Pediatric Food Research Articles

ASCIA‐P21: OPEN FOOD CHALLENGES IN A REGIONAL GENERAL PAEDIATRIC SERVICE: A FIVE YEAR RETROSPECTIVE REVIEW OF WOLLONGONG HOSPITAL DATA

Oral Allergen Testing (Food Challenge) in Australia is provided by specialist allergy services. There can be lengthy waiting periods for Food Challenges with the increasing prevalence of food allergy. Provision of Food Challenges by general paediatric departments could help address this service shortfall. To determine the safety and effectiveness of a regional paediatric Food Challenge service, we conducted a retrospective review of Food Challenges at the Wollongong Hospital. Wollongong Hospital medical record review was conducted for all patients who underwent Food Challenges during the period Jan 2010 – Sept 2015. Data collection included the number of Challenges per year, the variety of foods challenged, the presence or absence of reactions and the outcome of any reactions. Correlation was made between Food Challenge results and pre-Challenge Skin Prick Test (SPT) results. There were 164 paediatric Food Challenges performed at The Wollongong Hospital during the period Jan 2010 – Sep 2015. The number of Challenges per year increased over the years 2010 and 2011, remained constant for the years 2012 to 2014, then increased further in 2015. Eighteen different foods were challenged in total. The most challenged food was cooked egg, followed by peanut. There were 26 Food Challenge reactions in total. All were mild to moderate in severity. Most reactions required anti-histamine treatment and none required adrenaline. There were no adverse outcomes. There was incomplete correlation between Food Challenge results and pre-Challenge SPT results. The increasing demand on allergy services in the Australian paediatric population may be addressed by a collaborative approach between allergists and general paediatricians. Oral Allergen Testing has been safely and effectively provided by The Wollongong Hospital general paediatric service since 2010. This should encourage further Australian general paediatric departments to provide a Food Challenge service.

Epidemiological survey of pediatric food allergy in Mashhad in Northeast Iran.

IntroductionFood allergy is an increasing problem worldwide, but the foods responsible for food allergy are not the same in different countries, probably because of the role of genetic, cultural, and nutritional factors. The aim of this study was to determine the common food allergens in pediatric patients with different presentation of food allergy.MethodsIn this cross-sectional study, all of the patients were referred to pediatric allergy clinics affiliated with Mashhad University of Medical Sciences from September 2012 to August 2014. For patients with IgE-mediated food allergy that was diagnosed with clinical manifestations, the skin prick test was done. The results were analyzed by SPSS version 17 and statistical analysis was done with the chi-squared test and the t-test. P values < 0.05 were considered statistically significant.ResultsThree hundred seventy-one patients (53.9% male, 46.1% female) with ages in the range of three months to 18 years were studied. The most frequent food allergen in all patients with decreasing prevalence were egg white (17.8%), pepper (15.8%), curry (14.3%), egg yolk (14%), cow’s milk (10%), and tomato (7.8%). The most common presenting symptoms were respiratory (allergic rhinitis 45%, asthma 32%), dermatologic (atopic dermatitis 30%, urticaria 8.3%), colitis (17.5%), and gasteroesophagial reflux disease (GERD) (2%). According to the prevalence of food allergens in different age groups, we realized that, after the age of three years, the frequency of sensitization to egg white, egg yolk, cow’s milk, wheat and cereals was decreased and allergy to pepper and curry was increased.ConclusionThe prevalence of culprit foods that produce food allergies depends on several factors, including age, presenting manifestation, and where the patient lives. As many food allergies are outgrown, patients should be reevaluated regularly to determine whether they have lost their reactivity or not.

Recent Advances in Management of Pediatric Food Allergy.

Many children now suffer with a food allergy, immunoglobulin E (IgE) and/or non-IgE mediated. Food allergies have a significant impact on the child’s quality of life, as well as that of their family, due to the resultant dietary restrictions and the constant threat of a potentially life-threatening reaction. At present, there is no cure for food allergies, but there are exciting advances occurring in the management of IgE mediated allergies, including a more active approach to management with anticipatory screening testing, early introduction of common food allergens, active tolerance induction, use of biologics and active risk management. These areas will be discussed in this review.

