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Soller L, Williams BA, Mak R, Wong T, Erdle SC, Chomyn A, Tetreault B, Morrison K, Gaudet L, Chan ES. Safety and Effectiveness of Bypassing Oral Immunotherapy Buildup With an Initial Phase of Sublingual Immunotherapy for Higher-Risk Food Allergy. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00198-3. [PMID: 38423293 DOI: 10.1016/j.jaip.2024.02.024] [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: 09/12/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Because of its favorable safety, sublingual immunotherapy (SLIT) for food allergy has been proposed as an alternative treatment for those in whom oral immunotherapy (OIT) is of higher risk-older children, adolescents, adults, and those with a history of severe reactions. Although safe, SLIT has been shown to be less effective than OIT. OBJECTIVE To describe the safety of multifood SLIT in pediatric patients aged 4 to 18 years and the effectiveness of bypassing OIT buildup with an initial phase of SLIT. METHODS Patients aged 4 to 18 years were offered (multi)food SLIT. Patients built up to 2 mg protein SLIT maintenance over the course of 3 to 5 visits under nurse supervision. After 1 to 2 years of daily SLIT maintenance, patients were offered a low-dose oral food challenge (OFC) (cumulative dose, 300 mg protein) with the goal of bypassing OIT buildup. RESULTS Between summer 2020 and winter 2023, 188 patients were enrolled in SLIT (median age, 11 years). Four patients (2.10%) received epinephrine during buildup and went to the emergency department, but none experienced grade 4 (severe) reaction. A subset of 20 patients had 50 low-dose OFCs to 300 mg protein and 35 (70%) OFCs were successful, thereby bypassing OIT buildup. CONCLUSIONS In combination with very favorable safety of SLIT, with no life-threatening reactions and few reactions requiring epinephrine, we propose that an initial phase of SLIT to bypass supervised OIT buildup be considered for children in whom OIT is considered to be of higher risk.
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Affiliation(s)
- Lianne Soller
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Brock A Williams
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond Mak
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tiffany Wong
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie C Erdle
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alanna Chomyn
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brittany Tetreault
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Morrison
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Gaudet
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Schoos AMM, Chan ES, Wong T, Erdle SC, Chomyn A, Soller L, Mak R. Bypassing the build-up phase for oral immunotherapy in shrimp-allergic children. World Allergy Organ J 2024; 17:100865. [PMID: 38351903 PMCID: PMC10862060 DOI: 10.1016/j.waojou.2023.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
Background Oral immunotherapy is an effective treatment for food allergies; however, its use in clinical practice is limited by resources and lack of standardized protocols for foods other than peanut. Previous studies have suggested that shrimp has a higher threshold for reaction than other allergenic foods, suggesting it may be safe to directly administer maintenance doses of immunotherapy. Methods Children aged 3-17 years who had 1) skin prick test ≥3 mm and/or specific IgE level ≥0.35 kU/L and convincing objective IgE-mediated reaction to shrimp, or 2) no ingestion history and specific IgE level ≥5 kU/L, underwent a low-dose oral food challenge to 300 mg shrimp protein, with the goal of continuing daily ingestion of the 300 mg maintenance dose as oral immunotherapy. Results Between January 2020 and April 2023, 17 children completed the low-dose oral food challenge. Nine (53%) tolerated this amount with no reaction, and 8 (47%) had a mild reaction (isolated oral pruritis or redness on chin). Sixteen (94%) continued maintenance low-dose oral immunotherapy eating 300 mg shrimp protein daily. None of the patients developed anaphylaxis related to the immunotherapy. Conclusion Our case series suggests that some shrimp allergic patients being considered for oral immunotherapy should be offered a low-dose oral food challenge, to potentially bypass the build-up phase of immunotherapy.
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Affiliation(s)
- Ann-Marie M. Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Edmond S. Chan
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Tiffany Wong
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Stephanie C. Erdle
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alanna Chomyn
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Raymond Mak
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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Chua GT, Soller L, Kapur S, McHenry M, Rex GA, Cook VE, Cameron SB, Chan ES, Yeung J, Erdle SC. Real-world safety and effectiveness analysis of low-dose preschool sesame oral immunotherapy. J Allergy Clin Immunol Glob 2024; 3:100171. [PMID: 37915725 PMCID: PMC10616424 DOI: 10.1016/j.jacig.2023.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 11/03/2023]
Abstract
Background Previous studies support the effectiveness of sesame oral immunotherapy (S-OIT) in patients >4 years old using maintenance doses of 1200 mg protein. However, tahini is often not palatable to children, and high-maintenance doses may not be possible for preschoolers. Objective We studied the safety and effectiveness outcomes of preschoolers with sesame allergy who underwent low-dose S-OIT of 200 mg protein. Methods Preschoolers with sesame allergy, with a history of objective reaction to sesame, and with either a positive skin prick test result (wheal diameter ≥3 mm) or sesame-specific IgE level ≥0.35 kU/L were included. Doses were escalated every 2 to 4 weeks until the maintenance dose of 200 mg of sesame protein was reached. The maintenance dose was continued daily for 1 year, followed by exit oral food challenge (OFC). Primary safety outcomes included allergic reactions grade 2 or higher and the need for epinephrine therapy during buildup. The primary effectiveness outcome was proportion of patients tolerating a minimum of 2000 mg sesame protein at exit OFC. Results Twenty-eight preschoolers (median age, 33.5 months) were enrolled to receive S-OIT. During the buildup phase, 9 subjects (32.1%) had no reaction, and 8 (28.6%) and 11 (39.3%) had grade 1 and 2 reactions, respectively. One patient (3.57%) received epinephrine for a grade 2 reaction. Twenty-one (91.3%) of 23 eligible subjects underwent exit OFC; 18 (85.7%) of these 21 patients successfully completed exit OFC. One (4.8%) and 2 (9.5%) subjects had grade 1 and 2 reactions, respectively, during OFC. Conclusions A lower and age-appropriate maintenance dose is safe and effective in desensitizing preschoolers with sesame allergy.
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Affiliation(s)
- Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Allergy Centre, Union Hospital, Hong Kong, China
- Department of Paediatrics, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Lianne Soller
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
| | - Sandeep Kapur
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
- Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Mary McHenry
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
- Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Gregory A. Rex
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
- Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Victoria E. Cook
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
- Community Allergy Clinic, Victoria, British Columbia
| | - Scott B. Cameron
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
- Community Allergy Clinic, Victoria, British Columbia
| | - Edmond S. Chan
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
| | - Joanne Yeung
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
| | - Stephanie C. Erdle
- Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Vancouver, British Columbia
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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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Golding MA, Soller L, Protudjer JLP, Chan ES. Normative data for the Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool. J Allergy Clin Immunol Pract 2023; 11:3550-3552.e1. [PMID: 37572757 DOI: 10.1016/j.jaip.2023.08.011] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, 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; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Wingate KE, Gerdts J, Soller L, Chan ES. A Survey of Canadian Dietitians on Identification of Infants at High Risk of Food Allergy and Frequency of Allergenic Food Consumption. CAN J DIET PRACT RES 2023; 84:134-140. [PMID: 37379474 DOI: 10.3148/cjdpr-2022-041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Purpose: To assess knowledge of Canadian dietitians on the topics of food allergy and food allergy prevention guidelines, including introduction of allergenic solids to infants at risk of food allergy.Methods: An online survey was distributed via email listservs targeting Canadian dietitians.Results: In total, 144 of 261 dietitians completed the survey (60.5%). Respondents recommend introduction of peanut (89.5%) and allergenic solids (91.2%) within the recommended age of 4-6 months for infants at high risk of food allergy, but only 26.2% recommend offering peanut three times per week once it has been introduced. In identifying what constitutes an infant at high risk of developing peanut allergy, dietitians expressed lower comfort levels and lower number of correct responses.Conclusions: Dietitians demonstrated they are up to date regarding the timing of introduction of allergenic solids, but not the frequency of consumption once introduced, for infants at high risk of food allergy. They also expressed low comfort level identifying risk factors for peanut allergy. There are opportunities for further education of dietitians, as well as potential to further utilize dietitian services for the benefit of patients with food allergy or who are at risk for food allergy.
