Prevalence Of Allergy Research Articles

Using NHS Data to Monitor Trends in the Occurrence of Severe, Food-Induced Allergic Reactions Work Package 1

People with food allergies may experience food allergic reactions due to accidental exposure. These reactions are commonly categorised as non-severe, fatal food anaphylaxis and near-fatal food anaphylaxis. Non-severe allergic reactions to food are more common with an incidence of up to 1,000 times greater than fatal food-related anaphylaxis. However, obtaining accurate data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS). This project addressed two key questions: 1. What are the trends in the occurrence of food hypersensitivity (FHS) reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)? 2. What are the circumstances surrounding severe, life-threatening reactions to food? Approach The researchers used existing NHS datasets (relating to Hospital Admissions, Accident & Emergency visits, Critical Care admissions and Primary care visits) to evaluate healthcare encounters due to food hypersensitivity over the study period. Patient pathways through the healthcare system were also assessed by linking these different datasets. Key Results • Food-induced anaphylaxis represented 29.4% of reported anaphylaxis. admissions, and increased significantly from 1.23 to 4.02 admissions per 100,000 population per annum over the study period. • However, despite an annual increase of 5.7% in hospitalisation for food-induced anaphylaxis between 1998 and 2018, the case fatality rate (proportion of hospital admissions associated with a fatal outcome) more than halved, from 0.7% in 1998 to less than 0.3% in 2018. • 152 deaths were identified during the study period where the cause was very likely to have been food-induced anaphylaxis. • At least 86 (46%) fatalities were triggered by peanut or tree nuts. • Cows’ milk was reported to be the most common cause of fatal anaphylaxis in children aged under 16 years. • Using data from England for the period 2008-2018, the prevalence of food allergy ranged from 4% in preschool-aged children (under 5 years), 1-2% in school-aged children and young people (5 to 20 years) and 0.9% in adults. Although the same methods were used throughout the study period, the statistics presented may be prone to limitations such as miscoding and incomplete datasets. • Prescription of adrenaline auto-injector devices (AAI) are an important risk management intervention in people at risk of food-induced anaphylaxis. However, there is significant under-prescribing of AAI. Data showed that 40% of individuals with prior food-induced anaphylaxis were not prescribed AAI and at least 59% did not have AAI on repeat prescription. • Most healthcare visits for food allergy occurred in general practice. Less than 3% of individuals with a diagnosis of food allergy attended Accident and Emergency during the study period, 2008-2018. Therefore, using hospital data in isolation to analyse patterns of health service utilisation with respect to FHS may not provide a comprehensive overview.

Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data

Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset. We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England. The main outcomes were incidence and prevalence of food allergy, according to three definitions of food allergy: possible food allergy, probable food allergy, and probable food allergy with adrenaline autoinjectors prescription. We also evaluated the difference in proportion of patients prescribed adrenaline autoinjectors by English Index of Multiple Deprivation (IMD), age, and by previous food anaphylaxis, and explored differences in patient encounters (general practice vs emergency department setting). 7 627 607 individuals in the dataset were eligible for inclusion, of whom 150 018 (median age 19 years [IQR 4-34]; 82 614 [55·1%] female and 67 404 [44·9%] male) had a possible food allergy. 121 706 met diagnostic criteria for probable food allergy, of whom 38 288 were prescribed adrenaline autoinjectors. Estimated incidence of probable food allergy doubled between 2008 and 2018, from 75·8 individuals per 100 000 person-years (95% CI 73·7-77·9) in 2008 to 159·5 (156·6-162·3) individuals per 100 000 person-years in 2018. Prevalence increased from 0·4% (23 399 of 6 432 383) to 1·1% (82 262 of 7 627 607) over the same period and was highest in children under 5 years (11 951 [4·0%] of 296 406 in 2018) with lower prevalence in school-aged children (from 11 353 [2·4%] of 473 597 in 2018 for children aged 5-9 years to 6896 [1·7%] of 404 525 for those aged 15-19 years) and adults (42 848 [0·7%] of 5 992 454 in 2018). In those with previous food anaphylaxis, only 2321 (58·3%) of 3980 (975 [64·0%] of 1524 children and young people and 1346 [54·8%] of 2456 adults) had a prescription for adrenaline autoinjector. Adrenaline autoinjectors prescription was less common in those resident in more deprived areas (according to IMD). In the analysis of health-care encounters, 488 604 (97·1%) of 503 198 visits recorded for food allergy occurred in primary care, with 115 655 (88·4%) of 130 832 patients managed exclusively in primary care. These estimates indicate an important and increasing burden of food allergy in England. Our findings that most patients with food allergy are managed outside the hospital system, with low rates of adrenaline autoinjector prescription in those with previous anaphylaxis, highlight a need to better support those working in primary care to ensure optimal management of patients with food allergy. UK Food Standards Agency and UK Medical Research Council.

