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Anagnostou A, Yaworsky A, Brova M, Ibrahim N, Kakked S, Spite S, Duluc L, Shields AL, Lee T, Leonard S, Przywara K, Smith A. Evaluation and Modification of a Shared Decision-Making Tool for Peanut Allergy Management. Curr Allergy Asthma Rep 2024; 24:303-315. [PMID: 38639896 DOI: 10.1007/s11882-024-01146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Based on shared decision-making (SDM) principles, a decision aid was previously developed to help patients, their caregivers, and physicians decide which peanut allergy management approach best suits them. This study refined the decision aid's content to better reflect patients' and caregivers' lived experience. RECENT FINDINGS Current standard of care for peanut allergy is avoidance, although peanut oral immunotherapy has been approved by the Food and Drug Administration for use in patients 4-17 years old. An advisory board of allergy therapy experts (n = 3) and patient advocates (n = 3) informed modifications to the decision aid. The revised tool underwent cognitive debriefing interviews (CDIs) among adolescents (12-17 years old) with peanut allergy and caregivers of patients 4-17 years old with peanut allergy to evaluate its relevance, understandability, and usefulness. The 20 CDI participants understood the information presented in the SDM tool and reported it was important and relevant. Some revisions were made based on participant feedback. Results support content validity of the Peanut Allergy Treatment SDM Tool.
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Affiliation(s)
| | - Andrew Yaworsky
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA.
| | - Monica Brova
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Nazifa Ibrahim
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Siddharth Kakked
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Sasha Spite
- California State University San Marcos, San Marcos, CA, USA
| | - Linette Duluc
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Alan L Shields
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Tricia Lee
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
- American College of Allergy, Asthma, and Immunology, Arlington Heights, IL, USA
| | - Stephanie Leonard
- University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Kathy Przywara
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - Amelia Smith
- Food Allergy and Anaphylaxis Connection Team, Liberty Twp, OH, USA
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Foti Randazzese S, Panasiti I, Caminiti L, Catamerò F, Landi M, De Filippo M, Votto M, Olcese R, Favuzza F, Giovannini M, Barberi S. Current state and advances in desensitization for peanut allergy in pediatric age. Pediatr Allergy Immunol 2024; 35:e14127. [PMID: 38646959 DOI: 10.1111/pai.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
Peanut allergy affects about 1%-3% of the pediatric population in the world, with an important increase in the last decades. Nowadays, international guidelines recommend the early introduction of peanuts in the infant diet, with poor information about the quantity and the frequency of the intake. Allergen immunotherapy may represent the only therapeutic strategy able to modify the natural history of peanut allergy. In particular, oral immunotherapy showed the most promising results in terms of efficacy, but with significant rates of adverse reactions, mostly gastrointestinal. In 2020, the Food and Drug Administration and the European Medicines Agency approved Palforzia®, an oral drug for patients aged 4-17 years. Several studies are ongoing to improve the tolerability of oral immunotherapy and standardize the desensitization protocols. Sublingual immunotherapy permits to offer much lower doses than oral immunotherapy, but fewer adverse events are shown. Subcutaneous immunotherapy is associated with the greatest systemic adverse effects. Epicutaneous immunotherapy, for which Viaskin® patch was approved, has the highest safety profile. Innovative studies are evaluating the use of biological drugs, such as omalizumab or dupilumab, and probiotics, such as Lactobacillus rhamnosus, in monotherapy or associated with oral immunotherapy. Therapy for peanut allergy is constantly evolving, and new perspectives are ongoing to develop.
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Affiliation(s)
- Simone Foti Randazzese
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Ilenia Panasiti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Lucia Caminiti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Francesco Catamerò
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Massimo Landi
- Institute of Biomedicine and Molecular Immunology, Pediatric National Healthcare System, Turin, Italy
| | - Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Filippo Favuzza
- Pediatric Unit, Hospital Holy Family Fatebenefratelli Company, Erba, Italy
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Zhang Y, Geng Q, Song M, Li X, Yang A, Tong P, Wu Z, Chen H. The structure and potential allergenicity of peanut allergen monomers after roasting. Food Funct 2024; 15:2577-2586. [PMID: 38353700 DOI: 10.1039/d3fo05351b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Given that roasted peanut (Ro) products are commonly used in daily life, peanut allergenicity is a foremost concern. Analyzing the changes in the structure and potential allergenicity of individual allergens can promote the exploration of the structural basis of the alterations in the potential allergenicity of Ro. This work focused on four major allergens in raw peanut (Ra) and Ro. Structural changes were analyzed on the basis of circular dichroism, ultraviolet and fluorescence spectroscopy, and molecular dynamic simulation. The IgE recognition capability of allergens was assessed via western blot analysis. The IgE binding capacity of allergens was detected by conducting enzyme-linked immunosorbent assay. The potential allergenicity of allergens was evaluated using the KU812 cell degranulation model. The results showed that roasting induced different changes in the overall structures of allergens and altered the structures and electrostatic potential of IgE epitopes, especially Ara h 1 and Ara h 6. These alterations affected the potential allergenicity of allergens. Ara h 1 and Ara h 6 in Ro showed significantly enhanced IgE binding capacities and abilities to elicit KU812 cell degranulation, while Ara h 2 and Ara h 3 did not change significantly. For total protein, the roasted peanut protein showed decreased abilities to elicit KU812 cell degranulation. The results indicated that different allergens in Ro showed different changes of structures and potential allergenicity and that the conformational structure plays a crucial role in potential allergenicity of allergens.
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Affiliation(s)
- Ying Zhang
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- College of Food Science and Technology, Nanchang University, Nanchang, 330031, China
| | - Qin Geng
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- College of Food Science and Technology, Nanchang University, Nanchang, 330031, China
| | - Min Song
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- College of Food Science and Technology, Nanchang University, Nanchang, 330031, China
| | - Xin Li
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- College of Food Science and Technology, Nanchang University, Nanchang, 330031, China
| | - Anshu Yang
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Ping Tong
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- College of Food Science and Technology, Nanchang University, Nanchang, 330031, China
| | - Zhihua Wu
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China.
- Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
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Santos AF, Worm M, Kurita S, Wong T, Contato D, Pirillo E, Esteban AE, Tassinari P, Perna F, Chinthrajah RS. Living with food allergies: the experiences of adult patients and caregivers. FRONTIERS IN ALLERGY 2023; 4:1272851. [PMID: 38026132 PMCID: PMC10658712 DOI: 10.3389/falgy.2023.1272851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Few studies have addressed how food allergy may impact differently on the daily lives of adults with food allergies and caregivers for food-allergic dependents. Objective To explore similarities and differences in life experiences and unmet needs between individuals caring for a child with food allergy and adults with food allergy world-wide. Methods Two multinational, virtual, interactive, moderated discussions of specific questions between respectively people with food allergies and caregivers for people with food allergies, with experienced clinicians participating. Results Sixteen individuals living with food allergies and nine caregivers took part in the two roundtables. Food avoidance and antihistamines were the most common treatments for food-allergic reactions in both groups. Caregivers reported greater burden of disease on affected individuals and families than did adult patients. Adult panelists considered autoinjectors easy to use but caregivers reported additional emotional stress thinking about autoinjector use. Caregivers described an ever-present fear of inattention and of overlooking a risk factor for a severe reaction, whereas adult panelists showed a determination not to let their food allergies interfere with living their lives. Both groups had safety-conscious attitudes to treatments, but adult patients emphasized convenience while caregivers prioritized reduced severity of reactions and eliminated fear. Both groups confirmed the need for improved, trusted sources of information, and for resources and training programs for any new therapies. Conclusion The interactive exchange provided insights into differences between adult patients and caregivers, notably in fear and confidence in daily life, severity of disease impact, and unmet needs for treatments.
