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Shaker M, Abrams EM, Oppenheimer J, Anagnostou A, Codispoti CD, Golden DBK, Greenhawt M, Stukus D, Moore-Clingenpeel M, Hughes SW, Mack DP, Mustafa SS, Lang DM. Food sensitization and cardiovascular mortality: An intriguing association in need of further study. J Allergy Clin Immunol 2024; 153:1163-1165. [PMID: 38260919 DOI: 10.1016/j.jaci.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Marcus Shaker
- Department of Medicine and Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Oppenheimer
- Division of Allergy, Department of Medicine, University of Medicine and Dentistry of New Jersey-Rutgers, Newark, NJ
| | - Aikaterini Anagnostou
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Christopher D Codispoti
- Division of Allergy, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Matthew Greenhawt
- Children's Hospital Colorado, Section of Allergy and Clinical Immunology, University of Colorado School of Medicine, Aurora, Colo
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Sarah W Hughes
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
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2
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Amar S, Ioia RD, Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Simons E, Abrams EM, Colli MD, Moisan J, Ben-Shoshan M. Milk-induced anaphylaxis among children presenting to Canadian emergency departments. Ann Allergy Asthma Immunol 2024; 132:512-518.e1. [PMID: 38070650 DOI: 10.1016/j.anai.2023.11.031] [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: 11/02/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Cow's milk is one of the most common and burdensome allergens in pediatrics, and it can induce severe anaphylactic reactions in children. However, data on cow's milk-induced anaphylaxis are sparse. OBJECTIVE To describe the epidemiology of pediatric cow's milk-induced anaphylaxis and to determine risk factors for repeat emergency department (ED) epinephrine administration. METHODS Between April 2011 and May 2023, data were collected on children with anaphylaxis presenting to 10 Canadian EDs. A standardized form documenting symptoms, triggers, treatment, and outcome was used. Multivariate logistic regression was used. RESULTS Of 3118 anaphylactic reactions, 319 milk-induced anaphylaxis cases were identified (10%). In the prehospital setting, 54% of patients with milk-induced anaphylaxis received intramuscular epinephrine. In those with milk-induced anaphylaxis, receiving epinephrine before presenting to the ED was associated with a reduced risk of requiring 2 or more epinephrine doses in the ED (adjusted odds ratio, 0.95 [95% CI, 0.90-0.99]). Children younger than 5 years of age were more likely to experience a mild reaction compared with that in older children, who experienced a moderate reaction more often (P < .0001). Compared with other forms of food-induced anaphylaxis, children presenting with milk-induced anaphylaxis were younger; a greater proportion experienced wheezing and vomiting, and less experienced angioedema. CONCLUSION Prehospital epinephrine in pediatric milk-induced anaphylaxis is underused; however, it may decrease risk of requiring 2 ED epinephrine doses. Milk-induced anaphylaxis in children younger than 5 years of age may be less severe than in older children. Wheezing and vomiting are more prevalent in milk-induced anaphylaxis compared with that of other foods.
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Affiliation(s)
- Sam Amar
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Rose Di Ioia
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hospital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Divisions of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | | | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jocelyn Moisan
- Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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3
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024:S0091-6749(24)00238-0. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [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] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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4
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Harbottle Z, Nötzel A, Golding MA, Bhamra M, Kopsch I, Wilking E, Jonsson M, Abrams EM, Halbrich MA, Simons E, Roos LE, Keddy-Grant JA, Gerstner TV, St-Vincent JA, Ekström S, Protudjer JLP. Infantile atopic dermatitis - increasing severity predicts negative impacts on maternal and infant sleep: a mixed methods study. Allergy Asthma Clin Immunol 2024; 20:21. [PMID: 38519963 PMCID: PMC10960393 DOI: 10.1186/s13223-024-00883-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND While the impacts of atopic dermatitis (AD) on maternal and child sleep outcomes have been previously explored, less is known about the associations between infantile AD and sleep quality and quantity. OBJECTIVE To describe the perceived causes of AD-associated maternal sleep disturbances and the association between AD severity and infant sleep outcomes. METHODS Mothers with infants aged < 19 months old with a diagnosis of AD were recruited from social media and medical clinics in Winnipeg, Canada between October 2021 and May 2022. Infant AD severity was classified using maternal-reported data on the Patient-Oriented Scoring Atopic Dermatitis tool (PO-SCORAD). Quantitative data were collected via a series of questionnaires with a subset of mothers subsequently completing semi-structured interviews. Quantitative and qualitative data were integrated in the discussion. RESULTS Mothers of infants with moderate/severe AD (6/12) were more likely to report their infant suffering from a higher degree of sleeplessness (i.e., ≥ 5 on a scale of 0-10) over the past 48 h compared to mothers of infants with mild AD (0/18). This was supported by qualitative findings where mothers described how their infant's sleep quality and quantity worsened with AD severity. Additionally, 7/32 mothers reported that their child's AD, regardless of severity, disturbed their sleep. Maternal sleep loss was most commonly attributed to infant itching (6/7), followed by worry (4/7). CONCLUSION Infantile AD severity was associated with worse sleep outcomes for both mothers and infants. We propose that maternal and infantile sleep quality and quantity can be improved by reducing AD severity through adherence to topical treatments.
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Affiliation(s)
- Zoe Harbottle
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Michael A Golding
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
| | - Manvir Bhamra
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Marina Jonsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Elissa M Abrams
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle A Halbrich
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Allergy & Asthma Education Centre, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Leslie E Roos
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Jill A Keddy-Grant
- Department of Pediatrics and Child Health, Section of Dermatology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas V Gerstner
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jo-Anne St-Vincent
- Children's Allergy & Asthma Education Centre, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada.
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
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5
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Prosty C, Alyasin M, Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Abrams EM, Simons E, Ben-Shoshan M. Clinical characteristics and management of pediatric egg-induced anaphylaxis: A cross-sectional study. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00151-0. [PMID: 38499059 DOI: 10.1016/j.anai.2024.03.008] [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: 01/26/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Egg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse. OBJECTIVE To describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis. METHODS Children presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry, from which data on anaphylaxis triggered by egg were extracted. Multivariate logistic regression was used to determine factors associated with prehospital epinephrine autoinjector (EAI) use and to compare anaphylaxis triggered by egg with other triggers of food-induced anaphylaxis (FIA). RESULTS We recruited 302 children with egg-induced anaphylaxis. The mean age was 2.6 years (SD = 3.6), and 55.3% were male. Only 39.4% had previously been diagnosed with an egg allergy. Prehospital EAI use was 32.1%, but this was not significantly lower than in other triggers of FIA (P = .26). Only 1.4% of patients required hospital admission. Relative to other triggers of FIA, patients with egg-induced anaphylaxis were significantly younger (P < .001) and exhibited more vomiting (P = .0053) and less throat tightness (P = .0015) and angioedema (P < .001). CONCLUSION To the best of our knowledge, this is the largest published cohort of pediatric egg-induced anaphylaxis. In this cohort, prehospital EAI use was very low. In addition, we identified certain symptoms that distinguish egg-induced from other triggers of FIA. Taken together, high suspicion is crucial in identifying egg-induced anaphylaxis, given the younger patient demographic and frequent lack of FIA history.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Moniah Alyasin
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Moisan
- Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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6
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Ye L, Erdle SC, Abrams EM, Chan ES. Early solid introduction to prevent IgE-mediated food allergy should continue unabated while we learn more about food protein-induced enterocolitis syndrome prevalence. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00083-8. [PMID: 38369255 DOI: 10.1016/j.anai.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Linlei Ye
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephanie C Erdle
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
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7
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Ho JK, Shaker M, Greenhawt M, Sadatsafavi M, Abrams EM, Oppenheimer J, Mosnaim GS, Lee TY, Johnson KM. Cost-effectiveness of budesonide-formoterol vs inhaled epinephrine in US adults with mild asthma. Ann Allergy Asthma Immunol 2024; 132:229-239.e3. [PMID: 37879568 DOI: 10.1016/j.anai.2023.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/24/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The management of mild asthma has lacked an over-the-counter (OTC) option aside from inhaled epinephrine, which is available in the United States. However, inhaled epinephrine use without an inhaled corticosteroid may increase the risk of asthma death. OBJECTIVE To compare the cost-effectiveness of OTC as-needed budesonide-formoterol as a plausible alternative to inhaled epinephrine. METHODS We developed a probabilistic Markov model to compare OTC as-needed budesonide-formoterol inhaler use vs inhaled epinephrine use in adults with mild asthma from a US societal perspective over a lifetime horizon, with a 3% annual discount rate (2022 US dollars). Inputs were derived from the SYmbicort Given as-needed in Mild Asthma (SYGMA) trials, published literature, and commercial costs. Outcomes were quality-adjusted life-years (QALY), costs, incremental net monetary benefit (INMB), severe asthma exacerbations, well-controlled asthma days, and asthma-related deaths. Microsimulation was used to evaluate underinsured Americans living with mild asthma (n = 5,250,000). RESULTS Inhaled epinephrine was dominated (with lower QALYs gains at a higher cost) by both as-needed budesonide-formoterol (INMB, $15,541 at a willingness-to-pay of $100,000 per QALY) and the no-OTC inhaler option (INMB, $1023). Adults using as-needed budesonide-formoterol had 145 more well-controlled asthma days, 2.79 fewer severe exacerbations, and an absolute risk reduction of 0.23% for asthma-related death compared with inhaled epinephrine over a patient lifetime. As-needed budesonide-formoterol remained dominant in all sensitivity and scenario analyses, with a 100% probability of being cost-effective compared with inhaled epinephrine in probabilistic sensitivity analysis. CONCLUSION If made available, OTC as-needed budesonide-formoterol for treating mild asthma in underinsured adults without HCP management improves asthma outcomes, prevents fatalities, and is cost-saving.
