Journal of food allergy最新文献

Background: Current coronavirus disease 2019 (COVID-19) and influenza vaccination-related knowledge, attitudes, and behaviors remain poorly understood among U.S. children with food allergy, and, particularly, those from non-Hispanic Black, Latinx, and lower-income backgrounds who bear a disproportionate burden by allergic disease. These data are especially relevant due to historical vaccine hesitancy in children with food allergy and an initial contraindication for those with severe allergic reactions to be vaccinated against COVID-19.

Objective: We sought to characterize COVID-19 and influenza vaccination-related knowledge, attitudes, and behaviors in a racially, ethnically, and socioeconomically diverse longitudinal cohort of caregiver-child dyads with immunoglobulin E-mediated food allergy.

Methods: We leveraged the National Institutes of Health supported FORWARD cohort, which consists of non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx children diagnosed with food allergy to assess COVID-19 testing, vaccination, and influenza vaccine concern and utilization through administering a one-time institutional review board approved survey.

Results: Non-Hispanic Black participants were less likely than non-Hispanic White participants to be vaccinated (odds ratio [OR] 0.25 [95% confidence interval {CI}, 0.08-0.75]) or tested (OR 0.33 [95% CI, 0.13-0.85]) for COVID-19 and have the intention to vaccinate their children for influenza (OR 0.42 [95% CI, 0.18-0.98]). More than one-third of the participants reported that they believed that their child was at greater risk of complications from COVID-19 vaccination due to a food allergy. There were racial and/or ethnic disparities in the belief that COVID vaccines contain allergenic ingredients; more Hispanic/Latinx (37%) and Black (37%) than White (22%) participants reported this belief (p = 0.02).

Conclusion: The present findings of disparities in vaccination-related knowledge, attitudes, and behaviors across racial and/or ethnic, and household income strata suggested that initial reports of COVID-19 vaccination hesitancy within the population with food allergy may be further exacerbated by well-documented racial, ethnic, and socioeconomic differences in vaccine hesitancy, potentially leading to a greater infectious disease burden in these vulnerable populations. This highlights a need for targeted education and outreach among members of these communities who are living with food allergy.

Background: The prevalence of pediatric food allergies is increasing. Although pediatric residents are frontline providers for children with food allergies, little is known about pediatric residents' educational experiences and comfort with infant and toddler food allergy.

Methods: An anonymous online needs assessment survey was created and distributed to 64 residents in one residency program. The survey explored residents' knowledge sources, experience, and comfort in diagnosing, treating, and counseling patients with regard to food allergy and anaphylaxis.

Results: Fifty-one pediatric residents (79.7%) completed the survey. Pediatric residents who had formal engagement with allergy-trained clinicians had 8.27 times the odds (odds ratio 8.27 [95% confidence interval, 1.16-59.01]; p = 0.035) of feeling comfortable in treating infant and toddler anaphylaxis compared with those who did not feel comfortable.

Conclusion: These findings suggest that a standardized pediatric residency curriculum, in partnership with pediatric allergists, may present enhanced educational opportunities for pediatric residents.

Background: Legume and sesame are emerging food allergens. The utility of specific immunoglobulin E (sIgE) testing to predict clinical reactivity to these allergens is not well described.

Objective: To describe clinical outcomes and sIgE in sesame and legume oral food challenges (OFC).

Methods: We performed a retrospective review of 74 legume and sesame OFCs between 2007 and 2017 at the Ann and Robert H. Lurie Children's Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves and logistic regression models that predicted OFC outcome were generated.

Results: Twenty-eight patients (median age, 6.15 years) passed legume OFC (84.9%), and 25 patients (median age, 5.91 years) passed sesame OFC (61.0%). The median sIgE to legume was 1.41 kUA/L and, to sesame, was 2.34 kUA/L. In patients with failed legume OFC, 60.0% had cutaneous symptoms, 20.0% had gastrointestinal symptoms, and 20.0% had anaphylaxis. Of these reactions, 80.0% were controlled with antihistamine alone and 20.0% required epinephrine. In patients for whom sesame OFC failed, 50.0% had cutaneous symptoms, 12.5% had gastrointestinal symptoms, and 37.50% had anaphylaxis. Of these reactions, 6.3% required epinephrine, 31.3% were controlled with diphenhydramine alone, and 63.50% required additional epinephrine or prednisone.