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Affiliation(s)
- Alexandra F. Santos
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Children’s Allergy Service, Evelina London Children’s Hospital, London, United Kingdom
| | - Margitta Worm
- Division of Allergology and Dermatology, Charité, Berlin, Germany
| | - Shoko Kurita
- Japanese Mother’s Society for Allergy Care (JMSAC), Kanagawa, Japan
| | - Tania Wong
- Allergy & Anaphylaxis Australia, Castle Hill, NSW, Australia
| | | | | | - A. Esther Esteban
- Spanish Association for People with Food and Latex Allergy (AEPNAA), Madrid, Spain
| | | | | | - R. Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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Anagnostou A, Rodríguez Del Río P. Food Immunotherapy: Dissecting Current Guidelines and Navigating the Gray Zone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3040-3046. [PMID: 37391019 DOI: 10.1016/j.jaip.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
Food allergy is a common, chronic disease that is burdensome for patients and families, with multiple dietary and social limitations and a significant psychological impact stemming from the fear of accidental exposures and potentially severe, life-threatening reactions. Until recently, the only management option consisted of strict food avoidance. Food allergen immunotherapy (food AIT) has emerged as an alternative, active intervention to strict food avoidance, with a multitude of research studies supporting its efficacy and good safety profile. Food AIT results in a raise of allergenic threshold, which provides several benefits to food-allergic patients, including protection from accidental exposures, potentially decreased severity of allergic reactions on unintentional exposures, and improvement in quality of life. In the last few years, multiple independent reports have been published proposing strategies to implement food oral immunotherapy in U.S. clinics, although formal guidelines are currently lacking. Because food immunotherapy is gaining traction, popularity, and interest among both patients and health care providers, many physicians look for guidance on how to implement this intervention in their daily practice. In other parts of the world, use of this treatment has prompted the development of various guidelines from allergy societies. This rostrum discusses currently available guidelines on food AIT from different areas of the world, describes and comments on their similarities and differences, and highlights unmet needs in this area of therapy.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Pablo Rodríguez Del Río
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; IIS La Princesa, Madrid, Spain
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Skypala IJ, Reese I, Durban R, Hunter H, Podesta M, Chaddad MCC, Santos AF, Agache I. Food allergy-A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review. Pediatr Allergy Immunol 2023; 34:e14019. [PMID: 37747742 DOI: 10.1111/pai.14019] [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: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Following a diagnosis of IgE-mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross-contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels "may contain" statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy. Unnecessary exclusion of one or more foods that have not triggered allergic reactions, especially in individuals with allergic comorbidities, can result in severe IgE-mediated reactions on re-exposure. Given that food allergies may change over time, the diagnosis should be reviewed, to determine whether resolution is likely, or new-food triggers are reported. Regular assessment is vital, especially during childhood, to ensure reintroduction occurs at an appropriate time, thus enabling increased diversity of the diet and improvement in the quality of life. For some, an IgE-mediated food allergy may necessitate the life-long exclusion of foods, and for others, a food habitually eaten suddenly triggers an allergic reaction in adult life. People of all ages, ethnicities, and socioeconomic backgrounds deserve individual advice on the management of their food allergy to support a healthy diet and improve quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust, London, UK
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Imke Reese
- Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany
| | - Raquel Durban
- Carolina Asthma & Allergy Center, Charlotte, North Carolina, USA
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK
- Kings College, London, UK
| | | | | | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
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7
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Anagnostou A, Muraro A. Can we identify patients at risk of severe reactions to food? Expert Rev Clin Immunol 2023; 19:1427-1430. [PMID: 37753864 DOI: 10.1080/1744666x.2023.2265069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
- Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Antonella Muraro
- UOSD Department of Pediatric and Adult Food Allergies, University Hospital of Padua
- Center for the Study and Cure of Allergies and Food Intolerance of the Veneto Region, University Hospital of Padua
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Ciciulla D, Soriano VX, McWilliam V, Koplin JJ, Peters RL. Systematic Review of the Incidence and/or Prevalence of Eating Disorders in Individuals With Food Allergies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2196-2207.e13. [PMID: 37088367 DOI: 10.1016/j.jaip.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Chronic diseases involving strict dietary adherence have been associated with an increased risk of eating disorders (EDs). This is the first systematic review investigating the rate of EDs among individuals with food allergies (FAs). OBJECTIVE To report the incidence, prevalence, and types of EDs in individuals with FAs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases for studies published to January 2022 that reported the prevalence or incidence of EDs in samples with immunoglobulin E (IgE) or non-IgE-mediated allergy. Risk of bias was assessed and evidence qualitatively synthesized. RESULTS From 1,180 papers identified, 9 met inclusion criteria. There were 4,161 adult and pediatric participants with IgE-mediated FAs or eosinophilic esophagitis. Avoidant/Restrictive Food Intake Disorder (ARFID) or anorexia nervosa/bulimia nervosa were the main EDs identified. The prevalence of EDs in samples with FA ranged from 0.8% to 62.9%. Among studies investigating IgE-mediated FA (n = 6), the prevalence of anorexia nervosa and/or bulimia nervosa ranged from 17.6 to 61%, ARFID was 62.9%, and unspecified EDs was 0.8% to 6%. Among samples with eosinophilic esophagitis (n = 3), ARFID prevalence ranged from 4.5% to 51%. Most studies were limited by small sample size, possible selection bias, and lack of diagnostic EDs tools validated for food allergic populations. CONCLUSIONS Eating disorders appear prevalent in individuals with FA; however, prevalence estimates varied widely. Large studies with healthy control groups and validated measures to identify EDs in individuals with FA are needed to accurately determine the prevalence of EDs.
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Affiliation(s)
- Daniela Ciciulla
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Victoria X Soriano
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki McWilliam
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, St. Lucia, Queensland, Australia
| | - Rachel L Peters
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Aljameel GM, AlSedairy SA, Binobead MA, Alhussain MH, Bin Obaid MA, Al-Harbi LN, Alshammari GM, Arzoo S. Awareness of Food Allergies and Allergens on the Menus of Restaurants and Cafes among Saudi Female University Students. Healthcare (Basel) 2023; 11:healthcare11091259. [PMID: 37174801 PMCID: PMC10178210 DOI: 10.3390/healthcare11091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Exposure to allergens could be life-threatening for people with food allergies. Restaurants and cafes are challenging environments for accommodating food allergies. This study aimed to measure King Saud University female students' awareness about food allergens on restaurants' and cafes' menus. This cross-sectional study was conducted on 379 students aged 18 years and above. A paper-based questionnaire was used, which comprised 16 questions related to the definition of food allergies, food allergens, and food allergy symptoms; the definition and prevention of cross-contact of food allergies; emergency treatment procedures for food allergies; strategies for the prevention of food allergy reactions; customer expectations towards restaurants; and preventive measures taken for food allergies. The results indicate that the overall average score of food allergen awareness was 10.90, which falls in the higher range. Furthermore, female students in the age groups of 23 to 27 years and 33 to 37 years had higher levels of awareness than female students in the age group of 18 to 22 years. The results also showed that the level of awareness among science college and health college students was statistically significantly higher (p < 0.05) than that among humanities college students. Post-graduate students also showed a higher level of awareness of food allergens than bachelor's students. These findings also indicate that listing all allergens in the restaurants and cafes' menus statistically significantly (p < 0.05) increased the level of awareness of female students about food allergens on restaurants' and cafes' menus, compared to restaurants and cafes that do not list all allergens on their menus. In general, female students at King Saud University showed a high level of awareness about food allergies on restaurants' and cafes' menus. The study recommends assessing the impact of awareness of female students with and without food allergies on their practices and behaviors.
