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Turner PJ, Patel N, Blumchen K, Berkes S, Sampson HA, Beyer K. Impact of using less objective symptoms to define tolerated dose during food challenges: A data-driven approach. J Allergy Clin Immunol 2023; 152:145-154. [PMID: 36603776 DOI: 10.1016/j.jaci.2022.12.818] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Food challenges (FCs) form the basis for assessing efficacy outcomes in interventional studies of food allergy; however, different studies have used a variety of similar but not identical criteria to define a challenge reaction, including subjective (nonobjective) symptoms occurring in a single-organ system as dose limiting. OBJECTIVE Our aim was to undertake a secondary analysis of 4 interventional studies to assess the impact of using less objective criteria to determine challenge-stop on reaction thresholds and their reproducibility. METHODS We analyzed individual participant data, including individual participant data meta-analysis, by using 3 different published challenge-stop criteria: (1) PRACTALL consesus criteria; (2) Consortium for Food Allergy Research version 3 (CoFAR v3) with at least 1 moderate- or severe-grade symptom; or (3) CoFAR v3 with at least 2 mild symptoms occurring in different organ systems. Reproducibility of challenge threshold was also assessed in participants undergoing subsequent repeat FCs. RESULTS Four studies, with detailed challenge data from a total of 592 participants, were included. Applying CoFAR v3 definitions for dose-limiting symptoms resulted in an underestimate of reaction thresholds compared with those in PRACTALL (P < .001) that is equivalent to almost a single dosing increment when using a semi-log dosing regimen. Reproducibility was also reduced when applying CoFAR v3 (P < .001 [n = 223]). Using the least conservative interpretation of CoFAR v3 (≥2 mild symptoms occurring in different systems) resulted in a significant overestimate of 15% when assessing oral immunotherapy efficacy. Applying a data-driven minor modification to CoFAR v3 resulted in a new set of challenge-stop criteria with validity similar to that of PRACTALL but one that is simpler to implement and in which significant gastrointestinal discomfort with observable decreased activity remains a dose-limiting symptom. CONCLUSION The use of less objective symptoms to define challenge-stop compromises the reproducibility of the FC as a tool to assess efficacy outcomes in interventional studies, and potentially overestimates the efficacy of the intervention tested.
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Affiliation(s)
- Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine, Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefanie Berkes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hugh A Sampson
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universtãtsmedizin Berlin, Berlin Germany
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Muller T, Luc A, Adam T, Jarlot-Chevaux S, Dumond P, Schweitzer C, Codreanu-Morel F, Divaret-Chauveau A. Relevance of sensitization to legumes in peanut-allergic children. Pediatr Allergy Immunol 2022; 33:e13846. [PMID: 36156816 PMCID: PMC9544501 DOI: 10.1111/pai.13846] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/31/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Legume consumption has increased during the two past decades. In France, legumes are responsible for 14.6% of food-related anaphylaxis in children, with peanut as the main allergen (77.5%). Few studies have demonstrated cross-reactivities between peanut and other legumes. The aim of this study was to determine prevalence and relevance of sensitization to legumes in peanut-allergic children. METHODS All children, aged of 1-17 years, admitted to the Pediatric Allergy Department of the University Hospital of Nancy between January 1, 2017 and February 29, 2020 with a confirmed peanut allergy (PA) and a documented consumption or sensitization to at least one other legume were included. Data were retrospectively collected regarding history of consumption, skin prick tests, specific immunoglobulin E (IgE), prior allergic reactions, and oral food challenges for each legume. RESULTS Among the 195 included children with PA, 122 were sensitized to at least one other legume (63.9%). Main sensitizations were for fenugreek (N = 61, 66.3%), lentil (N = 38, 42.2%), soy (N = 61, 39.9%), and lupine (N = 63, 34.2%). Among the 122 sensitized children, allergy to at least one legume was confirmed for 34 children (27.9%), including six children who had multiple legume allergies (4.9%). Lentil, lupine, and pea were the main responsible allergens. Half of allergic reactions to legumes other than peanut were severe. CONCLUSION The high prevalence of legume sensitization and the frequent severe reactions reported in children with PA highlight that tolerated legume consumption should be explored for each legume in the case of PA, and sensitization should be investigated if not.
