherapy for the mitigation of allergic reactions following accidental peanut exposure, peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Palforzia®, Aimmune Therapeutics). AREAS COVERED This article highlights the unmet need for patients with peanut allergy, describes the therapeutic landscape, and reviews the development of and clinical data for PTAH. EXPERT OPINION PTAH offers a standardized preparation of peanut allergen, with a tolerability and efficacy profile clearly defined through its robust clinical development and trial program. In children 4-17 years old, PTAH provides a standardized, approved product that many clinicians sought prior to initiating oral immunotherapy. PTAH reduced the likelihood of more severe reactions following exposure to peanut protein; although peanut avoidance remains essential, PTAH will enable more individuals with peanut allergy to participate in activities of daily life with less anxiety.
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Affiliation(s)
- Thomas B Casale
- Internal Medicine, Morsani College of Medicine, Division of Allergy and Immunology, University of South Florida, Tampa Florida, USA
| | - Anne-Marie Irani
- Medical Affairs, Aimmune Therapeutics Inc, Brisbane California, USA
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Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
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Drakouli AE, Kontele I, Poulimeneas D, Saripanagiotou S, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review. CHILDREN 2023; 10:children10030433. [PMID: 36979991 PMCID: PMC10047601 DOI: 10.3390/children10030433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Recently, besides the focus on the medical diagnosis and therapeutic interventions for food allergy (FA), the psychosocial aspects of this frequent condition have also been investigated. The current systematic review aimed to explore and synthesize the scientific evidence published from January 2015 to April 2022 on Health-Related Quality of Life (HRQoL) among children and adolescents with FAs. Twenty-eight research studies were included in the review, which was conducted on three databases (PubMed, Scopus and Cochrane Library). In most studies, the scores indicate an average level of HRQoL for children and adolescents with FAs, with girls and older children being more negatively affected than boys and younger ones, respectively. Few studies compared HRQoL between children with FA and healthy children, with 3 of them showing worse HRQoL for children with FAs. Immunotherapy has been found to improve the QoL of children with FAs. Anaphylaxis history, number of FAs, additional allergies, number and severity of symptoms were identified as the main factors with a negative impact on QoL. More comparative studies on the HRQoL of children and adolescents with FAs and healthy populations or children with other chronic diseases are required in order to improve QoL of children with FAs.
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Affiliation(s)
- Artemis-Eirini Drakouli
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Ioanna Kontele
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, University of the Peloponnese, 24100 Kalamata, Greece
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece
| | | | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
- Correspondence: (T.N.S.); (T.V.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
- Correspondence: (T.N.S.); (T.V.)
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16
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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17
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Luo W, Cai Q, Chen R, Yin Y, Sun XX, Cai YP, Song HZ, Zhang YR, Liao Y. The Chinese version of the child food neophobia scale and its reliability and validity in preschool children. J Pediatr Nurs 2022; 69:1-5. [PMID: 36584591 DOI: 10.1016/j.pedn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To translate the English version Child Food Neophobia Scale (CFNS) into the Chinese version and test its reliability and validity in preschool children. METHODS To create the Chinese version of the CFNS, it was translated, back-translated, and cross-culturally adapted. The use of the Chinese version of CFNS by 575 parents of preschool children in two kindergartens in Yangzhou City was investigated using cluster sampling to assess the reliability and validity of the scale. RESULTS The Chinese version of CFNS has nine items in total. The scale-level average content validity index (S-CVI/Ave) is 0.983. Exploratory factor analysis (EFA) extracted 2 common factors, and the cumulative variance contribution rate was 49.437%. Confirmatory factor analysis (CFA) showed that the 2-factor model was well fitted. The Cronbach'α coefficient of the scale was 0.759, the Cronbach'α coefficients of the two factors were 0.735 and 0.713, the split-half reliability was 0.788, and the test-retest reliability was 0.756. CONCLUSION The Chinese version of the Child Food Neophobia Scale has good reliability and validity in preschool children and can be used as an assessment tool for food neophobia in preschool children in China. PRACTICE IMPLICATIONS This study has gone through a rigorous translation process, and the CFNS may support future exploration of food neophobia in preschool children. Food allergy factors in the results may be the next step in the research, and several studies are still needed to understand the relationship between food allergy and food neophobia.
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Affiliation(s)
- Wen Luo
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qian Cai
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Rong Chen
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yue Yin
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xin-Xin Sun
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Ye-Peng Cai
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Hui-Zi Song
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yi-Ran Zhang
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuexia Liao
- School of Nursing, School of public health, Yangzhou University, Yangzhou, Jiangsu, China.
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Schelly D, Ohl A, Meramo H. College students with food allergy: From hypervigilance to disclosure fatigue. J Pediatr Nurs 2022; 70:e32-e39. [PMID: 36494237 DOI: 10.1016/j.pedn.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to explore the impact of food allergy (FA) on the daily lives of young adults who recently transitioned to attending college away from home. DESIGN AND METHODS We conducted in-depth qualitative interviews using a grounded theory approach to data collection, data analysis, and theory development. For recruitment, we posted a flier on a FA Facebook group and reposted approximately monthly for one year. We completed and recorded 16 interviews that ranged in duration from 30 to 90 min. The interviews were transcribed, coded, and analyzed with the intention of developing mid-range theory. RESULTS Several interrelated themes were identified during the analytical process, including hypervigilance, misunderstood risk, and stigma management. Notably, a series of cascading effects eventually lead to what we call "disclosure fatigue," where students with FA tire of talking about their invisible disability with people who misunderstand it, and they eventually develop strategies to avoid conversations. The consequences include a narrowing of social networks and activities and even risky food behaviors. CONCLUSIONS Research is needed in other settings, for other conditions, to consider and ameliorate the negative health consequences associated with disclosure fatigue. PRACTICE IMPLICATIONS In addition to focusing on physical aspects of FA, including avoiding exposure, healthcare practitioners in pediatric settings should emphasize social aspects of FA that gain influence during the transition out of high school and away from home. Disclosure fatigue provides one explanation for why individuals with FA may choose to ignore best practices and engage in risky food behaviors.
