Pediatric Food Research Articles

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.

Don't Hold the Tahini: A Retrospective Chart Review of Sesame Oral Food Challenges in a Pediatric Food Allergy Clinic

Although allergy to sesame has a growing prevalence in the United States and is a common cause of anaphylaxis worldwide, diagnostic predictors of clinical reactivity remain elusive. Measures of sensitization including skin prick testing (SPT) and specific IgE (sIgE) have been poor predictors of outcomes of the gold standard oral food challenge (OFC). Here we report the results of sesame OFCs in a pediatric clinic population.

Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study.

The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort. Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure-Parent Form (FAIM), and the Food Allergy Quality of Life-Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables. Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = -.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67). In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers' perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.

Effect of Processing on the Structure and Allergenicity of Peanut Allergen Ara h 2 Roasted in a Matrix.

Peanut allergy is the leading pediatric food allergy. Many attempts have been made to reduce its allergenicity by processing. After roasting, Ara h 2 and its derivatives in the matrix were isolated by immunoaffinity chromatography (IAC). The structure and allergenicity of Ara h 2 were analyzed by circular dichroism, mass spectrometry (MS), western blotting, the enzyme-linked immunoassay, and cell modeling. Our results showed that a large portion of Ara h 2 was fragmented and cross-linked. Ara h 2 monomers accounted for only 13% of the total proteins after IAC purification. In addition, the structure of Ara h 2 changed after roasting. In addition to methylation and oxidation modification, the disulfide bonds of Ara h 2 were found to be rearranged after roasting. In the conformational structure of Ara h 2, the content of the α-helix decreased from 27.1 to 21.6% after roasting, while the content of the random coil increased from 29.1 to 34.3%. Six cleavage sites of trypsin were exposed, while three were covered. In terms of allergenicity, most of the cross-linking products were not recognized by patients' sera. Only one faint band around 40 kDa was observed in our blotting. For Ara h 2 monomers, roasting enhanced their IgE binding capacity and ability to stimulate the degranulation of basophils. The potential allergenicity increase of Ara h 2 monomers did not reflect the allergenicity change of Ara h 2 in the matrix due to the amount and property of its derivatives after roasting.

Potential Role of Omega-3 Polyunsaturated Fatty Acids in Pediatric Food Allergy.

Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. In particular, within the PUFAs category, omega-3 (ω-3) may reduce inflammation, whereas omega-6 (ω-6) PUFAs are generally considered to have a proinflammatory effect. Recent evidence highlights an imbalance in the ω-3:ω-6 ratio with an increased intake of ω-6, as a consequence of the shift towards a westernized diet. In critical age groups such as infants, toddlers and young children, as well as pregnant and lactating women or fish allergic patients, ω-3 intake may be inadequate. This review aims to discuss the potential beneficial effects of PUFAs on pediatric food allergy prevention and treatment, both at prenatal and postnatal ages. Data from preclinical studies with PUFAs supplementation show encouraging effects in suppressing allergic response. Clinical studies results are still conflicting about the best timing and dosages of supplementation and which individuals are most likely to benefit; therefore, it is still not possible to draw firm conclusions. With regard to food-allergic children, it is still debated whether PUFAs could slow disease progression or not, since consistent data are lacking. In conclusion, more data on the effects of ω-3 PUFAs supplementation alone or in combination with other nutrients are warranted, both in the general and food allergic population.

Optimizing tools for evaluating challenge outcomes in children with cashew nut allergy

BackgroundThe incidence of cashew nut anaphylaxis is increasing and there is a need for accurate diagnostic tests. Age-specific cutoffs in children are lacking. Changes in serum tryptase levels are not well documented in pediatric food allergy, except in anaphylaxis. ObjectiveTo evaluate the ability of various tests to diagnose cashew nut allergy and to predict reaction severity. We also investigated changes in tryptase and their correlation to reaction severity. MethodsWe performed an open cashew nut challenge on 106 children (aged 1-16 years), who were sensitized to cashew nut with either previous allergic reaction to cashew nut or no known exposure. We analyzed the accuracy of Ana o 3 immunoglobulin E (IgE), cashew nut IgE, skin prick test, basophil activation test (BAT), and combinations thereof to diagnose cashew nut allergy and to predict reaction severity. Tryptase level was measured at the baseline and during an allergic reaction. ResultsA total of 72 children had positive challenge outcomes. Ana o 3 IgE seemed to be the best single test to diagnose cashew allergy, with a 0.97 kU/L cutoff exhibiting 94.1% specificity and 61.1% sensitivity. Though BAT values of at least 22.8% best predicted reaction severity, with 91.7% specificity and 60.7% sensitivity, the cutoffs were age-specific. Tryptase levels increased substantially 1 to 2 hours after the first allergic symptoms compared with baseline. ConclusionAna o 3 IgE seems to be the best diagnostic test in pediatric cashew nut allergy, and test combinations do not seem to improve the diagnostics. Cutoffs are age-specific. BAT is promising in predicting reaction severity. Tryptase levels should be measured 1 to 2 hours after initiation of an allergic reaction.

