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Yamamoto-Hanada K, Pak K, Iwamoto S, Konishi M, Saito-Abe M, Sato M, Miyaji Y, Mezawa H, Nishizato M, Yang L, Kumasaka N, Ohya Y. Parental stress and food allergy phenotypes in young children: A National Birth Cohort (JECS). Allergy 2024. [PMID: 38269609 DOI: 10.1111/all.16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Food allergy children and their families tend to have emotional distress and anxiety. There have been few reports of differences in parenting stress and a child's food allergy phenotypes. METHODS We examined the associations between food allergy phenotypes in children and parenting stress assessed by the Parenting Stress Index-Short Form (PSI-SF) from a national birth cohort (Japan Environment and Children's Study). RESULTS We included 65,805 children for statistical analysis. Of them, 7.2% of children had a food allergy diagnosis at 2 years old. The means of the total PSI-SF (39.9 ± 10.3, 39.1 ± 9.9), CD-SF (19.5 ± 5.4, 19.1 ± 5.2), and PD-SF (20.5 ± 6.3, 20.0 ± 6.1) scores are similar for caregivers in the with and without food allergy groups. Food allergy diagnosis resulted in significantly higher total PSI scores (coefficient .47, 95% CI 0.19-0.75, p = .001), CD-SF (coefficient .22, 95% CI 0.07-0.38, p = .004), and PD-SF (coefficient .24, 95% CI 0.08-0.41, p = .004). A similar trend was observed for allergy reactions to hen's egg. However, there was no clear relationship between allergic reactions to milk, wheat, nuts, and PSI-SF. CONCLUSIONS Parental stress was significantly related to a child's food allergy. Furthermore, hen's egg allergy increased parental stress. Multiple food avoidance might also increase parental stress. Healthcare providers need to be aware of parental stress in our daily clinic.
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Affiliation(s)
- Kiwako Yamamoto-Hanada
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Shintaro Iwamoto
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Mizuho Konishi
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Faculty of Applied Psychology, Tokyo Seitoku University, Tokyo, Japan
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Natsuhiko Kumasaka
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Medical Support Center for the Japan Environment and Children's Study, National Research Institute for Child Health and Development, Tokyo, Japan
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2
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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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3
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Colton Z, Hill K, McLaughlin A, Peterson C. Anxiety in parents of children with IgE-mediated food allergies before and during the COVID-19 pandemic. Clin Exp Allergy 2023; 53:1067-1070. [PMID: 37549645 DOI: 10.1111/cea.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Zachary Colton
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Kelsey Hill
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Alix McLaughlin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Catherine Peterson
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
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Kılıç N, Kaya Ş, Taşçı G, Özsoy F, Kılıç M. Quality of life in children with food allergies, psychiatric symptoms, and caregiving burden of their mothers. Allergol Immunopathol (Madr) 2023; 51:48-56. [PMID: 37695230 DOI: 10.15586/aei.v51i5.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The present study aimed to evaluate the quality of life in children with food allergies, the accompanying depression and anxiety disorders, and caregiving burden of their mothers. MATERIAL AND METHODS A total of 168 children with food allergy visiting our clinic and their mothers were included in the study group. The control group included 152 children who visited the healthy child follow-up clinic of our hospital and their mothers. Studying mothers' opinions, the Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) was used for evaluating children, and the Beck's Depression Inventory, Beck's Anxiety Inventory, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, and Zarit Caregiver Burden Scales were used for evaluating mothers. RESULTS No differences were noticed between the study and control group regarding mean age and gender distribution (P > 0.05). In the study, the FAQLQ-PF total and subscale scores of children with food allergies were determined according to the opinions of their mothers, and scores tended to increase with age (P < 0.0001). In addition, it was determined that mothers of children with food allergies had higher levels of anxiety, depression, and caregiving burden than mothers of the control group (P < 0.0001). CONCLUSION In order to develop a multidisciplinary approach for children with food allergies, we conceived as appropriate to inform their families about the difficulties of caregiving and psychosocial disorders that could develop over time. They also must be informed to take preventive measures as well as the medical aspects of their children's disease.
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Affiliation(s)
- Nülüfer Kılıç
- Elazığ Mental Health and Diseases Hospital, Elazığ, Turkey;
| | - Şuheda Kaya
- Elazığ Mental Health and Diseases Hospital, Elazığ, Turkey
| | - Gülay Taşçı
- Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Filiz Özsoy
- Faculty of Medicine, Department of Psychiatry, Gaziosmanpasa University, Tokat/Turkey
| | - Mehmet Kılıç
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of Firat, Elazığ, Turkey
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5
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Jung M, Kang U, Kim S, Yoo HW, Kim HY, Kim M, Lee JY, Kim K, Lee E, Kang BC, Park B, Ahn K, Kim J. Psychological Distress and Perceived Burden in Parents of Korean Children With IgE-Mediated Food Allergy. J Korean Med Sci 2023; 38:e208. [PMID: 37431540 DOI: 10.3346/jkms.2023.38.e208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Food allergy (FA) can have a profound effect on quality of life (QoL), stress, and anxiety in the family. We aimed to validate the Korean version of the Food Allergy Quality of Life-Parental Burden (FAQL-PB) and identify factors related to the parental psychosocial burden of caring for children with FAs. METHODS Parents of children aged between 6 months and 17 years with immunoglobulin E (IgE)-mediated FAs from the Pediatric Allergy Department of five university hospitals in Korea were enrolled in the study. Parents were asked to complete the FAQL-PB, Food Allergy Independent Measure-Parent Form (FAIM-PF), Child Health Questionnaire-Parents Form 28 (CHQ-PF28), Beck's Anxiety Inventory, Connor-Davidson Resilience Scale, and Patient Health Questionnaire-9 for depression. Statistical analyses included internal consistency, test-retest reliability, concurrent validity, discriminative validity, and logistic regression analyses. RESULTS A total of 190 parents were enrolled. Social activity limitation was the item with the highest FAQL-PB scores. The Cronbach's α for each item was higher than 0.8. The test-retest reliability was good (intra-class correlation coefficient, 0.716; 95% confidence interval [CI], 0.100-0.935). An increase in the FAQL-PB was significantly associated with an increase in the FAIM-PF (β = 0.765, P < 0.001) (concurrent validity). There was a positive correlation between parental burden, anxiety, and depression, while resilience was inversely correlated with parental burden (all P < 0.001). The total FAQL-PB score in parents of children who had experienced anaphylaxis was significantly higher than that in parents of children who did not experience it (P = 0.008). When adjusting for age, sex, and underlying diseases, anaphylaxis (β = 9.32; 95% CI, 2.97 to 15.68), cow's milk (CM) allergy (β = 8.24; 95% CI, 2.04 to 14.44), soybean allergy (β = 13.91; 95% CI, 1.62 to 26.20), higher anxiety (β = 1.05; 95% CI, 0.07 to 1.41), higher depression (β = 2.15; 95% CI, 1.61 to 2.69), and lower resilience (β = -0.42; 95% CI, -0.61 to -0.2) were significantly associated with greater parental burden in children with IgE-mediated FAs. CONCLUSION FAQL-PB is a reliable and valid tool for use in Korea. Anaphylaxis, CM or soybean allergies, more anxiety and depression symptoms, and lower resilience are associated with poorer QoL in parents of children with FAs.
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Affiliation(s)
- Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Urim Kang
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Sukyung Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea
| | - Hye Won Yoo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Ji Young Lee
- Department of Pediatrics, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Korea
| | - KyooSang Kim
- Department of Occupational and Environmental Medicine, Seoul Medical Center, Seoul, Korea
| | - Eunsun Lee
- Korea University Graduate School of Public Health, Seoul, Korea
| | | | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
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Nakano A, Maeta A, Takaoka Y, Saeki K, Hamada M, Hiraguchi Y, Kawakami T, Okafuji I, Takemura Y, Takahashi K, Kameda M. Parents' Fears about Hospital Visits and Trait Anxiety in the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11081080. [PMID: 37107913 PMCID: PMC10137802 DOI: 10.3390/healthcare11081080] [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: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Anxiety in parents of children with allergic diseases during the COVID-19 pandemic may impact hospital visits. This study explored the effect of the pandemic on parents' fears about hospital visits and their relationship with their personality traits. A cross-sectional, questionnaire-based study was conducted between September 2020 and March 2021, with parents of children aged 0-15 years, who regularly visited 24 outpatient facilities for allergic disease. The survey included patient information, fears about hospital visits, desired information, and the State-Trait Anxiety Inventory. Responses were compared between parents with high and low trait anxiety. The response rate was 97.6% (2439/2500). The most common fear was "Fear of getting medical care as usual (85.2%)" and "Fear of COVID-19 infection during hospital visits (87.1%)". High trait anxiety showed a significant association with "Fear of worsening of children's allergies" (adjusted OR: 1.31, 95%CI: 1.04 to 1.65, p = 0.022), and "Fear of worsening of COVID-19 due to allergy" (adjusted OR: 1.52, 95%CI: 1.27 to 1.80, p < 0.01). Healthcare professionals should share updates on COVID-19 and healthcare system to reduce parents' fear. Subsequently, they should communicate the importance of continuing treatment to prevent worsening of COVID-19 and avoid emergency visits, considering parental trait anxiety.