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Affiliation(s)
- Joseph Khoa Ho
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, Newark, New Jersey
| | - Giselle S Mosnaim
- Division of Allergy, Asthma, and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois
| | - Tae Yoon Lee
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
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Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Abrams EM, Bernstein JA, Chu DK, Horner CC, Rank MA, Stukus DR, Burrows AG, Cruickshank H, Golden DBK, Wang J, Akin C, Campbell RL, Ellis AK, Greenhawt M, Lang DM, Ledford DK, Lieberman J, Oppenheimer J, Shaker MS, Wallace DV, Waserman S, Abrams EM, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt M, Horner CC, Ledford DK, Lieberman J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol 2024; 132:124-176. [PMID: 38108678 DOI: 10.1016/j.anai.2023.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/19/2023]
Abstract
This practice parameter update focuses on 7 areas in which there are new evidence and new recommendations. Diagnostic criteria for anaphylaxis have been revised, and patterns of anaphylaxis are defined. Measurement of serum tryptase is important for diagnosis of anaphylaxis and to identify underlying mast cell disorders. In infants and toddlers, age-specific symptoms may differ from older children and adults, patient age is not correlated with reaction severity, and anaphylaxis is unlikely to be the initial reaction to an allergen on first exposure. Different community settings for anaphylaxis require specific measures for prevention and treatment of anaphylaxis. Optimal prescribing and use of epinephrine autoinjector devices require specific counseling and training of patients and caregivers, including when and how to administer the epinephrine autoinjector and whether and when to call 911. If epinephrine is used promptly, immediate activation of emergency medical services may not be required if the patient experiences a prompt, complete, and durable response. For most medical indications, the risk of stopping or changing beta-blocker or angiotensin-converting enzyme inhibitor medication may exceed the risk of more severe anaphylaxis if the medication is continued, especially in patients with insect sting anaphylaxis. Evaluation for mastocytosis, including a bone marrow biopsy, should be considered for adult patients with severe insect sting anaphylaxis or recurrent idiopathic anaphylaxis. After perioperative anaphylaxis, repeat anesthesia may proceed in the context of shared decision-making and based on the history and results of diagnostic evaluation with skin tests or in vitro tests when available, and supervised challenge when necessary.
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Affiliation(s)
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Alyssa G Burrows
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - John Oppenheimer
- Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Allergy Group and Bernstein Clinical Research Center, Cincinnati, Ohio
| | - Derek K Chu
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - Caroline C Horner
- Division of Allergy & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Dennis K Ledford
- James A. Haley VA Hospital, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Marcus S Shaker
- Geisel School of Medicine, Hanover, New Hampshire; Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David R Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, New York
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Gabbay JM, Abrams EM, Nyenhuis SM, Wu AC. Housing Insecurity and Asthma Outcomes. J Allergy Clin Immunol Pract 2024; 12:327-333. [PMID: 37871647 DOI: 10.1016/j.jaip.2023.10.031] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.
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Affiliation(s)
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, Ill
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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10
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Yuan IH, Greenhawt M, Abrams EM, Kim EH, Mustafa SS, Iglesia EGA. Food allergies on a college campus. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00069-3. [PMID: 38296046 DOI: 10.1016/j.anai.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
There are limited data on food allergies among college students. In this article, we review the most current available studies. These self-reported surveys and qualitative interviews reported overall poor avoidance of known allergens and low rates of carrying self-injectable epinephrine among students with food allergy. College students may exhibit risk-taking food behaviors due to a number of factors, including age-appropriate risk-taking predilection, strong social influences, and lack of experience in self-advocacy. Having to disclose an otherwise invisible condition repeatedly in a new environment may also lead to "disclosure fatigue," creating an additional barrier to self-advocacy. Common themes in the narrative include hypervigilance, stigma management, and concern about others' misunderstanding of food allergy. Although there is a paucity of data in this area, it is likely that having greater support at the institution level, along with support from peers and faculty, may help improve awareness, self-injectable epinephrine carriage, and allergen avoidance. This review also discusses strategies for preparedness at school, including specific steps to maximize safety.
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Affiliation(s)
- Irene H Yuan
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, Aurora, Colorado
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Edwin H Kim
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Rochester Regional Health, Rochester, New York; Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Edward G A Iglesia
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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11
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Anagnostou A, Greenhawt M, Rodríguez Del Río P, Pickett G, Szafron V, Stukus D, Abrams EM. Addressing common questions on food oral immunotherapy: a practical guide for paediatricians. Arch Dis Child 2024:archdischild-2023-326225. [PMID: 38216305 DOI: 10.1136/archdischild-2023-326225] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
Food allergy has been increasing in prevalence in most westernised countries and poses a significant burden to patients and families; dietary and social limitations as well as psychosocial and economic burden affect daily activities, resulting in decreased quality of life. Food oral immunotherapy (food-OIT) has emerged as an active form of treatment, with multiple benefits such as increasing the threshold of reactivity to the allergenic food, decreasing reaction severity on accidental exposures, expanding dietary choices, reducing anxiety and generally improving quality of life. Risks associated with food immunotherapy mostly consist of allergic reactions during therapy. While the therapy is generally considered both safe and effective, patients and families must be informed of the aforementioned risks, understand them, and be willing to accept and hedge these risks as being worthwhile and outweighed by the anticipated benefits through a process of shared decision-making. Food-OIT is a good example of a preference-sensitive care paradigm, given candidates for this therapy must consider multiple trade-offs for what is considered an optional therapy for food allergy compared with avoidance. Additionally, clinicians who discuss OIT should remain increasingly aware of the growing impact of social media on medical decision-making and be prepared to counter misconceptions by providing clear evidence-based information during in-person encounters, on their website, and through printed information that families can take home and review.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Grant Pickett
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | | | - David Stukus
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elissa M Abrams
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Sillcox C, Gabrielli S, O'Keefe A, McCusker C, Abrams EM, Eiwegger T, Atkinson A, Kim V, Copaescu AM, Ben-Shoshan M. Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges. J Allergy Clin Immunol Pract 2024; 12:156-164.e4. [PMID: 37832819 DOI: 10.1016/j.jaip.2023.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Cephalosporins, β-lactam antibiotics, commonly cause allergic reactions. OBJECTIVE To assess the clinical characteristics and management of pediatric patients with suspected cephalosporin allergy using direct graded oral challenges (GOCs). METHODS Children referred for suspected cephalosporin allergy at 4 Canadian clinics were recruited over 10 years. Data on demographics, clinical reaction characteristics, and management were collected through a questionnaire. Patients underwent a direct GOC (initially 10% of the treatment dose, then 90% after 20 min), and reactions were monitored 1 week postchallenge. Families were contacted annually for up to 5 years to detect subsequent antibiotic reactions. Logistic regression analysis identified factors associated with positive GOC reactions. RESULTS Among the 136 patients reporting cephalosporin allergy, 75 (55.1%) were males with a median age of 3.9 years (interquartile range 2.3-8.7). Cefprozil represented the most common cephalosporin linked to the index reaction (67.6% of cases). Of the 136 direct GOCs, 5.1% had an immediate and 4.4% a nonimmediate reaction, respectively. Positive GOCs conducted in children with a history of skin-limited nonsevere rashes were classified as mild, benign skin rashes. Positive GOCs were more likely in children with food allergies (adjusted odds ratio 1.14; 95% confidence interval [95% CI] 1.00-1.29). CONCLUSIONS Direct GOCs are safe and effective for diagnosing pediatric cases that report nonvesicular skin-limited symptoms while being treated with cephalosporins.
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Affiliation(s)
- Carly Sillcox
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada
| | - Thomas Eiwegger
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria; Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria; Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Ont, Canada; Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont, Canada
| | - Adelle Atkinson
- Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada
| | - Vy Kim
- Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada
| | - Ana-Maria Copaescu
- Division of Allergy and Clinical Immunology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine and Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | | | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
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Abrams EM, Zafack JG, Jensen C, Bettinger JA, Top KA, Hildebrand KJ, Tunis MC. Vaccination and egg allergy: Considerations for family physicians. Can Fam Physician 2024; 70:10-12. [PMID: 38262763 DOI: 10.46747/cfp.700110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Elissa M Abrams
- Senior Medical Advisor in the Centre for Immunization Programs at the Public Health Agency of Canada (PHAC) in Ottawa, Ont; Associate Professor in the Pediatric Allergy and Immunology Program in the Department of Pediatrics and Child Health at the Max Rady College of Medicine at the University of Manitoba in Winnipeg; and Adjunct Professor in the Department of Pediatrics in the Division of Allergy and Immunology at the University of British Columbia in Vancouver
| | - Joseline G Zafack
- Senior Scientific Project Coordinator in the Centre for Immunization Programs at PHAC
| | - Christina Jensen
- Manager of the Canadian Immunization Guide in the Centre for Immunization Programs at PHAC
| | - Julie A Bettinger
- Vaccine safety scientist at the Vaccine Evaluation Center at BC Children's Hospital Research Institute in Vancouver and Associate Professor in the Division of Pediatric Infectious Diseases at the University of British Columbia
| | - Karina A Top
- Professor in the Department of Pediatrics and a researcher with the Women and Children's Health Research Institute, both at the University of Alberta in Edmonton
| | - Kyla J Hildebrand
- Associate Professor and Interim Division Head, Division of Immunology, in the Department of Pediatrics in the Division of Allergy and Immunology in the Department of Medicine at the University of British Columbia and an investigator in the BC Children's Hospital Research Institute
| | - Matthew C Tunis
- Executive Secretary to the National Advisory Committee on Immunization in the Centre for Immunization Programs at PHAC
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Abrams EM, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W, Killikelly A. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. Can Commun Dis Rep 2024; 50:1-15. [PMID: 38511049 PMCID: PMC10949905 DOI: 10.14745/ccdr.v50i12a01] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Passive immunization products for infants and pregnant women and people have sparked interest in understanding Canada's respiratory syncytial virus (RSV) burden. This rapid review examines RSV burden of disease in infants, young children and pregnant women and people. Methods Electronic databases were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit admissions, deaths and preterm labour associated with RSV. We also contacted Canadian respiratory virus surveillance experts for additional data. Results Overall, 17 studies on infants and young children and 10 studies on pregnant women and people were included, in addition to primary surveillance data from one Canadian territory (Yukon). There were higher rates of medical utilization for infants than older children. Hospitalization rates were highest in infants under six months (more than 1% annually), with 5% needing intensive care unit admission, but mortality was low. Severe outcomes often occurred in healthy full-term infants and burden was higher than influenza. Respiratory syncytial virus attack rate was 10%-13% among pregnant women and people. Only one study found a higher hospitalization rate in pregnant women and people compared to non-pregnant women and people. Limited evidence was found on intensive care unit admission, death and preterm birth for pregnant women and people. Conclusion While risk of severe outcomes is larger in high-risk infants and children, healthcare burden is greatest in healthy term infants. The RSV severity for pregnant women and people appears to be similar to that for non-pregnant women and people.