Associations of Food Allergy-Related Dietary Knowledge, Attitudes, and Behaviors Among Caregivers of Black and White Children With Food Allergy

BackgroundThe increasing prevalence of pediatric food allergy (FA) in the United States has disproportionately affected non-Hispanic Black youth. However, racial and other socioeconomic disparities in FA management among caregivers of children with FA remain unclear. ObjectiveTo determine associations between socioeconomic, clinical, and health care factors and FA-related knowledge, attitudes, and behaviors among caregivers of Black and White children with FA. DesignCross-sectional survey analysis from the Food Allergy Outcomes Related to White and African American Racial Differences Study. Participants/settingsLongitudinal cohort of caregivers of 385 Black and White children with FA ages birth to 12 years residing in Chicago, Illinois, Cincinnati, Ohio, and Washington, DC from 2017 to March 2021. Main outcome measuresThere were 3 primary outcomes of interest: (1) FA knowledge assessed by scores from the Knowledge Survey, (2) FA-related attitudes assessed by newly developed survey, and (3) food-related behaviors assessed by the FORWARD Diet and Purchasing Habit Surveys completed 6 months postenrollment. AnalysesMultivariable linear and logistic regression. ResultsThe overall response rate to the 6-month postenrollment survey was 51.3% (385 of 751). White caregivers represented 69.4% of the participants. Black race was associated with a 1.5-point mean decrease in FA knowledge score (95% CI: −2.2 to −0.7) compared with White caregivers, and a graduate degree or bachelor’s degree was associated with associated with a 1.7-point mean increase (95% CI: 0.8-2.7) and 1.1-point mean increase (95% CI: 0.2-2.0) in FA knowledge score, respectively, compared with caregivers who had less than a bachelor’s degree. Multiple FAs and ever visited the emergency department for a food-related allergic reaction were also associated with higher levels of FA knowledge. Ever visited the emergency department for FA was also associated with higher odds of 2 measures of FA attitudes reflecting parental anxiety. Greater FA knowledge scores were consistently associated with lower odds of several FA-related food purchasing and eating behaviors assumed to have elevated risk of FA. Eating food prepared at school was the only FA behavior associated with race. Compared with White children, Black children were 2.5 times more likely to eat school-prepared foods (95% CI: 1.2-5.6). ConclusionsFindings from this study identified socioeconomic, racial, and clinical factors associated with caregivers’ FA-related knowledge, attitudes, and behaviors, but further research is warranted to better understand these relationships.

The moderating role of parental self-efficacy on parental worry and social activity limitation associated with pediatric food allergy.

The moderating role of parental self-efficacy on parental worry and social activity limitation associated with pediatric food allergy.

Longitudinal Egg-Specific Regulatory T- and B-Cell Development: Insights From Primary Prevention Clinical Trials Examining the Timing of Egg Introduction

During early egg introduction to infants, regulatory immune cells involved in tolerance development were studied.In the study, the researchers included 124 Australian infants from 2 randomized controlled trials of early introduction of egg for the primary prevention of egg allergy.Two separate early introduction egg study cohorts (BEAT and STEP) were managed for 12 months. Cryopreserved peripheral blood mononuclear cells were ovalbumin-stimulated in vitro. Ovalbumin-specific regulatory T cells were then identified by flow cytometry detection of forkhead box P3 and interleukin 10 (IL-10). Ovalbumin-specific B regulatory cells were detected by coexpression of fluorescence-conjugated ovalbumin and IL-10.There were decreased ovalbumin-specific regulatory B cells and impaired ovalbumin-specific regulatory T cells in egg-allergic infants, compared with egg-tolerant infants. Ovalbumin-specific age-dependent regulatory T-cell expansion was also decreased in non–egg-allergic infants who did not introduce egg early.Ovalbumin-specific B and T cells were correlated with clinical egg tolerance. The timing of egg introduction also correlated with ovalbumin-specific T regulatory cell expansion. This study reveals the importance of the adaptive immune system in food tolerance. Future studies in which researchers evaluate the role and ratio of Th2 to T regulatory ovalbumin-specific cells would be helpful.Egg allergy is one of the most common pediatric food allergies in the United States and the world. The US-published 2017 Addendum Guidelines for the Prevention of Peanut Allergy has not formally addressed early egg introduction. Early egg introduction has been associated with a decreased risk of egg allergy. With this study, the researchers support the protective effects of early egg introduction and the underlying immunologic pathophysiology.