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Affiliation(s)
- Atsuko Nakano
- Department of Pediatrics, Kokuho Central Hospital, Nara 6360302, Japan
| | - Akihiro Maeta
- Department of Food Science and Nutrition, School of Food Science and Nutrition, Mukogawa Women's University, Hyogo 6638558, Japan
| | - Yuri Takaoka
- Department of Pediatrics, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka 5830872, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara 6348522, Japan
| | - Masaaki Hamada
- Department of Pediatrics, Yao Municipal Hospital, Osaka 5810069, Japan
| | - Yukiko Hiraguchi
- Department of Pediatrics, Osaka Saiseikai Nakatsu Hospital, Osaka 5300012, Japan
| | - Tomoko Kawakami
- Department of Pediatrics, Sumitomo Hospital, Osaka 5300005, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Hyogo 6500047, Japan
| | - Yutaka Takemura
- Department of Pediatrics, Kindai University Hospital, Osaka 5898511, Japan
| | - Kyoko Takahashi
- Department of Food Science and Nutrition, School of Food Science and Nutrition, Mukogawa Women's University, Hyogo 6638558, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka 5830872, Japan
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7
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Höfer V, Martini M, Dölle-Bierke S, Worm M, Bilò MB. Health-related quality of life in food and venom induced anaphylaxis and role of influencing factors. Clin Exp Allergy 2023; 53:295-306. [PMID: 36565032 DOI: 10.1111/cea.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/25/2022]
Abstract
The impact on health-related quality of life (HRQL) plays a key role for patients suffering from allergies and anaphylaxis. In this narrative review we review the HRQL in allergic patients suffering from food and venom allergy, both being the most frequent elicitors of severe allergic, potential life-threatening reactions and provide an overview on the current knowledge and identified gaps. The data show that for food and venom allergy standardized assessment tools to measure HRQL are available and have been successfully applied. Our analysis shows that multiple factors can modulate HRQL in these patient groups. These include sociodemographic data like patients' age and sex, fear of accidental reactions but also external factors like the social environment and the appreciation of the seriousness of the condition by others. External factors may have a significant impact on HRQL and should be considered in patient-related outcome assessments to avoid biased measurements possibly affecting the results. The assessment of the quality of life in the context of specific immunotherapy should consider lifestyle factors and ideally, the individual change in HRQL should be measured. Although there are many data indicating a negative impact on HRQL in food allergic children and their caregivers, limited data are existing from adults with food allergy and venom allergic patients from all age groups. Also, the use of standardized questionnaires should be extended to allow for a better comparability of results between studies. Therefore, translation to additional languages is necessary. Taken together, the eliciting allergen, the severity of the allergic disease but moreover multiple external factors impact the outcome in HRQL and should be considered in HRQL assessment.
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Affiliation(s)
- Veronika Höfer
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matteo Martini
- Allergy Unit, Ospedali Riuniti Marche Nord, Fano, Italy.,Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.,Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
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8
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Ballegaard ASR, Bøgh KL. Intestinal protein uptake and IgE-mediated food allergy. Food Res Int 2023; 163:112150. [PMID: 36596102 DOI: 10.1016/j.foodres.2022.112150] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
Food allergy is affecting 5-8% of young children and 2-4% of adults and seems to be increasing in prevalence. The cause of the increase in food allergy is largely unknown but proposed to be influenced by both environmental and lifestyle factors. Changes in intestinal barrier functions and increased uptake of dietary proteins have been suggested to have a great impact on food allergy. In this review, we aim to give an overview of the gastrointestinal digestion and intestinal barrier function and provide a more detailed description of intestinal protein uptake, including the various routes of epithelial transport, how it may be affected by both intrinsic and extrinsic factors, and the relation to food allergy. Further, we give an overview of in vitro, ex vivo and in vivo techniques available for evaluation of intestinal protein uptake and gut permeability in general. Proteins are digested by gastric, pancreatic and integral brush border enzymes in order to allow for sufficient nutritional uptake. Absorption and transport of dietary proteins across the epithelial layer is known to be dependent on the physicochemical properties of the proteins and their digestion fragments themselves, such as size, solubility and aggregation status. It is believed, that the greater an amount of intact protein or larger peptide fragments that is transported through the epithelial layer, and thus encountered by the mucosal immune system in the gut, the greater is the risk of inducing an adverse allergic response. Proteins may be absorbed across the epithelial barrier by means of various mechanisms, and studies have shown that a transcellular facilitated transport route unique for food allergic individuals are at play for transport of allergens, and that upon mediator release from mast cells an enhanced allergen transport via the paracellular route occurs. This is in contrast to healthy individuals where transcytosis through the enterocytes is the main route of protein uptake. Thus, knowledge on factors affecting intestinal barrier functions and methods for the determination of their impact on protein uptake may be useful in future allergenicity assessments and for development of future preventive and treatment strategies.
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Affiliation(s)
| | - Katrine Lindholm Bøgh
- National Food Institute, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark.
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9
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Golding MA, Lemoine-Courcelles C, Abrams EM, Ben-Shoshan M, Bégin P, Chan ES, Chu DK, Gerdts JD, Povolo B, Kim H, Simons E, Upton J, Protudjer JLP. Changes in food-related costs during the COVID-19 pandemic among families managing food allergy. FRONTIERS IN ALLERGY 2022; 3:915014. [PMID: 35910861 PMCID: PMC9334569 DOI: 10.3389/falgy.2022.915014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The COVID-19 pandemic has affected the supply, cost, and demand for certain foods, but it is not clear how these changes have affected food-allergic households. Objective To describe the changes in food-related costs that have followed COVID-19, as reported by higher- and lower-income households with a food-allergic member. Methods Between May 1-June 30, 2020, Canadian households, with at least one food-allergic member, completed an online survey on food shopping and preparation habits before and during the COVID-19 pandemic. The sample was divided into binary groups, either higher or lower than the sample median income. Data were analyzed using descriptive statistics and multiple regression. Results The sample was comprised of 102 participants (i.e., 51/ income group). The three most common food allergies amongst both groups were peanuts, tree nuts and milk. Since the start of the pandemic, both groups reported greater monthly direct grocery costs, although costs amongst the higher-income group were twice as high as the lower-income group ($212.86 vs. $98.89, respectively). Indirect food preparation costs were similarly elevated. Higher-income households with food procurement difficulties reported increased indirect shopping costs following the outbreak of COVID-19, whereas those without such difficulties reported decreased costs. Lower-income households with allergies to milk, wheat, or eggs (i.e., staple allergy) experienced a larger change in indirect food preparation costs following the outbreak of COVID-19 relative to those with other food allergies ($244.58 vs. –$20.28, respectively; p = 0.03). Conclusion Both higher and lower income households with food allergy reported greater direct food costs and indirect food preparation costs following the COVID-19. Households with staple allergy and those with difficulties finding their typical food items were particularly affected.
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Affiliation(s)
- Michael A. Golding
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Michael A. Golding
| | - Cathérine Lemoine-Courcelles
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M. Abrams
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Bégin
- Division of Clinical Immunology, Rheumatology, and Allergy, Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Edmond S. Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Derek K. Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada
| | | | | | - Harold Kim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
| | - Elinor Simons
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jennifer L. P. Protudjer
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Center for Healthcare Innovation, Winnipeg, MB, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada
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10
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Golding MA, Batac ALR, Gunnarsson NV, Ahlstedt S, Middelveld R, Protudjer JLP. The burden of food allergy on children and teens: A systematic review. Pediatr Allergy Immunol 2022; 33:e13743. [PMID: 35338731 DOI: 10.1111/pai.13743] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations. METHOD The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature. RESULTS Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples. CONCLUSION More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ayel L R Batac
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Polloni L, Muraro A, Bonaguro R, Toniolo A, Ballin A, Guarnaccia A, Lazzarotto F. Psychological needs and support among patients and families undergoing food oral immunotherapy. Clin Transl Allergy 2022; 12:e12078. [PMID: 35140908 PMCID: PMC8811642 DOI: 10.1002/clt2.12078] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/11/2021] [Accepted: 11/03/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Laura Polloni
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
- Psychology Unit Padua University Hospital Padua Italy
| | - Antonella Muraro
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
| | - Roberta Bonaguro
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
| | - Alice Toniolo
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
| | - Anna Ballin
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
| | - Alberto Guarnaccia
- Faculty of Medicine and Surgery Vita‐Salute San Raffaele University Milan Italy
| | - Francesca Lazzarotto
- Department of Women's and Children's Health Food Allergy Referral Centre, Veneto Region Padua University Hospital Padua Italy
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12
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Polloni L, Ferruzza E, Ronconi L, D'Ovidio G, Bonaguro R, Lazzarotto F, Toniolo A, Guarnaccia A, Muraro A. Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy. Pediatr Allergy Immunol 2022; 33:e13680. [PMID: 34655502 DOI: 10.1111/pai.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. METHODS Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. RESULTS A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p < .05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. CONCLUSIONS Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.
