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Vazquez JMC, Kankam A, Jordon K. Health disparities in food allergy. Curr Probl Pediatr Adolesc Health Care 2025:101731. [PMID: 40246638 DOI: 10.1016/j.cppeds.2025.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Rates of food allergy are rising worldwide, with a disproportionate amount of disease burden found in patients of Black, Asian, and Latinx descent. Recent guidelines have recommended early introduction of allergens as early as 4-months-old to mitigate the development of food allergy. However, non-White children continue to have significantly poorer outcomes with higher rates of food allergy-related emergency department visits for anaphylaxis without having equivalent access to epinephrine auto-injectors. With only half of allergists accepting Medicaid in the United States, and only one-third of Medicaid-enrolled children with food allergies having seen an allergist, underserved populations are less likely to have access to subspecialty care - a major determining factor in allergy health outcomes. In this review, we examine the health disparities that contribute to food allergy as well as possible solutions for physicians to combat inequity in allergy care.
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Affiliation(s)
- Joseline M Cruz Vazquez
- Division of Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, 145 East 32nd Street, Floor PH, New York, NY 10016, USA.
| | - Agartha Kankam
- Division of Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, 145 East 32nd Street, Floor PH, New York, NY 10016, USA
| | - Kara Jordon
- NYU Grossman School of Medicine, NYC Health + Hospitals/Bellevue Hospital, New York, NY USA
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2
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Jaiswal YS, Williams LL. The Rising Incidence of Food Allergies and Infant Food Allergies. Annu Rev Food Sci Technol 2025; 16:269-287. [PMID: 39971351 DOI: 10.1146/annurev-food-111523-121952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Infant food allergies have become a continually rising global health issue. There is a lack of global standardized recommendations on measures for prevention and treatment of infant food allergies because of the variations in ethnic, social, educational, and healthcare practices that affect the outcomes of research studies. Food allergies can cause mild to severe reactions and can affect social and emotional aspects of life up to the adolescent stage and are sometimes never outgrown. Maternal factors such as in utero supply of antibodies, dietary diversity, genetics, food allergen consumption during pregnancy, gut microbiota, and breastfeeding characteristics are the cornerstones of the development of an infant's immune system. In this review, we discuss how prenatal and postnatal factors affect the gut microbiota and development of an infant's immune system, and the current therapies available. The importance of food processing and education of stakeholders in the care of infants with food allergies is also discussed.
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Affiliation(s)
- Yogini S Jaiswal
- Center for Excellence in Post-Harvest Technologies, North Carolina Agricultural and Technical State University, The North Carolina Research Campus, Kannapolis, North Carolina, USA; ,
| | - Leonard L Williams
- Center for Excellence in Post-Harvest Technologies, North Carolina Agricultural and Technical State University, The North Carolina Research Campus, Kannapolis, North Carolina, USA; ,
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Harries M. Food Allergy Induced Anaphylaxis: An Overview. Pediatr Ann 2025; 54:e47-e49. [PMID: 39928425 DOI: 10.3928/19382359-20241203-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2025]
Abstract
Anaphylaxis is a potentially life-threatening condition that requires immediate medical treatment and evaluation. The prevalence of food allergies has risen during the last few decades, resulting in increased awareness of the potential for anaphylactic reactions and the need for patient and parent education around how to properly treat a reaction in the nonhospital setting. This article will address the epidemiology, patho-physiology, diagnostic criteria, and treatment of anaphylaxis. While anaphylaxis can result from exposure to non-food allergens (ie, medication, insect stings, environmental allergens), this article will specifically focus on the role of food allergies in anaphylaxis. [Pediatr Ann. 2025;54(2):e47-e49.].
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Mickle AT, Ciaccio CE, Seetasith A, Johnston KM, Dunne JS, Kowal S, Bever A, Ko S, Garmo V, Gupta S, Lloyd A, Warren CM. US general population food allergy treatment preferences: a discrete choice experiment. Curr Med Res Opin 2025; 41:269-279. [PMID: 39882592 DOI: 10.1080/03007995.2025.2459784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 12/20/2024] [Accepted: 01/24/2025] [Indexed: 01/31/2025]
Abstract
OBJECTIVE To quantify treatment preferences for food allergy management options (oral immunotherapy, biologic therapy, and allergen avoidance), overall and by sociodemographic strata. METHODS A US general population (≥13 years) discrete choice experiment (DCE) was conducted, including the Intolerance of Uncertainty-12 Scale and clinical/demographic questions. Conditional logistic regression analyses were conducted overall and by sociodemographic factors. DCE results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Participants (n = 294) mean (standard deviation) age was 47 (19.7) years; 48.6% were male. A 1% reduction in risk of having an exposure resulting in a moderate-to-severe reaction was statistically significantly associated with treatment preference (OR: 1.10; CI:1.04-1.16; p < 0.01). Features significantly associated with reduced preference included: a 1% increase in risk of treatment-related, severe anaphylaxis (0.85; 0.74-0.97; p=0.02); a 1% increase in risk of gastrointestinal symptoms (0.99; 0.99-0.99; p < 0.01); daily treatment (vs. every 2-4 weeks; 0.81; 0.72-0.91; p < 0.01); in-clinic administration (vs. at-home; 0.76; 0.66-0.87; p < 0.01); subcutaneous administration (vs. oral; 0.69; 0.61-0.78; p < 0.01); three-hour post-treatment physical activity limitation (0.84; 0.77-0.93; p < 0.01); and one-year life expectancy reduction (0.87; 0.85-0.89; p < 0.01). Rural dwellers favoured at-home use and no activity limits; lower-income respondents preferred convenience (oral, less frequent, and at-home administration). Teens strongly preferred being bite-safe (vs. fully allergic; 2.75; 1.09-6.90; p = 0.03). CONCLUSION When making food allergy management decisions, US general population respondents had strong preferences for features related to safety and convenience; however, the magnitude of preferences varied by sociodemographic factors. These findings may be pertinent for population-level health decision makers.
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Affiliation(s)
- Alexis T Mickle
- Broadstreet Health Economics & Outcomes Research, Vancouver, Canada
| | - Christina E Ciaccio
- Department of Pediatrics, The University of Chicago Medicine, Chicago, IL, USA
| | | | | | - Jessica S Dunne
- Broadstreet Health Economics & Outcomes Research, Vancouver, Canada
| | | | - Andrea Bever
- Broadstreet Health Economics & Outcomes Research, Vancouver, Canada
| | - Stella Ko
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Sachin Gupta
- Genentech, Inc., South San Francisco, CA, USA
- Department of Pulmonary Medicine, Alameda Health System, Oakland, CA, USA
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Treffeisen ER, Cromer SJ, Dy-Hollins ME, Lin SY, Naik H, Graham DA, Fiechtner L, Kuhlthau KA, Schneider LC, Walsh KE. The Association Between Child Food Allergy and Family Food Insecurity in a Nationally Representative US Sample. Acad Pediatr 2025; 25:102565. [PMID: 39181503 PMCID: PMC11805619 DOI: 10.1016/j.acap.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To assess whether child food allergy is associated with family food insecurity, overall, and across different income levels. METHODS We used the 2011-2018 National Health Interview Survey, a nationally representative cross-sectional survey. The exposure was child food allergy, and our main outcome was odds of family food insecurity, which was calculated using multivariable logistic regression models adjusted for child demographics, family characteristics and survey year. We examined for effect modification by the ratio of family income to the poverty threshold using stratification and tests for statistical interaction. RESULTS Among 83,287 children, 6% had food allergy and 22% experienced family food insecurity. Child food allergy was associated with a 1.39-fold (95% confidence interval [CI]: 1.26, 1.53) increased odds of family food insecurity overall. Child food allergy was associated with a 1.46-fold (95% CI: 1.29, 1.66) increased odds of family food insecurity among children whose families lived below 200% of the federal poverty level, and a 1.26-fold (95% CI: 1.05, 1.51) increased odds of family food insecurity among children whose families lived at 200 to 399% of the federal poverty level, with no association among children whose families lived at or above 400% of the federal poverty level (P = .04 for interaction). CONCLUSION There is an association between child food allergy and family food insecurity, and this association is modified by the ratio of family income to the poverty threshold. Improved availability and subsidy of allergen-free foods in nutrition assistance programs and food pantries are urgently needed.