Food Allergen Panel Testing Often Results in Misdiagnosis of Food Allergy

JA Bird, M Crain, P Varshney. J Pediatr. 2015;166(1):97–100 To determine the utility of food allergy panel testing among patients referred to a pediatric food allergy center. New patients seen between September 2011 and December 2012 by 1 provider in a tertiary referral pediatric food allergy center at Southwestern Medical Center in Dallas, Texas. This was a retrospective chart review. An analysis was performed to calculate the estimated cost of evaluation for patients who have received a food allergy panel. Of …

Relationship between maternal and child behaviors in pediatric food allergy—an exploratory study

Parents play an important role in developing young children's food choices. They influence children's eating environments through the foods they make available, their own eating behavior, and the quality of their interactions with children in eating contexts.

Mental Health Screening Outcomes in a Pediatric Specialty Care Setting

To evaluate whether a psychosocial screening program that included free and flexible access to mental health (MH) consultation resulted in increased rate of consultations. This is a post hoc review of a clinical screening program in a pediatric food allergy clinic in New York City. Screening was limited to 2 days per week, providing an opportunity to compare screened and nonscreened cohorts. Previous results from more than 1000 other families were analyzed to create the 1-page screening questionnaire. Participants were children with allergies and their parents who sought care at the clinic between March and September 2013. Parents were screened for distress and quality of life burden related to their child's allergy, and children were screened for anxiety, bullying, and quality of life. The predefined primary outcome was the percentage of families who received the free MH consultation after screening vs no-screening days in the allergy clinic. The 3143 encounters during the study period included 1171 on screening days and 1972 on no-screening days. Most (86%) eligible families completed the screen. Almost one-half (44%) met the initial screening thresholds. A total of 71 families (6.1% of screening days encounters) were referred to a MH consultation after a secondary review, but only 11 (1% of screening days encounters) scheduled a MH appointment. Eighteen families from the no-screening days came to a MH evaluation (1% of no-screening days encounters). Screening did not lead to enhanced MH follow-up. Resources may be better used on ensuring the availability of MH care rather than on screening in pediatric specialty clinics.

Empowering a Pediatric Hospital's Food Service Employees through Nutrition Education

Empowering a Pediatric Hospital's Food Service Employees through Nutrition Education

Copy Number Variations in CTNNA3 and RBFOX1 Associate with Pediatric Food Allergy.

Food allergy is a significant public health concern, especially among children. Previous candidate gene studies suggested a few susceptibility loci for food allergy, but no study investigated the contribution of copy number variations (CNVs) to food allergy on a genome-wide scale. To investigate the genetics of food allergy, we performed CNV assessment using high-resolution genome-wide single nucleotide polymorphism arrays. CNV calls from a total of 357 cases with confirmed food allergy and 3980 controls were analyzed within a discovery cohort, followed by a replication analysis composed of 167 cases and 1573 controls. We identified that CNVs in CTNNA3 were significantly associated with food allergy in both the discovery cohort and the replication cohort. Of particular interest, CTNNA3 CNVs hit exons or intron regions rich in histone marker H3K4Me1. CNVs in a second gene (RBFOX1) showed a significant association (p = 7.35 × 10(-5)) with food allergy at the genome-wide level in our meta-analysis of the European ancestry cohorts. The presence of these CNVs was confirmed by quantitative PCR. Furthermore, knockdown of CTNNA3 resulted in upregulation of CD63 and CD203c in mononuclear cells upon PMA stimulation, suggesting a role in sensitization to allergen. We uncovered at least two plausible genes harboring CNV loci that are enriched in pediatric patients with food allergies. The novel gene candidates discovered in this study by genome-wide CNV analysis are compelling drug and diagnostic targets for food allergy.

Pediatric Food Allergies and Psychosocial Functioning: Examining the Potential Moderating Roles of Maternal Distress and Overprotection.