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Affiliation(s)
- Laura Polloni
- Department of Women and Children Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | - Emilia Ferruzza
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Lucia Ronconi
- IT and Statistical Services, Multifunctional Pole of Psychology, University of Padua, Padua, Italy
| | - Giorgia D'Ovidio
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Roberta Bonaguro
- Department of Women and Children Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | - Francesca Lazzarotto
- Department of Women and Children Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | - Alice Toniolo
- Department of Women and Children Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | - Alberto Guarnaccia
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonella Muraro
- Department of Women and Children Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
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13
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Westwell-Roper C, To S, Andjelic G, Lu C, Lin B, Soller L, Chan ES, Stewart SE. Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review. Pediatr Allergy Immunol 2022; 33:e13695. [PMID: 34779046 DOI: 10.1111/pai.13695] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA. METHODS MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines. RESULTS Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors. CONCLUSIONS FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.
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Affiliation(s)
- Clara Westwell-Roper
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon To
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordan Andjelic
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cynthia Lu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Boyee Lin
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada
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14
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Bute JJ, Martins N. The association of news media with anxiety in food allergic children and their parents. Pediatr Allergy Immunol 2022; 33:e13660. [PMID: 34473377 DOI: 10.1111/pai.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jennifer J Bute
- Department of Communication Studies, IUPUI, Indianapolis, IN, USA
| | - Nicole Martins
- The Media School, Indiana University, Bloomington, IN, USA
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15
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Kisa PT, Uzun OU, Gunduz M, Bulbul FS, Kose E, Arslan N. Frequency and status of depression and anxiety in mothers of children with inborn errors of metabolism with restricted diet, with and without risk of metabolic crises. Arch Pediatr 2021; 28:702-706. [PMID: 34620546 DOI: 10.1016/j.arcped.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the frequency and status of depression and anxiety among mothers of children with inborn errors of metabolism (IEM) who were on a restricted diet and previously experienced metabolic crises. METHODS This cross-sectional multicenter descriptive study included 93 children with IEM who were on restricted diet. The patients were divided into two groups: those who had experienced metabolic crises (n=44, urea cycle defect, organic acidemia, maple syrup urine disease, hereditary fructose intolerance) and those who had not experienced previous metabolic crises (n=49; phenylketonuria, galactosemia, and non-ketotic hyperglycinemia). The control group comprised 37 healthy children. The mothers of the patients and control participants answered a questionnaire about their and their children's demographic and clinical characteristics and completed the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI-S and STAI-T). RESULTS The maternal BDI, STAI-S, and STAI-T scores were 6.3±5.2, 36.1±11.2, and 39.9±8.8, respectively, in the control group. The maternal BDI, STAI-S, and STAI-T scores of the children who had experienced (19.2±9.7; 44.0±12.4; 47.9±10.6) and those who had not experienced (13.9±9.1; 40.7 ±8.6; 45.3±8.3) a crisis were significantly higher than for the controls. The BDI score was significantly higher for the mothers of children who had experienced a crisis (p=0.011), whereas no significant difference was determined between the two patient groups regarding STAI-S and STAI-T scores. The mothers of four children who had experienced metabolic crises were on antidepressant therapy. CONCLUSION Although their children were on a similar restricted diet, the mothers of children who previously experienced or who had the risk of experiencing metabolic crises had higher depression scores as compared with the mothers of children who did not experience a previous crisis. Early supportive therapy may be required for the families of these patients to lower the burden of stress.
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Affiliation(s)
- Pelin Teke Kisa
- Dokuz Eylul University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Izmir, Turkey; University of Health Sciences, Dr. Behçet Uz Children's Research and Training Hospital, Department of Pediatric Metabolism and Nutrition, Izmir, Turkey
| | - Ozlem Unal Uzun
- Kocaeli University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Kocaeli, Turkey
| | - Mehmet Gunduz
- Ministry of Health Ankara City Hospital, Department of Pediatric Metabolism and Nutrition, Ankara, Turkey
| | - Fatma Selda Bulbul
- Kirikkale University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Kirikkale, Turkey
| | - Engin Kose
- Ankara University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Ankara, Turkey
| | - Nur Arslan
- Dokuz Eylul University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Izmir, Turkey; Izmir Biomedicine and Genome Center, Izmir, Turkey.
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16
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Batmaz SB, Birinci G, Akpınar Aslan E. Quality of Life of Children with Allergic Disease: The effect of Depression and Anxiety of Children and Their Mothers. J Asthma 2021; 59:1776-1786. [PMID: 34503366 DOI: 10.1080/02770903.2021.1978480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: In comparison with the general population, several studies have reported higher anxiety and depression rates not only in children with allergic diseases but also in their parents. We aimed to evaluate the mental health of children and their mothers affecting quality of life (QoL) in children with allergic diseases, and to compare anxiety and depression in these patients and their parents with the general population.Methods: One hundred and sixty-eight patients aged 8-18 years diagnosed with an allergic disease who visited our outpatient clinic and a control group of 61 children who did not have any chronic or allergic diseases were included in the study. Patients completed the Pediatric QoL Inventory, Trait Anxiety Inventory for Children, and Children's Depression Inventory, while mothers completed the General Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9). Independent samples' t-test was used to compare children's QoL, trait anxiety, and depression scores and mothers' GAD-7 and PHQ-9 scores between the controlled/mild and uncontrolled/moderate-severe groups. The effects of age, gender, disease severity, maternal depression/anxiety, and children's depression/anxiety on QoL were analyzed with multivariate regression analyses.Results: QoL was lower in children with allergic diseases than healthy children, and although the mean QoL score was lower in the group with high disease severity, QoL in children with allergic diseases was not associated with disease severity but inversely related to anxiety/depression and maternal depression.Conclusions: As per the results, QoL is impaired in children with allergic diseases. Both anxiety/depression in the child and maternal depression may adversely affect QoL in these patients.
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Affiliation(s)
- Sehra Birgül Batmaz
- Department of Pediatric Allergy and Clinical Immunology, Tokat State Hospital, Tokat, Turkey
| | | | - Esma Akpınar Aslan
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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17
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Roberts K, Meiser-Stedman R, Brightwell A, Young J. Parental Anxiety and Posttraumatic Stress Symptoms in Pediatric Food Allergy. J Pediatr Psychol 2021; 46:688-697. [PMID: 33704484 DOI: 10.1093/jpepsy/jsab012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore anxiety, worry, and posttraumatic stress symptoms (PTSS) in parents of children with food allergies, and to evaluate whether these three psychological outcomes could be predicted by allergy severity, intolerance of uncertainty, and food allergy self-efficacy. METHODS Participants were 105 parents who reported their children to have medically diagnosed food allergies. Participants were recruited to a study on parent wellbeing through an allergy clinic and social media advertisements. Participants completed online questionnaires assessing anxiety, worry, PTSS, intolerance of uncertainty, food allergy self-efficacy, and demographic and allergy information. RESULTS In this sample, 81.0% of parents reported clinically significant worry, 42.3% met the clinical cut-off for PTSS, and 39.1% reported moderate-extremely severe anxiety. Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes, with mixed results for allergy severity. However, intolerance of uncertainty was the only variable to consistently account for unique variance within regression models. CONCLUSIONS This study highlights the need for greater awareness of mental health in parents of children with food allergy. The study also indicates that factors impacting on parents' perception of threat may be most strongly predictive of psychological outcomes, warranting further research. Finally, the study indicates that intolerance of uncertainty may be a promising target for psychological interventions within this population.
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Affiliation(s)
- Kate Roberts
- Department of Clinical Health Psychology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust.,Community Paediatrics, Oak Tree Centre, Cambridgeshire Community Services NHS Trust
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia
| | - Alex Brightwell
- Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - Judith Young
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia.,Psychological Medicine Services for Children, Young People and Families, Children's Services Box 267, Addenbrooke's Cambridge University Hospital Trust
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18
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Abdelwadoud M, Eftekhari S, Jaffee H, Carver M, Mattingly TJ. Food allergy treatment value: Child caregiver and patient perspectives. Pediatr Allergy Immunol 2021; 32:1038-1047. [PMID: 33544417 PMCID: PMC8359212 DOI: 10.1111/pai.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Food allergy is a major health problem that significantly impacts quality of life (QoL). There is growing focus to evaluate food allergy-related QoL and treatment options' value beyond the clinical effectiveness perspective by engaging patients and caregivers. We aimed to identify and prioritize outcomes important to food allergy parents of children and patients allergic to milk, egg, and/or peanut, to guide comparative effectiveness research (CER) that focuses on evaluating food allergy treatment decisions. METHODS We conducted a modified 3-round Delphi study to identify and derive consensus on priority treatment outcomes for parents of children and adult patients with diagnosed allergies to at least one of three major allergenic foods (milk, egg, and peanut) from across the United States. RESULTS Round 1 yielded 44 statements for round 2, and 39 statements reached the agreement level for round 3 ranking. Statements were organized under 4 sections: 1) food allergy problems, 2) treatment experiences, 3) important treatment outcomes, and 4) value of different treatment options. CONCLUSION Food allergy parents and patients face several social, psychological, medical, healthcare, financial, food selection, and awareness challenges. The areas of consensus on important treatment outcomes revealed shared priority for reducing the risk of potentially fatal allergic reactions and having reliable treatments. The most valued treatment options reflect hope for permanent cure and fear of serious allergic reactions.
