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Anderson RP, Verma R, Schumann M. A Look Into the Future: Are We Ready for an Approved Therapy in Celiac Disease? Gastroenterology 2024:S0016-5085(24)00167-7. [PMID: 38355059 DOI: 10.1053/j.gastro.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
As it appears that we are currently at the cusp of an era in which drugs that are new, re-purposed, or "supplements" will be introduced to the management of celiac disease, we need to reflect on whether the framework is set for celiac disease to be treated increasingly with pharmaceuticals as well as diet. This refers to reflecting on the rigor of current diagnostic practices; the limitations of the current standard of care, which is a gluten-free diet; and that we lack objective markers of disease severity. Investigating these issues will help us to identify gaps in technology and practices that could be critical for selecting patients with a well-defined need for an improved or alternative treatment. Both aspects, circumscribed limitations of the gluten-free diet and diagnostics helping to define celiac disease target groups, together with the guiding requirements by the responsible regulatory authorities, will contribute to defining the subgroups of patients with confirmed celiac disease eligible for distinct pharmacologic strategies. Because many patients with celiac disease are diagnosed in childhood, these aspects need to be differentially discussed for the pediatric setting. In this perspective, we aimed to describe these contextual issues and then looked ahead to the future. What might be the major challenges in celiac disease clinics in the coming years once drugs are an option alongside diet? And what will be the future objectives for researchers who further decipher the mucosal immunology of celiac disease? Speculating on the answers to these questions is as stimulating as it is fascinating to be part of this turning point.
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Affiliation(s)
- Robert P Anderson
- Gastroenterology Service, Mackay Base Hospital, West Mackay, Queensland, Australia
| | - Ritu Verma
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | - Michael Schumann
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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2
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Rosser SA, Lloyd M, Hu A, Loke P, Tang MLK. Associations between gender and health-related quality of life in people with IgE-mediated food allergy and their caregivers: A systematic review. Clin Exp Allergy 2024; 54:93-108. [PMID: 38321912 DOI: 10.1111/cea.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Understanding factors that impact health-related quality of life (HRQL) is essential to inform personalised food allergy management. However, there are inconsistencies about the impact of gender on HRQL in food allergy. This review aimed to collate all investigations of the association between gender and total or subdomain HRQL scores of individuals with food allergy and their caregivers. DESIGN This is a narrative systematic review. We descriptively synthesised and compared HRQL outcomes by participant and parent genders according to statistical and clinical significance. Study quality was assessed using the ROBINS-I, inclusive of all domains. Sensitivity analysis of non-interventional studies was conducted using the ROBINS-E. DATA SOURCES A systematic search of Medline and Embase databases was conducted on 4 April 2022 and updated on 5 December 2023. ELIGIBILITY CRITERIA Studies were eligible for inclusion if they reported original data on the association between any sex and/or gender and HRQL, as measured with any validated instrument, in populations with IgE-mediated food allergy. Interventional and non-interventional studies were eligible. RESULTS A comparison of 34 eligible studies (10 interventional and 24 non-interventional) indicated females with food allergy (62.5% of studies of children, 83.3% of studies of adults) and mothers of children with food allergy (50% of studies of caregivers) experienced poorer self-reported baseline HRQL than their counterparts, notably in domains of physical, emotional or food anxiety-related well-being. Gender differences in child HRQL after food allergen immunotherapy were observed. However, selective reporting in included interventional studies meant the direction of this association could not be determined. The proxy-reported total HRQL of participants was not affected by caregiver gender, nor was caregiver HRQL likely impacted by child gender. CONCLUSIONS Gender should be considered an important modifier of participant HRQL outcomes in food allergy studies. Purposeful exploration of HRQL in all genders is needed to fully understand the implications of this construct on the lived experience of food allergy. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022329901).
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Affiliation(s)
- Sophie A Rosser
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia
| | - Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Alice Hu
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Victoria, Australia
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3
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Anagnostou A, Rodríguez Del Río P. Food Immunotherapy: Dissecting Current Guidelines and Navigating the Gray Zone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3040-3046. [PMID: 37391019 DOI: 10.1016/j.jaip.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
Food allergy is a common, chronic disease that is burdensome for patients and families, with multiple dietary and social limitations and a significant psychological impact stemming from the fear of accidental exposures and potentially severe, life-threatening reactions. Until recently, the only management option consisted of strict food avoidance. Food allergen immunotherapy (food AIT) has emerged as an alternative, active intervention to strict food avoidance, with a multitude of research studies supporting its efficacy and good safety profile. Food AIT results in a raise of allergenic threshold, which provides several benefits to food-allergic patients, including protection from accidental exposures, potentially decreased severity of allergic reactions on unintentional exposures, and improvement in quality of life. In the last few years, multiple independent reports have been published proposing strategies to implement food oral immunotherapy in U.S. clinics, although formal guidelines are currently lacking. Because food immunotherapy is gaining traction, popularity, and interest among both patients and health care providers, many physicians look for guidance on how to implement this intervention in their daily practice. In other parts of the world, use of this treatment has prompted the development of various guidelines from allergy societies. This rostrum discusses currently available guidelines on food AIT from different areas of the world, describes and comments on their similarities and differences, and highlights unmet needs in this area of therapy.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Pablo Rodríguez Del Río
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; IIS La Princesa, Madrid, Spain
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4
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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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5
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Kaman K, Dhodapkar M, Shabanova V, McCollum S, Factor J, Leeds S. Validated anxiety assessments among pediatric patients with peanut allergy on oral immunotherapy. Ann Allergy Asthma Immunol 2023; 130:657-663. [PMID: 36738780 DOI: 10.1016/j.anai.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although efficacy, safety, and quality of life measures associated with peanut oral immunotherapy (OIT) have been studied, the relationship between peanut OIT and clinical anxiety has not yet been evaluated. The latter is important to help providers and families have an improved shared medical decision discussion around the benefits of initiating OIT. OBJECTIVE To investigate the relationship between undergoing OIT and anxiety in patients with peanut allergy. METHODS In this prospective cross-sectional cohort study, using validated and age-appropriate anxiety scales administered with electronic survey questionnaires, we used generalized linear regressions to compare anxiety between patients undergoing OIT and similar patients with peanut allergy but not on OIT (controls). RESULTS In the younger cohort (<7 years, n = 80), there was generally a low prevalence of diagnosable anxiety across patients on OIT and controls. In the older cohort (>7 years, n = 125), there was a higher prevalence of anxiety but no clinically meaningful difference between anxiety scores of patients on OIT and controls. In the older cohort, patients with asthma were more likely to have higher mean anxiety scores (P = .04), as were female patients compared with male patients (P = .004). A subanalysis of separation anxiety scores in the older cohort revealed that younger age (7-12 years vs >12 years, P < .001), non-White race (P = .04), and eczema (P = .02) were found to be meaningful predictors of higher scores. A subanalysis of social anxiety on the older cohort pointed toward non-White race as a meaningful predictor of higher scores (P < .02). CONCLUSION The clinical implications of these findings suggest that allergists should particularly consider screening children with food allergy for anxiety and anxiety subtypes among patients who are non-White, female, or have asthma.