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Affiliation(s)
- Elsa R Treffeisen
- Division of Immunology (ER Treffeisen and LC Schneider), Boston Children's Hospital, Boston, Mass; Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass.
| | - Sara J Cromer
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; Division of Endocrinology (SJ Cromer), Massachusetts General Hospital, Boston, Mass
| | - Marisela E Dy-Hollins
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; Department of Neurology (ME Dy-Hollins), Massachusetts General Hospital, Boston, Mass
| | - Sheng Y Lin
- Department of Anesthesiology (SY Lin), Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine (SY Lin), Chang Gung University, Taoyuan City, Taiwan
| | - Hiten Naik
- Department of Medicine, University of British Columbia Clinician Investigator Program (H Naik), Vancouver, British Columbia, Canada
| | - Dionne A Graham
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; Program for Patient Safety and Quality (DA Graham), Boston Children's Hospital, Boston, Mass
| | - Lauren Fiechtner
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; The Greater Boston Food Bank (L Fiechtner), Boston, Mass; Division of General Academic Pediatrics (L Fiechtner and KA Kuhlthau), Department of Pediatrics, MassGeneral for Children, Boston, Mass; Division of Pediatric Gastroenterology and Nutrition (L Fiechtner), MassGeneral for Children, Boston, Mass
| | - Karen A Kuhlthau
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; Division of General Academic Pediatrics (L Fiechtner and KA Kuhlthau), Department of Pediatrics, MassGeneral for Children, Boston, Mass
| | - Lynda C Schneider
- Division of Immunology (ER Treffeisen and LC Schneider), Boston Children's Hospital, Boston, Mass; Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass
| | - Kathleen E Walsh
- Harvard Medical School (ER Treffeisen, SJ Cromer, ME Dy-Hollins, DA Graham, L Fiechtner, KA Kuhlthau, LC Schneider, and KE Walsh), Boston, Mass; Division of General Pediatrics (KE Walsh), Boston Children's Hospital, Boston, Mass
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Anagnostou A, Wang J, Chinthrajah S, Gupta R, Davis CM, Parrish C, Lo R, Groetch M, Herbert L, Shroba J, Sansweet S, Shaker M, Rolling C, Tam J, Greenhawt M. Addressing health disparities in food allergy: A Position Statement of the AAAAI Prior Authorization Task Force. J Allergy Clin Immunol 2025; 155:53-61. [PMID: 39545883 DOI: 10.1016/j.jaci.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/24/2024] [Accepted: 10/10/2024] [Indexed: 11/17/2024]
Abstract
Self-reported food allergies (FAs) affect approximately 8% of the US pediatric and approximately 10% of the adult population, which reflects potentially disproportionate increases among ethnically and racially minoritized groups. Multiple gaps and unmet needs exist regarding FA disparities. There is reported evidence of disparities in FA outcomes, and the FA burden may also be disproportionate in low-income families. Low family income has been associated with higher emergency care spending and insecure access to allergen-free food. Pharmacoinequity arises in part as a result of structural racism still experienced by historically marginalized populations today. Historically redlined communities continue to experience greater rates of neighborhood-level air pollution and indoor allergen exposure, lack of transportation to medical appointments, poverty, and lower prescription rates of necessary medications. Clinical research needs racially and ethnically diverse participation to ensure generalizability of research findings and equitable access to medical advances, but race reporting in clinical trials has been historically poor. Addressing health disparities in FA is a priority of clinical care, with professional organizations such as the American Academy of Allergy, Asthma & Immunology having a prominent role to play in mitigating the challenges faced by these individuals. In this position statement we recommend some key steps to address this important issue.
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Loeb L, Cangemi DC, Squire JD, Lacy BE. Clarifying the Hazy Concepts of Food Allergies and Sensitivities. Gastroenterol Hepatol (N Y) 2024; 20:524-531. [PMID: 39483998 PMCID: PMC11523085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Food allergies, food sensitivities, and adverse reactions to food represent common reasons for gastroenterology and allergy referral. The epidemiology of these disorders is changing; food allergies are more common than previously thought, and there is a heightened sense of awareness about food sensitivities. Symptoms do not always accurately predict the underlying pathophysiology nor distinguish the underlying etiology. This may lead to unnecessary testing, which is often unrewarding and expensive. Myths and misconceptions about food allergies and sensitivities are common and may lead to unwarranted treatment using untested therapies. Importantly, a missed diagnosis of a true food allergy can have serious consequences. This article discusses the differences between food allergies and sensitivities, including their epidemiology, underlying pathophysiology, key symptoms, and diagnostic criteria, as well as their treatment options.
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Affiliation(s)
- Lauren Loeb
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida
| | - David C. Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida
| | | | - Brian E. Lacy
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida
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Bao J, Qiu Y, Xu X, Fu X, Song J, Wang L, Huang L, Zhang W. Towards an optimized model of food allergy in zebrafish. Mol Immunol 2024; 173:110-116. [PMID: 39106608 DOI: 10.1016/j.molimm.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 06/15/2024] [Accepted: 07/30/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND The prevalence of food allergies is on the rise, posing a significant challenge to public health. Rodents serve as the predominant animal model in food allergy research; yet, the application of rodent models proves to be a laborious and time-consuming endeavor. It is imperative to develop novel in vivo models. METHODS Ovalbumin (OVA) was administered as the allergen, following the recommended dosage used in other species. During the sensitization phase, a dosage of 0.25 mg per 10 tails per 1 L was administered twice daily, and during the challenge phase, the dosage was increased to 3 times the initial level. The study explored two dimensions of sensitization: the mode of exposure, which can be either continuous or intermittent, and the duration of exposure, which includes 3 days, 5 days, and 7 days. We examined midgut pathological changes, immunoglobulins contents, and mRNA expressions associated to T helper cells (Th) 2 cytokines following exposure. RESULTS A significant 109.3 % increase in the number of eosinophils was observed in the midgut histopathology following intermittent 5-day OVA exposure, which emerged as the most effective model. OVA exposure increased concentrations of immunoglobulin M (IgM) (105.2 %), IgZ (312.1 %), and IgD (304.3 %) in this model. The mRNA expressions of Th2-related interleukin (IL)-4 and IL-13 were also elevated by 132.8 % and 421.0 %, respectively. CONCLUSION The intermittent 5-day OVA exposure was suggested to be the best constructed zebrafish food allergy model, which may be a potential tool for research into food allergies.
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Affiliation(s)
- Jiali Bao
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China; Department of Infectious Diseases, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou 310052, China
| | - Yushu Qiu
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xinyi Xu
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xiao Fu
- the Departments of Radiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Jingjing Song
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Lei Wang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Lisu Huang
- Department of Infectious Diseases, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou 310052, China.
| | - Weixi Zhang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
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Mendonca CE, Andreae DA. Food Allergy. Med Clin North Am 2024; 108:655-670. [PMID: 38816109 DOI: 10.1016/j.mcna.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
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Affiliation(s)
- Chelsea Elizabeth Mendonca
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77018, USA.
| | - Doerthe A Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA
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Proctor KB, Volkert VM, Klin A, Vickery BP, Sharp WG. The Intersection of Autism Spectrum Disorder, Food Allergy, and Avoidant/Restrictive Food Intake Disorder: A Clinical Case Study. J Pediatr 2024; 269:113965. [PMID: 38369235 DOI: 10.1016/j.jpeds.2024.113965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Kaitlin B Proctor
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
| | - Valerie M Volkert
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Ami Klin
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Brian P Vickery
- Division of Allergy/Immunology, Emory University School of Medicine, Atlanta, GA
| | - William G Sharp
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Winslow A, Mills C, Schwartz JT, Assa'ad A. Implementing Food Oral Immunotherapy Into Clinical Practice: Quality and Safety Perspectives From a US Academic Center. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1159-1169. [PMID: 38423284 DOI: 10.1016/j.jaip.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/03/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
Oral immunotherapy (OIT) is an accessible procedure for practicing allergy/immunology providers, yet rigorous safety standards are limited in the clinical setting. By exploring the transition from research to clinical practice OIT, we review relevant safety considerations necessary for the clinical provider. We offer a perspective on clinical benefits and considerations at the individual, collaboration, and policy levels from the vantage of a large academic OIT program, and we propose several practical start-up checklists and clerical considerations for practicing providers. Awareness of the local population and front-end planning is necessary to improve the accessibility of this procedure in clinical practice among racial and socioeconomic minority populations. Sharing and merging OIT protocols, procedural methods, and electronic medical record order sets may increase harmonization among OIT-providing institutions and further our abilities to pool safety and outcomes data, ultimately enhancing the safety and efficacy of clinical OIT.
