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Camargo López de Oliveira L, Morgenstern B. [Provocation tests]. Rev Alerg Mex 2023; 70:255-259. [PMID: 38506868 DOI: 10.29262/ram.v70i4.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Oral provocation tests involve the supervised administration of suspected foods in increasing doses to evaluate a patient's allergic condition. Acknowledged as the superior method for diagnosing food allergies, it surpasses results from specific IgE serum or prick tests, which indicate sensitization but not necessarily allergy. The test is indicated in cases of diagnostic uncertainty, assessment of natural or induced tolerance, or cross-reactivity risks. Three types of tests exist: open, single-blind, and double-blind with a placebo. While the latter two reduce anxiety, open tests are more practical for children under three.
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Affiliation(s)
| | - Beni Morgenstern
- Especialización en Alergia e inmunología, Título de especialista en Pediatría (Sociedad de Brasileira de Pediatría) y en Alergia e Inmunología (ASBAI); médico en la Unidad de Alergia e Inmunología Pediátrica, Instituto de niños, niñas y adolescentes; Hospital das Clínicas da Facultad de Medicina da Universidad de São Paulo, Brasil
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Chomyn A, Chan ES, Yeung J, Cameron S, Chua GT, Vander Leek TK, Williams BA, Soller L, Abrams EM, Mak R, Wong T. Safety and effectiveness of the Canadian food ladders for children with IgE-mediated food allergies to cow's milk and/or egg. Allergy Asthma Clin Immunol 2023; 19:94. [PMID: 37932826 PMCID: PMC10629013 DOI: 10.1186/s13223-023-00847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Food ladders are tools designed to facilitate home-based dietary advancement in children with food allergies through stepwise exposures to increasingly allergenic forms of milk and egg. Several studies have now documented safety and efficacy of food ladders. In 2021, we published a Canadian adaptation of the previously existing milk and egg ladders originating in Europe using foods more readily available/consumed in Canada. Our study adds to the growing body of evidence supporting food ladder use and provides safety and effectiveness data for our Canadian adaptation of the milk and egg ladders. METHODS Surveys were distributed to families of children using the Canadian Milk Ladder and/or the Canadian Egg Ladder at baseline, with follow up surveys at 3 months, 6 months, and 12 months. Data were analyzed using REDCap and descriptive and inferential statistics are presented. RESULTS One hundred and nine participants were started on milk/egg ladders between September 2020 and June 2022. 53 participants responded to follow up surveys. Only 2 of 53 (3.8%) participants reported receiving epinephrine during the study. Severe grade 4 reactions (defined according to the modified World Allergy Organization grading system) were not reported by any participants. Minor cutaneous adverse reactions were common, with about 71% (n = 10/14) of respondents reporting cutaneous adverse reactions by 1 year of food ladder use. An increasing proportion of participants could tolerate most foods from steps 2-4 foods after 3, 6, and 12 months of the food ladder compared to baseline. CONCLUSION The Canadian food ladders are safe tools for children with cow's milk and/or egg allergies, and participants tolerated a larger range of foods with food ladder use compared to baseline.
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Affiliation(s)
- Alanna Chomyn
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada.
| | - Edmond S Chan
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
| | - Joanne Yeung
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
| | - Scott Cameron
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
| | - Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Timothy K Vander Leek
- Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Brock A Williams
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
- Food, Nutrition, and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - Lianne Soller
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, University of Manitoba, Winnipeg, Canada
| | - Raymond Mak
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada
| | - Tiffany Wong
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B 4480 Oak Street, V5Z 4H4, Vancouver, BC, Canada.
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Horimukai K, Kinoshita M, Takahata N. Low-Dose Oral Challenge Test in Pediatric Patients With Peanut Allergy: Tolerance Assessment of a Trace 5 mg Peanut Test After Symptom Induction With a 500 mg Test. Cureus 2023; 15:e42245. [PMID: 37605681 PMCID: PMC10440023 DOI: 10.7759/cureus.42245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Introduction Peanut allergy (PA) represents a significant public health concern, particularly prevalent in Western countries. Children at high risk for PA may undergo a low-dose oral food challenge (OFC). However, if the result is positive, complete elimination of peanuts from the diet is recommended, and further trace OFC is typically not performed. Material and methods This cross-sectional study retrospectively examined the rate of positive peanut OFC with a total peanut load of 5 mg in children who tested positive with a total peanut load of 500 mg. Patient information was gathered from medical records. The primary endpoint was the rate at which children who tested positive in the OFC with 500 mg of peanut butter also tested positive with 5 mg of peanut butter equivalent. Results Among 32 children who underwent an OFC with a total peanut load of 500 mg, two were excluded for not meeting the criteria. Among the remaining 30 children, 14 (46.7%) had a positive 500 mg peanut OFC test, and three (10%) experienced an anaphylactic reaction. Those who tested positive for the OFC had higher peanut-specific and Ara h2-specific immunoglobulin E (IgE) antibodies. An OFC with 5 mg of peanuts performed on 10 of the 14 patients who tested positive for 500 mg of peanuts showed no positive results. Conclusion The results of this study suggest that children with severe PA who exhibit positive symptoms to a total peanut load of 500 mg can tolerate a 5 mg dose of peanuts and should be considered for an OFC.