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Affiliation(s)
- David Schelly
- Department of Occupational Therapy, Lewis School of Health Sciences, Clarkson University, Box 5883, 8 Clarkson Ave., Potsdam, NY 13699, USA.
| | - Alisha Ohl
- Department of Occupational Therapy, Lewis School of Health Sciences, Clarkson University, Box 5883, 8 Clarkson Ave., Potsdam, NY 13699, USA
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Rahman S, Elliott SA, Scott SD, Hartling L. Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs. PEC INNOVATION 2022; 1:100018. [PMID: 37213745 PMCID: PMC10194313 DOI: 10.1016/j.pecinn.2022.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore parents' self-reported experiences and information needs regarding recognition and management of pediatric anaphylaxis. Methods We searched Ovid Medline, Ovid PsychInfo, CINAHL Plus, the Cochrane Library, and grey literature to identify primary studies in English or French published since 2000. We used a mixed-method appraisal tool and convergent integrated approach to assess quality and synthesize data, respectively. Results 43 studies were included (22 quantitative, 19 qualitative, and 2 mixed-method); 77% of studies had high methodological quality. Parents' experiences were categorized as: recognizing an anaphylactic reaction; managing and responding to a reaction; emotional impact of caring for a child at risk of anaphylaxis; and interaction with the health system and healthcare providers. Parents' information needs were categorized into themes relating to: gaps in knowledge and information; type of information desired; information sources; and information delivery format. Conclusion Negative emotional experiences and a general lack of information were commonly reported by parents of included studies. Provision of relevant and comprehensible information may help parents to make informed decisions and manage reactions promptly. Innovation The findings of this review are guiding the development of an innovative knowledge translation tool (KT) as part of a larger initiative of developing a suite of parent-focused KT tools for acute childhood conditions.
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Affiliation(s)
- Sholeh Rahman
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Shannon D. Scott
- Translating Evidence in Child Health to Enhance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
- Correspondence to: L. Hartling, 4-472 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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Kostecka M, Kostecka-Jarecka J, Kostecka J, Iłowiecka K, Kolasa K, Gutowska G, Sawic M. Parental Knowledge about Allergies and Problems with an Elimination Diet in Children Aged 3 to 6 Years. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111693. [PMID: 36360421 PMCID: PMC9689114 DOI: 10.3390/children9111693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Allergic diseases are highly prevalent, and they can exert a significant influence on the patients’ physical and mental well-being, thus affecting the quality of their lives and society as a whole. The aim of this study was to evaluate parental knowledge about allergens, allergy symptoms, and treatment of allergies, and to identify problems with adherence to an elimination diet and the underlying difficulties. Twelve kindergartens and the parents of 1350 preschoolers took part in the first stage of the study. In a screening trial, allergies were diagnosed in 197 children, and their parents participated in the second stage of the study. The child’s age at the onset of the first symptoms was significantly correlated with allergy type. Age was significantly correlated with selected symptoms of an allergic reaction, and skin allergies were more prevalent in younger children. Erythema, skin reddening, and urticaria occurred more frequently in children aged 3−4 years (OR 1.45; 95%CI 1.24−1.77, p < 0.05) and were diagnosed in skin tests (OR 1.36; 95%CI 1.22−1.59, p < 0.05). Allergies to numerous food items were associated with a long-term elimination diet (OR 1.89; 95%CI 1.33−2.19, p < 0.01), as well as problems with preparing safe meals, shopping for food, or dietary adherence when eating out. According to the respondents, lack of support from other family members and compliance with dietary restrictions in kindergartens and when eating out posed the greatest barriers to dietary adherence. Parents do not have sufficient knowledge about environmental allergens and effective strategies for coping with acute allergic reactions, including anaphylactic shock. Children with diagnosed food allergies should enjoy a similar quality of life to their healthy peers, which is why the parents should be educated about diet therapy, duration of treatment, and safe food substitutes.
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Affiliation(s)
- Malgorzata Kostecka
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
- Correspondence: ; Tel.: +48-814-456-846
| | | | - Julianna Kostecka
- Faculty of Medicine, Medical University of Lublin, Chodźki 19, 20-093 Lublin, Poland
| | - Katarzyna Iłowiecka
- Department of Food and Nutrition, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | - Katarzyna Kolasa
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
| | - Gabriela Gutowska
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
| | - Magdalena Sawic
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
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21
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Stockhammer D, Katelaris CH, Simpson MD, Vanniasinkam T. Living with food allergy: What this means for children. J Child Health Care 2022; 26:262-274. [PMID: 33913341 DOI: 10.1177/13674935211013689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health-related knowledge, skills and attitudes that translate to behaviours are important foundations for healthy living. However, deficiencies in any one of these factors have the potential to impact quality of life. This study investigates how Australian children perceive and manage their food allergy as they transition through childhood onto adolescence. To measure this, children aged 12 years and under completed an online survey [under 8 years and 8-12 years] on knowledge, skills and attitudes. Although recruitment involved advertisements to over 700 Australian pre-schools, 44 allergy specialists and multiple representations to the patient support group, Allergy & Anaphylaxis Australia, completion relied on parental notification and/or guidance. Of the 139 participants recruited, 114 commenced the survey with 65 participants under 8 years (58%) and 49 between 8 and 12 years. Results showed participants recognised different ways to keep safe with children under 8 years (N = 65) 100% cognisant of the need to check with 'Mum/Dad' or teachers if they could safely eat food as well as the importance of not swapping lunches, while there was a slight change in compliance for those aged 8-12 years as three (6.1%, n = 3/49) children did not see the necessity of asking an adult/teacher if a food item was safe to eat. Older children were also less likely to tell friends about their food allergy even if they thought they were having an allergic reaction, despite children under 8 years more likely to feel different to friends (38%, n = 24/64) compared to those aged 8-12 years (31%, n = 14/45). Although both groups disliked parents' fussing, for children under 8 years, there was a strong association between this and 'feeling different to friends'. Results from this study highlight the importance of normalising food allergy at home and in the community, so children are confident in telling others about their food allergy.
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Affiliation(s)
- Debbi Stockhammer
- School of Biomedical Sciences, 1109Charles Sturt University, Wagga Wagga, Australia
| | - Connie H Katelaris
- Immunology & Allergy Unit, 63608Campbelltown Hospital, New South Wales, Australia
| | - Maree D Simpson
- School of Biomedical Sciences, 1109Charles Sturt University, Orange, Australia
| | - Thiru Vanniasinkam
- School of Biomedical Sciences, 1109Charles Sturt University, Wagga Wagga, Australia
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22
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Proctor KB, Tison K, Estrem H, Park J, Scahill L, Vickery BP, Sharp WG. A systematic review of parent report measures assessing the psychosocial impact of food allergy on patients and families. Allergy 2022; 77:1347-1359. [PMID: 34647344 DOI: 10.1111/all.15140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/10/2021] [Accepted: 10/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reducing the psychosocial impact of food allergy (FA) represents a top patient-centered research priority. This priority recognizes that psychosocial impact is an important outcome of current FA therapies (eg, oral immunotherapy), as well as interventions aimed at improving overall quality of life and illness adaptation. Reliable and valid measurement is a necessary prerequisite to developing and evaluating current and emerging FA therapies and potential changes in psychosocial impact. METHODS In this systematic review, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate available parent report measures assessing the psychosocial impact of pediatric IgE-mediated FA. RESULTS The systematic search yielded 64 articles involving 13 unique measures. Measures were evaluated through the lens of the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. Findings indicated that available measures show some evidence of reliability and validity; however, none completely adhere to PROMIS guidelines for measure development. CONCLUSION Results highlight a continued need to dedicate research to develop a measurement approach that assesses the full range of psychosocial impact that parents and families may experience as a result of FA, as well as serve as a research outcome as the field continues to develop effective treatments, including immunotherapy.
