Management Of Food Allergy Research Articles

Acceptance of Food Allergic Children in Japanese Childcare Facilities

Background: Food allergy management systems are important for childcare facilities to accept children with food allergies prescribed epinephrine (epinephrine-treated children). The relationship between the food allergy management system of a childcare facility and the willingness of children attending the facility to accept epinephrine is unclear. We believe that childcare facilities that cooperate with local health and medical institutions are more willing to accept children receiving epinephrine. Objective: This study aimed to clarify the actual situation of epinephrine acceptance in children attending childcare facilities across Japan and the factors associated with their willingness to accept them. Methods: Between May and June 2021, 686 childcare facilities across Japan were selected and surveyed. To analyze the factors related to the willingness to accept epinephrine children attending childcare facilities, the facilities were classified into 2 groups, “willingness to accept” and “no willingness to accept,” and their attributes and characteristics, food allergy management system, cooperation with relevant organizations and ability to cooperate were compared by univariate analysis. Results: A questionnaire-based survey of 162 centers revealed that 18.2% of the centers had accepted children receiving epinephrine and 74.7% were willing to accept them. There was a significant association between the willingness to accept epinephrine in children and satisfaction with the food allergy management system, availability of childcare consulting agencies, and ability to work with healthcare organizations, which differed. Conclusion: The results highlight the importance of strengthening the management system of facilities and cooperating with relevant institutions for epinephrine children to live safely in the community.

Dining out with food allergies: Two decades of evidence calling for enhanced consumer protection

Food allergic reactions in restaurant settings are regularly reported, including fatalities. The risk of dining out with food allergies is well documented, and is in part attributed to insufficient regulatory oversight. The objectives of this review were to (i) present scientific evidence characterizing the risk of dining out with food allergies, (ii) describe advances in proposed management mechanisms to mitigate this risk, and (iii) outline gaps in existing practices and regulations related to food allergen management in foodservice operations. Scientific publications (n=60) and laws/regulations from different jurisdictions (n=20) related to food allergy and food allergens management in foodservice operations were systematically retrieved and reviewed. Although the inherent nature of these operations poses challenges to the implementation of allergen control measures, evidence suggests that food-allergic consumers will continue to be at risk unless more stringent regulatory requirements, particularly related to communication with diners and between staff members, are adopted.

The impact of peer influence and social pressure on the management of food allergy in adolescents and young adults

The impact of peer influence and social pressure on the management of food allergy in adolescents and young adults

Oral immunotherapy with enteric-coated capsules for allergic rhinitis caused by house dust mites.

Oral immunotherapy (OIT) is a promising allergen-specific approach in the management of food allergy; however, studies on OIT for allergic rhinitis (AR) have rarely been reported. The purpose of this study is to evaluate the efficacy and safety of OIT using enteric-coated capsules for AR induced by house dust mites. A total of 49 patients with AR were enrolled, including 25 who received subcutaneous immunotherapy (SCIT) and 24 who received OIT. The clinical efficacy and safety in both groups were evaluated. After 1 year of treatment, both SCIT and OIT demonstrated significant therapeutic effects. OIT was found to be more effective than SCIT in reducing the total AR symptom score and improving the results of nasal provocation tests. Local and systemic adverse reactions were observed in the SCIT group, while none were reported in the OIT group. OIT is an effective and safe treatment for mite-induced AR.

Perspectives in the validation of DEFASE: a paradigm shift in food allergy management.

To explore the groundbreaking international consensus on the DEFASE (DEfinition of Food Allergy Severity) project as a revolutionary grading system for IgE-mediated food allergy severity. Against the backdrop of the growing public health challenge posed by food allergy, this article delves into the importance of validating and implementing DEFASE in real-world clinical settings. With new therapeutic options available for food allergy, including biologics alongside immunotherapy, it is urgent to properly support clinical decision-making in the management of the disease. The DEFASE score is the first international consensus-based grading system of severity associated with food allergy as a whole disease embracing multidisciplinary perspectives from different stakeholders involved. In its current version, this comprehensive scoring system has been developed to be used in research settings. The review emphasizes the potential impact of DEFASE on patient outcomes, healthcare management, and resource allocation, underscoring its significance for the allergy scientific community. Future research should focus on internal and external validation of the scoring system, targeting these models to various food allergenic sources, populations, and settings.