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children.

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10–33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37–0.74, p < 0.001; OR 0.55; 95%CI: 0.39–0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

Clinical Manifestations of Pediatric Food Allergy: a Contemporary Review.

Food allergies (FAs) are an emerging health care issue, and a "second wave of the allergy epidemic" was named. There are extensive data that documented the prevalence rate as high as approximately 10%. FAs are immunological adverse reactions, including IgE-mediated mechanisms, cell-mediated mechanisms, or mixed IgE- and cell-mediated mechanisms. A diagnosis of FA is made by specific symptoms encounter with food, detailed past history, sensitization tests, and oral food challenges (OFCs) if necessary. The component-resolved diagnostics (CRD) test can distinguish true or cross-reaction. "Minimal elimination" from the results of CRD and OFC could avoid unnecessary food restriction. Strict food limitation is harsh and stressful on patients and their families. Children with FAs experience a higher rate of post-traumatic stress symptoms (PTSS) and bullying than others. In the last 20years, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) are treatment strategies. OIT and EPIT are the most two encouraging treatments for FA. This review aims to introduce FAs in diverse clinical disorders, new perspectives, and their practical implications in diagnosing and treating FA.

Evaluation of a paediatric gluten-free food guide by children and youth with coeliac disease, their parents and health care professionals.

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4-18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4-18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher's exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings.

SC2 Trends in Diagnostic Prevalence, Treatment Patterns, and Healthcare Resource Utilization of Pediatric Food Allergy Patients in the United States, 2008-2018

With considerable variation between epidemiological studies, prevalence of food allergies (FA) has reportedly increased over the years. This study aimed to analyze diagnostic prevalence rates, treatment patterns, and healthcare resource utilization (HCRU) of FA among the United States pediatric insured population from 2008 to 2018.

Parental Anxiety and Posttraumatic Stress Symptoms in Pediatric Food Allergy

The purpose of this study was to explore anxiety, worry, and posttraumatic stress symptoms (PTSS) in parents of children with food allergies, and to evaluate whether these three psychological outcomes could be predicted by allergy severity, intolerance of uncertainty, and food allergy self-efficacy. Participants were 105 parents who reported their children to have medically diagnosed food allergies. Participants were recruited to a study on parent wellbeing through an allergy clinic and social media advertisements. Participants completed online questionnaires assessing anxiety, worry, PTSS, intolerance of uncertainty, food allergy self-efficacy, and demographic and allergy information. In this sample, 81.0% of parents reported clinically significant worry, 42.3% met the clinical cut-off for PTSS, and 39.1% reported moderate-extremely severe anxiety. Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes, with mixed results for allergy severity. However, intolerance of uncertainty was the only variable to consistently account for unique variance within regression models. This study highlights the need for greater awareness of mental health in parents of children with food allergy. The study also indicates that factors impacting on parents' perception of threat may be most strongly predictive of psychological outcomes, warranting further research. Finally, the study indicates that intolerance of uncertainty may be a promising target for psychological interventions within this population.

Prevalence and characteristics of peanut allergy in US adults

Peanut allergy (PA) is the leading pediatric food allergy and a common cause of anaphylaxis. Little is known, however, on the prevalence and characteristics of PA in the adult population and whether phenotypic differences exist between adult-onset and childhood-onset PA. This study describes the current US population-level burden of adult PA. A cross-sectional food allergy survey was administered via phone and web in 2015 and 2016, resulting in nationally representative complex-survey weighted data for 40,443 adults. Reported food allergies were considered "convincing" if symptoms to specific allergens were consistent with an IgE-mediated reaction. The prevalence of current self-reported PA was 2.9% among US adults, with 1.8% having convincing PA. Over 17% of adults with peanut allergy reported onset of their PA in adulthood. In adults with childhood-onset PA, 75.4% reported physician-diagnosed PA, compared with only 58.9% of adult-onset PA. Despite a similar frequency of food allergy-related emergency department visits within the past year (approximately 1 in 5 adults with PA allergy), adults with childhood-onset PA were significantly more likely to have a current epinephrine prescription compared with those with adult-onset PA (56% vs 44% respectively; P= .02) and were more likely to use an epinephrine autoinjector (48% vs 35%, P= .01). Approximately 4.6 million US adults have PA-over 800,000 of whom appear to have developed their PAafter age 18 years. Further examination of phenotypic differences between childhood-onset and adult-onset PA may improve understanding and management of adult PA.

