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Hill SA, Nurmatov U, DunnGalvin A, Reese I, Vieira MC, Rommel N, Dupont C, Venter C, Cianferoni A, Walsh J, Yonamine G, Beauregard A, Meyer R, Vazquez-Ortiz M. Feeding difficulties in children with food allergies: An EAACI Task Force Report. Pediatr Allergy Immunol 2024; 35:e14119. [PMID: 38566436 DOI: 10.1111/pai.14119] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
The term "feeding difficulties" refers to a spectrum of phenotypes characterized by suboptimal intake of food and/or lack of age-appropriate eating habits. While it is evident that feeding difficulties are prevalent within healthy children, no consensus has been reached for those with food allergies. The aim of this study was to systematically review all the available literature reporting the prevalence of feeding difficulties within food allergic children. We searched eight international electronic databases for all published studies until June 2022. International experts in the field were also contacted for unpublished and ongoing studies. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so narrative synthesis of quantitative data was performed. A total of 2059 abstracts were assessed, out of which 21 underwent full-text screening and 10 studies met the study criteria. In these, 12 different terms to define feeding difficulties and 11 diagnostic tools were used. Five papers included data of feeding difficulty prevalence in children with food allergies, ranging from 13.6% to 40%. Higher prevalence was associated with multiple food allergies. The current literature suggests that feeding difficulties are prevalent within food allergic children, particularly those with multiple food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging. Consensus guidelines for the diagnosis and management of feeding difficulties within food allergic children and further research on the development and perpetuation of feeding difficulties are needed to appropriately manage such patients.
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Affiliation(s)
- Sarah-Anne Hill
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Audrey DunnGalvin
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Natalie Rommel
- University Hospital Tübingen, Tübingen, Germany
- Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Christophe Dupont
- Paris Descartes University, Paris, France
- Clinique Marcel Sembat, Ramsay Group, Boulogne Billancourt, France
| | - Carina Venter
- University of Colorado/Children's Hospital Colorado, Denver, Colorado, USA
| | - Antonella Cianferoni
- Allergy and Immunology Division, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Glauce Yonamine
- Division of Nutrition, Instituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Alexia Beauregard
- Faculty, Ellyn Satter Institute, Clinical Dietetics Branch Winn Army Community Hospital, Fort Stewart, Georgia, USA
| | - Rosan Meyer
- Imperial College London, London, UK
- University of Winchester, Winchester, UK
- University of KU Leuven, Leuven, Belgium
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2
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Masumi H, Takemura Y, Arima T, Yamasaki K, Nagai M, Inoue N, Sugimoto K. Egg Reintroduction Following Oral Food Challenge in Japanese Children. Front Allergy 2022; 2:618713. [PMID: 35387062 PMCID: PMC8974774 DOI: 10.3389/falgy.2021.618713] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Oral food challenge (OFC) is the most reliable method for diagnosing food allergies. However, the scarcity of long-term data on eating habits of people after a negative OFC poses a challenge for provisional medical care. Objective: This study was performed to investigate the percentage of people who could reintroduce eggs into their diet several years after an OFC. Methods: Study participants included 0–6-year-old children with negative results from an OFC using one egg as the food allergen, boiled for 20 min, from January 2012–March 2017, 1–3 years after the OFC. Results: A total of 72 subjects were analyzed, out of which 52 were males (72.2%). The median age (range) was 20 months (16–32.3), and the median age (range) at the first OFC was 15 months (12.8–23.3). Eggs were reintroduced in 62 cases (86.1%), while 10 cases (13.9%) did not undergo any diet change. The adjusted odds ratio (OR, 95% CI), with post-OFC to pre-OFC anxiety ≥ 0.2, was 9.4 (1.0–86), p = 0.04; OR for allergic symptoms that occurred post-OFC was 2.2 (0.45–11), p = 0.34; OR for initial OFC at an age of ≥15 months was 3.2 (0.54–19), p = 0.2; and OR for the history of anaphylaxis from eggs was 0.17 (0.02–1.5), p = 0.11. Conclusion: Most cases reintroduced eggs after an OFC. However, reintroduction did not occur in some cases, which was associated with greater anxiety among caregivers post-OFC. If the caregiver's anxiety is intense, it is necessary to provide psychological intervention and dietary guidance when reintroducing eggs at home after an OFC and to follow-up outpatient long-term progress.