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Affiliation(s)
- Kenta Horimukai
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, JPN
| | - Misako Kinoshita
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, JPN
| | - Noriko Takahata
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, JPN
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Sage AP, James E, Burke M, Chan ES, Wong T. Assessment of multiple-opinion referrals and consults at the BC Children's Hospital Allergy Clinic. Allergy Asthma Clin Immunol 2023; 19:52. [PMID: 37316941 DOI: 10.1186/s13223-023-00806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Allergic disease is on the rise. Waitlists for specialists are long, and many referred patients have already received prior allergic assessment, either by a certified Allergist, Primary Care Provider, or other Specialist. It is important to understand the prevalence and motivating factors for multiple-opinion referrals, to deliver timely assessment for patients with allergic disease. METHODS A retrospective chart review of demographic information, number of previous consultations, and motivation for new consults and multiple-opinion referrals, of pediatric patients aged 8 months-17 years to BC Children's Hospital Allergy Clinic from September 1, 2016-August 31, 2017, was performed. Referral data including reason for referral or multiple-opinion, primary allergic concerns, and others, from referral forms and consult notes were accessed through local Electronic Medical Records and subsequently analyzed for trends in categorical variables to assess the rationale for and impact of multiple-opinion referrals to our clinic. RESULTS Of 1029 new referrals received, 210 (20.4%) were multiple-opinion referrals. Food allergy was the predominant allergic concern prompting further opinion (75.7%). The main rationale for seeking further opinions was wanting an assessment by a certified allergist in cases where prior consultation was performed by non-allergist specialist, primary care provider, or alternative health care provider. Of second-opinion referrals generated, 70 (33.3%) initial consultations were performed by an Allergist, whereas 140 (66.7%) were performed by a non-allergist. CONCLUSIONS Many new consults at the BCCH Allergy Clinic are multiple-opinion assessments, contributing to long waitlists. Advocacy at the systems level through standardized referral guidelines, centralized triaging systems, and stronger support for Primary Care Providers is needed to provide better access in Canada for children needing a specialized Allergist. Trial registration UBC/BCCH Research Ethics Board.
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Affiliation(s)
- Adam P Sage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elliot James
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada
| | - Megan Burke
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada
| | - Tiffany Wong
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada.
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Lloyd M, Loke P, Mack DP, Sicherer SH, Perkin MR, Boyle R, Yin Leung AS, Lee BW, Levin M, Blumchen K, Fiocchi A, Ebisawa M, Oliveira LCLD, Tang MLK. Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World. J Allergy Clin Immunol Pract 2023; 11:1010-1027.e6. [PMID: 36805346 DOI: 10.1016/j.jaip.2023.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Paxton Loke
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael R Perkin
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Robert Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Hub of Paediatric Excellence, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic Fibrosis, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Lucila Camargo Lopes de Oliveira
- Department of Paediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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Portnoy J, Shroba J, Tilles S, Romdhani H, Donelson SM, Latremouille-Viau D, Bungay R, Chen K, McCann W. Real-world experience of pediatric patients treated with peanut (Arachis hypogaea) allergen powder-dnfp. Ann Allergy Asthma Immunol 2023; 130:649-656.e4. [PMID: 36738781 DOI: 10.1016/j.anai.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) is the first oral immunotherapy indicated for children aged 4 to 17 years with peanut allergy. There are limited real-world data on patients treated with PTAH. OBJECTIVE To characterize pediatric patients treated with PTAH and associated treatment patterns in US clinical practice. METHODS US-based physicians with allergy and immunology training treating patients with peanut allergy aged 4 to 17 years with PTAH were recruited from an existing physician panel and completed an online case report form (October to December 2021) with data abstracted from patient medical charts. Physician practice circumstances, patient characteristics, and PTAH treatment patterns were reported. Time to reach the 300-mg dose and treatment persistence were assessed using Kaplan-Meier analysis. RESULTS A geographically balanced sample of 43 physicians contributed data for 118 demographically diverse pediatric patients. Patients had heterogeneous diagnostic test results, with a wide range of peanut-specific immunoglobulin E levels; 6.8% received an oral food challenge. During the updosing phase, there were no temporary interruptions and 5.1% of the patients required downdosing. Patients reached the 300-mg dose at a median of 21.3 weeks post-initiation. The rate of PTAH persistence at 24 weeks was 93.4%. Only 1 patient discontinued treatment because of treatment-related systemic allergic symptoms, and the remaining discontinuations were for reasons other than treatment-related symptoms. Prophylactic antihistamines were used by 33.9% of the patients to prevent PTAH adverse effects. CONCLUSION PTAH was prescribed in demographically diverse patients with a wide range of peanut-specific immunoglobulin E levels. Treatment persistence with PTAH was high in this study population, with a small number of patients experiencing treatment modification.