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Affiliation(s)
- Ghzail M Aljameel
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sahar Abdulaziz AlSedairy
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Manal Abdulaziz Binobead
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Maha H Alhussain
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Manar Abdulaziz Bin Obaid
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Laila Naif Al-Harbi
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ghedeir M Alshammari
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Shaista Arzoo
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Post hoc analysis examining symptom severity reduction and symptom absence during food challenges in individuals who underwent oral immunotherapy for peanut allergy: results from three trials. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:21. [PMID: 36915184 PMCID: PMC10009988 DOI: 10.1186/s13223-023-00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Peanut allergy and its current management, involving peanut avoidance and use of rescue medication during instances of accidental exposure, are burdensome to patients and their caregivers and can be a source of stress, uncertainty, and restriction. Physicians may also be frustrated with a lack of effective and safe treatments other than avoidance in the current management of peanut allergy. Efficacy, determined using double-blind, placebo-controlled food challenges (DBPCFCs), of oral immunotherapy with peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Palforzia®) was demonstrated versus placebo in children and adolescents aged 4 to 17 years in multiple phase 3 trials; continued benefit of PTAH was shown in a follow-on trial. The DBPCFC is a reproducible, rigorous, and clinically meaningful assessment accepted by regulatory authorities to evaluate the level of tolerance as an endpoint for accidental exposures to peanut in real life. It also provides useful clinical and patient-relevant information, including the amount of peanut protein an individual with peanut allergy can consume without experiencing dose-limiting symptoms, severity of symptoms, and organs affected upon ingestion of peanut protein. We explored symptoms of peanut exposure during DBPCFCs from phase 3 and follow-on trials of PTAH to further characterize treatment efficacy from a perspective relevant to patients, caregivers, and clinicians. METHODS Symptom data recorded during screening and/or exit DBPCFCs from participants aged 4 to 17 years receiving PTAH or placebo were examined post hoc across three PTAH trials (PALISADE [ARC003], ARC004 [PALISADE follow-on], and ARTEMIS [ARC010]). The maximum peanut protein administered as a single dose during DBPCFCs was 1000 mg (PALISADE and ARTEMIS) and 2000 mg (ARC004). Symptoms were classified by system organ class (SOC) and maximum severity. Endpoints were changes in symptom severity and freedom from symptoms (ie, asymptomatic) during DBPCFC. Relative risk (RR) was calculated for symptom severity by SOC and freedom from symptoms between groups; descriptive statistics were used to summarize all other data. RESULTS The risk of any respiratory (RR 0.42 [0.30-0.60], P < 0.0001), gastrointestinal (RR 0.34 [0.26-0.44], P < 0.0001), cardiovascular/neurological (RR 0.17 [0.08-0.39], P < 0.001), or dermatological (RR 0.33 [0.22-0.50], P < 0.0001) symptoms was significantly lower in participants treated with PTAH versus placebo upon exposure to peanut at the end of the PALISADE trial (ie, exit DBPCFC). Compared with placebo-treated participants (23.4%), the majority (76.3%) of PTAH-treated participants had no symptoms at the exit DBPCFC when tested at the peanut protein dose not tolerated (ie, reactive dose) during the screening DBPCFC. Significantly higher proportions of PTAH-treated participants were asymptomatic at doses ≤ 100 mg in the exit DBPCFC compared with placebo-treated participants (PALISADE: 69.35% vs 12.10%, RR 5.73 [95% confidence interval (CI) 3.55-9.26]; P < 0.0001; ARTEMIS: 67.42% vs 13.95%, RR 4.83 [95% CI 2.28-10.25]; P < 0.0001); findings were similar at peanut protein doses ≤ 1000 mg (PALISADE: RR 15.56 [95% CI 5.05-47.94]; P < 0.0001; ARTEMIS: RR 34.74 [95% CI 2.19-551.03]; P < 0.0001). In ARC004, as the period of PTAH maintenance became longer, greater proportions of participants were asymptomatic at doses of peanut protein ≤ 1000 mg in the exit DBPCFC (from 37.63% after ~ 6 months of maintenance treatment [exit DBPCFC of PALISADE] to 45.54% after ~ 13 months and 58.06% after ~ 20 months of overall PTAH maintenance treatment). CONCLUSIONS PTAH significantly reduced symptom severity due to exposure to peanut, which is clinically relevant. When exposed to peanut, participants with peanut allergy treated with PTAH rarely had moderate or severe respiratory or cardiovascular/neurological symptoms. Oral immunotherapy with PTAH appears to reduce frequency and severity of allergic reactions in individuals with peanut allergy after accidental exposure to peanut and may enable them and their families to have an improved quality of life. Trial registration ClinicalTrials.gov, NCT02635776, registered 17 December 2015, https://clinicaltrials.gov/ct2/show/NCT02635776?term=AR101&draw=2&rank=7 ; ClinicalTrials.gov, NCT02993107, registered 08 December 2016, https://clinicaltrials.gov/ct2/show/NCT02993107?term=AR101&draw=2&rank=6 ; ClinicalTrials.gov, NCT03201003, registered 22 June 2017, https://clinicaltrials.gov/ct2/show/NCT03201003 ? term = AR101&draw = 2&rank = 9.
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11
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Galvin AD, Vereda A, del Río PR, Muraro A, Jones C, Ryan R, Norval D, Jobrack J, Anagnostou A, Wang J. Children and caregiver proxy quality of life from peanut oral immunotherapy trials. Clin Transl Allergy 2022; 12:e12213. [PMID: 36573312 PMCID: PMC9762119 DOI: 10.1002/clt2.12213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is significantly and substantially reduced in individuals with peanut allergy due to many factors associated with unanticipated or potentially fatal reactions. Further insight on the impact of peanut oral immunotherapy in managing peanut allergy on HRQoL is needed. The aim of this analysis was to assess effects of peanut (Arachis hypogaea) allergen powder-dnfp (PTAH), a biologic drug for peanut oral immunotherapy, on HRQoL from three phase 3 and two follow-on trials of PTAH. METHODS HRQoL assessments from participants aged 4-17 in the PALISADE (ARC003), ARC004 (PALISADE follow-on), ARTEMIS (ARC010), RAMSES (ARC007), and ARC011 (RAMSES follow-on) trials were included in this analysis. Responses on the Food Allergy Quality of Life Questionnaire (FAQLQ) and Food Allergy Independent Measure (FAIM) were evaluated by age group and respondent (self or caregiver proxy). Data were analyzed with descriptive statistics and Student t tests. RESULTS Baseline FAQLQ and FAIM total scores appeared comparable between PTAH- and placebo-treated participants. Self and caregiver proxy-reported total scores on the FAQLQ for PTAH-treated participants generally improved at trial exit versus baseline; FAIM total scores improved throughout all trials. The tendency for improvement in FAQLQ total scores from baseline for PTAH appeared larger in self versus caregiver proxy-reports. Between treatment groups, PTAH was generally favored in the PALISADE and ARTEMIS trials; differences varied in the RAMSES trial based on age and respondent types. CONCLUSIONS PTAH for the management of peanut allergy in children appeared to have a beneficial effect on HRQoL in trials. Improvements were seen despite rigors of trial participation.
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Affiliation(s)
| | - Andrea Vereda
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | | | | | | | - Robert Ryan
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | - David Norval
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | | | | | - Julie Wang
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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12
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Rahman S, Elliott SA, Scott SD, Hartling L. Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs. PEC INNOVATION 2022; 1:100018. [PMID: 37213745 PMCID: PMC10194313 DOI: 10.1016/j.pecinn.2022.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore parents' self-reported experiences and information needs regarding recognition and management of pediatric anaphylaxis. Methods We searched Ovid Medline, Ovid PsychInfo, CINAHL Plus, the Cochrane Library, and grey literature to identify primary studies in English or French published since 2000. We used a mixed-method appraisal tool and convergent integrated approach to assess quality and synthesize data, respectively. Results 43 studies were included (22 quantitative, 19 qualitative, and 2 mixed-method); 77% of studies had high methodological quality. Parents' experiences were categorized as: recognizing an anaphylactic reaction; managing and responding to a reaction; emotional impact of caring for a child at risk of anaphylaxis; and interaction with the health system and healthcare providers. Parents' information needs were categorized into themes relating to: gaps in knowledge and information; type of information desired; information sources; and information delivery format. Conclusion Negative emotional experiences and a general lack of information were commonly reported by parents of included studies. Provision of relevant and comprehensible information may help parents to make informed decisions and manage reactions promptly. Innovation The findings of this review are guiding the development of an innovative knowledge translation tool (KT) as part of a larger initiative of developing a suite of parent-focused KT tools for acute childhood conditions.
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Affiliation(s)
- Sholeh Rahman
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Shannon D. Scott
- Translating Evidence in Child Health to Enhance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
- Correspondence to: L. Hartling, 4-472 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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13
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Tursi AR, Saba NK, Dunham D, Manohar M, Peters RL, Saffery R, Koplin JJ, Nadeau KC, Neeland MR, Andorf S. Mass cytometry analysis of blood from peanut-sensitized tolerant and clinically allergic infants. Sci Data 2022; 9:738. [PMID: 36456584 PMCID: PMC9715645 DOI: 10.1038/s41597-022-01861-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
IgE-mediated food allergies in infants are a significant health concern, with peanut allergy being of particular interest due to its prevalence and severity. Among individuals who produce peanut-specific IgE some experience no adverse reaction on peanut consumption. This asymptomatic phenotype is known as sensitized tolerance. To elucidate the immune environment of peanut sensitized tolerant and clinically allergic one-year-olds, high-dimensional mass cytometry was conducted as part of the HealthNuts study. The resulting data includes peripheral blood mononuclear cells from 36 participants encompassing non-allergic, peanut sensitized with tolerance, and clinically peanut allergic infants. The raw mass cytometry data is described here and freely available for reuse through the Immunology Database and Analysis Portal (ImmPort). Additional allergy information and serum vitamin D levels of the participants were measured and are also included in the data upload. These high-dimensional mass cytometry data, when combined with clinical information, offer a broad immune profile of peanut allergic and sensitized tolerant infants.