Patch Testing to Mentha piperita (Peppermint) Oil: The North American Contact Dermatitis Group Experience (2009-2020).

Background: Mentha piperita (MP; peppermint) oil has many commercial uses. Objective: To characterize the epidemiology of contact allergy to MP oil 2% petrolatum. Methods: Retrospective analysis of North American Contact Dermatitis Group data (2009-2020). Results: Of 28,128 patients tested to MP, 161 (0.6%) had an allergic reaction. Most allergic patients were female (77.0%) and/or over 40 years of age (71.4%). The most common anatomical sites of dermatitis included face (31.7%; of these, one-third specified lips), hands (17.4%), and scattered/generalized (18.6%). Nearly one-third (30.4%) of reactions were strong (++)/extreme (+++), and 80.1% were considered currently relevant. Common sources included oral hygiene preparations, foods, and lip products. Co-reaction with at least 1 of the other 19 fragrance/plant-related screening test preparations occurred in 82.6% (133/161) of MP-allergic patients, most commonly Cananga odorata oil (42.9%), fragrance mix I (41.0%), hydroperoxides of linalool (35.7%), Compositae mix (35.4%), Jasminum officinale oil (31.9%), Myroxylon pereirae (31.7%), and propolis (28.1%). Co-reaction with at least 1 of the 3 most commonly used fragrance screening allergens (fragrance mix I, fragrance mix II, and/or Myroxylon pereirae) was 59.6%. Conclusions: Twelve-year prevalence of MP allergy was 0.6%. Approximately 40% of cases would have been missed if only fragrance screening allergens were tested.

Prevalence of Parent-Reported Food Allergies Among Children in Saudi Arabia.

(1) Background: Food allergy (FA) is an immune-mediated hypersensitivity to foods, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence, characteristics, and influencing factors of parent-reported FAs among children in Saudi Arabia. (2) Methods: This cross-sectional study utilized a validated parental questionnaire distributed across all regions of Saudi Arabia. Data from 2130 participants were collected and analyzed using SPSS v. 26 and Prism software v. 10.3.0. (3) Results: Parent-reported FA prevalence was 15.2%. Egg was the most common allergen (6.2%), followed by tree nuts (4.1%), peanuts (4.0%), milk (3.8%), and sesame (3.2%). Significant geographical variations were observed, with the western region having the highest burden (p < 0.001). Older children had higher rates of shellfish and fish allergies. Parental allergies and co-existing asthma/drug allergies were positively associated with childhood FAs. (4) Conclusions: This study highlights a substantial burden of parent-reported FAs in Saudi Arabia, with regional variations in food allergen distribution. Parental allergies and co-existing allergic conditions may influence FA risk.

Comparing prevalence of food allergy in exercise-induced bronchoconstriction vs asthma

Comparing prevalence of food allergy in exercise-induced bronchoconstriction vs asthma

Hymenoptera venom allergy in children and adolescents.