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Affiliation(s)
- Elissa M Abrams
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB
- University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC
| | | | - Phaedra Davis
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | | | - Andrea Irwin
- Yukon Communicable Disease Control, Health and Social Services, Government of Yukon, Whitehorse, YT
| | - Winnie Siu
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | - April Killikelly
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
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Abrams EM, Zafack JG, Jensen C, Bettinger JA, Top KA, Hildebrand KJ, Tunis MC. La vaccination et l’allergie aux œufs. Can Fam Physician 2024; 70:13-15. [PMID: 38262764 DOI: 10.46747/cfp.700113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Elissa M Abrams
- Conseillère médicale principale au Centre des programmes d'immunisation de l'Agence de la santé publique du Canada (ASPC) à Ottawa (Ontario); professeure agrégée au Programme d'allergie et d'immunologie pédiatriques du Département de pédiatrie et de santé des enfants au Collège Max Rady de médecine de l'Université du Manitoba à Winnipeg; et professeure adjointe au Département de pédiatrie à la Division de l'allergie et de l'immunologie de l'Université de la Colombie-Britannique à Vancouver (Colombie-Britannique)
| | - Joseline G Zafack
- Coordonnatrice principale des projets scientifiques au Centre des programmes d'immunisation de l'ASPC
| | | | - Julie A Bettinger
- Scientifique spécialisée en sécurité des vaccins au Centre d'évaluation des vaccins de l'Institut de recherche du BC Children's Hospital à Vancouver; et professeure agrégée à la Division des maladies infectieuses pédiatriques de l'Université de la Colombie-Britannique
| | - Karina A Top
- Professeure au Département de pédiatrie et chercheuse au Women and Children's Health Research Institute, les 2 étant affiliés à l'Université de l'Alberta à Edmonton
| | - Kyla J Hildebrand
- Professeure agrégée et cheffe par intérim à la Division de l'immunologie du Département de pédiatrie et à la Division de l'allergie et de l'immunologie du Département de médecine de l'Université de la Colombie-Britannique; et investigatrice à l'Institut de recherche du BC Children's Hospital
| | - Matthew C Tunis
- Secrétaire de direction du Comité consultatif national de l'immunisation au Centre des programmes d'immunisation de l'ASPC
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Delli Colli L, Al Ali A, Gabrielli S, Delli Colli M, Mule P, Lawson B, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Bretholz A, McCusker C, Zhang X, Benor S, Simons E, Abrams EM, Protudjer JLP, Ben-Shoshan M. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol 2023; 131:752-758.e1. [PMID: 37689113 DOI: 10.1016/j.anai.2023.08.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/09/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Epinephrine is the first-line treatment for anaphylaxis but is often replaced with antihistamines or corticosteroids. Delayed epinephrine administration is a risk factor for fatal anaphylaxis. Convincing data on the role of antihistamines and corticosteroids in anaphylaxis management are sparse. OBJECTIVE To establish the impact of prehospital treatment with epinephrine, antihistamines, and/or corticosteroids on anaphylaxis management. METHODS Patients presenting with anaphylaxis were recruited prospectively and retrospectively in 10 Canadian and 1 Israeli emergency departments (EDs) between April 2011 and August 2022, as part of the Cross-Canada Anaphylaxis REgistry. Data on anaphylaxis cases were collected using a standardized form. Primary outcomes were uncontrolled reactions (>2 doses of epinephrine in ED), no prehospital epinephrine use, use of intravenous fluids in ED, and hospital admission. Multivariate regression was used to identify factors associated with primary outcomes. RESULTS Among 5364 reactions recorded, median age was 8.8 years (IQR, 3.78-16.9); 54.9% of the patients were males, and 52.5% had a known food allergy. In the prehospital setting, 37.9% received epinephrine; 44.3% received antihistamines, and 3.15% received corticosteroids. Uncontrolled reactions happened in 250 reactions. Patients treated with prehospital epinephrine were less likely to have uncontrolled reactions (adjusted odds ratio [aOR], 0.955 [95% CI, 0.943-0.967]), receive intravenous fluids in ED (aOR, 0.976 [95% CI, 0.959-0.992]), and to be admitted after the reaction (aOR, 0.964 [95% CI, 0.949-0.980]). Patients treated with prehospital antihistamines were less likely to have uncontrolled reactions (aOR, 0.978 [95% CI, 0.967-0.989]) and to be admitted after the reaction (aOR, 0.963 [95% CI, 0.949-0.977]). Patients who received prehospital corticosteroids were more likely to require intravenous fluids in ED (aOR, 1.059 [95% CI, 1.013-1.107]) and be admitted (aOR, 1.232 [95% CI, 1.181-1.286]). CONCLUSION Our findings in this predominantly pediatric population support the early use of epinephrine and suggest a beneficial effect of antihistamines. Corticosteroid use in anaphylaxis should be revisited.
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Affiliation(s)
- Luca Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pasquale Mule
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Benjamin Lawson
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hospital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Université de Montréal, Quebec, Canada
| | - Rod Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Faculty of Medicine, Department of Pediatrics, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Bretholz
- Department of Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Center for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Shira Benor
- Allergy and Clinical Immunology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Batac ALR, Merrill KA, Golding MA, Abrams EM, Bégin P, Ben-Shoshan M, Ladouceur E, Roos LE, Protudjer V, Protudjer JLP. A qualitative investigation into vaccine hesitancy and confidence among people managing allergy. Ann Allergy Asthma Immunol 2023; 131:775-777. [PMID: 37652234 DOI: 10.1016/j.anai.2023.08.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Ayel Luis R Batac
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn A Merrill
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Bégin
- Division of Allergy, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; Division of Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Clinical Immunology, and Dermatology, Department of Pediatrics Montreal Children's Hospital, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Leslie E Roos
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vladan Protudjer
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Batac ALR, Merrill KA, Golding MA, Bhamra M, Harbottle Z, Kopsch I, Wilking E, Jonsson M, Ekström S, Abrams EM, Halbrich MA, Simons E, Roos LE, Keddy-Grant JA, Gerstner TV, St-Vincent JA, Protudjer JLP. Infantile atopic dermatitis and maternal-infant bonding: a mixed methods study. Allergy Asthma Clin Immunol 2023; 19:100. [PMID: 38031081 PMCID: PMC10687835 DOI: 10.1186/s13223-023-00857-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Childhood atopic dermatitis can have a negative effect on caregivers' quality of life and stress levels due to the burdensome nature of its treatment. Given that the condition often emerges in infancy, atopic dermatitis-related stress also carries the potential to negatively affect the developing mother-infant bond. While it is plausible that atopic dermatitis has a negative impact on maternal-infant bonding, these relationships have not been studied directly. In light of this gap, the current study investigated the association between infantile atopic dermatitis and the maternal-infant bond using a mixed-method design. METHODS Mothers of infants (< 19 months) with atopic dermatitis were recruited from social media and medical clinics between October 2021 and May 2022. Mothers with infants unaffected by inflammatory skin conditions were also recruited to serve as a control group. Participants were asked to complete questionnaires related to their demographics, child's health, and mother-infant bond. Multiple linear regression analyses were used to assess bonding quality among cases and controls. A subset of cases were also asked to participate in semi-structured interviews focused on infantile atopic dermatitis and the maternal-infant bond. RESULTS The final sample consisted of 32 cases and 65 controls. Scores on the impaired bonding and risk of abuse subscales did not significantly differ between cases and controls. However, mothers of infants with atopic dermatitis did report lower levels of caregiving anxiety (b = - 1.47, p < 0.01) and pathological anger/rejection (b = - 1.74, p = 0.02) relative to controls. Qualitative findings suggest that the topical therapies required to manage atopic dermatitis may strengthen the bond between some mothers and infants. CONCLUSION Findings suggest that atopic dermatitis does not have a negative impact on maternal-infant bonding and may actually improve bonds in some cases. In light of this finding, clinicians may leverage the potentially positive impact of atopic dermatitis-related caregiving on the maternal-infant bond to encourage caregivers to remain adherent to their child's topical treatments.