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Affiliation(s)
- Hiroki Masumi
- Department of Pediatrics, Kaizuka City Hospital, Kaizuka, Japan.,Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yutaka Takemura
- Department of Pediatrics, Kaizuka City Hospital, Kaizuka, Japan.,Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Tomoyuki Arima
- Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Koji Yamasaki
- Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Megumi Nagai
- Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Norihiro Inoue
- Department of Pediatrics, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan
| | - Keisuke Sugimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
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Meng X, Wu Y, Wen X, Gao J, Xie Y, Zhao X, Yuan J, Yang H, Zeng Z, Li X, Chen H. Dietary Linolenic Acid Increases Sensitizing and Eliciting Capacities of Cow's Milk Whey Proteins in BALB/c Mice. Nutrients 2022; 14:822. [PMID: 35215473 DOI: 10.3390/nu14040822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
α-Lactalbumin (BLA) and β-lactoglobulin (BLG) are the major whey proteins causing allergic reactions. Polyunsaturated fatty acids (PUFAs) stand among the extrinsic factors of the food matrix that can bind BLA and BLG and change their bioactivities, but their contribution to change the allergenic properties of these proteins has not been investigated. Here, we aimed to determine how PUFAs influence BLA and BLG to sensitize and trigger allergic responses in BALB/c mice. First, tricine-SDS-PAGE and spectroscopic assays identified that α-linolenic acid (ALA, as a proof-of-concept model) can induce BLA and BLG to form cross-linked complexes and substantially modify their conformation. Then, BALB/c mice (n = 10/group) were orally sensitized and challenged with BLA and BLG or ALA-interacted BLA and BLG, respectively. Allergic reactions upon oral challenge were determined by measuring clinical allergic signs, specific antibodies, levels of type-1/2 cytokines, the status of mast cell activation, and percentage of cell populations (B and T cells) in different tissues (PP, MLN, and spleen). Overall, systemic allergic reaction was promoted in mice gavage with ALA-interacted BLA and BLG by disrupting the Th1/Th2 balance toward a Th2 immune response with the decreased number of Tregs. Enhanced induction of Th2-related cytokines, as well as serum-specific antibodies and mast cell activation, was also observed. In this study, we validated that ALA in the food matrix promoted both the sensitization and elicitation of allergic reactions in BALB/c mice.
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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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5
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Johnston N, Brown L, Alviani C, Cross S, Erlewyn-Lajeunesse M, Roberts G. Correspondence: BSACI 2021 guideline for the management of egg allergy. Clin Exp Allergy 2021; 52:586-587. [PMID: 34862823 DOI: 10.1111/cea.14075] [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: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
We are writing in response to the British Society of Allergy and Clinical Immunology (BSACI) egg allergy guideline, published earlier this year in your Journal [1]. The guideline includes a section on the home introduction of egg. This makes the point that home introduction is not the same as a food challenge. It further describes which children can reintroduce egg at home, for example those without asthma or with well controlled asthma and only mild to moderate symptoms on previous exposures.