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Affiliation(s)
- Andrew Winslow
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Christa Mills
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin T Schwartz
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amal Assa'ad
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lawson Y, Mpasi P, Young M, Comerford K, Mitchell E. A review of dairy food intake for improving health among black infants, toddlers, and young children in the US. J Natl Med Assoc 2024; 116:228-240. [PMID: 38360504 DOI: 10.1016/j.jnma.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.
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Affiliation(s)
- Yolanda Lawson
- Associate Attending, Baylor University Medical Center, Dallas, TX, United States
| | - Priscilla Mpasi
- ChristianaCare Health System, Assistant Clinical Director Complex Care and Community Medicine, Wilmington, DE, United States
| | - Michal Young
- Emeritus, Howard University College of Medicine, Department of Pediatrics and Child Health, Washington D.C., United States
| | - Kevin Comerford
- OMNI Nutrition Science; California Dairy Research Foundation, Davis, CA, United States.
| | - Edith Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
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Dehbozorgi S, Ramsey N, Lee ASE, Coleman A, Varshney P, Davis CM. Addressing Health Equity in Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:570-577. [PMID: 38280451 PMCID: PMC11611229 DOI: 10.1016/j.jaip.2024.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
Social determinants of health can lead to poor health outcomes for food-allergic patients, including limited access to allergen-free foods and specialty care. Housing and transportation limitations can worsen social factors including food insecurity, poor early food introduction, increased reactivity to foods, lower tertiary/allergy care utilization, and increased emergency department utilization. A key component of addressing health equity involves valuing all people with sustained, focused efforts to address social determinants of health. In this clinical commentary, we discuss the current state of heath equity for food-allergic patients, highlighting the disparities in emergency care, food allergy prevention, and food insecurity. Solutions to improve health equity through clinical practice are proposed. Currently available funding opportunities through the National Institutes of Health for health equity initiatives are outlined. Gaps in health equity for food-allergic patients include the lack of documented successful implementation of effective solutions to food insecurity, poor early food introduction uptake, poor access to specialist care, and unequal distribution of educational resources. The availability of research funding and legislative policies supporting access to food and education bolster the impetus to move toward health equity for 20 million people in the United States with food allergy.
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Affiliation(s)
- Sara Dehbozorgi
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nicole Ramsey
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Sang Eun Lee
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amaziah Coleman
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Pooja Varshney
- Division of Allergy and Immunology, Department of Pediatrics, Dell Medical School at the University of Texas Austin, Dell Children's Medical Center, Austin, Texas
| | - Carla M Davis
- Division of Allergy, Immunology, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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14
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Venter C, Meyer R, Bauer M, Bird JA, Fleischer DM, Nowak-Wegrzyn A, Anagnostou A, Vickery BP, Wang J, Groetch M. Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:579-589. [PMID: 38280452 DOI: 10.1016/j.jaip.2024.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Food allergies affect growth in children by decreasing the availability of nutrients through decreased dietary intake, increased dietary needs, food-medication interactions, and psychosocial burden. Guidelines on food allergy management frequently recommend nutrition counseling and growth monitoring of children with food allergies. OBJECTIVE To provide clear guidance for clinicians to identify children with food allergies who are at nutritional risk and ensure prompt intervention. METHODS We provide a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to identify those with food allergy at greatest nutritional risk, determine the impact of nutritional interventions on growth, and develop guidance for risk reduction in children with food allergies. RESULTS Children with food allergies are at increased risk of nutritional deficiencies and poor growth. Nutritional assessment and intervention can improve outcomes. Identifying poor growth is an important step in the nutrition assessment. Therefore, growth should be assessed at each allergy evaluation. Interventions to ensure adequate dietary intake for growth include appropriately prescribed elimination diets, breast-feeding support and assessment, supplemental formula, vitamin and/or mineral supplementation, appropriate milk substitutes, and timely introduction of nutrient-dense complementary foods. Access to foods of appropriate nutritional value is an ongoing concern. CONCLUSION Nutrition intervention or referral to registered dietitian nutritionists with additional training and/or experience in food allergy may result in improved growth and nutrition outcomes.
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Affiliation(s)
- Carina Venter
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo.
| | - Rosan Meyer
- Department of Medicine, Imperial College London, London, United Kingdom; Department of Nutrition and Dietetics, University of Winchester, Winchester, United Kingdom; Department of Medicine, KU Leuven, Leuven, Belgium
| | - Maureen Bauer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - David M Fleischer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aikaterini Anagnostou
- Section of Allergy and Immunology, Baylor College of Medicine, Houston, Texas; Section of Allergy and Immunology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Brian P Vickery
- Children's Healthcare of Atlanta, Atlanta, Ga; Department of Pediatrics, Emory University, Atlanta, Ga
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Chong AC, Diwakar L, Kaplan CM, Fox AT, Abrams EM, Greenhawt M, Oppenheimer JJ, Shaker MS. Provision of Food Allergy Care in the United Kingdom and United States: Current Issues and Future Directions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2054-2066. [PMID: 36990429 DOI: 10.1016/j.jaip.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
Food allergy (FA) is a growing issue worldwide. The United Kingdom and United States are high-income, industrialized countries with reported increases in FA prevalence over the past few decades. This review compares delivery of FA care in the United Kingdom and United States and each country's response to the heightened demand and disparities for FA services. In the United Kingdom, allergy specialists are scarce and general practitioners (GPs) provide most allergy care. Whereas the United States has more allergists per capita than the United Kingdom, there is still a shortage of allergy services owing to the greater reliance on specialist care for FA in America and wide geographic variation in access to allergist services. Currently, generalists in these countries lack the specialty training and equipment to diagnose and manage FA optimally. Moving forward, the United Kingdom aims to enhance training for GPs so they may provide better quality frontline allergy care. In addition, the United Kingdom is implementing a new tier of semi-specialized GPs and increasing cross-center collaboration through clinical networks. The United Kingdom and United States aim to increase the number of FA specialists, which is critical at a time of rapidly expanding management options for allergic and immunologic diseases requiring clinical expertise and shared decision-making to select appropriate therapies. While these countries aim to grow their supply of quality FA services actively, further efforts to build clinical networks and perhaps recruit international medical graduates and expand telehealth services are necessary to reduce disparities in access to care. For the United Kingdom in particular, increasing quality services will require additional support from the leadership of the centralized National Health Service, which remains challenging.
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Affiliation(s)
- Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Lavanya Diwakar
- Department of Immunology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Department of Health Economics, University of Birmingham, Birmingham, United Kingdom
| | - Cameron M Kaplan
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, Calif
| | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - John J Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, UMDJ Rutgers University School of Medicine, Newark, NJ
| | - Marcus S Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH.
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16
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Carucci L, Votto M, Licari A, Marseglia GL, Berni Canani R. Food allergy: cause or consequence of pediatric eosinophilic esophagitis? Potential implications of ultraprocessed foods in prevention and management. FRONTIERS IN ALLERGY 2023; 4:1138400. [PMID: 37456790 PMCID: PMC10344695 DOI: 10.3389/falgy.2023.1138400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by eosinophilic infiltration, leading to esophageal dysfunction, inflammation, and fibrotic remodeling. In the last few decades, there has been an increased prevalence of EoE at an alarming rate in the pediatric age. The pathogenesis of EoE is still largely undefined, and this limits the definition of effective strategies for the prevention and management of this condition. EoE is considered a multifactorial disease arising from a negative interaction between environmental factors and genetic background, causing an impaired esophageal epithelial barrier with subsequent abnormal allergen exposure activating type 2 (Th2) inflammation. Food antigens have been suggested as key players in Th2 inflammation in pediatric patients with EoE, but emerging evidence suggests a potential role of other dietary factors, including ultraprocessed foods, as possible triggers for the occurrence of EoE. In this paper, we discuss the potential role of these dietary factors in the development of the disease, and we propose a new approach for the management of pediatric patients with EoE.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples “Federico II,”Naples, Italy
- ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples “Federico II,”Naples, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples “Federico II,”Naples, Italy
- ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples “Federico II,”Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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17
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Jacobs S, Brar K, Nowak-Wegrzyn A, Louisias M. Why You Should Care About Implicit Bias as an Allergist-Immunologist and Ways We Can Address It. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1718-1724. [PMID: 36972799 DOI: 10.1016/j.jaip.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/06/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Samantha Jacobs
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Kanwaljit Brar
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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18
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Smith PK, Venter C, O’Mahony L, Canani RB, Lesslar OJL. Do advanced glycation end products contribute to food allergy? FRONTIERS IN ALLERGY 2023; 4:1148181. [PMID: 37081999 PMCID: PMC10111965 DOI: 10.3389/falgy.2023.1148181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Sugars can bind non-enzymatically to proteins, nucleic acids or lipids and form compounds called Advanced Glycation End Products (AGEs). Although AGEs can form in vivo, factors in the Western diet such as high amounts of added sugars, processing methods such as dehydration of proteins, high temperature sterilisation to extend shelf life, and cooking methods such as frying and microwaving (and reheating), can lead to inordinate levels of dietary AGEs. Dietary AGEs (dAGEs) have the capacity to bind to the Receptor for Advanced Glycation End Products (RAGE) which is part of the endogenous threat detection network. There are persuasive epidemiological and biochemical arguments that correlate the rise in food allergy in several Western countries with increases in dAGEs. The increased consumption of dAGEs is enmeshed in current theories of the aetiology of food allergy which will be discussed.