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Affiliation(s)
- Ayel Luis R Batac
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Kaitlyn A Merrill
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
| | - Manvir Bhamra
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Zoe Harbottle
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | | | | | - Marina Jonsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Elissa M Abrams
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle A Halbrich
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Allergy and Asthma Education Centre, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Leslie E Roos
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Jill A Keddy-Grant
- Department of Pediatrics and Child Health, Section of Dermatology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas V Gerstner
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jo-Anne St-Vincent
- Children's Allergy and Asthma Education Centre, Health Sciences Centre Winnipeg, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
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20
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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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21
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Kocatürk E, Abrams EM, Maurer M, Mitri J, Oppenheimer J, Vestergaard C, Zein J. COVID-19 and Its Impact on Common Diseases in the Allergy Clinics. J Allergy Clin Immunol Pract 2023; 11:3289-3303. [PMID: 37660731 DOI: 10.1016/j.jaip.2023.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/08/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has various effects on asthma, allergic rhinitis, atopic dermatitis, and urticaria and may change the course of the disease depending on the severity of the infection and control status of the disease. Conversely, these diseases may also impact the course of COVID-19. Patients with chronic urticaria and atopic dermatitis may have COVID-19-induced disease exacerbations and biological treatments reduce the risk of exacerbations. Poor asthma control is linked to severe COVID-19 while allergic asthma is associated with lower risk of death and a lower rate of hospitalization due to COVID-19 compared with nonallergic asthma. The use of intranasal corticosteroids is associated with lower rates of hospitalization due to COVID-19 in patients with allergic rhinitis, whereas the effect of inhaled corticosteroids is confounded by asthma severity. These observations reinforce the importance of keeping allergic diseases under control during pandemics. The use of biologicals during COVID-19 is generally regarded as safe, but more evidence is needed. The pandemic substantially changed the management of allergic disorders such as home implementation of various biologicals, allergen immunotherapy, food introduction, and increased use of telemedicine and even home management of anaphylaxis to reduce emergency department burden and reduce risk of infection. Physicians need to be aware of the potential impact of COVID-19 on allergic diseases and educate their patients on the importance of continuing prescribed medications and adhering to their treatment plans to maintain optimal control of their disease.
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Affiliation(s)
- Emek Kocatürk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Jad Mitri
- Department of Medicine, Saint Elizabeth Medical Center, Boston, Mass
| | - John Oppenheimer
- UMDNJ-Rutgers Department of Medicine, Division of Allergy and Immunology, Newark, NJ
| | | | - Joe Zein
- The Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
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Abrams EM, Shaker M, Stukus D, Mack DP, Greenhawt M. Updates in Food Allergy Prevention in Children. Pediatrics 2023; 152:e2023062836. [PMID: 37818612 DOI: 10.1542/peds.2023-062836] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 10/12/2023] Open
Abstract
Although significant evidence exists that feeding early has a role in the prevention of food allergy, this intervention in isolation may not be sufficient. Recent evidence highlights that early introduction of peanut specifically has had no significant impact on the populational prevalence of peanut allergy. Other factors that may contribute to food allergy prevention include regularity of ingestion once an allergen is introduced and consideration to the form in which the allergen is introduced (such as baked versus cooked egg). There are also many practicalities to early feeding and some discrepant viewpoints on these practicalities, which has led to poor implementation of early feeding strategies. In general, preemptive screening before food introduction is not recommended by most international allergy societies. Although there is little guidance to inform early introduction of allergens other than milk, egg, and peanut, the mechanism of sensitization is thought to be similar and there is no harm to early introduction. In terms of frequency and duration of feeding, there is little evidence to inform any concrete recommendations.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada, and Halton Pediatric Allergy, Burlington, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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23
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Shaker MS, Abrams EM, Mack DP, Chan ES, Iglesia EGA, Golden DBK, Greenhawt M. The promise and peril of knowledge translation for food allergy prevention. Ann Allergy Asthma Immunol 2023; 131:544-546. [PMID: 37652233 PMCID: PMC10964205 DOI: 10.1016/j.anai.2023.08.598] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Marcus S Shaker
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, The University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Edward G A Iglesia
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David B K Golden
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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24
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Shaker M, Abrams EM, Sublett JW. Corrigendum to "Contextual community epinephrine prescribing: Is more always better?" [Ann Allergy Asthma Immunol 131 (2023) 176-184]. Ann Allergy Asthma Immunol 2023; 131:534. [PMID: 37788880 DOI: 10.1016/j.anai.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine and Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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Perlman L, Gabrielli S, Clarke AE, Delli Colli L, Delli Colli M, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Abrams EM, Simons E, Ben-Shoshan M. Pediatric wheat-induced anaphylaxis from the Cross-Canada Anaphylaxis Registry: Clinical characteristics and management. J Allergy Clin Immunol Pract 2023; 11:2592-2594.e1. [PMID: 37245735 DOI: 10.1016/j.jaip.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Lauren Perlman
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luca Delli Colli
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina Delli Colli
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, and the BC Children's Research Institute, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | | | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Moisan
- Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Shaker M, Abrams EM, Sublett JW. Contextual community epinephrine prescribing: Is more always better? Ann Allergy Asthma Immunol 2023; 131:176-184. [PMID: 37209832 DOI: 10.1016/j.anai.2023.05.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Prompt administration of epinephrine is first-line management of anaphylaxis. Although severe anaphylaxis may require more than 1 epinephrine dose, multiple epinephrine device packs may not be necessary for all patients at risk for allergic reactions. DATA SOURCES A narrative review was used to describe key considerations to contextualize community epinephrine prescribing. RESULTS Anaphylaxis has a lifetime prevalence of 1.6% to 5.1%. Meeting diagnostic criteria for anaphylaxis is not required for epinephrine treatment of a severe allergic reaction. A "1-2-3" approach to anaphylaxis treatment is important to clearly relay central management steps: promptly administer a first dose of intramuscular epinephrine with proper positioning, and activate emergency medical services if immediate symptom resolution does not occur; consider a second dose of intramuscular epinephrine with consideration of oxygen administration and intravenous fluid if initial epinephrine response is not adequate; and consider a third intramuscular epinephrine dose together with consideration of intravenous fluid support and oxygen for continued lack of appropriate response. Although multiple epinephrine doses may be required to treat severe anaphylaxis, 90% of anaphylaxis cases do not require more than 1 epinephrine dose. A universal requirement for multiple epinephrine devices in patients without a history of anaphylaxis is not cost-effective. Patients without a history of anaphylaxis may be managed without multiple device prescriptions within a patient-preference sensitive paradigm of care. CONCLUSION Anaphylaxis prevention involves appropriate education to avoid allergen triggers, recognize symptoms of an allergic reaction, rapidly access and administer intramuscular epinephrine, and appropriately activate emergency medical services when needed. For patients with previous anaphylaxis, particularly those who have required more than 1 dose of epinephrine to treat an allergic reaction, possessing multiple epinephrine devices is an important part of managing community anaphylaxis risk.
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Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine and Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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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. Real-world data are critical for the implementation of preschool food allergen immunotherapy. J Allergy Clin Immunol Pract 2023; 11:2624-2625. [PMID: 37558366 DOI: 10.1016/j.jaip.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 08/11/2023]
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; Allergy Centre, Union Hospital, Hong Kong SAR, China.