This review will identify and summarize the published existing data pertaining specifically to Hymenoptera venom allergy in children and adolescents, highlighting the major studies currently available on venom immunotherapy (VIT) and its prognosis in children. The current review covers the incidence and prevalence of Hymenoptera venom allergy (HVA) in children, factors influencing occurrence and severity of reactions (age, sex, comorbidities, etc.), indications to perform diagnostic tests and start VIT in children, different existing VIT protocols and their safety and efficacy. Hymenoptera venom allergy is the second most common cause of anaphylaxis in children and it considerably affects quality of life. Cutaneous reactions are the most prevalent clinical presentation in children who usually have a more favourable prognosis than adult patients. However, studies on HVA in children and adolescents are still limited. Currently VIT is the only treatment able to modify the natural history of HVA in adults as well as in children, and to protect patients from systemic reactions after subsequent stings.

Differences in the prevalence of allergy and asthma among US children and adolescents during and before the COVID-19 pandemic

BackgroundThe increasing prevalence of allergies and asthma has led to a growing global socioeconomic burden. Since the outbreak of the COVID-19 pandemic, the health and lifestyles of children and adolescents have changed dramatically. It’s unclear how this shift impacted allergy and asthma, with limited studies addressing this question. We aim to explore the difference of the prevalence of allergies and asthma among US children and adolescents during and before the COVID-19 pandemic using a nationally representative sample of US children and adolescents.MethodsThis cross-sectional study included 31,503 participants in the National Health Interview Survey (NHIS) between 2018 and 2021. Allergies and asthma were defined on an affirmative response in the questionnaire by a parent or guardian. Chi-square tests were used to compare baseline characteristics with allergies and asthma for categorical variables. Differences in prevalence during and before the COVID-19 pandemic were estimated with weighted logistic regression, adjusting for demographic factors. Interaction analyses explored variations across strata.ResultsIn US children and adolescents aged 0 to 17, prevalence of any allergy was 26.1% (95% CI, 24.8%- 27.4%) in 2018 and 27.1% (95% CI, 25.9%- 28.2%) in 2021. Thereinto, in 2018, prevalence of respiratory allergies, food allergies and skin allergies were 14.0% (95% CI, 13.1%- 15.0%), 6.5% (95% CI, 5.8%- 7.1%) and 12.6% (95% CI, 11.6%- 13.5%), respectively, and in 2021, 18.8% (95% CI, 17.8%- 19.9%), 5.8% (95% CI, 5.2%- 6.4%) and 10.7% (95% CI, 9.9%- 11.5%), respectively. And prevalence of asthma was 11.1% (95% CI, 10.5%- 11.7%) in 2018–2019 and 9.8% (95% CI, 9.2%- 10.4%) in 2020–2021. Prevalence of respiratory allergies, skin allergies and asthma during and before the COVID-19 pandemic in children and adolescents had statistically significant differences. The differences persisted after adjusting for demographic and socioeconomic variables.ConclusionPrevalence of respiratory allergies increased and the prevalence of both skin allergies and asthma decreased among US children and adolescents during the COVID-19 pandemic compared with the pre-COVID-19 pandemic. Further research is required to explore the association between allergic diseases and the pandemic, with a particular emphasis on the impact of lifestyle changes resulting from measures to prevent COVID-19 infection.

Towards an optimized model of food allergy in zebrafish

BackgroundThe prevalence of food allergies is on the rise, posing a significant challenge to public health. Rodents serve as the predominant animal model in food allergy research; yet, the application of rodent models proves to be a laborious and time-consuming endeavor. It is imperative to develop novel in vivo models. MethodsOvalbumin (OVA) was administered as the allergen, following the recommended dosage used in other species. During the sensitization phase, a dosage of 0.25 mg per 10 tails per 1 L was administered twice daily, and during the challenge phase, the dosage was increased to 3 times the initial level. The study explored two dimensions of sensitization: the mode of exposure, which can be either continuous or intermittent, and the duration of exposure, which includes 3 days, 5 days, and 7 days. We examined midgut pathological changes, immunoglobulins contents, and mRNA expressions associated to T helper cells (Th) 2 cytokines following exposure. ResultsA significant 109.3 % increase in the number of eosinophils was observed in the midgut histopathology following intermittent 5-day OVA exposure, which emerged as the most effective model. OVA exposure increased concentrations of immunoglobulin M (IgM) (105.2 %), IgZ (312.1 %), and IgD (304.3 %) in this model. The mRNA expressions of Th2-related interleukin (IL)-4 and IL-13 were also elevated by 132.8 % and 421.0 %, respectively. ConclusionThe intermittent 5-day OVA exposure was suggested to be the best constructed zebrafish food allergy model, which may be a potential tool for research into food allergies.