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Affiliation(s)
- Amanda R. Tursi
- grid.239573.90000 0000 9025 8099Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Nicholas K. Saba
- grid.239573.90000 0000 9025 8099Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Diane Dunham
- grid.168010.e0000000419368956Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA USA
| | - Monali Manohar
- grid.168010.e0000000419368956Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA USA
| | - Rachel L. Peters
- grid.416107.50000 0004 0614 0346Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Richard Saffery
- grid.416107.50000 0004 0614 0346Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Jennifer J. Koplin
- grid.416107.50000 0004 0614 0346Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Kari C. Nadeau
- grid.168010.e0000000419368956Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA USA
| | - Melanie R. Neeland
- grid.416107.50000 0004 0614 0346Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Sandra Andorf
- grid.239573.90000 0000 9025 8099Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.239573.90000 0000 9025 8099Divisions of Allergy and Immunology and of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
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14
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Long Non-Coding RNAs Expressed in the Peanut Allergy for Understanding the Pathophysiology of Peanut Allergy Rat Model. Foods 2022; 11:foods11233760. [PMID: 36496569 PMCID: PMC9740276 DOI: 10.3390/foods11233760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Peanut allergy (PA) has become a clinical and public health problem, which is mainly regulated by genetics, immune responses, and environmental factors. Diagnosis and treatment for PA have always remained huge challenges due to its multiple triggers. Studies have shown that long non-coding RNAs (lncRNAs) play a critical role in the development of allergic diseases. METHOD AND RESULTS In the current study, we examined the plasma lncRNA expression profiles of peanut allergy Brown Norway rats and healthy controls and 496 differently expressed lncRNAs were identified, including 411 up-regulated genes and 85 down-regulated genes. We screened 8 lncRNAs based on the candidate principle and the candidates were verified in individual samples by quantitative real-time PCR. Then, the four lncRNA-based diagnostic model was established by least absolute shrinkage and selection operator (LASSO) and logistic regression, which was proved by area under the receiver operating characteristic curve (AUC). CONCLUSIONS In summary, we assessed the correlation between lncRNA expression levels and the diagnosis of peanut allergy, which may perform a vital role in guiding the management of peanut allergy.
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Abedini A, Alizadeh AM, Mahdavi A, Golzan SA, Salimi M, Tajdar-Oranj B, Hosseini H. Oilseed Cakes in the Food Industry; A Review on Applications,
Challenges, and Future Perspectives. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401317666211209150147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
By-products from the food sector now have a wide range of applications. Low-cost raw
materials, followed by low-cost goods, are regarded as one of the sectors’ top goals. Because of its
economic relevance, reduced price, and nutrients such as protein, fiber, carbs, and antioxidants,
oilseed cakes (OCs) have found a desirable place in livestock and poultry feed. Furthermore, because
the cake has the same desirable nutrients, its usage in the food business is unavoidable.
However, its use in this sector is not simply for nutritious purposes and has it has different impacts
on flavor, texture, color, and antioxidant qualities. Therefore, as a result of its desirable qualities,
the cake can be more useful in extensive applications in the food business, as well as in the manufacture
of supplements and novel foods. The current review looks at the reapplications of byproducts
obtained from oilseeds (soybean, sunflower, sesame, canola, palm kernel, peanut, mustard,
and almond) in the food sector in the future. Furthermore, allergenicity, toxicity, antinutritional
compounds, and techniques of extracting cakes from oilseeds have been discussed.
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Affiliation(s)
- Amirhossein Abedini
- Student Research Committee, Department of Food Science and Technology, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
| | - Adel Mirza Alizadeh
- Department of Food Safety and Hygiene, School of Public Health, Zanjan University of Medical Sciences,
Zanjan, Iran
| | - Aida Mahdavi
- Department of Food Science and Technology, Takestan Branch, Islamic Azad University, Qazvin,
Iran
| | - S. Amirhossein Golzan
- Student Research Committee, Department of Food Science and Technology, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
| | - Mahla Salimi
- Student Research Committee, Department of Food Science and Technology, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
| | - Behrouz Tajdar-Oranj
- Food and Drug Administration, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Hedayat Hosseini
- Department of
Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science
and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, 19395-4741, Iran
- Food
Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Fernández‐Rivas M, Gómez García I, Gonzalo‐Fernández A, Fuentes Ferrer M, Dölle‐Bierke S, Marco‐Martín G, Ballmer‐Weber BK, Asero R, Belohlavkova S, Beyer K, de Blay F, Clausen M, Datema MR, Dubakiene R, Grimshaw KEC, Hoffmann‐Sommergruber K, Hourihane JO, Jedrzejczak‐Czechowicz M, Knulst AC, Kralimarkova T, Le T, Papadopoulos NG, Popov TA, Poulsen LK, Purohit A, Seneviratne SL, Simpson A, Sinaniotis A, Turkalji M, Vázquez‐Cortés S, Vera‐Berrios RN, Muraro A, Worm M, Roberts G, van Ree R, Fernández‐Pérez C, Turner PJ, Mills ENC. Development and validation of the food allergy severity score. Allergy 2022; 77:1545-1558. [PMID: 34716996 PMCID: PMC9298738 DOI: 10.1111/all.15165] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/10/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND The heterogeneity and lack of validation of existing severity scores for food allergic reactions limit standardization of case management and research advances. We aimed to develop and validate a severity score for food allergic reactions. METHODS Following a multidisciplinary experts consensus, it was decided to develop a food allergy severity score (FASS) with ordinal (oFASS) and numerical (nFASS) formats. oFASS with 3 and 5 grades were generated through expert consensus, and nFASS by mathematical modeling. Evaluation was performed in the EuroPrevall outpatient clinic cohort (8232 food reactions) by logistic regression with request of emergency care and medications used as outcomes. Discrimination, classification, and calibration were calculated. Bootstrapping internal validation was followed by external validation (logistic regression) in 5 cohorts (3622 food reactions). Correlation of nFASS with the severity classification done by expert allergy clinicians by Best-Worst Scaling of 32 food reactions was calculated. RESULTS oFASS and nFASS map consistently, with nFASS having greater granularity. With the outcomes emergency care, adrenaline and critical medical treatment, oFASS and nFASS had a good discrimination (receiver operating characteristic area under the curve [ROC-AUC]>0.80), classification (sensitivity 0.87-0.92, specificity 0.73-0.78), and calibration. Bootstrapping over ROC-AUC showed negligible biases (1.0 × 10-6 -1.23 × 10-3 ). In external validation, nFASS performed best with higher ROC-AUC. nFASS was strongly correlated (R 0.89) to best-worst scoring of 334 expert clinicians. CONCLUSION FASS is a validated and reliable method to measure severity of food allergic reactions. The ordinal and numerical versions that map onto each other are suitable for use by different stakeholders in different settings.
