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Vourliotis N, Grimshaw K, Harris R. 5 Quality Improvement Project (QIP): A Teamwork Approach to Optimise Fluid Intake in Older Inpatients #ButFirstADrink. Age Ageing 2021. [DOI: 10.1093/ageing/afab028.05] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
The shortfalls of hydration management have been widely exposed since the Frances report in 2013. Age-related changes create challenges for people to drink adequate fluid amounts (Nazarko, 2018), making dehydration prevention in older people an ongoing public health priority (NICE, 2016). Hydration needs of older people are complex and may not be fully understood. A proactive MDT approach to facilitate regular drinking opportunities seems an achievable solution to increase hydration awareness, knowledge and daily fluid intake in older inpatients.
A QI methodology was used, including stakeholder engagement and PDSA learning cycles to influence, engage and educate staff on hydration management. Outcome measures: Fluid intake (ml/day), number of drinks/days based on fluid balance chart recordings. Interventions: Sharing the #ButFirstADrink social media hydration movement, which includes educational posters, flyers and a YouTube video. Face to face drop-in education sessions were implemented using local hydration education resources from Age UK Salford and GM nutrition and hydration programme as teaching tools. SPC charts were used to show a time-series data. In 15 weeks, 461/525 fluid charts were reviewed from 169 patients. Mean age was 84 years and 68% females. Average daily fluid intake increased by 25% (exceeding aim) indicating 176mls more fluid was offered on average/day. Mean number of drinks/days increased from 4.6 to 6 post interventions.
Knowledge and attitude improved in some areas; however fluid output is not routinely recorded. Post intervention, 89% of staff felt that offering a drink at first contact is a suitable hydration promotion campaign. The project scored 58% using the NHS sustainability model (ACT Academy, 2018) suggesting reason for optimism. As it is a behaviour change project, further engagement and momentum is dependent on ongoing enthusiasm to drive the #ButFirstADrink approach. This intervention is free, simple and innovative and stimulates behaviour change, raises drinking awareness and increases hydration.
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Affiliation(s)
- N Vourliotis
- Project supervisor of the Older Persons Fellowship at Kings College London (KCL)
| | | | - R Harris
- Professor of Health Care for Older Adults, KCL
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Wiles PG, Gray IK, Kissling RC, Delahanty C, Evers J, Greenwood K, Grimshaw K, Hibbert M, Kelly K, Luckin H, McGregor K, Morris A, Petersen M, Ross F, Valli M. Routine Analysis of Proteins by Kjeldahl and Dumas Methods: Review and Interlaboratory Study Using Dairy Products. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.3.620] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
abstract
The Kjeldahl and Dumas (combustion) methods were compared in 11 laboratories analyzing samples of milk, skim milk powder, whole milk powder, whey protein concentrate, infant formula, casein, caseinate, 2 reference compounds (glycine and EDTA), and a secondary reference skim milk powder. The comparison was conducted by using international standards where applicable. Overall means were 8.818 g N/100 g by the Kjeldahl method and 8.810 g N/100 g by the Dumas method. No evidence was found for a consistent bias between methods that may be of concern in the trading of dairy produce. A review of more than 10 related trials revealed a lack of consensus in the bias between the 2 methods, suggesting that differences in methodology and sources of systematic error may be contributors. For samples containing >2 g N/100 g, the Dumas relative repeatability and reproducibility standard deviations were consistently about 0.35 and 0.75%, respectively, whereas the corresponding Kjeldahl values declined generally with N content and were significantly larger. The Dumas precision characteristics may be due to the dominance of Leco analyzers in this trials, and in most other recent trials, rather than an inherent method attribute. Protein determination methods for dairy products need to be reviewed and updated. The Dumas method needs Codex Alimentarius status as a recognized test method.