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Affiliation(s)
- P. K. Smith
- Clinical Medicine and Menzies School of Research, Griffith University, Gold Coast, QLD, Australia
- Correspondence: P. K. Smith
| | - C. Venter
- Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - L. O’Mahony
- Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - R. Berni Canani
- Department of Translational Medical Science and ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
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19
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Xiao S, Sahasrabudhe N, Yang M, Hu D, Sleiman P, Hochstadt S, Cabral W, Gilliland F, Gauderman WJ, Martinez F, Hakonarson H, Kumar R, Burchard EG, Williams LK. Differences in Self-Reported Food Allergy and Food-Associated Anaphylaxis by Race and Ethnicity Among SAPPHIRE Cohort Participants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1123-1133.e11. [PMID: 36403896 PMCID: PMC10085828 DOI: 10.1016/j.jaip.2022.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although food allergies are considered common, relatively little is known about disparities in food allergy by race in the United States. OBJECTIVE To evaluate differences in reported food allergy and food-associated anaphylaxis among individuals enrolled in a longitudinal cohort study from metropolitan Detroit, Michigan. METHODS Participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE) were asked about food allergies, including the inciting food and associated symptoms. Individuals were considered to have food-associated anaphylaxis if symptoms coincided with established clinical criteria. Logistic regression was used to assess whether race difference persisted after adjusting for and stratifying by potential confounders. African genetic ancestry was individually estimated among African American SAPPHIRE participants to assess whether ancestry was associated with food allergy. RESULTS Within the SAPPHIRE cohort, African American participants were significantly more likely to report food allergy (26.1% vs 17%; P = 3.47 × 10-18) and have food-associated anaphylactic symptoms (12.7% vs 7%; P = 4.65 × 10-14) when compared with European American participants. Allergy to seafood accounted for the largest difference (13.1% vs 4.6%; P = 1.38 × 10-31). Differences in food allergy by race persisted after adjusting for potential confounders including asthma status. Among African American participants, the proportion of African ancestry was not associated with any outcome evaluated. CONCLUSION Compared with European Americans, African Americans appear to be at higher risk for developing food allergy and food-associated anaphylaxis, particularly with regard to seafood allergy. The lack of association with genetic ancestry suggests that socioenvironmental determinants may play a role in these disparities.
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Affiliation(s)
- Shujie Xiao
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Neha Sahasrabudhe
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Mao Yang
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Donglei Hu
- Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Patrick Sleiman
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Samantha Hochstadt
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Whitney Cabral
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - W James Gauderman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fernando Martinez
- Arizona Respiratory Center and Department of Pediatrics, University of Arizona, Tucson, Ariz
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Rajesh Kumar
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Esteban G Burchard
- Department of Medicine, University of California San Francisco, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, Calif
| | - L Keoki Williams
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich.
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20
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Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
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21
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Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1162-1168.e7. [PMID: 36716996 DOI: 10.1016/j.jaip.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prevalence of pediatric food allergy (FA) has increased in the past 2 decades. The previous literature suggests that FA presents burdens, both economically and psychosocially, to children and their caregivers, especially families in lower-income strata. Using data from a previously published needs assessment, the Food Allergy Management in Low-Income Youth study, the FA Passport and Workbook tools were developed to address identified needs. OBJECTIVE This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. METHODS Families insured through Illinois Medicaid were recruited from two Chicago-based allergy clinics. Caregivers of children with FA completed a pretest evaluating knowledge, attitudes, beliefs, and practices regarding FA management. A clinician guided caregivers through the FA Passport. The caregivers then completed a posttest immediately afterward and again 3 months later. Changes were evaluated from baseline responses and direct feedback was elicited about the tool. RESULTS The FA Passport successfully improved caregiver-reported confidence with epinephrine autoinjector use (from 69% to 93%), caregiver anaphylaxis recognition (from 66% to 73%), and reported quality of life, and it nearly doubled caregiver comfort regarding leaving the child in the care of others (from 40% to 75.7%). Caregivers rated the FA Passport tool as extremely helpful overall (9.4 out of 10). CONCLUSIONS The FA Passport is a novel FA clinical support tool that addresses barriers to proper FA management described in previous studies. It proved effective at improving caregiver comfort with regarding leaving the food-allergic children with other caregivers, increasing FA knowledge, and improving the quality of life in families affected by FA.
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22
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Chen Y, Jin T, Li M, Yun X, Huan F, Liu Q, Hu M, Wei X, Zheng P, Liu G. Crystal Structure Analysis of Sarcoplasmic-Calcium-Binding Protein: An Allergen in Scylla paramamosain. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:1214-1223. [PMID: 36602420 DOI: 10.1021/acs.jafc.2c07267] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The structure of allergenic proteins provides important information about the binding of allergens to antibodies. In this study, the crystal structure of Scy p 4 with a resolution of 1.60 Å was obtained by X-ray diffraction. Epitope mapping of Scy p 4 revealed that linear epitopes are located on the surface of Scy p 4. Also, conformational epitopes are mostly located in the structural conservative region. Further structural comparison, surface electrostatic potential, and hydrogen bond force analysis showed that mutation of Asp70 and Asp18/20/70 would lead to calcium-binding capacity being lost and destruction of allergenicity. Furthermore, a comparative analysis of structure showed that sarcoplasmic-calcium-binding protein (SCP) had high sequence, secondary, and spatial structural identity in crustaceans, which may be an important factor leading to cross-reactivity among crustaceans. The structure of Scy p 4 provides a template for epitope evaluation and localization of SCPs, which will help to reveal cross-reactivity among species.
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Affiliation(s)
- Yiyu Chen
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, China
| | - Tengchuan Jin
- Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science & Technology of China, Hefei, Anhui 230026, China
| | - Mengsi Li
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
| | - Xiao Yun
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
| | - Fei Huan
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
| | - Qingmei Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
| | - Mengjun Hu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
| | - Xiaofeng Wei
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, China
| | - Peiyi Zheng
- Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, Division of Life Sciences and Medicine, University of Science & Technology of China, Hefei, Anhui 230026, China
| | - Guangming Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Jimei University, Xiamen, Fujian 361021, China
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23
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Disparities in the Diagnosis and Management of Anaphylaxis. Curr Allergy Asthma Rep 2023; 23:13-19. [PMID: 36454450 DOI: 10.1007/s11882-022-01053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to characterize health disparities impacting the recognition and treatment of anaphylaxis. RECENT FINDINGS Previous research has identified major health disparities related to atopic conditions including asthma, atopic dermatitis, and food allergies (FA); however, disparities related to anaphylaxis have yet to be examined in depth. We found widespread health disparities in the incidence and severity of anaphylaxis, as well as in the management of allergies (particularly food allergies) that place individuals at risk of anaphylaxis. Sociodemographic factors are associated with numerous negative health outcomes related to anaphylaxis. We highlight several key steps that must be taken to address these disparities.
