Allergy Training Research Articles

Shaping Allergy Training in the UK Foundation Programme: A National Survey.

Shaping Allergy Training in the UK Foundation Programme: A National Survey.

Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report.

Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5-point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut-off for inclusion and statistical analysis. In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first-line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e-learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p = .000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met.

Looking at the impact of COVID-19 on pediatric allergic diseases: Effects on pediatric allergy care and training

Looking at the impact of COVID-19 on pediatric allergic diseases: Effects on pediatric allergy care and training

The influence of empathy on food allergy training effectiveness: An experimental study with foodservice employees in the U.S.

This study aimed to examine the effects of empathy intervention on food allergy training through a between-subjects factorial experiment. A total of 388 foodservice employees participated, with half randomly assigned to the control group and half to the intervention group. Participants in the intervention group were shown a video describing a food allergy death to elicit empathic responses. Results showed that the intervention video elicited higher empathic responses toward food allergy victims among foodservice employees than those in the control group. Empathic responses positively related to post-training food allergy knowledge acquisition and practices. Emotional attachment and attitude towards food allergy training mediated the relationships between empathic responses and post-training knowledge acquisition and post-training practices. Meanwhile, prosocial motivations moderated the indirect effects of empathy intervention on post-training food allergy knowledge acquisition and food allegory practices through empathic response and emotional attachment/attitude towards the training. Theoretical and practical implications are discussed.

Preparing the Allergist/Immunologist for the Next Pandemic

The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.

Sex differences in Allergy and Immunology training programs

Currently, women represent 54% of enrolled U.S. medical students and 47% of all residents and fellows in ACGME-accredited programs, having achieved equal representation at a trainee level in the last decades.1,2 However, this still has not translated into equality in leadership positions across all medical fields.3 In particular with Allergy and Immunology (A/I), it has been demonstrated that female academic allergists are less likely to become full professors than their male counterparts,4 and women are less frequently first authors, although this is increasing.5 Although A/I has made efforts to address these disparities, such as through the creation of specialized committees and professional development initiatives6, it is clear that these efforts take time to have meaningful effects and promote more complete representation, particularly in leadership. A variety of factors likely contribute to this, including increased childcare and household responsibilities for female physicians compared to male physicians, lack of mentorship, and cultural expectations.4,7 This paper seeks to evaluate the current breakdown of A/I trainees, faculty and leadership position by sex and to identify what discrepancies still exist in training, faculty, or in leadership positions, if at all.

A tribute to allergy and immunology fellowship training program directors and to the fellows they train.

A tribute to allergy and immunology fellowship training program directors and to the fellows they train.

Updating the definition of V(D)J recombination signal sequences with high-throughput recombination assays

Abstract V(D)J recombination initiates the production of a diverse antigen receptor repertoire in developing B and T cells. Antigen receptor diversity is required for adaptive immunity in all jawed vertebrates. Recombination activating proteins, RAG1 and RAG2 (RAG1/2), catalyze V(D)J recombination by cleaving adjacent to recombination signal sequences (RSSs) that flank antigen receptor gene segments. Previous studies defined the consensus RSS as containing conserved heptamer and nonamer sequences separated by a less conserved 12 or 23 base-pair spacer sequence. However, many RSSs deviate from the consensus sequence, and the molecular mechanism for semi-selective V(D)J recombination specificity is unknown. Here, we developed a cell-based, high-throughput V(D)J recombination assay to evaluate RAG1/2 activity on thousands of RSSs in parallel. Specifically, we focused our study on the RSS heptamer and adjoining spacer region because it undergoes extensive conformational changes during RAG-mediated DNA cleavage. While the consensus heptamer sequence (CACAGTG) was marginally preferred, RAG1/2 was highly active on a wide range of non-consensus sequences. RAG1/2 generally selected purine/pyrimidine motifs instead of specific bases. Molecular dynamics simulations of RSSs showed that DNA sequences preferred by RAG1/2 had dynamic structural features that may accommodate heptamer unwinding in the RAG1/2 active site. Our results suggest RAG1/2 specificity for RSS heptamers is primarily dictated by dynamic DNA properties dependent on purine/pyrimidine pattern. Further investigation of RAG1/2 specificity will help elucidate the genetic instructions guiding V(D)J recombination to antigen receptor gene segments. National Institutes of Health (AI128137, AI15635); Oklahoma Center for Advancement in Science and Technology (OCAST) [HR21-142]; Presbyterian Health Foundation of Oklahoma City; National Institute of Allergy and Infectious Diseases Immunology training grant [T32 AI7633-16]

Allergic rhinitis in India.

