Pediatric Food Research Articles

Association of food allergy in children with vitamin D insufficiency: a systematic review and meta-analysis.

Current literature regarding the association of vitamin D insufficiency and food allergy is contradicting. The purpose of our study was to investigate this association. This is a systematic review and meta-analysis according to the PRISMA statement. PubMeD and Scopus databases were systematically searched for case-control studies investigating the association between pediatric food allergy and vitamin D insufficiency. Our search yielded 806 studies. Ten final studies were considered eligible for qualitative and quantitative analysis. Children with vitamin D insufficiency were found to have 68% more probability to present a food allergy episode (adjusted pooled OR: 1.68, 95% CI [1.25-2.27], p-value: 0.001). In their second year of life they were 4 times more likely to present a food allergy episode (adjusted pooled OR: 4.06, 95% CI [1.93-8.56], p-value: < 0.001), and 56% more probable to develop food sensitization (OR: 1.56, 95% CI [1.15-2.11], p-value: < 0.004). Children in Australia with vitamin D insufficiency were almost 4 times more likely to develop egg sensitization (adjusted OR: 3.79, 95% CI [1.19-12.08], p-value: 0.024). Children with vitamin D insufficiency were almost twice as likely to have peanut sensitization (OR: 1.96, 95% CI [1.08-3.57], p-value: 0.028). Conclusion: Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies, particularly in the second year of life. To confirm this association, multicenter longitudinal studies are required. What is Known: • In newborns and young children, vitamin D deficiency and insufficiency are prevalent. • The exact role of vitamin D in atopic diseases remains controversial. What is New: • Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies. This association is more evident in the second year of life.

Assessing the Family-Level Impact of Pediatric Food Allergy: Development of the PEACH Tool

Psychosocial care for food allergy is a top stakeholder priority and requires consideration of the patient and larger family system in pediatrics. A valid, clinically useful tool capturing the full range of FA impacts on children and families is needed. Here we describe item generation and content validation processes for a first draft of the Psychosocial Evaluation of Allergy on Caregivers and Households (PEACH).

Efficacy of a 6-Month Online Market Platform in Addressing Food Insecurity and Supporting Food Allergy Management in Predominantly Spanish-speaking and Low-income communities During the COVID-19 Pandemic

In the context of rising food insecurity and food allergy (FA) burden, this pilot study aimed to evaluate an intervention that supports low-income families at-risk of food insecurity in managing pediatric food allergy.

Food Insecurity in the Pediatric Food Allergy Population

Food insecurity affects approximately 15% of children in the United States and has increased due to the COVID-19 pandemic and rising food costs. Previous studies have shown higher rates of food insecurity in food allergic children, though data is limited. We aim to investigate food insecurity trends in an urban, children’s hospital-based, Allergy/Immunology outpatient clinic.

Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool

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. This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. 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. 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). 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.

Impact of a dietitian in general practice: paediatric food allergy.

Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% (p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits (p = 0.001); and input from secondary care was also lower, 8 versus 25 patients (p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% (p < 0.001) in dietetic community care. Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.

Trends in the contributions of atopic family history to pediatric food sensitization and allergy.

Family history of atopic diseases (FHA) contributes to food allergy (FA). But little is known whether FHA primarily increases IgE-mediated, non-IgE-mediated FA, or both. And the trends in the contributions of FHA to food sensitization (FS) and FA remain unclear. We aim to clarify the associations among FHA, FS and FA and to understand the trends in the contributions of FHA to FS and FA. We used chi-square test and mediating effect model to analyze the associations among FHA, FS and FA through comparisons between two cross-sectional investigations on FA in children under 2 years old in 2009 and 2019. In 2009 and 2019, the positive FHA proportion tended to be increasing without significance (28.9% to 31.6%, P = 0.39). Subgroup analysis showed the FS rate in FA group decreased significantly (37/39 to 44/62, P = 0.003). In 2009, the FS rate and FA prevalence were higher in FHA (+) group than in FHA (-) group (26% vs. 14.7%, P = 0.008 and 15% vs. 7.7%, P = 0.03), and FS had a complete mediating effect on the association between FHA and FA (Z = 2.54, P = 0.011), but the results lost significance in 2019. The association between FHA and FA was completely mediated by FS, which means FHA mainly increases IgE-mediated FA. And the contributions of FHA to FS and FA tended to be stabilized or even diminished, which means FHA alone could no longer be enough to screen high-risk children.

The potential role of preventive and therapeutic immunonutrition strategies for pediatric food allergy: A mini-review.