IgE-Mediated Cannabis Allergy and Cross-Reactivity Syndromes: A Roadmap for Correct Diagnosis and Management.

With increased access and decriminalization of cannabis use, cases of IgE-dependent cannabis allergy (CA) and cross-reactivity syndromes have been increasingly reported. However, the exact prevalence of cannabis allergy and associated cross-reactive food syndromes (CAFS) remains unknown and is likely to be underestimated due to a lack of awareness and insufficient knowledge of the subject among health care professionals. Therefore, this practical roadmap aims to familiarize the reader with the early recognition and correct management of IgE-dependent cannabis-related allergies. In order to understand the mechanisms underlying these cross-reactivity syndromes and to enable personalized diagnosis and management, special attention is given to the molecular diagnosis of cannabis-related allergies. The predominant signs and symptoms of CA are rhinoconjunctivitis and contact urticaria/angioedema. However, CA can also present as a life-threatening condition. In addition, many patients with CA also have distinct cross-reactivity syndromes, mainly involving fruits, vegetables, nuts and cereals. At present, five allergenic components of Cannabis sativa (Can s); Can s 2 (profilin), Can s 3 (a non-specific lipid protein), Can s 4 (oxygen-evolving enhancer protein 2 oxygen), Can s 5 (the Bet v 1 homologue) and Can s 7 (thaumatin-like protein) have been characterized and indexed in the WHO International Union of Immunological Sciences (IUIS) allergen database. However, neither of them is currently readily available for diagnosis, which generally starts by testing crude extracts of native allergens. The road to a clear understanding of CA and the associated cross-reactive food syndromes (CAFS) is still long and winding, but well worth further exploration.

A New Hybrid Classification Framework in Childhoods Allergies with Dataset Slicing Method

Childhood allergies, particularly food allergies, are growing more frequent. Their major influence on children's health and well-being has piqued the interest of worldwide public health officials. The increased prevalence of childhood allergies in Turkey, where these patterns are also relevant, adds urgency to the need for effective classification and management options. This study addresses the shortcomings of simple classification algorithms in obtaining high accuracy by presenting a novel hybrid classification methodology. The research creates a novel method where three different prediction models are built by combining Support Vector Machine and Decision Tree classifiers. This method improves the classification process by taking into account instances that have been incorrectly classified as possible sources of useful information instead of just being noise. This instance filtering-based hybrid classification algorithm that is used in this study maintains the simplicity of interpreting learning outcomes while achieving comparatively high accuracy. Extensive experiments on the allergy dataset show the effectiveness of this hybrid approach, with an impressive accuracy of 0.906. This greatly outperforms the fundamental classification algorithms. The experimental outputs have important implications for medical professionals. This study might add a valuable contribution to the literature by giving a fresh solution to childhood allergy classification.

Allergies. there are People who are Born with Allergies, and there are others who Develop them after Years of Consuming an Aliment without any Problem

Survey collected demographic, psychosocial, and allergic data from 108 food allergy sufferers (85% female; 18-87). Following that, participants completed a two-week online diary survey on stress, mood, and energy and a 25-item food allergy checklist (based on iii Study 1) throughout the day. Daily polls show widespread allergies. Food allergies, the cost of avoiding particular foods, the anxiety of food safety concerns, the difficulty of maintaining a balanced diet, and the pressure of social activities centred on food were all issues. Allergy days increased stress and negativity, according to multilevel studies. Seniors were less energetic on allergy days. Rural and suburban communities frequently do better than smaller cities. Character may affect food allergy management. This study supports the first's results While food allergy rates are rising, little is known about its practical effects. This research sought to identify food allergy sufferers' issues, measure how much they affect daily life, explore how demographic and psychological factors affect food allergies, and devise solutions to help them. Study 1's qualitative results informed Study 2's quantitative findings. (2). The first research examined dietary allergies and health-related quality of life. Focus groups with four demographics helped researchers understand food allergy problems. Lifelong consumer susceptibility. Vulnerability depended on demographics, food allergy awareness, prejudice and stigma, pricing and availability of allergen-free choices, food label clarity, and restaurant wait staff skill (external conditions). The second research examined how much food allergy symptoms affected daily living (in terms of stress, mood, and energy levels). An online on food allergy prevalence and stress.