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, 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, Man, 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
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, 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
| | - Timothy K Vander Leek
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alta, 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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Greenhawt M, Dribin TE, Abrams EM, Shaker M, Chu DK, Golden DBK, Akin C, Anagnostou A, ALMuhizi F, Alqurashi W, Arkwright P, Baldwin JL, Banerji A, Bégin P, Ben-Shoshan M, Bernstein J, Bingemann TA, Bindslev-Jensen C, Blumenthal K, Byrne A, Cahill J, Cameron S, Campbell D, Campbell R, Cavender M, Chan ES, Chinthrajah S, Comberiati P, Eastman JJ, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Garvey LH, Grayson MH, Isabwe GAC, Hartog N, Hendron D, Horner CC, Hourihane JO, Iglesia E, Kan M, Kaplan B, Katelaris CH, Kim H, Kelso JM, Khan DA, Lang D, Ledford D, Levin M, Lieberman JA, Loh R, Mack DP, Mazer B, Mody K, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Nathan R, Oppenheimer J, Otani IM, Park M, Pawankar R, Perrett KP, Peter J, Phillips EJ, Picard M, Pitlick M, Ramsey A, Rasmussen TH, Rathkopf MM, Reddy H, Robertson K, Rodriguez Del Rio P, Sample S, Sheshadri A, Sheik J, Sindher SB, Spergel JM, Stone CA, Stukus D, Tang MLK, Tracy JM, Turner PJ, Vander Leek TK, Wallace DV, Wang J, Wasserman S, Weldon D, Wolfson AR, Worm M, Yacoub MR. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. J Allergy Clin Immunol 2023; 152:309-325. [PMID: 37295474 PMCID: PMC10247143 DOI: 10.1016/j.jaci.2023.05.019] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K Chu
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada; Evidence in Allergy Group, McMaster University Medical Centre, Hamilton, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Bethesda
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Akterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Arabia
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - James L Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Philippe Bégin
- Centre Hospital Universitaire Sainte-Justine, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa A Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | - Kim Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Aideen Byrne
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Cahill
- University of Alberta, Faculty of Medicine, Calgary, Canada
| | - Scott Cameron
- Allergy Victoria, Victoria, British Columbia, Canada
| | | | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester
| | | | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jacqueline J Eastman
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guys's and St Tomas's Hospital National Health Service Foundation Trust, London, Mass
| | - Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Nicholas Hartog
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - David Hendron
- Access Health Care Physicians LLC, New Port Richey, Fla
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | | | - Edward Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, New York, NY
| | | | - Harold Kim
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, St Joseph's Health Care, London (Canada), Mass
| | - John M Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David A Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada; Halton Pediatric Allergy, Burlington, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Ketan Mody
- Elite Sports Medicine Institute Ltd, Westmont, Ill
| | - Gisele Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, Mass
| | - S Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex; Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Tex
| | | | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Kirsten P Perrett
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill; Population Allergy Group and the Centre for Food and Allergy Research, Murdoch Children's Research Institute, University of Melbourne, University of Melbourne, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | | | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Trine Holm Rasmussen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | | | - Hari Reddy
- Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St Joseph's Health Care, London (Canada), Mass; Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care, London (Canada), Mass
| | | | | | - Ajay Sheshadri
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Javed Sheik
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - James M Tracy
- Allergy, Asthma, and Immunology Associates PC, Omaha, Neb; Department of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J Turner
- Imperial College Healthcare National Health Service Trust, London, Mass; Royal Brompton and Harefield National Health Service Foundation Trust, London, Mass
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Dana V Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Wasserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - David Weldon
- Baylor Scott and White Clinic, College Station, Tex
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mona-Rita Yacoub
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Segrate, Milan, Italy
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Bhamra M, Harbottle Z, Golding MA, Ben-Shoshan M, Roos LE, Abrams EM, Penner SJ, St-Vincent JA, Protudjer JL. Parental perceptions of a novel subsidy program to address the financial burden of milk allergy: a qualitative study. Allergy Asthma Clin Immunol 2023; 19:65. [PMID: 37516877 PMCID: PMC10385888 DOI: 10.1186/s13223-023-00828-w] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Approximately 6-7% of Canadian children have food allergy. These families face substantial burdens due to the additional costs incurred purchasing allergy-friendly products necessary for management compared to families without food allergies. In the year prior to the COVID-19 pandemic, these costs were equivalent to an average of $200 monthly compared to families without food allergy. As food prices continue to rise, rates of food insecurity also increase, disproportionately affecting households with food allergy who have limited choices at food banks. METHODS Families living or working in Winnipeg, Canada with an annual net income of about $70,000 or less the year prior to recruitment and a child under the age of 6 years old with a physician diagnosed milk allergy were recruited between January and February 2022. Participating families received bi-weekly home deliveries for six months, from March to August 2022, of subsidy kits containing ~$50 worth of milk allergy-friendly products. Semi-structured interviews, completed ± 2 weeks from the final delivery, were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS Eight interviews, averaging 32 min (range 22-54 min), were completed with mothers from all different families. On average, mothers were 29.88 ± 4.39 years old and children were 2.06 ± 1.32 years old. All children reported allergies in addition to milk. Based on the data from these interviews, we identified 3 themes: food allergy causes substantial burden for families, "I have to get his allergy-friendly food first before getting to my basic needs", and perceived emotional and financial benefits of a milk allergy-friendly food subsidy program. CONCLUSIONS This study, along with previous research, suggests that there is a need for assistance for families managing milk allergies. It also provides important information to inform development of programs which can address these financial challenges. Our in-kind food subsidy was perceived as having a positive impact on food costs and stress associated with food allergy management, however, parents identified a need for more variety in the food packages. Future programs should strive to incorporate a greater variety of products to address this limitation.
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Affiliation(s)
- Manvir Bhamra
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zoe Harbottle
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael A Golding
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Department of Allergy and Immunology, McGill University, Montreal, QC, Canada
| | - Leslie E Roos
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Sara J Penner
- Department of Business and Administration, University of Winnipeg, Winnipeg, MB, Canada
| | | | - Jennifer Lp Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Abrams EM, Ben-Shoshan M, Protudjer JLP, Lavine E, Chan ES. Early introduction is not enough: CSACI statement on the importance of ongoing regular ingestion as a means of food allergy prevention. Allergy Asthma Clin Immunol 2023; 19:63. [PMID: 37464441 DOI: 10.1186/s13223-023-00814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada.
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elana Lavine
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Pediatrics, Queen's University, Humber River Hospital, Toronto, ON, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
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Santos MJL, Merrill K, Riediger N, Abrams EM, Piquemal N, Simons E, Protudjer JLP. Winnipeg-based elementary school teachers' perspectives on food allergy management: a qualitative analysis. Allergy Asthma Clin Immunol 2023; 19:62. [PMID: 37452340 PMCID: PMC10347816 DOI: 10.1186/s13223-023-00798-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Food allergy affects 7-8% of children worldwide. Teachers supervise children in school, where most children spend their day. Yet, teachers have variable food allergy-related knowledge. OBJECTIVE We aimed to identify how Winnipeg-based elementary school teachers manage food allergy and prevent food-triggered allergic reactions in their classrooms and schools. METHODS Kindergarten-Grade 6 public and private school teachers, from Winnipeg, Canada, were interviewed virtually upon providing written informed consent. Interviews were recorded and transcribed verbatim. The study followed a pragmatic framework. Data were analysed via thematic analysis by multiple researchers. RESULTS We interviewed 16 teachers, who primarily identified as female (87.5%). Most teachers worked in public schools (87.5%) and, on average, had 5.8 years of teaching experience. We identified four themes within the data. Most teachers (68.9%) had direct or indirect experience with food allergy. Theme 1 described the minimal standardization and inconsistent enforcement of food allergy policies between and within schools. Teachers also had varied food allergy knowledge. Theme 2 reflected teachers' variable confidence/perceived knowledge towards food allergy management, including feeling of stress and anxiety. Theme 3 captured the lack of standardized food allergy education for teachers, and concerns about the adequacy of the current provincial program. Theme 4 described how teachers spoke of relying on other school staff, families and students to have effective communication. CONCLUSION Teachers' food allergy management was informed by their knowledge and lived experience, guided by their school policies and individualized students' needs. Teachers identified gaps in knowledge and communication, and desired more training and resources.
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Affiliation(s)
- Mae Jhelene L Santos
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Kaitlyn Merrill
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Riediger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Section of Allergy, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | | | - Elinor Simons
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Section of Allergy, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Jennifer L P Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
- George and Fay Yee Centre for Healthcare Innovation, 501G-715 McDermot Avenue, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Chong AC, Diwakar L, Kaplan CM, Fox AT, Abrams EM, Greenhawt M, Oppenheimer JJ, Shaker MS. Provision of Food Allergy Care in the United Kingdom and United States: Current Issues and Future Directions. J Allergy Clin Immunol Pract 2023; 11:2054-2066. [PMID: 36990429 DOI: 10.1016/j.jaip.2023.03.029] [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] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
Food allergy (FA) is a growing issue worldwide. The United Kingdom and United States are high-income, industrialized countries with reported increases in FA prevalence over the past few decades. This review compares delivery of FA care in the United Kingdom and United States and each country's response to the heightened demand and disparities for FA services. In the United Kingdom, allergy specialists are scarce and general practitioners (GPs) provide most allergy care. Whereas the United States has more allergists per capita than the United Kingdom, there is still a shortage of allergy services owing to the greater reliance on specialist care for FA in America and wide geographic variation in access to allergist services. Currently, generalists in these countries lack the specialty training and equipment to diagnose and manage FA optimally. Moving forward, the United Kingdom aims to enhance training for GPs so they may provide better quality frontline allergy care. In addition, the United Kingdom is implementing a new tier of semi-specialized GPs and increasing cross-center collaboration through clinical networks. The United Kingdom and United States aim to increase the number of FA specialists, which is critical at a time of rapidly expanding management options for allergic and immunologic diseases requiring clinical expertise and shared decision-making to select appropriate therapies. While these countries aim to grow their supply of quality FA services actively, further efforts to build clinical networks and perhaps recruit international medical graduates and expand telehealth services are necessary to reduce disparities in access to care. For the United Kingdom in particular, increasing quality services will require additional support from the leadership of the centralized National Health Service, which remains challenging.
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Affiliation(s)
- Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Lavanya Diwakar
- Department of Immunology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Department of Health Economics, University of Birmingham, Birmingham, United Kingdom
| | - Cameron M Kaplan
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, Calif
| | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - John J Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, UMDJ Rutgers University School of Medicine, Newark, NJ
| | - Marcus S Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH.
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Ridley D, Abrams EM, Wong P, Chan ES. Challenges implementing recent recommendations of daily formula supplementation for allergy prevention and practical real-world options. Paediatr Child Health 2023; 28:208-211. [PMID: 37287476 PMCID: PMC10243975 DOI: 10.1093/pch/pxac121] [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] [Received: 06/16/2022] [Accepted: 11/09/2022] [Indexed: 01/25/2024] Open
Abstract
The Canadian Paediatric Society's Position statement 'Dietary exposures and allergy prevention in high-risk infants' December 2021 provides recommendations for regular ingestion of cow's milk protein (CMP) once introduced in early infancy. These recommendations are based on evidence from randomized controlled trials (RCTs) where researchers supported participants in adhering to diet recommendations. Real-life dilemmas that relate to dietary adherence including cost, food wastage, and practicality are not addressed and are the crux of where -evidence-based recommendations fail. This commentary highlights the difficulties in carrying out the proposed recommendation for regular ingestion of CMP in practice and offers three practical real-world options instead.