Food allergy (FA) represents one of the main chronic conditions of the pediatric population. The gut microbiome (GM)-immune system axis is a milestone in affecting FA susceptibility. The dynamic and bidirectional crosstalk between the GM and immune system starts early in life, and it is deeply modulated during the first 1,000 days of life. Nutritional factors during this crucial period mainly influence the proper GM-immune system development and function across the lifespan, with potential beneficial or detrimental effects on health status. Immunonutrition strategies, applied from conception, could represent an innovative target for prevention and treatment of pediatric FA. Here we described the potential role of preventive and therapeutic immunonutrition strategies for pediatric FA, highlighting putative future perspectives in this field.

Racial, ethnic, and socioeconomic disparities in COVID-19 and influenza vaccination in pediatric food allergy.

Current coronavirus disease 2019 (COVID-19) and influenza vaccination-related knowledge, attitudes, and behaviors remain poorly understood among U.S. children with food allergy, and, particularly, those from non-Hispanic Black, Latinx, and lower-income backgrounds who bear a disproportionate burden by allergic disease. These data are especially relevant due to historical vaccine hesitancy in children with food allergy and an initial contraindication for those with severe allergic reactions to be vaccinated against COVID-19. We sought to characterize COVID-19 and influenza vaccination-related knowledge, attitudes, and behaviors in a racially, ethnically, and socioeconomically diverse longitudinal cohort of caregiver-child dyads with immunoglobulin E-mediated food allergy. We leveraged the National Institutes of Health supported FORWARD cohort, which consists of non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx children diagnosed with food allergy to assess COVID-19 testing, vaccination, and influenza vaccine concern and utilization through administering a one-time institutional review board approved survey. Non-Hispanic Black participants were less likely than non-Hispanic White participants to be vaccinated (odds ratio [OR] 0.25 [95% confidence interval {CI}, 0.08-0.75]) or tested (OR 0.33 [95% CI, 0.13-0.85]) for COVID-19 and have the intention to vaccinate their children for influenza (OR 0.42 [95% CI, 0.18-0.98]). More than one-third of the participants reported that they believed that their child was at greater risk of complications from COVID-19 vaccination due to a food allergy. There were racial and/or ethnic disparities in the belief that COVID vaccines contain allergenic ingredients; more Hispanic/Latinx (37%) and Black (37%) than White (22%) participants reported this belief (p = 0.02). The present findings of disparities in vaccination-related knowledge, attitudes, and behaviors across racial and/or ethnic, and household income strata suggested that initial reports of COVID-19 vaccination hesitancy within the population with food allergy may be further exacerbated by well-documented racial, ethnic, and socioeconomic differences in vaccine hesitancy, potentially leading to a greater infectious disease burden in these vulnerable populations. This highlights a need for targeted education and outreach among members of these communities who are living with food allergy.

PRE-TEEN FATAL COW'S MILK ANAPHYLAXIS: PROTEIN BEVERAGE INGESTION IRREVERSIBLY MISTAKEN WITHOUT ALLERGEN ON FRONT LABEL

<h3>Introduction</h3> IgE-mediated cow's milk allergy (CMA) is the most common pediatric food allergen (FA). Persistent CMA is uncommon (50% CMA tolerance, by 5 years-of-age/75% by adolescence/0.2% remain into adulthood). FA Labeling and Consumer Protection Act (FALCPA) requires product listing of 8 major FAs, including cow's milk (CM). This mandate does not require front-product labeling (FPL) on FA-containing products. We describe a CMA fatality in a parent-supervised pre-teen female who ingested CM-protein drink, misinterpreted as non-CM-containing with FPL of fruit imagery, without CM-FA notation. <h3>Case Description</h3> Early childhood, atopic asthma and CMA confirmed (history; IgE-CM); allergist prescribed epinephrine/gave CMA education. Late childhood, failed baked-CM challenge and intermittent CMA exposures resulted in extended CM avoidance. Mother and patient identified new protein beverage that appeared juice-like with its transparency and FPL-CM absence. Back label was not seen/read before ingestion: "whey" "contains milk". Immediate anaphylaxis ensued; despite immediate epinephrine administered by mother, 911 resuscitation and intensive care-tertiary pediatric attention, anaphylaxis persisted; patient succumbed to irreversible anaphylaxis with death within 24 hours. <h3>Discussion</h3> CMA morbidity-mortality alerts are illuminated: 1. CMA may persist beyond early childhood and can be fatal; 2. Thorough FA education for practical application was missing; education alone was incomplete. FA-registered dietitians are trained to teach FA patients-families-communities to implement FA health literacy techniques, critical to preventing life-threatening exposures; 3. Current FALCPA is insufficient given that FA identifiers may be absent on FPL, leaving consumer products to masquerade as non-FA products, posing irreversible risks. FA labeling renewal combined with effective FA health literacy is necessary and life-saving.

