1
|
Nocerino R, Carucci L, Coppola S, Cecere G, Micillo M, Castaldo T, Russo S, Sandomenico M, Marino A, Gualano R, Ercolini P, Capasso A, Bedogni G, Berni Canani R. Epidemiology of Paediatric Italian Food Allergy: Results of the EPIFA study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100246. [PMID: 38655562 PMCID: PMC11035069 DOI: 10.1016/j.jacig.2024.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/14/2024] [Accepted: 01/27/2024] [Indexed: 04/26/2024]
Abstract
Background Updated epidemiologic data are important for defining effective public health strategies for pediatric food allergy (FA). Objective The Epidemiology of Paediatric Italian Food Allergy (EPIFA) study was designed to investigate the epidemiology of pediatric FA in one of the most heavily populated Italian regions. Methods A retrospective cohort study was performed in collaboration with family pediatricians aimed at investigating the epidemiology of Italian pediatric FA during 2009 to 2021. Family pediatricians in the Campania region were invited to use the Google Forms platform for online compilation of data forms. Data forms were reviewed by experienced pediatric allergists at the coordinating center. Results A total population of 105,151 subjects (aged 0-14 years) was screened during the study period. Data from 752 FA patients were evaluated. A progressive increase in FA incidence and prevalence was observed from 2009 to 2021, with a relative increase up to 34% and 113.6%, respectively, at the end of study period. The relative increase in FA prevalence was higher in the 0-3-year-old age group in the same study period (+120.8%). The most frequent allergens were cow's milk, hen's egg, and nuts. Conclusion The results of the EPIFA study showed an increase in pediatric FA incidence and prevalence from 2009 to 2021 in Italy. These results underline the necessity of new effective strategies for preventing and managing these conditions.
Collapse
Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Gaetano Cecere
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Maria Micillo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Tina Castaldo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Stefania Russo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Marialuisa Sandomenico
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Antonio Marino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Renato Gualano
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Paola Ercolini
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Antonella Capasso
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Internal Medicine, S Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Italian Society of Pediatric Gastroenterology and Nutrition (SIGENP)
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Internal Medicine, S Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| |
Collapse
|
2
|
Kivistö JE, de Blok BF, Protudjer JLP, Ojaniemi I, Karjalainen J, Huhtala H, Dunn Galvin A. Validation of the Finnish version of the food allergy quality of life questionnaire-parent form (F-FAQLQ-PF). Acta Paediatr 2024; 113:91-97. [PMID: 37548086 DOI: 10.1111/apa.16937] [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: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
AIM Specific questionnaires about food allergy and health-related quality of life (HRQoL) have been developed and validated in several languages, but not Finnish. We aimed to validate the Finnish Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) for children under age 13 years. METHODS The original FAQLQ-PF and Food Allergy Independent Measure (FAIM) were translated into Finnish per World Health Organisation guidelines and tested by 72 parents of children under age 13 years with suspected severe peanut or tree nut allergy who were recruited at Allergy Centre in Tampere University Hospital in Tampere, Finland. We calculated the construct validity of the questionnaire by calculating the coefficients between the two measures and used Cronbach's alpha to establish the internal consistency. RESULTS The FAQLQ-PF showed strong correlations with domain structure and internal consistency, based on Spearman's correlations (rho) for the HRQoL questions, FAIM questions and FAIM mean values. The total questionnaire score correlated significantly with the mean FAIM (rho = 0.95, p < 0.001) and individual FAIM questions. The FAQLQ-PF and domains had good or excellent internal consistency (Cronbach's alpha >0.70). CONCLUSION The Finnish FAQLQ-PF demonstrated good construct validity and excellent internal consistency for measuring food allergy HRQoL in children under age 13 years.
Collapse
Affiliation(s)
- J E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - B Flokstra de Blok
- General Practitioners Research Institute, Groningen, The Netherlands
- University Medical Center Groningen, Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, Groningen, The Netherlands
| | - J L P Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Ojaniemi
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - J Karjalainen
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - A Dunn Galvin
- School of Applied Psychology, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Saarimäki L, Kivistö J, Palmu S, Protudjer JLP, Huhtala H, Karjalainen J. Trends in severe allergic reactions of adults in Finland between 1999 and 2020: A national population study. Allergy 2024; 79:252-254. [PMID: 37902169 DOI: 10.1111/all.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Lasse Saarimäki
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Juho Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Sauli Palmu
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | |
Collapse
|
4
|
Al Ali A, Gabrielli S, Delli Colli L, Delli Colli M, McCusker C, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, Zhang X, Protudjer JL, Abrams EM, Simons E, Ben-Shoshan M. Temporal trends in anaphylaxis ED visits over the last decade and the effect of COVID-19 pandemic on these trends. Expert Rev Clin Immunol 2023; 19:341-348. [PMID: 36620923 DOI: 10.1080/1744666x.2023.2166934] [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: 01/10/2023]
Abstract
BACKGROUND Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. METHODS A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children's Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. RESULTS Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011-2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). CONCLUSIONS The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED.
Collapse
Affiliation(s)
- Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Luca Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Moisan
- Department of Emergency Medicine, Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
5
|
Stiles SL, Roche I, Said M, Clifford RM, Sanfilippo FM, Loh R, Salter SM. Overview of registries for anaphylaxis: a scoping review. JBI Evid Synth 2022; 20:2656-2696. [PMID: 35942638 DOI: 10.11124/jbies-21-00182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This review aimed to describe the scope and operational features of anaphylaxis registries, and to assess their contribution to improving knowledge of anaphylaxis and care of patients who experience anaphylaxis by measuring their research output. INTRODUCTION Structured data collection and reporting systems, such as registries, are needed to better understand the burden of anaphylaxis and to protect the growing number of patients with severe allergy. There is a need to characterize current anaphylaxis registries to identify their value in anaphylaxis surveillance, management, and research. Information synthesized in this review will provide knowledge on benefits and gaps in current registries, which may inform the implementation and global standardization of future anaphylaxis reporting systems. INCLUSION CRITERIA This scoping review considered literature describing registries worldwide that enroll patients who have experienced anaphylaxis. Published and gray literature sources were included if they described the scope and operational features of anaphylaxis registries. METHODS This review followed the JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, and CINAHL were searched for relevant articles. Identified keywords and index terms were adapted for searches of gray literature sources, using Google advanced search functions. Only full-text studies in English were considered for inclusion. Two independent reviewers conducted title and abstract screening and those that did not meet the inclusion criteria were excluded. The full text of potentially relevant articles were retrieved; full-text screening and data extraction were also conducted by two independent reviewers. Any discrepancies were resolved through discussion or with a third reviewer. Tables and a narrative summary were used to describe and compare the scope and features (eg, inclusion criteria, patient demographics, clinical symptoms) of the identified anaphylaxis registries, and to outline their output to assess their contribution to research and clinical practice for anaphylaxis. RESULTS A total of 77 full-text publications and eight gray literature sources were used to extract data. The literature search identified 19 anaphylaxis registries, with sites in 28 countries including Europe, the United Kingdom, Canada, the United States, Korea, and Australia. The main purposes of the identified registries were to collect clinical data for research; provide clinical support tools to improve patient care; and operate as allergen surveillance systems to protect the wider community with allergies. Differences in inclusion and health care settings exist, with 11 collecting data on anaphylaxis of any cause, two on food reactions alone, three on fatal anaphylaxis, one on perioperative anaphylaxis, and two on allergic reactions (including anaphylaxis). Five registries enroll cases in allergy centers, five in hospital settings, one in schools, and others target a combination of general practitioners, specialists in emergency departments, and other relevant hospital departments and allergy outpatient clinics. Only three registries operate under a mandatory framework. A total of 57 publications were considered research outputs from registries. All registries except two have published studies from collected data, with the greatest number of articles published from 2019 to the present. Publications mostly addressed questions regarding demographic profile, causes and cofactors, severity, fatal reactions, and gaps in management. CONCLUSIONS This review demonstrated that anaphylaxis registries differ in their scope and operation, having been established for different purposes. Importantly, registries have contributed significantly to research, which has highlighted gaps in anaphylaxis management, provoking allergens, and informed targets for prevention for severe and fatal events. Beyond this, registries relay information about anaphylaxis to clinicians and regulatory bodies to improve patient care and protect the community. The ability to link registry data with other health datasets, standardization of data across registries, and incorporation of clinical care indicators to promote quality health care across the health system represent important targets for future systems.