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Affiliation(s)
- Peter G Wiles
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
| | - Ian K Gray
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
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3
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Skypala IJ, de Jong NW, Angier E, Gardner J, Kull I, Ryan D, Venter C, Vlieg-Boerstra BJ, Grimshaw K. Promoting and achieving excellence in the delivery of Integrated Allergy Care: the European Academy of Allergy & Clinical Immunology competencies for allied health professionals working in allergy. Clin Transl Allergy 2018; 8:31. [PMID: 30151118 PMCID: PMC6102852 DOI: 10.1186/s13601-018-0218-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/14/2018] [Indexed: 12/27/2022] Open
Abstract
The multi-disciplinary team approach is an effective model for patient care. Allied health professionals (AHPs) are an important part of such teams, bringing specific knowledge and skills related to the target patient population. The AHPs most often involved in allergy care are nurses and dietitians. Nurses are often involved in the care of patients with all types of allergy and also with asthma, whilst allergy-specialist dietitians provide vital nutritional and dietary support for the diagnosis and management of food allergy. There are many other AHPs who have a role to play in allergy care, including physiotherapists, psychologists, pharmacists and speech therapists, and their involvement is likely to develop as allergy care becomes more rooted in the community. With the development of multi-professional teams comes the requirement for disease-specific knowledge and skill sets, with all allergy team members required to have baseline knowledge and competency of the condition being managed. Whilst some competencies for AHPs practising in other disease states have been published, none are available for allergic disease against which AHPs can be benchmarked. The European Academy of Allergy & Clinical Immunology (EAACI) recognised this need, and supported the establishment of a Task Force to develop allergy-focussed competencies for AHPs. The varied skills, expertise and professional background of the Task Force members enabled the creation of a set of allergy competencies relevant to all AHPs working in allergy. It is recognised that the training and allergy expertise of AHPs, and their role within the allergy setting, will vary considerably depending on the country. However, it is important for patient care, that all AHP involved in allergy services have access to training, of a sufficiently high enough level to be aspirational and enable the continued growth and development of a wide range of allergy services, given the increasing need. The EAACI competencies will provide an important benchmark for allergy knowledge and skills against which education and training can be designed and health care professionals can subsequently be measured. However, more importantly, the EAACI AHP allergy competencies will enable the development and reach of specialist allergy services, with allergy-specialist AHPs undertaking key roles, especially in the community care setting.
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Affiliation(s)
- I J Skypala
- 1Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP UK.,2Imperial College, London, UK
| | | | - E Angier
- 4University of Southampton, Southampton, UK
| | - J Gardner
- 5Great North Children's Hospital, Newcastle, UK.,6Newcastle University, Newcastle, UK
| | - I Kull
- 7Karolinska Institutet, Stockholm, Sweden.,8Sachs Children's Hospital, Stockholm, Sweden
| | - D Ryan
- 9Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Venter
- 10Denver School of Medicine, Colorado Children's Hospital, University of Colorado, Denver, USA
| | | | - K Grimshaw
- 4University of Southampton, Southampton, UK.,12Southampton Children's Hospital, Southampton, UK
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4
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Maslin K, Grimshaw K, Oliver E, Roberts G, Arshad SH, Dean T, Grundy J, Glasbey G, Venter C. Taste preference, food neophobia and nutritional intake in children consuming a cows' milk exclusion diet: a prospective study. J Hum Nutr Diet 2016; 29:786-796. [PMID: 27298213 DOI: 10.1111/jhn.12387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows' milk allergy who consume a substitute formula and/or a cows' milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake. METHODS Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed. RESULTS One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant. CONCLUSIONS Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.
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Affiliation(s)
- K Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - K Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK
| | - E Oliver
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - G Roberts
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S H Arshad
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - T Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - J Grundy
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - G Glasbey
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Venter