Intestinal microbiota is modified in pediatric food protein-induced enterocolitis syndrome.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food hypersensitivity that affects the gastrointestinal system, especially in children, who often present with more severe clinical manifestations than adults do. Although its pathogenesis is poorly understood and biomarkers are still lacking, scientific evidence suggests that gut microbiota may play an important role in the development of FPIES. We aimed to compare the composition of gut microbiota in children with FPIES with that in age- and sex-matched healthy controls. We analyzed the gut microbiota profiles in fecal samples of 17 patients with FPIES (case patients) and 12 age-matched healthy children (controls) by tag sequencing of the 16S ribosomal RNA gene hypervariable V4-V5 regions. Subjects' sociodemographic, clinical, and food diary variables were described and compared between groups by using inferential statistical tests. Nonparametric linear discriminant analysis was performed for intestinal microbiota data. Patients with confirmed cases FPIES (n= 17; average patient age, 7.5± 3.2 years) and controls without FPIES or any atopy (n= 12, average patient age, 6.9± 2.7 years) were included. Fish was the main FPIES-inducing allergen in 65% of the cases. The patients with FPIES showed higher proportions of Lachnospiraceae spp (P< .0286) and a lower proportion of Ruminococcaceae spp (P< .0066), Lactobacillaceae spp (P< .0075), and Leuconostocaceae spp (P< .0173) than the controls. Our data clearly show a different gut microbial signature in patients with FPIES, suggesting a new potential avenue for aiding the diagnosis and clinical management of FPIES. Larger studies are needed to confirm these results.

Psychosocial functioning in pediatric food allergies: A scoping review

The psychosocial burden of food allergy (FA) can significantly affect the lives of pediatric patients and their families. Acomprehensive understanding of the state of the literature on psychosocial functioning is imperative to identify gaps that may affect clinical care and future research. This review characterizes the current literature on psychosocial functioning in pediatric patients with FA and their caregivers, siblings, and families. Aliterature search of 5 databases (PubMed, Ovid MEDLINE, PsycINFO, Web of Science, and Embase) was conducted to identify original research articles and abstracts on psychosocial functioning of patients with FA who were aged 0 to 18 years and their caregivers, siblings, and families. Atotal of 257 studies met the inclusion criteria. The majority of studies examined child or caregiver psychosocial functioning, with child and caregiver quality of life examined most frequently. Most studies utilized quantitative and cross-sectional methods and inconsistently reported participant race and ethnicity. Existing research on psychosocial functioning in pediatric FA may not be generalizable to patients of color and families and siblings. Future research should diversify recruited samples regarding race, ethnicity, and country of origin; examine psychosocial functioning longitudinally; examine constructs beyond quality of life; and adopt a biopsychosocial approach by considering the interplay among psychosocial functioning, disease burden, and social contexts.

Prize‐winning abstracts from BSACI/WAO 2022 meeting

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

A Review on the Toxicological Elements of Commercial Pediatric Food and its Long-Term Bodily Effects

Commercial food has been an essential part of any pediatric individual’s diet since the minerals and vitamins help sustain their dietary requirements and is given as early as being a newborn. However, it also contains toxicological elements which are associated with long-term bodily effects. These elements can be essential and non-essential. Essential elements found in pediatric food given as early as infancy play a part in the development of pediatric individuals. On the other hand, non-essential elements which include the heavy metals and other toxins may have long-term effects with their brain development. Pediatric individuals, but most especially newborns, infants, and young children are the most vulnerable to these contaminants since their brain and organ systems are yet undeveloped. This article aims to identify the long-term bodily effects and the risk factors of toxicological elements found in commercial pediatric food, which will either hinder or suppress the proper growth of these individuals.

The perceived impact of pediatric food allergy on mental health care needs and supports: Apilot study.

Evidence suggests a mental health impact of food allergy on affected children and their families; however, little is known about health care professionals' understanding of these impacts and the resources available to patients and their families. Our aim was to conduct a pilot study examining health care professionals' perceptions of the psychosocial and financial burden of food allergy to identify gaps in education and resources and thus better support families with food allergy moving forward. Between February 20 and November 19, 2020, we conducted audiorecorded interviews (n= 6) and profession-specific focus groups (n= 2 [representing 7 individuals]). The participants included pediatric allergists, allergy nurse educators, and clinical dietitians who were directly involved in pediatric food allergy care. The interviews were recorded and transcribed verbatim. Thematic analysis was subsequently applied to identify the main themes. Our study consisted of an interdisciplinary group of Manitoban health care providers (N= 13) who were directly involved with pediatric food allergy care. We identified 3 main themes from these interviews: anxiety among families with food allergy, which is a common comorbidity; limited resources available within current public infrastructure; and empowerment through education. These themes describe issues surrounding access to information and resources and how this can affect anxiety and parenting styles among families with food allergy. Health care professionals perceive that many families experience anxiety as a result of their child's food allergy. They further advocate that access to information and suitability of public resources be considered when planning forrelated programs.