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Affiliation(s)
- Denise Ridley
- Department of Nutrition Services, Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
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Abrams EM, Protudjer JLP. Factoring in cofactors in the diagnosis and management of anaphylaxis. Ann Allergy Asthma Immunol 2023; 130:695-696. [PMID: 37270227 DOI: 10.1016/j.anai.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jennifer L P Protudjer
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Faculty of Agricultural and Food Sciences, Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Stirton H, Kosowan L, Abrams EM, Protudjer JL, Queenan J, Singer A. Validation of a primary care electronic medical records case definition for eczema: retrospective cross-sectional study. Allergy Asthma Clin Immunol 2023; 19:46. [PMID: 37246208 DOI: 10.1186/s13223-023-00785-4] [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: 05/03/2022] [Accepted: 03/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND To validate case definitions for eczema using primary care Electronic Medical Record (EMR) data from the Canadian Primary Care Sentential Surveillance Network (CPCSSN). METHODS This study used EMR data from 1,574 primary care providers in seven Canadian provinces, representing 689,301 patients. Using a subset of patient records seven medical students or family medicine residents created a reference set of 1,772 patients. A total of 23 clinician-informed case definitions were validated against the reference. We assessed agreement using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. The case definitions with the best agreement statistics were deployed to estimate the prevalence of eczema in the CPCSSN. RESULTS Case definition 1 had the highest SE (92.1%,85.0-96.5) but a lower SP (88.5%,86.7-90.1) and PPV (36.6%,33.1-40.3). Case definition 7 was the most specific case definition with a SP (99.8%, 99.4-100) and PPV (84.2%,61.2-94.7) but low SE (15.8%,9.3-24.5). Case definition 17 had a SE (75.3%, 65.7-83.3), SP (93.8%, 91.5-94.3) and PPV 43.7% (38.3-49.2). When we applied the most specific and most sensitive case definitions, we estimate the prevalence of eczema to be between 0.8 and 15.1%. Case definition 17 suggests an eczema prevalence estimate of 8.2% (8.08-8.21%). CONCLUSIONS We validated EMR-based eczema case definitions to estimate the prevalence of clinician-documented eczema. Future studies may choose to apply one or more of these definitions' dependent on their studies objectives to inform disease surveillance as well as explore burden of illness or interventions related to eczema care in Canada.
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Affiliation(s)
- Hannah Stirton
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - John Queenan
- Department of Family Medicine, Queens University, Kingston, Ontario, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Golding MA, Roos LE, Abrams EM, Gerdts JD, Protudjer JLP. Temporal examination of adult food insecurity amongst Canadian families managing food allergy. Allergy Asthma Clin Immunol 2023; 19:45. [PMID: 37245046 DOI: 10.1186/s13223-023-00802-6] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pediatric food allergy is associated with excess familial food costs compared to families without allergy. Since the start of the COVID-19 pandemic, food prices have increased substantially. OBJECTIVE To understand the temporal pattern of food insecurity amongst Canadian families with food allergy from the year prior to the pandemic, through May 2022. METHODS Using data collected electronically from families reporting food allergy using a validated food security questionnaire, we estimated food insecurity, including categories of food insecurity (marginal, moderate, secure) in the year prior to the pandemic (2019; Wave 1), and the first (2020; Wave 2) and second years of the pandemic (2022; Wave 3). RESULTS Participants in all waves were commonly in 2 + adult, 2 child households. Less than half of participants (Waves 1-3: 45.7%, 31.0%, and 22.9%, respectively) reported household incomes below the median Canadian. Common allergies were milk, eggs, peanuts and tree nuts. In Wave 1, 22.9% of families reported food insecurity; corresponding numbers at Waves 2 and 3 were 30.6% and 74.4%, respectively, representing an overall increase of 225.6%, including notable increases in severe food insecurity. CONCLUSION Canadian families with pediatric food allergy report higher rates of food insecurity compared to the general Canadian population, especially during the pandemic.
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Affiliation(s)
- Michael A Golding
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
| | - Leslie E Roos
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada
- University of British Columbia, Vancouver, BC, Canada
| | | | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Batac ALR, Merrill KA, Askin N, Golding MA, Abrams EM, Bégin P, Ben-Shoshan M, Ladouceur E, Roos LE, Protudjer V, Protudjer JLP. Vaccine confidence among those living with allergy during the COVID pandemic (ACCORD): A scoping review. J Allergy Clin Immunol Glob 2023; 2:100079. [PMID: 36785543 PMCID: PMC9907785 DOI: 10.1016/j.jacig.2023.100079] [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] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 02/11/2023]
Abstract
Background Reports of allergic reactions to coronavirus disease 2019 (COVID-19) vaccines, coupled with an "infodemic" of misinformation, carry the potential to undermine confidence in the COVID-19 vaccines. However, no attempts have been made to comprehensively synthesize the literature on how allergic disease and fear of allergic reactions to the vaccines contribute to hesitancy. Objectives Our aim was to review the academic and gray literature on COVID-19 vaccine hesitancy and allergic reactions. Methods We searched 4 databases (CINAHL, PsycINFO, MEDLINE, and Embase) using a search strategy developed by content and methodologic experts. No restrictions were applied regarding COVID-19 vaccine type, country of study, or patient age. Eligible articles were restricted to 10 languages. Results Of the 1385 unique records retrieved from our search, 60 articles (4.3%) were included. Allergic reactions to the COVID-19 vaccine were rare but slightly more common in individuals with a history of allergic disease. A fifth of the studies (13 of 60 [22%]) discussed vaccine hesitancy due to possibility of an allergic reaction. Additionally, the present review identified research on details of vaccine-related anaphylaxis (eg, a mean and median [excluding clinical trial data] of 12.4 and 5 cases per million doses, respectively) and allergic reactions (eg, a mean and median [excluding clinical trial data] of 489 and 528 cases per million doses, respectively). Conclusion COVID-19 vaccine acceptance among individuals living with allergy and among those with no history of allergic disease may be affected by fear of an allergic reaction. Despite the low incidence of allergic reactions to the COVID-19 vaccine, fear of such reactions is one of the most commonly cited concerns reported in the literature.
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Affiliation(s)
- Ayel Luis R Batac
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn A Merrill
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- WRHA Virtual Library, Winnipeg, Manitoba, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Bégin
- Division of Allergy, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Division of Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Clinical Immunology, and Dermatology, Department of Pediatrics, Montréal Children's Hospital, Montréal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, Quebec, Canada.,Division of Experimental Medicine, Department of Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | | | - Leslie E Roos
- Department of Psychology, Faculty of Arts, Winnipeg, Manitoba, Canada
| | - Vladan Protudjer
- College of Nursing, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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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. Reply to "Peanut allergy prevention: A mother's perspective". J Allergy Clin Immunol Pract 2023; 11:1574-1575. [PMID: 37150549 DOI: 10.1016/j.jaip.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 05/09/2023]
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; Allergy Centre, Union Hospital, Hong Kong SAR, China.
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, 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
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, 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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Karunakaran D, Chan ES, Zhang Q, Bone JN, Carr S, Kapur S, Rex GA, McHenry M, Cameron SB, Cook VE, Leo S, Wong T, Gerstner TV, Yeung J, Abrams EM, Mak R, Erdle SC, Soller L. Risk factors associated with safety of preschool peanut oral immunotherapy. J Allergy Clin Immunol Glob 2023; 2:100094. [PMID: 37780798 PMCID: PMC10510002 DOI: 10.1016/j.jacig.2023.100094] [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: 09/12/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 10/03/2023]
Abstract
Background An understanding of how patient characteristics such as age, baseline peanut-specific IgE, and atopic comorbidities may influence potential safety outcomes during peanut oral immunotherapy (P-OIT) could aid in shared decision making between clinicians and patient families. Objective This study explored the relationship between baseline patient characteristics and reactions during P-OIT using a large sample size to better understand potential risk factors influencing P-OIT safety. Methods Data were obtained from the Food Allergy Immunotherapy (FAIT) registry, which collects real-world OIT data from community and academic allergy clinics across Canada. Multivariable logistic regression modeling was performed to examine the relationship between baseline patient characteristics and reactions during P-OIT. Multiple imputation was applied to reduce potential bias caused by missingness and to maximize the use of available information to preserve statistical power. Results Between April 2017 and June 2021, a total of 653 eligible patients initiated P-OIT. Multivariable regression analysis showed pre-OIT grade 2+ initial reaction (odds ratio [OR] = 1.33, 95% confidence interval [CI] 1.10, 1.61), allergic rhinitis (OR = 1.60, 95% CI 1.08, 2.38), older age (OR = 1.01, 95% CI 1.00, 1.02), and higher baseline peanut-specific IgE (OR = 1.02, 95% CI 1.02, 1.03) were associated with grade 2+ reaction during P-OIT after adjusting for potential risk factors. Conclusion Our study identified several clinically important risk factors for grade 2+ reactions during P-OIT: pre-OIT grade 2+ initial reaction, allergic rhinitis, older age, and higher baseline peanut-specific IgE. These results highlight the need for individualized risk stratification for OIT.
