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Lloyd M, Loke P, Mack DP, Sicherer SH, Perkin MR, Boyle R, Yin Leung AS, Lee BW, Levin M, Blumchen K, Fiocchi A, Ebisawa M, Oliveira LCLD, Tang MLK. Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1010-1027.e6. [PMID: 36805346 DOI: 10.1016/j.jaip.2023.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael R Perkin
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Robert Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Hub of Paediatric Excellence, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Lucila Camargo Lopes de Oliveira
- Department of Paediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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Vazquez-Ortiz M, Gore C, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga-Baraut T, Gowland MH, Egmose B, Knibb R, Khaleva E, Mortz CG, Pfaar O, Pite H, Podesta M, Santos AF, Sanchez-Garcia S, Timmermans F, Roberts G. A practical toolbox for the effective transition of adolescents and young adults with asthma and allergies: An EAACI position paper. Allergy 2023; 78:20-46. [PMID: 36176045 PMCID: PMC10091987 DOI: 10.1111/all.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI. AIM We herein summarize practical resources to support this guideline's implementation in clinical practice. METHODS For this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence-basis and user friendliness. RESULTS Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web-based and had limited evidence-basis. CONCLUSIONS This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care.
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Affiliation(s)
- Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Claudia Gore
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Cherry Alviani
- Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine, Paediatric Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Bettina Duca
- Department of Child and Adolescent Health, Mater Dei Hospital, Malta
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Teresa Garriga-Baraut
- Pediatric Allergy Unit. Vall d'Hebron University Hospital, Barcelona, Spain
- 'Growth and Development' Research Group. Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Britt Egmose
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital; CEDOC, Cardiovascular and Metabolic Pharmacology, iNOVA4Health, NOVA
| | | | - Alexandra F Santos
- Department of Women and Children's Health (Paediatric 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, Guy's and St Thomas' Hospital, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk-European Anaphylaxis Taskforce, Dordrecht, The Netherlands
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Newman KL, Chater A, Knibb RC. Beliefs about food allergies in adolescents aged 11–19 years: A systematic review. Clin Transl Allergy 2022; 12:e12142. [PMID: 35414890 PMCID: PMC8984676 DOI: 10.1002/clt2.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Research suggests of people with food allergy (FA), adolescents have the highest risk of fatal allergic reactions to food, yet understanding of this population and how they manage their condition is limited. Understanding beliefs and how they affect behaviour could inform ways to reduce risk taking behaviour and fatal reactions in adolescents. This systematic review aimed to explore beliefs adolescents hold about their FA, and how these may be associated with FA management. Demographics Adolescents aged 11–19 years with FA. Methodology A systematic search of seven databases was conducted. Papers of any design were included that reported on the beliefs about FA in adolescents aged 11–19 years. Data was systemised by narrative thematic analysis. Findings 20 studies were included. Themes included navigating FA in different environments, carriage and use of adrenaline auto‐injectors, management of the risk of anaphylaxis, behaviour and understanding of others, and food‐allergic identity. Implications Adolescents with FA hold a variety of condition beliefs; some beliefs were related to behaviour that could lead to an allergic reaction, while other beliefs were related to protective behaviours. Further research into understanding adolescent beliefs in order to inform clinical management and reduce the risk of potential fatal reactions is essential.
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Affiliation(s)
- Kristina L. Newman
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
- Department of Psychology School of Social Sciences Nottingham Trent University Nottingham UK
| | - Angel Chater
- Department for Sport Science and Physical Activity University of Bedfordshire Bedford UK
| | - Rebecca C. Knibb
- Psychology Department School of Life and Health Sciences Aston University Birmingham UK
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Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, Riggioni C, Silva D, Angier E, Arasi S, Bellou A, Beyer K, Bijlhout D, Bilò MB, Bindslev‐Jensen C, Brockow K, Fernandez‐Rivas M, Halken S, Jensen B, Khaleva E, Michaelis LJ, Oude Elberink HNG, Regent L, Sanchez A, Vlieg‐Boerstra BJ, Roberts G. EAACI guidelines: Anaphylaxis (2021 update). Allergy 2022; 77:357-377. [PMID: 34343358 DOI: 10.1111/all.15032] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022]
Abstract
Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014 guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer-reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first-line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis.
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Affiliation(s)
- Antonella Muraro
- Food Allergy Referral Centre Veneto Region Department of Women and Child Health Padua General University Hospital Padua Italy
| | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venerology and Allergy Charité Universitätsmedizin Berlin Germany
| | - Cherry Alviani
- Clinical and Experimental Sciences and Human Development in Health Faculty of Medicine University of Southampton UK
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Audrey DunnGalvin
- University College Cork Cork Ireland
- Sechnov University Moscow Moscow Russia
| | - Lene Heise Garvey
- Allergy Clinic Department of Dermatology and allergy Copenhagen University Hospital Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Carmen Riggioni
- Allergy, Immunology and Rheumatology Division Department of Pediatrics Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | | | - Elizabeth Angier
- Primary Care, Population Science and Medical Education Faculty of Medicine University of Southampton Southampton UK
| | - Stefania Arasi
- Allergy Unit ‐ Area of Translational Research in Pediatric Specialities Bambino Gesù Children's HospitalIRCCS Rome Italy
| | - Abdelouahab Bellou
- European Society for Emergency Medicine Brussels Belgium
- Department of Emergency Medicine Wayne State University School of Medicine Detroit Michigan USA
- University of Rennes 1 Rennes France
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité Universitätsmedizin Berlin Berlin Germany
| | - Diola Bijlhout
- Association for Teacher Education in Europe (ATEE Brussels Belgium
| | - Maria Beatrice Bilò
- Allergy Unit Department of Clinical and Molecular Sciences Polytechnic University of Marche Ancona Italy
- Department of Internal Medicine University Hospital of Ancona Ancona Italy
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Montserrat Fernandez‐Rivas
- Allergy Department Hospital Clinico San CarlosFacultad Medicina Universidad ComplutenseIdISSCARADyAL Madrid Spain
| | - Susanne Halken
- Hans Christian Andersen Children's HospitalOdense University Hospital Odense Denmark
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - Ekaterina Khaleva
- Clinical and Experimental Sciences and Human Development in Health Faculty of Medicine University of Southampton UK
| | - Louise J. Michaelis
- Department of Paediatric Immunology, Allergy, and Infectious Diseases Great North Children's Hospital Newcastle upon Tyne UK
- Faculty of Medical Sciences Population Health Sciences InstituteNewcastle University Newcastle upon Tyne UK
| | - Hanneke N. G. Oude Elberink
- Department of Allergology University Medical Center GroningenUniversity of Groningen, and Groningen Research Institute for Asthma and COPD Groningen The Netherlands
| | | | - Angel Sanchez
- AEPNAA Spanish Association for People with Food and Latex Allergy Madrid Spain
| | | | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health Faculty of Medicine University of Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research CentreSt Mary's Hospital Isle of Wight UK
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