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Affiliation(s)
| | | | - Hayley Estrem
- University of North Carolina Wilmington Wilmington NC USA
| | | | - Lawrence Scahill
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
| | - Brian P. Vickery
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
| | - William G. Sharp
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
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23
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Wilton EP, Luke AK, Gladstone TR, Lahoud AA, Biscarri Clark SD, Flessner CA. Psychometric Properties of a Measure Assessing Anxiogenic Parenting Practices in Food Allergy. J Pediatr Psychol 2022; 47:769-784. [DOI: 10.1093/jpepsy/jsac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Pediatric food allergy represents a significant public health burden. In order to avoid allergen consumption, adequate management requires daily vigilance and involvement from parents, frequently leading to increased parental anxiety. While specific anxiogenic parenting practices (i.e., parenting behaviors which may aid in the development and/or exacerbation of childhood anxiety) have been documented within this population, to this point, these behaviors have not been systematically measured.
Objectives
The current study aimed to develop and examine a parent-report scale designed to measure anxiogenic parenting behaviors related to food allergy.
Methods
Participants included 177 parents of children with food allergy recruited online using Amazon Mechanical Turk (mTurk). An exploratory factor analysis was conducted to determine the factor structure of the newly developed scale. Subsequently, psychometric properties (e.g., construct validity) were examined via correlational analyses.
Results
Results indicated a 24-item, 3 factor (Factor 1: Involvement in Food Allergy; Factor 2: Worry about Food Allergy; Factor 3: Autonomy Promotion) scale, which accounted for 53.11% of the total variance. The Kaiser–Meyer–Olkin measure was acceptable, KMO = 0.872 and Bartlett’s test of sphericity indicated sufficient correlations between items (χ2 (378) = 2568.95). All subscales demonstrated strong internal consistency (Involvement in Food Allergy: α = .880; Worry about Food Allergy: α = .892; Autonomy Promotion α = .796) as well as convergent and discriminant validity.
Conclusions
Results support the overall psychometric properties of the scale. Interpretations, limitations, and future directions are discussed.
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Affiliation(s)
- Emily P Wilton
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
| | | | - Theresa R Gladstone
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
| | - Ashley A Lahoud
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
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24
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Hwang DW, Nagler CR, Ciaccio CE. New and Emerging Concepts and Therapies for the Treatment of Food Allergy. IMMUNOTHERAPY ADVANCES 2022; 2:ltac006. [PMID: 35434724 PMCID: PMC9007422 DOI: 10.1093/immadv/ltac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Food allergy is an increasingly common disease that often starts in early childhood and lasts throughout life. Self-reported food allergy has risen at a rate of 1.2% per decade since 1988, and by 2018, the prevalence of food allergy in the United States was estimated to be 8% in children and 11% in adults.- This prevalence has led to an economic burden of almost $25 billion annually. Despite these staggering statistics, as of the time of this writing, the Food and Drug Administration (FDA) has only approved one treatment for food allergy, which is limited to use in children with peanut allergy. Fortunately, a new horizon of therapeutic interventions, in all stages of development, lay ahead and hold promise for the near future.
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Affiliation(s)
- David W Hwang
- Departments of Medicine, The University of Chicago, Chicago, IL
| | - Cathryn R Nagler
- Departments of Medicine, The University of Chicago, Chicago, IL
- Departments of Medicine Pediatrics, The University of Chicago, Chicago, IL
- Departments of Medicine Pathology, The University of Chicago, Chicago, IL
- Pritzker School of Molecular Engineering, The University of Chicago, Chicago, IL
| | - Christina E Ciaccio
- Departments of Medicine, The University of Chicago, Chicago, IL
- Departments of Medicine Pediatrics, The University of Chicago, Chicago, IL
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25
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Kotsapas C, Nicolaou N, Haider S, Kerry G, Turner PJ, Murray CS, Simpson A, Custovic A. Early-life predictors and risk factors of peanut allergy, and its association with asthma in later-life: Population-based birth cohort study. Clin Exp Allergy 2022; 52:646-657. [PMID: 35108754 PMCID: PMC9303430 DOI: 10.1111/cea.14103] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Understanding risk factors for peanut allergy (PA) is essential to develop effective preventive measures. OBJECTIVE To ascertain associates and predictors of PA, and the relationship between PA and asthma severity. METHODS In a population-based birth cohort, we investigated the association between objectively confirmed PA with early-life environmental exposures, filaggrin (FLG)-loss-of-function mutations and other atopic disease. We then examined the association of PA with longitudinal trajectories of sensitisation, wheeze and allergic comorbidities, which were previously derived using machine learning. Finally, we ascertained the relationship between PA and asthma severity. RESULTS PA was confirmed in 30/959 participants with evaluable data. In the multivariate analysis, eczema in infancy (OR=4.4, 95% CI 1.5-13.2, p=0.007), egg sensitisation at age 3 years (OR=9.7, 95% CI 3.3-29.9, p<0.001) and early-life cat ownership (OR=3.0, 95% CI 1.1-8.4, p=0.04) were independent associates of PA. In the stratified analysis among 700 participants with genetic information, in children with early-life eczema there was no difference in FLG mutations between children with and without PA (3/18 [16.7%] vs. 42/220 [19.1%], p=1.00). In contrast, among children without eczema, those with PA were almost 8-times more likely to have FLG mutations (2/6 [33.3%] vs. 27/456 [5.9%], p=0.049). We observed associations between PA and multiple allergic sensitisation profiles derived using machine learning, with ~60-fold increase in risk amongst individuals assigned to multiple early sensitisation. PA was significantly associated with persistent wheeze (but not other wheeze phenotypes), and with trajectories of atopic disease characterised by co-morbid persistent eczema and wheeze (but not with transient phenotypes). Children with PA were more likely to have asthma, but among asthmatics we found no evidence of an association between PA and asthma severity. CONCLUSIONS Peanut allergy is associated with multiple IgE-sensitisation and early-onset persistent eczema and wheeze. FLG loss-of-function mutations were associated with peanut allergy in children without eczema.