Identify factors associated with maternal perceptions of health-related quality of life (QoL) among youth with food allergies (FA), and identify maternal factors that may moderate relationships between FA-related challenges and child QoL. In all, 533 mothers of children with FA completed measures assessing characteristics of their child's FA, maternal perceptions of child QoL, maternal psychological distress, and maternal overprotection. FA severity, maternal psychological distress, and overprotection were significantly associated with maternal reports of poorer child functioning and/or poorer QoL among youth with FA. Hierarchical linear regression analyses showed an FA severity by maternal distress interaction in the prediction of child FA-related anxiety; children of higher stress mothers showed a stronger link between auto-injector use and anxiety than children of lower stress mothers. When identifying youth with FA who are at risk for low QoL, it is important to assess history of FA-related challenges, parental psychological distress, and overprotection.

Topical Review: Pediatric Food Allergies Among Diverse Children.

To present a brief review of the literature regarding potential racial/ethnic disparities in pediatric food allergy (FA). Topical review considering data regarding FA prevalence, asthma comorbidity, epinephrine access/use, and psychosocial impact (e.g., burden, quality of life). Methodological variation precludes firm conclusions regarding disparities in prevalence; however, some data suggest Black children may be at particular risk. The comorbidity of FA and asthma among urban populations may increase risk of negative outcomes. There are clear racial/ethnic and socioeconomic disparities in epinephrine access and use. Psychosocial measures are frequently validated on samples that are not racially or ethnically diverse. Studies investigating FA's psychosocial impact are often composed of mostly White, non-Hispanic participants (>85% of study sample). Further research is needed to clarify prevalence patterns by race/ethnicity, to investigate the sources of disparity in epinephrine use, and to evaluate the differential impact of FA on diverse children.

Anaphylaxis and epinephrine in North Carolina public schools

Between 1 and 2 students in every classroom is at risk for anaphylaxis from food ingestion or insect stings. 1 Branum A.M. Lukacs S.L. Food allergy among children in the United States. Pediatrics. 2009; 124: 1549-1555 Crossref PubMed Scopus (563) Google Scholar , 2 Gupta R.S. Springston E.E. Warrier M.R. et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011; 128: e9-e17 Crossref PubMed Scopus (993) Google Scholar The prevalence of pediatric food allergy, in particular, has increased significantly. [1] Branum A.M. Lukacs S.L. Food allergy among children in the United States. Pediatrics. 2009; 124: 1549-1555 Crossref PubMed Scopus (563) Google Scholar Although most reactions in children occur at home, harrowing accounts of fatalities in schools 3 Bock S.A. Munoz-Furlong A. Sampson H.A. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001; 107: 191-193 Abstract Full Text PDF PubMed Scopus (1358) Google Scholar , 4 Bock S.A. Munoz-Furlong A. Sampson H.A. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007; 119: 1016-1018 Abstract Full Text Full Text PDF PubMed Scopus (772) Google Scholar highlight the need for advance preparation. Early studies found that a significant number of school-related anaphylactic reactions occur in individuals without a history of allergy 5 McIntyre C.L. Sheetz A.H. Carroll C.R. Young M.C. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005; 116: 1134-1140 Crossref PubMed Scopus (126) Google Scholar , 6 Sicherer S.H. Furlong T.J. DeSimone J. Sampson H.A. The US Peanut and Tree Nut Allergy Registry: characteristics of reactions in schools and day care. J Pediatr. 2001; 138: 560-565 Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar ; consequently, school districts across the country have begun to supply stock epinephrine. Stock epinephrine is a term used to refer to an unassigned supply of epinephrine that may be used to treat anyone experiencing a life-threatening reaction.

Apples or candy? Internal and external influences on children's food choices

The goal of this concise narrative review is to examine the current literature regarding endogenous and exogenous influences on youth food choices. Specifically, we discuss internal factors such as interoception (self-awareness) of pain and hunger, and neural mechanisms (neurofunctional aspects) of food motivation. We also explore external factors such as early life feeding experiences (including parenting), social influences (peers), and food marketing (advertising). We conclude with a discussion of the overlap of these realms and future directions for the field of pediatric food decision science.