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Affiliation(s)
- Kirstin E Wingate
- Department of Pediatrics, Division of Allergy & Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lianne Soller
- BC Children's Hospital Research Institute, Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- BC Children's Hospital Research Institute, Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia, 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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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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11
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Sethuraman A, Chan E, Jia J, Soller L, Erdle S, Avinashi V. A145 PEDIATRIC PATIENTS’ & PARENTS’ PERSPECTIVES ON TREATMENT PREFERENCE IN EOSINOPHILIC ESOPHAGITIS: A CROSS SECTIONAL, QUALITATIVE RESEARCH STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991244 DOI: 10.1093/jcag/gwac036.145] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus which impairs quality of life in children and adolescents. Given the wide variety of symptomatic presentations in pediatrics, the varying time to diagnosis, and differing severity (including stricturing phenotype) initial treatments are not standardized. An important part of this individualization, beyond the health care practitioner counseling involves the patients’ and parents’ preferences which incorporates personal beliefs and attitudes. Purpose The study aim was to qualitatively describe parental and patient preferences regarding treatment options in EoE. Method This was a cross-sectional qualitative research study conducted in the EoE clinic at BC Children’s Hospital, Vancouver. Parents and their children completed semi-structured survey questions regarding treatment preference in EoE. Patients along with their parents who completed their survey questions were included in the study. Incomplete forms were excluded from the study. Result(s) The survey was attempted by 15 children, 7-11yrs of age, and 42 children, 12-18yrs of age, along with their parents. Completed response by both parent and their children were seen in 47 patients, 40 were adolescents 12-18yrs of age and 7 were 7-11yrs of age. Parent treatment preferences were diet in 17/47(36.2%), medications in 21/47 (44.7%) and 9/47 (19%) were unsure. 75% of parents who preferred dietary management thought it was less risky than medication. Parents who chose medication thought it would be easier (8/21) and more effective (8/21). Most of the parents’ decisions were influenced by the physician (35/47; 74.5%) and more so by the gastroenterologist (28/47; 59.6%). In 12–18-yr olds, 6/40 (15%) had preference for diet, 25/40 (62.5%) preferred medication and 9/40 (22.5%) were unsure. 3/6 adolescents thought that diet was less risky and 4/6 thought it was more effective than medication. Among the teens who preferred medication, 17/25 (68%) felt it to be easier and 9/25 (36%) thought it would work better than diet. Teenagers found their parents to be helpful for deciding (50%) and doctor (50%) with the gastroenterologist again playing a prominent role. In the 7 to 11yr old age group, 4/7 (57.1%) predominantly had preference for dietary treatment. Conclusion(s) The overall preference in the adolescent age group is for medication supported by patients’ and parents’, with ease of use being a primary driver for adolescents, whereas ease of use and effectiveness were drivers for the parents. Parents were more often interested in dietary therapy than the adolescents. With regards to parents of younger children and younger children themselves, dietary management was the preference as they felt it to be less risky. The numbers, though small, represent one of the few studies done on patient preference in EoE. Future studies should include formal qualitative studies and preferences could ultimately be tied to better counseling and tracking adherence to therapy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A Sethuraman
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
| | - E Chan
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
| | - J Jia
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
| | - L Soller
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
| | - S Erdle
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
| | - V Avinashi
- Division of Allergy and Immunology, BC Children's Hospital, Vancouver, Canada
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12
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Erdle SC, Cook VE, Cameron SB, Yeung J, Kapur S, McHenry M, Chan ES, Mak R, Rex GA, Wong T, Soller L. Real-World Safety Analysis of Preschool Tree Nut Oral Immunotherapy. J Allergy Clin Immunol Pract 2023; 11:1177-1183. [PMID: 36736958 DOI: 10.1016/j.jaip.2023.01.031] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our group previously described preschool peanut oral immunotherapy (OIT) in a real-world, multicenter setting, suggesting that this therapy is safe for most preschoolers. OBJECTIVE To examine the safety and tolerability of tree nut (TN) OIT in preschoolers in the real world. METHODS As part of a Canada-wide quality improvement project, TN-OIT (cashew/pistachio, walnut/pecan, hazelnut, almond, and macadamia nut) was performed in preschoolers who had (1) a skin prick test wheal diameter greater than or equal to 3 mm or a specific IgE level greater than or equal to 0.35 kU/L and a convincing objective IgE-mediated reaction or (2) no ingestion history and a specific IgE level greater than or equal to 5 kU/L. Dose escalations were performed every 2 to 4 weeks till a maintenance dose of 300 mg of TN protein was reached. Symptoms were recorded and classified using the modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System (1, mildest; 5, fatal). RESULTS Of the 92 patients who started TN-OIT from 2018 to 2021, 79 (85.9%) underwent single-food TN-OIT and 13 (14.1%) underwent multifood TN-OIT to 2 (10.8%) or 3 (3.3%) TNs. Eighty-nine (96.7%) patients reached maintenance, and 4 (4.3%) dropped out. Sixty-five (70.7%) patients experienced reactions during buildup: 35 (38.0%) grade 1 reactions, 30 (32.6%) grade 2 reactions, no grade 3 or 4 reactions, and 2 (2.17%) received epinephrine. CONCLUSIONS Preschool TN-OIT in a real-world, multicenter setting appears safe and tolerable, with results comparable with our previously reported peanut OIT findings.
