1,721,132 research outputs found
Food allergy and asthma--what is the link?
No full textFood allergy and asthma are both atopic diseases and therefore frequently co-exist. Food allergy is common in childhood, affecting approximately 8% of infants. The diagnosis is based on a suggestive history supported by skin-prick testing, serum specific IgE or food challenge. The role of diet in the aetiology of asthma and as a precipitant of exacerbations has been investigated extensively. Many people perceive diet as being an important precipitant of their asthma but objective testing suggests that it is only important in a minority. Meanwhile, there is considerable epidemiological evidence to suggest that there is a link between asthma and food allergy. Food can induce bronchospasm and food allergy has been implicated as a risk factor for life-threatening asthma. Additionally, asthma also seems to be a risk factor for life-threatening food allergy. The mechanism underlying this connection is unclear. The co-existence of food allergy should be considered in any child with asthma. Where food allergy is confirmed, steps should be taken to avoid these foods as this may considerably improve asthma control
Relevance of inhalational exposure to food allergens
No full textPurpose of review: This review discusses the inhalational route as a clinically important route of exposure to food allergens.Recent findings: In childhood, we have recently demonstrated that food allergens can induce both early and late phase bronchial reactions within blinded, placebo-controlled challenges. Additionally, clinically important levels of food allergens have been measured in environmental air samples.Summary: It is well known that the ingestion of food allergens frequently causes respiratory symptoms and that the mechanism of death in fatal anaphylaxis is usually profound bronchospasm. The mechanism by which ingested food allergens induce bronchial reactions is unclear. There are many case reports of bronchial reactions to aerosolized food allergens. Within the food industry the problems have been examined more systematically. From such work it is possible to gain an impression of the potential prevalence of the problem. With 10% of adult asthma being occupational and 10% of occupational asthma being induced by aerosolized food, inhalational exposure to food allergens plays a major role in at least 1% of adult asthma. For a patient with co-existent food allergy and asthma it is important that both dietary and environmental avoidance be practised. The similar pathophysiology of allergic and occupational asthma and the ability of inhaled food allergens to cause the latter raises the question as to whether aerosolized food could play a role in the pathogenesis of childhood asthma
Diagnosing peanut allergy with skin prick and specific IgE testing
No full textBackgroundFood allergy is common in childhood. It has been suggested that the magnitude of a skin prick test or specific IgE result can improve diagnostic usefulness, but this has been addressed in only a few tertiary challenge-based studies.
ObjectiveTo determine the predictive value of a wheal ? 8 mm or serum specific IgE ? 15 kUA/L for clinical allergy and investigate whether results are generalizable.
MethodsAll subjects, up to 16 years of age, who had been investigated with a peanut or tree nut food challenge were eligible for the study. Subjects were referred from either a tertiary allergy clinic or a community birth cohort. All subjects with a history suggestive of food allergy were offered a challenge unless there were features of anaphylaxis. Details of challenges were prospectively recorded. Results were modeled by using logistic regression.
ResultsThere was a total of 161 peanut challenges. Recent skin prick (longest wheal diameter) and specific IgE data were available for 135 and 136 challenges, respectively. The results suggest that a skin prick result ? 8 mm and a specific IgE ? 15 kUA/L have predictive values of 95% (95% CI, 76.2% to 99.9%) and 92.0% (74.0% to 99.0%), respectively, for a positive challenge. Age, the type of nut, and referral pattern of the subject did not appear to alter this relationship.
ConclusionThese data suggest that a skin prick result ? 8 mm or a specific IgE ? 15 kUA/L have a high predictive value for clinical allergy to peanut and that these cutoff figures appear generalizable to different populations of children undergoing an assessment for peanut allergy
Development of a quality-of-life assessment for the allergic child or teenager with multisystem allergic disease
No full textBackground: Health-related quality of life (HRQOL) questionnaires currently being used to evaluate allergic disease are organ-specific. They therefore fail to take account of the systemic aspects of allergic disease. Objective: To develop and validate a pediatric HRQOL questionnaire for allergic disease (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ) that encapsulates problems related to the eyes, ears, nose, lungs, skin, emotions, and everyday activities. Methods: In the development phase, 77 subjects (6 to 16 years of age), with seasonal or perennial allergic problems, were asked how much they were bothered by each different area of HRQOL impairment. The highest scoring areas were used to construct the PADQLQ. In the validation phase of the study, 36 subjects (8 to 16 years of age) with seasonal allergic rhinoconjunctivitis, seasonal allergic asthma, and/or cutaneous manifestations of grass pollen allergy were assessed before and during the pollen season. Results: The PADQLQ contains 26 questions. In addition to standard symptoms (eg, rhinitis), it incorporates multiorgan symptoms that are usually overlooked (eg, hearing problems). The PADQLQ demonstrated good cross-sectional and longitudinal validity, showing a high degree of correlation with symptom scores and quality of life as measured by a visual analogue scale and two-organ specific questionnaires. The PADQLQ showed good within-subject reliability and a small minimal important difference (0.33; 95% CI, 0.11 to 0.54 on a 7-point scale). Conclusions: The PADQLQ has good cross-sectional and longitudinal validity, making it a potentially useful outcome measure in the evaluation of systemic treatments such as antihistamine medications and immunotherapy in children with multisystem allergic disease
Grass pollen immunotherapy as an effective therapy for childhood seasonal allergic asthma
No full textBackground:
Few studies have investigated the use of specific immunotherapy (SIT) for childhood seasonal allergic asthma.Objective:
We sought to examine the efficacy and safety of SIT with Alutard SQ grass pollen (Phleum pratense Alutard SQ; ALK-Abelló, Hørsholm, Denmark) in children with seasonal allergic asthma.Methods:
A randomized, double-blind, placebo-controlled study assessing the efficacy of grass pollen SIT over 2 pollen seasons was performed. Children (3-16 years) with a history of seasonal allergic asthma sensitized to grass pollen (P pratense) and requiring at least 200 ?g of inhaled beclomethasone equivalent per day were enrolled. Subjects with symptomatic asthma or rhinoconjunctivitis outside the grass pollen season were excluded. The primary outcome measure was a combined asthma symptom-medication score during the second pollen season. Secondary outcome measures included end-point titration skin prick testing and conjunctival and bronchial provocation testing to allergen, sputum eosinophilia, exhaled nitric oxide, and adverse events.Results:
Thirty-nine subjects were enrolled. Thirty-five subjects provided data for analysis. The use of SIT was associated with a substantial reduction in asthma symptom-medication score compared with that after placebo (P = .04). There were also significant reductions in cutaneous (P = .002), conjunctival (P = .02), and bronchial (P = .01) reactivity to allergen after SIT compared with that after placebo. The 2 groups had similar levels of airway inflammation, despite a trend toward less inhaled steroid use in the active group. No serious adverse events were reported, and no subjects withdrew because of adverse events.Conclusion:
The study has shown that SIT is effective and well tolerated in children with seasonal allergic asthma to grass pollen
Defining the window of opportunity and target populations to prevent peanut allergy
No full textBACKGROUND: Peanut allergy affects 1% to 2% of European children. Early introduction of peanut into the diet reduces allergy in high-risk infants.OBJECTIVE: We aimed to determine the optimal target populations and timing of introduction of peanut products to prevent peanut allergy in the general population.METHODS: Data from the Enquiring About Tolerance (EAT; n = 1303; normal risk; 3-year follow-up; ISRCTN14254740) and Learning Early About Peanut Allergy study (LEAP; n = 640; high risk; 5-year follow-up; NCT00329784) randomized controlled trials plus the Peanut Allergy Sensitization (PAS; n = 194; low and very high risk; 5-year follow-up) observational study were used to model the intervention in a general population. Peanut allergy was defined by blinded peanut challenge or diagnostic skin prick test result.RESULTS: Targeting only the highest-risk infants with severe eczema reduced the population disease burden by only 4.6%. Greatest reductions in peanut allergy were seen when the intervention was targeted only to the larger but lower-risk groups. A 77% reduction in peanut allergy was estimated when peanut was introduced to the diet of all infants, at 4 months with eczema, and at 6 months without eczema. The estimated reduction in peanut allergy diminished with every month of delayed introduction. If introduction was delayed to 12 months, peanut allergy was only reduced by 33%.CONCLUSIONS: The preventive benefit of early introduction of peanut products into the diet decreases as age at introduction increases. In countries where peanut allergy is a public health concern, health care professionals should help parents introduce peanut products into their infants' diet at 4 to 6 months of life
Investigating the health economic burden of atopic disease in children from the EAT-On Study
No full textBackground: there is growing interest in the health economic burden of childhood diseases. This study aimed to compare healthcare costs between atopic and non-atopic children in a general UK population.Methods: participants were recruited from the EAT-On study which followedchildren originally seen from 3 months old and then 7–12 years. A health economics questionnaire (HEQ) collected data from 2018 to 2022 on the utilization of UK healthcare services and were valued using published unit costs for UK£2021. Mean (standard deviation) resource use and cost were estimated for atopic and non-atopic children, in addition to mean difference (95% confidence interval) between atopic and non-atopic children. Two-part logistic regression analyses were performed to examine the likelihood of a child incurring healthcare costs including variables associated with the level of cost incurred.Results: 625 children completed the HEQ; 33% reported zero healthcare costs over a 12-month period and 34.4% (215/625) had at least 1 atopic disease. Children with any atopic disease had higher total costs compared to those without atopic disease (mean difference £77 (95% CI −16.9, 170.6) per participant); if extrapolated to population level, this equated to £104.7 million more per year. Children with atopy were more likely to utilize hospital-based services compared to children without atopy (mean difference £104.3 (95% CI 36.2, 172.5) per participant). Being younger in the 7–12 y age bracket or coming from a lowerincome household (<£60,000/year) was associated with higher total healthcare costs.Conclusion: children with atopy incur greater total healthcare costs compared to children without atopy
Food allergy as a risk factor for life-threatening asthma in childhood: a case-controlled study
No full textBackground: No objective clinical risk factors exist for pediatric life-threatening asthma. Objectives: In this study, we address whether persistent food allergy and degree of atopy are risk factors for life-threatening asthma. Methods: By use of a case-controlled design, children (1-16 years) ventilated for an exacerbation of asthma were enrolled. Each case was matched by sex, age, and ethnicity, with 2 controls who had attended with a non–life-threatening exacerbation. All subjects were assessed by means of a questionnaire, spirometry, and skin prick or RAST testing. The data were analyzed by conditional logistic regression. Results: Nineteen cases and 38 controls were enrolled. Compared with controls, cases were found to have the following risk factors: food allergy (odds ratio, 8.58; 95% CI, 1.85-39.71), multiple allergic diagnoses (4.42; 1.17-16.71), early onset of asthma (6.48; 1.36-30.85), and frequent admissions (14.2; 1.77-113.59). After regression analysis, only frequent admission with asthma (9.85; 1.04-93.27) and food allergy (5.89; 1.06-32.61) were independently associated with life-threatening asthma. Half the cases had food allergy compared with only 10% of controls. Conclusion: This study demonstrates that poorly controlled asthma and food allergy are significant risk factors for life-threatening asthma. More intensive management of this high-risk group of children might help to reduce future morbidity and mortality
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