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Affiliation(s)
| | | | - Stephen Tilles
- Aimmune Therapeutics, a Nestlé Health Science Company, Brisbane, California
| | | | - Sarah M Donelson
- Aimmune Therapeutics, a Nestlé Health Science Company, Brisbane, California
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El Baba A, Jeimy S, Soller L, Kim H, Begin P, Chan ES. Geographical discrepancy in oral food challenge utilization based on Canadian billing data. Allergy Asthma Clin Immunol 2023; 19:5. [PMID: 36650588 PMCID: PMC9843933 DOI: 10.1186/s13223-022-00751-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Oral food challenges (OFC) confer the highest sensitivity and specificity in diagnosis; however, uptake has been variable across clinical settings. Numerous barriers were identified in literature from inadequate training to resource access. OFC utilization patterns using billing data have not been previously studied. OBJECTIVE The objective of this study is to explore the geographic differences in utilization of OFCs across Ontario and Québec using anonymized billing data from 2013 to 2017. METHODS Anonymized OFC billing data were obtained between 2013 and 2017 from Ontario Health Insurance Plan (OHIP) and Régie de l'Assurance Maladie du Québec (RAMQ). The number of OFCs was extracted by location, billings, and physician demographics for clinic and hospital-based challenges. RESULTS Over the period studied, the number of OFCs increased by 92% and 85% in Ontario clinics and Québec hospitals, respectively. For Ontario hospitals, the number of OFCs increased by 194%. While Québec performed exclusively hospital-based OFCs, after controlling for the population, the number of OFCs per 100,000 residents annually were similar to Ontario at 50 and 49 OFCs, respectively. The number of OFCs varied across the regions studied with an annual rate reaching up to 156 OFCs per 100,000 residents in urban regions and as low as 0.1 in regions furthest from city centers. CONCLUSION OFC utilization has steadily increased over the last decade. There has been marked geographical discrepancies in OFC utilization which could be driven by the location of allergists and heterogeneity in their practices. More research is needed to identify barriers and propose solutions to them.
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Affiliation(s)
- Ala El Baba
- grid.39381.300000 0004 1936 8884Division of Internal Medicine, Department of Medicine, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Samira Jeimy
- grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - Lianne Soller
- grid.17091.3e0000 0001 2288 9830Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Harold Kim
- grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada ,grid.25073.330000 0004 1936 8227Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Philippe Begin
- grid.411418.90000 0001 2173 6322Division of Allergy, Rheumatology and Immunology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC Canada ,grid.410559.c0000 0001 0743 2111Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, QC Canada
| | - Edmond S. Chan
- grid.17091.3e0000 0001 2288 9830Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, BC Canada
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Merrill KA, Abrams EM, Good SV, Gupta RS, Venter C, Frykas TLM, Golding MA, Protudjer JLP. Associations between food allergy, country of residence, and healthcare access. Allergy Asthma Clin Immunol 2022; 18:103. [PMID: 36474254 DOI: 10.1186/s13223-022-00745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To date, little consideration has been given to access to allergy-related care, despite the fact that food allergy affects a considerable proportion of children. As such, the current study aimed to describe access to food allergy-related services in Canada and the United States (US). METHODS Participants were recruited via social media from March-July 2021 and were asked to complete an online survey focused on food allergy-related medical care. Participants were Canadian and US residents who live with a child < 18 years old, with ≥ 1 food allergy. A series of logistic regressions were used to assess the associations between country of residence and type of allergy testing utilized during diagnosis. RESULTS Fifty-nine participants were included in the analysis (Canadian: 32/59; 54.2%; US residents: 27/59; 45.8%). Relative to Canadian participants, US respondents were less likely to be diagnosed using an oral food challenge (OFC; OR 0.16; 95% CI 0.04; 0.75: p < 0.05). Compared to children diagnosed by age 2 years, those diagnosed at age 3 years and older were less likely to have been diagnosed using an OFC (OR 0.12; 95% CI 0.01; 1.01; p = 0.05). CONCLUSIONS Access to food allergy-related services, varies between Canada and the US. We speculate that this variation may reflect differences in clinical practice and types of insurance coverage. Findings also underscore the need for more research centered on food allergy-related health care, specifically diagnostic testing, among larger and more diverse samples.