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Affiliation(s)
- Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Sanaz Eftekhari
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - Hannah Jaffee
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - Melanie Carver
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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19
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Golding MA, Gunnarsson NV, Middelveld R, Ahlstedt S, Protudjer JLP. A scoping review of the caregiver burden of pediatric food allergy. Ann Allergy Asthma Immunol 2021; 127:536-547.e3. [PMID: 33971359 DOI: 10.1016/j.anai.2021.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although a number of articles have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus or methodologically limited. Consequently, this study aimed to synthesize both the quantitative and qualitative literature to achieve a better understanding of the psychosocial and financial burdens faced by families who raise children with food allergy. DATA SOURCES Searches were performed on PubMed, Scopus, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles related to the psychosocial and financial burden experienced by individuals who care for a child with food allergy. STUDY SELECTIONS English language, original research articles were included in this review. RESULTS A total of 54 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (ie, food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower quality of life than their comparison groups. Within-group analyses suggest that this burden is increased for parents who manage multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure and the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs. CONCLUSION Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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20
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Coelho GLDH, Byrne A, Hourihane J, DunnGalvin A. Development of the Food Allergy Anxiety Scale in an Adult Population: Psychometric Parameters and Convergent Validity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3452-3458.e1. [PMID: 33895363 DOI: 10.1016/j.jaip.2021.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Food allergy (FA) affects up to 10% of young children and 2% to 3% of adults, and appears to be increasing in prevalence across the world. The adverse and growing impact of FAs warrants that closer attention is needed to the psychological mechanisms underlying FA and quality of life, to provide benefits for both clinicians and patients. One of these psychological mechanisms, frequently present in individuals struggling with FA, is anxiety. OBJECTIVE To provide an FA-specific measure to properly assess the impact of anxiety, the present research proposed the novel Food Allergy Anxiety Scale in an adult population. METHODS Two studies were conducted (n = 412), and the psychometric properties of the measure were extensively assessed through several robust statistical techniques (eg, exploratory factor analysis, confirmatory factor analysis, and item response theory). RESULTS Our findings indicated a reliable 1-factor structure, significantly associated with other constructs such as general anxiety, depression, and FA quality of life. CONCLUSIONS We are confident that the Food Allergy Anxiety Scale is a powerful tool to assess this specific role of FA within anxiety, which might lead to a better comprehension on how this psychological distress works, and consequently, the development of better strategies to reduce its impact.
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Affiliation(s)
| | | | | | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
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21
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Buyuktiryaki B, Masini M, Mori F, Barni S, Liccioli G, Sarti L, Lodi L, Giovannini M, du Toit G, Lopata AL, Marques-Mejias MA. IgE-Mediated Fish Allergy in Children. ACTA ACUST UNITED AC 2021; 57:medicina57010076. [PMID: 33477460 PMCID: PMC7830012 DOI: 10.3390/medicina57010076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
Fish allergy constitutes a severe problem worldwide. Its prevalence has been calculated as high as 7% in paediatric populations, and in many cases, it persists into adulthood with life-threatening signs and symptoms. The following review focuses on the epidemiology of Immunoglobulin E (IgE)-mediated fish allergy, its pathogenesis, clinical manifestations, and a thorough approach to diagnosis and management in the paediatric population. The traditional approach for managing fish allergy is avoidance and rescue medication for accidental exposures. Food avoidance poses many obstacles and is not easily maintained. In the specific case of fish, food is also not the only source of allergens; aerosolisation of fish proteins when cooking is a common source of highly allergenic parvalbumin, and elimination diets cannot prevent these contacts. Novel management approaches based on immunomodulation are a promising strategy for the future of these patients.
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Affiliation(s)
- Betul Buyuktiryaki
- Division of Pediatric Allergy, Koc University Hospital, 34010 Istanbul, Turkey;
| | - Marzio Masini
- Department of Pediatrics, Sapienza University of Rome, 00185 Rome, Italy;
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Giulia Liccioli
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Lorenzo Lodi
- Department of Health Sciences, Division of Immunology, Section of Pediatrics, University of Florence and Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Correspondence:
| | - George du Toit
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King’s College London, London SE5 9NU, UK
| | - Andreas Ludwig Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Maria Andreina Marques-Mejias
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
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22
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Efficacy, safety, and parental anxiety in a randomized trial of two dietary instruction methods for children with suspected hen's egg allergy. Allergol Int 2021; 70:114-120. [PMID: 32814667 DOI: 10.1016/j.alit.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little has been reported on how to introduce hen's egg into the diet of children with suspected egg allergy. We compared the efficacy, safety, and parental anxiety of two different dietary instruction methods to introduce egg. METHODS Eligible participants were children aged 1-4 years who were positive for egg white IgE, and ovomucoid IgE <3.5 kUA/L. Participants were either naïve in egg consumption or had a history of an immediate, but non-anaphylactic, allergic reaction to egg. After a negative result of baseline 2 g boiled egg white oral food challenge (OFC), participants were randomly assigned to the step-up OFC testing (SOFT) or home incrementing group. The primary outcome was the proportion of participants who were able to ingest 20 g of boiled egg white 6 months after initiation. This study is registered with the University Hospital Medical Information Network clinical trial registry (UMIN000024192). RESULTS Between September 2016 and August 2018, we randomly allocated 55 participants to the SOFT (n = 33 [60%]) and home incrementing (n = 22 [40%]) groups and analyzed 51 patients. Four patients were excluded because they were lost to follow-up. Thirty-one (96.9%) of 32 participants in the SOFT and 12 (63.2%) of 19 in the home incrementing group achieved the primary outcome (p = 0.003). No serious adverse reactions were observed in either group. Parental anxiety significantly improved during treatment in both groups. CONCLUSIONS The SOFT method was more effective than home incrementing as dietary instruction to introduce egg in children with suspected egg allergy.
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23
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Maciag MC, Herbert LJ, Sicherer SH, Young MC, Schultz F, Westcott-Chavez AA, Phipatanakul W, Bingemann TA, Bartnikas LM. The Psychosocial Impact of Food Protein-Induced Enterocolitis Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:3508-3514.e5. [PMID: 32569756 PMCID: PMC7655634 DOI: 10.1016/j.jaip.2020.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the psychosocial impact of food protein-induced enterocolitis syndrome (FPIES). OBJECTIVE To characterize quality of life, stress, worry, anxiety, and self-efficacy in caregivers of children with FPIES and affected children, and determine risk factors for increased psychosocial burden. METHODS Surveys completed by caregiver-members of the International FPIES Association at a conference (n = 42) and online (n = 368) were analyzed. RESULTS There was significant burden, stress, worry, and anxiety among caregivers. There was a positive correlation among Food Allergy Quality of Life-Parental Burden, Perceived Stress Scale-10, Penn State Worry Questionnaire, and Beck Anxiety Inventory scores, and these were negatively associated with Food Allergy Self-Efficacy for Parents (FASE-P) scores. Lower income was associated with poorer caregiver health-related quality of life (HRQoL) (P = .039) and lower FASE-P (P = .028). Greater number of food groups avoided correlated moderately with poorer HRQoL (r = 0.386; P < .001), higher anxiety among preschoolers (r = 0.262; P = .013) and parents (r = 0.594, P = .025). Avoiding cow's milk due to FPIES was associated with poorer caregiver HRQoL (P < .001), higher stress (P = .001), and lower FASE-P (P = .013). Caregivers whose child was not attending daycare/school due to FPIES had poorer HRQoL (P < .001), higher stress (P < .014), and worry (P = .004). Compared with published cohorts of caregivers of children with IgE-mediated food allergy, the burden of FPIES on caregivers was significantly higher (mean = 3.4 vs 3.0; P < .001) and self-efficacy was significantly lower (mean = 63.9 vs 76.1; P < .001). CONCLUSIONS There is increased stress, worry, anxiety, and reduced HRQoL and self-efficacy among caregivers of children with FPIES and increased general anxiety among preschoolers. Additional research is needed to inform effective psychosocial interventions.
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Affiliation(s)
- Michelle C. Maciag
- Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Linda J. Herbert
- Division of Allergy and Immunology, Children’s National Hospital, Washington, DC
| | - Scott H. Sicherer
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael C. Young
- Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Fallon Schultz
- International FPIES Association (I-FPIES), Point Pleasant Beach, NJ
| | | | - Wanda Phipatanakul
- Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Theresa A. Bingemann
- Allergy and Immunology, the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Lisa M. Bartnikas
- Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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24
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Poehacker S, McLaughlin A, Humiston T, Peterson C. Assessing Parental Anxiety in Pediatric Food Allergy: Development of the Worry About Food Allergy Questionnaire. J Clin Psychol Med Settings 2020; 28:447-456. [PMID: 32986182 DOI: 10.1007/s10880-020-09737-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Food allergies (FAs) in children are increasingly common, and strict allergen avoidance and safety concerns place parents at risk for anxiety (Lau et al. in Pediatr Allergy Immunol 25:236-242, 2014). Assessing parental anxiety with generic instruments may not capture the unique experience of parents managing children's FAs. This study developed and preliminarily validated the 13-item Worry About Food Allergy (WAFA) questionnaire, a measure of FA-specific parental anxiety, in an online sample of 265 parents aged 22-66 (M = 40.25) of children with FAs. The WAFA showed good internal reliability (Cronbach's α = .89) and moderate convergent validity with other anxiety measures, indicating support for a reliable measure of a discrete, specific construct. Exploratory factor analysis indicated a single factor structure. Criterion validity was established through significant, small, positive correlations with relevant allergy variables. A coherent single factor measure, the WAFA, shows promise as a screening tool for parental anxiety in pediatric practice and FA management.