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Affiliation(s)
- Duva Karunakaran
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Medicine, Queen’s University, Kingston, Ontario
| | - Edmond S. Chan
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
| | - Qian Zhang
- British Columbia Children’s Hospital, Vancouver, British Columbia
| | - Jeffrey N. Bone
- British Columbia Children’s Hospital, Vancouver, British Columbia
| | - Stuart Carr
- Snö Asthma & Allergy Clinic, Abu Dhabi, United Arab Emirates
| | - Sandeep Kapur
- Department of Pediatrics, Division of Allergy, Dalhousie University/IWK Health Centre, Halifax
- Halifax Allergy & Asthma Associates, Halifax, Nova Scotia
| | - Gregory A. Rex
- Department of Pediatrics, Division of Allergy, Dalhousie University/IWK Health Centre, Halifax
- Halifax Allergy & Asthma Associates, Halifax, Nova Scotia
| | - Mary McHenry
- Department of Pediatrics, Division of Allergy, Dalhousie University/IWK Health Centre, Halifax
- Halifax Allergy & Asthma Associates, Halifax, Nova Scotia
| | - Scott B. Cameron
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
- Community Allergy Clinic, Victoria, British Columbia
| | - Victoria E. Cook
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
- Community Allergy Clinic, Victoria, British Columbia
| | - Sara Leo
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
- West Coast Allergy and Immunology Clinic, Vancouver, British Columbia
| | - Tiffany Wong
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
| | - Thomas V. Gerstner
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba
- Meadowood Medical Center, Winnipeg, Manitoba
| | - Joanne Yeung
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
- Meadowood Medical Center, Winnipeg, Manitoba
- Vancouver Kids Allergy, Vancouver, British Columbia
| | - Elissa M. Abrams
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba
- Meadowood Medical Center, Winnipeg, Manitoba
| | - Raymond Mak
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
| | - Stephanie C. Erdle
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
| | - Lianne Soller
- British Columbia Children’s Hospital, Vancouver, British Columbia
- Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia
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Kovaltchouk U, Jeimy S, Soller L, Robertson K, Abrams EM, Cameron SB, Kim H, Chan ES. Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature. J Allergy Clin Immunol Glob 2023; 2:100080. [PMID: 37780796 PMCID: PMC10509862 DOI: 10.1016/j.jacig.2023.100080] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 10/03/2023]
Abstract
Background The safety of pediatric food oral immunotherapy (Ped-OIT) has been depicted by some as less favorable than subcutaneous immunotherapy (SCIT) owing to the increased number of serious adverse events requiring epinephrine. A review of real-world data comparing Ped-OIT and SCIT safety is necessary to guide shared decision making. Objectives Our aim was to compare the safety and adverse event profiles of peanut Ped-OIT and SCIT using Canadian real-word literature. Methods We performed a retrospective review of recent Canadian real-world literature on peanut Ped-OIT and SCIT safety and adverse events. Results The incidences of systemic reactions requiring epinephrine were 11 in 270 patients (4.07%) and 12 in 41,020 doses (0.029%) in a multicenter study in British Columbia, Alberta, Manitoba, and Nova Scotia studying 270 preschool-age children treated with peanut OIT. Similarly, a multicenter study in South-Western Ontario examining 160 patients between the ages of 1 and 17 years who were treated with peanut OIT showed that the incidences of systemic reactions requiring epinephrine were 5 in 160 patients (3.1%) and 8 in 52,751 doses (0.015%). A single-center retrospective review of 380 patients receiving aeroallergen SCIT showed that the incidences of systemic reactions requiring epinephrine were 28 in 380 patients (7.4%) and 1 in 1047 injection visits (0.095%). These findings are comparable to those of a review of 860 patients in Ontario who received either aeroallergen or venom SCIT, in which the incidence of systemic reaction requiring epinephrine was 10 in 4242 injections (0.24%). Conclusion Despite differences in the OIT protocols used and age groups studied, recent real-world data suggest that the safety of preschool peanut OIT or peanut OIT using a slower buildup schedule is comparable to that of SCIT.
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Affiliation(s)
- Uliana Kovaltchouk
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Lianne Soller
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B. Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Edmond S. Chan
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
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Jafri S, Janzen J, Kim R, Abrams EM, Gruber J, Protudjer JLP. Reply to "The intersection of sexual identity and race and ethnicity in allergic diseases". J Allergy Clin Immunol Pract 2023; 11:974-975. [PMID: 36621606 DOI: 10.1016/j.jaip.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Syeda Jafri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacob Janzen
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Kim
- Faculty of Arts and Science, Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jackie Gruber
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Al Ali A, Gabrielli S, Delli Colli L, Delli Colli M, McCusker C, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, Zhang X, Protudjer JL, Abrams EM, Simons E, Ben-Shoshan M. Temporal trends in anaphylaxis ED visits over the last decade and the effect of COVID-19 pandemic on these trends. Expert Rev Clin Immunol 2023; 19:341-348. [PMID: 36620923 DOI: 10.1080/1744666x.2023.2166934] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Anaphylaxis is an acute systemic and potentially fatal allergic reaction. We evaluated trends in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. METHODS A prospective and retrospective recruitment process was used to find families of children who had presented with anaphylaxis at the Montreal Children's Hospital between April 2011 and April 2021. Using a uniform recruitment form, data were collected. Anaphylaxis patterns were compared to clinical triggers using descriptive analysis. RESULTS Among 830,382 ED visits during the study period, 2726 (26% recruited prospectively) presented with anaphylaxis. The median age was 6 years (IQR: 0.2, 12.00), and 58.7% were males. The relative frequency of anaphylaxis cases doubled between 2011-2015, from 0.22% (95% CI, 0.19, 0.26) to 0.42 March 2020, the total absolute number of anaphylaxis cases and relative frequency declined by 24 cases per month (p < 0.05) and by 0.5% of ED visits (p < 0.05). CONCLUSIONS The rate of anaphylaxis has changed over the years, representing modifications in food introduction strategies or lifestyle changes. The decrease in the frequency of anaphylaxis presenting to the ED during the COVID pandemic may reflect decreased accidental exposures with reduced social gatherings, closed school, and reluctance to present to ED.
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Affiliation(s)
- Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Luca Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Moisan
- Department of Emergency Medicine, Regional Medical Director of Emergency Medical Services of Outaouais, Outaouais, Quebec, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Abrams EM, Zafack JG, Ismail SJ, Bettinger JA, Hildebrand KJ, Tunis MC. Vaccine anaphylaxis and Canadian public health policy. The Lancet Respiratory Medicine 2023; 11:306-308. [PMID: 37000715 DOI: 10.1016/s2213-2600(23)00037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Elissa M Abrams
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, K1A 0K9, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
| | - Joseline G Zafack
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, K1A 0K9, Canada
| | - Shainoor J Ismail
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, K1A 0K9, Canada; Metro City Medical Clinic, Edmonton, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Kyla J Hildebrand
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Matthew C Tunis
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, ON, K1A 0K9, Canada
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Bjelac J, Abrams EM, Iglesia EGA. Food allergies on vacation-there and back again. Ann Allergy Asthma Immunol 2023; 130:438-443. [PMID: 36690205 DOI: 10.1016/j.anai.2023.01.008] [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: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Food allergy is an important public health concern that affects all facets of life, and travel is no exception. We sought to provide a scoping review regarding the literature pertaining to management of FA while traveling. DATA SOURCES Medline and Embase were queried for English-language articles published in the last 20 years containing "food allergy" and "travel". STUDY SELECTIONS The search produced 83 references which were reviewed. After removal of duplicates and irrelevant material, 23 references that discussed travel and FA remained, 13 of which were conference abstracts published as supplemental material. RESULTS Priorities for consideration by patient-families and their allergist-immunologist include concern for reactions away from home, proximity to emergency medical services, risk for various methods of travel including potential for cross-contact exposure resulting in symptoms, and considerations for international travel including language barriers. CONCLUSION Patients with FA must use careful planning and preparation to ensure access to safe food and emergency medications at all times while away from home.