All roads lead to IgA: Mapping the many pathways of IgA induction in the gut.

The increasing prevalence of food allergy and related pathologies in recent years has underscored the need to understand the factors affecting adverse reactions to food. Food allergy is caused when food-specific IgE triggers the release of histamine from mast cells. However, other food-specific antibody isotypes exist as well, including IgG and IgA. IgA is the main antibody isotype in the gut and mediates noninflammatory reactions to toxins, commensal bacteria, and food antigens. It has also been thought to induce tolerance to food, thus antagonizing the role of food-specific IgE. However, this has remained unclear as food-specific IgA generation is poorly understood. Particularly, the location of IgA induction, the role of T cell help, and the fates of food-specific B cells remain elusive. In this review, we outline what is known about food-specific IgA induction and highlight areas requiring further study. We also explore how knowledge of food-specific IgA induction can be informed by and subsequently contribute to our overall knowledge of gut immunity.

Current frequency of contact allergy to isothiazolinones (methyl-, benz- and octylisothiazolinone) across Europe.

The use of methylisothiazolinone (MI) as a preservative in cosmetic products caused an alarming increase in MI contact allergy across Europe in the 2010s. This was followed by regulations of use with a total ban on leave-on (implemented in 2017) and reduced use concentrations in rinse-off cosmetics (2018). To follow-up on the prevalence of contact allergy to MI and the related benzisothiazolinone (BIT) and octylisothiazolinone (OIT) in consecutively patch-tested patients in Europe. A cross-sectional audit following the design of two previous audits on MI contact allergy from 1 May 2022 to 31 October 2022 included all patients patch tested with the European baseline series, including or supplemented with MI, BIT and OIT across 10 departments in eight European countries. A total of 2554 patients were consecutively patch tested with the three isothiazolinones during the study period. The prevalence of MI and BIT contact allergy was 2.9% (95% confidence interval [CI]: 2.3%-3.7%; range 1.1%-5.8%) and 3.1% (95% CI: 2.4%-3.9%; range 0.0%-6.6%), respectively; that of OIT was 0.7% (95% CI: 0.4%-1.1%; range 0%-3.2%). Rinse-off cosmetic (73.3%) and leave-on cosmetic products (13.3%) were still associated with eliciting allergic contact dermatitis to MI. We confirmed a positive impact of regulatory measures on the prevalence of MI contact allergy in Europe, which halved compared to 2015. However, our data suggest that consumers may still be exposed to older cosmetic products containing MI. BIT has superseded MI in causing contact allergy, despite not being allowed for use in cosmetic products.

Comparison of allergy prevalence using brinzolamide 1.0% / brimonidine 0.2% fixed combination with and without β-blocker in glaucoma patients: a retrospective cohort study