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Affiliation(s)
- Stephanie C Erdle
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada; Community Allergy Clinic, Victoria, British Columbia, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada; Community Allergy Clinic, Victoria, British Columbia, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada; Vancouver Kids Allergy, Vancouver, British Columbia, Canada
| | - Sandeep Kapur
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Mary McHenry
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Gregory A Rex
- Division of Allergy, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
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13
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El Baba A, Jeimy S, Soller L, Kim H, Begin P, Chan ES. Geographical discrepancy in oral food challenge utilization based on Canadian billing data. Allergy Asthma Clin Immunol 2023; 19:5. [PMID: 36650588 PMCID: PMC9843933 DOI: 10.1186/s13223-022-00751-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Oral food challenges (OFC) confer the highest sensitivity and specificity in diagnosis; however, uptake has been variable across clinical settings. Numerous barriers were identified in literature from inadequate training to resource access. OFC utilization patterns using billing data have not been previously studied. OBJECTIVE The objective of this study is to explore the geographic differences in utilization of OFCs across Ontario and Québec using anonymized billing data from 2013 to 2017. METHODS Anonymized OFC billing data were obtained between 2013 and 2017 from Ontario Health Insurance Plan (OHIP) and Régie de l'Assurance Maladie du Québec (RAMQ). The number of OFCs was extracted by location, billings, and physician demographics for clinic and hospital-based challenges. RESULTS Over the period studied, the number of OFCs increased by 92% and 85% in Ontario clinics and Québec hospitals, respectively. For Ontario hospitals, the number of OFCs increased by 194%. While Québec performed exclusively hospital-based OFCs, after controlling for the population, the number of OFCs per 100,000 residents annually were similar to Ontario at 50 and 49 OFCs, respectively. The number of OFCs varied across the regions studied with an annual rate reaching up to 156 OFCs per 100,000 residents in urban regions and as low as 0.1 in regions furthest from city centers. CONCLUSION OFC utilization has steadily increased over the last decade. There has been marked geographical discrepancies in OFC utilization which could be driven by the location of allergists and heterogeneity in their practices. More research is needed to identify barriers and propose solutions to them.
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Affiliation(s)
- Ala El Baba
- grid.39381.300000 0004 1936 8884Division of Internal Medicine, Department of Medicine, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Samira Jeimy
- grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - Lianne Soller
- grid.17091.3e0000 0001 2288 9830Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Harold Kim
- grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada ,grid.25073.330000 0004 1936 8227Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Philippe Begin
- grid.411418.90000 0001 2173 6322Division of Allergy, Rheumatology and Immunology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC Canada ,grid.410559.c0000 0001 0743 2111Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, QC Canada
| | - Edmond S. Chan
- grid.17091.3e0000 0001 2288 9830Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, BC Canada
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14
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Cruz J, Irvine MA, Avinashi V, Chan ES, Vallance BA, Soller L, Bush JW. Application of the Eosinophilic Esophagitis Histology Scoring System Grade Scores in Patients at British Columbia Children's Hospital. Fetal Pediatr Pathol 2022; 41:962-976. [PMID: 35094661 DOI: 10.1080/15513815.2022.2028950] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Histologic diagnosis of eosinophilic esophagitis (EoE) involves peak eosinophil counts (PEC) being greater than 15 per high power field. The EoE Histology Scoring System (EoEHSS) was developed to comprehensively evaluate biopsies to better predict symptom and endoscopy response; we aimed to validate the EoEHSS in our provincial registry, where EoEHSS had not been employed. METHODS We reviewed 186 esophageal biopsies from 16 patients at diagnosis and follow-up. Statistical analyses were conducted to quantify how grade scores correlate with active EoE status and PEC counts, and each feature's ability to predict active disease. RESULTS Nearly all EoEHSS variables were associated with active EoE and high PEC, with basal zone hyperplasia, eosinophil abscesses, and surface epithelial alteration being most predictive in identifying active EoE. CONCLUSIONS We validated and demonstrated each EoEHSS variable's strength in tracking traditional PEC counts, resulting in its adoption as a standard reporting element for our research registry.
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Affiliation(s)
- Justin Cruz
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- Biostatistics Core, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Vishal Avinashi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Bruce A Vallance
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Lianne Soller
- British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jonathan W Bush
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, British Columbia, Canada
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15
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Chua GT, Greenhawt M, Shaker M, Soller L, Abrams EM, Cameron SB, Cook VE, Erdle SC, Fleischer DM, Mak R, Vander Leek TK, Chan ES. The Case for Prompt Salvage Infant Peanut Oral Immunotherapy Following Failed Primary Prevention. J Allergy Clin Immunol Pract 2022; 10:2561-2569. [PMID: 35752433 DOI: 10.1016/j.jaip.2022.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 05/15/2023]
Abstract
Recent guideline recommendations have shifted from recommending prolonged avoidance of allergenic foods in the first 3 years of life to a primary prevention approach involving the deliberate early introduction to infants at risk of developing food allergy. Despite this, some infants, especially those with severe eczema who are at highest risk for developing peanut allergy, fail to receive the preventative benefits of early peanut introduction due to hesitancy and other factors. Difficulty adhering to regular ingestion after introduction further reduces the effectiveness of primary prevention. As emerging real-world evidence has demonstrated that performing peanut oral immunotherapy (OIT) among infants is effective and safe, peanut OIT could be a treatment option for infants with peanut allergy. This review discusses the benefits, risks, and barriers to offering peanut OIT to infants who fail primary prevention strategies. We propose the novel concept that infants with peanut allergy be offered peanut OIT as soon as possible after failed peanut introduction through a shared decision-making process with the family, where there is a preference for active management rather than avoidance.
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Affiliation(s)
- Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China; Department of Paediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, New Hampshire, Lebanon, NH
| | - Lianne Soller
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Victoria E Cook
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Stephanie C Erdle
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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16
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Chua GT, Chan ES, Yeung J, Cameron SB, Soller L, Williams BA, Chomyn A, Vander Leek TK, Abrams EM, Mak R, Wong T. Patient selection for milk and egg ladders using a food ladder safety checklist. Allergy Asthma Clin Immunol 2022; 18:51. [PMID: 35692059 PMCID: PMC9188637 DOI: 10.1186/s13223-022-00696-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
A food ladder is a form of home-based dietary advancement therapy that gradually increases exposure to an allergenic food through the gradual introduction of egg or milk containing food with increasing quantity and allergenicity from extensively heated forms, such as baked goods, to less processed products. While widely considered safe, the food ladder is not risk-free and most of the egg and milk ladder studies only included preschoolers with mild egg and milk allergies, and with no or well-controlled asthma. We propose a Food Ladder Safety Checklist to assist with patient selection using “4 A's” based on available evidence for food ladders, including Age, active or poorly controlled Asthma, history of Anaphylaxis, and Adherence.
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Affiliation(s)
- Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, New Clinical Building, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong,, SAR, China. .,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, SAR, China. .,Department of Paediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, 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
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Brock A Williams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Food, Nutrition, and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - Alanna Chomyn
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Timothy K Vander Leek
- Department of Pediatrics, Pediatric Allergy & Asthma, University of Alberta, Edmonton, AB, 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, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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17
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Canessa CE, Soller L, To S, Newlove TA, Chan ES. Reducing parental anxiety during oral food challenges: A randomized controlled trial of deep breathing exercises. Ann Allergy Asthma Immunol 2022; 128:605-607. [PMID: 35123075 DOI: 10.1016/j.anai.2022.01.029] [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: 09/17/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Chantel E Canessa
- Division of Speciality Medicine, Department of Pediatrics, The University of British Columbia, Vancouver, Canada; Adjunct Faculty, School of Nursing, The University of British Columbia, Vancouver, Canada.