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Affiliation(s)
| | - Nicolaos Nicolaou
- University of Nicosia Medical School, Cyprus.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gina Kerry
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
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26
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Abrams EM, Greenhawt M, Shaker M, Alqurashi W. Separating Fact from Fiction in the Diagnosis and Management of Food Allergy. J Pediatr 2022; 241:221-228. [PMID: 34678246 DOI: 10.1016/j.jpeds.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Canada.
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon; Geisel School of Medicine at Dartmouth, Hanover
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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27
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Westwell-Roper C, To S, Andjelic G, Lu C, Lin B, Soller L, Chan ES, Stewart SE. Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review. Pediatr Allergy Immunol 2022; 33:e13695. [PMID: 34779046 DOI: 10.1111/pai.13695] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA. METHODS MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines. RESULTS Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors. CONCLUSIONS FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.
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Affiliation(s)
- Clara Westwell-Roper
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon To
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordan Andjelic
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cynthia Lu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Boyee Lin
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada
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28
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Gallop K, Acaster S, de Vries J, Browne R, Ryan R, Baker S, Du Toit G. Exploring Health-Related Quality of Life Burden in Peanut Allergy and the Potential Benefit of Oral Immunotherapy: Estimation of Health State Utility Values for Children and Adolescents and Their Caregivers. Patient Prefer Adherence 2022; 16:1269-1278. [PMID: 35619589 PMCID: PMC9129262 DOI: 10.2147/ppa.s357864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to estimate utility values for health states relating to oral immunotherapy (OIT) for peanut allergy (PA), for children with PA and their caregivers. PATIENTS AND METHODS Two methods were used: an online survey and structured interviews. Both methods assessed current utility/untreated PA (health-related quality of life, HRQoL) and HRQoL in different health states: "up-dosing phase of treatment", "maintenance phase" and "able to tolerate 6-8 peanuts if accidentally ingested". The survey was conducted in individuals with and without experience of OIT; data collected included the EQ-5D-Y (child states) and EQ-5D-5L (caregiver states). RESULTS In total, 100 caregivers and 38 adolescents completed the treatment-naïve survey, a separate sample of 50 caregivers participated in structured interviews. Seven caregivers and two adolescents with experience of OIT for PA completed the survey. Data from the three samples were pooled, the mean utility values were untreated PA: 0.796 (child), 0.855 (caregiver); up-dosing: 0.711 (child), 0.806 (caregiver); maintenance: 0.821 (child), 0.849 (caregiver), tolerate 6-8 peanuts: 0.859 (child), 0.884 (caregiver). The results show a gain in utility of 0.063 for children and 0.029 for caregivers between the untreated and tolerate 6-8 peanuts health states. CONCLUSION This study is the first to assess utilities relating to OIT for PA. The results show the potential benefit of OIT for individuals with PA and their caregivers and provide values for use in cost-effectiveness evaluation.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, UK
- Correspondence: Katy Gallop, Acaster Lloyd Consulting, 84 Theobalds Road, London, WC1X 8NL, UK, Tel +44 203 9781686, Email
| | | | | | | | - Robert Ryan
- Aimmune Therapeutics, London, UK
- Robert Ryan, Aimmune Therapeutics, 10 Eastbourne Terrace, London, W2 6LG, UK, Email
| | | | - George Du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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29
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Akarsu A, Brindisi G, Fiocchi A, Zicari AM, Arasi S. Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective. Front Pediatr 2022; 10:842196. [PMID: 35273931 PMCID: PMC8901728 DOI: 10.3389/fped.2022.842196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.
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Affiliation(s)
- Aysegul Akarsu
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Giulia Brindisi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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30
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Steiner EM, Dahlquist L. Intolerance of uncertainty and protective parenting: the mediating role of maternal appraisals and the moderating role of child health status. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.2007771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emily M. Steiner
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Lynnda Dahlquist
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
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31
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Adaptation, Translation and Validation of the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF): The Malay Version. CHILDREN 2021; 8:children8111050. [PMID: 34828763 PMCID: PMC8617718 DOI: 10.3390/children8111050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Food allergy has a significant impact on the quality of life (QoL) of children and can be measured using The Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF). This study aimed to adapt, translate the FAQLQ-PF into Malay and determine the validity and reliability of the translated version. This cross-sectional questionnaire validation study was conducted among parents of children (0 to 12 years old) with food allergies across five sites in Selangor and Kuala Lumpur, Malaysia. The FAQLQ-PF-Malay underwent cross-cultural adaptation, translation, validation (content, face and construct) and reliability assessment. Exploratory factor analysis, internal consistency and test-retest reliability analyses were used to examine its construct validity and reliability. Out of 150 children, the majority were between the age of 7 to 12 years old (41%) and were female (81%). Three subscales were identified, which were: (i) social and dietary implication, (ii) food anxiety and (iii) emotional and physical impact. Four items were eliminated because of weak factor loadings. The Cronbach’s alpha for each subscale ranged from 0.88 to 0.94, with an overall Cronbach’s alpha of 0.95. The intra-class correlation coefficient ranged from 0.54 (95% CI: 0.10–0.77) to 0.97 (95% CI: 0.90–0.99). The 26-item FAQLQ-PF-Malay retained the three-factor structure of the original FAQLQ-PF. The FAQLQ-PF-Malay is a valid and reliable tool to assess the QoL of Malaysian children with food allergies.
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32
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Soares JRA, Pereira E Silva A, de Souza Oliveira AL, Guimarães IM, das Neves Faccini CRJ, de Aquino Mattos EB, Rodrigues SKPM, Marmello BO, Teixeira GAPB. Allergen extraction: Factors influencing immunogenicity and sensitivity of immunoassays. J Immunol Methods 2021; 498:113125. [PMID: 34450115 DOI: 10.1016/j.jim.2021.113125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Food allergy prevalence is increasing worldwide, therefore there is a high demand for reliable tests to correctly diagnose this disease. Knowledge of proteins allergenicity and how they react both in the body and in diagnostic tests is necessary to adequately assess the potential immunogenicity of both natural foods and those produced through biotechnological processes. Thus, our aim was to analyze the factors that influence the protein extraction of foods in terms of, immunogenicity and immunoassays sensitivity. Peanut proteins were extracted using four distinct extraction buffers with different pH values (physiological saline, tris buffer, borate buffer with and without β-mercaptoethanol), the protein concentration was determined by the Lowry method and polyacrylamide electrophoresis (SDS-PAGE) was used to compare the protein profile of each extract. The immunogenicity of each extract was verified by sensitizing two mouse strains (Balb/c and C57Bl/6) with a solution containing 100 μg of the extracted proteins and was determined by ELISA. Results show that extraction with the distinct buffers resulted in protein solutions with different yields and profiles. The immunogenicity of the different extracts also demonstrated distinct patterns that varied depending on the extraction methods, mouse strain and in vitro test. Immunoreactivity varied in accordance with the protein extract used to coat the microtitration plates. In conclusion, the protein profile in the extracts is critically influenced by the salt composition and pH of the extraction buffers, this in turn influences both in vivo immunogenicity and in vitro immunoreactivity.