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Affiliation(s)
- Montserrat Fernández‐Rivas
- Allergy DepartmentHospital Clínico San CarlosFacultad de MedicinaUniversidad Complutense (UCM)IdISSC, ARADyALMadridSpain
| | | | | | - Manuel Fuentes Ferrer
- Unidad de Apoyo a la InvestigaciónPreventive Medicine DepartmentHospital Clínico San CarlosIdISSCUniversidad Alfonso X El SabioMadridSpain
| | - Sabine Dölle‐Bierke
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | | | - Barbara K. Ballmer‐Weber
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland,Clinic for Dermatology and AllergologyKantonsspital St GallenSt GallenSwitzerland
| | - Riccardo Asero
- Ambulatorio di AllergologiaClinica San CarloPaderno Dugnano, MilanItaly
| | | | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Frédéric de Blay
- Chest Diseases DepartmentStrasbourg University HospitalFederation of Translational MedicineUniversity of StrasbourgStrasbourgFrance
| | - Michael Clausen
- Children's Hospital and Department of AllergyLandspitali University HospitalReykjavikIceland
| | - Mareen R. Datema
- Department of Experimental Immunology, and Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam University Medical CenterAmsterdamThe Netherlands
| | | | - Kate E. C. Grimshaw
- Department of DieteticsSalford Royal NHS Foundation TrustSalfordUK,Clinical and Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | - Jonathan O’B Hourihane
- Royal College of Surgeons in IrelandChildren's Health Ireland at Temple StreetDublinIreland
| | | | - André C. Knulst
- Dept. Dermatology/AllergologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Thuy‐My Le
- Dept. Dermatology/AllergologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Nikolaos G. Papadopoulos
- Allergy Dpt, 2nd Pediatric clinicUniversity of AthensAthensGreece,Division of InfectionImmunity & Respiratory MedicineUniversity of ManchesterManchesterUK
| | | | - Lars K. Poulsen
- Allergy ClinicCopenhagen University Hospital at Herlev‐GentofteCopenhagenDenmark
| | - Ashok Purohit
- Allergy DivisionChest Disease DepartmentUniversity Hospital of StrasbourgStrasbourgFrance
| | - Suranjith L. Seneviratne
- Department of Clinical Immunology and AllergyCentral Manchester and Manchester Children's University Hospitals NHS TrustManchesterUK,Institute of Immunity and TransplantationRoyal Free Hospital and University College LondonLondonUK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory MedicineSchool of Biological SciencesManchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, and Manchester University NHS Foundation TrustThe University of ManchesterManchesterUK
| | - Atanasios Sinaniotis
- Allergy Department2nd Pediatric ClinicUniversity of AthensAthensGreece,Allergy DepartmentSotiria Chest Diseases HospitalAthensGreece
| | - Mirjana Turkalji
- Srebrnjak Children's Hospital ZagrebCatholic University of Croatia Zagreb, and Medical Faculty OsijekJ.J.Strossmayer UniversityOsijekCroatia
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Veneto RegionDepartment of Women and Child HealthPadua General University HospitalPaduaItaly
| | - Margitta Worm
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Graham Roberts
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK,Clinical and Experimental Sciences and Human Development in HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK,The David Hide Asthma and Allergy Research CentreSt Mary's HospitalIsle of WightUK
| | - Ronald van Ree
- Departments of Experimental Immunology and of OtorhinoraryngologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Cristina Fernández‐Pérez
- Preventive Medicine DepartmentHospital Clínico San CarlosIdISSCMadridSpain,Preventive Medicine DepartmentComplejo Hospitalario Universitario Santiago de CompostelaSantiago de CompostelaSpain
| | - Paul J. Turner
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Elizabeth N. Clare Mills
- Division of Infection, Immunity and Respiratory MedicineManchester Academic Health Sciences CentreManchester Institute of BiotechnologyUniversity of ManchesterManchesterUK
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Lang A, Kaur O, Devonshire A, Kaat AJ, Kumar R. Learning Early About Peanut worries: Evaluation of parental PROMIS-29 anxiety scores during early peanut introduction clinics. Ann Allergy Asthma Immunol 2022; 128:472-473. [PMID: 35124222 PMCID: PMC8977240 DOI: 10.1016/j.anai.2022.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Abigail Lang
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Opinderjit Kaur
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ashley Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajesh Kumar
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tsoumani M, Regent L, Warner A, Gallop K, Patel R, Ryan R, Vereda A, Acaster S, DunnGalvin A, Byrne A. Allergy to Peanuts imPacting Emotions And Life (APPEAL): The impact of peanut allergy on children, teenagers, adults and caregivers in the UK and Ireland. PLoS One 2022; 17:e0262851. [PMID: 35130296 PMCID: PMC8820639 DOI: 10.1371/journal.pone.0262851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
The Allergy to Peanuts imPacting Emotions And Life study (APPEAL) explored the psychosocial burden of living with self-reported peanut allergy experienced by children, teenagers, adults and caregivers in the UK and Ireland. A two-stage (quantitative survey and qualitative interview [APPEAL-1]), cross-sectional study of the psychosocial burden of peanut allergy (APPEAL-2) was conducted. Quantitative data were evaluated using descriptive statistics and qualitative data were analysed using MAXQDA software. A conceptual model specific to UK and Ireland was developed using the concepts identified during the analysis. A total of 284 adults in the UK and Ireland completed the APPEAL-1 survey and 42 individuals participated in APPEAL-2. Respondents reported that peanut allergy restricts their choices in various situations, especially with regard to choosing food when eating out (87% moderately or severely restricted), choosing where to eat (82%), special occasions (76%) and when buying food from a shop (71%). Fifty-two percent of survey participants and 40% of interview participants reported being bullied because of PA. Psychological impact of peanut allergy included feeling at least moderate levels of frustration (70%), uncertainty (79%), and stress (71%). The qualitative analysis identified three different types of coping strategies (daily monitoring or vigilance, communication and planning) and four main areas of individuals’ lives that are impacted by peanut allergy (social activities, relationships, emotions and work [adults and caregivers only]). The extent of the impact reported varied substantially between participants, with some reporting many negative consequences of living with peanut allergy and others feeling it has minimal impact on their health-related quality of life. This large survey and interview study highlight the psychosocial burden of peanut allergy for adults, teenagers, children and caregivers in the UK and Ireland. The analysis demonstrates the wide variation in level of impact of peanut allergy and the unmet need for those individuals who experience a substantial burden from living with peanut allergy.
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Affiliation(s)
- Marina Tsoumani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Lynne Regent
- Anaphylaxis Campaign, Farnborough, United Kingdom
| | | | - Katy Gallop
- Acaster Lloyd Consulting, London, United Kingdom
| | - Ram Patel
- Brainsell Ltd., London, United Kingdom
| | - Robert Ryan
- Aimmune Therapeutics, A Nestlé Health Science Company, London, United Kingdom
| | - Andrea Vereda
- Aimmune Therapeutics, A Nestlé Health Science Company, London, United Kingdom
| | | | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- * E-mail:
| | - Aideen Byrne
- Allergy Dept, Children’s Health Ireland and Paediatrics and Child Health Trinity College Dublin, Dublin, Ireland
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19
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Gallop K, Acaster S, de Vries J, Browne R, Ryan R, Baker S, Du Toit G. Exploring Health-Related Quality of Life Burden in Peanut Allergy and the Potential Benefit of Oral Immunotherapy: Estimation of Health State Utility Values for Children and Adolescents and Their Caregivers. Patient Prefer Adherence 2022; 16:1269-1278. [PMID: 35619589 PMCID: PMC9129262 DOI: 10.2147/ppa.s357864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to estimate utility values for health states relating to oral immunotherapy (OIT) for peanut allergy (PA), for children with PA and their caregivers. PATIENTS AND METHODS Two methods were used: an online survey and structured interviews. Both methods assessed current utility/untreated PA (health-related quality of life, HRQoL) and HRQoL in different health states: "up-dosing phase of treatment", "maintenance phase" and "able to tolerate 6-8 peanuts if accidentally ingested". The survey was conducted in individuals with and without experience of OIT; data collected included the EQ-5D-Y (child states) and EQ-5D-5L (caregiver states). RESULTS In total, 100 caregivers and 38 adolescents completed the treatment-naïve survey, a separate sample of 50 caregivers participated in structured interviews. Seven caregivers and two adolescents with experience of OIT for PA completed the survey. Data from the three samples were pooled, the mean utility values were untreated PA: 0.796 (child), 0.855 (caregiver); up-dosing: 0.711 (child), 0.806 (caregiver); maintenance: 0.821 (child), 0.849 (caregiver), tolerate 6-8 peanuts: 0.859 (child), 0.884 (caregiver). The results show a gain in utility of 0.063 for children and 0.029 for caregivers between the untreated and tolerate 6-8 peanuts health states. CONCLUSION This study is the first to assess utilities relating to OIT for PA. The results show the potential benefit of OIT for individuals with PA and their caregivers and provide values for use in cost-effectiveness evaluation.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, UK
- Correspondence: Katy Gallop, Acaster Lloyd Consulting, 84 Theobalds Road, London, WC1X 8NL, UK, Tel +44 203 9781686, Email
| | | | | | | | - Robert Ryan
- Aimmune Therapeutics, London, UK
- Robert Ryan, Aimmune Therapeutics, 10 Eastbourne Terrace, London, W2 6LG, UK, Email
| | | | - George Du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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20
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Akarsu A, Brindisi G, Fiocchi A, Zicari AM, Arasi S. Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective. Front Pediatr 2022; 10:842196. [PMID: 35273931 PMCID: PMC8901728 DOI: 10.3389/fped.2022.842196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.