Collapse
Affiliation(s)
| | | | - Maria Said
- The University of Western Australia, Perth, WA, Australia.,Allergy and Anaphylaxis Australia, Sydney, NSW, Australia.,National Allergy Strategy, Sydney, NSW, Australia
| | | | | | - Richard Loh
- The University of Western Australia, Perth, WA, Australia.,Perth Children's Hospital, Perth, WA, Australia.,Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney, NSW, Australia
| | | |
Collapse
|
6
|
Thomander T, Toppila-Salmi S, Salimäki J, Jantunen J, Huhtala H, Pallasaho P, Kauppi P. Allergic multimorbidity is associated with self-reported anaphylaxis in adults-A cross-sectional questionnaire study. Clin Transl Allergy 2022; 12:e12184. [PMID: 35874970 PMCID: PMC9301681 DOI: 10.1002/clt2.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/01/2022] [Accepted: 07/02/2022] [Indexed: 11/07/2022] Open
Abstract
Background Anaphylaxis has increased over the last two decades in Europe, reaching an estimated prevalence of 0.3% and an incidence of 1.5-7.9 per 100,000 person-years. Allergic multimorbidity is associated with asthma severity, yet its role in anaphylaxis is not fully understood. Our aim was to study association between allergic multimorbidity and anaphylaxis in adults. Methods We used population-based data from the Finnish Allergy Barometer Study (n = 2070, age range: 5-75). Food allergy (FA), atopic dermatitis (AD), allergic rhinitis (AR) and allergic conjunctivitis (AC), were defined from a self-completed questionnaire. A logistic regression adjusted on potential confounders (sex, age, smoking status) was applied to estimate the anaphylaxis risk associated with allergic multimorbidity. Results 1319 adults with at least one allergic disease (FA, AD, AR, AC) with/without asthma (AS) were included. Of these, 164 had self-reported anaphylaxis [mean (SD, min-max) 54 (14, 22-75) years, 17% men]. AS, FA, AR, AC, or AD were reported by 86.0%, 62.2%, 82.3%, 43.3%, and 53.7% of subjects with anaphylaxis and respectively by 67.8%, 29.5%, 86.2%, 29.4%, and 34.4% of subjects without anaphylaxis. Compared with subjects exhibiting only one allergic disease, the risk of anaphylaxis increased with the number of allergic diseases; adjusted odds ratios (OR) [CI95%] for two, three, four and five coinciding allergic diseases were 1.80 [0.79-4.12], 3.35 [1.47-7.66], 7.50 [3.25-17.32], and 13.5 [5.12-33.09], respectively. The highest risk of anaphylaxis (6.47 [4.33-9.92]) was associated with FA + AS or their various variations with AR/AC/AD embodied, when compared with AR, AC, and AS separately or their combinations. Conclusions Anaphylaxis was positively associated with the number of allergic diseases a subject exhibited and with subgroups including FA and/or AS. The results can be applied when estimating the risk of anaphylaxis for individual patients.
Collapse
Affiliation(s)
- Tuuli Thomander
- Doctoral Programme in Clinical Research University of Helsinki Helsinki Finland.,Department of Allergology Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Sanna Toppila-Salmi
- Department of Allergology Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | | | - Juha Jantunen
- South Karelia Allergy and Environment Institute Imatra Finland
| | - Heini Huhtala
- Faculty of Social Sciences Tampere University Tampere Finland
| | - Paula Pallasaho
- Department of Allergology Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Paula Kauppi
- The Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland
| |
Collapse
|
7
|
Tikkakoski AP, Karjalainen J, Sipilä K, Kivistö JE, Kähönen M, Lehtimäki L, Tikkakoski A. Outdoor pollen concentration is not associated with exercise-induced bronchoconstriction in children. Pediatr Pulmonol 2022; 57:695-701. [PMID: 34894109 DOI: 10.1002/ppul.25782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/07/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Free running exercise test outdoors is an important method to diagnose asthma in children. However, the extent of how much exposure to pollens of outdoor air affects the results of the test is not known. METHODS We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 799) between January 2012 and December 2014 in Tampere University Hospital. Pollen concentrations at the time of the test were collected from the register of Biodiversity Unit of the University of Turku. We compared the frequency of exercise-induced bronchoconstriction and pollen concentrations. RESULTS The analyses were restricted to birch and alder pollen as high counts of grass and mugwort pollen were so infrequent. The relative change in resistance at 5 Hz after exercise or the frequency of exercise-induced bronchoconstriction were not related to alder or birch pollen concentrations over 10 grains/m3 (p = 0.125-0.398). In logistic regression analysis comparing the effects of alder or birch pollen concentrations, immunoglobulin E (IgE)-mediated alder or birch allergy and absolute humidity over 10 g/m3 only absolute humidity was independently associated with change in airway resistance (odds ratio [OR]: 0.32, confidence interval [CI]: 0.13-0.67, p: 0.006). CONCLUSIONS In our large clinical sample, outdoor air pollen concentration was not associated with the probability of exercise-induced bronchoconstriction in free running test in children while low absolute humidity was the best predictor of airway obstruction.