The Indirect Costs of Avoidance in Food Allergy Management: A Scoping Review

Background: Food allergy management requires avoidance of allergenic food. While the direct costs of food allergy management have been described, avoidance may also contribute to time and opportunity costs. We aimed to conduct a scoping review of the peer-reviewed literature on the indirect costs of food allergy, and to characterise these costs through a series of fictitious case studies. Methods: We performed a scoping review, guided by Arskey and O’Malley’s methodological framework, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Eligible studies included original, peer-reviewed, English language literature with no lower limits to publication dates, which addressed the indirect costs of food allergy, including time and opportunity costs. A search strategy was developed by content experts with experience performing multi-database scoping reviews. The search was performed on 10 July 2023, managed using Rayyan (Cambridge, USA), and screened for eligibility. Results: Searches yielded 104 articles. After deduplication, 96 articles were screened at the title and abstract level; 12 articles were included following full-text screening. Of these, three studies were performed on adults with food allergy, eight studies were based on data collected from caregivers of children with food allergy, and one study made use of data reflecting adults and caregivers of children with food allergy. Collectively, indirect costs were identified as higher amongst those with vs. without food allergy. The few studies on age and food allergy differences (e.g., type and number of food allergies, history of reaction) are equivocal. Conclusions: The limited body of peer-reviewed literature supports that food allergy commonly carries substantial indirect costs across diverse measurement tools, albeit with age-group differences.

New biologics for food allergy.

This review aims to explore role of emerging biologics, including ligelizumab, UB-221, dupilumab, and antialarmins, in food allergy management. With a focus on recent developments, we evaluate their promise in mitigating adverse events during oral immunotherapy (OIT), reducing allergic reactions, and addressing the limitations of current therapeutic options. Antiimmunoglobulin E mAbs, exemplified by omalizumab, demonstrate efficacy in desensitization and safety improvement during multiallergen OIT. Next-generation antibodies like ligelizumab and UB-221 exhibit enhanced potency and unique mechanisms, holding promise for food allergy treatment. Dupilumab, targeting IL-4 receptor alpha, presents potential benefits in decreasing allergen-specific IgE and modifying the atopic march. Exploration of antialarmins, specifically anti-IL-33 (etokimab) and anti-TSLP (tezepelumab), reveals encouraging results, with etokimab showing early success in peanut allergy trials. Biologics hold promising potential for food allergy treatment. Tailoring therapeutic approaches based on shared decision-making becomes pivotal. While omalizumab remains a significant option, next-generation anti-IgE antibodies and agents targeting alarmins exhibit unique strengths. Dupilumab, despite limited success as monotherapy, shows promise as an adjunct for OIT. Careful consideration of treatment goals, patient preferences, and the evolving landscape of biologics will shape future clinical practice, offering allergists an expanded toolbox for personalized food allergy management.

Management of food allergy based on oral food challenge.

Food allergy is a growing health problem that affects both patients and society in multiple ways. Despite the emergence of novel diagnostic tools, such as component-resolved diagnostics (CRD) and basophil activation tests (BAT), oral food challenge (OFC) still plays an indispensable role in the management of food allergies. This review aimed to highlight the indications and safety concerns of conducting an OFC and to provide insights into post-OFC management based on recent findings. Standardized OFC protocols have regional diversification, especially in Japan and Western countries. Recent studies suggested that the interval between doses should be at least more than an hour. Furthermore, applying a stepwise method tailored to the patient's specific immunoglobulin E level and history of anaphylaxis seems to mitigate these risks. Recent surveys have shown that, following a positive OFC, options other than strict avoidance are also selected. OFC serves diverse purposes, yet the risks it carries warrant caution. The stepwise protocol appears promising for its safety. Subthreshold consumption following OFC shows potential; however, further research on its efficacy and safety is required. Management following OFC should be tailored and well discussed between clinicians and patients.

Role of biologics in severe food allergy.

This review examine the dynamic landscape of food allergy treatment within the context of emerging biologics. Our purpose is to comprehensively evaluate the potential benefits, challenges, and transformative impact associated with the utilization of biologics in comparison to conventional therapeutic modalities. This document synthesizes recent scientific investigations to various biologics, such as omalizumab, ligelizumab, dupilumab, and tezepelumab, providing a nuanced understanding of their roles in oral immunotherapy, rapid desensitization, and overall food allergy management. Recent studies and clinical trials highlight the impact of anti-IgE treatment on food allergies, revealing critical findings such as dose-related efficacy, facilitation of rapid desensitization in peanut allergies, and the sustained positive outcomes observed in individuals with multifood allergies. The use of biologics presents a groundbreaking approach in the treatment of food allergies. The multifaceted action of these agents, along with their potential to overcome the challenges associated with traditional therapies, marks a significant advancement. Despite the persisting challenges of economic constraints and the need for further safety studies, biologics offer a promising avenue for improving the quality of life for individuals with food allergies. Ongoing research and collaborative efforts are imperative to fully realize the transformative potential inherent in these emerging therapeutic frontiers.