Pediatric food allergies in primary care: the GPs perspective

Results 66% of GPs report that they always or almost always take a focussed FA history for patients presenting with urticaria. Significantly more histories were taken for urticaria than for feeding problems (p=0.007), eczema (p=0.025) or asthma (p<0.001). Self-reported confidence in diagnosing FA correlated directly and significantly with confidence in interpreting specific IgE results (p<0.001). Perception of confidence in diagnosis and management of FA was significantly greater in those who have had training in allergy management in the last 5 years (p<0.001) and those who are aware of local guidelines (p=0.004). GPs with higher confidence scores in interpreting specific IgE testing results had a better understanding of who to contact for specialist advice (p=0.009) and more often sought advice (p=0.036). 99% of GPs surveyed expressed interest in learning more about paediatric FA. Conclusions This study demonstrated variability in the confidence of GPs to deal with paediatric food allergies. It also revealed an appetite for further training and suggests targeted education is effective in increasing confidence amongst GPs in diagnosing and managing FA.

Children's Food Allergies: Development of the Food Allergy Management and Adaptation Scale.

Develop a measure that evaluates effective pediatric food allergy (FA) management, child and parent FA anxiety, and integration of FA into family life. A semistructured family interview was developed to evaluate FA management using a pilot sample (n = 27). Rating scales evaluated eight dimensions of FA management (FAMComposite), child anxiety, parent anxiety, and overall balanced integration (BI). Families of children with IgE-mediated food allergies (n = 60, child age: 6-12) were recruited for interview and rating scale validation. FAMComposite was correlated with physician ratings for families' food avoidance and reaction response readiness. FA anxiety was correlated with general anxiety measures for children, but not parents. Parents' FA anxiety was correlated with expectations of negative outcomes from FA. Low BI was associated with poor quality of life and negative impact on family functioning. Preliminary analyses support Food Allergy Management and Adaptation Scale validity as a measure of family adaptation to pediatric FA.

Diagnosis and treatment of pediatric food allergy: an update.

The prevalence of pediatric food allergy and anaphylaxis has increased in the last decades, especially in westernized countries where this emerging phenomenon was marked as a “second wave” of the allergic epidemic. Over recent years great advances have been achieved in the field of in vitro allergy testing and component-resolved diagnosis has increasingly entered clinical practice. Testing for allergen components can contribute to a more precise diagnosis by discriminating primary from cross-reactive sensitizations and assessing the risk of severe allergic reactions.The basic concept of the management of food allergy in children is also changing. Avoidance of the offending food is still the mainstay for disease management, especially in primary health care settings, but it severely affects the patients’ quality of life without reducing the risk of accidental allergic reactions. There is a growing body of evidence to show that specific oral tolerance induction can represent a promising treatment option for food allergic patients. In parallel, education of food allergic patients and their caregivers as well as physicians about anaphylaxis and its treatment is becoming recognized a fundamental need. International guidelines have recently integrated these new evidences and their broad application all over Europe represents the new challenge for food allergy specialists.

The F3A-App: Interactive Software for Children with Food Allergies

U E S D A Y 828 The F3A-App: Interactive Software for Children with Food Allergies Elizabeth L. McQuaid, PhD, ABPP, Michael L. Farrow, MA, Cynthia Esteban, MSN, MPH, Barbara N. Jandasek, PhD, Susan A. Rudders, MD, Dawn McDaniel, PhD, Josh Spitalnick, PhD, ABPP; Bradley/Hasbro Children’s Research Center, Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, University of Rhode Island, Kingston, RI, Division of Asthma and Allergy, Department of Pediatrics, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI, Virtually Better, Inc, Decatur, GA, Citrine Tchnologies, LLC, Atlanta, GA. RATIONALE: Pediatric food allergy (FA) is increasingly common, yet few interventions exist to promote effective management in school-aged children. METHODS: We utilized focus groups and expert panel input to design a prototype of the Friends, Family, and Food App (FA-App) a computerized intervention for school-aged children with FA. The FA-App consists of: a school cafeteria scene where the child interacts with virtual peers and adults; two fast-paced, multi-tiered games to build skills in food avoidance and symptom awareness; and a reward system where the child earns points to decorate an animated aquarium. Skills of food avoidance, symptom recognition/management, and responding to bullying/teasing are emphasized. We evaluated feasibility and preliminary efficacy in an open trial of families (n 5 32) with children (ages 8-12, 44% female) with documented FA to peanut/tree nut. RESULTS: The FA-App was well-received by families (84% would probably/definitely recommend to others). Most children (76%) reported feeling ‘‘less nervous’’ about ‘‘what it might be like getting a shot during an allergic reaction’’; analyses revealed increased self-efficacy using epinephrine (t 5 2.24, p < .05), and trends toward increased knowledge of ‘‘what would happen’’ during a reaction (t 5 1.98, p 5 .06) and confidence to stay calm during reactions (t 5 1.98, p 5 .06). Many parents (62%) reported that the FA-App prompted family discussions regarding the social pressures of FA, including bullying. CONCLUSIONS: Computerized interventions may be a useful channel to enhance children’s confidence regardingFAmanagement and facilitate family communication regarding the stresses of FA management around peers.