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Affiliation(s)
- Kelsey Kaman
- Connecticut Asthma and Allergy Center, West Hartford, Connecticut.
| | | | | | | | - Jeffrey Factor
- Connecticut Asthma and Allergy Center, West Hartford, Connecticut; New England Food Allergy Treatment Center, West Hartford, Connecticut
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6
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Proctor KB, Tison K, Estrem H, Park J, Scahill L, Vickery BP, Sharp WG. A systematic review of parent report measures assessing the psychosocial impact of food allergy on patients and families. Allergy 2022; 77:1347-1359. [PMID: 34647344 DOI: 10.1111/all.15140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/10/2021] [Accepted: 10/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reducing the psychosocial impact of food allergy (FA) represents a top patient-centered research priority. This priority recognizes that psychosocial impact is an important outcome of current FA therapies (eg, oral immunotherapy), as well as interventions aimed at improving overall quality of life and illness adaptation. Reliable and valid measurement is a necessary prerequisite to developing and evaluating current and emerging FA therapies and potential changes in psychosocial impact. METHODS In this systematic review, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate available parent report measures assessing the psychosocial impact of pediatric IgE-mediated FA. RESULTS The systematic search yielded 64 articles involving 13 unique measures. Measures were evaluated through the lens of the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines. Findings indicated that available measures show some evidence of reliability and validity; however, none completely adhere to PROMIS guidelines for measure development. CONCLUSION Results highlight a continued need to dedicate research to develop a measurement approach that assesses the full range of psychosocial impact that parents and families may experience as a result of FA, as well as serve as a research outcome as the field continues to develop effective treatments, including immunotherapy.
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Affiliation(s)
| | | | - Hayley Estrem
- University of North Carolina Wilmington Wilmington NC USA
| | | | - Lawrence Scahill
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
| | - Brian P. Vickery
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
| | - William G. Sharp
- Children’s Healthcare of Atlanta Atlanta GA USA
- Emory University Atlanta GA USA
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7
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Akarsu A, Brindisi G, Fiocchi A, Zicari AM, Arasi S. Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective. Front Pediatr 2022; 10:842196. [PMID: 35273931 PMCID: PMC8901728 DOI: 10.3389/fped.2022.842196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.
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Affiliation(s)
- Aysegul Akarsu
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Giulia Brindisi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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8
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Mori F, Giovannini M, Barni S, Jiménez-Saiz R, Munblit D, Biagioni B, Liccioli G, Sarti L, Liotti L, Ricci S, Novembre E, Sahiner U, Baldo E, Caimmi D. Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate. Front Immunol 2021; 12:636612. [PMID: 34650547 PMCID: PMC8507468 DOI: 10.3389/fimmu.2021.636612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Rodrigo Jiménez-Saiz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain.,Department of Immunology & Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain.,Faculty of Experimental Sciences, Universidad Francisco de Vitoria (UFV), Madrid, Spain.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Benedetta Biagioni
- Allergy Outpatient Clinic, Division of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy
| | - Giulia Liccioli
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti Ancona, Ancona, Italy
| | - Silvia Ricci
- Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Umit Sahiner
- Department of Pediatric Allergy, Hacettepe University, Ankara, Turkey
| | - Ermanno Baldo
- "Giovan Battista Mattei" Research Institute, Stenico, Italy
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Univ Montpellier, Montpellier, France.,IDESP, UA11, INSERM-Univ Montpellier, Montpellier, France
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9
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Brough HA, Gourgey R, Radulovic S, Caubet JC, Lack G, Anagnostou A. Latest Developments in the Management of Nut Allergies. CURRENT TREATMENT OPTIONS IN ALLERGY 2021; 8:97-110. [PMID: 34150446 PMCID: PMC8203721 DOI: 10.1007/s40521-021-00290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length and administration devices have been recently debated considering the risk of bone penetration vs subcutaneous administration, and autoinjectors seem to deliver higher peak concentrations than syringes. Selective nut introduction has gained momentum in the last 5 years, demonstrating improved quality of life but with the need for motivated parents for continued consumption and available resources for challenges. Immunotherapy to nuts is also a rapidly developing field, with the balance of efficacy and safety being important considerations in the differing modes of administration. Summary The management of nut allergies is a rapidly developing field, and dietary and medical management have progressed significantly in the last 5 years. Future research directions include improving safety and efficacy of food immunotherapy and examining patients’ goals for therapy and treatment outcomes.