Precision allergy molecular diagnosis applications in food allergy.

Precision medicine has become important in the diagnosis and management of food allergies. This review summarizes the latest information regarding molecular allergology, an essential component of food allergy managements. Component-resolved diagnostics (CRD) can be used to investigate sensitization to allergens based on symptoms and to reveal co-sensitization and/or cross-sensitization in patients with allergies. The following allergen components are known to be associated with symptoms: ovomucoid from eggs, omega-5 gliadin from wheat, and many storage proteins (Gly m 8 from soy, Ara h 2 from peanut, Cor a 14 from hazelnut, Ana o 3 from cashew nut, Jug r 1 from walnut, and Ses i 1 from sesame). Recent studies on allergens of macadamia nuts (Mac i 1 and Mac i 2), almonds (Pru du 6), fish (parvalbumin and collagen), and shrimp (Pem m 1 and Pem m 14) have provided additional information regarding CRD. In addition, Pru p 7 is a risk factor for systemic reactions to peaches and has recently been found to cross-react with cypress and Japanese cedar pollen. CRD provides information of individualized sensitization profiles related to symptoms and severity of allergies in patients. Clinical practice based on CRD offers many benefits, such as higher diagnostic accuracy and improved management of individual patients.

Navigating Food Allergies: Advances in Diagnosis and Treatment Strategies.

Food allergy is a major health concern worldwide, encompassing both immunologic and non-immunologic reactions. This review thoroughly examines the pathophysiology, clinical manifestations, and treatment options for various types of food allergies. Immunologic food allergies, including IgE-mediated reactions such as oral allergy syndrome and systemic anaphylaxis, pose various diagnostic and management challenges. Non-IgE-mediated reactions such as food protein-induced enterocolitis syndrome, dermatitis herpetiformis, and proctocolitis necessitate individualized patient care.In addition, mixed reactions such as eosinophilic esophagitis and atopic dermatitis complicate the clinical picture. Skin prick tests, serum-specific IgE tests, and oral food challenges are all necessary for accurate food allergy diagnosis. The primary therapeutic options are allergen avoidance, epinephrine-based emergency management, and emerging treatments like immunotherapy. Our review emphasizes the importance of multidisciplinary collaboration and ongoing research in improving our understanding and managing food allergies, promising a brighter future for those affected.

Recognition of nuts and seeds in children with/without food allergies and their mothers: A reflection of culinary culture.

Nuts and seeds are among the leading causes of food allergy. Effective food allergy management hinges on the ability to identify and avoid relevant foods. To evaluate the nut/seed recognition ability in both children and mothers. Primary caregivers (mothers) and their children (6-18 years old) with/without food allergies were shown photographs of nuts/seeds, and their products with visible/hidden allergens to assess their ability to recognize accurately. A total of 196 children and 184 mothers participated. The median ages of the children and mothers were 7.6 (6.8-10) and 37.8 (33.1-41.5) years, respectively. Over 75% of the children/adolescents and over 90% of the mothers accurately identified the kernel forms of nuts/seeds, except pine nuts. Walnuts, hazelnuts, almonds, and cashews were the most accurately recognized kernel forms by both populations. Generally, the kernel forms were recognized 5-20% more accurately than their in-shell forms, followed by products with visible and hidden forms, respectively. Some Turkish culinary-specific products with visible/hidden allergens were recognized as frequently as the kernel/in-shell forms by both study groups. Although there was a similar recognition pattern between study groups and subgroups (nut/seed allergy, other food allergy, controls), higher rates of recognition were found in mothers than in their children and adolescents than in schoolchildren. In Eastern Mediterranean region, nuts and sesame seeds are highly recognized by both mothers and their children. Accurate identification of these foods is likely a culinary feature, but not the result of increased awareness. More information is needed on whether this ability reduces the risk of exposure.

Probiotics supplementation during pregnancy or infancy on multiple food allergies and gut microbiota: a systematic review and meta-analysis.