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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Fleischer DM, Sicherer S, Greenhawt M, Campbell D, Chan E, Muraro A, Halken S, Katz Y, Ebisawa M, Eichenfield L, Sampson H, Lack G, Du Toit G, Roberts G, Bahnson H, Feeney M, Hourihane J, Spergel J, Young M, As'aad A, Allen K, Prescott S, Kapur S, Saito H, Agache I, Akdis CA, Arshad H, Beyer K, Dubois A, Eigenmann P, Fernandez-Rivas M, Grimshaw K, Hoffman-Sommergruber K, Host A, Lau S, O'Mahony L, Mills C, Papadopoulos N, Venter C, Agmon-Levin N, Kessel A, Antaya R, Drolet B, Rosenwasser L. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. Allergy 2015; 70:1193-5. [PMID: 26148305 DOI: 10.1111/all.12687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - M. Greenhawt
- American College of Allergy, Asthma & Immunology (ACAAI)
| | - D. Campbell
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - E. Chan
- Canadian Society of Allergy and Clinical Immunology (CSACI)
| | - A. Muraro
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - S. Halken
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - Y. Katz
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | | | | | | | - G. Lack
- World Allergy Organization (WAO)
| | - G. Du Toit
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - G. Roberts
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | | | - J. Hourihane
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - J. Spergel
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - M. Young
- American Academy of Allergy, Asthma & Immunology (AAAAI)
| | - A. As'aad
- American College of Allergy, Asthma & Immunology (ACAAI)
| | - K. Allen
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - S. Prescott
- Australasian Society of Clinical Immunology and Allergy (ASCIA)
| | - S. Kapur
- Canadian Society of Allergy and Clinical Immunology (CSACI)
| | - H. Saito
- Japanese Society for Allergology (JSA)
| | - I. Agache
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - C. A. Akdis
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - H. Arshad
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - K. Beyer
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - A. Dubois
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - P. Eigenmann
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - K. Grimshaw
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - A. Host
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - S. Lau
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - L. O'Mahony
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - C. Mills
- European Academy of Allergy and Clinical Immunology (EAACI)
| | | | - C. Venter
- European Academy of Allergy and Clinical Immunology (EAACI)
| | - N. Agmon-Levin
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | - A. Kessel
- Israel Association of Allergy and Clinical Immunology (ISACI)
| | - R. Antaya
- Society for Pediatric Dermatology (SPD)
| | - B. Drolet
- Society for Pediatric Dermatology (SPD)
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6
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DunnGalvin A, Chan CH, Crevel R, Grimshaw K, Poms R, Schnadt S, Taylor SL, Turner P, Allen KJ, Austin M, Baka A, Baumert JL, Baumgartner S, Beyer K, Bucchini L, Fernández-Rivas M, Grinter K, Houben GF, Hourihane J, Kenna F, Kruizinga AG, Lack G, Madsen CB, Clare Mills EN, Papadopoulos NG, Alldrick A, Regent L, Sherlock R, Wal JM, Roberts G. Precautionary allergen labelling: perspectives from key stakeholder groups. Allergy 2015; 70:1039-51. [PMID: 25808296 DOI: 10.1111/all.12614] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/22/2023]
Abstract
Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the possibility of reaction from the unintended presence of allergens in foods. However, in its current form, PAL is counterproductive for consumers with food allergies. This review aims to summarize the perspectives of all the key stakeholders (including clinicians, patients, food industry and regulators), with the aim of defining common health protection and risk minimization goals. The lack of agreed reference doses has resulted in inconsistent application of PAL by the food industry and in levels of contamination that prompt withdrawal action by enforcement officers. So there is a poor relationship between the presence or absence of PAL and actual reaction risk. This has led to a loss of trust in PAL, reducing the ability of consumers with food allergies to make informed choices. The result has been reduced avoidance, reduced quality of life and increased risk-taking by consumers who often ignore PAL. All contributing stakeholders agree that PAL must reflect actual risk. PAL should be transparent and consistent with rules underpinning decision-making process being communicated clearly to all stakeholders. The use of PAL should indicate the possible, unintended presence of an allergen in a consumed portion of a food product at or above any proposed action level. This will require combined work by all stakeholders to ensure everyone understands the approach and its limitations. Consumers with food allergy then need to be educated to undertake individualized risk assessments in relation to any PAL present.
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Affiliation(s)
- A. DunnGalvin
- Department of Paediatrics and Child Health; School of Applied Psychology; University College Cork; Cork Ireland
| | - C.-H. Chan
- Food Allergy Branch; Food Standards Agency; Bedford UK
| | - R. Crevel
- Safety and Environmental Assurance Centre; Unilever; Colworth Science Park Sharnbrook Bedford UK
| | - K. Grimshaw
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | | | - S. Schnadt
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
| | - S. L. Taylor