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Affiliation(s)
- H A Brough
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - R Gourgey
- Department of Paediatric Allergy, The Royal London Children's Hospital, Barts Health NHS Trust, E1 1FR, London, UK
| | - S Radulovic
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - J C Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé, Geneva, Switzerland
| | - G Lack
- Paediatric Allergy Group, Department Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Paediatric Allergy Group, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, 2nd Floor, Stairwell B, South Wing, Westminster Bridge Rd, London, SE1 7EH UK
| | - A Anagnostou
- Section of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, TX USA.,Department of Pediatrics, Section of Allergy, Immunology and Retrovirology, Texas Children's Hospital, Houston, TX USA
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10
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Cao S, Borro M, Alonzi S, Sindher S, Nadeau K, Chinthrajah RS. Improvement in Health-Related Quality of Life in Food-Allergic Patients: A Meta-analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3705-3714. [PMID: 34089927 DOI: 10.1016/j.jaip.2021.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Food allergy (FA) is a growing global problem that can affect patients' health-related quality of life (HRQoL) owing to increased anxiety as well as social and economic restrictions. Interventions such as oral food challenges (OFCs) and oral immunotherapy (OIT) have been shown to improve HRQoL. However, meta-analyses and systematic synthesis of these data are lacking. OBJECTIVE To review and quantitatively synthesize potential benefits of interventions (OIT and OFC) systematically to address FA to a variety of foods. METHODS We conducted a systematic search through PubMed and Cochrane Medical Library databases and performed a meta-analysis focusing on studies assessing changes in HRQoL after OIT and/or OFCs in FA participants and caregivers from 2010 to July 2020. Random effects model and I2 statistics were used to assess overall intervention effects and heterogeneity across studies. RESULTS We included 13 publications in this meta-analysis (OIT = 7; OFCs = 6). Mean change in HRQoL scores after OIT and OFCs was -1.25 (P < .001) and -0.78 (P = .052), with a significant I2 of 87% (P < .001) and 90% (P < .001), respectively. Five OIT studies found significant improvements in HRQoL in the OIT group compared with the placebo group, with an overall standardized mean difference of -0.56 (P = .007; I2 = 42%, P = .099). CONCLUSIONS This meta-analysis showed that in FA patients, both OIT and OFCs are associated with an improvement in HRQoL. Well-designed and long-term HRQoL studies are necessary to ascertain sustained benefits of OIT and OFCs.
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Affiliation(s)
- Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif
| | - Matteo Borro
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine, San Paolo Hospital, Savona, Italy
| | - Sarah Alonzi
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Department of Psychology, Loyola University, New Orleans, La
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, Calif.
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11
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Anagnostou A. A Practical, Stepwise Approach to Peanut Oral Immunotherapy in Clinical Practice: Benefits and Risks. J Asthma Allergy 2021; 14:277-285. [PMID: 33790583 PMCID: PMC8006756 DOI: 10.2147/jaa.s290915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Food allergies are common, affecting 6–8% of the children in the United States. There is a significant burden on the quality of life of allergic children and their caregivers, due to multiple dietary, social and psychological restrictions. Peanut allergy affects approximately 2–5% of the school-age children. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposures and the fear of accidental ingestions potentially resulting in anaphylaxis and death, which creates a lot of anxiety in peanut-allergic individuals. Peanut oral immunotherapy (POIT) has emerged as a form of active treatment and has shown high efficacy in research trials with the majority of participants achieving desensitization and protection from trace exposures. An improved quality of life has also been noted following successful POIT. The risks of POIT should be balanced against the benefits resulting from successful treatment for each individual. Rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy, but most subjects will experience mild or moderate reactions during treatment. The landscape of peanut allergy management is changing and the future offers more options for patients than were previously available. Shared decision-making, which is the process of how to choose between different available options, becomes an ongoing discussion between the clinician and the patient, which will ensure achievement of the best possible outcome for the peanut-allergic child. This is a multistep process that evaluates the benefits and risks of therapy or no therapy, as well as patient and family preferences and we review it in detail in this manuscript with the aim to provide clinicians with a practical approach.
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Affiliation(s)
- Aikaterini Anagnostou
- Baylor College of Medicine, Section of Pediatric Immunology, Allergy and Rheumatology, Houston, TX, USA.,Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Houston, TX, USA
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12
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Anagnostou A. Weighing the benefits and risks of oral immunotherapy in clinical practice. Allergy Asthma Proc 2021; 42:118-123. [PMID: 33685555 DOI: 10.2500/aap.2021.42.200107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Food allergies are common and affect 6-8% of children in the United States; they pose a significant burden on the quality of life of children with allergy and their caregivers due to multiple daily restrictions. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposure to the allergenic food trigger. Fear of accidental ingestions with potentially severe reactions, including anaphylaxis and death, creates anxiety in individuals with food allergy. Oral immunotherapy has emerged as a form of active and potentially disease-modifying treatment for common food allergies encountered in childhood. The efficacy of oral immunotherapy is high, with the majority of participants achieving desensitization and, as a result, protection from trace exposures and improved quality of life. The main risk of oral immunotherapy consists of allergic reactions to treatment. In general, rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy options, but most subjects who undergo oral immunotherapy will likely experience mild or moderate reactions during treatment. Adverse events tend to reduce in both frequency and number in the maintenance period. The use of immune modulators alongside oral immunotherapy has been suggested, with the aim to improve efficacy and safety, and to facilitate the overall process. It is evident that the landscape of food allergy management is changing and that the future looks brighter, with different options emerging over time. The process of how to choose the appropriate option becomes a discussion between the clinician and the patient, which involves a joint review of the current medical evidence but also the patient's preference for balancing particular attributes of the treatment. By working together, providers and patients will ensure achievement of the best possible outcome for children with food allergies.