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Chua GT, Greenhawt M, Shaker M, Soller L, Abrams EM, Cameron SB, Cook VE, Erdle SC, Fleischer DM, Mak R, Vander Leek TK, Chan ES. The Case for Prompt Salvage Infant Peanut Oral Immunotherapy Following Failed Primary Prevention. J Allergy Clin Immunol Pract 2022; 10:2561-2569. [PMID: 35752433 DOI: 10.1016/j.jaip.2022.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 05/15/2023]
Abstract
Recent guideline recommendations have shifted from recommending prolonged avoidance of allergenic foods in the first 3 years of life to a primary prevention approach involving the deliberate early introduction to infants at risk of developing food allergy. Despite this, some infants, especially those with severe eczema who are at highest risk for developing peanut allergy, fail to receive the preventative benefits of early peanut introduction due to hesitancy and other factors. Difficulty adhering to regular ingestion after introduction further reduces the effectiveness of primary prevention. As emerging real-world evidence has demonstrated that performing peanut oral immunotherapy (OIT) among infants is effective and safe, peanut OIT could be a treatment option for infants with peanut allergy. This review discusses the benefits, risks, and barriers to offering peanut OIT to infants who fail primary prevention strategies. We propose the novel concept that infants with peanut allergy be offered peanut OIT as soon as possible after failed peanut introduction through a shared decision-making process with the family, where there is a preference for active management rather than avoidance.
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Affiliation(s)
- Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China; Department of Paediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, New Hampshire, Lebanon, NH
| | - Lianne Soller
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Victoria E Cook
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Stephanie C Erdle
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abrams EM, Watson W, Vander Leek TK, Atkinson A, Primeau MN, Francoeur MJ, McHenry M, Lavine E, Orkin J, Cummings C, Blair B, Chan ES. Dietary exposures and allergy prevention in high-risk infants. Allergy Asthma Clin Immunol 2022; 18:36. [PMID: 35501827 PMCID: PMC9063186 DOI: 10.1186/s13223-021-00638-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow's milk protein formula has been introduced in an infant's diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early-at around 6 months, but not before 4 months of age-can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada.
| | - Wade Watson
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Timothy K Vander Leek
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Adelle Atkinson
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Marie-Noel Primeau
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Marie-Josee Francoeur
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Mary McHenry
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Elana Lavine
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Julia Orkin
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Carl Cummings
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Becky Blair
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Edmond S Chan
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
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12
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Westwell-Roper C, To S, Andjelic G, Lu C, Lin B, Soller L, Chan ES, Stewart SE. Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review. Pediatr Allergy Immunol 2022; 33:e13695. [PMID: 34779046 DOI: 10.1111/pai.13695] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA. METHODS MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines. RESULTS Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors. CONCLUSIONS FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.
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Affiliation(s)
- Clara Westwell-Roper
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon To
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordan Andjelic
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cynthia Lu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Boyee Lin
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada
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13
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Venter C, Meyer R, Ebisawa M, Athanasopoulou P, Mack DP. Food allergen ladders: A need for standardization. Pediatr Allergy Immunol 2022; 33:e13714. [PMID: 34882843 DOI: 10.1111/pai.13714] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens. METHODS We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders. RESULTS There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders. DISCUSSION Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally. Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.