Conclusion: Most OFCs to legumes were passed and reactions to failed legume OFCs were more likely to be nonsevere. Sesame OFC that failed was almost twice as likely compared with legume OFC that failed, and reactions to sesame OFC that failed were often more severe. Sesame sIgE did not correlate with OFC outcome.

Food additives are naturally occurring or synthetic substances that are added to food to modify the color, taste, texture, stability, or other characteristics of foods. These additives are ubiquitous in the food that we consume on a daily basis and, therefore, have been the subject of much scrutiny about possible reactions. Despite these concerns, the overall prevalence of food additive reactions is 1-2%, with a minority of the wide variety of symptoms attributed to food-additive exposure being reproduced by double-blind placebo controlled challenges. Reactions can be broadly classified into either immunoglobulin E (IgE)- and non-IgE-mediated reactions, with natural additives accounting for most IgE-mediated reactions, and both natural and synthetic additives being implicated in the non-IgE-mediated reactions. Reactions that include asthma exacerbations, urticaria and/or angioedema, or anaphylaxis with ingestion of a food additive are most deserving of further allergy evaluation. In this article, we discussed the different types of adverse reactions that have been described to various food additives. We also reviewed the specifics of how to evaluate and diagnose a food additive allergy in a clinic setting.

Background: Oral food challenge (OFC) remains the criterion standard diagnostic procedure for food allergy. Although the need for OFCs has increased, some allergists may not perform them due to the risk for adverse events and lack of backup resources.

Objective: The study aimed to elucidate the frequency of reactions in which emergency backup resources were used and reported on various challenge outcomes at a tertiary pediatric hospital.

Methods: We retrospectively reviewed children and young adults (ages, 0-21 years) who completed OFCs in 2013-2018 at Cleveland Clinic Children's Hospital. Demographics, atopic history, culprit food, reaction history, and diagnostic testing as well as challenge details and outcomes were collected and analyzed.

Results: A total of 1269 challenges of 812 unique patients ages 5 months to 21 years were reviewed. More than half of challenges were performed in patients with a history of a reaction and positive testing result before challenge. The foods with the highest proportion of allergic outcomes were egg, sesame, and baked egg. More than one-third of challenge reactions were grade 3 or 4 anaphylaxis when using a food-induced anaphylaxis grading scale. Epinephrine was used for reactions in 7.2% of all challenges. Reactions in five challenges (0.4%) prompted utilization of backup emergency resources.

Conclusion: On review of nearly 1300 OFCs, emergency backup resources were rarely used, despite a large proportion of moderate-to-severe reactions. The need for backup resources during food challenges is rare, which suggests that most typical allergy offices are able to treat OFC reactions.

Background: U.S. national emergency was declared in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, a period of stay-at-home orders, regulatory changes, evolving medical recommendations, and food supply chain disruptions occurred. There is little published research on how such changes affected food allergy management for children with this diagnosis.

Objective: The study goal was to identify parent perspectives with regard to if and/or how pandemic-related regulatory changes and evolving medical recommendations have affected food allergy management.

Methods: A survey was distributed to parents of children with food allergy. An electronic Internet forms survey link was available for completion during July 2020. Data were presented as descriptive statistics, cleaned, and coded into a spreadsheet before analysis. Frequencies and percentage were calculated to describe participants' characteristics and responses.

Results: Of 377 responses, 359 met inclusion criteria. Concerns about COVID-19 exposure were expressed in 65.7% about accessing an emergency department and 73.6% had school reentry concerns; 66% had not discussed recommended anaphylaxis management algorithm changes with a provider; 85.8% had not discussed the temporary U.S. Food and Drug Administration food labeling policy with a provider. Most (62%) reported shortages of preferred safe food brands. 62% spent more time cooking safe foods from scratch. With regard to the recommendation by the U.S. Centers for Disease Control and Prevention (CDC) for classroom dining, 57.7% planned to request modifications. With regard to the CDC's recommendation to use inhalers versus nebulizers, 37.7% had not discussed the topic with a provider. Ninety-two written comments were analyzed and grouped into seven themes.

Conclusion: New pandemic-related regulations, food supply chain disruptions, and evolving medical recommendations resulted in intensified burdens for respondents, including the increased time needed to complete food allergy management and school reentry concerns. Study results can inform clinical team members (e.g., physicians, nurses, dieticians) of effects that pandemic-related changes may have on this patient population, with subsequent consideration of patient-specific screening, education, and shared decision-making with regard to risk mitigation needs.