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Affiliation(s)
- Naoise Johnston
- University of Southampton, Faculty of Medicine, Southampton, UK
| | - Lindsay Brown
- Paediatric Allergy, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Cherry Alviani
- University of Southampton, Faculty of Medicine, Southampton, UK.,Paediatric Allergy, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Stephanie Cross
- Paediatric Allergy, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Mich Erlewyn-Lajeunesse
- University of Southampton, Faculty of Medicine, Southampton, UK.,Paediatric Allergy, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Graham Roberts
- University of Southampton, Faculty of Medicine, Southampton, UK.,Paediatric Allergy, Southampton University Hospital NHS Foundation Trust, Southampton, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, Newport, UK
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6
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Cheah JWM, Wainstein BK. Factors influencing reintroduction of peanut and tree nuts after negative oral food challenges in children. Ann Allergy Asthma Immunol 2021; 128:199-205.e1. [PMID: 34673221 DOI: 10.1016/j.anai.2021.10.013] [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: 07/15/2021] [Revised: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Compliance with reintroduction of foods after a negative oral food challenge (OFC) is variable. Ongoing avoidance of tolerated foods is associated with recurrence of allergy and a reduced quality of life. OBJECTIVE To determine the proportion of children who reintroduced peanut or tree nuts after a negative OFC and to describe factors that influenced decisions regarding reintroduction or avoidance of nonallergic (negative) nuts. METHODS Families of children that had undergone an OFC for peanut or tree nuts at Sydney Children's Hospital were invited to participate. Consenting families were sent an online questionnaire. RESULTS The response rate to the questionnaire was 64%. More than 85% of respondents had introduced all or some of the negative nuts after the OFC and most had maintained at least some regular exposure in the child's diet at the time of the study. The age at diagnosis of the nut allergy and an awareness of the benefit of introducing foods after a negative OFC were significantly (P < .05) associated with introducing negative nuts. There was improved quality of life in those that introduced negative nuts. CONCLUSION Most families introduced or attempted to introduce negative nuts after a negative OFC. Educating families on the benefits of introducing foods after a negative OFC result is an important factor contributing to successful reintroduction.
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Affiliation(s)
- Jamie Wei Min Cheah
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, High Street, Randwick, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brynn Kevin Wainstein
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, High Street, Randwick, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
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7
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Hamada K, Nagao M, Imakiire R, Furuya K, Mizuno Y, Sato Y, Matsunaga M, Yamada S, Nogami K, Hoshi M, Kobori T, Kainuma K, Iijima K, Fujisawa T. Factors associated with outcome of egg allergy 1 year after oral food challenge: A good baseline quality of life may be beneficial. Pediatr Allergy Immunol 2021; 32:1490-1496. [PMID: 33960022 DOI: 10.1111/pai.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/11/2020] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Safely liberalizing the diet to include an allergenic food may accelerate resolution of food allergy. The outcome of liberalization, however, varies among patients. METHODS We conducted a prospective observational study to identify factors associated with outcome for egg allergy 1 year after oral food challenge (OFC). We enrolled children <72 months old who had egg allergy and underwent OFC for determination of the safe intake quantity of egg allergen. Each child's baseline clinical background was recorded. Caregivers used the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) to assess their children's QoL. Dietary advice based on the OFC result was provided to support safe egg consumption. At 1 year after OFC, the quantity of egg each child safely consumed in daily life was surveyed. We classified the outcome as Successful (Group S) if the quantity increased during the 1 year, or as Unsuccessful (Group U) if it did not. Factors associated with the outcome were investigated by multivariate logistic regression analysis. RESULTS A total of 93 children were enrolled, and after 1 year, 57 finished in Group S and 36 in Group U. The mean FAQLQ-PF score at baseline was significantly lower (ie, a better QoL) in Group S than in Group U. Multivariate logistic regression analysis identified a good QoL and absence of comorbid asthma or atopic dermatitis as factors predicting a favorable outcome. CONCLUSION QoL may affect food allergy outcome. Intervention focusing on the QoL may promote outgrowing of food allergies.