- Food Allergy Research & Resource Program; University of Nebraska; Lincoln NE USA
| | - P. Turner
- Section of Paediatrics (Allergy and Infectious Diseases); MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | - K. J. Allen
- Centre of Food and Allergy Research; Murdoch Children's Research Institute; Melbourne Vic. Australia
- Department of Paediatrics; Royal Children's Hospital; Melbourne Vic. Australia
| | - M. Austin
- Anaphylaxis Campaign; Farnborough UK
| | - A. Baka
- ILSI Europe; Brussels Belgium
| | - J. L. Baumert
- Food Allergy Research & Resource Program; University of Nebraska; Lincoln NE USA
| | - S. Baumgartner
- Center for Analytical Chemistry; University of Natural Resources and Life Sciences; Vienna Austria
| | - K. Beyer
- Department of Paediatric Pneumology & Immunology; Charité University Medical Centre; Berlin Germany
| | | | | | - K. Grinter
- Allergen Bureau & Nestle; Rhodes New South Wales Australia
| | | | - J. Hourihane
- Paediatrics and Child Health; University College Cork; Cork Ireland
| | - F. Kenna
- Anaphylaxis Ireland; Cork Ireland
| | | | - G. Lack
- Division of Asthma, Allergy and Lung Biology; King's College London; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - C. B. Madsen
- National Food Institute; Technical University of Denmark; Søborg Denmark
| | - E. N. Clare Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - N. G. Papadopoulos
- Centre for Pediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | | | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - R. Sherlock
- Allergen Bureau & DTS Facta; Hobart Australia
| | | | - G. Roberts
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust
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7
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de Silva D, Roberts G, Halken S, Høst A, Grimshaw K, Venter C, Panesar S, Sheikh A, Muraro A. Reply: To PMID 24433563. Allergy 2014; 69:972-973. [PMID: 25025107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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8
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Lodge CJ, Lowe AJ, Allen KJ, de Silva D, Roberts G, Halken S, Høst A, Grimshaw K, Venter C, Panesar S, Sheikh A, Muraro A. Primary prevention of food allergy in children and adults. Allergy 2014; 69:971-2. [PMID: 24898677 DOI: 10.1111/all.12417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. J. Lodge
- School of Population and Global Health; University of Melbourne; Parkville Vic. Australia
| | - A. J. Lowe
- School of Population and Global Health; University of Melbourne; Parkville Vic. Australia
- Murdoch Children's Research Institute; Royal Children's Hospital; Parkville Vic. Australia
| | - K. J. Allen
- Murdoch Children's Research Institute; Royal Children's Hospital; Parkville Vic. Australia
- Department of Allergy and Clinical Immunology; Royal Children's Hospital; Parkville Vic. Australia
- Department of Paediatrics; University of Melbourne; Parkville Vic. Australia
| | | | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; UK
| | - S. Halken
- Odense University Hospital; Odense C Denmark
| | - A. Høst
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - K. Grimshaw
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - C. Venter
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
| | - S. Panesar
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| | - A. Muraro
- Department of Mother and Child Health Referral Centre Food Allergy Diagnosis and Treatment, Veneto Region; University of Padua; Padua Italy
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9
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de Silva D, Geromi M, Halken S, Host A, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Cardona V, Dubois AEJ, Poulsen LK, Van Ree R, Vlieg-Boerstra B, Agache I, Grimshaw K, O'Mahony L, Venter C, Arshad SH, Sheikh A. Primary prevention of food allergy in children and adults: systematic review. Allergy 2014; 69:581-9. [PMID: 24433563 DOI: 10.1111/all.12334] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food allergies can have serious physical, social, and financial consequences. This systematic review examined ways to prevent the development of food allergy in children and adults. METHODS Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after studies, interrupted time series studies, and prospective cohort studies. Experts were consulted for additional studies. There were no language or geographic restrictions. Two reviewers appraised the studies using appropriate tools. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesized. RESULTS Seventy-four studies were included, one-third of which were of high quality. There was no good evidence to recommend that pregnant or breastfeeding women should change their diet or take supplements to prevent allergies in infants at high or normal risk. There were mixed findings about the preventive benefits of breastfeeding for infants at high or normal risk, but there was evidence to recommend avoiding cow's milk and substituting with extensively or partially hydrolyzed whey or casein formulas for infants at high risk for the first 4 months. Soy milk and delaying the introduction of solid foods beyond 4 months did not have preventive benefits in those at high or normal risk. There was very little evidence about strategies for preventing food allergy in older children or adults. CONCLUSIONS There is much to learn about preventing food allergy, and this is a priority given the high societal and healthcare costs involved.