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24
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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25
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Multi-Perspective Observation on the Prevalence of Food Allergy in the General Chinese Population: A Meta-Analysis. Nutrients 2022; 14:nu14235181. [PMID: 36501216 PMCID: PMC9736235 DOI: 10.3390/nu14235181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/19/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Reliable estimates of the prevalence of food allergy (FA) among the general Chinese population have remained unclear. This meta-analysis aims to provide an accurate estimate of FA prevalence in China with comprehensive data. A systematic literature search was conducted in eight electronic databases, i.e., China National Knowledge Infrastructure, Wanfang, Weipu, China Biology Medicine, Web of Science, PubMed, Cochrane, and Embase. A random-effects model was used to analyze the pooled prevalence of FA for four different assessment methods. A total of 46 eligible articles were included in the narrative synthesis, and 41 articles were ultimately included in the meta-analysis. Overall, the pooled prevalence of self-reported FA, self-reported physician-diagnosed FA, SPT (specific skin prick test)-positive FA, and OFC (open food challenge)-positive FA were 11.5% (95% CI: 9.8-13.5%), 5.3% (95% CI: 4.2-6.5%), 11.6% (95% CI: 9.6-14.1%), and 6.2% (95% CI: 4.4-8.7%), respectively. Subgroup analyses suggested that the prevalence of FA was affected by age, year of data collection, region, and sample size, but not by gender. This meta-analysis indicated that FA is common among Chinese people, with an increasing trend in prevalence during the past two decades. Given the high heterogenicity between these studies, a national survey with a large sample size based on standardized diagnosis is urgently needed to gain a more scientific understanding of the actual situation of food allergy in China.
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Diversité des allergies alimentaires. REVUE FRANÇAISE D'ALLERGOLOGIE 2022. [DOI: 10.1016/s1877-0320(22)00484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kong W, Xie Y, Zhong J, Cao C. Ultra-processed foods and allergic symptoms among children and adults in the United States: A population-based analysis of NHANES 2005-2006. Front Public Health 2022; 10:1038141. [PMID: 36407984 PMCID: PMC9670314 DOI: 10.3389/fpubh.2022.1038141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Design There is a strong correlation between dietary intake and allergic diseases. Ultra-processed foods (UPFs) are gradually becoming dominant worldwide and causing health problems for children and adults. We hope to determine whether links exist between UPFs and allergic symptoms. Methods We investigated data from 2,736 children (16-19 years) and 4,256 adults (≥20 years) from the National Health and Nutritional Examination Survey (NHANES) 2005-2006. The associations between the mean UPFs contribution to total energy intake and all allergic symptoms (IgE, current asthma, allergy, rash, sneeze, wheeze, eczema, and hay fever) were estimated by weighted multivariate logistic regression. Results Logistic regression analysis showed UFPs were negatively associated with IgE levels in children. Those with higher quartiles had a reduced risk from 16% (OR, 0.84, 95%CI, 0.55 to 1.28) to 34% (OR, 0.66, 95%CI, 0.49 to 0.89), p for trend = 0.006. UPFs were also positively related to current asthma in children with an increased risk of 11% (OR, 1.11, 95%CI, 0.79 to 1.56) to 76% (OR, 1.76, 95%CI, 1.10 to 2.82), p for trend = 0.0393. UPFs were also associated with eczema in girls. But there was no association observed between UPFs and allergic symptoms in adults. Conclusion Our results suggested that UPFs assessed by the NOVA system were associated with IgE, current asthma in children, and eczema in girls. These results further support the need to test the association of modern dietary patterns with allergic symptoms.
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Scurlock AM, Brown E, Davis CM. Food insecurity in children and adults with food allergies. Ann Allergy Asthma Immunol 2022; 129:424-429. [PMID: 35987455 DOI: 10.1016/j.anai.2022.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Food allergy is a substantial public health concern associated with risk of severe or potentially life-threatening reactions and requiring life-altering changes in dietary habits. This increasingly prevalent health concern is associated with adverse medical, nutritional, psychosocial, and economic effects on the estimated 32 million affected individuals in the United States. Management of food allergy requires life-altering dietary modifications and constant vigilance to avoid implicated allergens to minimize the risk of anaphylaxis, which can lead to considerable anxiety and reduced quality of life. Specialized diets are expensive and often difficult to access, particularly for low-income and minority individuals with food allergy. The overlap of food insecurity with diet-treated illnesses further increases the burden on patients with food allergies and their families, with overall rates of food insecurity increasing substantially during the coronavirus disease 2019 pandemic. Universal screening to identify food insecure households and connect them with appropriate resources is a critical step in addressing unmet needs at the individual and family level. At the systems level, integrated advocacy approaches addressing the complex interplay between multiple societal issues such as poverty, systemic racism, wage inequality, housing insecurity, lack of transportation, and other social determinants of health are vital to ensure access to safe, healthy, nutritionally complete options for patients with food allergies and their families.
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Affiliation(s)
- Amy M Scurlock
- Department of Pediatrics, Arkansas Children's Hospital and Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | | | - Carla M Davis
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Exploring the mechanism of sweetener neohesperidin dihydrochalcone on oral tolerance via a network pharmacology approach combined with vivo and vitro methods. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Warren C, Bartell T, Nimmagadda SR, Bilaver LA, Koplin J, Gupta R. Socioeconomic Determinants of Food Allergy Burden-A clinical introduction. Ann Allergy Asthma Immunol 2022; 129:407-416. [PMID: 35914663 DOI: 10.1016/j.anai.2022.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This review characterizes what is currently known about how prevalence, severity, distribution, and management of food allergy (FA) differs across socioeconomic strata and provides guidance for practicing clinicians about how to improve equity in research participation, healthcare delivery, and patient outcomes through a deeper understanding of the socioeconomic determinants of FA. DATA SOURCES Epidemiological and biomedical literature published prior to April 2022. RESULTS Socioeconomic status (SES) is a complex concept that not only encompasses economic resources (e.g., income, wealth) but also a person's social, economic and political power and standing, each of which can impact health. However, in many studies of individuals and families with FA, assessment of SES has been limited and often a respondent's membership within a racial and ethnic group is utilized as a proxy for low SES. As a whole, findings from US-population-based studies indicate a consistent trend: those who self-identify as non-Hispanic Black, and to a lesser extent other subpopulations who identify as being of non-White race and ethnicity, experience a greater burden of food-allergic sensitization and disease including higher rates of emergency health care utilization and food-induced anaphylactic fatality as compared to those identifying as White. CONCLUSION Reports of FA management and outcomes highlight inequities among specific low SES populations in the US. Clinicians can and should act to reduce inequities by engaging more diverse populations in clinical research, equitably implementing FA risk screening and prevention, thoughtfully utilizing emerging technologies to ameliorate disparities based on SES in healthcare delivery and outcomes, and advocating for social change.
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Affiliation(s)
- Christopher Warren
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine and Center for Food Allergy and Asthma Research.
| | - Tami Bartell
- Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sai R Nimmagadda
- Northwestern University, Feinberg School of Medicine, Center for Food Allergy and Asthma Research; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, Division of Allergy and Immunology
| | - Lucy A Bilaver
- Northwestern University, Feinberg School of Medicine, Department of Pediatrics and Center for Food Allergy and Asthma Research
| | - Jennifer Koplin
- Murdoch Children's Research Institute Melbourne, Melbourne, Vic., Australia. Department of Paediatrics and School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Ruchi Gupta
- Center for Food Allergy & Asthma Research; Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago
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Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management. Ann Allergy Asthma Immunol 2022; 129:430-439. [PMID: 35568300 DOI: 10.1016/j.anai.2022.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.
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Affiliation(s)
- Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts.
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Elghoudi A, Narchi H. Food allergy in children-the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family's quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
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Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
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Tepler E, Wong KH, Soffer GK. Health disparities in pediatric food allergy. Ann Allergy Asthma Immunol 2022; 129:417-423. [PMID: 35476967 DOI: 10.1016/j.anai.2022.04.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the current literature regarding the health disparities in the prevalence, diagnosis, and management of pediatric food allergy and discuss possible interventions. DATA SOURCES Literature search of PubMed and Google Scholar databases regarding pediatric food allergy and health disparities. STUDY SELECTIONS Original research articles, reviews, and guidelines on health disparities in pediatric food allergy were included in this review. RESULTS The overall prevalence of food allergy appears to be increasing and disproportionately affecting minority groups. Racial and socioeconomic disparities are evident across all aspects of food allergy care: diagnosis, prevention, acute management (eg, access to epinephrine autoinjectors, visits to emergency department), and long-term management (eg, oral immunotherapy). Children of minority populations and those of low socioeconomic status are at a greater risk of food insecurity, which is further exacerbated by the high cost of allergen-free foods and limited support from food assistance programs. CONCLUSION Racial, ethnic, and socioeconomic disparities in food allergy among children in the United States are evident and negatively affect the outcomes of children with food allergies. Active efforts to decrease racial and socioeconomic disparities, through education, research, and advocacy, will be important to help improve health outcomes in food allergy for all children, regardless of their race, ethnicity, or socioeconomic status.