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Affiliation(s)
- João Ricardo Almeida Soares
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Airton Pereira E Silva
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Ana Luísa de Souza Oliveira
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Isabelle Mazza Guimarães
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil
| | - Claudia Regina Josetti das Neves Faccini
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Erika Bertozzi de Aquino Mattos
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Sónia Kristy Pinto Melo Rodrigues
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Bárbara Oliveira Marmello
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil
| | - Gerlinde Agate Platais Brasil Teixeira
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil.
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33
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Leech SC, Ewan PW, Skypala IJ, Brathwaite N, Erlewyn-Lajeunesse M, Heath S, Ball H, James P, Murphy K, Clark AT. BSACI 2021 guideline for the management of egg allergy. Clin Exp Allergy 2021; 51:1262-1278. [PMID: 34586690 DOI: 10.1111/cea.14009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 12/19/2022]
Abstract
This guideline advises on the management of patients with egg allergy. Most commonly egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults. A clear clinical history will confirm the diagnosis in most cases. Investigation by measuring egg-specific IgE (by skin prick testing or specific IgE assay) is useful in moderate-severe cases or where there is diagnostic uncertainty. Following an acute allergic reaction, egg avoidance advice should be provided. Egg allergy usually resolves, and reintroduction can be achieved at home if reactions have been mild and there is no asthma. Patients with a history of severe reactions or asthma should have reintroduction guided by a specialist. All children with egg allergy should receive the MMR vaccine. Most adults and children with egg allergy can receive the influenza vaccine in primary care, unless they have had anaphylaxis to egg requiring intensive care support. Yellow Fever vaccines should only be considered in egg-allergic patients under the guidance of an allergy specialist. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for allergists and others with a special interest in allergy. The recommendations are evidence based. Where evidence was lacking, consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, diagnosis, treatment, prognosis and co-morbid associations.
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Affiliation(s)
- Susan C Leech
- Department of Child Health, Kings College Hospital, London, UK
| | - Pamela W Ewan
- Allergy Clinic, NHS Foundation Trust, Cambridge University, Cambridge, UK
| | | | - Nicola Brathwaite
- Department of Child Health, Kings College Hospital, London, UK.,Department of Child Health, Kings College Hospital, London, UK
| | | | - Sarah Heath
- Department of Child Health, Kings College Hospital, London, UK
| | - Heidi Ball
- University Hospitals Leicester, Leicester, UK
| | - Polly James
- Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Murphy
- Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew T Clark
- Allergy Clinic, NHS Foundation Trust, Cambridge University, Cambridge, UK
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34
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Guilleminault L, Michelet M, Reber LL. Combining Anti-IgE Monoclonal Antibodies and Oral Immunotherapy for the Treatment of Food Allergy. Clin Rev Allergy Immunol 2021; 62:216-231. [PMID: 34550555 DOI: 10.1007/s12016-021-08902-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
Immunoglobulin E (IgE)-mediated food allergy is a real public health problem worldwide. The prevalence of food allergy is particularly high in children. Patients with food allergy experience high morbidity with a change in quality of life due to the risk of severe anaphylaxis. Current treatment options are poor. Allergen avoidance is widely recommended but exposes patients to accidental ingestion. Oral immunotherapy is also used in patients with food allergies to the most common allergens. Oral immunotherapy consists of a daily administration of small, gradually increasing amounts of allergens to induce desensitisation. This procedure aims at inducing immune tolerance to the ingested food allergens. However, some patients experience adverse reactions and discontinue oral immunotherapy.Given that IgE plays a crucial role in food allergy and anti-IgE are effective in allergic asthma, the use of anti-IgE therapeutic monoclonal antibodies (mAbs) such as omalizumab has been assessed in food allergy patients. The use of omalizumab as a monotherapy in food allergy has not been extensively studied but looks promising. There is more published evidence regarding the effect of omalizumab and oral immunotherapy in food allergy. Given the promising results of oral immunotherapy regarding sustained tolerance in clinical trials and the potential capacity of omalizumab to reduce symptoms in case of accidental exposure, a strategy combining oral immunotherapy with omalizumab pre-treatment has been suggested as a safer option in patients with severe food allergy compared to isolated therapy. Omalizumab seems useful in ensuring safer administration of oral immunotherapy with the oral immunotherapy maintenance dose being reached more rapidly. Quality-of-life improvement is greater with oral immunotherapy + omalizumab compared to oral immunotherapy alone. Moreover, sustained unresponsiveness is achieved more frequently with omalizumab. Considering that precision medicine and personalised therapy are major goals for allergic diseases, predictive biomarkers are crucial in order to identify food allergy patients more likely to benefit from anti-IgE therapies.
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Affiliation(s)
- Laurent Guilleminault
- Toulouse Institute for Infectious, Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, C. H. U. Purpan, CNRS, U5282, Toulouse, France. .,Department of Respiratory Medicine and Allergic Diseases, Toulouse University Hospital Centre, Toulouse, France.
| | - Marine Michelet
- Toulouse Institute for Infectious, Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, C. H. U. Purpan, CNRS, U5282, Toulouse, France.,Paediatric Pneumo-Allergology Department, Children's Hospital, Toulouse University Hospital Centre, 330 Avenue de Grande Bretagne, 31300, Toulouse, France
| | - Laurent Lionel Reber
- Toulouse Institute for Infectious, Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, C. H. U. Purpan, CNRS, U5282, Toulouse, France
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35
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Salsabila HY, Putera AM, Baskoro A. Correlation between nutritional status and children's activity with food allergy: A cross-sectional study. Ann Med Surg (Lond) 2021; 68:102652. [PMID: 34401134 PMCID: PMC8355818 DOI: 10.1016/j.amsu.2021.102652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 10/27/2022] Open
Abstract
Background Food allergy in children affects nutritional status that limits their daily activities to prevent eating various foods to avoid allergic reactions. Objective Analyzing the relationship between nutritional status and daily activities in children with food allergies. Methods This study used a cross-sectional design that was carried out on children diagnosed with food allergies who underwent outpatient management of food allergies. The data were collected from January to May 2021 that included participant characteristics, nutritional status, and daily activities. Data analysis used Chi-Square and spearman rho test with p < 0.05. Results There was a significant relationship between age and FAIS (CI 1.83-4.24; p = 0.025). In addition, there was no significant relationship between the affected organs and FAIS (OR = 0.174; p = 0.052). Meanwhile, the relationship between nutritional status and FAIS was significant (OR = 0.161; p = 0.007). There was no significant relationship between parental education and FAIS (OR = 0.817; p = 0.776) as well as sex of the child and FAIS (OR = 0.982; p = 0.977). Conclusion Daily activities of children with food allergies are influenced by the nutritional status of children and children's age in choosing food.