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Affiliation(s)
- Stefanie Poehacker
- Department of Psychology, Eastern Michigan University, 352E Science Complex, Ypsilanti, MI, 48197, USA.
| | - Alix McLaughlin
- Department of Psychology, Eastern Michigan University, 352E Science Complex, Ypsilanti, MI, 48197, USA
| | - Tori Humiston
- Department of Psychology, Eastern Michigan University, 352E Science Complex, Ypsilanti, MI, 48197, USA
| | - Catherine Peterson
- Department of Psychology, Eastern Michigan University, 352E Science Complex, Ypsilanti, MI, 48197, USA
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25
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Mahmoud AB, Hack-Polay D, Fuxman L, Naquiallah D, Grigoriou N. Trick or treat? - when children with childhood food allergies lead parents into unhealthy food choices. BMC Public Health 2020; 20:1453. [PMID: 32977776 PMCID: PMC7517056 DOI: 10.1186/s12889-020-09556-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study examines the relationships between childhood food allergy and parental unhealthy food choices for their children across attitudes towards childhood obesity as mediators and parental gender, income and education as potential moderators. METHODS We surveyed parents with at least one child between the ages of 6 and 12 living in Canada and the United States. We received 483 valid responses that were analysed using structural equation modelling approach with bootstrapping to test the hypothetical path model and its invariance across the moderators. RESULTS The analysis revealed that pressure to eat fully mediated the effects of childhood food allergy and restriction on parental unhealthy food choices for their children. Finally, we found that parental gender moderated the relationship between childhood food allergy and the pressure to eat. CONCLUSIONS The paper contributes to the literature on food allergies among children and the marginalisation of families with allergies. Our explorative model is a first of its kind and offers a fresh perspective on complex relationships between variables under consideration. Although our data collection took place prior to Covid-19 outbreak, this paper bears yet particular significance as it casts light on how families with allergies should be part of the priority groups to have access to food supply during crisis periods.
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Affiliation(s)
| | - Dieu Hack-Polay
- Crandall University, Moncton, Canada
- University of Lincoln, Lincoln, UK
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26
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Lozoya-Ibáñez C, Morgado-Nunes S, Rodrigues A, Fernandes P, Lourenço O, Mafalda Fonseca A, Taborda-Barata L. Prevalence and clinical features of adverse food reactions in Portuguese adolescents. World Allergy Organ J 2020; 13:100453. [PMID: 32817783 PMCID: PMC7424229 DOI: 10.1016/j.waojou.2020.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background & aims The objective of the present study was to determine, for the first time, the prevalence and clinical features of food allergy in Portuguese adolescents. Methods Cross-sectional study performed in various secondary schools in central Portugal. Randomly selected adolescents replied to a validated food allergy questionnaire. Those who reported an adverse food reaction were seen at participating hospitals, where clinical history was taken, skin prick (SPT) and prick-prick skin (SPPT) tests were performed, and food allergen-specific IgE levels (sIgE) were determined. An open oral challenge was performed in selected cases. Cases of positive clinical history of immediate (up to 2 h after ingestion) reaction in association with positive food sIgE levels and/or SPT were classified as IgE-associated probable food allergy and as confirmed IgE-mediated food allergy if food challenges were positive. Cases of positive clinical history of delayed (more than 2 h after ingestion) and negative food sIgE levels independently of positive SPT or SPPT results, were classified as non-IgE associated probable food allergy. Results The prevalence of probable food allergy in Portuguese adolescents was 1.41% (95% CI: 0.90–2.03%), with fresh fruits, shellfish, nuts, and peanut as the most frequently implicated foods. IgE-mediated probable food allergy occurred in 1.23% (95% CI: 0.67–1.72%) of cases, with fresh fruits, shellfish, and nuts mainly involved. Cutaneous symptoms were most frequently reported. Conclusions The prevalence of probable food allergies in Portuguese adolescents is low, is mostly related to fresh fruits, shellfish, nuts, and peanut, and most frequently involves cutaneous symptoms.
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Affiliation(s)
- Carlos Lozoya-Ibáñez
- Allergy Department, Castelo Branco Local Health Unit, Portugal.,CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Sara Morgado-Nunes
- CACB - Clinical Academic Center of Beiras, Portugal.,Polytechnic Institute of Castelo Branco, Escola Superior de Gestão, Castelo Branco, Portugal
| | - Alexandra Rodrigues
- CACB - Clinical Academic Center of Beiras, Portugal.,Outpatient Clinic Department, Castelo Branco Local Health Unit, Portugal
| | - Patrícia Fernandes
- CACB - Clinical Academic Center of Beiras, Portugal.,Clinical Pathology Department, Castelo Branco Local Health Unit, Portugal
| | - Olga Lourenço
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Ana Mafalda Fonseca
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Luis Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal.,Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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27
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Soller L, To S, Hsu E, Chan ES. Current tools measuring anxiety in parents of food-allergic children are inadequate. Pediatr Allergy Immunol 2020; 31:678-685. [PMID: 32320501 DOI: 10.1111/pai.13260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/20/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of food allergy, excessive parental anxiety can be maladaptive and lead to unnecessary restriction of social activities. No validated tool exists to measure food allergy-associated anxiety (FAAA). This study sought to explore factors associated with parental FAAA, determine sensitivity and specificity of using generic state anxiety measure-State-Trait Anxiety Inventory (STAI) versus FAAA, and determine whether validated tools for generalized anxiety or food allergy-specific quality of life (QoL) could be used as surrogates for FAAA. METHODS Canadian parents of food-allergic children completed an online survey. Without a validated tool for FAAA, a visual analogue scale was used to assess parent-reported FAAA. Multivariable linear regression was performed with FAAA as the outcome. Sensitivity and specificity analysis of state anxiety vs. FAAA, and factor analysis of state anxiety and QOL, was performed to determine whether these could be used as surrogates for FAAA. RESULTS A total of 548 of 1244 parents (44.1%) completed the survey. Factors positively associated with FAAA included parental burden, risk perception, state anxiety, intolerance of uncertainty and perceived severity of child's food allergy; personal/family history of mental health was negatively associated. Sensitivity and specificity of state anxiety were 68.6% and 70.0%. Factor analysis revealed that state anxiety and QOL were correlated (r = 0.54, P < .001) but distinct constructs. CONCLUSION Our study identified factors associated with FAAA, and determined that generic anxiety and QOL tools do not accurately categorize parents with self-reported high FAAA. Future research will develop a validated screening tool to help allergists identify anxious parents and provide psychosocial resources.
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Affiliation(s)
- Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Sharon To
- Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Elaine Hsu
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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28
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Filiz S, Keleş Ş, Akbulut UE, Işık IA, Kara MZ. Sleep disturbances and affecting factors in young children with food allergy and their mothers. Allergol Immunopathol (Madr) 2020; 48:158-164. [PMID: 31601501 DOI: 10.1016/j.aller.2019.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine sleep patterns and sleep disturbance of children with food allergy (FA) and their mothers. METHODS The food allergy group included 71 children with mean age, 2.97±1.52 years, and 58 control children were recruited the study. Mothers of children completed the Childhood Sleep Habits Questionnaire (CSHQ) and The Pittsburgh Sleep Quality Index (PSQI) in order to evaluate sleep disturbance in both children and themselves. Depressive symptomatology of mothers of children with or without food allergy was assessed with Beck-Depression Inventory II (BDI-II). RESULTS The mean total scores of CSHQ was 49.33±7.93 (range=31-68) in the FA and 42.39±6.43 (range=30-62) in controls. The total CSHQ scores were significantly higher in children with FA than in controls (p=0.002). The total PSQI score was significantly higher in mothers of children with FA than in mothers of children without FA (7.09±3.11 vs 5.15±2.59, p<0.001) indicating that the mothers of children with FA had worse sleep quality. The mothers of children with FA had more depressive symptoms than mothers of children without FA. The mean total scores of BDI-II were 10.10±6.95 in mothers of children with FA and 7.78±6.64 in mothers of children without FA (p=0.005). CONCLUSION The presence of a food allergy in a child may be associated with a deterioration in sleep quality in children and mothers as well as increased depressive symptoms in mothers.