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Affiliation(s)
- Elizabeth Tepler
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
| | - Katelyn H Wong
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gary K Soffer
- Section of Allergy and Immunology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Trends in Food Allergy Research, Regulations and Patient Care. NUTRITION TODAY 2022; 57:64-69. [PMID: 35369380 PMCID: PMC8946589 DOI: 10.1097/nt.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review provides an overview of food allergies, their impact on affected individuals and caregivers, regulatory activities, and current research efforts to improve allergen management and patient care. Food allergies have been reported to affect up to 32 million Americans, including approximately 6 million children. The Centers for Disease Control and Prevention reported that food allergies in children have clearly increased by 50% between 1997 and 2011. Recent years have seen significant advances in the understanding of responses to food allergens such as the development of response thresholds that hold promise for developing more informative labels on food packaging. Staying current on advances in food allergy research will allow healthcare and nutrition practitioners to provide evidence-based guidance to individuals they serve.
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Hong X, Liang L, Ji H, Frischmeyer-Guerrerio P, Wang G, Pearson C, Stampfer M, Hu FB, Wang X. Fetal lipidome and incident risk of food allergy: A prospective birth cohort study. Pediatr Allergy Immunol 2022; 33:e13722. [PMID: 34918394 PMCID: PMC8881306 DOI: 10.1111/pai.13722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/24/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lipids are proposed to be important in developing adaptive immunity and allergy. However, studies to date reported inconsistent findings. OBJECTIVE To examine newborn lipidome (a comprehensive profiling of circulating lipid metabolites) on child's risk of developing food allergy (FA). The maternal-cord joint effects of lipid metabolites on FA development were also investigated. METHODS This study included 647 mother-child pairs from the Boston Birth Cohort and analyzed 202 lipid metabolites in cord plasma profiled by liquid chromatography tandem mass spectrometry. FA was defined based on standard clinical criteria. Logistic regression was applied to examine the relationships between individual metabolites and risk of FA. RESULTS Of the 647 children, 61 developed FA. Cord triacylglycerols of long carbon chains and multiple double bonds were significantly associated with decreased risk of FA. These associations were comparable across strata of pertinent maternal and child covariates, and were independent of maternal triacylglycerols when assessed simultaneously. Besides, cord and maternal triacylglycerols had an additive effect in association with risk of FA: Children having high (≥Median) C56:8 triacylglycerol levels in both cord and maternal plasma were at the lowest risk of developing FA (OR = 0.24, 95% CI = 0.10-0.56, p = .001), compared to those having low levels in both cord and maternal plasma. CONCLUSION This is the first birth cohort study to link altered cord plasma lipidome with future risk of development FA during childhood. It calls for further investigation on triacylglycerols of long carbon chains and multiple double bonds as potential novel predictive biomarkers and therapeutic targets for FA.
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Affiliation(s)
- Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liming Liang
- Departments of Epidemiology and Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Meir Stampfer
- Departments of Epidemiology and Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Frank B Hu
- Departments of Epidemiology and Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Pappalardo AA, Herbert L, Warren C, Lombard L, Ramos A, Asa’ad A, Sharma H, Tobin MC, Choi J, Hultquist H, Jiang J, Kulkarni A, Mahdavinia M, Vincent E, Gupta R. Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study. J Pediatr Psychol 2022; 47:674-684. [PMID: 35079803 PMCID: PMC9425846 DOI: 10.1093/jpepsy/jsab137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/20/2023] Open
Abstract
Abstract
Objective
The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort.
Methods
Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure—Parent Form (FAIM), and the Food Allergy Quality of Life—Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables.
Results
Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = −.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67).
Conclusions
In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers’ perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.
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Affiliation(s)
| | - Linda Herbert
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | - Christopher Warren
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
| | - Lisa Lombard
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
| | - Ashley Ramos
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | - Amal Asa’ad
- Cincinnati Children’s Hospital Medical Center, USA
| | - Hemant Sharma
- Children’s National Hospital, USA
- George Washington University School of Medicine, USA
| | | | - Jonathan Choi
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Haley Hultquist
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Jialing Jiang
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Ashwin Kulkarni
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | | | - Eileen Vincent
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Ruchi Gupta
- Northwestern Feinberg School of Medicine, Center for Food Allergy and Asthma Research, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
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Graf MD, Lutenbacher M, Wasser H, Dietrich MS, Karp SM. Choking, allergic reactions, and pickiness: A qualitative study of maternal perceived threats and risk avoidance strategies during complementary feeding. Appetite 2022; 171:105914. [PMID: 35007666 PMCID: PMC8842507 DOI: 10.1016/j.appet.2022.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022]
Abstract
An infant's early eating experiences influence later growth and health. However, motivators for mothers' complementary feeding decisions for their infants, such as the process of introducing solid foods, remains unclear. This qualitative study identified maternal perceived threats surrounding complementary feeding and strategies mothers use to mitigate perceived threats of adverse feeding-related health outcomes for their infants. Twenty-seven mothers participated in private, semi-structured interviews. Inductive and deductive qualitative content analysis revealed three primary themes of maternal perceived threats: a) choking, b) allergic reaction, and c) pickiness. Within each primary theme were sub-themes that further delineated the perceived threats and outlined specific and focused complementary feeding practices (CFPs) mothers used for each type of perceived threat. Findings suggest mothers have difficulty with estimating the likelihood and severity of risks and rely on elevated threat perception to guide their feeding decisions. CFPs used to prevent perceived threats were disproportionate to risks, and, at times, actually introduced additional, alternative risks.
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Affiliation(s)
| | - Melanie Lutenbacher
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States
| | - Heather Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States; Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, 37235, United States
| | - Sharon M Karp
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, United States
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Coleman AT, Sharma H, Robinson A, Pappalardo AA, Vincent E, Fierstein JL, Frazier M, Bilaver L, Jiang J, Choi JJ, Kulkarni A, Fox S, Warren C, Mahdavinia M, Tobin M, Assa'ad A, Gupta R. Access to Allergen-Free Food Among Black and White Children with Food Allergy in the FORWARD Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:182-188. [PMID: 34419681 PMCID: PMC9527819 DOI: 10.1016/j.jaip.2021.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Racial differences in access to allergen-free food have not been fully described among children with food allergy (FA). OBJECTIVE To examine access to allergen-free foods among Black and White children with FA. METHODS Black and White children with FA were enrolled in Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD), a multisite prospective cohort study at 4 urban US centers. Caregivers completed questionnaires regarding access to allergen-free foods. Univariable statistics described demographics. Bivariable statistics evaluated crude associations with access to allergen-free foods. Multivariable logistic regression evaluated the adjusted effect of race on access to allergen-free foods. Geospatial analyses examined the distribution of race, socioeconomic status, and food desert residence. RESULTS Among participants (n = 336), White caregivers (88.1%) were more likely to report access to allergen-free foods than Black caregivers (59%) (P < .001). White caregivers were more likely to purchase allergen-free foods online (35.2%) than Black caregivers (12%) (P < .001). Although Black children were more likely to live in a food desert, access to allergen-free food was not related to food desert residence. In the unadjusted analysis, White children were 5.2 times as likely to have access than Black children (P < .001); after adjusting for demographics, this increase in access was no longer significant (P = .08). Other predictors of access to allergen-free foods included online food purchasing, annual household income, respondent education level, milk allergy, and child age >5 years. CONCLUSION In the FORWARD cohort, Black children have less access to allergen-free foods than White children, but much of the difference is accounted for by socioeconomic status and other participant characteristics.
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Affiliation(s)
- Amaziah T Coleman
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC.