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Affiliation(s)
| | - Azwin Mengindra Putera
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ari Baskoro
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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36
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Epstein Rigbi N, Schwartz N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy. Pediatr Allergy Immunol 2021; 32:1029-1037. [PMID: 33452829 DOI: 10.1111/pai.13445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined. METHODS Children aged 4-12 years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied. Children in the same age range starting OIT without the support of a MC served as controls. Parents of all children completed the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF), and children aged 8-12 years completed the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF). QOL scores of parents and children with and without a MC support were compared. RESULTS Children with (n = 88) and without (n = 212) the support of a MC were comparable in demographics and clinical characteristics. The study group had a significantly lower single highest tolerated dose compared to controls (57 ± 83 vs 162 ± 274 mg protein, respectively, P < .001). Parental perception of the QOL of children was not associated with a MC support (P = .81) but rather with previous reaction severity (P < .01). In contrast, the QOL of children aged 8-12 years (n = 119) was positively associated primarily with a MC support, total score 3.7 ± 1.1 vs 4.6 ± 1.3 (P < .001). CONCLUSIONS While the perception of QOL of parents of children with food allergy at OIT initiation is mainly associated with previous reaction severity, the QOL of the children themselves is primarily positively associated with MC support.
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Affiliation(s)
- Naama Epstein Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Schwartz
- School of Public Health, Haifa University, Haifa, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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37
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Maciag MC, Sheehan WJ, Bartnikas LM, Lai PS, Petty CR, Filep S, Chapman MD, Phipatanakul W. Detection of Food Allergens in School and Home Environments of Elementary Students. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3735-3743. [PMID: 34174494 DOI: 10.1016/j.jaip.2021.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known about environmental food allergen exposure on school surfaces. OBJECTIVE To compare the distribution of major food allergens in floor dust and table wipe samples from elementary schools and dust samples from students' homes. METHODS In this substudy of the School Inner-City Asthma Study-II, 103 table wipe samples and 98 floor dust samples from cafeterias and classrooms in 18 elementary schools were analyzed for milk, peanut, cashew, hazelnut, and egg using a multiplex array. Home kitchen floor and bed dust samples from 90 students were also analyzed. RESULTS Food allergens were detectable in schools, but at significantly lower levels than in homes (P < .001). In schools, milk and peanut were detected in all table wipe samples; milk and egg were detected in all floor dust samples. Cafeteria table wipe samples contained significantly higher levels of milk, peanut, hazelnut, and egg, compared with classrooms. Cafeteria floor dust samples contained higher levels milk than classrooms. Peanut-restrictive policies did not consistently reduce environmental peanut exposure in schools. Peanut allergen was lower in dust from homes of students with peanut allergy (n = 5) compared with those without peanut allergy (n = 85) (P < .001). Reassuringly, peanut allergen in the schools of peanut-allergic students was not significantly different than in their homes. CONCLUSION Food allergens were readily detectable on tables and floors in elementary schools, but at levels lower than in students' homes. For peanut-allergic students, the levels of detectable peanut in their schools were not higher than their homes. The low levels of detectable food allergens in school environments are unlikely to result in severe allergic reactions.
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Affiliation(s)
- Michelle C Maciag
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Asthma & Allergy Affiliates, Salem, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lisa M Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - Carter R Petty
- Biostatistics and Research Design Core, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | | | | | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
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38
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Zepeda-Ortega B, Goh A, Xepapadaki P, Sprikkelman A, Nicolaou N, Hernandez REH, Latiff AHA, Yat MT, Diab M, Hussaini BA, Setiabudiawan B, Kudla U, van Neerven RJJ, Muhardi L, Warner JO. Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy. Front Immunol 2021; 12:608372. [PMID: 34177882 PMCID: PMC8222906 DOI: 10.3389/fimmu.2021.608372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
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Affiliation(s)
- Benjamin Zepeda-Ortega
- Pediatric Allergist Private Practice, Angeles Lomas Hospital Huixquilucan Mexican State, Mexico City, Mexico
| | - Anne Goh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Aline Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | | | - Miu Ting Yat
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China
| | - Mohamed Diab
- Pediatric Department Faculty of Medicine, Children Hospital Cairo University, Cairo, Egypt
| | - Bakr Al Hussaini
- Department of Pediatrics, Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Univesitas Padjadjaran, Bandung, Indonesia.,Department of Pediatrics, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - R J Joost van Neerven
- R&D, FrieslandCampina, Amersfoort, Netherlands.,Wageningen University & Research, Wageningen, Netherlands
| | - Leilani Muhardi
- Medical Affairs, Friesland Campina AMEA, Singapore, Singapore
| | - John O Warner
- Inflammation Repair and Development, National Heart and Lung Institute Imperial College, London, United Kingdom.,Paediatrics, University of Cape Town, Cape Town, South Africa
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39
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Francis O, Kim EH. Peanut Immunotherapy: Practical Applications. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Pistiner M, Theodorakakis M. Development and Implementation of a Community Mentorship Program to Support Children with Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2129-2131.e2. [PMID: 33966873 DOI: 10.1016/j.jaip.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Pistiner
- MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
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41
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Golding MA, Gunnarsson NV, Middelveld R, Ahlstedt S, Protudjer JLP. A scoping review of the caregiver burden of pediatric food allergy. Ann Allergy Asthma Immunol 2021; 127:536-547.e3. [PMID: 33971359 DOI: 10.1016/j.anai.2021.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although a number of articles have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus or methodologically limited. Consequently, this study aimed to synthesize both the quantitative and qualitative literature to achieve a better understanding of the psychosocial and financial burdens faced by families who raise children with food allergy. DATA SOURCES Searches were performed on PubMed, Scopus, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles related to the psychosocial and financial burden experienced by individuals who care for a child with food allergy. STUDY SELECTIONS English language, original research articles were included in this review. RESULTS A total of 54 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (ie, food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower quality of life than their comparison groups. Within-group analyses suggest that this burden is increased for parents who manage multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure and the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs. CONCLUSION Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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42
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Lieberman JA, Gupta RS, Knibb RC, Haselkorn T, Tilles S, Mack DP, Pouessel G. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy 2021; 76:1367-1384. [PMID: 33216994 PMCID: PMC8247890 DOI: 10.1111/all.14666] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self‐management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%–14% of patients with PA experience accidental peanut exposure annually, and one‐third to one‐half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health‐related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.