157 Evaluating Interest in Clinical Trial Participation for the Treatment of Pediatric Food Allergy

OBJECTIVES/GOALS: Roughly 8% of children in the United States have a diagnosed food allergy (FA). The ubiquity of most food allergens increases the potential for accidental exposures. Clinical trials (CT) are used to test novel treatments for FA. This project will evaluate the influence of biopsychosocial factors on interest in CT participation for pediatric FA. METHODS/STUDY POPULATION: This project is subsumed under the FORWARD study (5R01AI130348-04), a multisite study currently underway at four pediatric FA clinics across the United States. Eligible participants include patients and families who meet the following criteria: 1) New clinic visit presenting for a possible FA complaint and/or has a physician diagnosis in a follow-up clinic visit; 2) child is between the age of 6-months and 12 years at intake visit; 3) are English speaking, and 4) no history of developmental disorders. Parents are asked to complete an intake survey, followed by a series of quarterly surveys administered via REDCap. A single variable from the intake survey queries interest in CT participation; quarterly surveys assess FA knowledge, attitudes, health beliefs, and management practices. RESULTS/ANTICIPATED RESULTS: To date, 890 families have completed the intake survey. Working hypotheses include: 1) parents of older children and children with a higher condition severity rating will report greater levels of interest in CT participation; 2) parents with greater FA knowledge, more health management beliefs that support action, and less FA-related anxiety, will report greater levels of interest in CT participation; 3) relative to White families, African American families will be less interested in participating; 4) families with &gt;1 child with FA will report greater levels of interest in CT participation; 5) families who are uninsured, low-SES, and are unemployed will report lower levels of interest in CT participation; and 6) families with higher educational attainment will report lower levels of interest in CT participation. DISCUSSION/SIGNIFICANCE: This study will advance decision science, address existing disparities, and have far-reaching clinical implications. This novel approach will enhance our ability to predict who is at the greatest risk of anaphylaxis and help healthcare providers identify families who could benefit from experimental treatment options for pediatric FA.

Needs assessment for an infant and toddler food allergy curriculum for pediatric residents.

The prevalence of pediatric food allergies is increasing. Although pediatric residents are frontline providers for children with food allergies, little is known about pediatric residents' educational experiences and comfort with infant and toddler food allergy. An anonymous online needs assessment survey was created and distributed to 64 residents in one residency program. The survey explored residents' knowledge sources, experience, and comfort in diagnosing, treating, and counseling patients with regard to food allergy and anaphylaxis. Fifty-one pediatric residents (79.7%) completed the survey. Pediatric residents who had formal engagement with allergy-trained clinicians had 8.27 times the odds (odds ratio 8.27 [95% confidence interval, 1.16-59.01]; p = 0.035) of feeling comfortable in treating infant and toddler anaphylaxis compared with those who did not feel comfortable. These findings suggest that a standardized pediatric residency curriculum, in partnership with pediatric allergists, may present enhanced educational opportunities for pediatric residents.

Psychometric Properties of a Measure Assessing Anxiogenic Parenting Practices in Food Allergy.

Pediatric food allergy represents a significant public health burden. In order to avoid allergen consumption, adequate management requires daily vigilance and involvement from parents, frequently leading to increased parental anxiety. While specific anxiogenic parenting practices (i.e., parenting behaviors which may aid in the development and/or exacerbation of childhood anxiety) have been documented within this population, to this point, these behaviors have not been systematically measured. The current study aimed to develop and examine a parent-report scale designed to measure anxiogenic parenting behaviors related to food allergy. Participants included 177 parents of children with food allergy recruited online using Amazon Mechanical Turk (mTurk). An exploratory factor analysis was conducted to determine the factor structure of the newly developed scale. Subsequently, psychometric properties (e.g., construct validity) were examined via correlational analyses. Results indicated a 24-item, 3 factor (Factor 1: Involvement in Food Allergy; Factor 2: Worry about Food Allergy; Factor 3: Autonomy Promotion) scale, which accounted for 53.11% of the total variance. The Kaiser-Meyer-Olkin measure was acceptable, KMO = 0.872 and Bartlett's test of sphericity indicated sufficient correlations between items (χ2(378)=2568.95). All subscales demonstrated strong internal consistency (Involvement in Food Allergy: α = .880; Worry about Food Allergy: α = .892; Autonomy Promotion α = .796) as well as convergent and discriminant validity. Results support the overall psychometric properties of the scale. Interpretations, limitations, and future directions are discussed.

Development of the Pediatric food allergy disease-specific quality of life Questionnaire

Development of the Pediatric food allergy disease-specific quality of life Questionnaire

The burden of food allergy on children and teens: A systematic review.

Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations. The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature. Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples. More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.