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Adam Robinson
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago, Chicago, Ill
| | - Eileen Vincent
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jamie L Fierstein
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mech Frazier
- Department of Research Services, Northwestern University Libraries, Chicago, Ill
| | - Lucy Bilaver
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jialing Jiang
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Johnathan J Choi
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ashwin Kulkarni
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Susan Fox
- Division of Allergy/Immunology, Rush University Medical Center, Chicago, Ill
| | - Christopher Warren
- Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | | | - Mary Tobin
- Division of Allergy/Immunology, Rush University Medical Center, Chicago, Ill
| | - Amal Assa'ad
- Division of Allergy & Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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Engel ML, Pike MR, Cohen MF, Dunlop AL, Corwin EJ, Pearce BD, Brennan PA. Intergenerational Impacts of Maternal Stress on Early Childhood Atopy in Black Americans. J Pediatr Psychol 2021; 46:891-901. [PMID: 34100948 PMCID: PMC8357225 DOI: 10.1093/jpepsy/jsab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Black children are disproportionately affected by atopic diseases (i.e., atopic dermatitis, allergic rhinitis, asthma, and food allergies), with health disparities present in early life. Studies in White samples suggest that maternal stress confers risk for offspring atopy, yet little is known about these relationships in Black populations. This study seeks to (a) examine the relationship between self-reported and physiological indicators of maternal stress and offspring atopy and (b) explore warm and responsive caregiving as a potential protective factor in Black Americans. METHODS A sample of 179 Black mother-child dyads of varying socioeconomic status participated in a prospective longitudinal study. Mothers completed self-reports of childhood trauma, prenatal stress, postnatal stress, and physician diagnosis of offspring atopy; provided blood samples to assess physiological responses to chronic stress exposure; and participated in a behavioral task with their infant. RESULTS Maternal self-reports of childhood trauma, prenatal stress, and postnatal stress were not associated with offspring diagnosis of atopy by 2-3 years of age. Mothers who produced a smaller inflammatory response during pregnancy were more likely to have an offspring with atopy by 2-3 years of age. Warm and responsive parenting demonstrated a protective effect; the positive association between maternal stress and offspring atopy was less apparent in cases of mother-child interactions characterized by high levels warm and responsive parenting. CONCLUSION Failure to replicate previous findings suggests that the maternal stress-offspring atopy relationship is complex. Future studies must examine the unique stressors in Black Americans, as well as caregiving as a potential protective factor.
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Affiliation(s)
| | - Madeline R Pike
- Department of Psychiatry and Behavioral Sciences, Emory University, USA
| | | | - Anne L Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | | | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
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40
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The gut microbiome-immune axis as a target for nutrition-mediated modulation of food allergy. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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41
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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: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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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42
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Early Introduction of Food Allergens and Risk of Developing Food Allergy. Nutrients 2021; 13:nu13072318. [PMID: 34371828 PMCID: PMC8308770 DOI: 10.3390/nu13072318] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/27/2022] Open
Abstract
There is increasing evidence that early introduction of allergenic foods may decrease the risk of developing IgE-mediated food allergy. Patterns of food introduction before the 2015 publication of the Learning Early about Peanut Allergy (LEAP) trial are not well-studied, but are important as a baseline for evaluating subsequent changes in infant feeding practices and potentially food allergy. We performed a retrospective longitudinal study using data from a multicenter cohort of infants hospitalized with bronchiolitis between 2011–2014. The primary outcomes were IgE-mediated egg or peanut allergy by age 3 years. Of 770 participants included in the analysis, 635 (82%) introduced egg, and 221 (27%) introduced peanut by age 12 months per parent report. Four participants had likely egg allergy, and eight participants had likely peanut allergy by age 3 years. Regular infant egg consumption was associated with less egg allergy. The association was suggestive for infant peanut consumption with zero peanut allergy cases. Overall, our results suggest that early introduction of peanut was uncommon before 2015. Although limited by the small number of allergy cases, our results suggest that early introduction of egg and peanut are associated with a decreased risk of developing food allergy, and support recent changes in practice guidelines.
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Krempski JW, Warren C, Han X, Zhang W, He Z, Lejeune S, Nadeau K. Food Allergies: An Example of Translational Research. Immunol Allergy Clin North Am 2021; 41:143-163. [PMID: 33863476 DOI: 10.1016/j.iac.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Food allergies have been rising in prevalence since the 1990s, imposing substantial physical, psychosocial, and economic burdens on affected patients and their families. Until recently, the only therapy for food allergy was strict avoidance of the allergenic food. Recent advances in translational studies, however, have led to insights into allergic sensitization and tolerance. This article provides an overview of cutting-edge research into food allergy and immune tolerance mechanisms utilizing mouse models, human studies, and systems biology approaches. This research is being translated and implemented in the clinical setting to improve diagnosis and reduce food allergy's public health burden.
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Affiliation(s)
- James Walter Krempski
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA.
| | - Christopher Warren
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Xiaorui Han
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Wenming Zhang
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Ziyuan He
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Stéphanie Lejeune
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
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Noah TK, Lee JB, Brown CA, Yamani A, Tomar S, Ganesan V, Newberry RD, Huffnagle GB, Divanovic S, Hogan SP. Thermoneutrality Alters Gastrointestinal Antigen Passage Patterning and Predisposes to Oral Antigen Sensitization in Mice. Front Immunol 2021; 12:636198. [PMID: 33841417 PMCID: PMC8034294 DOI: 10.3389/fimmu.2021.636198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/05/2021] [Indexed: 01/02/2023] Open
Abstract
Food allergy is an emerging epidemic, and the underlying mechanisms are not well defined partly due to the lack of robust adjuvant free experimental models of dietary antigen sensitization. As housing mice at thermoneutrality (Tn) - the temperature of metabolic homeostasis (26-30°C) - has been shown to improve modeling various human diseases involved in inflammation, we tested the impact of Tn housing on an experimental model of food sensitization. Here we demonstrate that WT BALB/c mice housed under standard temperature (18-20°C, Ts) conditions translocated the luminal antigens in the small intestine (SI) across the epithelium via goblet cell antigen passages (GAPs). In contrast, food allergy sensitive Il4raF709 mice housed under standard temperature conditions translocated the luminal antigens in the SI across the epithelium via secretory antigen passages (SAPs). Activation of SI antigen passages and oral challenge of Il4raF709 mice with egg allergens at standard temperature predisposed Il4raF709 mice to develop an anaphylactic reaction. Housing Il4raF709 mice at Tn altered systemic type 2 cytokine, IL-4, and the landscape of SI antigen passage patterning (villus and crypt involvement). Activation of SI antigen passages and oral challenge of Il4raF709 mice with egg antigen under Tn conditions led to the robust induction of egg-specific IgE and development of food-induced mast cell activation and hypovolemic shock. Similarly, Tn housing of WT BALB/c mice altered the cellular patterning of SI antigen passage (GAPs to SAPs). Activation of SI antigen passages and the oral challenge of WT BALB/c mice with egg antigen led to systemic reactivity to egg and mast cell activation. Together these data demonstrate that Tn housing alters antigen passage cellular patterning and landscape, and concurrent oral exposure of egg antigens and SAP activation is sufficient to induce oral antigen sensitization.
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MESH Headings
- Administration, Oral
- Allergens/administration & dosage
- Allergens/immunology
- Allergens/metabolism
- Anaphylaxis/immunology
- Anaphylaxis/metabolism
- Anaphylaxis/microbiology
- Animals
- Disease Models, Animal
- Egg Hypersensitivity/immunology
- Egg Hypersensitivity/metabolism
- Egg Hypersensitivity/microbiology
- Egg Proteins/administration & dosage
- Egg Proteins/immunology
- Egg Proteins/metabolism
- Gastrointestinal Microbiome
- Goblet Cells/immunology
- Goblet Cells/metabolism
- Goblet Cells/microbiology
- Housing, Animal
- Intestine, Small/immunology
- Intestine, Small/metabolism
- Intestine, Small/microbiology
- Mast Cells/immunology
- Mast Cells/metabolism
- Mice, Inbred BALB C
- Mice, Knockout
- Permeability
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Temperature
- Mice
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Affiliation(s)
- Taeko K. Noah
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
| | - Jee-Boong Lee
- Division of Allergy and Immunology, Cincinnati Children’s Medical Center, Cincinnati, OH, United States
| | - Christopher A. Brown
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amnah Yamani
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
| | - Sunil Tomar
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
| | - Varsha Ganesan
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
| | - Rodney D. Newberry
- Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, United States
| | - Gary B. Huffnagle
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, United States
| | - Senad Divanovic
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Immunobiology, Cincinnati Children’s Medical Center, Cincinnati, OH, United States
- Center for Inflammation and Tolerance, Cincinnati Children’s Medical Center, Cincinnati, OH, United States
| | - Simon P. Hogan
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
- Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, United States
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Abstract
Immunoglobulin E-mediated food allergy is an increasingly prevalent public health concern globally. In North America, particularly in the United States, racial and ethnic differences in food allergy prevalence and rates of sensitization have become apparent. Black and Hispanic children in the United States have been estimated to have the highest rates of food allergy. Beyond rates of prevalence, food allergy outcomes, such as health care utilization, psychosocial outcomes, and economic burden, also vary considerably by race and ethnicity. It is important to consider socioeconomic status in conjunction with race and ethnicity in studying differences in food allergy outcomes.