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Affiliation(s)
- Jay A. Lieberman
- University of Tennessee Health Science Center/Le Bonheur Children’s Hospital Memphis TN USA
| | - Ruchi S Gupta
- Institute for Public Health and Medicine Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern School of Medicine Chicago IL USA
| | | | | | | | - Douglas P. Mack
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Guillaume Pouessel
- Pneumology and Allergology Unit Children's HospitalLille University Hospital Jeanne de Flandre France
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43
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Engel ML, Bunning BJ. The Unmet Needs of Patients with Food Allergies. Immunol Allergy Clin North Am 2021; 41:321-330. [PMID: 33863486 DOI: 10.1016/j.iac.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article reviews the unmet needs of patients with food allergies. Anxiety is common among patients with food allergies and their caregivers, which naturally stems from the avoidance, exposure, and uncertainty involved in care. Anxiety associated with allergen avoidance can have both adaptive and detrimental effects on overall health. Anxiety has implications for transitioning the responsibility of health and well-being from caregivers to the patients. As more children with food allergies become adults with food allergies, this will be an urgent topic. Moreover, as more exposure-based therapies become available, understanding patients' psychological expectations and experiences of exposure is vital.
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Affiliation(s)
- Melissa L Engel
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - Bryan J Bunning
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, FL R6, New York, NY 10032, USA.
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44
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Broome B, Madisetti M, Prentice M, Williams KW, Kelechi T. Food Allergy Symptom Self-Management With Technology (FASST) mHealth Intervention to Address Psychosocial Outcomes in Caregivers of Children With Newly Diagnosed Food Allergy: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25805. [PMID: 33656448 PMCID: PMC7970224 DOI: 10.2196/25805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Approximately 2.4 million children in the United States suffer from food-induced anaphylaxis, a condition that is annually responsible for over 200 deaths and 200,000 emergency room visits. As a result, caregivers of children newly diagnosed with severe and life-threatening food allergic reactions experience clinically significant symptoms of psychological distress, including fatigue, anxiety, depressed mood, social isolation, and substantially reduced quality of life. Despite this recognition, there is a lack of caregiver-centered self-management interventions to address these concerns. Objective In this protocol, we propose to develop and conduct feasibility testing of a technology-enhanced, self-management, mobile health, smartphone app intervention called Food Allergy Symptom Self-Management with Technology for Caregivers (FASST) designed to meet the psychosocial health needs of caregivers of children with a new diagnosis of food allergy. Methods This pilot study uses qualitative work (Phase I) to inform a 4-week longitudinal randomized controlled trial (Phase II). In Phase I, 10 caregivers of children (≤18 years old) with established food allergy (≥1 year from diagnosis) will participate in semistructured interviews to inform the development of the FASST app. In Phase II, 30 caregivers of children (≤18 years old) with a newly diagnosed food allergy (≤90 days from diagnosis) will be randomized 2:1 to receive the FASST intervention (n=20) or control condition (basic app with educational resources; n=10). Process measures include feasibility, caregiver acceptability, adherence, and satisfaction. Outcome measures include caregiver fatigue, anxiety, depression, sleep, self-efficacy, and quality of life measured at baseline, week 4, and 3 months post study completion. Results Phase I study activities have been completed, and Phase II participant enrollment into the randomized controlled trial is expected to commence in 2021. Conclusions With limited readily available resources at their disposal, the results from this study have the potential to provide caregivers of children with a newly diagnosed food allergy a tool to help them self-manage and mitigate negative psychosocial factors during a critical time period in the caregiving/condition trajectory. Trial Registration ClinicalTrials.gov Identifier NCT04512924: https://clinicaltrials.gov/ct2/show/NCT04512924 International Registered Report Identifier (IRRID) DERR1-10.2196/25805
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Affiliation(s)
- Brantlee Broome
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Margaret Prentice
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Kelli Wong Williams
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Teresa Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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45
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Epicutaneous immunotherapy for treatment of peanut allergy: Follow-up from the Consortium for Food Allergy Research. J Allergy Clin Immunol 2021; 147:992-1003.e5. [DOI: 10.1016/j.jaci.2020.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022]
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Vasudevan A. Allergies and Adaptations: A Perspective on the Need for Culturally Responsive Care to Medically Indicated Dietary Restrictions. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:765-767. [PMID: 33380938 PMCID: PMC7757056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In medicine, we tend to think of food as being equivalent to nutrition, and food allergies are understood primarily as a biomedical process. In this piece, I explore how my experience with food allergies intersects with my cultural identity as a second-generation Indian-American. I also offer insights from my experiences in medical training and practice and reflect on the responsibility of health providers to understand the social and cultural context of food allergies.
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Affiliation(s)
- Anita Vasudevan
- To whom all correspondence should be addressed:
Anita Vasudevan, M.D., Yale Primary Care Internal Medicine Residency Program,
Yale New Haven Hospital, 20 York St, New Haven, CT 06510;
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47
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Mahr TA, Lieberman JA, Haselkorn T, Damle V, Ali Y, Chidambaram A, Griffin NM, Sublett JW. Characteristics of Peanut Allergy Diagnosis in a US Health Care Claims Database (2011-2017). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1683-1694.e5. [PMID: 33346150 DOI: 10.1016/j.jaip.2020.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peanut allergy is the most common food allergy among children. Studies assessing the burden of peanut allergy in a real-world setting are limited. OBJECTIVE To estimate annual incidence and prevalence of peanut allergy cases among children aged 4 to 17 years and assess severe reaction and associated health care utilization rates. METHODS Patient longitudinal data between January 2011 and December 2017 from a geographically and payer-type representative US health care claims database were used. Peanut allergy cases were identified using diagnostic codes and/or services indicating peanut-allergy-associated severe reactions/anaphylaxis. Estimated annual incidence was defined as peanut-allergic births as a proportion of all 1-year-olds and adjusted for less than 100% data set capture, undercoding, patient underpresenting rates, and spontaneous outgrowth. Prevalence was calculated on the basis of incidence. To assess rates of severe reactions to peanut and associated health care utilization, the cohort of 720,490 peanut allergy cases identified in 2011 was evaluated over a 6-year period from 2011 to 2017. RESULTS Annual incidence increased from 1.7% to 5.2% between 2001 and 2017. Estimated prevalence in 4- to 17-year-olds was 1.25 million (2.2%) in 2017. Atopic comorbidities (asthma, 60.8%; atopic dermatitis, 61.7%) and other food allergies (35.3%) were common. Severe reactions (≥1) were observed in more than half (n = 399,806) the patients, and 37.9% were triggered by an accidental exposure. One in 5 patients (n = 144,883) visited the emergency department due to peanut exposure. CONCLUSIONS Claims data suggest that the incidence and prevalence of peanut allergy in the United States may be increasing. Estimated severe reaction rates and health care utilization were high, suggesting that the burden of peanut allergy may be considerable.