BackgroundGlaucoma treatment often involves multi-drug regimens, which can lead to poor adherence and side effects. Fixed-dose combinations aim to improve adherence and reduce side effects compared to traditional therapies. This study aimed to compare the prevalence and clinical characteristics of ocular allergy in glaucoma patients using brinzolamide 1.0%/brimonidine 0.2% fixed combination (BBFC), with and without concurrent β-blocker.MethodsOf these, 176 patients used a β-blocker concurrently, whereas 96 patients did not. Allergy prevalence, allergy type, and allergy occurrence time were compared between the concurrent and non-concurrent β-blocker-usage groups. Ocular allergies were classified and evaluated using Kaplan–Meier survival analysis.ResultsAllergy prevalence was 10.23% and 15.63% (p = 0.193), whereas allergy occurrence time was 15.92 ± 13.80 months and 6.26 ± 6.20 months (p = 0.04) in the concurrent and non-concurrent β-blocker-usage groups, respectively. Kaplan–Meier survival analysis indicated that half of the allergies in the concurrent β-blocker-usage group occurred within 12.5 months, with the BBFC discontinuation rate gradually increasing up to 36 months. Contrarily, half of the allergies in the non-concurrent β-blocker-usage group occurred within 3.3 months, with a rapid increase in BBFC discontinuation rate the first 6 months. Intergroup differences in allergy types were significant (p = 0.015). Among all patients with allergy, the average allergy occurrence time of blepharoconjunctivitis, papillary conjunctivitis, and follicular conjunctivitis was 12.52, 9.53, and 13.23 months, respectively. Follicular conjunctivitis tended to occur later than papillary conjunctivitis (p = 0.042). In the concurrent β-blocker-usage group, follicular conjunctivitis was the most prevalent allergy type (61.1%), whereas papillary conjunctivitis was the most common (66.7%) in in the non-concurrent β-blocker-usage group.ConclusionsConcurrent use of β-blocker with BBFC decreases allergy prevalence, delays allergy onset, and predominantly results in follicular conjunctivitis, thereby facilitating longer treatment duration. Understanding these characteristics of allergy in BBFC users is useful to manage patients and improve treatment adherence. This study provides insights into the role of β-blockers in modulating ocular allergy in BBFC-treated glaucoma patients, highlighting implications for clinical practice and patient education.

Inulin-gel-based oral immunotherapy remodels the small intestinal microbiome and suppresses food allergy.

Despite the potential of oral immunotherapy against food allergy, adverse reactions and loss of desensitization hinder its clinical uptake. Dysbiosis of the gut microbiota is implicated in the increasing prevalence of food allergy, which will need to be regulated to enable for an effective oral immunotherapy against food allergy. Here we report an inulin gel formulated with an allergen that normalizes the dysregulated ileal microbiota and metabolites in allergic mice, establishes allergen-specific oral tolerance and achieves robust oral immunotherapy efficacy with sustained unresponsiveness in food allergy models. These positive outcomes are associated with enhanced allergen uptake by antigen-sampling dendritic cells in the small intestine, suppressed pathogenic type 2 immune responses, increased interferon-γ+ and interleukin-10+ regulatory T cell populations, and restored ileal abundances of Eggerthellaceae and Enterorhabdus in allergic mice. Overall, our findings underscore the therapeutic potential of the engineered allergen gel as a suitable microbiome-modulating platform for food allergy and other allergic diseases.

Infantile Peanut Introduction and Peanut Allergy in Regions With a Low Prevalence of Peanut Allergy: The Japan Environment and Children's Study (JECS).

In regions with a high prevalence of peanut allergy (PA), there is a consensus that the introduction of peanuts in early infancy is preventive against the development of PA. However, few studies have investigated whether the introduction of peanuts to infants is associated with PA in regions with a low prevalence of PA, including Japan. We used data from 74,240 mother-child pairs who participated in the Japan Environment and Children's Study, a prospective birth cohort recruited between January 2011 and March 2014. A logistic regression model was used to analyze the association between infantile peanut introduction and PA at the age of 4 years with non-infantile peanut introduction as the reference group, adjusted for potential confounders. The percentage of infantile peanut introduction was 4.9% (n = 3,294), and 286 (0.4%) participants had allergic symptoms to peanuts at 4 years of age. Of all participants, 129 (0.2%) had PA at 4 years of age, which was defined as allergic symptoms and sensitization to peanuts. Those with infantile peanut introduction had a lower prevalence of PA than those without infantile peanut introduction, although this did not reach statistical significance (adjusted odds ratio 0.53; 95% confidence interval, 0.17-1.68). Sensitivity analysis using IgE-mediated symptoms caused by peanuts as the outcome showed a similar result in relation to infantile peanut introduction. In countries with a low prevalence of PA, the effect of infantile peanut introduction on PA prevention was unclear.