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Affiliation(s)
- Kana Hamada
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Ryo Imakiire
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan.,Department of Pediatrics, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Kanae Furuya
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan.,Aichi Konan College, Konan, Japan
| | - Yumi Mizuno
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Mayumi Matsunaga
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Shingo Yamada
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Kazutaka Nogami
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Miyuki Hoshi
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Taiga Kobori
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Keigo Kainuma
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
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Affiliation(s)
- Yamini V Virkud
- From the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Massachusetts General Hospital, and the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Harvard Medical School - both in Boston
| | - Neil D Fernandes
- From the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Massachusetts General Hospital, and the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Harvard Medical School - both in Boston
| | - Ruth Lim
- From the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Massachusetts General Hospital, and the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Harvard Medical School - both in Boston
| | - Deborah M Mitchell
- From the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Massachusetts General Hospital, and the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Harvard Medical School - both in Boston
| | - William T Rothwell
- From the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Massachusetts General Hospital, and the Departments of Pediatrics (Y.V.V., N.D.F., D.M.M.), Radiology (R.L.), and Pathology (W.T.R.), Harvard Medical School - both in Boston
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9
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Upton JEM, Bird JA. Oral food challenges: Special considerations. Ann Allergy Asthma Immunol 2020; 124:451-8. [PMID: 32088320 DOI: 10.1016/j.anai.2020.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To reinforce special considerations when offering and conducting oral food challenges (OFCs). DATA SOURCES Published studies and reviews. STUDY SELECTIONS Studies concerning OFCs and their conduct. RESULTS Multiple OFC protocols for various clinical situations and foods were reviewed. CONCLUSION OFCs are used for the definitive diagnosis of food allergy. Risk and benefit assessment guide the OFC procedure. The conduct of OFCs is influenced by multiple factors, including age, food, and goal of the challenge.
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Muraro A, Mendoza Hernandez DA. Managing food allergy and anaphylaxis: A new model for an integrated approach. Allergol Int 2020; 69:19-27. [PMID: 31759890 DOI: 10.1016/j.alit.2019.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022] Open
Abstract
There is an increasing public concern on food allergy and related anaphylactic reactions that occur mainly at the community level. The perception of the disease is huge among parents who believe that 1 out of 20 children suffers from severe food allergy. The discrepancy between this self-reported prevalence and the real one when a food challenge is performed, points out the gap in the implementation of guidelines for clinical practice. Health professionals as well show scarce adherence to the guidelines both at the Emergency Departments and at the primary care level. Anaphylactic reaction are not recognized, adrenaline is under-used and self-injectable devices are not prescribed. Although education and training are limited to local, spontaneous initiatives from patient's organization and few allergists, the data so far available demonstrate that improvement in knowledge and attitudes can be achieved further to a structured program. There is the need to establish good evidence -based practices for educational intervention that should be adopted in the context of public health policies for food allergy. This would imply a change in legislation in many countries to prevent prosecution for liability of lay people administering adrenaline when properly trained. In parallel an integrated clinical care pathway should be developed by multidisciplinary and multi-professional teams in the context of national Centres of Excellence -CoE. These CoE could drive the progression to digital health create, creating networks of CoE for best practices of care and for clinical trials.
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Abstract
Food challenges are the criterion standard for establishing the presence or absence of food allergy. However, they remain underused because of their resource-intensive nature, inadequate reimbursement, and concern for the risk of anaphylaxis. Here, we review indications for performing food challenges, including scenarios of uncertain diagnosis, quality-of-life effects following food challenges, and the impact on office practice including coding and reimbursement issues. Demand for food challenges is likely to increase and allergists should be capable of providing this service to their patients when indicated.
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13
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Abstract
PURPOSE OF REVIEW This review incorporates findings from studies of oral food challenges (OFC) over the last decade and highlights the latest innovations and understanding of the procedure. RECENT FINDINGS PRACTALL guidelines are widely used in OFC research, but there is still no international consensus on the OFC protocol in clinical practice. Guidelines for performing OFC in clinical practice have been updated to include oral food challenges for infants. There have been advances in predictive models for outcomes and severity of reaction during OFC that take into account multiple clinical data as well as newer laboratory modalities. Low-dose OFC and eliciting threshold dose determination are being examined for additional diagnostic and therapeutic use in the management of food allergy. Quality-of-life considerations have also been reviewed, as well as post-OFC assessment and care. The OFC remains an important diagnostic tool in the management of food allergy and in clinical research. Advances in the field should improve safety and broaden the clinical applications of this essential procedure.
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