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Vernooij RWM, Zeraatkar D, Han MA, El Dib R, Zworth M, Milio K, Sit D, Lee Y, Gomaa H, Valli C, Swierz MJ, Chang Y, Hanna SE, Brauer PM, Sievenpiper J, de Souza R, Alonso-Coello P, Bala MM, Guyatt GH, Johnston BC. Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:732-741. [PMID: 31569217 DOI: 10.7326/m19-1583] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Studying dietary patterns may provide insights into the potential effects of red and processed meat on health outcomes. PURPOSE To evaluate the effect of dietary patterns, including different amounts of red or processed meat, on all-cause mortality, cardiometabolic outcomes, and cancer incidence and mortality. DATA SOURCES Systematic search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global from inception to April 2019 with no restrictions on year or language. STUDY SELECTION Teams of 2 reviewers independently screened search results and included prospective cohort studies with 1000 or more participants that reported on the association between dietary patterns and health outcomes. DATA EXTRACTION Two reviewers independently extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. DATA SYNTHESIS Eligible studies that followed patients for 2 to 34 years revealed low- to very-low-certainty evidence that dietary patterns lower in red and processed meat intake result in very small or possibly small decreases in all-cause mortality, cancer mortality and incidence, cardiovascular mortality, nonfatal coronary heart disease, fatal and nonfatal myocardial infarction, and type 2 diabetes. For all-cause, cancer, and cardiovascular mortality and incidence of some types of cancer, the total sample included more than 400 000 patients; for other outcomes, total samples included 4000 to more than 300 000 patients. LIMITATION Observational studies are prone to residual confounding, and these studies provide low- or very-low-certainty evidence according to the GRADE criteria. CONCLUSION Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
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Affiliation(s)
- Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Regina El Dib
- Dalhousie University, Halifax, Nova Scotia, Canada, and Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Daegan Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Huda Gomaa
- Alexandria University, Alexandria, Egypt, and Tanta Chest Hospital, Ministry of Health, Tanta, Egypt (H.G.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau, Barcelona, Spain (C.V.)
| | - Mateusz J Swierz
- Jagiellonian University Medical College, Krakow, Poland (M.J.S., M.M.B.)
| | - Yaping Chang
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Steven E Hanna
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | | | - John Sievenpiper
- University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada (J.S.)
| | - Russell de Souza
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and CIBER de Epidemiología y Salud Publicá (CIBERESP), Barcelona, Spain (P.A.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (M.J.S., M.M.B.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
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Zeraatkar D, Han MA, Guyatt GH, Vernooij RWM, El Dib R, Cheung K, Milio K, Zworth M, Bartoszko JJ, Valli C, Rabassa M, Lee Y, Zajac J, Prokop-Dorner A, Lo C, Bala MM, Alonso-Coello P, Hanna SE, Johnston BC. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:703-710. [PMID: 31569213 DOI: 10.7326/m19-0655] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [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: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. PURPOSE To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. DATA SOURCES EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. STUDY SELECTION Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. DATA SYNTHESIS Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. LIMITATION Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. CONCLUSION The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
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Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Jessica J Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Claudia Valli
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Montserrat Rabassa
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Joanna Zajac
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Anna Prokop-Dorner
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Calvin Lo
- University of British Columbia, Vancouver, British Columbia, Canada (C.L.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Pablo Alonso-Coello
- Biomedical Research Institute San Pau (IIB Sant Pau) and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (P.A.)
| | - Steven E Hanna
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
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Zeraatkar D, Johnston BC, Bartoszko J, Cheung K, Bala MM, Valli C, Rabassa M, Sit D, Milio K, Sadeghirad B, Agarwal A, Zea AM, Lee Y, Han MA, Vernooij RWM, Alonso-Coello P, Guyatt GH, El Dib R. Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes: A Systematic Review of Randomized Trials. Ann Intern Med 2019; 171:721-731. [PMID: 31569236 DOI: 10.7326/m19-0622] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Few randomized trials have evaluated the effect of reducing red meat intake on clinically important outcomes. PURPOSE To summarize the effect of lower versus higher red meat intake on the incidence of cardiometabolic and cancer outcomes in adults. DATA SOURCES EMBASE, CENTRAL, CINAHL, Web of Science, and ProQuest from inception to July 2018 and MEDLINE from inception to April 2019, without language restrictions. STUDY SELECTION Randomized trials (published in any language) comparing diets lower in red meat with diets higher in red meat that differed by a gradient of at least 1 serving per week for 6 months or more. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed the risk of bias and the certainty of the evidence. DATA SYNTHESIS Of 12 eligible trials, a single trial enrolling 48 835 women provided the most credible, though still low-certainty, evidence that diets lower in red meat may have little or no effect on all-cause mortality (hazard ratio [HR], 0.99 [95% CI, 0.95 to 1.03]), cardiovascular mortality (HR, 0.98 [CI, 0.91 to 1.06]), and cardiovascular disease (HR, 0.99 [CI, 0.94 to 1.05]). That trial also provided low- to very-low-certainty evidence that diets lower in red meat may have little or no effect on total cancer mortality (HR, 0.95 [CI, 0.89 to 1.01]) and the incidence of cancer, including colorectal cancer (HR, 1.04 [CI, 0.90 to 1.20]) and breast cancer (HR, 0.97 [0.90 to 1.04]). LIMITATIONS There were few trials, most addressing only surrogate outcomes, with heterogeneous comparators and small gradients in red meat consumption between lower versus higher intake groups. CONCLUSION Low- to very-low-certainty evidence suggests that diets restricted in red meat may have little or no effect on major cardiometabolic outcomes and cancer mortality and incidence. PRIMARY FUNDING SOURCE None (PROSPERO: CRD42017074074).