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Affiliation(s)
- Carina Venter
- Children's Hospital Colorado, University of Colorado, AuRoRa, Colorado, USA
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | | | - Douglas Paul Mack
- Department of Paediatrics, Paediatric Allergy, Asthma, and Immunology, McMaster University, Hamilton, Ontario, Canada
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14
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Correa N, Protudjer JLP, Hsu E, Soller L, Chan ES, Kim H, Jeimy S. Canadian parent perceptions of oral food challenges: A qualitative analysis. Pediatr Allergy Immunol 2022; 33:e13698. [PMID: 34811822 DOI: 10.1111/pai.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natasha Correa
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Elaine Hsu
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
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15
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Perrett KP, Sindher SB, Begin P, Shanks J, Elizur A. Advances, Practical Implementation, and Unmet Needs Regarding Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract 2022; 10:19-33. [PMID: 34785391 DOI: 10.1016/j.jaip.2021.10.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Treatment of food allergy is a rapidly changing landscape, with arguably, the most significant advancement in recent years, the transition of oral immunotherapy (OIT) to clinical practice. As an innovation, OIT is a phase of rapidly increasing demand, particularly for some allergens such as peanut, egg, and milk, which have substantial evidence of efficacy. However, significant questions remain about how to best treat multiple food allergies and less common food allergies and how to optimize long-term safety and efficacy. This review summarizes the currently available resources for integrating food allergy OIT into clinical practice and focuses on the multiple remaining unmet needs such as providing an approach for OIT to food allergens for which there is no or limited evidence; practical issues related to food allergy treatment particularly when it is not going well; long-term outcomes and follow-up after OIT; and strategies to help meet the impending increase in demand.
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Affiliation(s)
- Kirsten P Perrett
- Population Allergy, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford, California
| | - Philippe Begin
- Division of Allergy, Immunology and Rheumatology, CHU Sainte-Justine, Montréal, Canada
| | - Josiah Shanks
- Population Allergy, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Al Saleemi A, Farren L, McCarthy KF, Hourihane J, Byrne AM, Trujillo J, O'Carroll C, Tariq M, Fitzsimons JJ, Coghlan D. Management of anaphylaxis in children undergoing oral food challenges in an adapted COVID-19 field hospital. Arch Dis Child 2021; 106:e52. [PMID: 34433551 DOI: 10.1136/archdischild-2021-322920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Ali Al Saleemi
- Department of Paediatric, Qassim University College of Medicine, Buraidah, Saudi Arabia.,Children's Health Ireland, Dublin, Ireland
| | | | | | - Jonathan Hourihane
- Children's Health Ireland, Dublin, Ireland.,Department of Allergy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aideen M Byrne
- Children's Health Ireland, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Juan Trujillo
- Cork University Hospital, Cork, Ireland.,University College Cork, Cork, Ireland
| | | | | | | | - David Coghlan
- Children's Health Ireland, Dublin, Ireland .,Trinity College Dublin, Dublin, Ireland
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17
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Byrne AM, Trujillo J, Fitzsimons J, Mohammed T, Ghent R, O'Carroll C, Coghlan D, Hourihane JO, Alsalemi A, Cassidy A, Corbet E, Creighton R, d'Art Y, Farren L, Flanagan R, Flynn N, Franklin R, Gray C, Harding P, Hendrick C, Heraghty F, Hurley S, Kavanagh V, Lad D, Leddy K, Lewis S, McGlynn T, O'Connor D, O'Neill P, O'Shea O, O'Toole A, Quinn R, Reid A, Russell A, Ruth E, Rynne A, Sanneerappa PB, Sheehan M, Thompson C, Tobin C, Trayer J, Wallace A, Walsh N, Wilson F. Mass food challenges in a vacant COVID-19 stepdown facility: Exceptional opportunity provides a model for the future. Pediatr Allergy Immunol 2021; 32:1756-1763. [PMID: 34152649 PMCID: PMC8420236 DOI: 10.1111/pai.13580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi-elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short-term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll-out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards. METHODS The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established. RESULTS After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. CONCLUSIONS Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality-of-life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy-in-even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.
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Affiliation(s)
- Aideen M Byrne
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | | | | | | | | | - Cathryn O'Carroll
- Children's Health Ireland, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - David Coghlan
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | - Jonathan O'B Hourihane
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Eva Corbet
- Children's Health Ireland, Dublin, Ireland
| | | | | | | | | | | | - Ruth Franklin
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | - Sadhbh Hurley
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Emma Ruth
- Children's Health Ireland, Dublin, Ireland
| | - Anne Rynne
- Children's Health Ireland, Dublin, Ireland
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18
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Chua GT, Chan ES, Soller L, Cook VE, Vander Leek TK, Mak R. Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond. Front Allergy 2021; 2:725165. [PMID: 35387028 PMCID: PMC8974914 DOI: 10.3389/falgy.2021.725165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT. Eight of them (88.9%) completed the build-up phase at home in 11–28 weeks, tolerating a daily maintenance dose of 320 mg peanut protein. During the build-up, six patients (75.0%) reported urticaria, three (33.3%) reported gastrointestinal tract symptoms, and one (14.3%) reported oral pruritis. None of the patients developed anaphylaxis, required epinephrine, or attended emergency services related to OIT. One or two virtual follow-up visits were completed per patient during the build-up phase. Our case series shows that home-based OIT could be offered to the low-risk preschoolers during the COVID-19 pandemic when non-emergency services are limited and could be considered beyond the pandemic, especially for the families living in the rural or remote areas that may otherwise be unable to access OIT.