Collapse
Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
8
|
Haahtela T, Jantunen J, Saarinen K, Tommila E, Valovirta E, Vasankari T, Mäkelä MJ. Managing the allergy and asthma epidemic in 2020s-Lessons from the Finnish experience. Allergy 2022; 77:2367-2380. [PMID: 35202479 PMCID: PMC9546028 DOI: 10.1111/all.15266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/13/2022]
Abstract
In Finland, a systematic public health programme was implemented from 2008 to 2018 to mitigate the burden of allergic disorders by revisiting the prevention strategy. Allergy health and contacts with natural environment were emphasized to promote immunological and psychological resilience instead of poorly justified avoidance. Allergy management practices were improved and low‐valued recommendations for care, for example for food allergy, were revised. Patients and families were empowered to use guided self‐management to proactively stop symptom exacerbations. A professional non‐governmental organization implemented the nationwide education for healthcare and patient NGOs for patients, families and lay public. In healthcare, the work supporting allergic patients and families was organized towards common goals and integrated into everyday work without extra costs. Reaching the predefined goals was followed by employing the national healthcare registers and questionnaire surveys. Governmental bodies contributed with kick‐off funding, which was supplemented by private funding. International collaboration, for example with the European patient organization (EFA), increased awareness of the Finnish action and predisposed it for peer review. The 10‐year results are favourable, patients are less disabled, practices and attitudes in healthcare have changed, and major cost savings have been obtained. Views of the lay public and patients are slow to move, however. Local multidisciplinary allergy teams were set up to continue the activities also after the Programme. Changes in environment and lifestyle in the last 50 years are the main reasons for the allergy rise. The Finnish experience may help to manage allergic diseases, improve nature relatedness in the fast‐urbanizing world, combat nature loss and reduce the disease burden.
Collapse
Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Juha Jantunen
- Allergy, Skin and Asthma Federation Helsinki Finland
| | | | - Erja Tommila
- Finnish Lung Health Association (FILHA) Helsinki Finland
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Allergology University of Turku, and Allergy ClinicTerveystalo Turku Finland
| | | | - Mika J. Mäkelä
- Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| |
Collapse
|
9
|
Tanno LK, Clark E, Mamodaly M, Cardona V, Ebisawa M, Asontegui I, Sanchez-Borges M, Santos AF, Fiocchi A, Worm M, Caimmi D, Latour Staffeld P, Muraro A, Pawankar R, Greenberger PA, Thong BYH, Martin B, Demoly P. Food-induced anaphylaxis morbidity: Emergency department and hospitalization data support preventive strategies. Pediatr Allergy Immunol 2021; 32:1730-1742. [PMID: 34142390 DOI: 10.1111/pai.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. METHODS We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. RESULTS A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. CONCLUSION Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.
Collapse
Affiliation(s)
- Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL Research Network, Barcelona, Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Ignacio Asontegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Alexandra F Santos
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Davide Caimmi
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | | | - Paul Allen Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| |
Collapse
|
10
|
Haahtela T, Valovirta E, Saarinen K, Jantunen J, Lindström I, Kauppi P, Laatikainen T, Pelkonen A, Salava A, Tommila E, Bousquet J, Vasankari T, Mäkelä MJ. The Finnish Allergy Program 2008-2018: Society-wide proactive program for change of management to mitigate allergy burden. J Allergy Clin Immunol 2021; 148:319-326.e4. [PMID: 33965232 DOI: 10.1016/j.jaci.2021.03.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022]
Abstract
A 10-year national program to improve prevention and management of allergic diseases and asthma was implemented in Finland (population 5.5. million) in 2008-2018. The main aim was to reduce the long-term burden of these conditions. The strategy was changed from traditional avoidance to tolerance and resilience of the population. Health was endorsed instead of medicalization of mild symptoms. Disease severity was reevaluated, and disabling clinical manifestations were given high priority. For health care, 5 quantitative goals and 1 qualitative goal were set. For each of the goals, specific tasks, tools, and outcome evaluation were stipulated. During the program, 376 educational sessions gathered 24,000 health care participants. An information campaign targeted the lay public, and social media was used to contact people. In the 10 years of the program, the prevalence of allergic diseases and asthma leveled off. Asthma caused fewer symptoms and less disability, and 50% fewer hospital days. Food allergy diets in day care and schools decreased by half. Occupational allergies were reduced by 45%. In 2018, the direct and indirect costs of allergic diseases and asthma ranged from €1.5 billion to €1.8 billion, with the 2018 figures being 30% less than in the respective figures in 2007. The Finnish proactive and real-world intervention markedly reduced the public health burden of allergic disorders. The allergy paradigm was revisited to improve management with systematic education.
Collapse
Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland; Allergy Clinic, Suomen Terveystalo Oy, Turku, Finland
| | | | - Juha Jantunen
- Allergy, Skin, and Asthma Federation, Helsinki, Finland
| | | | - Paula Kauppi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anna Pelkonen
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Alexander Salava
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Erja Tommila
- Finnish Lung Health Association, Helsinki, Finland
| | - Jean Bousquet
- Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany; University Hospital, Montpellier, France; MACVIA France, Montpellier, France
| | | | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
11
|
Miles LM, Ratnarajah K, Gabrielli S, Abrams EM, Protudjer JLP, Bégin P, Chan ES, Upton J, Waserman S, Watson W, Gerdts J, Ben-Shoshan M. Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2321-2333. [PMID: 33549844 DOI: 10.1016/j.jaip.2021.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. OBJECTIVES A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis. METHODS Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis. RESULTS Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P = .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine. CONCLUSION The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.
Collapse
Affiliation(s)
- Laura May Miles
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
| | - Kayadri Ratnarajah
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Philippe Bégin
- Division of Clinical Immunology and Allergy, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Wade Watson
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, ON, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
12
|
Salter SM, Marriott RJ, Murray K, Stiles SL, Bailey P, Mullins RJ, Sanfilippo FM. Increasing anaphylaxis events in Western Australia identified using four linked administrative datasets. World Allergy Organ J 2020; 13:100480. [PMID: 33294113 PMCID: PMC7677753 DOI: 10.1016/j.waojou.2020.100480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Anaphylaxis events are increasing worldwide, based on studies of single administrative datasets including hospital admissions, emergency room presentations, and prescription and medical claims data. Linking multiple administrative datasets may provide better epidemiological estimates, by capturing a greater number of anaphylaxis events occurring at the individual level. In this linked data study in Western Australia, we combined 4 population-based datasets to identify anaphylaxis events, factors influencing occurrence, and change in event rates from 2002 to 2013. Methods Four linked administrative datasets from the Western Australian Data Linkage System were used, representing ambulance attendances, emergency department presentations, hospital inpatient admissions and death registrations. An anaphylaxis cohort was identified using ICD-9-CM, ICD-10-AM and additional anaphylaxis diagnosis codes, with event rates calculated. We explored the impact of age, gender, cause, Indigenous status and socioeconomic index on event rates. Standard Poisson regression models were used to examine the significance of the change in anaphylaxis event rates over time. Results A total 12,637 individuals (mean age 31.8 years, 49.6% female) experienced 15,462 anaphylaxis events between 2002 and 2013 (97.5% in non-Indigenous patients and 59.5% residing in the area of greatest socioeconomic advantage). Anaphylaxis event rates increased from 15.4 to 82.5/105 population between 2002 and 2013. The greatest increase in anaphylaxis events was seen in those coded as unspecified anaphylaxis (all ages, males and females combined, p < 0.001), with the highest rates of unspecified anaphylaxis in males 0–4 years (171.9/105 population in 2013), and females 15–19 years (104.0/105 in 2013). The average annual percent increase (95% CI) for food-related anaphylaxis was 9.2% (6.6–12.0); for medication-related anaphylaxis was 5.8% (4.5–7.1); and for unspecified anaphylaxis was 10.4% (9.8–11.0); all p < 0.001. There was a significant increase in ambulance attendance, emergency presentations and inpatient admissions for anaphylaxis between 2002 and 2013, with emergency presentations (56.0/105 population), inpatient admissions (43.2/105), and ambulance attendance (21.6/105) highest in 2013. Only 25 anaphylaxis-related deaths were recorded in the mortality register with no significant change in rates over time. Conclusion Using multiple linked administrative datasets, we identified significantly higher rates of total anaphylaxis than previously reported, with more than 5-fold increases in anaphylaxis events between 2002 and 2013. While the combination of 4 population-level datasets provides a more comprehensive capture of cases, even at the individual dataset level, admission rates for anaphylaxis in Western Australia are substantially higher than those previously reported for similar time periods, both in Australia and worldwide.