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Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Bradley C Johnston
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Jessica Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | | | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Daegen Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Behnam Sadeghirad
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Arnav Agarwal
- University of Toronto, Toronto, Ontario, Canada (A.A.)
| | - Adriana M Zea
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Regina El Dib
- Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
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Zeraatkar D, Cheung K, Milio K, Zworth M, Gupta A, Bhasin A, Bartoszko JJ, Kiflen M, Morassut RE, Noor ST, Lawson DO, Johnston BC, Bangdiwala SI, de Souza RJ. Methods for the Selection of Covariates in Nutritional Epidemiology Studies: A Meta-Epidemiological Review. Curr Dev Nutr 2019; 3:nzz104. [PMID: 31598577 PMCID: PMC6778415 DOI: 10.1093/cdn/nzz104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Observational studies provide important information about the effects of exposures that cannot be easily studied in clinical trials, such as nutritional exposures, but are subject to confounding. Investigators adjust for confounders by entering them as covariates in analytic models. OBJECTIVE The aim of this study was to evaluate the reporting and credibility of methods for selection of covariates in nutritional epidemiology studies. METHODS We sampled 150 nutritional epidemiology studies published in 2007/2008 and 2017/2018 from the top 5 high-impact nutrition and medical journals and extracted information on methods for selection of covariates. RESULTS Most studies did not report selecting covariates a priori (94.0%) or criteria for selection of covariates (63.3%). There was general inconsistency in choice of covariates, even among studies investigating similar questions. One-third of studies did not acknowledge potential for residual confounding in their discussion. CONCLUSION Studies often do not report methods for selection of covariates, follow available guidance for selection of covariates, nor discuss potential for residual confounding.
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Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kirolos Milio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Max Zworth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arrti Bhasin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Salmi T Noor
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Rosenfield L, Tsoulis MW, Milio K, Schnittke M, Kim H. High rate of house dust mite sensitization in a shrimp allergic southern Ontario population. Allergy Asthma Clin Immunol 2017; 13:5. [PMID: 28115965 PMCID: PMC5244585 DOI: 10.1186/s13223-017-0177-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Shrimp and house dust mite (HDM) allergies are common in Canadians. Often, both of these allergies occur in the same patient. This may be due to homology of tropomyosin or other potentially shared proteins. The aim of our study was to assess the frequency of house dust mite sensitization in a shrimp allergic Canadian population. Methods We undertook a retrospective chart review of shrimp allergic patients at an outpatient allergy clinic in Kitchener, Ontario, Canada. Our primary endpoint was to assess for presence of HDM sensitization in this population. Patients were categorized into approximate quartiles. We assessed the severity of the shrimp reactions, correlated shrimp skin test size to HDM skin test size, and measured the proportion of patients with atopic symptoms. Results We identified 95 shrimp allergic patients who were tested for house dust mite. 86 (90.5%) of these patients had a positive skin test to HDM. Patients with a shrimp skin test ≥5 mm were 5.31 times (95% CI, 1.55–18.14; p = 0.008) more likely to exhibit a dust mite skin test ≥5 mm than patients with a shrimp skin test <5 mm. The odds of a patient with a shrimp skin test between 10 and 18 mm having a larger HDM skin test were 3.93 times (95% CI 1.03–14.98, p = 0.045) the odds for a patient with a shrimp skin test size between 3 and 4 mm. We did not find a correlation between shrimp skin test size and shrimp reaction symptom grade (p = 0.301). Conclusion In our Canadian patients, we found a large majority of shrimp allergic patients to be sensitized to HDM. We found that patients with a large skin test to shrimp were more likely to have a large skin test to HDM compared to those patients with a small skin test to shrimp. We did not find a correlation between shrimp skin test size and shrimp reaction symptom severity. Most of these patients had symptoms of rhinitis and/or asthma that may have been caused by house dust mite allergy.
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Affiliation(s)
- Lana Rosenfield
- Division of Clinical Immunology and Allergy, Department of Medicine Michael D. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Kirolos Milio
- Faculty of Science, University of Waterloo, Waterloo, ON Canada
| | | | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine Michael D. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada.,Grandriver Allergy, Kitchener, ON Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON Canada
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