Probiotics show promise in preventing and managing food allergies, but the impact of supplementation during pregnancy or infancy on children's allergies and gut microbiota remains unclear. This study aimed to assess the effects of maternal or infant probiotic supplementation on food allergy risk and explore the role of gut microbiota. A systematic search of databases (PubMed, Cochrane Library, Embase, and Medline) identified 37 relevant studies until May 20, 2023. Two independent reviewers extracted data, including probiotics intervention details, gut microbiota analysis, and food allergy information. Probiotics supplementation during pregnancy and infancy reduced the risk of total food allergy (relative risk [RR], 0.79; 95% CI, 0.63-0.99), cow-milk allergy (RR, 0.51; 95% CI, 0.29-0.88), and egg allergy (RR, 0.57; 95% CI, 0.39-0.84). Infancy-only supplementation lowered cow-milk allergy risk (RR, 0.69; 95% CI, 0.49-0.96), while pregnancy-only had no discernible effect. Benefits were observed with over 2 probiotic species, and a daily increase of 1.8 × 109 colony-forming units during pregnancy and infancy correlated with a 4% reduction in food allergy risk. Children with food allergies had distinct gut microbiota profiles, evolving with age. Probiotics supplementation during pregnancy and infancy reduces food allergy risk and correlates with age-related changes in gut microbial composition in children. PROSPERO registration no. CRD42023425988.

Food Service Professionals’ Competencies in Managing Food Allergies and Intolerances: A South African Perspective

The prevalence of food allergies and intolerances (FAI) has been rising significantly, yet there are no effective solutions to manage their impact. South Africa’s tourism sector is pursuing to attract more visitors to bolster its performance. Most of South Africa’s international tourists come from Western countries, where food allergies and intolerances are common. Consequently, an increasing proportion of tourists with these health concerns are cautious about traveling to destinations that might not guarantee expertise in managing food allergies. In food service, the Knowledge-Attitude-Practice (KAP)-Gap theory serves as a tool to assess the alignment between food service professionals’ understanding and perceptions of food allergies and intolerances and their actual practices in addressing these dietary needs. This study enriches the academic discourse by examining the KAP-Gap among South African food service professionals in managing food allergies and intolerances. In this qualitative study, 12 comprehensive interviews were undertaken using an inductive methodology, which underwent manual thematic content analysis to identify recurring patterns. The primary respondents were food service professionals from full-service restaurants in South Africa, notably head chefs and food service managers. Data collection was facilitated through semi-structured interviews. The findings highlighted a significant knowledge gap regarding effective FAI management strategies. This lack of awareness poses potential risks to tourists with food allergies or intolerances when they eat outside their homes, especially in unfamiliar locales. While communication on allergies often leaned towards avoiding legal complications, the overall staff attitude was positive and adaptable, essential for addressing FAI-specific requirements. The study suggests practical implications and best practices, including enhanced food labeling and developing allergy response strategies, and suggests potential training and infrastructural enhancements. There is also an implication for reconsidering legislative frameworks in managing food allergies and intolerances.

The Future of Food Allergy Management: Advancements in Therapies.

To review current and future treatment options for IgE-mediated food allergy. Recent years have seen major developments in both allergen-specific and allergen-non-specific treatment options, with the first FDA-approved peanut oral immunotherapy (OIT) product becoming available in 2020. In addition to OIT, other immunotherapy modalities, biologics, adjunct therapies, and novel therapeutics are under investigation. Food allergy is a potentially life-threatening condition associated with a significant psychosocial impact. Numerous products and protocols are under investigation, with most studies focusing on OIT. A high rate of adverse events, need for frequent office visits, and cost remain challenges with OIT. Further work is needed to unify outcome measures, develop treatment protocols that minimize adverse events, establish demographic and clinical factors that influence candidate selection, and identify patient priorities.

Unveiling the Immunomodulatory Potential of Phenolic Compounds in Food Allergies.

Food allergies are becoming ever more prevalent around the world. This pathology is characterized by the breakdown of oral tolerance to ingested food allergens, resulting in allergic reactions in subsequent exposures. Due to the possible severity of the symptoms associated with this pathology, new approaches to prevent it and reduce associated symptoms are of utmost importance. In this framework, dietary phenolic compounds appear as a tool with a not fully explored potential. Some phenolic compounds have been pointed to with the ability to modulate food allergies and possibly reduce their symptoms. These compounds can modulate food allergies through many different mechanisms, such as altering the bioaccessibility and bioavailability of potentially immunogenic peptides, by modulating the human immune system and by modulating the composition of the human microbiome that resides in the oral cavity and the gastrointestinal tract. This review deepens the state-of-the-art of the modulation of these mechanisms by phenolic compounds. While this review shows clear evidence that dietary supplementation with foods rich in phenolic compounds might constitute a new approach to the management of food allergies, it also highlights the need for further research to delve into the mechanisms of action of these compounds and decipher systematic structure/activity relationships.