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Affiliation(s)
- Aysegul Akarsu
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Giulia Brindisi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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21
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White Paper Erdnussallergie - Teil 3: Ernährungstherapie bei Erdnussallergie. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Blum LA, Ahrens B, Klimek L, Beyer K, Gerstlauer M, Hamelmann E, Lange L, Nemat K, Vogelberg C, Blümchen K. White Paper Erdnussallergie - Teil 2: Diagnostik der Erdnussallergie unter besonderer Berücksichtigung der molekularen Komponentendiagnostik. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Mori F, Giovannini M, Barni S, Jiménez-Saiz R, Munblit D, Biagioni B, Liccioli G, Sarti L, Liotti L, Ricci S, Novembre E, Sahiner U, Baldo E, Caimmi D. Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate. Front Immunol 2021; 12:636612. [PMID: 34650547 PMCID: PMC8507468 DOI: 10.3389/fimmu.2021.636612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Rodrigo Jiménez-Saiz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain.,Department of Immunology & Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain.,Faculty of Experimental Sciences, Universidad Francisco de Vitoria (UFV), Madrid, Spain.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Benedetta Biagioni
- Allergy Outpatient Clinic, Division of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy
| | - Giulia Liccioli
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti Ancona, Ancona, Italy
| | - Silvia Ricci
- Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Umit Sahiner
- Department of Pediatric Allergy, Hacettepe University, Ankara, Turkey
| | - Ermanno Baldo
- "Giovan Battista Mattei" Research Institute, Stenico, Italy
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Univ Montpellier, Montpellier, France.,IDESP, UA11, INSERM-Univ Montpellier, Montpellier, France
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24
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Childs CE, Munblit D, Ulfman L, Gómez-Gallego C, Lehtoranta L, Recker T, Salminen S, Tiemessen M, Collado MC. Potential Biomarkers, Risk Factors and their Associations with IgE-mediated Food Allergy in Early Life: A Narrative Review. Adv Nutr 2021; 13:S2161-8313(22)00081-3. [PMID: 34596662 PMCID: PMC8970818 DOI: 10.1093/advances/nmab122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Food allergy affects the quality of life of millions of people worldwide and presents a significant psychological and financial burden for both national and international public health. In the past few decades, the prevalence of allergic disease has been on the rise worldwide. Identified risk factors for food allergy include family history, mode of delivery, variations in infant feeding practices, prior diagnosis of other atopic diseases such as eczema, and social economic status. Identifying reliable biomarkers which predict the risk of developing food allergy in early life would be valuable in both preventing morbidity and mortality and by making current interventions available at the earliest opportunity. There is also the potential to identify new therapeutic targets. This narrative review provides details on the genetic, epigenetic, dietary and microbiome influences upon the development of food allergy and synthesizes the currently available data indicating potential biomarkers. While there is a large body of research evidence available within each field of potential risk factors, there are very limited number of studies which span multiple methodological fields, for example including immunology, microbiome, genetic/epigenetic factors and dietary assessment. We recommend that further collaborative research with detailed cohort phenotyping is required to identify biomarkers, and whether these vary between at-risk populations and the wider population. The low incidence of oral food challenge confirmed food allergy in the general population, and the complexities of designing nutritional intervention studies will provide challenges for researchers to address in generating high quality, reliable and reproducible research findings. STATEMENT OF SIGNIFICANCE Food allergy affects the quality of life of millions of people worldwide and presents a significant psychological and financial burden for both national and international public health. Identifying reliable biomarkers which predict the risk of developing food allergy would be valuable in both preventing morbidity and mortality and by making current interventions available at the earliest opportunity. This review provides details on the genetic, epigenetic, dietary and microbiome influences upon the development of food allergy. This helps in identifying reliable biomarkers to predict the risk of developing food allergy, which could be valuable in both preventing morbidity and mortality and by making interventions available at the earliest opportunity.
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Affiliation(s)
- Caroline E Childs
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel Munblit
- Imperial College London, London, United Kingdom,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Carlos Gómez-Gallego
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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25
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Lange L, Klimek L, Beyer K, Blümchen K, Novak N, Hamelmann E, Bauer A, Merk H, Rabe U, Jung K, Schlenter W, Ring J, Chaker A, Wehrmann W, Becker S, Mülleneisen N, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Zuberbier T, Spindler T, Vogelberg C. White paper on peanut allergy - part 1: Epidemiology, burden of disease, health economic aspects. ACTA ACUST UNITED AC 2021; 30:261-269. [PMID: 34603938 PMCID: PMC8477625 DOI: 10.1007/s40629-021-00189-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Peanuts are Leguminosae, commonly known as the legume or pea family, and peanut allergy is among the most common food allergies and the most common cause of fatal food reactions and anaphylaxis. The prevalence of peanut allergy increased 3.5-fold over the past two decades reaching 1.4–2% in Europe and the United States. The reasons for this increase in prevalence are likely multifaceted. Sensitization via the skin appears to be associated with the development of peanut allergy and atopic eczema in infancy is associated with a high risk of developing peanut allergy. Until recently, the only possible management strategy for peanut allergy was strict allergen avoidance and emergency treatment including adrenaline auto-injector in cases of accidental exposure and reaction. This paper discusses the various factors that impact the risks of peanut allergy and the burden of self-management on peanut-allergic children and their caregivers.
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Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, GFO Clinics Bonn, Bonn, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Kirsten Beyer
- Department of Pediatrics m.S. Pneumology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blümchen
- Center of Pediatric and Adolescent Medicine, Focus on Allergology, Pneumology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Bethel Children's Center, OWL University Hospital of Bielefeld University, Bielefeld, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Hans Merk
- Department of Dermatology & Allergology, RWTH Aachen, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Kirsten Jung
- Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
| | | | | | - Adam Chaker
- Department of Otolaryngology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Sven Becker
- Department of Otolaryngology, University of Tübingen, Tübingen, Germany
| | | | - Katja Nemat
- Pediatric Pneumology/Allergology Practice, Kinderzentrum Dresden (Kid), Dresden, Germany
| | - Wolfgang Czech
- Practice and clinic for allergology/dermatology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Holger Wrede
- Practice and clinic for allergology/ear, nose and throat specialist, Herford, Germany
| | - Randolf Brehler
- Clinic for Skin Diseases, Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Hospital, Georg-August-University, Göttingen, Germany
| | - Thilo Jakob
- rd Clinic for Dermatology and Allergology University Hospital Giessen, UKGM Justus Liebig University Giessen, Giessen, Germany
| | - Tobias Ankermann
- th Clinic for Pediatric and Adolescent Medicine, Pneumology, Allergology, Neonatology, Intensive Care Medicine, Infectiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian M Schmidt
- th Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, Greifswald University Medical Center, Greifswald, Germany
| | - Michael Gerstlauer
- pediatric pneumologist/pediatric allergologist, II. clinic for children and adolescents, University Hospital Augsburg, Augsburg, Germany
| | - Torsten Zuberbier
- Clinic for Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Spindler
- Department of Pediatrics and Adolescent Medicine, Pediatric Pneumology, Allergology, Sports Medicine, Hochgebirgsklinik Davos, Davos-Wolfgang, Switzerland
| | - Christian Vogelberg
- TU Dresden/UKDD, Pediatric Department, University Hospital Dresden, Dresden, Germany.,Department of Pediatric Pneumology/Allergology, Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Hospital Carl Gustav Carus, Fetscher Street 74, 01307 Dresden, Germany
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26
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Imai T, Hirano K, Ohzeki T. Association between allergic diseases and mental health among Japanese adolescents. Allergol Int 2021; 70:379-381. [PMID: 33676839 DOI: 10.1016/j.alit.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
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27
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Brough HA, Gourgey R, Radulovic S, Caubet JC, Lack G, Anagnostou A. Latest Developments in the Management of Nut Allergies. CURRENT TREATMENT OPTIONS IN ALLERGY 2021; 8:97-110. [PMID: 34150446 PMCID: PMC8203721 DOI: 10.1007/s40521-021-00290-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length and administration devices have been recently debated considering the risk of bone penetration vs subcutaneous administration, and autoinjectors seem to deliver higher peak concentrations than syringes. Selective nut introduction has gained momentum in the last 5 years, demonstrating improved quality of life but with the need for motivated parents for continued consumption and available resources for challenges. Immunotherapy to nuts is also a rapidly developing field, with the balance of efficacy and safety being important considerations in the differing modes of administration. Summary The management of nut allergies is a rapidly developing field, and dietary and medical management have progressed significantly in the last 5 years. Future research directions include improving safety and efficacy of food immunotherapy and examining patients’ goals for therapy and treatment outcomes.