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Affiliation(s)
- Aikaterini Anagnostou
- From the Section of Pediatric Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, and
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13
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The Peanut Allergy Burden Study: Impact on the quality of life of patients and caregivers. World Allergy Organ J 2021; 14:100512. [PMID: 33664934 PMCID: PMC7898168 DOI: 10.1016/j.waojou.2021.100512] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 02/04/2023] Open
Abstract
Background Peanut allergy (PA) places significant burden on peanut-allergic individuals and their families, yet limited research in the United States has quantitatively examined the impact on peanut-allergic individuals and their families' health-related quality of life (HRQoL). The Peanut Allergy Burden Study (PABS) aimed to quantify the impact of PA on the general and disease-specific HRQoL of children, adolescents, and adults with PA, as well as caregivers of children with PA. Methods A cross-sectional survey design was employed to examine the real-world impact of PA in children, adolescents, and adults with PA, and caregivers of children with PA. Results Of 153 adult patients, 102 adolescents, and 382 caregivers of peanut-allergic children (n = 382), 6.8% and 24.8% of participants indicated being dissatisfied or somewhat dissatisfied, respectively, with current approaches to avoid or prevent PA reactions. Approximately two-thirds of patients and caregivers indicated that PA interferes at least somewhat with daily living. In terms of general HRQoL, adolescents, adult patients, and caregivers indicated that mental/psychosocial health was more problematic than physical health. PA patients and caregivers indicated worse HRQoL in all domains compared to healthy samples, and worse overall HRQoL, psychosocial, emotional, and social functioning than a sample of chronically ill patients. Results from the allergy-specific HRQoL measures showed that adolescents experienced greater impairment in overall HRQoL due to PA and in allergen avoidance and dietary restriction than adults. Conclusion PA negatively affects the general and PA-specific HRQoL of both patients and caregivers. The high emotional and psychosocial burden, in particular, demonstrates significant unmet need for patients with PA and their caregivers. Future work on treatment and preventive options to improve HRQoL for PA patients, particularly adolescents and their families, is needed.
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14
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Anagnostou A. Food immunotherapy: Choosing wisely. Clin Exp Allergy 2020; 51:9-13. [PMID: 32970897 DOI: 10.1111/cea.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
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Blackman AC, Staggers KA, Kronisch L, Davis CM, Anagnostou A. Quality of life improves significantly after real-world oral immunotherapy for children with peanut allergy. Ann Allergy Asthma Immunol 2020; 125:196-201.e1. [PMID: 32278075 DOI: 10.1016/j.anai.2020.03.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peanut oral immunotherapy (POIT) is a novel and active form of treatment for patients with peanut allergy, with multiple research studies supporting its efficacy and safety. However, there are limited data available on changes in patients' quality of life (QoL) after successful desensitization. The Food and Drug Administration in the United States recently approved the first POIT drug for commercial use. OBJECTIVE To evaluate the QoL of patients with peanut allergy receiving POIT in a real-world academic setting. METHODS Twenty-one patients aged 4 to 17 years with a physician-established diagnosis of peanut allergy were offered POIT. Quality-of-life scores were assessed with the use of a validated Food Allergy Quality of Life questionnaire. Changes in quality-of-life scores were measured for each patient before and after POIT. The Wilcoxon signed-rank test was used to compare the distributions of scores before and after therapy. RESULTS We noted a statistically significant drop (reflecting improvement in the QoL) in the overall Food Allergy Quality of Life score (median 3.70 vs 2.97, P = .049) between baseline and successful desensitization to 300-mg peanut protein. In addition, the Social and Dietary Limitations subscale score (median 4.33 vs 2.89, P = .02) and the Food Allergy Independent Measure score (median 3.17 vs 2.22, P = .001) also improved significantly after therapy. CONCLUSION We report a significant improvement in the overall QoL before and after POIT treatment, with fewer concerns about accidental exposures and severity of allergic reactions as well as fewer limitations in dietary choices and social interactions.
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Affiliation(s)
- Andrea C Blackman
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Lauren Kronisch
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Carla M Davis
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
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16
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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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Eiwegger T, Anagnostou K, Arasi S, Bégin P, Ben-Shoshan M, Beyer K, Blumchen K, Brough H, Caubet JC, Chan ES, Chinthrajah S, Davis CM, Roches AD, Du Toit G, Elizur A, Galli SJ, Håland G, Hoffmann-Sommergruber K, Kim H, Leung DYM, Muraro A, Nurmatov UB, Pajno GB, Sindher S, Szepfalusi Z, Torres MJ, Upton J, Worm M, Nadeau K. ICER report for peanut OIT comes up short. Ann Allergy Asthma Immunol 2019; 123:430-432. [PMID: 31513908 DOI: 10.1016/j.anai.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Thomas Eiwegger
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Research Institute, The Hospital for Sick Children, Translational Medicine, Toronto, Canada; Department of Immunology, The University of Toronto, Toronto, Canada
| | - Katherine Anagnostou
- Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Stefania Arasi
- Department of Pediatric Medicine, Pediatric Allergology Unit, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Philippe Bégin
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada; Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helen Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Carla M Davis
- Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Anne Des Roches
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Arnon Elizur
- The Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center and Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Department of Pathology and Department of Microbiology and Immunology, Stanford University, Stanford, California
| | - Geir Håland
- Department of Paediatric Allergy and Pulmonology, Oslo University Hospital, Oslo, Norway
| | | | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, and the Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colorado
| | - Antonella Muraro
- Food Allergy Centre -Veneto Region, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, The National Centre for Population Health and Wellbeing Research, Wales, United Kingdom
| | - Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Zsolt Szepfalusi
- Division of Ped. Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolecent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Jose Torres
- Allergy Unit, National Network ARADyAL, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Germany
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA; Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA; Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California.