India is the home of nearly 20% of the global population with 1.35 billion people. Of all non-communicable diseases, allergic diseases such as allergic rhinitis (AR) and asthma appear to have increased in India over the past decades. Approximately 22% of adolescents currently suffer from AR in India. However, owing to the lack of adequate epidemiological studies in India, particularly in rural and suburban areas, this number may misrepresent the true burden of this disease. While the risk factors for AR are mainly environmental exposures or genetic factors, several new environmental, social, and behavioural risk factors such as the presence of dumpsters near residences, movement of vehicles near homes, and exposure to artificial light at night have been found to be associated with AR. However, despite international guidelines, the diagnosis and management of AR in India are often suboptimal, for multiple reasons such as the lack of specialized training in allergy and immunology among Indian clinicians, the lack of diagnostic facilities, and the high cost of medications. This review aims at highlighting the current scenario of AR in India and how it differs from the rest of the world. It also highlights the need for developing a strategic approach to enhance the quality of care for allergic diseases by upgrading education and training for healthcare professionals, creating awareness among clinicians and patients, and involving stakeholders and policymakers in making treatments accessible and affordable to patients.

Food Allergy Knowledge and Attitudes of Owners and Managers of Independently Owned Restaurants in Metro Orlando, Florida

Owners and managers (n = 102) of independently owned restaurants in Metro Orlando, FL, completed a web-based questionnaire that assessed food allergy knowledge and attitudes. Participants were confident in their knowledge of food allergens (4.28 ± 0.63). The attitude item with the lowest mean score was “not all restaurants needed to comply with food allergy policies” (2.70 ± 1.26), suggesting participants believed compliance with food allergy policies was critical in all restaurants. Eighty (78.4%) participants correctly answered all 10 knowledge questions. The mean knowledge score was 7.7 of 10 possible points. Florida requires foodservice workers to be knowledgeable about food allergies but does not mandate food allergy training or certification. It is in the best interest of foodservice establishments to train workers on food allergies to safeguard customer health.

Real-world experience of pediatric patients treated with peanut (Arachis hypogaea) allergen powder-dnfp

BackgroundPeanut (Arachis hypogaea) allergen powder-dnfp (PTAH) is the first oral immunotherapy indicated for children aged 4 to 17 years with peanut allergy. There are limited real-world data on patients treated with PTAH. ObjectiveTo characterize pediatric patients treated with PTAH and associated treatment patterns in US clinical practice. MethodsUS-based physicians with allergy and immunology training treating patients with peanut allergy aged 4 to 17 years with PTAH were recruited from an existing physician panel and completed an online case report form (October to December 2021) with data abstracted from patient medical charts. Physician practice circumstances, patient characteristics, and PTAH treatment patterns were reported. Time to reach the 300-mg dose and treatment persistence were assessed using Kaplan-Meier analysis. ResultsA geographically balanced sample of 43 physicians contributed data for 118 demographically diverse pediatric patients. Patients had heterogeneous diagnostic test results, with a wide range of peanut-specific immunoglobulin E levels; 6.8% received an oral food challenge. During the updosing phase, there were no temporary interruptions and 5.1% of the patients required downdosing. Patients reached the 300-mg dose at a median of 21.3 weeks post-initiation. The rate of PTAH persistence at 24 weeks was 93.4%. Only 1 patient discontinued treatment because of treatment-related systemic allergic symptoms, and the remaining discontinuations were for reasons other than treatment-related symptoms. Prophylactic antihistamines were used by 33.9% of the patients to prevent PTAH adverse effects. ConclusionPTAH was prescribed in demographically diverse patients with a wide range of peanut-specific immunoglobulin E levels. Treatment persistence with PTAH was high in this study population, with a small number of patients experiencing treatment modification.

A systematic review of the knowledge and training of food service workers on food allergies

<abstract><sec> <title>Background</title> <p>Food allergies are adverse reactions to a specific food antigen which is mediated by immunological mechanisms and are fast rising to become a significant public health concern. Around 1% of the world's adult population suffers from food allergies. The prevalence of food allergies which can be life-threatening is commonly estimated to affect 3–5% of the adult population in North America.</p> </sec><sec> <title>Objectives</title> <p>The purpose of this study is to review published food allergy knowledge and training amongst food service workers and identify the policies in place concerning food allergies globally.</p> </sec><sec> <title>Methodology</title> <p>Documented food service workers' knowledge and training about food allergies published between September 2006 and February 2021 were comprehensively reviewed. A widespread literature search was carried out using subject headings, search terms, and keywords. Results were examined in groups to explore patterns through research.</p> </sec><sec> <title>Results</title> <p>A total of 18 relevant studies that analyzed the food allergies knowledge and training of food service workers were reviewed. Eight studies (44%) were performed in the USA, followed by two studies (11%) in the UK, and one study each (5%) for New Zealand, Turkey, Malaysia, France, Western Romania, Germany, Brazil, and Canada. In the studies, respondents were asked a series of questions to assess their level of knowledge and the types of training relating to food allergies they received.</p> </sec><sec> <title>Conclusions</title> <p>This study identified the gaps in policy, as well as knowledge and training among food service workers, to manage food allergies safely, thus emphasizing the importance and need for food allergy training.</p> </sec></abstract>