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Affiliation(s)
- Jaclyn Bjelac
- Food Allergy Center of Excellence, Center for Pediatric Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Greenhawt M, Shaker M, Golden DBK, Abrams EM, Blumenthal KG, Wolfson AR, Stone CA, Krantz MS, Chu DK, Dwamena BA. Diagnostic accuracy of vaccine and vaccine excipient testing in the setting of allergic reactions to COVID-19 vaccines: A systematic review and meta-analysis. Allergy 2023; 78:71-83. [PMID: 36321821 PMCID: PMC9878056 DOI: 10.1111/all.15571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/29/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
For persons with immediate allergic reactions to mRNA COVID-19 vaccines, skin testing (ST) to the vaccine/excipients (polyethylene glycol[PEG] and polysorbate 80 [PS]) has been recommended, but has unknown accuracy. To assess vaccine/excipient ST accuracy in predicting all-severity immediate allergic reactions upon re-vaccination, systematic review was performed searching Medline, EMBASE, Web of Science, and the WHO global coronavirus database (inception-Oct 4, 2021) for studies addressing immediate (≤4 h post-vaccination) all-severity allergic reactions to 2nd mRNA COVID-19 vaccination in persons with 1st dose immediate allergic reactions. Cases evaluating delayed reactions, change of vaccine platform, or revaccination without vaccine/excipient ST were excluded. Meta-analysis of diagnostic testing accuracy was performed using Bayesian methods. The GRADE approach evaluated certainty of the evidence, and QUADAS-2 assessed risk of bias. Among 20 studies of mRNA COVID-19 first dose vaccine reactions, 317 individuals underwent 578 ST to any one or combination of vaccine, PEG, or PS, and were re-vaccinated with the same vaccine. Test sensitivity for either mRNA vaccine was 0.2 (95%CrI 0.01-0.52) and specificity 0.97 (95%CrI 0.9-1). PEG test sensitivity was 0.02 (95%CrI 0.00-0.07) and specificity 0.99 (95%CrI 0.96-1). PS test sensitivity was 0.03 (95%CrI 0.00-0.0.11) and specificity 0.97 (95%CrI 0.91-1). Combined for use of any of the 3 testing agents, sensitivity was 0.03 (95%CrI 0.00-0.08) and specificity was 0.98 (95%CrI 0.95-1.00). Certainty of evidence was moderate. ST has low sensitivity but high specificity in predicting all-severity repeat immediate allergic reactions to the same agent, among persons with 1st dose immediate allergic reactions to mRNA COVID-19 vaccines. mRNA COVID-19 vaccine or excipient ST has limited risk assessment utility.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Marcus Shaker
- Dartmouth‐Hitchcock Medical Center, Section of Allergy and ImmunologyLebanonNew HampshireUSA,Dartmouth Geisel School of MedicineHanoverNew HampshireUSA
| | - David B. K. Golden
- Division of Allergy and Clinical ImmunologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Elissa M. Abrams
- Department of Pediatrics and Child Health, Section of Allergy and ImmunologyThe University of ManitobaWinnipegManitobaCanada
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and ImmunologyDepartment of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Anna R. Wolfson
- Division of Rheumatology, Allergy, and ImmunologyDepartment of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Matthew S. Krantz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Derek K. Chu
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada,Department of Health Research Methods, Evidence & ImpactMcMaster UniversityHamiltonOntarioCanada,The Research Institute of St. Joe's HamiltonHamiltonOntarioCanada,Evidence in Allergy GroupHamiltonOntarioCanada
| | - Ben A. Dwamena
- Division of Nuclear Medicine, Department of Radiology, Michigan MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Singer A, Kosowan L, LaBine L, Shenoda D, Katz A, Abrams EM, Halas G, Wong ST, Talpade S, Kirby S, Baldwin A, Francois J. Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study. BMC Prim Care 2022; 23:320. [PMID: 36496379 PMCID: PMC9736717 DOI: 10.1186/s12875-022-01890-w] [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] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). CONCLUSION Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
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Affiliation(s)
- Alexander Singer
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Leanne Kosowan
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Lisa LaBine
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Daniel Shenoda
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Alan Katz
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Departments of Community Health Science and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Manitoba Centre for Health Policy, Winnipeg, MB Canada
| | - Elissa M Abrams
- grid.21613.370000 0004 1936 9609Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada
| | - Gayle Halas
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Sabrina T. Wong
- grid.17091.3e0000 0001 2288 9830School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Siddhesh Talpade
- grid.416388.00000 0001 1245 5369Planning and Knowledge Management, Manitoba Health and Seniors Care, Winnipeg, MB Canada
| | - Sarah Kirby
- grid.21613.370000 0004 1936 9609George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB Winnipeg, Canada
| | - Alanna Baldwin
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Jose Francois
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
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Wolfson AR, Wong D, Abrams EM, Waserman S, Sussman GL. Diphenhydramine: Time to Move on? J Allergy Clin Immunol Pract 2022; 10:3124-3130. [PMID: 35999169 DOI: 10.1016/j.jaip.2022.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
Diphenhydramine is one of the most widely available, longest-used antihistamine medications but has many side effects including sedation and risk of toxicity in overdose including cardiac toxicity. It is frequently inappropriately used when newer, more favorable antihistamine medications are available. Second-generation antihistamines are also widely available and affordable, with many of the same desired effects as diphenhydramine and fewer, if any, of the undesirable side effects. Because of the negative side effects and wide availability of alternative antihistamine medications, it is definitively time to move on from diphenhydramine.
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Affiliation(s)
- Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Dennis Wong
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elissa M Abrams
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB, Canada; University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gordon L Sussman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Greenhawt M, Abrams EM, Chalil JM, Tran O, Green TD, Shaker MS. The Impact of Allergy Specialty Care on Health Care Utilization Among Peanut Allergy Children in the United States. J Allergy Clin Immunol Pract 2022; 10:3276-3283. [PMID: 35973525 DOI: 10.1016/j.jaip.2022.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The influence of allergist management on peanut allergy (PA)-related health care utilization is unknown. OBJECTIVE To determine whether allergist care lowers PA costs. METHODS IBM MarketScan Commercial Claims and Encounters Database was analyzed for PA diagnosis/reaction-related codes (January 2010-June 2019) in patients 64 years or younger, with demographically matched non-PA food allergy controls (NPAFACs). Outcomes were measured and compared 12 months before/after first claim date. RESULTS Among 72,854 persons with PA (39,068 with ≥1 allergist visit, 53.6%), and 166,825 NPAFACs, the number of National Drug Codes and International Classification of Diseases, 10th Revision codes was higher for persons with PA with versus without an allergist visit during both baseline and follow-up (all P < .001). Persons with PA with versus without an allergist visit were prescribed epinephrine at significantly higher rates (RR, 1.67; P < .001). Rates of epinephrine claims, mean epinephrine costs, and proportion with peanut anaphylaxis were higher among the PA group with versus without an allergist visit (69.9% vs 63.3%; $676 vs $493, 48.9% vs 20.7%; all P < .001). The proportion with anaphylaxis episodes was higher in the PA group versus the NPAFAC group (53.1% vs 31.6%; P < .001). Total health care costs were higher in the NPAFAC group versus the PA group ($7863 vs $7261; P < .001) and lower for persons with PA with versus without an allergist visit ($6347 vs $8270; P < .001), with no significant differences in PA reaction-related costs between PA groups. CONCLUSIONS Higher rates of anaphylaxis were seen among the PA group with versus without an allergist visit during the follow-up period (53.6% of overall PA group). Allergist care was associated with a reduction in total health care costs and higher rates of epinephrine prescription.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | | | | | - Oth Tran
- IBM Watson Health, Cambridge, Mass
| | - Todd D Green
- DBV Technologies, Montrouge, France; UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Marcus S Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
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Singer A, Kosowan L, Abrams EM, Katz A, Lix L, Leong K, Paige A. Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations: clustered randomized trail. BMC Prim Care 2022; 23:302. [PMID: 36435746 PMCID: PMC9701433 DOI: 10.1186/s12875-022-01912-7] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to reduce antibiotic prescribing for viral infections and antipsychotic prescribing to patients with dementia. METHODS Clustered randomized trial of 239 primary care providers in Manitoba, Canada, participating in the Manitoba Primary Care Research Network. Forty-six practices were randomly assigned to one of three groups: control group, intervention 1 (recommendations summary), intervention 2 (recommendations summary and personalized feedback). We assessed prescribing rates prior to the intervention (2014/15), during and immediately after the intervention (2016/17) and following the intervention (2018/19). Physician characteristics were assessed. RESULTS Between 2014/15-2016/17, 91.6% of providers in intervention group 1 and 95.9% of providers in intervention group 2 reduced their antibiotic and antipsychotic prescribing rate by ≥ 1 compared to the control group (77.6%) (p-value 0.0073). This reduction was maintained into 2018/19 at 91.4%. On multivariate regression alternatively funded providers had 2.4 × higher odds of reducing their antibiotic prescribing rate compared to fee-for-service providers. In quantile regression of providers with a reduction in antibiotic prescribing, alternatively funded (e.g. salaried or locum) providers compared to fee-for-service providers were significant at the 80th quantile. CONCLUSIONS Both A&F and recommendation summaries sent to providers by a trusted source reduced unnecessary prescriptions. Our findings support further scale up of efforts to engage with primary care practices to improve care with A&F. TRIAL REGISTRATION ClinicalTrials.gov NCT05385445, retrospectively registered, 23/05/2022.
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Affiliation(s)
- Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada.
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Alan Katz
- Departments of Community Health Science & Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, Winnipeg, MB, Canada
| | - Lisa Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Katrina Leong
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada
| | - Allison Paige
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada
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Cosyns JC, Frykas TLM, Hildebrand HV, Kim H, Gerdts JD, Abrams EM, Protudjer JL. Peanut, soy, and emerging legume allergy in Canada. J Allergy Clin Immunol Glob 2022; 1:319-321. [PMID: 37779533 PMCID: PMC10509839 DOI: 10.1016/j.jacig.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/18/2022] [Accepted: 05/26/2022] [Indexed: 10/03/2023]
Abstract
Background Individuals with 1 legume allergy may be cosensitized to other legumes and thus may potentially have other legume allergies as well. Although the use of emerging legumes (eg, pea, lentils, chickpeas) in commercial food production is increasingly common, the literature has largely focused on peanut and soy, both of which are priority allergens in Canada. Objective We aimed to describe the distribution of priority and emerging legume allergies in Canada, with consideration for patient age. Methods Cross-sectional survey data collected between 2019 and 2021 from families who follow food allergy-related social media platforms were queried for demographics, as well as for food allergy (including by type and number of foods and by age [0-5 vs ≥6 years]). Data were described and then analyzed by using logistic regression and adjusted for sex, age at diagnosis, and number of food allergies. Results Of the 115 participating children, the majority (64.6%) were boys. Nearly all of the children (109 of 115 [94.8%]) had peanut allergy, whereas soy and emerging legume allergies were reported by 15.7% and 13.0% of the children, respectively. Of these 115 children, 85 had mono-peanut allergy, 6 had mono-soy allergy, none had emerging legume allergy in the absence of peanut or soy, 12 had peanut and emerging legume allergy, 9 had peanut and soy allergy, and 3 had peanut, soy, and emerging legume allergy. Compared with children aged 0 to 5 years, children aged 6 years or older were significantly less likely to have peanut plus soy or emerging legume allergy (odds ratio = 0.22 [95% CI = 0.05-0.94]; P = .04). Conclusion Of the children with peanut allergy, a considerable number also had peanut allergy and soy allergy and/or another legume allergy. Younger children have higher odds of multiple legume allergy.
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Affiliation(s)
- Josie C.E. Cosyns
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara Lynn M. Frykas
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Hailey V. Hildebrand
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Harold Kim
- Canadian Society of Allergy and Clinical Immunology, Orleans, Ontario, Canada
- Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, McMaster University, London, Ontario, Canada
| | | | - Elissa M. Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer L.P. Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Canadian Society of Allergy and Clinical Immunology, Orleans, Ontario, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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