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18
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Pajno GB, Castagnoli R, Muraro A, Alvaro-Lozano M, Akdis CA, Akdis M, Arasi S. Allergen immunotherapy for IgE-mediated food allergy: There is a measure in everything to a proper proportion of therapy. Pediatr Allergy Immunol 2019; 30:415-422. [PMID: 30770574 DOI: 10.1111/pai.13042] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/30/2022]
Abstract
IgE-mediated food allergy (FA) is a potentially life-threatening condition with a negative impact on quality of life and an increasing prevalence in westernized countries in the recent two decades. A strict avoidance of the triggering food(s) represents the current standard approach. However, an elimination diet may be difficult and frustrating, in particular for common foods, (eg, milk, egg, and peanut). Food allergy immunotherapy (FA-AIT) may provide an active treatment that enables to increase the amount of food that the patient can intake without reaction during treatment (ie, desensitization), and reduces the risk of potential life-threatening allergic reaction in the event of accidental ingestion. However, several gaps need still to be filled. A memorable Latin orator stated: "Est modus in rebus" (Horace, Sermones I, 1, 106-07). This sentence remembers that there is a measure in everything to a proper proportion of therapy. The common sense of measure should find application in each stage of treatment. A personalized approaching should consider the specific willing and features of each patient. Efforts are devoted to improve the efficacy, the safety but also the quality of life of patients suffering from FA. In the near future, it will be important to clarify immunologic pathways of FA-AIT, and to identify reliable biomarkers in order to recognize the most suitable candidates to FA-AIT and algorithms for treatments tailored on well-characterized subpopulations of patients.
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Affiliation(s)
| | - Riccardo Castagnoli
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonella Muraro
- Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - Montserrat Alvaro-Lozano
- Paediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Cezmi A Akdis
- Swiss Institute for Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Műbeccel Akdis
- Swiss Institute for Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Stefania Arasi
- Department of Pediatric Medicine, Pediatric Allergology Unit, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
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19
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Howe LC, Leibowitz KA, Perry MA, Bitler JM, Block W, Kaptchuk TJ, Nadeau KC, Crum AJ. Changing Patient Mindsets about Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1550-1559. [PMID: 30682576 DOI: 10.1016/j.jaip.2019.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/09/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed. OBJECTIVE To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes. METHODS In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17 years, M = 10.82, standard deviation = 3.01) completed 6-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy and Asthma Research between January 5, 2017, and August 3, 2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets. RESULTS Compared with families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B = -0.46, 95% confidence interval [CI]: -0.76 to -0.16; P = .003), less likely to contact staff about symptoms (5/24 [9.4%] vs 27/154 [17.5%] instances; P = .036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction = -0.54, 95% CI: -0.83 to -0.27; P < .001), less likely to skip/reduce doses (1/26 [4%] vs 5/24 [21%] patients; P = .065), and showed a greater increase in patient peanut-specific blood IgG4 levels (BInteraction = 0.76, 95% CI: 0.36 to 1.17; P < .001). CONCLUSIONS Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.
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Affiliation(s)
- Lauren C Howe
- Department of Psychology, Stanford University, Stanford, Calif.
| | | | | | - Julie M Bitler
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Whitney Block
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Ted J Kaptchuk
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Mass
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, Calif
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20
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Kao LM, Greenhawt MJ, Warren CM, Siracusa M, Smith BM, Gupta RS. Parental and parent-perceived child interest in clinical trials for food allergen immunotherapy. Ann Allergy Asthma Immunol 2018; 120:331-333.e1. [PMID: 29508722 DOI: 10.1016/j.anai.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren M Kao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Christopher M Warren
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mary Siracusa
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Boston University School of Medicine, Boston, Massachusetts
| | - Bridget M Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Spinal Cord Injury QUERI Center for Management of Complex Chronic Care, Edward J. Hines Jr., VA Hospital, Hines, Illinois
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Abstract
PURPOSE OF REVIEW This review examines the current literature and provides insight into the role of food immunotherapy in the management of food-allergic children. Key food immunotherapy trials, benefits, and risks of the intervention, as well as areas requiring further study are all discussed. RECENT FINDINGS Research studies have reported encouraging results regarding the efficacy of food immunotherapy in desensitizing food-allergic patients with an acceptable safety profile and a documented improvement in quality of life. The role of biologics and long-term effects of food immunotherapy are still under investigation. SUMMARY The burden of food allergy is significant, multifaceted, and well documented. Food immunotherapy is a novel treatment option and an exciting area of research that has seen tremendous progress over the last decade, presenting encouraging results for the treatment of children with food allergies.