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sharon To
- Department of Psychology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Theresa A Newlove
- Department of Psychology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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18
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Westwell-Roper C, To S, Soller L, Chan ES, Stewart SE. Decreased food allergy-specific anxiety and increased general anxiety in parents of children with food allergies during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 129:242-246. [PMID: 35470036 PMCID: PMC9033624 DOI: 10.1016/j.anai.2022.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Clara Westwell-Roper
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
| | - Sharon To
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Research Institute, Vancouver, BC, Canada
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19
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Soller L, Carr S, Kapur S, Rex GA, McHenry M, Cook VE, Leo S, Wong T, Vander Leek TK, Gerstner TV, Yeung J, Abrams EM, Mak R, Hildebrand KJ, Erdle SC, Cameron SB, Chan ES. Real-world peanut OIT in infants may be safer than non-infant preschool OIT and equally effective. J Allergy Clin Immunol Pract 2022; 10:1113-1116.e1. [PMID: 34954121 DOI: 10.1016/j.jaip.2021.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Lianne Soller
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Stuart Carr
- Snö Asthma and Allergy Clinic, Abu Dhabi, United Arab Emirates
| | - Sandeep Kapur
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Gregory A Rex
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Mary McHenry
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, Nova Scotia, Canada; Halifax Allergy and Asthma Associates, Halifax, Nova Scotia, Canada
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Community Allergy Clinic, Victoria, British Columbia, Canada
| | - Sara Leo
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; West Coast Allergy and Immunology Clinic, Vancouver, British Columbia, Canada
| | - Tiffany Wong
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Thomas V Gerstner
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Meadowood Medical Center, Winnipeg, Manitoba, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Kids Allergy, Vancouver, British Columbia, Canada
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Meadowood Medical Center, Winnipeg, Manitoba, Canada
| | - Raymond Mak
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyla J Hildebrand
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie C Erdle
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Community Allergy Clinic, Victoria, British Columbia, Canada
| | - Edmond S Chan
- Allergy Clinic, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Karunakaran D, Chan E, Zhang Q, Bone J, Carr S, Kapur S, Rex G, McHenry M, Cameron S, Cook V, Leo S, Wong T, Leek TV, Gerstner T, Yeung J, Abrams E, Mak R, Hildebrand K, Erdle S, Soller L. Predictors of Safety for Preschool Peanut Oral Immunotherapy that can help inform a Personalized Medicine Approach. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.471] [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: 10/19/2022]
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21
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Baaske A, Soller L, Mak R, Wong T, Cook V, Rex G, Kapur S, McHenry M, Yeung J, Cameron S, Erdle S, Chan E. Real-World Safety Analysis of Preschool Tree Nut and Sesame Oral Immunotherapy. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.164] [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: 11/29/2022]
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22
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Westwell-Roper C, To S, Andjelic G, Lu C, Lin B, Soller L, Chan ES, Stewart SE. Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review. Pediatr Allergy Immunol 2022; 33:e13695. [PMID: 34779046 DOI: 10.1111/pai.13695] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA. METHODS MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines. RESULTS Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors. CONCLUSIONS FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.
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Affiliation(s)
- Clara Westwell-Roper
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon To
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordan Andjelic
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cynthia Lu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Boyee Lin
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, British Columbia, Canada
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23
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Correa N, Protudjer JLP, Hsu E, Soller L, Chan ES, Kim H, Jeimy S. Canadian parent perceptions of oral food challenges: A qualitative analysis. Pediatr Allergy Immunol 2022; 33:e13698. [PMID: 34811822 DOI: 10.1111/pai.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natasha Correa
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Elaine Hsu
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
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24
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Chan ES, Jeimy S, Hanna M, Cook VE, Mack DP, Abrams EM, Soller L, Wong T, Protudjer JL. Caregiver views on virtual management of food allergy: A mixed-methods study. Pediatr Allergy Immunol 2021; 32:1568-1572. [PMID: 33978254 DOI: 10.1111/pai.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Mariam Hanna
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lp Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Karolinska Institutet, Centre for Allergy Research, Stockholm, Sweden
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25
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Chua GT, Chan ES, Soller L, Cook VE, Vander Leek TK, Mak R. Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond. Front Allergy 2021; 2:725165. [PMID: 35387028 PMCID: PMC8974914 DOI: 10.3389/falgy.2021.725165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT. Eight of them (88.9%) completed the build-up phase at home in 11–28 weeks, tolerating a daily maintenance dose of 320 mg peanut protein. During the build-up, six patients (75.0%) reported urticaria, three (33.3%) reported gastrointestinal tract symptoms, and one (14.3%) reported oral pruritis. None of the patients developed anaphylaxis, required epinephrine, or attended emergency services related to OIT. One or two virtual follow-up visits were completed per patient during the build-up phase. Our case series shows that home-based OIT could be offered to the low-risk preschoolers during the COVID-19 pandemic when non-emergency services are limited and could be considered beyond the pandemic, especially for the families living in the rural or remote areas that may otherwise be unable to access OIT.
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Affiliation(s)
- Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
- *Correspondence: Gilbert T. Chua
| | - Edmond S. Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Victoria E. Cook
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Community Allergy Clinic, Victoria, BC, Canada
| | - Timothy K. Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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26
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Avinashi V, Al Yarubi Z, Soller L, Lam G, Chan ES. Oral peanut immunotherapy acutely unmasking eosinophilic esophagitis with an esophageal stricture. Ann Allergy Asthma Immunol 2021; 127:691-692. [PMID: 34517129 DOI: 10.1016/j.anai.2021.09.001] [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: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
| | - Zuwaina Al Yarubi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Godfrey Lam
- Division of Allergy and Clinical Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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27
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Chomyn A, Chan ES, Yeung J, Vander Leek TK, Williams BA, Soller L, Abrams EM, Mak R, Wong T. Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg. Allergy Asthma Clin Immunol 2021; 17:83. [PMID: 34353372 PMCID: PMC8340453 DOI: 10.1186/s13223-021-00583-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022] Open
Abstract
Food ladders are clinical tools already widely used in Europe for food reintroduction in milk- and egg-allergic children. Previously developed milk and egg ladders have limited applicability to Canadian children due to dietary differences and product availability. Herein we propose a Canadian version of cow’s milk and egg food ladders and discuss the potential role that food ladders may have in the care of children with IgE-mediated allergies to cow’s milk and/or egg, as either a method of accelerating the acquisition of tolerance in those who would outgrow on their own, or as a form of modified oral immunotherapy in those with otherwise persistent allergy.
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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, Vancouver, BC, V5Z 4H4, 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, Vancouver, BC, V5Z 4H4, Canada
| | - Joanne Yeung
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada
| | - 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, Vancouver, BC, V5Z 4H4, 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, Vancouver, BC, V5Z 4H4, 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, Vancouver, BC, V5Z 4H4, 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, Vancouver, BC, V5Z 4H4, Canada
| | - Tiffany Wong
- Department of Pediatrics, Division of Clinical Immunology & Allergy, University of British Columbia, BC Children's Hospital, Room 1C31B, 4480 Oak Street, Vancouver, BC, V5Z 4H4, Canada.