Knowledge gaps in food allergy among the general public in Jeddah, Saudi Arabia: Insights based on the Chicago food allergy research survey.

Food allergy is an increasing health concern. Studies have shown that food allergy knowledge is lacking among people, especially in areas related to distinction between food allergy and intolerance, symptoms recognition, and current means of management. This knowledge gap puts allergic patients at more risk of getting fatal anaphylactic reactions, which occur mostly in public areas. Locally, Public's knowledge and attitudes of food allergy was not sufficiently investigated. Therefore, we aim to assess food allergy knowledge and attitudes among Jeddah population in Saudi Arabia. We adopted The Chicago Food Allergy Research Survey for the General Public (CFARS-GP) and used it as a data collection tool. We hosted the questionnaire on Google Forms and distributed the link through social media outlets targeting individuals of Jeddah population who are 18 years old and above. A total of 510 individuals completed the survey. The respondents answered 56% of the knowledge-based items correctly. Knowledge was strongest in symptoms/severity and definition/diagnosis, while it was weakest in susceptibility and prevalence, distinction between food allergy and intolerance, and food allergy management. Higher knowledge was significantly associated with prior training in food allergy, food-allergic acquaintance (i.e., having food allergy or knowing an allergic patient), and being a relative of a health care worker. For the attitudes, respondents thought that food allergy negatively affects patients' quality of life, and that schools should establish policies to protect allergic children; however, they downplayed stigma associated with food allergy. Increased food allergy knowledge among the general public is needed especially in areas related to susceptibility and prevalence, distinction between food allergy and intolerance, triggers and environmental risks, and the management of food allergy. Prior experience with food allergy through (1) training, (2) food-allergic acquaintance, or (3) being a relative of a health care worker increases food allergy knowledge significantly. Thus, targeted educational interventions might have a significant effect in improving food allergy knowledge among the general population.

THE LEARN EARLY PROJECT: LEARNING EDUCATORS ANAPHYLAXIS RESPONSE NEEDS

<h3>Introduction</h3> With the Incidence of food allergies on the rise, and more studies demonstrating the disproportionate impact on Black and Hispanic children, it is crucial that allergists investigate and begin to address these disparities. A significant gap in this area is the role that daycares and preschools may play in helping to prevent anaphylaxis and death. <h3>Method</h3> The LEARN Early Project partnered with 17 Head-Start centers to investigate barriers they face in managing food allergies. Individual needs assessments were performed as well as food allergy knowledge tests. The results of these were then discussed in focus groups to identify potential areas for improvement as well as solutions. <h3>Results</h3> Significant variability exists in the structure of each Head Start center which presents implementation dilemmas. Additionally, there is no standardization of epinephrine training or food allergy training. In general, educators tended to over-estimate their food allergy knowledge as well as their capability of managing food allergy emergencies in comparison to that of center directors. Finally, despite some legislation appearing to support policies surrounding food allergy, such as stock epinephrine, early childcare centers are sometimes considered exceptions to these policies. <h3>Conclusion</h3> Identifying barriers that early learning centers face in providing for children with food allergies is critical in ensuring equitable, and safe care. These barriers are likely distinct for each center, but general themes were identified. It is likely that these needs will continue to evolve, and it is important to continue to reassess these needs to ensure we are implementing appropriate solutions.

Editorial introductions.

Editorial introductions.