Collapse
Key Words
- Anaphylaxis
- Australia
- EDDC, Emergency Department Data Collection
- EPAWA, Epidemiology of Anaphylaxis in Western Australia
- Epidemiology
- Events
- HMDC, Hospital Morbidity Data Collection
- ICD-10-AM, International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification
- ICD-9-CM, International Classification of Diseases, 9th revision, Clinical Modification
- IRSAD, Index of Relative Socio-Economic Advantage and Disadvantage
- Linked data
- SEIFA, Socio-Economic Indexes for Areas
- WAAC, Western Australian Anaphylaxis Cohort
- WADLS, Western Australian Data Linkage System
Collapse
Affiliation(s)
- Sandra M Salter
- School of Allied Health, Faculty of Health and Medical Sciences, The University of Western Australia, M315, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Ross J Marriott
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, 6009, Australia
| | - Kevin Murray
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, 6009, Australia
| | - Samantha L Stiles
- School of Allied Health, Faculty of Health and Medical Sciences, The University of Western Australia, M315, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Paul Bailey
- St John WA, Belmont, Western Australia, 6104, Australia
| | - Raymond J Mullins
- Suite 1, John James Medical Centre, 175 Strickland Crescent, Deakin, ACT, 2600, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, 6009, Australia
| |
Collapse
|
13
|
The Challenge of Establishing the Burden of Anaphylaxis: Some Recent Trends. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00257-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Stiles SL, Roche I, Said M, Clifford RM, Sanfilippo FM, Loh R, Salter SM. Overview of registries for anaphylaxis: a scoping review protocol. JBI Evid Synth 2020; 19:1193-1201. [PMID: 33165169 DOI: 10.11124/jbisrir-d-19-00434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will describe the scope and operational features of global registries for anaphylaxis and assess their contribution to improving knowledge and care of anaphylaxis by measuring their research output. INTRODUCTION The incidence of anaphylaxis is increasing around the world. Structured reporting systems, such as patient registries, are needed to better understand the burden of anaphylaxis and protect the growing number of allergic patients. INCLUSION CRITERIA The concept to be mapped is registries across the world that enroll patients who have experienced anaphylaxis. Published and gray literature sources will be considered if they describe the scope and operational features of anaphylaxis registries. Only full-text studies published in English will be included. There will be no date restriction. METHODS The JBI methodology for scoping reviews will be followed. Embase, MEDLINE, Scopus, and CINAHL will be searched from inception date for relevant articles. Identified keyword and index terms will be adapted for searches of gray literature sources, using Google advanced search functions. The authors and developers of identified registries will be contacted, where possible, to obtain additional information about the development and structure of systems. Data will be extracted by two independent reviewers. Any discrepancies will be resolved by a third reviewer. Tables and a narrative summary will be used to describe and compare the scope and features of anaphylaxis registries and outline their output to assess their contribution to research, clinical practice, and public health policy for anaphylaxis.
Collapse
Affiliation(s)
| | | | - Maria Said
- Allergy and Anaphylaxis Australia, Sydney, NSW, Australia.,National Allergy Strategy, Sydney, NSW, Australia
| | | | | | - Richard Loh
- The University of Western Australia, Perth, WA, Australia.,Perth Children's Hospital, Perth, WA, Australia.,National Allergy Strategy, Sydney, NSW, Australia.,Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney, NSW, Australia
| | | |
Collapse
|
15
|
Rosenlund M, Ekström N, Törnblom M, Wintzell V, Stark JH, Titievsky L. Impact of variable look-back periods on the incidence rates of chronic diseases using real world data. Pharmacoepidemiol Drug Saf 2020; 29:1086-1092. [PMID: 32648308 DOI: 10.1002/pds.5066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE Estimating disease incidence based on secondary data requires a look-back period to exclude patients with pre-existing disease from the incidence risk set. However, the optimal length of the look-back period and its impact on incidence rates are often unknown. We studied the impact of the length of the look-back period on incidence rates of 24 different chronic diseases. METHODS Everyone residing in Sweden between January 1, 2005 and December 31, 2013 were identified from national registries and followed up to 2 years (through December 31, 2015). Outcome events were identified from inpatient and outpatient hospital contacts and incidence rates were calculated per 100 000 person-years. The length of the look-back period was varied with 6-month increments, starting at 6 months. The maximum look-back period of 9 years was used as reference period. RESULTS There were 7 943 807 individuals with a look-back period of at least 9 years (mean age 46.5 years) and a mean follow-up time of 1.97 years. Incidence rates were higher across all diseases when restricting the look-back to 1 year compared to 9 years, with a magnitude of overestimation of the incidence rates between 13% (temporal arteritis) and 174% (type 1 diabetes). However, for most diseases the effect of extending the look-back period beyond 3-5 years appeared comparably small. CONCLUSIONS This study illustrates how short look-back periods cause overestimation of the incidence rates of chronic diseases, suggesting that sensitivity analyses with respect to look-back period are considered, particularly using data sources with limited information on past medical history.
Collapse
Affiliation(s)
- Mats Rosenlund
- IQVIA, Real World Evidence Solutions, Nordics, Solna, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Nils Ekström
- IQVIA, Real World Evidence Solutions, Nordics, Solna, Sweden
| | | | - Viktor Wintzell
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
| | | | | |
Collapse
|
16
|
Protudjer JLP, Mikkelsen A. Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring. BMC Pediatr 2020; 20:341. [PMID: 32650748 PMCID: PMC7350184 DOI: 10.1186/s12887-020-02236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Vegan diets – defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child’s previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).