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28
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Clarke AE, Elliott SJ, St Pierre Y, Soller L, La Vieille S, Ben-Shoshan M. Demographic characteristics associated with food allergy in a Nationwide Canadian Study. Allergy Asthma Clin Immunol 2021; 17:72. [PMID: 34274025 PMCID: PMC8285771 DOI: 10.1186/s13223-021-00572-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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We conducted a nationwide Canadian telephone survey on food allergy prevalence between February 2016 and January 2017, targeting vulnerable populations (New, Indigenous, and lower-income Canadians). OBJECTIVE To examine the independent effect of demographic characteristics on food allergy. METHODS Canadian households with vulnerable populations were targeted using Canadian Census data and the household respondent reported whether each household member had a perceived (self-reported) or probable (self-report of a convincing history or physician diagnosis) food allergy. The association between perceived and probable food allergy and demographic characteristics was assessed through weighted multivariable random effects logistic regressions. RESULTS Children, females, Canadian-born participants, adults with post-secondary education, and those residing in smaller households were more likely to report perceived or probable food allergy. Although immigrant parents self-reported less food allergy, Canadian-born children of Southeast/East Asian immigrant versus other immigrant or Canadian-born parents reported more food allergy. CONCLUSION We have demonstrated clear associations between demographic characteristics and food allergy, which may provide important clues to the environmental determinants of food allergy.
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Affiliation(s)
- Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sebastien La Vieille
- Bureau of Chemical Safety, Health Canada, Ottawa, ON, Canada.,Food Science Department, Faculty of Agricultural and Nutrition Sciences, Laval University, Quebec City, QC, 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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29
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Soller L, La Vieille S, Cameron SB, Mak R, Cook VE, Gerdts J, Chan ES. Allergic reactions to emerging food allergens in Canadian children. Allergy Asthma Clin Immunol 2021; 17:71. [PMID: 34256836 PMCID: PMC8276401 DOI: 10.1186/s13223-021-00573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Most Canadian food allergy data has focused on Health Canada’s priority food allergens. This study describes which non-priority (emerging) food allergens were most commonly reported by Canadian parents and categorized/confirmed by allergists. A secondary aim was to describe severity of allergic reactions to emerging allergens. Parents reported allergic reactions to emerging food allergens experienced by their child (< 18 years) which occurred in the past 12 months, and allergists categorized/confirmed them according to likelihood of IgE-mediated food allergy. Of 68 eligible patients completing the survey, the most commonly reported emerging allergens were fruits/vegetables (58.8%), seeds (22.1%), legumes (19.1%) and other (11.8%). Median allergist ranking for legumes was ‘probable’ IgE-mediated food allergy, ‘possible’ for seeds and fruits/vegetables, and ‘unlikely’ for other. Median reaction severity was mild for legumes, and moderate for seeds, fruits/vegetables, and other. Our study highlights that non-priority food allergens, namely legumes and seeds, can lead to probable/likely allergic reactions in Canadian children. These food allergens are increasing in popularity in the Canadian diet, which could lead to increasing reports of allergic reactions. More research is needed to confirm reports of reactions to emerging allergens, and to document their inclusion as ingredients in packaged foods.
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Affiliation(s)
- Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.
| | | | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.,Victoria Allergy, Victoria, BC, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.,Victoria Allergy, Victoria, BC, Canada
| | | | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada
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30
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Latrous M, Zhu R, Mack DP, Soller L, Chan ES, Jeimy S, Hanna M, Abrams EM, Cameron SB, Cook VE, Erdle S, Protudjer JLP, Wong T. Web-based Infant Food Introduction (WIFI): Feasibility and satisfaction of virtual allergist-supervised food introduction. J Allergy Clin Immunol Pract 2021; 9:3521-3523.e1. [PMID: 34051393 PMCID: PMC8421738 DOI: 10.1016/j.jaip.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/25/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Meriem Latrous
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rongbo Zhu
- Division of Allergy and Immunology, Department of Medicine, Western University, London, Ont, Canada
| | - Douglas P Mack
- Division of Allergy and Immunology, Department of Pediatrics, McMaster University, Hamilton, Ont, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Samira Jeimy
- Division of Allergy and Immunology, Department of Medicine, Western University, London, Ont, Canada
| | - Mariam Hanna
- Division of Allergy and Immunology, Department of Pediatrics, McMaster University, Hamilton, Ont, 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
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Erdle
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
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Chua GT, Chan ES, Soller L, Cameron SB. Grass pollen allergy as an anaphylaxis cofactor during peanut oral immunotherapy. Ann Allergy Asthma Immunol 2021; 127:263-264. [PMID: 33971356 DOI: 10.1016/j.anai.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Edmond S Chan
- BC Children's Hospital, Vancouver, Canada; Division of Allergy & Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Lianne Soller
- BC Children's Hospital, Vancouver, Canada; Division of Allergy & Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Scott B Cameron
- Division of Allergy & Immunology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada; Community Allergy Clinic, Victoria, Canada.
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32
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Yuan (Ethan) Zhang B, Soller L, Avinashi V, Chan E, Hin Ko H. Characterization of Adults with Eosinophilic Esophagitis in British Columbia, Canada. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.344] [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: 10/22/2022]
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33
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To S, Westwell-Roper C, Soller L, Chan E, Stewart SE. Development and Initial Validation of a Food Allergy Associated Parental Anxiety Screening Tool: IMPAACT. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.454] [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: 10/22/2022]
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Latrous M, Zhu R, Jeimy S, Mack D, Soller L, Chan E, Protudjer J, Hanna M, Abrams E, Cook V, Cameron S, Erdle S, Wong T. Web-based Infant Food Introduction (WIFI): Improving Access to Allergist-supervised Infant Food Introduction. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.599] [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: 10/22/2022]
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Singer AG, Kosowan L, Soller L, Chan ES, Nankissoor NN, Phung RR, Abrams EM. Prevalence of Physician-Reported Food Allergy in Canadian Children. The Journal of Allergy and Clinical Immunology: In Practice 2021; 9:193-199. [DOI: 10.1016/j.jaip.2020.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022]
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Mack DP, Soller L, Chan ES, Hanna MA, Terpstra C, Vander Leek TK, Bégin P. A High Proportion of Canadian Allergists Offer Oral Immunotherapy but Barriers Remain. J Allergy Clin Immunol Pract 2020; 9:1902-1908. [PMID: 33359585 DOI: 10.1016/j.jaip.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited data on clinical implementation of oral immunotherapy (OIT) have been reported with incomplete evaluation of barriers. OBJECTIVE To survey Canadian allergists on their current practice of OIT and barriers to implementation and expansion of OIT. METHODS A survey investigating current practice and logistical and clinical barriers to offering or expanding OIT was distributed to all Canadian Society of Allergy and Clinical Immunology allergists. RESULTS Of 90 responding allergists, 52.2% reported offering OIT, most commonly to peanut. Food sublingual immunotherapy was offered by 7% of allergists. Having received training for OIT was associated with currently performing OIT (P = .008); 44.7% of allergists offering OIT had received training on OIT, and 81.4% not offering OIT had no training. A total of 87% of allergists performing OIT reported lack of efficacy data and lack of support staff and clinic space, and concerns about increased oral challenges (84%) were "moderately" to "extremely" important barriers to expanding OIT. For clinicians not offering OIT, concerns about safety (95%), after-hours support (95%), efficacy (93%), medicolegal risk (93%), and long-term practice implications (93%) were prioritized as significant barriers. Qualitative assessment suggested concerns about the practical challenges associated with OIT, the need for increased safety and efficacy data, and a desire for OIT guidelines and training. CONCLUSION The implementation of OIT faces many barriers, both clinical and logistical. Increasing high-quality safety and efficacy data may support those hesitant to offer OIT, and improving funding may address the practical infrastructure challenges. In addition, training will help expand access for allergists interested in performing OIT.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Lianne Soller
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Mariam A Hanna
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Collin Terpstra
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Philippe Bégin
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
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Roberts H, Soller L, Ng K, Chan ES, Roberts A, Kang K, Hildebrand KJ, Wong T. First pediatric electronic algorithm to stratify risk of penicillin allergy. Allergy Asthma Clin Immunol 2020; 16:103. [PMID: 33292528 PMCID: PMC7716490 DOI: 10.1186/s13223-020-00501-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/08/2019] [Accepted: 11/05/2020] [Indexed: 12/03/2022] Open
Abstract
Beta-lactam allergy is reported in 5–10% of children in North America, but up to 94–97% of patients are deemed not allergic after allergist assessment. The utility of standardized skin testing for penicillin allergy in the pediatric population has been recently questioned. Oral drug challenges when appropriate, are preferred over skin testing, and can definitively rule out immediate, IgE-mediated drug allergy. To our knowledge, this is the only pediatric study to assess the reliability of a penicillin allergy stratification tool using a paper and electronic clinical algorithm. By using an electronic algorithm, we identified 61 patients (of 95 deemed not allergic by gold standard allergist decision) as low risk for penicillin allergy, with no false negatives and without the need for allergist assessment or skin testing. In this study, we demonstrate that an electronic algorithm can be used by various pediatric clinicians when evaluating possible penicillin allergy to reliably identify low risk patients. We identified the electronic algorithm was superior to the paper version, capturing an even higher percentage of low risk patients than the paper version. By developing an electronic algorithm to accurately assess penicillin allergy risk based on appropriate history, without the need for diagnostic testing or allergist assessment, we can empower non-allergist health care professionals to safely de-label low risk pediatric patients and assist in alleviating subspecialty wait times for penicillin allergy assessment.