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Affiliation(s)
- Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
- *Correspondence: Gilbert T. Chua
| | - Edmond S. Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Victoria E. Cook
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Community Allergy Clinic, Victoria, BC, Canada
| | - Timothy K. Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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19
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Abstract
Food allergy is a public health concern and has been found to be increasing in prevalence; however, psychosocial factors differentiate challenges related to management throughout the lifespan. Resilience has been found to improve quality of life in other chronic diseases, but little has been published regarding increasing resilience in food allergy. The psychosocial impacts of food allergy vary by age group and developmental stage. This article reviews developmental milestones within the context of food allergy in infancy, school-age children, adolescents, and adults. Recommendations for promoting resilience in patients with food allergy are provided.
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Affiliation(s)
- Christine J Rubeiz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michelle M Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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20
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Shaker M, Chan ES, Protudjer JLP, Soller L, Abrams EM, Greenhawt M. The Cost-Effectiveness of Preschool Peanut Oral Immunotherapy in the Real-World Setting. J Allergy Clin Immunol Pract 2021; 9:2876-2884.e4. [PMID: 33744474 DOI: 10.1016/j.jaip.2021.02.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Across North America, 1.4% to 4.5% of children and families live with peanut allergy (PA). Preschool peanut oral immunotherapy (POIT) has been shown to be safe and effective in the real-world setting. OBJECTIVE Evaluate the cost effectiveness of preschool POIT in North America. METHODS Markov cohort analyses and microsimulation was used to evaluate simulated preschool children with PA over an 80-year time horizon. Models incorporated the natural history of PA, comparing children treated with preschool POIT with those not receiving immunotherapy. Costs were expressed in U.S. and Canadian dollars. RESULTS A preschool POIT strategy was associated with cost savings while improving quality-adjusted life-years (QALY), dominating a nonimmunotherapy approach. Over the model horizon, when all costs (and effectiveness) of PA were included from a societal perspective, a POIT versus a non-POIT approach cost $82,514 (18.51 QALY) versus $84,367 (17.75 QALY) in the United States, and $40,111 (18.83 QALY) versus $53,848 (18.26 QALY) in Canada. In microsimulations, systemic reactions to POIT were less frequent than anaphylaxis from accidental exposure without POIT (United States: 3.59, SD 3.49 vs 19.53, SD 11.71; Canada: 3.63, SD 3.54 vs 4.56, SD 3.30), epinephrine use was reduced with POIT (United States: 5.85, SD 5.73 vs 9.76, SD 5.85; Canada: 0.34, SD 0.36 vs 0.53, SD 0.38), and fatalities were rare but lower in the POIT strategy (United States: 0.00005, SD 0.0071 vs 0.00015, SD 0.012; Canada: 0.00005, SD 0.0071 vs 0.00009, SD 0.0095). CONCLUSIONS Preschool POIT in a real-world setting improved health and economic outcomes in the United States and Canada.
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21
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Graham F, Mack DP, Bégin P. Practical challenges in oral immunotherapy resolved through patient-centered care. Allergy Asthma Clin Immunol 2021; 17:31. [PMID: 33736692 PMCID: PMC7971360 DOI: 10.1186/s13223-021-00533-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/24/2021] [Indexed: 12/14/2022] Open
Abstract
Oral immunotherapy (OIT) is now widely recognized as a valid option for the management of IgE-mediated food allergies. However, in real-life practice, OIT can lead to a variety of unique situations where the best course of action is undetermined. In patient-centered care, individual patient preferences, needs and values, should guide all clinical decisions. This can be achieved by using shared-decision making and treatment customization to navigate areas of uncertainty in a way that is responsive to patient’s needs and preferences. However, in the context of OIT, lack of awareness of potential protocol adaptability or alternatives can become a barrier to treatment personalization. The purpose of this article is to review the theoretical bases of patient-centered care and shared decision-making and their practical implication for the patient-centered delivery of OIT. Clinical cases highlighting common challenges in real-life OIT practice are presented along with a discussion of potential personalized management options to be considered. While the practice of OIT is bound to evolve as additional scientific and experiential knowledge is gained, it should always remain rooted in the general principles of patient-centered care.