Collapse
Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. .,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. .,Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada. .,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
| | - Andrea Mikkelsen
- Paediatric Primary Health Care Clinics of Västra Götaland, Västra Götaland, Sweden.,Research and Development Primary Health Care, Gothenburg and Södra Bohuslän, Region Västra Götaland, Sweden.,Institute of Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. RECENT FINDINGS Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.
Collapse
Affiliation(s)
- Christopher M Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
| | - Jialing Jiang
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
| |
Collapse
|
18
|
Global Trends in Anaphylaxis Epidemiology and Clinical Implications. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1169-1176. [PMID: 31786255 PMCID: PMC7152797 DOI: 10.1016/j.jaip.2019.11.027] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
The true global scale of anaphylaxis remains elusive, because many episodes occur in the community without presentation to health care facilities, and most regions have not yet developed reliable systems with which to monitor severe allergic events. The most robust data sets currently available are based largely on hospital admissions, which are limited by inherent issues of misdiagnosis, misclassification, and generalizability. Despite this, there is convincing evidence of a global increase in rates of all-cause anaphylaxis, driven largely by medication- and food-related anaphylaxis. There is no evidence of parallel increases in global all-cause anaphylaxis mortality, with surprisingly similar estimates for case-fatality rates at approximately 0.5% to 1% of fatal outcomes for hospitalizations due to anaphylaxis across several regions. Studying regional patterns of anaphylaxis to certain triggers have provided valuable insights into susceptibility and sensitizing events: for example, the link between the mAb cetuximab and allergy to mammalian meat. Likewise, data from published fatality registers can identify potentially modifiable risk factors that can be used to inform clinical practice, such as prevention of delayed epinephrine administration, correct posturing during anaphylaxis, special attention to populations at risk (such as the elderly on multiple medications), and use of venom immunotherapy in individuals at risk of insect-related anaphylaxis.
Collapse
|
19
|
Genetic and environmental susceptibility to food allergy in a registry of twins. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2916-2918. [DOI: 10.1016/j.jaip.2019.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 11/23/2022]
|
20
|
Nationwide Survey of Hospitalization Due to Pediatric Food-Induced Anaphylaxis in the United States. Pediatr Emerg Care 2019; 35:769-773. [PMID: 30113437 DOI: 10.1097/pec.0000000000001543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear. METHODS Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were weighted to estimate the number of hospitalizations in the United States. We identified annual hospitalization rates by patients' characteristics and anaphylaxis-trigger foods and investigated factors associated with severity and use of mechanical ventilation with multivariable logistic regression. RESULTS A total of 3427 hospitalizations were obtained, and annual hospitalization rates showed a significantly increasing trend from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012 (P < 0.001). The leading causes of hospitalizations due to food-induced anaphylaxis were peanuts (0.35-0.48 per 100,000 children), tree nuts and seeds (0.20-0.32 per 100,000 children), and milk products (0.09-0.13 per 100,000 children), with significantly increasing trends during 2006-2012. Milk products were significantly associated with severity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-2.9). Ages between 13 and 20 years (OR, 2.7; 95% CI, 1.4-5.1) and comorbidity of asthma (OR, 2.1; 95% CI, 1.3-3.4) were significantly associated with the use of mechanical ventilation. CONCLUSIONS The annual hospitalization rates in the entire United States showed an increasing trend during 2006-2012. The rates of peanuts, tree nuts and seeds, and milk products demonstrated upward trends. Milk products, ages between 13 and 20 years, and comorbidities of asthma were related to severity and morbidity.
Collapse
|
21
|
Wai HM, Middelveld R, Thörnqvist V, Ballardini N, Nilsson E, Strömquist J, Nilsson L, Ahlstedt S, Protudjer JLP. Pediatric food allergy-related household costs are influenced by age, but not disease severity. World Allergy Organ J 2019; 12:100061. [PMID: 31641409 PMCID: PMC6796906 DOI: 10.1016/j.waojou.2019.100061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/01/2022] Open
Abstract
Objective The economic burden of food allergy on households is poorly understood. We evaluated the household costs associated with specialist-diagnosed pediatric food allergy, with focus on age and disease severity. Study design A cross-sectional study of 70 Swedish case-control pairs (59% boys) was conducted using Food Allergy Economic questionnaire. Household costs were analyzed between age- and gender-matched cases (children aged 0–17 years, with specialist-diagnosed food allergy) and controls (non-food allergic households). Results Parents were predominantly university-educated and employed full-time. Most cases had parent-reported previous anaphylaxis. Mean total annual household costs were comparable between cases and controls. However, compared to controls, cases had significantly higher direct medical-, and non-medical related costs; higher indirect medical-related costs, and higher intangible costs (all p < 0.05). In a sensitivity analyses of only cases aged 0–12 years, direct household costs, including lost earnings due to child's hospitalization, were significantly higher than controls. Results from only children with severe disease paralleled those of all cases vs. controls. Conclusions Although pediatric food allergy is not associated with higher total annual household costs, these households have significantly higher direct medical-related, indirect and intangible costs vs. non-food allergic households. Higher household costs were identified amongst younger children, but not disease severity.