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Affiliation(s)
- Hannah Roberts
- Division of Allergy and Immunology, Department of Medicine, Western University, St. Joseph's Health Care, 268 Grosvenor St, London, ON, N6A 3N3, Canada.
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Karen Ng
- Division of Clinical Pharmacy, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ashley Roberts
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Kristopher Kang
- Division of General Pediatrics, University of British Columbia, Vancouver, Canada
| | - Kyla J Hildebrand
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Soller L, Abrams EM, Carr S, Kapur S, Rex GA, Leo S, McHenry M, Vander Leek TK, Yeung J, Cook VE, Wong T, Hildebrand KJ, Mak R, Gerstner TV, Cameron SB, Chan ES. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract 2020; 9:1349-1356.e1. [PMID: 33221274 DOI: 10.1016/j.jaip.2020.10.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. OBJECTIVE To determine the effectiveness of preschool P-OIT after 1 year of maintenance. METHODS Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. RESULTS Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. CONCLUSIONS Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.
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Affiliation(s)
- Lianne Soller
- British Columbia Children's Hospital, 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; Meadowood Medical Center, Winnipeg, MB, Canada
| | - Stuart Carr
- Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sandeep Kapur
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Gregory A Rex
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Sara Leo
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; West Coast Allergy and Immunology Clinic, Vancouver, BC, Canada
| | - Mary McHenry
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Timothy K Vander Leek
- Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Pediatric Allergy & Immunology, Edmonton, AB, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Vancouver Pediatric and Allergy Centre, Vancouver, 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
| | - Tiffany Wong
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kyla J Hildebrand
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Thomas V Gerstner
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, 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
| | - Edmond S Chan
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Jia J, Chan ES, Avinashi V, Hsu E, Ko HH, Soller L. Aiming for a shorter time to diagnosis: pediatric eosinophilic esophagitis in British Columbia. Allergy Asthma Clin Immunol 2020; 16:88. [PMID: 33072158 PMCID: PMC7557005 DOI: 10.1186/s13223-020-00486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
Longer time to diagnosis for patients with eosinophilic esophagitis can lead to adverse patient outcomes, but the length of diagnostic delay has not been quantified for patients with eosinophilic esophagitis in Canada. Our study defines the time to diagnosis (TTD) for pediatric patients with eosinophilic esophagitis in British Columbia and identifies factors that predict increased time to diagnosis. The median TTD was 21 months (1.75 years; IQR = 7, 45) with a median age at EoE diagnosis of 105 months (8.75 years; IQR = 44, 156). Caucasians experienced significantly longer TTD compared to other ethnicities (24 months (IQR = 7, 52) and 12 months (IQR = 4.5, 23) respectively, p = 0.008). Caucasian ethnicity (p = 0.037) and older age at the time of diagnosis (p = 0.006) predicted increased TTD. Our model explained 7.9% (Adjusted R2 = 0.079) of the total variance for our cohort.
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Affiliation(s)
- Jocelyn Jia
- Faculty of Medicine, University of Toronto, Toronto, ON Canada.,BC Children's Hospital Research Institute, Vancouver, BC Canada
| | - Edmond S Chan
- BC Children's Hospital Research Institute, Vancouver, BC Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Vishal Avinashi
- BC Children's Hospital Research Institute, Vancouver, BC Canada.,Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Elaine Hsu
- BC Children's Hospital Research Institute, Vancouver, BC Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Hin Hin Ko
- Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada.,St. Paul's Hospital, Vancouver, BC Canada
| | - Lianne Soller
- BC Children's Hospital Research Institute, Vancouver, BC Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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Asai Y, Martino D, Eiwegger T, Nadeau K, Koppelman GH, Clarke AE, Lee Y, Chan ES, Simons E, Laprise C, Mazer B, Marenholz I, Royce D, Elliott SJ, Hampson C, Gerdts J, Eslami A, Soller L, Hui J, Azad M, Sandford A, Daley D. Phenotype consensus is required to enable large-scale genetic consortium studies of food allergy. Allergy 2020; 75:2383-2387. [PMID: 32323869 PMCID: PMC7540469 DOI: 10.1111/all.14333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Yuka Asai
- Division of Dermatology Department of Medicine Queen’s University Kingston Ontario Canada
| | - David Martino
- Telethon Kids Institute Perth Western Australia Australia
- Centre for Food and Allergy Research Murdoch Children’s Research Institute Melbourne Victoria Australia
| | - Thomas Eiwegger
- Department of Paediatrics Division of Clinical Immunology and Allergy Food allergy and Anaphylaxis Program The Hospital for Sick Children The University of Toronto Toronto Ontario Canada
| | - Kari Nadeau
- Pediatrics Stanford University Stanford CA USA
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, and Groningen Research Institute for Asthma and COPD University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - Ann E. Clarke
- Division of Rheumatology Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Young‐Ae Lee
- Clinic for Pediatric Allergy Experimental and Clinical Research Center Charité University Medical Center, and Max‐Delbrück‐Center (MDC) for Molecular Medicine Berlin Germany
| | - Edmond S. Chan
- BC Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Elinor Simons
- Pediatrics & Child Health Section of Allergy & Clinical Immunology University of Manitoba Winnipeg Manitoba Canada
| | - Catherine Laprise
- Département des sciences fondamentales Université du Québec à Chicoutimi Saguenay Quebec Canada
| | - Bruce Mazer
- Research Institute of the McGill University Health Centre Montreal Quebec Canada
| | - Ingo Marenholz
- Clinic for Pediatric Allergy Experimental and Clinical Research Center Charité University Medical Center, and Max‐Delbrück‐Center (MDC) for Molecular Medicine Berlin Germany
| | | | - Susan J. Elliott
- Applied Health Sciences University of Waterloo Waterloo Ontario Canada
| | | | | | - Aida Eslami
- Département de médecine sociale et préventive Faculté de médecine Université Laval Quebec Quebec Canada
| | - Lianne Soller
- BC Children’s Hospital University of British Columbia Vancouver British Columbia Canada
| | - Jennie Hui
- School of Population Health University of Western Australia Perth Western Australia Australia
| | - Meghan Azad
- Pediatrics College of Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Andrew Sandford
- Department of Medicine The University of British Columbia Centre for Heart Lung Innovation Vancouver British Columbia Canada
| | - Denise Daley
- Department of Medicine The University of British Columbia Centre for Heart Lung Innovation Vancouver British Columbia Canada