The Effect of Pediatric Food Allergy on Caregiver Quality of Life: A Study in Asian Population

Food allergy is associated with decreased caregiver quality of life (QoL). While incidence of food allergy has been increasing worldwide, studies of caregiver QoL are limited in Asian population. We aimed to evaluate the effect of pediatric food allergy on caregiver QoL in a population treated in a tertiary care center in Thailand.

An Association Between Pediatric Food Allergy and Food Deserts

An Association Between Pediatric Food Allergy and Food Deserts

A practical approach to vitamin and mineral supplementation in food allergic children.

BackgroundThe management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diaries. Ideally these should be analysed using a computerised program, but are very time consuming. We therefore set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies.MethodsThis prospective, observational study recruited children aged 4 weeks – 16 years, who required to follow an elimination diet for non-IgE mediated allergies. Only children that improved according to a symptom score and were on a vitamin and/or mineral supplement were included. A 3-day food diary including vitamin and mineral supplementation was recorded and analysed using Dietplan computer program. We assessed dietary adequacy with/without the supplement using the Dietary Reference Values.ResultsOne hundred-and-ten children had completed food diaries and of these 29% (32/110) were taking vitamin and/or mineral supplements. Children on hypoallergenic formulas were significantly (p = 0.007) less likely to be on supplements than those on alternative over-the-counter milks. Seventy-one percent had prescribable supplements, suggested by a dietitian/physician. Sixty percent of those without a vitamin supplement had a low vitamin D intake, but low zinc, calcium and selenium was also common. Of the supplemented cohort many continued to be either under or over-supplemented.ConclusionThis study has raised the question for the first time, whether clinicians dealing with paediatric food allergies should consider routine vitamin and/or mineral supplements in the light of deficient intake being so common in addition to being so difficult to predict.

Support and negativity in interpersonal relationships impact caregivers' quality of life in pediatric food allergy.

This study examined interpersonal relationship processes as they relate to health-related quality of life (HRQL) in caregivers of food-allergic children. Research questions explored the relative contributions of social support and social negativity to caregivers' adaptation as well as mechanisms of moderation, mediation, and moderated mediation through which these influences affect the association of time since children's food allergy diagnosis to caregivers' HRQL. Caregivers (N = 299) of food-allergic children were recruited from parent groups associated with a food allergy nonprofit organization. Participants completed web-based questionnaires assessing demographics and child allergy characteristics, the extent of support and negativity experienced in their social relationships related caregiving, and their HRQL. Multiple regression analyses were used to examine relations among time since diagnosis, interpersonal relationship processes, and caregiver HRQL. Social negativity was directly related to diminished caregiver HRQL and was a stronger predictor of caregiver HRQL than social support. The effect of time since diagnosis on caregiver HRQL was indirect through social support, and this mediating effect did not depend on caregivers' experience of social negativity. Interpersonal relationship processes appear influential in the adaptation of caregivers in the context of pediatric food allergy. Psychosocial interventions targeting support and negativity in caregivers' social relationships may help improve their HRQL.