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Affiliation(s)
| | | | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - A. Host
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - S. S. Panesar
- Primary Care Research & Development; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment; University of Padua; Padua Italy
| | - T. Werfel
- Hanover Medical School; Hanover Germany
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | | | - A. E. J. Dubois
- Division of Paediatric Pulmonology and Paediatric Allergy; Department of Paediatrics; University Medical; Centre Groningen; University of Groningen; RB Groningen the Netherlands
| | - L. K. Poulsen
- Allergy Clinic; Laboratory of Medical Allergology; Copenhagen University Hospital; Hellerup Denmark
| | - R. Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. Vlieg-Boerstra
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam the Netherlands
| | - I. Agache
- Transylvania University; Brasov Romania
| | - K. Grimshaw
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - L. O'Mahony
- Swiss Institute of Allergy and Asthma Research; University of Zurich; Davos Platz Switzerland
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
| | - S. H. Arshad
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
| | - A. Sheikh
- Primary Care Research & Development; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
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10
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McBride D, Keil T, Grabenhenrich L, Dubakiene R, Drasutiene G, Fiocchi A, Dahdah L, Sprikkelman AB, Schoemaker AA, Roberts G, Grimshaw K, Kowalski ML, Stanczyk-Przyluska A, Sigurdardottir S, Clausen M, Papadopoulos NG, Mitsias D, Rosenfeld L, Reche M, Pascual C, Reich A, Hourihane J, Wahn U, Mills ENC, Mackie A, Beyer K. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries. Pediatr Allergy Immunol 2012; 23:230-9. [PMID: 22192443 DOI: 10.1111/j.1399-3038.2011.01254.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It is unclear why some children develop food allergy. The EuroPrevall birth cohort was established to examine regional differences in the prevalence and risk factors of food allergy in European children using gold-standard diagnostic criteria. The aim of this report was to describe pre-, post-natal and environmental characteristics among the participating countries. In nine countries across four major European climatic regions, mothers and their newborns were enrolled from October 2005 through February 2010. Using standardized questionnaires, we assessed allergic diseases and self-reported food hypersensitivity of parents and siblings, nutrition during pregnancy, nutritional supplements, medications, mode of delivery, socio-demographic data and home environmental exposures. A total of 12,049 babies and their families were recruited. Self-reported adverse reactions to food ever were considerably more common in mothers from Germany (30%), Iceland, United Kingdom, and the Netherlands (all 20-22%) compared with those from Italy (11%), Lithuania, Greece, Poland, and Spain (all 5-8%). Prevalence estimates of parental asthma, allergic rhinitis and eczema were highest in north-west (Iceland, UK), followed by west (Germany, the Netherlands), south (Greece, Italy, Spain) and lowest in central and east Europe (Poland, Lithuania). Over 17% of Spanish and Greek children were exposed to tobacco smoke in utero compared with only 8-11% in other countries. Caesarean section rate was highest in Greece (44%) and lowest in Spain (<3%). We found country-specific differences in antibiotic use, pet ownership, type of flooring and baby's mattress. In the EuroPrevall birth cohort study, the largest study using gold-standard diagnostic criteria for food allergy in children worldwide, we found considerable country-specific baseline differences regarding a wide range of factors that are hypothesized to play a role in the development of food allergy including allergic family history, obstetrical practices, pre- and post-natal environmental exposures.
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Affiliation(s)
- D McBride
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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Barnett J, Leftwich J, Muncer K, Grimshaw K, Shepherd R, Raats MM, Gowland MH, Lucas JS. How do peanut and nut-allergic consumers use information on the packaging to avoid allergens? Allergy 2011; 66:969-78. [PMID: 21320134 DOI: 10.1111/j.1398-9995.2011.02563.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent legislation has sought to improve the information printed on packaged foods relevant to the safety of food allergic consumers. We aimed to understand the complex risk assessment decisions made by peanut and nut-allergic adults when purchasing food, with particular reference to use of printed package information. METHODS The behaviour and 'thinking aloud' of 32 participants were recorded during their normal food shop, followed by a semi-structured interview. During the interview they were given 13 potentially problematic packaged foods, and asked if they would purchase the product and what their reasons were. Transcribed data from the shop, interview and 13-product task were analysed to explore use of allergy advice boxes, ingredients lists and other packaging information. RESULTS Some participants used the ingredients list as their primary check for allergens, but most used the allergy advice box. Package-based information was generally considered reliable, but some supermarket and brand labels were trusted more than others. Images and product names were used to draw inferences about the presence of nuts. A number of improvements were suggested by participants, particularly a request for more 'nut free' labelling. CONCLUSIONS Food labels were used in conjunction with nonpacket-based strategies (e.g. previous experience) to make choices. External factors (e.g. trust of manufacturer) informed interpretation of and confidence in labels. Images and product names, not intended by manufacturers as an allergen risk assessment aid, were also used to inform choices.