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Soller L, To S, Hsu E, Chan ES. Current tools measuring anxiety in parents of food-allergic children are inadequate. Pediatr Allergy Immunol 2020; 31:678-685. [PMID: 32320501 DOI: 10.1111/pai.13260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/20/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of food allergy, excessive parental anxiety can be maladaptive and lead to unnecessary restriction of social activities. No validated tool exists to measure food allergy-associated anxiety (FAAA). This study sought to explore factors associated with parental FAAA, determine sensitivity and specificity of using generic state anxiety measure-State-Trait Anxiety Inventory (STAI) versus FAAA, and determine whether validated tools for generalized anxiety or food allergy-specific quality of life (QoL) could be used as surrogates for FAAA. METHODS Canadian parents of food-allergic children completed an online survey. Without a validated tool for FAAA, a visual analogue scale was used to assess parent-reported FAAA. Multivariable linear regression was performed with FAAA as the outcome. Sensitivity and specificity analysis of state anxiety vs. FAAA, and factor analysis of state anxiety and QOL, was performed to determine whether these could be used as surrogates for FAAA. RESULTS A total of 548 of 1244 parents (44.1%) completed the survey. Factors positively associated with FAAA included parental burden, risk perception, state anxiety, intolerance of uncertainty and perceived severity of child's food allergy; personal/family history of mental health was negatively associated. Sensitivity and specificity of state anxiety were 68.6% and 70.0%. Factor analysis revealed that state anxiety and QOL were correlated (r = 0.54, P < .001) but distinct constructs. CONCLUSION Our study identified factors associated with FAAA, and determined that generic anxiety and QOL tools do not accurately categorize parents with self-reported high FAAA. Future research will develop a validated screening tool to help allergists identify anxious parents and provide psychosocial resources.
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Affiliation(s)
- Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Sharon To
- Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Elaine Hsu
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, UBC, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Mack DP, Hanna MA, Abrams EM, Wong T, Soller L, Erdle SC, Jeimy S, Protudjer JLP, Chan ES. Virtually supported home peanut introduction during COVID-19 for at-risk infants. J Allergy Clin Immunol Pract 2020; 8:2780-2783. [PMID: 32534149 PMCID: PMC7284246 DOI: 10.1016/j.jaip.2020.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Tiffany Wong
- University of British Columbia, Vancouver, BC, Canada
| | - Lianne Soller
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Edmond S Chan
- University of British Columbia, Vancouver, BC, Canada
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Chooniedass R, Soller L, Hsu E, To S, Cameron SB, Chan ES. Parents of children with food allergy: A qualitative study describing needs and identifying solutions. Ann Allergy Asthma Immunol 2020; 125:674-679. [PMID: 32454095 DOI: 10.1016/j.anai.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parents experience a wide range of emotions, specifically stress and anxiety, when their child receives a diagnosis of a food allergy. Managing this health condition and coping with emotions require professional and peer support. Currently, there is a lack of resources and a lack of awareness of the resources that are required to help assist parents in managing their child's food allergy. OBJECTIVE To describe parental experiences when caring for a child with food allergy and to review the resources parents need to manage living with a child with food allergy and more specifically how they would want these resources delivered. METHODS A total of 7 semistructured focus groups were conducted in British Columbia, Canada. Parents were asked to describe their experiences with managing their child's food allergy and identify helpful resources. RESULTS A total of 40 parents (33 females) participated in the focus groups. Participant demographics were collected. The following 3 main themes emerged: (1) anxiety (an emotional roller coaster); (2) a transformational journey (the waiting game, loss of normalcy, strained relationships and mistrust, and financial challenges); and (3) the need for resources (day to day management, ages and stages, mental health supports, and "the dream"). CONCLUSION An in-person allied health care team is needed to provide an integrated, patient-centered approach for how families can live and manage food allergies. Credible information and resources, such as medically reviewed websites, support groups, and counseling services, with a goal of reducing child and parental anxiety, should be provided by health care professionals.
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Affiliation(s)
- Rishma Chooniedass
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, British Columbia, Canada.
| | - Lianne Soller
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Elaine Hsu
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Sharon To
- BC Children's Hospital, Vancouver, Canada; Department of Psychology, University of British Columbia, British Columbia, Canada
| | - Scott B Cameron
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Edmond S Chan
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, British Columbia, Canada; BC Children's Hospital, Vancouver, Canada
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Protudjer JLP, Soller L, Abrams EM, Chan ES. Billing fees for various common allergy tests vary widely across Canada. Allergy Asthma Clin Immunol 2020; 16:28. [PMID: 32336976 PMCID: PMC7178720 DOI: 10.1186/s13223-020-00426-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of food allergy in Canada is high and has increased over time. To date, there are no Canadian data on the healthcare costs of visits to allergists. Methods We sent an anonymous survey to allergist members of the Canadian Society of Allergy and Clinical Immunology (CSACI) between October and December 2019. Survey questions included demographic information and billing fees for various types of allergy visits and diagnostic testing. Results Of 200 allergists who are members of CSACI, 43 allergists responded (21.5% response rate). Billing fees varied widely. The greatest ranges were noted for oral immunotherapy (OIT; both initial consultation [mean $198.70; range $0 to $575] and follow up/build up visits [mean $125.74; range: $0 to $575]). There were significant provincial differences in billing fees, as well as significant billing fee differences between hospital versus community allergists (e.g. oral food challenge [OFC]: $256.38 vs. $134.94, p < 0.01). Billing fees were higher outside of Ontario, with the exception of specific Immunoglubulin E (sIgE) testing and OIT visits. Conclusions Greater standardization of billing fees across provinces and between hospital versus community allergy could result in more consistency of billing fees for OFC and OIT across Canada. Further knowledge of exact costs will help inform practice and policy in the diagnosis and management of food allergy.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,The Children's Health Research Institute of Manitoba, Winnipeg, Canada.,4Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,6Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, Canada
| | - Lianne Soller
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
| | - Elissa Michelle Abrams
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada
| | - Edmond S Chan
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
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Clarke AE, Elliott SJ, St Pierre Y, Soller L, La Vieille S, Ben-Shoshan M. Comparing food allergy prevalence in vulnerable and nonvulnerable Canadians. J Allergy Clin Immunol Pract 2020; 8:2425-2430.e11. [PMID: 32304831 DOI: 10.1016/j.jaip.2020.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 03/18/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sebastien La Vieille
- Bureau of Chemical Safety, Health Canada, Ottawa, ON, Canada; Food Science Department, Faculty of Agricultural and Nutrition Sciences, Laval University, Quebec City, QC, 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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Al Yaarubi Z, Foster A, Avinashi V, Lam G, Soller L, Chan E. A198 EOSINOPHILIC ESOPHAGITIS WITH STRICTURE PRESENTING SHORTING AFTER INITIATION OF ORAL PEANUT IMMUNOTHERAPY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Oral immunotherapy (OIT) is increasingly practiced outside of research settings with reasonable success (Soller 2019).