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Affiliation(s)
- S Filiz
- Training and Research Hospital, Department of Pediatric Allergy and Immunology, Antalya, Turkey.
| | - Ş Keleş
- Training and Research Hospital, Department of Pediatric Allergy and Immunology, Antalya, Turkey
| | - U E Akbulut
- Training and Research Hospital, Department of Pediatric Gastroenterology, Antalya, Turkey
| | - I A Işık
- Training and Research Hospital, Department of Pediatric Gastroenterology, Antalya, Turkey
| | - M Z Kara
- Training and Research Hospital, Department of Pediatric Psychiatry, Antalya, Turkey
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29
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Polloni L, Muraro A. Anxiety and food allergy: A review of the last two decades. Clin Exp Allergy 2020; 50:420-441. [DOI: 10.1111/cea.13548] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Laura Polloni
- Department of Women and Child Health Food Allergy Referral Centre for Diagnosis and Treatment Veneto Region Padua University Hospital Padua Italy
| | - Antonella Muraro
- Department of Women and Child Health Food Allergy Referral Centre for Diagnosis and Treatment Veneto Region Padua University Hospital Padua Italy
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30
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Kim M, Lee JY, Yang HK, Won HJ, Kim K, Kim J, Ahn K. The Natural Course of Immediate-Type Cow's Milk and Egg Allergies in Children. Int Arch Allergy Immunol 2019; 181:103-110. [PMID: 31752004 DOI: 10.1159/000503749] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most of children with cow's milk (CM) and hen's egg allergies are known to outgrow their diseases with time, but recent studies have demonstrated that children tend to continue to have allergic symptoms in adolescence and adulthood. The aim of this study was to investigate the natural course of CM and egg allergies in Korean children and analyze prognostic factors. METHODS In this retrospective study, we reviewed data of children with CM allergy and with egg allergy using medical records and parental telephone interviews. Diagnosis of CM or egg allergy was based on positive oral food challenge test or convincing history of allergic symptoms in combination with positive allergen-specific IgE. Acquisition of tolerance was defined by the absence of allergic symptoms after reintroduction of the offending foods. RESULTS Half of the children outgrew CM allergy at a median age of 8.7 years. CM-specific IgE level at the first reaction was a significant prognostic factor for oral tolerance in CM allergy (p < 0.05). The median age to acquire oral tolerance in 50% of patients with egg allergy was 5.6 years. Egg-specific IgE level at the first reaction and family history of allergic diseases significantly affected the prognosis in children with egg allergy (p < 0.05). CONCLUSIONS Half of Korean children with CM and egg allergies had symptom resolution at 8.7 and 5.6 years of age, respectively. Our results also suggest that CM- and egg-specific IgE levels at the first reaction are the most significant prognostic factors in predicting acquisition of oral tolerance.
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Affiliation(s)
- Minji Kim
- Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Dongtan, Republic of Korea
| | - Ji Young Lee
- Department of Pediatrics, Hangang Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
| | - Hea-Kyoung Yang
- Department of Pediatrics, Oz Pediatric Clinic, Seoul, Republic of Korea
| | - Ho Jeong Won
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Republic of Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, .,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Republic of Korea,
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31
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Portnoy J, Wade RL, Kessler C. Patient Carrying Time, Confidence, and Training with Epinephrine Autoinjectors: The RACE Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2252-2261. [DOI: 10.1016/j.jaip.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
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32
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Vickers B, Boyle RJ, Umasunthar T, Smith JG, Hodes M. Therapy competence in delivering a brief cognitive behavioural therapy intervention to reduce maternal anxiety associated with child food allergy. J Child Health Care 2019; 23:446-457. [PMID: 31146547 DOI: 10.1177/1367493519853436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Child food allergy is increasingly prevalent, and caring for such children is associated with elevated parental anxiety. We previously carried out a randomized-controlled trial (RCT) of brief cognitive behavioural therapy (CBT) for parental anxiety associated with child food allergy which found that treatment to be effective. This study describes the manualized brief CBT intervention and assesses the acquisition of competence in delivering this therapy. Three healthcare professionals were trained and supervised in the delivery of brief CBT to 98 mothers of food-allergic children. Competency was assessed using the Revised Cognitive Therapy Scale (CTS-R), with 'competency' defined as a CTS-R score ≥3. All therapists' CTS-R scores increased over time. In the first four months, the mean (SD) CTS-R score was 2.31 (0.56), increasing to 3.14 (0.41) in the second four months (p < .001). Overall, 13/19 (68%) of CBT sessions were rated with a CTS-R score ≥3 in the second four months. After eight months, all therapists were performing CBT at a competent level (17 of the 18 sessions or 94%). The therapists participated in a RCT that reduced maternal anxiety (reported elsewhere). We have shown that therapists not previously trained in CBT can be trained in specific interventions and reach competent levels quickly.
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Affiliation(s)
- Bea Vickers
- 1 South West London and St Georges' Mental Health NHS Trust, Springfield Hospital, London, UK
| | - Robert J Boyle
- 2 Department of Paediatrics, Imperial College London, London, UK.,3 NIHR Imperial Biomedical Research Centre, St Mary's Hospital, London, UK
| | - Thisanayagam Umasunthar
- 2 Department of Paediatrics, Imperial College London, London, UK.,3 NIHR Imperial Biomedical Research Centre, St Mary's Hospital, London, UK
| | - Jared G Smith
- 4 Population Health Research Institute, St George's University of London, London, UK
| | - Matthew Hodes
- 5 Centre for Psychiatry, Imperial College London, London, UK.,6 CNWL NHS Foundation Trust, London, UK
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33
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Licari A, Ciprandi R, Marseglia G, Ciprandi G. Anxiety and Depression in Adolescents with Severe Asthma and in Their Parents: Preliminary Results after 1 Year of Treatment. Behav Sci (Basel) 2019; 9:bs9070078. [PMID: 31337076 PMCID: PMC6680478 DOI: 10.3390/bs9070078] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Emotional problems, such as anxiety and depression, are a relevant co-morbidity in severe asthma. Anxiety and depression may also be common in the parents of asthmatic adolescents. The current study evaluated anxious and depressive symptoms in 40 adolescents suffering from severe asthma, and in their parents, before and after 1 year of treatment, tailored according to validated asthma guidelines. We used the HADS (Hospital Anxiety Depression Scale) questionnaire for the adolescents, and HADS, STAY (State-Trait Anxiety Inventory), and BDI (Beck Depression Inventory) questionnaires for their parents. We also considered the grade of asthma severity before and after 1 year of treatment. The current study demonstrated that anxiety and depression are common in both the adolescents suffering from severe asthma and their parents. Anxious and depressive symptoms were correlated between adolescents and their parents. Asthma treatment improved the asthma severity in almost all adolescents. However, the parental anxiety and depression remained unchanged at the end of the asthma treatment. Thus, a psychological assessment could be included in the adolescent severe asthma work-up, involving both the adolescents and their parents.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | | | - Gianluigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, 16145 Genoa, Italy.
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34
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Urrutia-Pereira M, Mocellin L, de Oliveira R, Simon L, Lessa L, Solé D. Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergol Immunopathol (Madr) 2018; 46:421-430. [PMID: 29338962 DOI: 10.1016/j.aller.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Allergic diseases have become an increasingly common reality in the last years, extending beyond the family context. OBJECTIVE Assessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children's parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil. METHOD 577 individuals (PC - N=111; EST - N=177; US - N=299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis. RESULTS Although PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students. CONCLUSION Despite the high prevalence of allergic diseases in childhood, asthmatic children's parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients.
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Abstract
PURPOSE OF REVIEW This review aims to provide an update of recent advances in the epidemiology, clinical features and diagnosis, and management of food-induced anaphylaxis (FIA). RECENT FINDINGS Food allergy prevalence and FIA rates continue to rise, but FIA fatalities are stable. Basophil and mast cell activation tests promise more accurate identification of food triggers. Oral, sublingual, and epicutaneous immunotherapy can desensitize a significant portion of subjects. Epinephrine use for FIA remains sub-optimal. As the burden of food allergy continues to increase, it appears that the corresponding increase in research focused on this epidemic is beginning to bear fruit. The stable number of FIA fatalities in the face of an ongoing epidemic indicates lives have already been saved. The emergence of new diagnostic tests and interventional therapies may transform the management of FIA in the coming years.
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Affiliation(s)
- Christopher P Parrish
- Department of Pediatrics and Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9063, USA.
| | - Heidi Kim
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
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Cortes A, Castillo A, Sciaraffia A. Food allergy: Children's symptom levels are associated with mothers' psycho-socio-economic variables. J Psychosom Res 2018; 104:48-54. [PMID: 29275785 DOI: 10.1016/j.jpsychores.2017.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Allergies affect children's health as well as their quality of life, stress levels, and family budget. The available literature suggests that family, social and psychological factors are affected by allergic pathologies such as rhinitis, asthma and atopic dermatitis. However, few studies have focused on quantifying such association in child food allergy. This study aims to enhance the understanding of the associations between caregiver variables and children's Food Allergy (FA). METHODS The study involved 206 participants: 103 mothers plus 103 children with IgE mediated FA. The analyses excluded two outliers comprising 101 subjects. For statistical analyses, each dyad -mother/child- was considered to be one subject unity. A between-subjects one-way ANOVA determined the association of children's cutaneous, gastric and respiratory symptoms with anxiety, depression, perceived social support and socioeconomic factors in the mothers. RESULTS There are significant associations between children's allergic symptoms (gastric and cutaneous) and mothers' psychological state (anxiety and depression); family budget; social interactions (with friends, family and partner); understanding of health care required by their child; and sleep disorders. Respiratory symptoms did not show any significant associations with the dependent variables. CONCLUSION FA is a process in which children's symptoms are significantly associated with socioeconomic and psychological variables of the mothers. The presence or absence of some specific symptoms is directly associated with specific impacts on the mothers. An understanding of such dynamics supports the consideration of a comprehensive and multidisciplinary therapeutic approach to offer more ecological healthcare for "families living with FA."