Collapse
Affiliation(s)
- Hay Mar Wai
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Health Economics, Policy and Management, Karolinska Institutet, Stockholm, Sweden
| | - Roelinde Middelveld
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Health Economics, Policy and Management, Karolinska Institutet, Stockholm, Sweden
| | - Victoria Thörnqvist
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Ballardini
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Lung Clinic, Södersjukhuset, Stockholm, Sweden
| | - Evalill Nilsson
- Institutionen för Medicin och Hälsa, Linköpings Universitetet, Linköping, Sweden
| | | | - Lennart Nilsson
- Pediatric Allergy, Linköpings Universitetet, Linköping, Sweden
| | - Staffan Ahlstedt
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Lisa Penner Protudjer
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| |
Collapse
|
22
|
Edelman SM, Kukkonen AK, Mäkelä MJ. Eliciting allergens and treatment of anaphylaxis: Report of the finnish national anaphylaxis registry. Allergy 2019; 74:2010-2013. [PMID: 31070796 DOI: 10.1111/all.13858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Sanna M Edelman
- Allergen Laboratory, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.,Department of Dermatology, Allergology and Venereology, University of Helsinki, Helsinki, Finland
| | - Anna Kaarina Kukkonen
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Department of Dermatology, Allergology and Venereology, University of Helsinki, Helsinki, Finland.,Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
23
|
Protudjer JLP, Middelveld R, Ballardini N, Wai HM, Ahlstedt S, Nilsson L, Kivistö JE. Epinephrine dispensings, allergy hospitalizations and the elimination of co-payments in Sweden. Allergy 2019; 74:1197-1200. [PMID: 30697761 DOI: 10.1111/all.13733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jennifer L. P. Protudjer
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics and Child Health; University of Manitoba; Winnipeg Canada
- George and Fay Yee Centre for Healthcare Innovation; Winnipeg Canada
- The Children's Hospital Research Institute of Manitoba; Winnipeg Canada
| | - Roelinde Middelveld
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Natalia Ballardini
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- St John's Institute of Dermatology; King's College London; London UK
| | - Hay Mar Wai
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Health Economics, Policy and Management; Karolinska Institutet; Stockholm Sweden
| | - Staffan Ahlstedt
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Lennart Nilsson
- Paediatric Allergy; Linköpings Universitetet; Linköping Sweden
| | - Juho E. Kivistö
- Allergy Centre; Tampere University Hospital; Tampere Finland
- Tampere Centre for Child Health Research; University of Tampere; Tampere University Hospital; Tampere Finland
| |
Collapse
|
24
|
Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy 2019; 74:1063-1080. [PMID: 30688375 DOI: 10.1111/all.13732] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/15/2018] [Accepted: 01/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite an increasing number of publications from individual countries and regions, there is still no systematic review of the global epidemiology of anaphylaxis in the general paediatric population. METHODS We conducted a systematic review, using a protocol registered and published with the international prospective register of systematic reviews (PROSPERO). Results were reported following PRISMA guidelines. The search strategy was designed in Medline (ovid) and modified for Embase (ovid) and PubMed. Papers were screened by two independent reviewers following selection and exclusion criteria. Data extraction and risk of bias assessment were completed by the same two reviewers. Studies in adults only or those that did not report data in children separately were excluded. RESULTS A final total of 59 articles were included. Of these, 5 reported cumulative incidence, 39 reported incidence rate and 17 reported prevalence data. The incidence of anaphylaxis in children worldwide varied widely, ranging from 1 to 761 per 100 000 person-years for total anaphylaxis and 1 to 77 per 100 000 person-years for food-induced anaphylaxis. The definition of anaphylaxis from NIAID/FAAN was the most commonly used. Gender and ethnicity were demographic risk factors associated with anaphylaxis in children. Increasing total or food-induced anaphylaxis incidence over time was reported by 19 studies. CONCLUSION The reported incidence of anaphylaxis in children varied widely. Studies in developing countries are underrepresented. To accurately compare anaphylaxis incidence between countries and investigate the time trends, further studies using a standardized definition across different countries are required.
Collapse
Affiliation(s)
- Yichao Wang
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Katrina J. Allen
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- The Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Noor H. A. Suaini
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- The Department of Allergy and Immunology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Rachel L. Peters
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Jennifer J. Koplin
- Murdoch Children's Research Institute; Parkville Victoria Australia
- The School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
25
|
Österlund J, Winberg A, West CE. A 10-year review found increasing incidence trends of emergency egg allergy reactions and food-induced anaphylaxis in children. Acta Paediatr 2019; 108:314-320. [PMID: 29920760 DOI: 10.1111/apa.14464] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022]
Abstract
AIM International reports have suggested that food allergies and food-induced anaphylaxis have increased in children. We investigated the incidence of emergency food reactions over a 10-year period. METHODS This study retrospectively reviewed the medical records of children presenting to Umeå University hospital, Sweden, with an emergency food reaction from January 1, 2006 to December 31, 2015. Cases were identified using discharge codes for allergies and anaphylaxis. Anaphylaxis cases were included if they fulfilled the international criteria. RESULTS We found emergency food allergy reactions in 519 children (58% boys) from 2006-2015 at a median age of 1.3 years. One-third were hospitalised (32%) including 71/99 cases of anaphylaxis. Milk and eggs were the most commonly identified triggers. Emergency reactions to eggs increased during the study period with a Spearman rank correlation coefficient of 0.770 (p < 0.01) and the figures for anaphylaxis were 0.745 (p = 0.013). The incidence of food-induced anaphylaxis increased and was 30 per 100 000 person-years for the study period. CONCLUSION Most of the emergency reactions, treated by secondary care paediatricians and emergency physicians, were to milk and eggs. Allergic reactions to eggs increased from 2006 to 2015, as did food-related anaphylaxis.
Collapse
Affiliation(s)
- J Österlund
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - A Winberg
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - C E West
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| |
Collapse
|
26
|
Yao TC, Wu AC, Huang YW, Wang JY, Tsai HJ. Increasing trends of anaphylaxis-related events: an analysis of anaphylaxis using nationwide data in Taiwan, 2001-2013. World Allergy Organ J 2018; 11:23. [PMID: 30349617 PMCID: PMC6178262 DOI: 10.1186/s40413-018-0202-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Anaphylaxis is a severe, potentially fatal, and systemic allergic reaction. Previous studies document increasing trends in incidence rates of anaphylaxis-related events in Western countries, yet little is known about the incidence and trend of anaphylaxis in Asia. In this study, we aimed to determine time trends in incidence rates of anaphylaxis-related events in Taiwan from 2001 through 2013. Methods We utilized medical claims data from the National Health Insurance Research Databases in Taiwan. We identified anaphylaxis-related events (ICD-9-CM-codes: 995.0, 995.60–995.69, 999.41–999.42, and 999.49) and calculated incidence rates. Poisson regression models were applied to examine trends and incidence rates. Results A total of 2496 patients (mean age, 45.11 years; 56% male) with first-time anaphylaxis were identified during 34,430,000 person-years of observation time. The overall incidence of anaphylaxis was 7.25 (95% confidence interval (CI) = 6.97–7.53) per 100,000 person-years, increasing from 4.79 in 2001 to 8.20 in 2013, with an incidence rate ratio (IRR) of 1.05 (95%CI = 1.04–1.06). Over the 13-year period, the increasing trends were found in incident diagnosis of anaphylaxis-related outpatient or emergency department visits (IRR = 1.06, 95%CI = 1.05–1.08) and admissions to intensive care units (IRR = 1.06, 95%CI = 1.03–1.10), whereas the trends in incidence of anaphylaxis-related hospitalizations remained steady. The proportion of patients requiring hospitalizations among all patients with anaphylaxis (p_trend = 0.01), as well as the proportion requiring intensive care treatment among patients who were hospitalized (p_trend = 0.01), both increased with age. Conclusion The incidence rate of anaphylaxis in Taiwan has increased at an average rate of 5% annually since 2001, paralleling the rising trends in several Western countries. Electronic supplementary material The online version of this article (10.1186/s40413-018-0202-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tsung-Chieh Yao
- 1Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,2Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,3Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ann Chen Wu
- 4PrecisiOn Medicine and Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA USA.,5Department of Pediatrics, Children's Hospital, Boston, MA USA
| | - Ya-Wen Huang
- 6Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli 350 Taiwan
| | - Jiu-Yao Wang
- 7Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,8Allergy and Clinical Immunology Research (ACIR) Centre, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- 6Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli 350 Taiwan
| |
Collapse
|
27
|
The Epidemiology of Food Allergy in the Global Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092043. [PMID: 30231558 PMCID: PMC6163515 DOI: 10.3390/ijerph15092043] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 01/27/2023]
Abstract
There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow’s milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country’s feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.
