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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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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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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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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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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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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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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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8
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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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9
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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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10
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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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11
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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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12
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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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13
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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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Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, Pumphrey R, Boyle RJ. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol 2014; 135:956-963.e1. [PMID: 25468198 PMCID: PMC4382330 DOI: 10.1016/j.jaci.2014.10.021] [Citation(s) in RCA: 436] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/03/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022]
Abstract
Background The incidence of anaphylaxis might be increasing. Data for fatal anaphylaxis are limited because of the rarity of this outcome. Objective We sought to document trends in anaphylaxis admissions and fatalities by age, sex, and cause in England and Wales over a 20-year period. Methods We extracted data from national databases that record hospital admissions and fatalities caused by anaphylaxis in England and Wales (1992-2012) and crosschecked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal anaphylaxis caused by food, drugs, and insect stings. Results Hospital admissions from all-cause anaphylaxis increased by 615% over the time period studied, but annual fatality rates remained stable at 0.047 cases (95% CI, 0.042-0.052 cases) per 100,000 population. Admission and fatality rates for drug- and insect sting–induced anaphylaxis were highest in the group aged 60 years and older. In contrast, admissions because of food-triggered anaphylaxis were most common in young people, with a marked peak in the incidence of fatal food reactions during the second and third decades of life. These findings are not explained by age-related differences in rates of hospitalization. Conclusions Hospitalizations for anaphylaxis increased between 1992 and 2012, but the incidence of fatal anaphylaxis did not. This might be due to increasing awareness of the diagnosis, shifting patterns of behavior in patients and health care providers, or both. The age distribution of fatal anaphylaxis varies significantly according to the nature of the eliciting agent, which suggests a specific vulnerability to severe outcomes from food-induced allergic reactions in the second and third decades.
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Affiliation(s)
- Paul J Turner
- Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Division of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
| | - M Hazel Gowland
- Allergy Action & Anaphylaxis Campaign UK, Farnborough, United Kingdom
| | - Vibha Sharma
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Despo Ierodiakonou
- Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Nigel Harper
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Tomaz Garcez
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Pumphrey
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Robert J Boyle
- Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
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