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Affiliation(s)
- Aaron Cortes
- Departamento de Traumatología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Angela Castillo
- Sección de Medicina, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Alicia Sciaraffia
- Sección de Inmunología, VIH y Alergias, Hospital Clínico Universidad de Chile, Santiago, Chile
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Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2017; 141:41-58. [PMID: 29157945 DOI: 10.1016/j.jaci.2017.11.003] [Citation(s) in RCA: 838] [Impact Index Per Article: 119.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
Abstract
This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.
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Affiliation(s)
- 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.
| | - Hugh A Sampson
- 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
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Boyle RJ, Umasunthar T, Smith JG, Hanna H, Procktor A, Phillips K, Pinto C, Gore C, Cox HE, Warner JO, Vickers B, Hodes M. A brief psychological intervention for mothers of children with food allergy can change risk perception and reduce anxiety: Outcomes of a randomized controlled trial. Clin Exp Allergy 2017; 47:1309-1317. [DOI: 10.1111/cea.12981] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 05/12/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R. J. Boyle
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - T. Umasunthar
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. G. Smith
- Population Health Research Institute; St. George's, University of London; London UK
| | - H. Hanna
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - A. Procktor
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - K. Phillips
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Pinto
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Gore
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - H. E. Cox
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. O. Warner
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - B. Vickers
- Adolescent Assertive Outreach Team; South West London and St Georges’ Mental Health NHS Trust; London UK
| | - M. Hodes
- Imperial College Healthcare NHS Trust; London UK
- Centre for Mental Health; Imperial College London; London UK
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Ekim A, Hecan M, Oren S. Psychometric Properties of the Turkish Version of Caregiver Burden Index (CBI) for Parents of Children with Allergies. J Pediatr Nurs 2017; 35:78-82. [PMID: 28728773 DOI: 10.1016/j.pedn.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/18/2017] [Accepted: 03/18/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Childhood chronic diseases have a great impact, including physiological, social and financial burdens, on parents. The concept of "caregiver burden" is gaining importance to understand the effects of allergic diseases and plan family-centered strategies. PURPOSE The purpose of this study was to examine the psychometric properties of the Caregiver Burden Index (CBI) in Turkish mothers of children with allergies. METHOD The participants of this methodological study were 213 mothers of children with allergies between 6 and 12years. Construct validity was evaluated through factor analysis and reliability was evaluated through internal consistency and item-total correlation. RESULTS In reliability analysis, the overall Cronbach's alpha value (0.85) demonstrated a high level of reliability. The corrected item-total correlation varied between 0.63 and 0.84. In exploratory factor analysis, it was detected that 3 factors structure explained 73.6% of the total variance. CONCLUSION This study indicated that the CBI is a valid and reliable tool to assess the caregiver burden of mothers of Turkish children with allergies. IMPLICATION FOR PRACTICES The results of this study contribute to the development and implementation of evidence based models of care that address the caregiver burden needs of parents whose children have allergies.
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Affiliation(s)
- Ayfer Ekim
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey.
| | - Melis Hecan
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Serkan Oren
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
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Hanna HJ, Emmanuel J, Naim S, Umasunthar T, Boyle RJ. Community healthcare professionals overestimate the risk of fatal anaphylaxis for food allergic children. Clin Exp Allergy 2016; 46:1588-1595. [DOI: 10.1111/cea.12846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. J. Hanna
- Department of Paediatric Allergy; Imperial College London; London UK
| | - J. Emmanuel
- Department of Paediatric Allergy; Imperial College London; London UK
| | - S. Naim
- Department of Paediatric Allergy; Imperial College London; London UK
| | - T. Umasunthar
- Department of Paediatric Allergy; Imperial College London; London UK
| | - R. J. Boyle
- Department of Paediatric Allergy; Imperial College London; London UK
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Validation of the English Version of the Scale for Psychosocial Factors in Food Allergy and the Relationship with Mental Health, Quality of Life, and Self-Efficacy. J Allergy (Cairo) 2016; 2016:4850940. [PMID: 27688785 PMCID: PMC5027308 DOI: 10.1155/2016/4850940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The Scale for Psychosocial Factors in Food Allergy (SPS-FA) is based on the biopsychosocial model of health and was developed and validated in Chile to measure the interaction between psychological variables and allergy symptoms in the child. We sought to validate this scale in an English speaking population and explore its relationship with parental quality of life, self-efficacy, and mental health. Methods. Parents (n = 434) from the general population in the UK, who had a child with a clinical diagnosis of food allergy, completed the SPS-FA and validated scales on food allergy specific parental quality of life (QoL), parental self-efficacy, and general mental health. Findings. The SPS-FA had good internal consistency (alphas = .61–.86). Higher scores on the SPS-FA significantly correlated with poorer parental QoL, self-efficacy, and mental health. All predictors explained 57% of the variance in SPS-FA scores with QoL as the biggest predictor (β = .52). Discussion. The SPS-FA is a valid scale for use in the UK and provides a holistic view of the impact of food allergy on the family. In conjunction with health-related QoL measures, it can be used by health care practitioners to target care for patients and evaluate psychological interventions for improvement of food allergy management.
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Lozoya-Ibáñez C, Morgado-Nunes S, Rodrigues A, Lobo C, Taborda-Barata L. Prevalence and clinical features of adverse food reactions in Portuguese adults. Allergy Asthma Clin Immunol 2016; 12:36. [PMID: 27499765 PMCID: PMC4975906 DOI: 10.1186/s13223-016-0139-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/13/2016] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Only one previous study, via telephone call, on the prevalence of self-reported food allergies has been performed in Portugal, in a small sample of adults. The objective of this study was to determine the prevalence of self-reported and probable food allergy, analyze the clinical features and involved foods in Portuguese adults. METHODS Population-based, cross-sectional study performed in various healthcare centres from central Portugal. All 1436 randomly selected individuals (median age: 45 years, 50.6 % female) replied to a validated food allergy questionnaire by phone. Those who reported an adverse food reaction were invited to come to the hospital, where clinical history was taken, skin prick (SPT) and prick-prick skin (SPPT) tests were performed and food allergen-specific IgE levels (sIgE) were determined. An open oral challenge was performed in selected cases. Cases of positive clinical history of immediate (up to 2 h after ingestion) reaction in association with positive food sIgE levels and/or skin prick tests were classified as IgE-associated probable food allergy. Cases of positive clinical history of delayed (more than 2 h after ingestion) and negative food sIgE levels independently of positive SPT or SPPT results were classified as non-IgE associated probable food allergy. RESULTS The prevalence of probable food allergy in our sample was 1 %, with shellfish and fish as the most frequently implicated foods. IgE-mediated probable food allergy occurred in 0.71 % of cases, with shellfish, peanut and nuts mainly involved. Cutaneous symptoms were most frequently reported. Prevalence values and food types were discrepant between self-reported and probable food allergies. CONCLUSIONS The prevalence of probable food allergies in Portuguese adults is low, is mostly related to shellfish, peanut and nuts and most frequently involves cutaneous symptoms.
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Affiliation(s)
- Carlos Lozoya-Ibáñez
- Castelo Branco Local Health Unit, Allergy Department, Castelo Branco, Portugal ; Faculty of Health Sciences, CICS-Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Sara Morgado-Nunes
- Polytechnic Institute of Castelo Branco, Escola Superior de Gestão, Castelo Branco, Portugal
| | - Alexandra Rodrigues
- Castelo Branco Local Health Unit, Outpatient Department, Castelo Branco, Portugal
| | - Cláudia Lobo
- Faculty of Health Sciences, CICS-Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal ; Castelo Branco Local Health Unit, Clinical Pathology Department, Castelo Branco, Portugal
| | - Luis Taborda-Barata
- Faculty of Health Sciences, CICS-Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal ; Department of Allergy and Clinical Immunology, Cova da Beira Hospital Centre, Covilhã, Portugal
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Quality of Life, Stress, and Mental Health in Parents of Children with Parentally Diagnosed Food Allergy Compared to Medically Diagnosed and Healthy Controls. J Allergy (Cairo) 2016; 2016:1497375. [PMID: 27429624 PMCID: PMC4939330 DOI: 10.1155/2016/1497375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/14/2016] [Accepted: 06/02/2016] [Indexed: 12/02/2022] Open
Abstract
Background. Food allergy is related to poorer quality of life (QoL) and mental health of caregivers. Many parents diagnose food allergy in their child without seeking medical care and there is limited research on this group. This study investigated parental QoL and mental health in parents of children with parent-diagnosed food allergy (PA), medically diagnosed food allergy (MA), and a control group with no allergy (NA). Methods. One hundred and fifty parents from a general population completed validated measures of QoL, anxiety, depression, and stress. Results. Parents of children with food allergy (PA or MA) reported higher stress, anxiety, and depression than the control group (all p < 0.05). Parents of children with MA reported poorer food allergy related QoL compared to parents of children with PA (p < 0.05); parents of children with PA reported poorer general QoL compared to parents of children with MA (p < 0.05). Conclusion. Parents of children with food allergy have significantly poorer mental health compared to healthy controls, irrespective of whether food allergy is medically diagnosed or not. It is important to encourage parents to have their child medically tested for food allergy and to recognise and refer for psychological support where needed.