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Affiliation(s)
- Timé Muller
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France
| | - Amandine Luc
- DRCI, MPI Department, Methodology, Data Management and Statistics Unit, University Hospital of Nancy, Vandœuvre-les-Nancy, France
| | - Tania Adam
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France
| | - Sophie Jarlot-Chevaux
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France
| | - Pascale Dumond
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France.,EA3450 DevAH - Department of Physiology, Faculty of Medicine, University of Lorraine, Vandœuvre-les-Nancy, France
| | | | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandœuvre-les-Nancy, France.,EA3450 DevAH - Department of Physiology, Faculty of Medicine, University of Lorraine, Vandœuvre-les-Nancy, France
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3
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Patel N, Adelman DC, Anagnostou K, Baumert JL, Blom WM, Campbell DE, Chinthrajah RS, Mills ENC, Javed B, Purington N, Remington BC, Sampson HA, Smith AD, Yarham RAR, Turner PJ. Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis. J Allergy Clin Immunol 2021; 147:2249-2262.e7. [PMID: 33571537 PMCID: PMC8168954 DOI: 10.1016/j.jaci.2021.01.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Eliciting doses (EDs) (eg, ED01 or ED05 values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown. OBJECTIVE Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge. METHODS We conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between January 2010 and September 2020. Risk of bias was assessed by using National Institute for Clinical Excellence methodologic checklists. RESULTS A total of 19 studies were included (covering a total of 3151 participants, 534 of whom subsequently underwent further peanut challenge). At individual participant data meta-analysis, 4.5% (95% CI, 1.9% to 10.1%) of individuals reacted to 5 mg or less of peanut protein with anaphylaxis (moderate heterogeneity [I2 = 57%]). Intraindividual thresholds varied by up to 3 logs, although this variation was limited to a half-log change in 71.2% (95% CI, 56.2% to 82.6%) of individuals. In all, 2.4% (95% CI, 1.1% to 5.0%) of patients initially tolerated 5 mg of peanut protein but then reacted to this dose at subsequent challenge (low heterogeneity [I2 = 16%]); none developed anaphylaxis. CONCLUSION Around 5% of individuals reacting to an ED01 or ED05 level of exposure to peanut might develop anaphylaxis in response to that dose. This equates to 1 and 6 anaphylaxis events per 2500 patients exposed to an ED01 or ED05 dose, respectively, in the broader population of individuals with peanut allergy.
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Affiliation(s)
- Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Katherine Anagnostou
- Section of Allergy and Immunology, Baylor College of Medicine, Houston, Tex; Section of Allergy and Immunology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, Neb
| | - W Marty Blom
- The Netherlands Organisation of Applied Scientific Research, Utrecht, The Netherlands
| | - Dianne E Campbell
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, Australia; DBV Technologies, Montrouge, France
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, Calif; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, Calif
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Bushra Javed
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Natasha Purington
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, Calif
| | - Benjamin C Remington
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, Neb
| | - Hugh A Sampson
- DBV Technologies, Montrouge, France; Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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4
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Turner PJ, Ruiz‐Garcia M, Patel N, Abrantes G, Burrell S, Vazquez‐Ortiz M, Skypala I, Durham SR, Boyle RJ. Delayed symptoms and orthostatic intolerance following peanut challenge. Clin Exp Allergy 2021; 51:696-702. [DOI: 10.1111/cea.13865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Paul J. Turner
- National Heart & Lung Institute Imperial College London London UK
| | | | - Nandinee Patel
- National Heart & Lung Institute Imperial College London London UK
| | - Gonçalo Abrantes
- National Heart & Lung Institute Imperial College London London UK
| | - Sarah Burrell
- National Heart & Lung Institute Imperial College London London UK
| | | | - Isabel Skypala
- Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK
| | - Stephen R. Durham
- National Heart & Lung Institute Imperial College London London UK
- Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK
| | - Robert J. Boyle
- National Heart & Lung Institute Imperial College London London UK
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5
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McCarthy S, Murphy M, Turner PJ, Hourihane OB. Comment on 'Four-year data from use of the nut and soya allergy testing protocol before treatment with isotretinoin and alitretinoin'. Clin Exp Dermatol 2020; 45:1071. [PMID: 32686162 DOI: 10.1111/ced.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- S McCarthy
- Department of Paediatric Dermatology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - M Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - P J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - O B Hourihane
- Paediatrics and Child Health and RCSI and Children's Health Ireland, Temple Street, Dublin, Ireland
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Eigenmann PA, Akdis C, Bousquet J, Grattan CE, Hoffmann-Sommergruber K, Jutel M. Food and drug allergy, and anaphylaxis in EAACI journals (2018). Pediatr Allergy Immunol 2019; 30:785-794. [PMID: 31539176 DOI: 10.1111/pai.13125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: "Allergy," "Pediatric Allergy and Immunology (PAI)," and "Clinical and Translational Allergy (CTA)." One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. This paper summarizes the achievements of 2018 in anaphylaxis, and food and drug allergy. Main topics that have been focused are anaphylaxis, mechanisms of food allergy (FA), epidemiology of FA, food allergens, diagnosis of FA, prevention and control of FA, FA immunotherapy, drug allergy, and political agenda.
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Affiliation(s)
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases - Epidemiological and Public Health Approaches, Villejuif, France.,UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Euforea, Brussels, Belgium
| | | | | | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland.,ALL-MED Medical Research Institute, Wrocław, Poland
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Harvey S, O'Connell SM, Hourihane JO. Safety of intramuscular testosterone in arachis oil for boys with peanut allergy requiring pubertal induction. Ann Allergy Asthma Immunol 2019; 124:94-95. [PMID: 31654765 DOI: 10.1016/j.anai.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Susan Harvey
- Department of Paediatrics Cork, University Hospital, Cork, Ireland
| | - Susan M O'Connell
- Department of Diabetes and Endocrinology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Jonathan O'B Hourihane
- Department of Paediatrics Cork, University Hospital, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Ireland.
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