Collapse
|
28
|
Kivistö JE, Karjalainen J, Kivelä L, Huhtala H, Protudjer JLP. Very low asthma death incidence among Finnish children from 1999 to 2015. Pediatr Pulmonol 2018; 53:1009-1013. [PMID: 29717545 DOI: 10.1002/ppul.24027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The most recent reports concerning asthma fatalities in Finnish children are from 1998. Since that time, asthma care has improved and asthma-related hospitalizations have decreased. Yet, it is unknown whether pediatric asthma deaths have similarly decreased. OBJECTIVE To investigate the epidemiology of asthma deaths in the Finnish pediatric population from 1999 onward and to describe the details of fatal asthma exacerbations. METHODS We obtained copies of the death certificates from Statistics Finland of all Finnish children aged 0-19 years who died from asthma between 1999 and 2015. After analyzing the death certificates, the medical records of those with possible asthma death were evaluated in detail to confirm the diagnosis. Incidence rates (IR) of asthma deaths were estimated per 1 000 000 person-years by dividing the number of asthma deaths by the total number of person-years. RESULTS Between 1999-2015, there were 6845 deaths among 0-19 year-old children, of which 21 were possible asthma deaths. Based on patient records and pathological findings, we identified four convincing asthma deaths: aged 7 months, 1 year, 2.5 years, and 19 years. None had known allergies or regularly used inhaled corticosteroids. No pre-school or school-aged children died from asthma in Finland between 1999 and 2015. The cumulative incidence of pediatric asthma deaths was 0.19 per million person-years. CONCLUSION Four Finnish children died from asthma between 1999 and 2015. This corresponds to a total incidence of 0.19 per million person-years. No pre-school or school-aged children died from asthma in Finland during the study period.
Collapse
Affiliation(s)
- Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Laura Kivelä
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm, Sweden
| |
Collapse
|
29
|
Feldman LY, Thacher JD, van Hage M, Kull I, Melén E, Pershagen G, Wickman M, To T, Protudjer JL, Bergström A. Early-life secondhand smoke exposure and food hypersensitivity through adolescence. Allergy 2018; 73:1558-1561. [PMID: 29675922 DOI: 10.1111/all.13463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Y. Feldman
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
| | - J. D. Thacher
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - M. van Hage
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| | - I. Kull
- Department of Clinical Science and Education; Stockholm South General Hospital; Stockholm Sweden
- Sachs' Children's Hospital; Stockholm South General Hospital; Stockholm Sweden
| | - E. Melén
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children's Hospital; Stockholm South General Hospital; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - G. Pershagen
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - M. Wickman
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Eskilstuna Sweden
| | - T. To
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - J. L. Protudjer
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - A. Bergström
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| |
Collapse
|
30
|
Wang Y, Koplin JJ, Ho MHK, Wong WHS, Allen KJ. Increasing hospital presentations for anaphylaxis in the pediatric population in Hong Kong. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1050-1052.e2. [DOI: 10.1016/j.jaip.2017.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
|
31
|
Palmu S, Heikkilä P, Uski V, Niitty S, Kurikka S, Korppi M. National allergy programme had little impact on parent-reported food allergies in children aged 6-7 years. Acta Paediatr 2018; 107:121-125. [PMID: 28925556 DOI: 10.1111/apa.14083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/07/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
AIM The ten-year Finnish national allergy programme was launched in 2008 to lessen the disease and psychological burden of allergy. This study assessed the prevalence of parent-reported food allergies requiring avoidance diets at primary school in children aged six and seven years. METHODS The cohort comprised 1937 children (51% boys) who started primary school in Tampere, Finland, in August 2016. School health nurses charted parent-reported, doctor-diagnosed food allergies requiring avoidance diets as part of the routine health examination. RESULTS We found that 127 (6.6%) children had parent-reported, doctor-diagnosed allergies to at least one food and 37 (1.9%) were allergic to basic foods, namely cows' milk, wheat and one other grain. All required an avoidance diet. The figure did not differ significantly from the 2.7% and 2.5% found by studies of this age group in 2009 and 2013, respectively. Allergies to fresh fruit and vegetables decreased from 5.8% in 2009 to 3.6% in 2016. CONCLUSION We studied the national allergy programme that started in 2008 and found that there was a nonsignificant overall decrease in the number of children aged six to seven years on avoidance diets for allergies between 2009 and 2016. The only allergies that showed significant decreases were fresh fruit and vegetables.
Collapse
Affiliation(s)
- Sauli Palmu
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Paula Heikkilä
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Virpi Uski
- Tampereen Voimia; Catering Enterprise; Tampere Finland
| | - Siina Niitty
- Health Services for Children and Youth; Tampere Finland
| | - Sari Kurikka
- Health Services for Children and Youth; Tampere Finland
| | - Matti Korppi
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| |
Collapse
|
32
|
Vetander M, Protudjer JLP, Lilja G, Kull I, Hedlin G, van Hage M, Östblom E, Bergström A, Wickman M. Anaphylaxis to foods in a population of adolescents: incidence, characteristics and associated risks. Clin Exp Allergy 2017; 46:1575-1587. [PMID: 27790764 DOI: 10.1111/cea.12842] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Information about severe reactions to foods in adolescence is limited. OBJECTIVE To describe reactions to foods, including anaphylaxis, with regard to incidence, characteristics and associated risks, among 16-year-olds (adolescents) in a large, population-based birth cohort. METHODS Parent-reported questionnaire data from ages 2-3 months, and 1, 2 and 16 years were used (N = 3153). Anaphylaxis at age 16 years was defined per NIAID/FAAN criteria. Immunoglobulin E (IgE) antibodies to 14 common food and inhalant allergens were analysed at ages 4 (n = 2283) and 16 years (n = 2510). Among adolescents with food-related symptoms (FRS) and for whom blood was available (n = 221), 25 additional food allergen extracts or allergen components were analysed. Associations between reactions to foods, and sensitization and allergic multimorbidity were investigated. RESULTS In the 12 months prior to the 16-year assessment, 8.5% of adolescents had FRS. This included 0.8% (n = 24) adolescents who were classified as having anaphylaxis, yielding an incidence rate of 761/100 000 person-years. One-third of adolescents accessed health care during anaphylaxis. Allergic multimorbidity in infancy, as well as sensitization to foods and airborne allergens at age 4 years, was associated with an increased risk for FRS in adolescence. Peanuts and tree nuts were the most common culprit foods for anaphylaxis, and fruits and vegetables for non-anaphylactic reactions. Adolescents with anaphylaxis were significantly more likely to be sensitized to storage proteins (Ara h 2, Cor a 9, Cor a 14) and to be polysensitized to foods (P < 0.001 vs. non-anaphylactic reactions). CONCLUSIONS AND CLINICAL RELEVANCE The incidence of food-induced anaphylaxis during adolescence in our population-based birth cohort is higher than previously reported. Adolescents with anaphylaxis differ from adolescents with non-anaphylactic FRS with regard to culprit foods and sensitization. Adolescents with previous anaphylaxis are likely to be polysensitized to foods, particularly tree nut and peanut storage proteins, and which warrants consideration at follow-up.