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Affiliation(s)
- H A Brough
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - R Gourgey
- Department of Paediatric Allergy, The Royal London Children's Hospital, Barts Health NHS Trust, E1 1FR, London, UK
| | - S Radulovic
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - J C Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé, Geneva, Switzerland
| | - G Lack
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - A Anagnostou
- Section of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, TX USA.,Department of Pediatrics, Section of Allergy, Immunology and Retrovirology, Texas Children's Hospital, Houston, TX USA
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28
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Studie Allergy to Peanuts imPacting Emotions And Life (APPEAL). Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund
In Industrieländern sind bis zu 3 % aller Kinder von einer Erdnussallergie betroffen. Allergy to Peanuts imPacting Emotions And Life (APPEAL) ist die erste große Studie, die die Auswirkungen und Belastungen durch eine Erdnussallergie auf Betroffene und Angehörige untersucht.
Material und Methoden
Betroffene mit Erdnussallergie und deren Eltern/Betreuer nahmen entweder an einer Online-Umfrage teil (APPEAL‑1, n = 273) oder gaben detaillierte Interviews (APPEAL‑2, n = 32).
Ergebnisse
Von den Befragten der APPEAL-1-Studie (56 erwachsene Patienten mit Erdnussallergie und 217 Eltern/Betreuer von Personen mit Erdnussallergie) gaben 85 % an, dass die Erdnussallergie ihre täglichen Aktivitäten beeinflusst, 65 % fühlten sich deshalb isoliert. 91 % sorgten sich besonders bei gesellschaftlichen Anlässen vor einer potenziellen Erdnussexposition; 85 % verspürten Hindernisse beim Pflegen sozialer Kontakte. Die häufigsten psychologischen Auswirkungen der Erdnussallergie waren Frustration (89 %), Unsicherheit (86 %) und Stress (88 %). Ein Großteil der Befragten (84 %) beschrieb ein Gefühl der Andersartigkeit. Durch die Erdnussallergie kommt es häufig zu Beeinträchtigungen bei sozialen Aktivitäten, im schulischen Umfeld, im Beruf (bei Eltern und erwachsenen Betroffenen) sowie in Bezug auf emotionales Befinden und Beziehungen. Als wichtigste Bewältigungsstrategien nannten die Teilnehmer eine gute Überwachung von Nahrung und Hygiene, den Austausch mit anderen und eine akribische Planung von Aktivitäten.
Schlussfolgerungen
Dies ist die erste alltagsbezogene Umfrage in Deutschland, die die Auswirkungen und Belastungen einer Erdnussallergie bei betroffenen Kindern, Jugendlichen und deren Eltern/Betreuern sowie bei selbst betroffenen Erwachsenen aufzeigt.
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Sharma V, Jobrack J, Cerenzia W, Tilles S, Ryan R, Sih-Meynier R, Zeitler S, Manning M. A study to assess current approaches of allergists in European countries diagnosing and managing children and adolescents with peanut allergy. PLoS One 2020; 15:e0241648. [PMID: 33270629 PMCID: PMC7714149 DOI: 10.1371/journal.pone.0241648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Food allergy is documented to result in considerable morbidity, negative impact on quality of life, and substantial medical care costs. Although anecdotal data suggest widely varying practices in the diagnosis and management of food allergies, the diversity and relative frequency of these practices have not been documented. METHODS A questionnaire was developed evaluating allergists' management approaches of individuals with peanut allergy (PA) in Germany (DE), France (FR), and the United Kingdom (UK). RESULTS Here, we report the survey results from a total of 109 allergists from DE, FR and the UK. They reported to confirm PA at initial diagnosis using skin prick test (≥60%), while allergists from DE and FR reported using allergen-specific IgE testing more (>86%) compared to the UK (<50%). At initial diagnosis, oral food challenge was used less in DE (13%) and FR (14%) and very rarely in the UK (3%) to confirm diagnosis. Recognition of acute reactions, use of adrenaline auto-injectors and allergen avoidance were reported to be discussed with the patient/caregiver at the initial office visit by most allergists (>75%). Half of the responders reported assessing the patient's quality of life. 63% allergists reported retesting for PA resolution at a later date, with 45% allergists indicated to recommend ingestion of a normal serving of peanut regularly upon resolution. Lack of effective PA treatment was reported to be a 'very significant' barrier for optimal PA treatment, with allergists being less than 'moderately familiar' with data from clinical trials testing new treatments options for PA. Lastly, allergists stated that the severity of patient's PA ranked as the most important factor in their decision to recommend oral immunotherapy for PA treatment. CONCLUSIONS This survey provides essential insights into the practice of allergists and highlights some areas that would inform strategies for education and improving PA healthcare.
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Affiliation(s)
- Vibha Sharma
- Lydia Becker Institute of Immunology and Inflammation University of Manchester and Royal Manchester Children’s Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Stephen Tilles
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
- University of Washington, Seattle, WA, United States of America
| | - Robert Ryan
- Aimmune Therapeutics, London, United Kingdom
| | - Regina Sih-Meynier
- Medical Affairs, Aimmune Therapeutics, Brisbane, CA, United States of America
| | | | - Michael Manning
- Medical Research of Arizona, Scottsdale, AZ, United States of America
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Blumchen K, DunnGalvin A, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fisher HR, Fernández‐Rivas M. APPEAL-1: A pan-European survey of patient/caregiver perceptions of peanut allergy management. Allergy 2020; 75:2920-2935. [PMID: 32438514 DOI: 10.1111/all.14414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peanut allergy (PA) is associated with marked quality-of-life (QoL) impairment. However, data are lacking on the experience and impact of living with PA from the perspectives of persons with PA (PwPA) and their caregivers. Allergy to Peanuts imPacting Emotions And Life study 1 (APPEAL-1) was a pan-European survey investigating these perspectives. This first of two articles reports clinical characteristics of PwPA and PA management practices. METHODS APPEAL-1 was a quantitative, online survey conducted in eight European countries, developed by eight representatives of patient advocacy groups and five healthcare professionals and researchers. Eligible participants included adults with PA and parents/caregivers of PwPA who responded by self-report and provided proxy-report for the PwPA under their care. Data were summarized using nonweighted descriptive statistics. RESULTS Of 1846 completed/analysed questionnaires, 528 were from adults with PA (self-report); 437 by proxy for children with PA (34 aged 0-3 years, 287 aged 4-12 years, 116 aged 13-17 years) and 881 from parents/caregivers (self-report). Of PwPA (N = 965), 95% reported diagnosis by healthcare professionals, mostly by clinical history and peanut-specific allergy testing. Rates of allergic rhinitis, asthma and other food allergies in PwPA were 50%, 42% and 79%, respectively. Only 31% of PwPA received HCP advice/support following their worst allergic reaction, and 28% had not been prescribed an adrenaline auto-injector. Results were similar by country but varied by age group. CONCLUSIONS The APPEAL-1 findings contribute to greater understanding of PA impact on PwPA, caregivers and family members and the need for improved PA management across Europe.