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Arasi S, Caminiti L, Crisafulli G, Pajno GB. A general strategy for de novo immunotherapy design: the active treatment of food allergy. Expert Rev Clin Immunol 2018; 14:665-671. [PMID: 29984605 DOI: 10.1080/1744666x.2018.1498784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION IgE-mediated food allergy (FA) has been emerging as a public health priority. It is a potentially life-threatening condition with negative impact on the quality of life of patients and their family and its prevalence is increasing in westernized countries in the recent two decades. The current standard approach to FA consists of the strict avoidance of the triggering food. However, an elimination diet may be difficult and frustrating, above all for those foods (e.g. milk and egg) that are pivotal in the common diet. Oral immunotherapy (OIT) may increase the amount of food that the patient can intake without reaction and reduce the risk of potential life-threatening allergic reactions. It is currently considered the most promising treatment for FA. However, many gaps are still unsolved. Areas covered: The aim of this review is to shed light on the current evidence and the main needs in OIT in order to stimulate the development of longitudinal, prospective, and well-designed studies with the final goal of a 'precision medicine.' Expert commentary: Clinical trials for OIT conducted so far are extremely heterogeneous. The aim in the near future is to identify the most suitable candidates to OIT and algorithms for treatments tailored on well-characterized subpopulations of patients.
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Affiliation(s)
- Stefania Arasi
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy.,b SIAF- Schweizerischers Institut für Allergie- und Asthmaforschung , Davos , Switzerland.,c Pediatric Allergy Unit , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy
| | - Lucia Caminiti
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy
| | - Giuseppe Crisafulli
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy
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Arasi S, Corsello G, Villani A, Pajno GB. The future outlook on allergen immunotherapy in children: 2018 and beyond. Ital J Pediatr 2018; 44:80. [PMID: 29996875 PMCID: PMC6042356 DOI: 10.1186/s13052-018-0519-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
Allergen immunotherapy (AIT) is the only currently available immune-modifying and aetiological treatment for patients suffering from IgE-mediated diseases. In childhood, it represents a suitable therapeutic option to intervene during the early phases of respiratory allergic diseases such as rhino-conjunctivitis and asthma, which is when their progression may be more easily influenced. A growing body of evidence shows that oral immunotherapy represents a promising treatment option in children with persistent IgE- mediated food allergy. The efficacy of AIT is under investigation also in patients with extrinsic atopic dermatitis, currently with controversial results. Furthermore, AIT might be a strategy to prevent the development of a new sensitization or of a (new) allergic disease. However, there are still some methodological criticisms, such as: a) the regimen of administration and the amount of the maintenance dose are both largely variable; b) the protocols of administration are not standardized; c) the description and classification of side effects is variable among studies and needs to be standardized; d) quality of life and evaluation of health economics are overall missing. All these aspects make difficult to compare each study with another. In addition, the content of major allergen(s) remains largely variable among manufacturers and the availability of AIT products differences among countries. The interest and the attention to AIT treatment are currently fervent and increasing. Well-designed studies are awaited in the near future in order to overcome the current gaps in the evidence and furtherly promote implementation strategies.
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Affiliation(s)
- Stefania Arasi
- Allergy Unit- Department of Pediatrics, University of Messina, Messina, Italy. .,SIAF- Schweizerischers Institut für Allergie-und Asthmaforschung, Davos, Switzerland. .,Pediatric Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Andorf S, Manohar M, Dominguez T, Block W, Tupa D, Kshirsagar RA, Sampath V, Chinthrajah RS, Nadeau KC. Observational long-term follow-up study of rapid food oral immunotherapy with omalizumab. Allergy Asthma Clin Immunol 2017; 13:51. [PMID: 29296107 PMCID: PMC5738812 DOI: 10.1186/s13223-017-0223-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background A number of clinical studies focused on treating a single food allergy through oral immunotherapy (OIT) with adjunctive omalizumab treatment have been published. We previously demonstrated safety and tolerability of a rapid OIT protocol using omalizumab in a phase 1 study to achieve desensitization to multiple (up to 5) food allergens in parallel, rapidly (7–36 weeks; median = 18 weeks). In the current long-term, observational study, we followed 34 food allergic participants for over 5 years, who had originally undergone the phase 1 rapid OIT protocol. Methods After reaching the maintenance dose of 2 g protein for each of their respective food allergens as a part of the phase 1 study, the long-term maintenance dose was reduced for some participants based on a pragmatic team-based decision. Participants were followed up to 62 months through standard oral food challenges (OFCs), skin prick tests, and blood tests. Results Each participant passed the 2 g OFC to each of their offending food allergens (up to 5 food allergens in total) at the end of the long-term follow-up (LTFU) study. Conclusion Our data demonstrate the feasibility of long-term maintenance dosing of a food allergen without compromising the desensitized status conferred through rapid-OIT. Trial registration Registry: Clinicaltrials.gov. Registration numbers: NCT01510626 (original study), NCT03234764 (LTFU study). Date of registration: November 29, 2011 (original study); July 26, 2017 (LTFU study, retrospectively registered) Electronic supplementary material The online version of this article (10.1186/s13223-017-0223-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Tina Dominguez
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Whitney Block
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Dana Tupa
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Rohun A Kshirsagar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