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Affiliation(s)
- J Barnett
- Department of Information Systems and Computing, Brunel University, Uxbridge, UK
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Lucas J, Barnett J, Leftwich J, Muncer K, Shepherd R, Raats M, Gowland M, Grimshaw K. The Challenge Of Using Information On Food Packaging To Avoid Peanut And Nut Allergens. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Keil T, McBride D, Grimshaw K, Niggemann B, Xepapadaki P, Zannikos K, Sigurdardottir ST, Clausen M, Reche M, Pascual C, Stanczyk AP, Kowalski ML, Dubakiene R, Drasutiene G, Roberts G, Schoemaker AFA, Sprikkelman AB, Fiocchi A, Martelli A, Dufour S, Hourihane J, Kulig M, Wjst M, Yazdanbakhsh M, Szépfalusi Z, van Ree R, Willich SN, Wahn U, Mills ENC, Beyer K. The multinational birth cohort of EuroPrevall: background, aims and methods. Allergy 2010; 65:482-90. [PMID: 19793062 DOI: 10.1111/j.1398-9995.2009.02171.x] [Citation(s) in RCA: 84] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM The true prevalence and risk factors of food allergies in children are not known because estimates were based predominantly on subjective assessments and skin or serum tests of allergic sensitization to food. The diagnostic gold standard, a double-blind placebo-controlled food provocation test, was not performed consistently to confirm suspected allergic reactions in previous population studies in children. This protocol describes the specific aims and diagnostic protocol of a birth cohort study examining prevalence patterns and influential factors of confirmed food allergies in European children from different regions. METHODS Within the collaborative translational research project EuroPrevall, we started a multi-center birth cohort study, recruiting a total of over 12 000 newborns in nine countries across Europe in 2005-2009. In addition to three telephone interviews during the first 30 months, parents were asked to immediately inform the centers about possible allergic reactions to food at any time during the follow-up period. RESULTS All children with suspected food allergy symptoms were clinically evaluated including double-blind placebo-controlled food challenge tests. We assessed sensitization to different food allergens by measurements of specific serum immunoglobulin E and skin prick tests, collect blood, saliva or buccal swabs for genetic tests, breast milk for measurement of food proteins/cytokines, and evaluate quality-of-life and economic burden of families with food allergic children. CONCLUSIONS This birth cohort provides unique data on prevalence, risk factors, quality-of-life, and costs of food allergies in Europe, leading to the development of more informed and integrated preventative and treatment strategies for children with food allergies.
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Affiliation(s)
- T Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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Foster R, Mead S, Grimshaw K. 499 POSTER The effects of hypoxia on the sensitivity of glioma cells to gemcitabine treatment. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
BACKGROUND Lupin has now been introduced into food production in the UK. There is a concern that, on account of cross-reactivity, peanut-allergic children are at high risk for lupin allergy. AIMS To investigate the prevalence of lupin sensitization and allergy in children with peanut allergy compared with atopic controls. METHODS Children (<18 years) were recruited. Peanut-allergic subjects either had a convincing history of peanut allergy with diagnostic peanut skin prick test (SPT) or specific-immunoglobulin E (IgE) results or a positive food challenge. Control subjects were atopic but not peanut-allergic. All subjects had SPT to peanut and lupin. Sensitized subjects were offered a randomized, double-blind, placebo-controlled lupin challenge. Lupin allergy was defined as objective immediate hypersensitivity reaction at food challenge. RESULTS Forty-seven peanut-allergic children and 46 atopic controls were recruited. Sixteen peanut-allergic children were sensitized to lupin [34%, 95% confidence interval (CI): 21-49%]. Nine were challenged to lupin. Two reacted (itchy mouth and urticaria; itchy mouth and 20% drop in peak expiratory flow rate) giving a minimum prevalence of lupin allergy in peanut-allergic children of 4.0% (95% CI: 1-15%). Atopic controls were significantly (P = 0.001) less likely to be sensitized to lupin (4%, 95% CI: 1-15%) and had smaller wheals and serum-specific IgE results. None of the atopic controls reacted on lupin challenge, giving a rate of allergy in the atopic controls of 0% (95% CI: 0-8%). CONCLUSIONS A small but significant number of children with peanut allergy are allergic to lupin. Sensitization to lupin is much rarer in nonpeanut-allergic atopic subjects.
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Affiliation(s)
- J Shaw
- University Child Health, University of Southampton, Southampton, UK
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Bouley G, Grimshaw K, Lindewall-Matto D, Kiernan L. Transjugular intrahepatic portosystemic shunt: an alternative. Crit Care Nurse 1996. [DOI: 10.4037/ccn1996.16.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bouley G, Grimshaw K, Lindewall-Matto D, Kiernan L. Transjugular intrahepatic portosystemic shunt: an alternative. Crit Care Nurse 1996; 16:23-9. [PMID: 8697772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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