Collapse
Affiliation(s)
- M Vetander
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - J L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - G Lilja
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - G Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - M van Hage
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - E Östblom
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
Haahtela T, Valovirta E, Bousquet J, Mäkelä M. The Finnish Allergy Programme 2008-2018 works. Eur Respir J 2017. [PMID: 28642312 DOI: 10.1183/13993003.00470-2017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Erkka Valovirta
- Dept of Lung Diseases and Clinical Allergology, University of Turku, and Allergy Clinic, Terveystalo, Turku, Finland
| | - Jean Bousquet
- MACVIA-France, Contre les Maladies Chroniques pour un Vieillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles Saint-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
34
|
Kivistö JE, Protudjer JLP, Karjalainen J, Bergström A, Korppi M. Trends in paediatric asthma hospitalisations - differences between neighbouring countries. Thorax 2017; 73:185-187. [PMID: 28373348 DOI: 10.1136/thoraxjnl-2016-209739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/23/2017] [Accepted: 03/12/2017] [Indexed: 11/04/2022]
Abstract
Paediatric asthma hospitalisation trends in Finland and Sweden over the past 10 years are unclear. We investigated the incidence of paediatric asthma hospitalisations in both countries from 2005 to 2014, using Finland's National Hospital Discharge Register and Sweden's National Patient Register which cover all hospitalisations in the respective countries. During the study period, the incidence of paediatric asthma hospitalisations decreased by 51% in Finland, but remained stable in Sweden. In both countries, asthma hospitalisations decreased over time among children aged 0-4 years, with unclear trends for older ages. The reasons for these intercountry differences are unclear, thus warranting future research.
Collapse
Affiliation(s)
- Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Finland.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Matti Korppi
- Tampere Center for Child Health Research, University of Tampere, Finland
| |
Collapse
|
35
|
Zellweger F, Eggel A. IgE-associated allergic disorders: recent advances in etiology, diagnosis, and treatment. Allergy 2016; 71:1652-1661. [PMID: 27709638 DOI: 10.1111/all.13059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/11/2022]
Abstract
IgE-associated allergic diseases belong to the most common inflammatory conditions. Their clinical manifestation ranges from mild symptoms to life-threatening episodes. Often patients experience a reduction in physical and psychologic well-being and suffer from a decreased quality of life due to disease activity. The continuously rising number of people that are affected by an allergic condition indicates an urgent need for better diagnostics and more efficient treatment options. Recent progress in the understanding of pathophysiologic mechanisms underlying IgE-associated allergic disorders has led to the identification of novel therapeutic targets and the development of drug candidates that are currently under evaluation. In this review, we highlight studies and clinical trials, which have helped to gain further insight in the etiology of IgE-associated allergic conditions as well as advances in the development of diagnostic tools and therapeutic approaches recently published in Allergy (European Journal of Allergy and Clinical Immunology).
Collapse
Affiliation(s)
- F. Zellweger
- Department of Rheumatology, Immunology and Allergology; University Hospital Bern; Bern Switzerland
- Department of Clinical Research; University of Bern; Bern Switzerland
| | - A. Eggel
- Department of Rheumatology, Immunology and Allergology; University Hospital Bern; Bern Switzerland
- Department of Clinical Research; University of Bern; Bern Switzerland
| |
Collapse
|
36
|
Protudjer JLP, Vetander M, Kull I, Hedlin G, van Hage M, Wickman M, Bergström A. Food-Related Symptoms and Food Allergy in Swedish Children from Early Life to Adolescence. PLoS One 2016; 11:e0166347. [PMID: 27846286 PMCID: PMC5112902 DOI: 10.1371/journal.pone.0166347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/27/2016] [Indexed: 12/03/2022] Open
Abstract
Background Risk factors for persistence of food-related symptoms (FRS) and food allergy (FA) from early life to adolescence are incompletely understood. The aim of this study was to identify risk factors for FRS and FA in adolescence amongst children with FRS or FA in the first four years of life (early life). Methods In children enrolled in a Swedish birth cohort and followed to 16 years (n = 2572), we defined children with early life FRS in the absence of FA, and FA. Corresponding phenotypes were defined at 16 years. Associations between potential risk factors at 4 years and FRS and FA at 16 years were investigated using logistic regression. Results Early life FRS and FA prevalences were 12.2% and 6.8%, respectively. Amongst children with early life FRS, 35.7% had FRS or FA at 16 years, whereas 74.3% of the children with early life FA had FA at 16 years. For each of the early life phenotypes, parental allergy, early life allergic multimorbidity, early life reactions to peanuts/tree nuts and IgE reactivity at 4 years were statistically significantly associated with FRS or FA at 16 years. In contrast, male sex was associated with an increased risk of FA at 16 years among children with early life FA only. Conclusions In early life, food-related symptoms are twice as common as food allergy. Unlike food allergy, food-related symptoms often remit by adolescence. Yet, these phenotypes have many common risk factors for persistence to adolescence.
Collapse
Affiliation(s)
- Jennifer L. P. Protudjer
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Mirja Vetander
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Inger Kull
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Marianne van Hage
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
37
|
Protudjer JLP, Jansson SA, Middelveld R, Östblom E, Dahlén SE, Arnlind MH, Bengtsson U, Kallström-Bengtsson I, Marklund B, Rentzos G, Sundqvist AC, Åkerström J, Ahlstedt S. Impaired health-related quality of life in adolescents with allergy to staple foods. Clin Transl Allergy 2016; 6:37. [PMID: 27733903 PMCID: PMC5045620 DOI: 10.1186/s13601-016-0128-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background Cow’s milk, hen’s egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall’s disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. Methods In this cross-sectional study, 58 adolescents aged 13–17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow’s milk, hen’s egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of ≥0.5. Results Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30–5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. Conclusions As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL. Electronic supplementary material The online version of this article (doi:10.1186/s13601-016-0128-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jennifer Lisa Penner Protudjer
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Arne Jansson
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Roelinde Middelveld
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Östblom
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Heibert Arnlind
- Swedish Council on Health Technology Assessment, SBU, Stockholm, Sweden ; Department of Learning, Informatics, Management and Ethics, and Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Bengtsson
- Allergy Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Birgitta Marklund
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Georgios Rentzos
- Allergy Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Staffan Ahlstedt
- The Centre for Allergy Research, Karolinska Institutet, P.O. Box 287, 17177 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
38
|
Kivistö JE, Dunder T, Protudjer JLP, Karjalainen J, Huhtala H, Mäkelä MJ. Adult but no pediatric anaphylaxis-related deaths in the Finnish population from 1996 to 2013. J Allergy Clin Immunol 2016; 138:630-2. [PMID: 27343204 DOI: 10.1016/j.jaci.2016.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Teija Dunder
- PEDEGO Research Center, and Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|