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Affiliation(s)
- Todd A Mahr
- Division of Allergy, Asthma, and Immunology, Gundersen Health System, La Crosse, Wis.
| | - Jay A Lieberman
- Department of Pediatrics, Division of Pulmonology, Allergy, & Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
| | | | - Varsha Damle
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
| | - Yasser Ali
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
| | | | - Noelle M Griffin
- Aimmune Therapeutics, a Nestle Health Science Company, Brisbane, Calif
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48
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Blumchen K, DunnGalvin A, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fisher HR, Fernández‐Rivas M. APPEAL-1: A pan-European survey of patient/caregiver perceptions of peanut allergy management. Allergy 2020; 75:2920-2935. [PMID: 32438514 DOI: 10.1111/all.14414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peanut allergy (PA) is associated with marked quality-of-life (QoL) impairment. However, data are lacking on the experience and impact of living with PA from the perspectives of persons with PA (PwPA) and their caregivers. Allergy to Peanuts imPacting Emotions And Life study 1 (APPEAL-1) was a pan-European survey investigating these perspectives. This first of two articles reports clinical characteristics of PwPA and PA management practices. METHODS APPEAL-1 was a quantitative, online survey conducted in eight European countries, developed by eight representatives of patient advocacy groups and five healthcare professionals and researchers. Eligible participants included adults with PA and parents/caregivers of PwPA who responded by self-report and provided proxy-report for the PwPA under their care. Data were summarized using nonweighted descriptive statistics. RESULTS Of 1846 completed/analysed questionnaires, 528 were from adults with PA (self-report); 437 by proxy for children with PA (34 aged 0-3 years, 287 aged 4-12 years, 116 aged 13-17 years) and 881 from parents/caregivers (self-report). Of PwPA (N = 965), 95% reported diagnosis by healthcare professionals, mostly by clinical history and peanut-specific allergy testing. Rates of allergic rhinitis, asthma and other food allergies in PwPA were 50%, 42% and 79%, respectively. Only 31% of PwPA received HCP advice/support following their worst allergic reaction, and 28% had not been prescribed an adrenaline auto-injector. Results were similar by country but varied by age group. CONCLUSIONS The APPEAL-1 findings contribute to greater understanding of PA impact on PwPA, caregivers and family members and the need for improved PA management across Europe.
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Affiliation(s)
- Katharina Blumchen
- Division of Allergology, Pneumology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund, (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSCARADyAL Madrid Spain
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DunnGalvin A, Blumchen K, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fernández‐Rivas M, Fisher HR. APPEAL-1: A multiple-country European survey assessing the psychosocial impact of peanut allergy. Allergy 2020; 75:2899-2908. [PMID: 32400915 PMCID: PMC7689848 DOI: 10.1111/all.14363] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
Background Peanut allergy (PA) is a common, potentially life‐threatening and typically lifelong condition with a significant burden of illness. However, information is lacking on how persons with PA (PwPA) and their caregivers perceive the psychosocial impact of living with PA. The Allergy to Peanuts imPacting Emotions And Life 1 (APPEAL‐1) survey, conducted across Europe, investigated the experience and impact of living with PA. Here, we report data evaluating the psychosocial impact of PA on PwPA and their caregivers. Methods Allergy to Peanuts imPacting Emotions And Life study 1 was an online survey conducted in eight European countries. Representatives of eight patient advocacy groups and five healthcare‐research specialists developed the survey. Eligible respondent groups included the following: adults diagnosed with PA (self‐report); parent/nonparent caregivers (proxy‐report for a child with PA); and parent/nonparent caregivers (self‐report of PA impact on themselves). Results Of 1846 total study respondents, 419 were adults with PA (self‐report); 546 were parents/caregivers (proxy‐report); and 881 were parents/caregivers (self‐report). Most respondents reported lifestyle restrictions regarding food (84%‐93%) and additional domains including parties and socializing, holiday activities and destinations, and taking public transport (53%‐89%). Approximately 40% rated themselves as “very” frustrated and “very” stressed. Two‐thirds (65%) felt socially isolated; 43% were bullied. Less than half felt confident in knowing when to use an adrenaline autoinjector. Several intercountry differences were observed such as high levels of uncertainty and stress in respondents from Ireland, highest rates of anxiety in respondents from Germany, and social exclusion and isolation most common in respondents from France. Conclusions Peanut allergy imposes an adverse psychosocial impact on patients and caregivers, leading to frustration, stress and isolation. Attention to the impact of PA is needed in research and clinical practice to improve PA healthcare and public education programmes.
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Affiliation(s)
- Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Katharina Blumchen
- Division of Pneumology, Allergology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSC, ARADyAL Madrid Spain
| | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
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Epstein‐Rigbi N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Quality of life of children aged 8-12 years undergoing food allergy oral immunotherapy: Child and parent perspective. Allergy 2020; 75:2623-2632. [PMID: 32350869 DOI: 10.1111/all.14350] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) for food allergy improves the quality of life (QOL) of children from parental perspective but little is known about the child perception. METHODS The Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) was administered to children aged 8-12 years, and the FAQLQ-Parent Form (FAQLQ-PF) was administered to their parents at the start of OIT for milk, egg, peanut, sesame, or tree nuts, at the end of up-dosing, and after 6 months of follow-up. Food-allergic children not undergoing OIT served as controls. Children QOL scores were compared to their parents. RESULTS The total FAQLQ-CF score of 103 children undergoing OIT improved significantly from start of OIT (median (IQR); 4.8, 3.8-5.7) to end of up-dosing (3.9, 3-5.2) (P < .001). A greater improvement was noted in the 56 children who reached a follow-up visit, from 5.0 (3.7-5.8) at OIT start to 3.1 (1.8-5.0) on follow-up, (P < .001). In contrast, FAQLQ-CF scores of control patients improved mildly and nonsignificantly between the two time points from 5.3 (4.3-5.7) to 4.8 (3.6-6.0), (P = .13). The improvement in the total FAQLQ-CF scores from OIT start to follow-up was significantly greater compared to the change in control patients during observation (P = .015). Parents reported better QOL scores compared to their children at all stages of OIT (start 4.0, 3.2-5, P = .004; end of up-dosing 2.9, 1.9-4.7, P = .04; follow-up 2.2, 1.6-3.6, P = .003). CONCLUSIONS QOL of food-allergic children undergoing OIT improves significantly compared to controls. Parents perceive QOL to be better than the perception of the children.
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Affiliation(s)
- Na'ama Epstein‐Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
| | - Michael R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Pediatrics Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Medicine Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (former Assaf Harofeh) Medical Center Zerifin Israel
- Department of Pediatrics Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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