Low-dose oral immunotherapy in immunoglobulin E-mediated food allergies.

Nowadays, the management of food allergies has increasingly moved from conventional oral immunotherapy (OIT) to low-dose OIT or low-dose OIT utilizing hypoallergenic foods. This shift is largely because the latter appears to induce oral tolerance with fewer adverse effects than the former. However, the mechanisms underpinning such differences remain unclear. To better understand these mechanisms, we conducted a comparative study scrutinizing the mechanisms of OIT, especially those of low-dose desensitization. We also summarized articles on low-dose OIT and low-dose OIT using hypoallergenic foods. We examined the efficacy, safety, and immunological parameters of low-dose OIT and those of low-dose OIT with hypoallergenic foods with the aim of shedding some light on low-dose OIT and its therapeutic application in inducing oral tolerance for individuals with food allergies.

Assessing the Role of Peer Influence and Social Pressure on the Management of Food Allergies in Adolescents and Young Adults

Assessing the Role of Peer Influence and Social Pressure on the Management of Food Allergies in Adolescents and Young Adults

Food Insecurity and Psychosocial Burden in a National Community-Based Sample of Households Managing Food Allergy.

Experiencing food allergies and food insecurity has been linked to socioeconomic, physical, and mental health-related challenges, but less is known about the intersection of these experiences. This study aims to better understand the impact of food insecurity on food allergy patients and their caregivers, with the intention of informing ongoing efforts to improve screening for food insecurity and mental health concerns and reducing their burden among households managing food allergy. As part of a community needs assessment, a cross-sectional survey was administered to a large, national sample (N=5,940) of US households with at least one food-allergic individual, The Hunger Vital Sign was utilized to assess food insecurity, the Patient Health Questionnaire (PHQ-4) and Food Allergy Independent Measure (FAIM) were leveraged to measure psychosocial outcomes. Among respondents, 69.9% screened at-risk of food insecurity on the Hunger Vital Sign, while 5.6% reported very low food security. Both adults and children with food allergy (FA) from households at risk for food insecurity were more likely to report FA-related anxiety, anger, loneliness, fear of eating, and bullying victimization than their counterparts from households not at risk of food insecurity (p < .0001 for all). Among these specific experiences, FA-related anxiety was the most common (25.4%/30.1% of children/adults). Perceived risk of food allergy-related fatality was positively associated with food insecurity status. Individuals with food allergies who are concomitantly experiencing food insecurity are at greater risk of a variety of mental health concerns, including those specific to food allergy as well as more general anxiety and depressive symptoms.

Flex-IT! Applying “Platform Trials” Methodology to Immunotherapy for Food Allergy in Research and Clinical Practice

There is an increasing trend in the management of food allergy toward active treatment using allergen immunotherapy (AIT). Although AIT is efficacious, treatment-related adverse events are common, particularly with oral immunotherapy in those with high levels of allergen-specific IgE sensitization. In clinical practice, these adverse events inevitably create challenges: clinicians and patients routinely face decisions whether to alter the dose itself, the frequency of dosing, and the pace of escalation, or indeed discontinue AIT altogether. Flexibility is therefore needed to adapt treatment, particularly in clinical practice, so that participants are "treated-to-target." For example, this may entail a significant change in the dosing protocol or even switching from one route of administration to another in response to frequent adverse events. We refer to this approach as flexible immunotherapy. However, there is little evidence to inform clinicians as to what changes to treatment are most likely to result in treatment success. Classical clinical trials rely, by necessity, on relatively rigid updosing protocols. To provide an evidence base to optimize AIT, the food allergy community should adopt adaptive platform trials, where a "master protocol" facilitates more efficient evaluation, including longer-term outcomes of multiple interventions. Within a single clinical trial, participants are able to switch between different treatment arms; interventions can be added or dropped without compromising the integrity of the trial. Developing platform trials for food AIT may initially be costly, but they represent a significant opportunity to grow the evidence base (with respect to both treatment outcomes and biomarker discovery) at scale. In addition, they could help understand longitudinal disease trajectories that are difficult to study in clinical trials for food allergy due to the time needed to demonstrate changes in efficacy. Finally, their adoption would achieve greater collaboration and consistency in approaches to proactive management of food allergy in routine clinical practice. As a community, we need to actively pursue this with funders and established research collaborations to deliver the very best outcomes for our patients and their families.