Prevalence and Determinants of Food Allergy in the Era of Early Allergen Introduction: the EarlyNuts Population-Based Study

BackgroundInfant feeding guidelines in Australia changed in 2016 to recommend introduction of common allergy causing foods by age 1 year to prevent food allergy. Although the majority of Australian infants now eat peanut and egg by age 6-months, some still develop food allergy despite introducing allergens early. ObjectiveWe aimed to describe the prevalence of food allergy in a cohort recruited after introducing the nation-wide allergy prevention recommendations; identify characteristics of infants who developed allergy despite early introduction of allergens; and estimate the causal effect of modifiable exposures on food allergy prevalence and whether this differed between infants who were introduced to allergen before or after age 6 months. MethodsWe recruited a population-based sample of 12-month-old infants in Melbourne, Australia. Infants had skin prick tests to 4 foods and parents completed questionnaires. Infants with evidence of sensitisation were offered oral food challenges. Prevalence estimates were adjusted using inverse probability weighting. ResultsIn a cohort of infants (n=1420) where nearly all infants had been introduced to common allergens such as egg, milk and peanut by one-year-of age, the prevalence of food allergy remained high at 11.3% (95% CI 9.6-13.4%). Infants who developed food allergy despite introducing the allergen by age 6-months were more likely to have Asian-born parents. Early-onset moderate/severe eczema was associated with an increased odds of food allergy, irrespective of whether allergens were introduced before or after age 6 months. Among infants who were introduced to peanut ≤6m, antibiotic use by age 6 months was associated with an increased odds of peanut allergy (aOR 6.03 (95%CI 1.15-31.60). ConclusionIn a cohort where early allergen introduction was common, the prevalence of food allergy remained high. Infants who developed food allergy despite introducing the respective allergen by 6 months were more likely to have Asian parents and early-onset eczema. New interventions are needed for infants with a phenotype of food allergy that is not amenable to early allergen introduction.

Prevalence of food allergy increased 1.7 times in the past 10 years among Japanese patients below 6 years of age.

While food allergy (FA) has been increasingly recognized as a growing public health burden worldwide, epidemiological studies on FA in Japan are limited. This was a noninterventional, observational study using the administrative claims data from 2010 to 2019 (10 years). Patients with physician-diagnosed FA in Japan (prevalent cohort) were divided into high-risk or low-risk cohorts using adrenaline prescription. The high-risk cohort was further divided into anaphylaxis or nonanaphylaxis cohort based on the occurrence of anaphylaxis or a serious allergic reaction (SAR) during 1 year after adrenaline prescription. The primary objective was to examine yearly prevalence of FA. The secondary objectives were to describe demographics/clinical characteristics and healthcare resource utilization (HCRU), to evaluate the number of occurrences of anaphylaxis/SAR in the high-risk cohort, and the impact of anaphylaxis/SAR on HCRU. The overall standardized prevalence rate was 0.325% (95% confidence interval [CI], 0.311-0.339) in 2010 and 0.797% (95% CI, 0.790-0.804) in 2019 and predominant in patients age <6 years (preschool; 3.377% [95% CI, 3.229-3.525] in 2010 and 5.726% [95% CI, 5.663-5.789] in 2019). Majority of FA patients (>80%) were children/adolescent throughout the 10 years. While high-risk cohort was a relatively minor population (8.5% in the prevalent cohort in 2019), the occurrence of anaphylaxis/SAR in the high-risk cohort was 227,690/100,000 patient-years. Multivariate analysis showed a significant increase in HCRU variables in the anaphylaxis versus nonanaphylaxis cohort (e.g., 2.08 [95% CI, 2.05-2.11] times more FA-related outpatient visits). Prevalence of FA increased in a statistically significant way from 2010 to 2019; 1.7-fold increase was observed in patients <6 years old. Patients in the high-risk cohort appear to have suffered from frequent anaphylaxis/SAR, highlighting an unmet medical need for FA patients at "high-risk," considering the unavailability of approved medications to prevent anaphylaxis/SAR.