Needs Assessment for an Infant and Toddler Food Allergy Curriculum for Pediatric Residents

The prevalence of pediatric food allergies is increasing. Approximately 6% of children ages 0 to 2 years have a food allergy. Pediatric residents are frontline providers for children with food allergies, but little is known about their educational experiences and comfort managing infant/toddler food allergies. An anonymous online needs assessment survey was created and distributed to pediatric residents in one residency program. The survey explored residents’ knowledge sources, experience and comfort diagnosing, treating and counseling patients regarding infant/toddler food allergies. Forty-nine pediatric residents (77%) responded. Prior to residency, most residents (94%) did not have any formal training on infant/toddler food allergies. The most common sources of information on infant/toddler food allergies included outpatient pediatric clinicians (74%), other pediatric residents (59%) and emergency department clinicians (55%). Nearly all residents were uncomfortable (69%) evaluating food allergies. Most residents were very uncomfortable (20%) or uncomfortable (65%) managing food allergies. Most residents were very uncomfortable (16%) or uncomfortable (65%) counseling families about food allergy diagnosis. The majority of residents were very uncomfortable (14%) or uncomfortable (53%) counseling families about food allergy prevention. In contrast, most residents were very comfortable (16%) or comfortable (53%) diagnosing anaphylaxis. Similarly, most were very comfortable (20%) or comfortable (49%) treating anaphylaxis. While pediatric residents feel comfortable diagnosing and treating infant/toddler anaphylaxis, there is a lack of comfort surrounding infant/toddler food allergy evaluation, management, and counseling for families. Pediatric residents may benefit from a comprehensive infant/toddler food allergy curriculum which focuses on these specific areas of need.

Pediatric food allergy clinic: a way to improve the quality of service.

Pediatric food allergy clinic: a way to improve the quality of service.

Heterodox Microeconomics: A Spatial Turn for Environmental Health and Just Food System Social Provisioning

This paper examines food system social provisioning at low levels of geographic scale to merge the heterodox microeconomic approach outlined by Frederic Lee (2018) and the activist spatial justice methodology of Edward Soja (2010). Combining these two theoretical frameworks blends academia and activism by joining community perspectives with spatial, quantitative and qualitative data techniques to hypothesis test and investigate disparities in social provisioning. Initiating the inquiry with data available at the address level of geography allows the analysis to develop across diverse geographic scales and reveal consistent patterns of inequality. It is argued that these consistencies afford researchers, activists, and practitioners benchmarks for the study and development of transdisciplinary intervention design and implementation. This spatial study of pediatric food allergy frames a practical example of how this approach is applicable across a variety of socioeconomic and environmental health disparities and the pursuit of spatial justice outcomes at local and national levels of social provisioning.

The impact of provider training on patient education for pediatric early food introduction

Pediatric food allergies (FAs) present significant health and economic problems. Currently, there are no cures for FAs. Recent studies suggest that early introduction (EI), between 4 and 6 months of age, of commonly allergenic foods (CAFs) may reduce the risk of developing FAs. This contradicts the current standard of care, food avoidance. A federally qualified health center saw 894 patients aged 0-24 months during a 12-month period with only 18.9% receiving nutrition education. New dietary recommendations to prevent FA were not in place. A retrospective chart review was used to evaluate use of an order set with patient education on EI to CAFs in the electronic medical record (EMR). Providers attended training on EI to CAFs and use of the EMR order set. Data were collected on the use of the order set over a 3-month period. Provider training significantly improved knowledge of FA as well as EI guidelines. After 3 months of implementation, 25.95% of eligible encounters contained the EI order set; 52% of patients received the order set during the measurement period. In the impact population, patients 4-12 months of age, 74.55% of patients received the order set. Evidence-based clinical content in EMR order sets coupled with provider training ensure clinical decision support in identifying, monitoring, and optimizing quality care standards.