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Davis CM, Apter AJ, Casillas A, Foggs MB, Louisias M, Morris EC, Nanda A, Nelson MR, Ogbogu PU, Walker-McGill CL, Wang J, Perry TT. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved. J Allergy Clin Immunol 2021; 147:1579-1593. [PMID: 33713767 DOI: 10.1016/j.jaci.2021.02.034] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/18/2022]
Abstract
Health disparities are health differences linked with economic, social, and environmental disadvantage. They adversely affect groups that have systematically experienced greater social or economic obstacles to health. Renewed efforts are needed to reduced health disparities in the United States, highlighted by the disparate impact on racial minorities during the coronavirus pandemic. Institutional or systemic patterns of racism are promoted and legitimated through accepted societal standards, and organizational processes within the field of medicine, and contribute to health disparities. Herein, we review current evidence regarding health disparities in allergic rhinitis, asthma, atopic dermatitis, food allergy, drug allergy, and primary immune deficiency disease in racial and ethnic underserved populations. Best practices to address these disparities involve addressing social determinants of health and adopting policies to improve access to specialty care and treatment for the underserved through telemedicine and community partnerships, cross-cultural provider training to reduce implicit bias, inclusion of underserved patients in research, implementation of culturally competent patient education, and recruitment and training of health care providers from underserved communities. Addressing health disparities requires a multilevel approach involving patients, health providers, local agencies, professional societies, and national governmental agencies.
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Affiliation(s)
- Carla M Davis
- Baylor College of Medicine, Houston, Tex; Texas Children's Hospital Food Allergy Program, Texas Children's Hospital, Houston, Tex.
| | - Andrea J Apter
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Adrian Casillas
- Texas Tech Health Sciences Center, Sierra Providence Medical Partners, El Paso, Tex
| | - Michael B Foggs
- Advocate Medical Group, Advocate Aurora Health Clinic, Chicago, Ill
| | - Margee Louisias
- Boston Children's Hospital, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
| | | | - Anil Nanda
- Asthma and Allergy Center, Lewisville, Tex; Asthma and Allergy Center, Flower Mound, Tex; University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michael R Nelson
- Allergy-Immunology Service, Walter Reed National Military Medical Center, Bethesda, Md
| | - Princess U Ogbogu
- Case Western Reserve University-Rainbow Babies and Children/UH Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl Lynn Walker-McGill
- Carolina Complete Health, Charlotte, NC; Wingate University Graduate School of Business, Charlotte, NC
| | - Julie Wang
- Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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Szmyd B, Biedrzycka M, Karuga FF, Rogut M, Strzelecka I, Respondek-Liberska M. Interventricular Septal Thickness as a Diagnostic Marker of Fetal Macrosomia. J Clin Med 2021; 10:jcm10050949. [PMID: 33804406 PMCID: PMC7957748 DOI: 10.3390/jcm10050949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Serious complications in both mother and newborn arising as a result of fetal macrosomia indicate the need for early diagnosis and prevention. Unfortunately, current predictors, such as fetal biometry, fundal height, and amniotic fluid index, appear to be insufficient. Therefore, we decided to assess the predictive potential of interventricular septal thickness (IVST), as measured at ≥33 weeks of gestation. Two hundred and ninety-nine patients met the inclusion criteria: complete medical history including all necessary measurements—namely, IVST obtained by M-mode echocardiography, fetal biometry, and birth weight. The Statistica 13.1 PL software was used to generate the receiver operating curve. The optimal cut-off point (IVST of 4.7 mm) was selected using the Youden index method. The analysis of fetal biometry abnormalities resulted in 46.6% of macrosomia cases being correctly predicted; however, IVST analysis detected 71.4% of cases. IVST at ≥4.7 mm appears to have a higher sensitivity and negative predictive value (NPV) than routine ultrasound.
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Affiliation(s)
- Bartosz Szmyd
- Department of Pediatrics, Oncology, and Hematology, Medical University of Lodz, 91-738 Łódź, Poland;
| | - Małgorzata Biedrzycka
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Filip Franciszek Karuga
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Magdalena Rogut
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Iwona Strzelecka
- Department of Diagnosis and Prevention Fetal Malformations, Medical University of Lodz, 93-338 Łódź, Poland;
- Correspondence:
| | - Maria Respondek-Liberska
- Department of Diagnosis and Prevention Fetal Malformations, Medical University of Lodz, 93-338 Łódź, Poland;
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital, 93-338 Łódź, Poland
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48
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Keet C, Pistiner M, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, Peng R, Dantzer J, Togias A. Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy. J Allergy Clin Immunol 2021; 147:984-991.e5. [PMID: 33483153 PMCID: PMC8462937 DOI: 10.1016/j.jaci.2020.11.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether to screen high-risk groups before early peanut introduction is controversial. OBJECTIVE We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH). METHODS Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding. RESULTS A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA. CONCLUSIONS PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.
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Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Mihaela Plesa
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Daria Szelag
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Robert Wood
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Joan Dunlop
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jennifer Dantzer
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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49
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Prevalence and Correlates of Food Allergy Among Medicaid-Enrolled United States Children. Acad Pediatr 2021; 21:84-92. [PMID: 32200110 DOI: 10.1016/j.acap.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study is to provide a comprehensive epidemiological profile detailing food allergy (FA) prevalence and related correlates among Medicaid-enrolled children. METHODS The 2012 Medicaid Analytic eXtract person-level 100% files for 50 states and the District of Columbia were analyzed. The analytic sample of 23,825,160 included all children ages 0 to 19 years as of January 1, 2012 who were continuously enrolled in Medicaid in 2012. The prevalence of FA was measured using International Classification of Diseases, Ninth Revision, Clinical Modification codes and compared with other atopic conditions (atopic dermatitis, allergic rhinitis, and asthma). Logistic regression was used to evaluate child characteristics associated with FA. RESULTS The prevalence of FA among Medicaid-enrolled children was less than 1% (0.6%). State-level prevalence ranged from a high of 1.4% in Alaska to a low of 0.2% in Nevada. Race and ethnicity were associated with FA such that Asian, Black, and Pacific Islander/Native Hawaiian children had a higher odds of FA, while Hispanic and Native American children had 15% and 24% lower odds of FA, respectively, compared with White children. CONCLUSIONS Compared with estimates of parent-reported, physician-diagnosed FA in the general population, the claims-based prevalence of FA among Medicaid-enrolled children is substantially lower. Racial and ethnic differences are consistent with the general population. The findings signal a need to better understand reasons for these differences including awareness, access to care, and service utilization patterns in this population.
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50
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Warren CM, Turner PJ, Chinthrajah RS, Gupta RS. Advancing Food Allergy Through Epidemiology: Understanding and Addressing Disparities in Food Allergy Management and Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:110-118. [PMID: 33065370 PMCID: PMC7938932 DOI: 10.1016/j.jaip.2020.09.064] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 01/15/2023]
Abstract
Epidemiological studies have been pivotal in advancing understanding of the etiology of food allergy and in guiding the development of evidence-based guidelines for food allergy prevention and clinical management. In recent years, as research into the population-level distribution and determinants of food allergy has accumulated, data indicate that substantial differences in food allergy outcomes and management exist across racial/ethnic and other socioeconomic strata. This clinical commentary aims to provide a review of existing epidemiological studies and shed valuable light on the disparate burden of food allergy. Emerging methods to quantify environmental exposure and food allergy outcomes are detailed, as are specific areas in which future research is warranted. We also highlight the role that epidemiology plays in advancing health equity and provide a framework as to how it can effectively inform health policy at all phases of the policy cycle-from initial population health assessment to the evaluation and refinement of specific health policies (ie, national guidelines to promote earlier introduction of peanut-containing foods for allergy prevention).
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Affiliation(s)
- Christopher M Warren
- Center for Food Allergy and Asthma Research at the Northwestern University Feinberg School of Medicine, Chicago, Ill; Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Mountain View, Calif.
| | - Paul J Turner
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, United Kingdom; Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Mountain View, Calif
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research at the Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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