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Andorf S, Manohar M, Dominguez T, Block W, Tupa D, Kshirsagar RA, Sampath V, Chinthrajah RS, Nadeau KC. Feasibility of sustained response through long-term dosing in food allergy immunotherapy. Allergy Asthma Clin Immunol 2017; 13:52. [PMID: 29296108 PMCID: PMC5738818 DOI: 10.1186/s13223-017-0224-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials using oral immunotherapy (OIT) for the treatment of food allergies have shown promising results. We previously demonstrated the feasibility of desensitization for up to 5 food allergens simultaneously through OIT. In this observational study, we report the findings of long-term follow-up (LTFU) of the participants treated through a single site OIT phase 1 trial. Methods The participants (n = 46) were followed up to 72 months since the time they reached 2 g maintenance dose per food in the initial phase 1 trial. During the long-term maintenance dosing, participants continued or reduced the initial maintenance dose of food allergen protein to high (median 2 g protein) vs. low (median 300 mg protein). Participant follow-up included clinical monitoring, standardized OFCs, and in some cases, skin prick tests and measurement of allergen-specific IgE and IgG4. Results Irrespective of the high vs. low long-term maintenance dose during LTFU, all participants were able to ingest 2 g protein of each food allergen protein during OFCs performed at the end of our LTFU. Conclusion Our LTFU cohort of food OIT participants from a single site, phase 1 OIT study, supports the feasibility of sustained desensitization through long-term maintenance dosing. Trial registration Registry: Clinicaltrial.gov. Registration numbers: NCT01490177 (original study); NCT03234764 (LTFU study). Date of registration: November 29, 2011 (original study); July 26, 2017 (LTFU study, registered) Electronic supplementary material The online version of this article (10.1186/s13223-017-0224-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Tina Dominguez
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Whitney Block
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Dana Tupa
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Rohun A Kshirsagar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101 USA
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Andorf S, Purington N, Block WM, Long AJ, Tupa D, Brittain E, Rudman Spergel A, Desai M, Galli SJ, Nadeau KC, Chinthrajah RS. Anti-IgE treatment with oral immunotherapy in multifood allergic participants: a double-blind, randomised, controlled trial. Lancet Gastroenterol Hepatol 2017; 3:85-94. [PMID: 29242014 PMCID: PMC6944204 DOI: 10.1016/s2468-1253(17)30392-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite progress in single food oral immunotherapy (OIT), there is little evidence concerning the safety and efficacy of treating individuals with multiple food (multifood) allergies. We conducted a pilot study testing whether anti-IgE (omalizumab) combined with multifood OIT benefitted multifood allergic patients. METHODS In this blinded, phase 2 clinical trial conducted at Stanford University, 48 participants, aged 4-15 years, with multifood allergies validated by double-blind, placebo-controlled food challenges (DBPCFCs) to their offending foods were block randomized (3:1) to receive multifood OIT to 2-5 foods, together with omalizumab (n=36) or placebo (n=12). Omalizumab or placebo was administered subcutaneously for 16 weeks with OIT starting at week 8; omalizumab or placebo was stopped 20 weeks before exit DBPCFCs (week 36) to determine the primary endpoint: the proportion of participants who passed DBPCFCs to at least 2 of their offending foods. This completed trial is registered with ClinicalTrials.gov, . FINDINGS At week 36, a significantly greater proportion of the omalizumab (30/36, 83%) vs. placebo (4/12, 33%) participants passed DBPCFCs to 2 g protein for ≥ 2 of their offending foods (odds ratio (OR): 10, 95% confidence interval (CI): 1·8, 58·3, P=0·004). The same individuals also tolerated 4 g protein of ≥ 2 foods (secondary endpoint, P=0·004). A greater proportion of omalizumab (13/17, 77%) vs. placebo (0/5, 0%) participants passed a DBPCFC to 2 g protein for ≥ 4 of their offending foods (OR: 33, 95% CI: 1·9, ∞, P=0·01). All participants completed the study. There were no serious or severe (≥ grade 3) adverse events. INTERPRETATION In multifood allergic patients, omalizumab improves the efficacy of multifood OIT and enables safe and rapid desensitization. FUNDING NIH U19 AADCRC and Opportunity Fund, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Simons Foundation, Myra Reinhard Foundation, FARE Center of Excellence, Department of Pathology, and Department of Pediatrics, Stanford University.
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Affiliation(s)
- Sandra Andorf
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Natasha Purington
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Whitney M Block
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew J Long
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Dana Tupa
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Erica Brittain
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Manisha Desai
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen J Galli
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Departments of Pathology and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kari C Nadeau
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - R Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA.
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Elimination diet and the development of multiple tree-nut allergies. Pediatr Res 2017; 82:671-677. [PMID: 28549059 DOI: 10.1038/pr.2017.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/21/2017] [Indexed: 11/08/2022]
Abstract
BackgroundDespite its high prevalence, relatively little is known about the characteristics of patients with multiple tree-nut allergies.MethodsPatients (n=60, aged 4-15 years), recruited for a multiple food (tree nuts, peanut, milk, egg, soy, sesame, and wheat) oral immunotherapy (OIT) study, filled a questionnaire on their initial allergy evaluation. Medical records were reviewed. At OIT enrollment (median interval, 7.5 years), patients underwent oral food challenges (OFCs) to foods still eliminated.ResultsThere was significantly less evidence for eliminating tree nuts compared with other foods, as reflected by a lower rate of acute reaction to the offending food, either as the trigger for initial allergy evaluation (5.9% for tree-nuts vs. 20-40% for other foods, respectively P<0.001) or later in life (14.5% vs. 38-75%, respectively P=0.001), and a higher rate of negative skin prick test (SPT)/specific IgE (sIgE) at initial diagnosis (25% vs. <10%, P<0.001). SPT/sIgE increased significantly from past initial levels to present for tree nuts (P<0.001) and peanut (P=0.001) but not for other foods, and most OFCs performed at present were positive.ConclusionsTree nuts are often eliminated from the diet of multiple-food-allergic patients, despite their low probability for allergy. Sensitization and allergy to most tree nuts exist years later, suggesting that it developed during the period of elimination.