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Affiliation(s)
- François Graham
- Allergy and Immunology, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada.,Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Cote Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Philippe Bégin
- Allergy and Immunology, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada. .,Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Cote Sainte-Catherine, Montréal, QC, H3T1C5, Canada.
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22
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Kelleher MM, Cro S, Van Vogt E, Cornelius V, Lodrup Carlsen KC, Ove Skjerven H, Rehbinder EM, Lowe A, Dissanayake E, Shimojo N, Yonezawa K, Ohya Y, Yamamoto‐Hanada K, Morita K, Cork M, Cooke A, Simpson EL, McClanahan D, Weidinger S, Schmitt J, Axon E, Tran L, Surber C, Askie LM, Duley L, Chalmers JR, Williams HC, Boyle RJ. Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis. Clin Exp Allergy 2021; 51:402-418. [DOI: 10.1111/cea.13847] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Suzie Cro
- Imperial Clinical Trials Unit Imperial College London London UK
| | | | | | - Karin C. Lodrup Carlsen
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Håvard Ove Skjerven
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Eva Maria Rehbinder
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - Adrian Lowe
- Allergy and Lung Health Unit Melbourne School of Population and Global Health University of Melbourne Melbourne VIC Australia
| | - Eishika Dissanayake
- Department of Pediatrics School of Medicine and Public Health University of Wisconsin Madison WI USA
| | - Naoki Shimojo
- Center for Preventive Medical Sciences Chiba University Chiba Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yukihiro Ohya
- Allergy Center National Center for Child Health and Development Tokyo Japan
| | | | - Kumiko Morita
- Department of Pediatrics Keio University School of Medicine Tokyo Japan
| | - Michael Cork
- Sheffield Dermatology Research Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield Sheffield UK
| | - Alison Cooke
- Division of Nursing, Midwifery and Social Work School of Health Sciences The University of Manchester Manchester UK
| | | | | | - Stephan Weidinger
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Campus Kiel Kiel Germany
| | - Jochen Schmitt
- Centre for Evidence‐Based Healthcare Medizinische Fakultät Carl Gustav Carus, TU Dresden Dresden Germany
| | - Emma Axon
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - Lien Tran
- Imperial Clinical Trials Unit Imperial College London London UK
| | - Christian Surber
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - Lisa M. Askie
- NHMRC Clinical Trials Centre University of Sydney Camperdown NSW Australia
| | - Lelia Duley
- Nottingham Clinical Trials Unit Nottingham Health Science Partners Nottingham UK
| | - Joanne R. Chalmers
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - Hywel C. Williams
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
| | - Robert J. Boyle
- National Heart and Lung InstituteImperial College London London UK
- Centre of Evidence Based Dermatology University of Nottingham Nottingham UK
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Mack DP, Soller L, Chan ES, Hanna MA, Terpstra C, Vander Leek TK, Bégin P. A High Proportion of Canadian Allergists Offer Oral Immunotherapy but Barriers Remain. J Allergy Clin Immunol Pract 2020; 9:1902-1908. [PMID: 33359585 DOI: 10.1016/j.jaip.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited data on clinical implementation of oral immunotherapy (OIT) have been reported with incomplete evaluation of barriers. OBJECTIVE To survey Canadian allergists on their current practice of OIT and barriers to implementation and expansion of OIT. METHODS A survey investigating current practice and logistical and clinical barriers to offering or expanding OIT was distributed to all Canadian Society of Allergy and Clinical Immunology allergists. RESULTS Of 90 responding allergists, 52.2% reported offering OIT, most commonly to peanut. Food sublingual immunotherapy was offered by 7% of allergists. Having received training for OIT was associated with currently performing OIT (P = .008); 44.7% of allergists offering OIT had received training on OIT, and 81.4% not offering OIT had no training. A total of 87% of allergists performing OIT reported lack of efficacy data and lack of support staff and clinic space, and concerns about increased oral challenges (84%) were "moderately" to "extremely" important barriers to expanding OIT. For clinicians not offering OIT, concerns about safety (95%), after-hours support (95%), efficacy (93%), medicolegal risk (93%), and long-term practice implications (93%) were prioritized as significant barriers. Qualitative assessment suggested concerns about the practical challenges associated with OIT, the need for increased safety and efficacy data, and a desire for OIT guidelines and training. CONCLUSION The implementation of OIT faces many barriers, both clinical and logistical. Increasing high-quality safety and efficacy data may support those hesitant to offer OIT, and improving funding may address the practical infrastructure challenges. In addition, training will help expand access for allergists interested in performing OIT.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Lianne Soller
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Mariam A Hanna
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Collin Terpstra
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Philippe Bégin
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
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24