État des connaissances et besoins en formation en biologie de l’allergie : enquête du Groupe de Travail Biologie de l’Allergie de la Société française d’allergologie à l’intention des jeunes allergologues

Blood tests are an essential tool for the diagnosis and management of allergy. Learning how to interpret test results is therefore essential for the physician. Due to the diversity of their education, young allergists do not all have the same training. At the request of the French Society of Allergology (SFA) Scientific Committee, the In vitro Diagnosis Working Group carried out a survey for young allergists in order to evaluate their level of initial training in allergy in vitro diagnosis and to know their expectations in terms of continuing medical education. A total of 162 allergists were consulted and 36 responded. Half of them considered that they had sufficient training in allergy in vitro diagnosis and 50% considered themselves competent in the interpretation of tests. For their continuing medical education, they use the websites of learned societies (SFA, EEACI), scientific journals and webinars and consider them satisfactory or very satisfactory. More than 95% of them are in favour of the online availability of summary sheets or reference documents in in vitro diagnosis, and all of them would consult these tools if they were accessible on the SFA website. In conclusion, the training of young allergists in allergy blood tests needs to be completed and standardised, both theoretically and practically. Several educational tools are available and popular to achieve this and help them to keep valuable skills up to date.

Prize‐winning abstracts from BSACI/WAO 2022 meeting

Prize‐winning abstracts from <scp>BSACI</scp>/<scp>WAO</scp> 2022 meeting

Toolkit for Developing Structural Competency in Health Disparities in Allergy and Immunology Training and Research

Resources to prepare Allergy and Immunology trainees and providers to recognize and address health disparities are lacking. We designed a curriculum using interactive sessions incorporating disease-specific, evidence-based content, and a panel-based workshop with facilitated discussion to prepare Allergy and Immunology trainees to identify structural racism and health disparities. Pre-session surveys revealed that a high portion of trainees reported feeling comfortable recognizing bias and discussing health equity (n= 16, mean= 3.6/5 on a Likert scale), but felt less confident in their ability to address disparities in practice or to identify resources to care for historically disadvantaged communities (n= 16, mean= 2.9/5 on a Likert scale). The curriculum improved respondents' confidence in their ability to address these issues, with a panel-based workshop increasing attendees' scores an average of 0.65 points (n= 17, mean: pre-survey 3.31 vs post-survey 3.95). After the sessions, a toolkit was created to optimize delivery of medical education to address health disparities and define core concepts for this subject. Resources to implement these concepts in research design and recruitment efforts were included. With inadequate guidance for the incorporation of disparities-focused medical education curricula, our educational series, resources, and interactive toolkit add to existing literature to improve disparities competencies in teaching, clinical practices, and research design.

Food Allergy Education and Management in Schools: A Scoping Review on Current Practices and Gaps.

Currently, no synthesis of in-school policies, practices and teachers and school staff’s food allergy-related knowledge exists. We aimed to conduct a scoping review on in-school food allergy management, and perceived gaps or barriers in these systems. We conducted a PRISMA-ScR-guided search for eligible English or French language articles from North America, Europe, or Australia published in OVID-MedLine, Scopus, and PsycINFO databases. Two reviewers screened 2010 articles’ titles/abstracts, with 77 full-text screened. Reviewers differed by language. Results were reported descriptively and thematically. We included 12 studies. Among teachers and school staff, food allergy experiences, training, and knowledge varied widely. Food allergy experience was reported in 10/12 studies (83.4%); 20.0–88.0% had received previous training (4/10 studies; 40.0%) and 43.0–72.2% never had training (2/10 studies; 20.0%). In-school policies including epinephrine auto-injector (EAI) and emergency anaphylaxis plans (EAP) were described in 5/12 studies (41.7%). Educational interventions (8/12 studies; 66.7%) increased participants’ knowledge, attitudes, beliefs, and confidence to manage food allergy and anaphylaxis vs. baseline. Teachers and school staff have more food allergy-related experiences than training and knowledge to manage emergencies. Mandatory, standardized training including EAI use and evaluation, and the provision of available EAI and EAPs may increase school staff emergency preparedness.

Lessons learned in allergy and immunology training: a survey analysis

BackgroundThere is currently little Canadian data to assess how well traditional time-based residency training programs have prepared residents for careers in Clinical Immunology and Allergy (CIA). This study aims to identify the perceived preparedness of residents in various areas of practice upon the completion of a Canadian CIA residency training program.MethodsIn the summer of 2020, an electronic survey was sent to 2018 and 2019 graduates of Canadian CIA training programs by the Canadian Society of Allergy and Clinical Immunology (CSACI).ResultsFormer residents felt well prepared in most Medical Expert areas. Residents felt less prepared for the intrinsic roles of Leader, Communicator, Collaborator, Health Advocate, Scholar, and Professional. The majority of the intrinsic competencies were learned through mentorship and on the job after finishing training.ConclusionsUpon completion of training, Canadian CIA residents felt well prepared for many competencies, particularly in Medical Expert areas. Training programs may wish to focus on various intrinsic competencies in order to better prepare residents for transition to practice. Academic half-day was not identified as a primary learning centre for intrinsic competencies, suggesting that new teaching strategies may be required.