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Arasi S, Pajno GB. Evidence Gaps in Oral Immunotherapy for Food Allergy. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0146-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Hamad A, Burks WA. Emerging Approaches to Food Desensitization in Children. Curr Allergy Asthma Rep 2017; 17:32. [PMID: 28429307 DOI: 10.1007/s11882-017-0700-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the recent advances in food desensitization in children with food allergy. RECENT FINDINGS Recent advancements in epicutaneous, sublingual, and oral immunotherapy for food allergy in the future may offer children with food allergy and their families a viable option to reduce risk or severity of anaphylaxis with phase III trials ongoing for two of these treatment modalities. Food allergy prevalence in children is estimated to be up to 8%. These children are at risk of significant allergic reactions and anaphylaxis. Food avoidance and use of antihistamines or epinephrine has been the standard of care for these patients. This approach also has a significant socioeconomic effects on patients and their families. Recent advancements in understanding food allergy have allowed for exploring new methods of treatment. There is an increasing interest in oral immunotherapy, epicutaneous immunotherapy, or sublingual immunotherapy for food allergy. There have been also innovative approaches to immunotherapy by modification of food allergens (to make them less allergenic while maintain their immunogenicity) or adding adjunctive treatments (probiotics, anti-IgE, etc.) to increase efficacy or safety.
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Affiliation(s)
- Ahmad Hamad
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, 27517, USA.
| | - Wesley A Burks
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, USA
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Pajno GB, Bernardini R, Peroni D, Arasi S, Martelli A, Landi M, Passalacqua G, Muraro A, La Grutta S, Fiocchi A, Indinnimeo L, Caffarelli C, Calamelli E, Comberiati P, Duse M. Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report. Ital J Pediatr 2017; 43:13. [PMID: 28257631 PMCID: PMC5347813 DOI: 10.1186/s13052-016-0315-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/25/2016] [Indexed: 02/07/2023] Open
Abstract
Allergen-specific immunotherapy (AIT) is currently recognized as a clinically effective treatment for allergic diseases, with a unique disease-modifying effect. AIT was introduced in clinical practice one century ago, and performed in the early years with allergenic extracts of poor quality and definition. After the mechanism of allergic reaction were recognized, the practice of AIT was refined, leading to remarkable improvement in the efficacy and safety profile of the treatment. Currently AIT is accepted and routinely prescribed worldwide for respiratory allergies and hymenoptera venom allergy. Both the subcutaneous (SCIT) and sublingual (SLIT) routes of administration are used in the pediatric population.AIT is recommended in allergic rhinitis/conjunctivitis with/without allergic asthma, with an evidence of specific IgE-sensitization towards clinically relevant inhalant allergens. Long-term studies provided evidence that AIT can also prevent the onset of asthma and of new sensitizations. The favorable response to AIT is strictly linked to adherence to treatment, that lasts 3-5 years. Therefore, several factors should be carefully evaluated before starting this intervention, including the severity of symptoms, pharmacotherapy requirements and children and caregivers' preference and compliance.In recent years, there have been increasing interest in the role of AIT for the treatment of IgE-associated food allergy and extrinsic atopic dermatitis. A growing body of evidence shows that oral immunotherapy represents a promising treatment option for IgE-associated food allergy. On the contrary, there are still controversies on the effectiveness of AIT for patients with atopic dermatitis.This consensus document was promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP) to provide evidence-based recommendations on AIT in order to implement and optimize current prescription practices of this treatment for allergic children.
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Affiliation(s)
- Giovanni Battista Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Via Consolare Valeria-Gazzi, Messina, 98124 Italy
| | | | | | - Stefania Arasi
- Department of Pediatrics, Allergy Unit, University of Messina, Via Consolare Valeria-Gazzi, Messina, 98124 Italy
- Molecular Allergology and Immunomodulation- Department of Pediatric Pneumology and Immunology, Charité Medical University Berlin, Berlin, Germany
| | - Alberto Martelli
- Pediatric Unit, Hospital “G. Salvini”, Garbagnate Milanese, Italy
| | - Massimo Landi
- National Pediatric Healthcare System, Turin, Italy
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | | | | | - Carlo Caffarelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | | | - Marzia Duse
- Department of Pediatrics, University “La Sapienza”, Rome, Italy
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Food allergen detection by mass spectrometry: the role of systems biology. NPJ Syst Biol Appl 2016; 2:16022. [PMID: 28725476 PMCID: PMC5516885 DOI: 10.1038/npjsba.2016.22] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 11/08/2022] Open
Abstract
Food allergy prevalence is rising worldwide, motivating the development of assays that can sensitively and reliably detect trace amounts of allergens in manufactured food. Mass spectrometry (MS) is a promising alternative to commonly employed antibody-based assays owing to its ability to quantify multiple proteins in complex matrices with high sensitivity. In this review, we discuss a targeted MS workflow for the quantitation of allergenic protein in food products that employs selected reaction monitoring (SRM). We highlight the aspects of SRM method development unique to allergen quantitation and identify opportunities for simplifying the process. One promising avenue identified through a comprehensive survey of published MS literature is the use of proteotypic peptides, which are peptides whose presence appears robust to variations in food matrix, sample preparation protocol, and MS instrumentation. We conclude that proteotypic peptides exist for a subset of allergenic milk, egg, and peanut proteins. For less studied allergens such as soy, wheat, fish, shellfish, and tree nuts, we offer guidance and tools for peptide selection and specificity verification as part of an interactive web database, the Allergen Peptide Browser (http://www.AllergenPeptideBrowser.org). With ongoing improvements in MS instrumentation, analysis software, and strategies for targeted quantitation, we expect an increasing role of MS as an analytical tool for ensuring regulatory compliance.
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Effect of processing on conformational changes of food proteins related to allergenicity. Trends Food Sci Technol 2016. [DOI: 10.1016/j.tifs.2016.01.001] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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The Heterogeneity of Oral Immunotherapy Clinical Trials: Implications and Future Directions. Curr Allergy Asthma Rep 2016; 16:25. [DOI: 10.1007/s11882-016-0602-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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