Knowledge, attitude, and practices of restaurant and foodservice personnel in food allergy. A systematic review and meta-analysis

BackgroundCurrently, there may be 240–250 million people worldwide affected by food allergies. Dining out can be challenging for individuals with food allergies who rely on restaurant and food service staff to properly prepare allergen-free meals. For this reason, the personnel working in restaurants and other food services play a significant role in managing the risks faced by customers with food allergies. ObjectivesA systematic review and meta-analysis was conducted to assess the existing evidence concerning the knowledge, attitudes, and practices related to food allergies among restaurant and foodservice personnel. MethodsTo identify, characterize, and synthesize published research on the prevalence of positive responses regarding knowledge, attitudes, and practices related to food allergies among restaurant and food service personnel, international recommendations for systematic reviews and PRISMA guidelines were followed. The search was conducted between January 2012 and January 2022, utilizing the electronic databases PubMed, Web of Science, Scopus, and the Cochrane Library. Selection and data extraction were carried out following predefined protocols, and constructs based on reported outcomes were generated and subsequently analyzed in the meta-analysis. Trials were evaluated using the Cochrane tool for risk of bias. The results are presented using summary tables, forest plots, and box plots, showcasing the combined proportion of constructs obtained from independent surveys conducted without control groups. These constructs were then grouped into categories as an organizational framework and analyzed to determine their distribution among quintiles, aiming to provide a detailed overview of data variability. This strategy allowed us to demonstrate how results from the analyzed categories were distributed. ResultsThe algorithm identified 23 relevant studies, primarily originating from the United States and Europe. The main observed variability was related to the evaluated populations and the instruments used. A total of 28 constructs were identified, with 10 related to knowledge, 9 to attitudes, and 9 to practices. A proportion meta-analysis was conducted to determine the prevalence of positive responses within these three study categories. The results obtained reveal that, in the knowledge category, quintiles 4 and 5 exhibit strong knowledge on the subject (over 84 %). In contrast, starting from quintile 2, the majority of participants shows a positive attitude toward catering to consumers with food allergies (over 85 %). However, after examining the practices category, responses belonging to quintile 5 reflect a low level of risk, while in the other quintiles, behaviors with a higher potential risk for consumers with food allergies are identified. ConclusionsThe knowledge, attitudes, and practices of personnel in the food service sector are crucial due to the increasing prevalence of food allergies today, as well as the growing frequency of eating out. Knowledge is the most extensively studied category, showing generally acceptable but still insufficient levels in some areas. Positive attitudes are expressed towards individuals disclosing allergic conditions, yet they do not necessarily correlate with high levels of knowledge. The identified practices do not ensure the safety of the dish served to the customer. There is limited awareness regarding the importance of preventing acute allergic reactions at the time of food consumption. Restaurants and food services should train all staff involved in customer service, implement protocols aimed at preventing allergic reactions during food service, and establish guidelines for handling a customer experiencing an acute reaction.The limitations of this research are related to the heterogeneity present in the synthesized results, urging caution when interpreting the overall estimate of the combined effect, as the findings may not be applicable to all populations or study settings. Indeed, more studies are needed to enhance result precision and provide more specific recommendations for catering to allergic customers in restaurants and food services.

A synbiotic of Anaerostipes caccae and lactulose prevents and treats food allergy in mice

Depletion of beneficial microbes by modern lifestyle factors correlates with the rising prevalence of food allergies. Re-introduction of allergy-protective bacteria may be an effective treatment strategy. We characterized the fecal microbiota of healthy and food-allergic infants and found that the anaerobe Anaerostipes caccae (A.caccae) was representative of the protective capacity of the healthy microbiota. We isolated a strain of A.caccae from the feces of a healthy infant and identified lactulose as a prebiotic to optimize butyrate production by A.caccae invitro. Administration of a synbiotic composed of our isolated A.caccae strain and lactulose increased luminal butyrate in gnotobiotic mice colonized with feces from an allergic infant and in antibiotic-treated specific pathogen-free (SPF) mice, and prevented or treated an anaphylactic response to allergen challenge. The synbiotic's efficacy in two models and microbial contexts suggests that it may be a promising approach for the treatment of food allergy.