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Fedele DA, McQuaid EL, Faino A, Strand M, Cohen S, Robinson J, Atkins D, Hourihane JO, Klinnert MD. Patterns of adaptation to children's food allergies. Allergy 2016; 71:505-13. [PMID: 26687298 DOI: 10.1111/all.12825] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Families with food allergy (FA) are at risk of reduced quality of life and elevated anxiety. A moderate level of anxiety may be beneficial to sustain vigilance for food avoidance; however, excessive anxiety may increase risk for burden and maladjustment. The current study presents a framework for understanding the patterns of adaptation to FA across families and to identify typologies of families that would benefit from intervention. METHODS Participants included 57 children, 6-12 years old with documented FA, and their mothers. Families were assessed using the Food Allergy Management and Adaptation Scale. Families also completed measures of quality of life, anxiety, FA management, and psychosocial impairment. RESULTS A hierarchical cluster analysis revealed that 56 of the 57 families of food-allergic children were categorized into four groups that differed on their adequacy of family FA management, levels of anxiety, and balanced psychosocial functioning: balanced responders (n = 23; 41%), high responders (n = 25; 45%), and low responders (n = 3; 5%). The fourth group, anxious high responders (n = 5; 9%), was characterized by extremely high maternal FA anxiety scores and low scores for balanced integration of FA management and psychosocial functioning. Families in clusters differed across illness and psychosocial outcome variables. CONCLUSION Families with FA were characterized by patterns of FA management, anxiety, and ability to integrate FA demands into daily life. Identified adaptation patterns correspond with clinical impressions and provide a framework for identifying families in need of intervention.
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Affiliation(s)
| | - E. L. McQuaid
- Bradley/Hasbro Children's Research Center; Brown University; Providence RI USA
| | - A. Faino
- National Jewish Health; Denver CO USA
| | - M. Strand
- National Jewish Health; Denver CO USA
| | - S. Cohen
- National Jewish Health; Denver CO USA
| | - J. Robinson
- National Jewish Health; Denver CO USA
- University of Colorado School of Medicine; Aurora CO USA
| | - D. Atkins
- National Jewish Health; Denver CO USA
- University of Colorado School of Medicine; Aurora CO USA
| | | | - M. D. Klinnert
- National Jewish Health; Denver CO USA
- University of Colorado School of Medicine; Aurora CO USA
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Vazquez-Ortiz M, Turner PJ. Improving the safety of oral immunotherapy for food allergy. Pediatr Allergy Immunol 2016; 27:117-25. [PMID: 26593873 PMCID: PMC4950028 DOI: 10.1111/pai.12510] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 12/11/2022]
Abstract
Food allergy is a major public health problem in children, impacting upon the affected individual, their families and others charged with their care, for example educational establishments, and the food industry. In contrast to most other paediatric diseases, there is no established cure: current management is based upon dietary avoidance and the provision of rescue medication in the event of accidental reactions, which are common. This strategy has significant limitations and impacts adversely on health-related quality of life. In the last decade, research into disease-modifying treatments for food allergy has emerged, predominantly for peanut, egg and cow's milk. Most studies have used the oral route (oral immunotherapy, OIT), in which increasing amounts of allergen are given over weeks-months. OIT has proven effective to induce immune modulation and 'desensitization' - that is, an increase in the amount of food allergen that can be consumed, so long as regular (typically daily) doses are continued. However, its ability to induce permanent tolerance once ongoing exposure has stopped seems limited. Additionally, the short- and long-term safety of OIT is often poorly reported, raising concerns about its implementation in routine practice. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Long-term adherence is unclear, which rises concerns given the low rates of long-term tolerance induction. Current research focuses on improving current limitations, especially safety. Strategies include alternative routes (sublingual, epicutaneous), modified hypoallergenic products and adjuvants (anti-IgE, pre-/probiotics). Biomarkers of safe/successful OIT are also under investigation.
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Affiliation(s)
| | - Paul J Turner
- Section of Paediatrics, Imperial College London, London, UK.,Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, NSW, Australia
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Sánchez-García S, Cipriani F, Ricci G. Food Allergy in childhood: phenotypes, prevention and treatment. Pediatr Allergy Immunol 2015; 26:711-20. [PMID: 26595763 DOI: 10.1111/pai.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
The prevalence of food allergy in childhood increased in the last decades, especially in Westernized countries where this phenomenon has been indicated as a second wave of the allergic epidemic. In parallel, scientific interest also increased with the effort to explain the reasons of this sudden rise and to identify potential protective and risk factors. A great attention has been focused on early exposures to allergenic foods, as well as on other nutritional factors or supplements that may influence the immune system in a positive direction. Both interventions on maternal diet before birth or during breastfeeding and then directly on infant nutrition have been investigated. Furthermore, the natural history of food allergy also seems to be changing over time; IgE-mediated cow's milk allergy and egg allergy seem to be more frequently a persistent rather than a transient disease in childhood, as described in the last years. Food avoidance and the emergency drugs in case of an adverse event, such as epinephrine self-injector, are currently the first-line treatment in patients with food allergies, with a resulting impairment in the quality of life and social behaviour. During the last decade, oral immunotherapy emerged as an optional treatment with remarkable results, offering a novel perspective in the treatment for and management of food allergy.
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Affiliation(s)
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Tsoumani M, Sharma V, Papadopoulos NG. Food-Induced Anaphylaxis Year in Review. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Parental Perception, Prevalence and Primary Care Physicians' Knowledge on Childhood Food Allergy in Croatia. CHILDREN-BASEL 2015; 2:305-16. [PMID: 27417365 PMCID: PMC4928769 DOI: 10.3390/children2030305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022]
Abstract
Food allergy in children is increasing and the perception of food allergy among parents is even more common. In a questionnaire-based study of 702 children aged 6 to 48 months in four primary care settings, the aim was to determine the prevalence of perception vs. proven food allergy, parental anxiety and general pediatrician knowledge of food allergy. In 95/702 children (13.5%) parentally-reported food was associated reactions. IgE and/or skin prick test (SPT) and/or an open provocation test were performed in 48 (6.8%) and allergy was proven in 38 (5.4%) children. Discrepancy between parental perception and proven allergy is significant (p < 0.001), especially for food other than milk, egg and peanut (p < 0.001). Allergy to milk was the most common. Allergy to peanut was significantly more common in children ≥2 years (p < 0.05). Severe reactions occurred in 5/95 (5.2%) of all children and in 5/38 (13.1%) of allergic children, in 3/5 caused by peanut. Parents of children with proven allergy do not experience high degree of anxiety. The perception of food allergy among general pediatricians is limited, and in children with severe reactions precautionary measures and information to parents were insufficient. Parents and general pediatricians need additional education in food allergy.
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Allen CW, Bidarkar MS, vanNunen SA, Campbell DE. Factors impacting parental burden in food-allergic children. J Paediatr Child Health 2015; 51:696-8. [PMID: 25594910 DOI: 10.1111/jpc.12794] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
AIM This study aims to determine factors impacting the parental burden in immunoglobulin E (IgE)-mediated food-allergic children (FAC), focusing on attitudes towards adrenaline autoinjectors (AAIs). METHODS Questionnaires were sent to parents of diagnosed IgE-mediated FAC attending follow-up allergy clinic appointments at two Sydney hospitals in May-September 2013. The questionnaires ascertained parental attitudes, confidence and knowledge regarding AAIs and included the validated, Food Allergy Quality of Life-Parental Burden (FAQL-PB) questionnaire. RESULTS The response rate was 68%. Of FAC, 62% were male aged 1-17 years (median 6.0). There was a high proportion of children with multiple food allergies (52% allergic to >2 foods), coexistant eczema (85%) and asthma (54%). Sixty-three per cent reported a past history of anaphylaxis and 42% reported reactions in the last 6 months. AAI had been prescribed for 84%. FAC with a history of anaphylaxis were more likely to have had an AAI prescribed (P < 0.0001). There was no difference in FAQL-PB mean scores with age or AAI prescription status. The PB score was greater if the parent had administered the AAI (P = 0.02) and where the child was allergic to >2 foods (P < 0.0001).The Ninety per cent of parents reported that the AAI increased or did not change the child's quality of life, the family or FACs freedom. Three per cent of parents whose FAC children were prescribed an AAI reported increased stress related to AAI prescription. CONCLUSION Severity of food allergy, number of food allergens and past anaphylaxis rather than prescription of an AAI appear to be major influences on parental burden.
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Affiliation(s)
- Clare W Allen
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Manasee S Bidarkar
- Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sheryl A vanNunen
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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Benoit J, Berdah L, Carlier-Gonod A, Guillou T, Kouche C, Patte M, Schneider M, Talcone S, Chappuy H. [Ethics in pediatric emergencies: Care access, communication, and confidentiality]. Arch Pediatr 2015; 22:554-61. [PMID: 25840466 DOI: 10.1016/j.arcped.2015.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/18/2014] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality.
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Affiliation(s)
- J Benoit
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - L Berdah
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - A Carlier-Gonod
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - T Guillou
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - C Kouche
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - M Patte
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - M Schneider
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - S Talcone
- Groupe symposium d'Automne 2014 du DES de pédiatrie d'Île-de-France, France
| | - H Chappuy
- Urgences pédiatriques, université Pierre-et-Marie-Curie, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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