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Mack DP, Chan ES, Shaker M, Abrams EM, Wang J, Fleischer DM, Hanna MA, Greenhawt M. Novel Approaches to Food Allergy Management During COVID-19 Inspire Long-Term Change. J Allergy Clin Immunol Pract 2020; 8:2851-2857. [PMID: 32721605 PMCID: PMC7382335 DOI: 10.1016/j.jaip.2020.07.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
The SARS-CoV2 pandemic has prompted a re-evaluation of our current practice of medicine. The seemingly abrupt worldwide spread of this disease resulted in immediate changes and a reduction in many allergy-focussed services and procedures. The reality of the long-term circulation of this virus in our communities requires us to evolve as a specialty. In this article, we outline current and future challenges in the management of food allergy in light of coronavirus disease 2019 (COVID-19). We focus on infant food allergy prevention, management of anaphylaxis, accurate diagnosis with oral food challenges, and active management of food allergy with oral immunotherapy. This article identifies the challenges of conflicting guidelines, shortcomings of acute management approaches, and inherent system deficiencies. We offer perspectives and strategies that can be implemented now, including an evaluation of virtual care and telemedicine for the management of food allergy. The use of a shared decision-making model results in novel approaches that can benefit our patients and our specialty for years to come. COVID-19 has forced us to re-evaluate our current way of thinking about food allergy management to better treat our patients.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Edmond S Chan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Elissa M Abrams
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Wang
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David M Fleischer
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Mariam A Hanna
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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25
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Abrams EM, Simons E, Gerdts J, Nazarko O, Povolo B, Protudjer JLP. "I want to really crack this nut": an analysis of parent-perceived policy needs surrounding food allergy. BMC Public Health 2020; 20:1194. [PMID: 32738893 PMCID: PMC7395383 DOI: 10.1186/s12889-020-09309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Orla Nazarko
- Participant Advisory Committee to J Protudjer, Winnipeg, MB, Canada
| | - Beatrice Povolo
- Advocacy and Media Relations, Food Allergy Canada, Toronto, ON, Canada
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26
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Abrams EM, Singer AG, Chan ES. Pre-emptive screening for peanut allergy before peanut ingestion in infants is not standard of care. CMAJ 2020; 191:E1169-E1170. [PMID: 31636168 DOI: 10.1503/cmaj.73447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Elissa M Abrams
- Pediatric allergist, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man
| | - Alexander G Singer
- Family physician, Department of Family Medicine, University of Manitoba, Winnipeg, Man
| | - Edmond S Chan
- Pediatric allergist, Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC
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27
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Abrams EM, Greenhawt M, Protudjer JLP. The need for patient voices in food allergy research. Ann Allergy Asthma Immunol 2020; 125:346-7. [PMID: 32454093 DOI: 10.1016/j.anai.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
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28
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Protudjer JLP, Soller L, Abrams EM, Chan ES. Billing fees for various common allergy tests vary widely across Canada. Allergy Asthma Clin Immunol 2020; 16:28. [PMID: 32336976 PMCID: PMC7178720 DOI: 10.1186/s13223-020-00426-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of food allergy in Canada is high and has increased over time. To date, there are no Canadian data on the healthcare costs of visits to allergists. Methods We sent an anonymous survey to allergist members of the Canadian Society of Allergy and Clinical Immunology (CSACI) between October and December 2019. Survey questions included demographic information and billing fees for various types of allergy visits and diagnostic testing. Results Of 200 allergists who are members of CSACI, 43 allergists responded (21.5% response rate). Billing fees varied widely. The greatest ranges were noted for oral immunotherapy (OIT; both initial consultation [mean $198.70; range $0 to $575] and follow up/build up visits [mean $125.74; range: $0 to $575]). There were significant provincial differences in billing fees, as well as significant billing fee differences between hospital versus community allergists (e.g. oral food challenge [OFC]: $256.38 vs. $134.94, p < 0.01). Billing fees were higher outside of Ontario, with the exception of specific Immunoglubulin E (sIgE) testing and OIT visits. Conclusions Greater standardization of billing fees across provinces and between hospital versus community allergy could result in more consistency of billing fees for OFC and OIT across Canada. Further knowledge of exact costs will help inform practice and policy in the diagnosis and management of food allergy.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,The Children's Health Research Institute of Manitoba, Winnipeg, Canada.,4Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,6Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, Canada
| | - Lianne Soller
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
| | - Elissa Michelle Abrams
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada
| | - Edmond S Chan
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
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