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Affiliation(s)
- Katharina Blumchen
- Division of Allergology, Pneumology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund, (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSCARADyAL Madrid Spain
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DunnGalvin A, Blumchen K, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Couratier P, Feeney M, Hjorth B, Patel R, Lush T, Ryan R, Vereda A, Fernández‐Rivas M, Fisher HR. APPEAL-1: A multiple-country European survey assessing the psychosocial impact of peanut allergy. Allergy 2020; 75:2899-2908. [PMID: 32400915 PMCID: PMC7689848 DOI: 10.1111/all.14363] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
Background Peanut allergy (PA) is a common, potentially life‐threatening and typically lifelong condition with a significant burden of illness. However, information is lacking on how persons with PA (PwPA) and their caregivers perceive the psychosocial impact of living with PA. The Allergy to Peanuts imPacting Emotions And Life 1 (APPEAL‐1) survey, conducted across Europe, investigated the experience and impact of living with PA. Here, we report data evaluating the psychosocial impact of PA on PwPA and their caregivers. Methods Allergy to Peanuts imPacting Emotions And Life study 1 was an online survey conducted in eight European countries. Representatives of eight patient advocacy groups and five healthcare‐research specialists developed the survey. Eligible respondent groups included the following: adults diagnosed with PA (self‐report); parent/nonparent caregivers (proxy‐report for a child with PA); and parent/nonparent caregivers (self‐report of PA impact on themselves). Results Of 1846 total study respondents, 419 were adults with PA (self‐report); 546 were parents/caregivers (proxy‐report); and 881 were parents/caregivers (self‐report). Most respondents reported lifestyle restrictions regarding food (84%‐93%) and additional domains including parties and socializing, holiday activities and destinations, and taking public transport (53%‐89%). Approximately 40% rated themselves as “very” frustrated and “very” stressed. Two‐thirds (65%) felt socially isolated; 43% were bullied. Less than half felt confident in knowing when to use an adrenaline autoinjector. Several intercountry differences were observed such as high levels of uncertainty and stress in respondents from Ireland, highest rates of anxiety in respondents from Germany, and social exclusion and isolation most common in respondents from France. Conclusions Peanut allergy imposes an adverse psychosocial impact on patients and caregivers, leading to frustration, stress and isolation. Attention to the impact of PA is needed in research and clinical practice to improve PA healthcare and public education programmes.
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Affiliation(s)
- Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Katharina Blumchen
- Division of Pneumology, Allergology and Cystic Fibrosis Department of Children and Adolescent Medicine University Hospital Frankfurt Frankfurt am Main Germany
| | - Frans Timmermans
- Nederlands Anafylaxis Netwerk ‐ European Anaphylaxis Taskforce Dordrecht The Netherlands
| | | | - Sabine Schnadt
- Deutscher Allergie‐ und Asthmabund (DAAB) Mönchengladbach Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex (AEPNAA) Madrid Spain
| | - Pascale Couratier
- Association Française de Prévention des Allergies (AFPRAL) Paris France
| | - Mary Feeney
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | | | | | | | | | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de MadridIdISSC, ARADyAL Madrid Spain
| | - Helen R. Fisher
- Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy King's College London, and Guy's and St. Thomas' NHS Foundation Trust London UK
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Couratier P, Montagne R, Acaster S, Gallop K, Patel R, Vereda A, Pouessel G. Allergy to Peanuts imPacting Emotions And Life (APPEAL): the impact of peanut allergy on children, adolescents, adults and caregivers in France. Allergy Asthma Clin Immunol 2020; 16:86. [PMID: 33042203 PMCID: PMC7541331 DOI: 10.1186/s13223-020-00481-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022] Open
Abstract
Background Peanut allergy (PA) has increased in developed countries and can have a dramatic effect on quality of life but data surrounding this is limited in France. Allergy to Peanuts imPacting Emotions And Life study (APPEAL) investigated the experience and impact of living with PA in France. Methods Respondents affected by PA directly (children aged 8–12 years, teenagers aged 13–17 years, or adults aged ≥ 18 years) or indirectly (caregiver) completed either an online questionnaire (APPEAL-1, N = 198), or provided in-depth interviews (APPEAL-2, N = 32). Quantitative data was evaluated using descriptive statistics. Qualitative data was analysed thematically, using MAXQDA software. Results Of 198 responders in APPEAL-1, 88% stated that PA affects their daily activities, and 74% felt isolated as a result of living with PA. Feelings of worry about exposure to peanuts on social occasions where food is involved was reported by 91%. A total of 44% reported some restrictions in their job options, 85% in socializing. Psychological impact of PA included responders feeling emotions of frustration (89%), uncertainty (87%), and stress (93%) and 93% reporting encountering instances of feeling different due to their PA. Main factors that drove PA impact included social activities and relationships; whereas main coping strategies to avoid peanuts included monitoring, communication and planning. Conclusion The analysis of French respondents from the APPEAL study demonstrates the impact and burden of PA on allergic children, teenagers, adults and their caregivers, and highlights the unmet need to be addressed.
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Affiliation(s)
- Pascale Couratier
- Association Française pour la Prévention des Allergies (AFPRAL), 4, place Louis Armand - La Tour de l'Horloge, 75012 Paris, France
| | - Romain Montagne
- Aimmune Therapeutics, 10 Eastbourne Terrace, London, W2 6LG UK
| | - Sarah Acaster
- Acaster Lloyd Consulting, Ltd, 16 Woburn Pl, Bloomsbury, London, WC1H 0BS UK
| | - Katy Gallop
- Acaster Lloyd Consulting, Ltd, 16 Woburn Pl, Bloomsbury, London, WC1H 0BS UK
| | - Ram Patel
- Brainsell Ltd, 4 Duke Street, Richmond, TW9 1HP UK
| | - Andrea Vereda
- Aimmune Therapeutics, 10 Eastbourne Terrace, London, W2 6LG UK
| | - Guillaume Pouessel
- Department of Pediatrics, Children's Hospital, F-59056 Roubaix, France.,Pediatric Pulmonology and Allergy Department, CHU Lille, Lille University, F-59000 Lille, France.,Unité de pneumologie et allergologie pédiatriques, Hôpital Jeanne de Flandre, CHRU Lille et Université Lille2, 2 Avenue Oscar Lambret, 59037 Lille, France
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DunnGalvin A, Gallop K, Acaster S, Timmermans F, Regent L, Schnadt S, Podestà M, Sánchez A, Ryan R, Couratier P, Feeney M, Hjorth B, Fisher HR, Blumchen K, Vereda A, Fernández-Rivas M. APPEAL-2: A pan-European qualitative study to explore the burden of peanut-allergic children, teenagers and their caregivers. Clin Exp Allergy 2020; 50:1238-1248. [PMID: 32757478 PMCID: PMC7780296 DOI: 10.1111/cea.13719] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
Abstract
Background Allergy to Peanuts ImPacting Emotions And Life (APPEAL‐1) was a recent European multi‐country questionnaire survey that highlighted the negative impacts of peanut allergy (PA) on quality of life. A follow‐on qualitative study, APPEAL‐2, further assessed the burden of PA and associated coping strategies through semi‐structured interviews. Objective To gain qualitative insight on the strategies used to cope with and manage PA and the impact of these strategies on the quality of life of children, teenagers and caregivers. Methods This cross‐sectional qualitative study was conducted in eight European countries: the United Kingdom, France, Germany, Ireland, Spain, Italy, Denmark and the Netherlands. Semi‐structured interviews were conducted with children (aged 8‐12 years) and teenagers (aged 13‐17 years) with self‐/proxy‐reported moderate or severe PA and with parents/caregivers of children or teenagers (aged 4‐17 years) with moderate or severe PA. Data were analysed using thematic analysis; data saturation was assessed. Two conceptual models were developed to illustrate the impacts of PA and coping strategies used to manage them for (a) individuals with PA and (b) parents/caregivers of children with PA. Results 107 participants were interviewed: 24 children, 39 teenagers and 44 caregivers. The conceptual models illustrated themes related to coping and control, driven by the fear of PA reactions, and the associated emotional, social, relationship and work impacts. Factors moderating these impacts included social attitudes and support, child‐caregiver relationship and coping strategies used. Conclusions and Clinical Relevance The APPEAL‐2 results substantiate the findings of APPEAL‐1; the results also suggest that the severity of experience with PA may not correlate with perception of its overall burden and show variable impacts by country.
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Affiliation(s)
| | | | | | | | | | - Sabine Schnadt
- Deutscher Allergie- und Asthmabund, Mönchengladbach, Germany
| | | | - Angel Sánchez
- Asociación Española de Personas con Alergia a Alimentos y Látex, Madrid, Spain
| | | | - Pascale Couratier
- Association Française pour la Prévention des Allergies, Paris, France
| | | | | | | | - Katharina Blumchen
- Division of Pneumology, Allergology and Cystic Fibrosis, Department of Children and Adolescent Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
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