With OIT, a patient eats their food allergen daily, gradually increasing the dose, with the goal to prevent or reduce the severity of an anaphylactic reaction.
One of the described adverse events of OIT is a risk of developing Eosinophilic Esophagitis (EoE), with cited frequency of 2.7% (Lucendo 2014). In addition, OIT is typically contraindicated in patients with known EoE but patients are not routinely screened for EoE prior to initiation of OIT.
Aims
To present a case of a 12 year old boy with peanut anaphylaxis who developed eosinophilic esophagitis and an esophageal stricture shortly after starting peanut immunotherapy
Methods
Patient chart review was conducted. A literature review was done using the words “eosinophilic esophagitis” and “immunotherapy”.
Results
A12 year old boy with asthma, allergic rhinitis and multiple anaphylactic food allergies, started peanut OIT with an allergist. Prior to OIT, the patient had no symptoms suggestive of EoE such as dysphagia, heartburn, chest pain or washing of food. Approximately 3.5 weeks into treatment, the patient developed daily vomiting. The patient was advised to stop the peanut OIT three days after symptom onset, but the vomiting continued for another 8 days. By the time of endoscopy (16 days after onset of vomiting), the vomiting had completely subsided for the previous five days.
The upper GI endoscopy demonstrated signs of EoE throughout the length of the esophagus. In the mid esophagus there was resistance where the 9.8 mm gastroscope was unable to pass. A smaller gastroscope with a 5.9 mm width was easily able to pass through the stricture. Histology showed marked eosinophilia throughout the esophagus with basal cell hyperplasia, spongiosis, superficial microabscesses and stromal fibrosis consistent with EoE. The patient continued to be ‘asymptomatic’ at the time of endoscopy and after despite the presence of a stricture. After discussion, the patient was started on oral viscous budesonide (OVB) 1mg PO BID.
The patient was re-scoped 4 weeks into OVB therapy with complete resolution of the stricture with neither macroscopic nor histologic findings of EoE. Patient is now off OVB for over a month, remains asymptomatic, and will undergo repeat endoscopy in the upcoming month to ensure normal histology
Conclusions
This is the first case describing EoE with an esophageal stricture shortly after initiation of OIT. Pediatric Gastroenterologists need to be increasingly aware that patients undergoing OIT are at an increasing risk of ‘developing’ or at least ‘unmasking’ EoE. More research is required to evaluate whether EoE screening, by symptom questionnaire or endoscopy is warranted prior to beginning OIT, and whether OIT is truly needed.
Upper GI endoscopy showing signs of EoE and an esophageal stricture
Funding Agencies
CAG
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Affiliation(s)
- Z Al Yaarubi
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Foster
- BC Children’s Hospital, Vancouver, BC, Canada
| | - V Avinashi
- BC Children’s Hospital, Vancouver, BC, Canada
| | - G Lam
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - L Soller
- BC Children’s Hospital, Vancouver, BC, Canada
| | - E Chan
- BC Children’s Hospital, Vancouver, BC, Canada
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Soller L, Abrams E, Carr S, Kapur S, Rex G, Lidman P, Leek TV, Yeung J, McHenry M, Wong T, Cook V, Hildebrand K, Gerstner T, Mak R, Hsu E, Cameron S, Chan E. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Avinashi V, Chan JM, Bush JW, Vallance BA, Yang H, Portales-Casamar E, Soller L, Mill C, Chan ES. Poor Correlation of Oral Swabs with Esophageal Eosinophil Counts. Dysphagia 2019; 35:773-779. [PMID: 31773332 DOI: 10.1007/s00455-019-10082-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/28/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic condition that requires repeated endoscopies/biopsies to track the disease and treatment response. This invasive procedure involves risk to the patient and has significant costs. We studied whether the detection of specific proteins (cytokines and eosinophil degranulation products) from oral swabs could serve as a minimally invasive test for EoE. Swabs of the oral cavity (buccal and oropharyngeal) were obtained prior to endoscopy/biopsies in patients with EoE, possible EoE, and non-EoE patients in addition to obtaining additional esophageal biopsy tissue. ELISAs measuring the levels of cytokines IL-5, IL-8, IL-13, and eosinophil degranulation products including major basic protein (MBP), eosinophil derived neurotoxin (EDN), and eosinophil peroxidase (EPO) were performed on the samples. Comparisons were made to peak esophageal eosinophil counts. Tolerability of the swabs was evaluated. 43 patients, 4-17 years old, participated in the study. Swabs were well tolerated and all showed measurable protein. 26 patients had EoE [14 active (> 15 eosinophils/high power field), 12 non-active], 17 patients did not have EoE. Results obtained from oral swabs showed poor correlation with those from esophageal tissue. Only measurement of eosinophil degranulation products EDN and EPO from esophageal tissues showed strong correlations with eosinophil counts. In this study, the levels of cytokines and eosinophil degranulation products detected from oral swabs did not correlate with esophageal eosinophilia, and their detection would be insufficient to displace endoscopy/biopsies.
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Affiliation(s)
- Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, 4480 Oak Street, Vancouver, BC, V63V4, Canada.
| | - Justin M Chan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, 4480 Oak Street, Vancouver, BC, V63V4, Canada
| | - Jonathan W Bush
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, and University of British Columbia, Vancouver, Canada
| | - Bruce A Vallance
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, 4480 Oak Street, Vancouver, BC, V63V4, Canada
| | - Hyungjun Yang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, 4480 Oak Street, Vancouver, BC, V63V4, Canada
| | - Elodie Portales-Casamar
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, Vancouver, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, Vancouver, Canada
| | - Christopher Mill
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, and University of British Columbia, Vancouver, Canada
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Clarke AE, Elliott SJ, St Pierre Y, Soller L, La Vieille S, Ben-Shoshan M. Temporal trends in prevalence of food allergy in Canada. J Allergy Clin Immunol Pract 2019; 8:1428-1430.e5. [PMID: 31706046 DOI: 10.1016/j.jaip.2019.10.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, 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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Soller L, Clarke AE, Lyttle A, Chin R, Ben-Shoshan M, Cheuk S, Asai Y, Chan ES. Comparing quality of life in Canadian children with peanut, sesame, and seafood allergy. J Allergy Clin Immunol Pract 2019; 8:352-354.e1. [PMID: 31326619 DOI: 10.1016/j.jaip.2019.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander Lyttle
- Arid Mountain Allergy and Asthma Clinic, Calgary, Alberta, Canada
| | - Ricky Chin
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Clinical Immunology, and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephen Cheuk
- Arid Mountain Allergy and Asthma Clinic, Calgary, Alberta, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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