0 Food Allergy Counseling: Study from Northwestern Medicine: Risk Taking Behavior Among Adolescents with Food Allergy

My colleague, Dr Ruchi Gupta sent me the following information about a study she is conducting for teens ages 14-22.  

"The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy."  

*Nota Bene: I am in no way involved in any aspect this study.*

More information is below from Dr Ruchi Gupta at Northwestern Feinberg School of Medicine, Northwestern University:

Study Overview: Researchers at Northwestern Medicine are conducting a research study entitled “Risk Taking Behavior among Adolescents with Food Allergy," which is currently enrolling participants.  The goal of this study is to learn more about the risk taking behaviors of food allergic adolescents – both in regard to general risk taking and risk taking as it relates to food allergy.  In order to participate in the study, adolescents between the ages of 14 and 22 years who currently have a food allergy are being asked to complete an entirely anonymous and confidential electronic survey. 

No protected health or identifying information is being collected.  No compensation is being offered in exchange for study participation. All aspects of this research study have been approved by the Northwestern Institutional Review Board, IRB STU00097291.

If you are between the ages of 18 and 22 and are interested in participating in this study, please click on this secure link to access the anonymous and confidential survey [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].

If you are a parent with a food allergic child between the ages of 14 and 17 and have no objections to your adolescent child participating in this study, please forward him/her this link [https://redcap.nubic.northwestern.edu/redcap/surveys/?s=TcT8XLeZeA].  The link will take him/her to the completely anonymous and confidential survey.

If you have any questions prior to making your decision, please feel free to contact Jacquie, jacqueline.pence@northwestern.edu, or Dr. Gupta, r-gupta@northwestern.edu.

Detail: Food Allergy Counseling: Study from Northwestern Medicine: Risk Taking Behavior Among Adolescents with Food Allergy

0 Food Allergy Counseling: How Common Is Anaphylaxis: Study

Some of the most well-respected leaders in the food allergy medical field, including Robert A. Wood, MD; Philip Lieberman, MD; Hugh A. Sampson, MD; and F. Estelle R. Simons, MD
were involved in a new study about anaphylaxis.

The conclusion: "According to the peer-reviewed study, anaphylaxis very likely occurs in nearly 1-in-50 Americans (1.6%), and the rate is probably higher, close to 1-in-20 (5.1%)."

Here's a full text of the Journal of Allergy and Clinical Immunology (JACI) study. 

Below is a partial of the press release from Asthma and Allergy Foundation of America (AAFA).

***

NEW STUDY SHOWS NEARLY 1-IN-50 AMERICANS AT-RISK FOR SEVERE ALLERGIC REACTIONS

Anaphylaxis is More Common Than Many Thought, Most Patients are Not Prepared

A novel study by the Asthma and Allergy Foundation of America (AAFA) published today in the Journal of Allergy and Clinical Immunology (JACI), finds that severe life-threatening allergic reactions – anaphylaxis – are common in the U.S.  According to the peer-reviewed study, anaphylaxis very likely occurs in nearly 1-in-50 Americans (1.6%), and the rate is probably higher, close to 1-in-20 (5.1%).

The article, Anaphylaxis in America: The Prevalence and Characteristics of Anaphylaxis in the United States, based on AAFA’s study of the same name, provides one of the most reliable estimates to-date of the prevalence of severe, life-threatening allergies in the general population.  It is also helping experts understand how the public, patients and caregivers think, feel and behave regarding anaphylaxis.  For the full text of the article, visit www.aafa.org/AnaphylaxisInAmerica.

Dr. Robert Wood is the lead author of the article, chair of the AAFA research panel that conducted the study, and Director of Allergy & Immunology at Johns Hopkins Children’s Center.  “This study provides the first estimate of anaphylaxis prevalence in the United States using a large unbiased survey,” according to the article.  But the authors also pointed out that patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.

“One of the most alarming things we found is that, despite the common occurrence of anaphylaxis, most people are not prepared to do the right thing when emergency reactions occur,” says Mike Tringale, Senior Vice President at AAFA and one of the authors of the article.  “We need to re-double our efforts to make sure that people are informed and have access to the right medication.”


For the full text of the article, visit www.aafa.org/AnaphylaxisInAmerica.

Detail: Food Allergy Counseling: How Common Is Anaphylaxis: Study

0 International Study, Flying with Food Allergies

Matthew Greenhawt, M.D., M.B.A., M.Sc., of the University of Michigan’s Food Allergy Center and C.S. Mott Children’s Hospital has authored a new study about the risks of flying with a peanut or tree nut allergy published in the Journal of Allergy and Clinical Immunology-In Practice called: International Study of Risk-Mitigating Factors and In-Flight Allergic Reactions to Peanut and Tree Nut.  [Disclosure: Greenhawt is a colleague and wrote about theories of the rise of food allergies in my food allergy lifestyle guide Allergic Girl: Adventures in Living Well with Food Allergies published by John Wiley & Sons in 2011.]

Here is a New York Times Well column about the study: Wisdom From Flyers With Nut Allergies.

And here's more information from a press release from the University of Michigan about Journal of Allergy and Clinical Immunology-In Practice study: International Study of Risk-Mitigating Factors and In-Flight Allergic Reactions to Peanut and Tree Nut:  

“Greenhawt, and his co-authors from Allergy & Anaphylaxis Australia and the International Food Allergy & Anaphylaxis Alliance, asked passengers to answer an online survey about their in-flight experiences.  More than 3,200 people from 11 countries completed the survey. Of those, 349 reported having an allergic reaction during an airline flight.”

The actionable items for all of us flying with a severe food allergy: “Flying with a peanut/tree nut allergy is equal parts frustrating and frightening for allergic passengers.  These eight passenger-initiated risk-mitigating behaviors may help clinicians wishing to advise concerned patients planning to fly commercially,” says Greenhawt, of U-M’s Food Allergy Center.

Passengers with peanut/tree nut allergies who reported taking these actions had significantly lower odds of reporting a reaction:
 
(1) requesting any accommodation
(2) requesting a peanut/tree nut-free meal
(3) wiping their tray table with a commercial wipe
(4) avoiding use of airline pillows
(5) avoiding use of airline blankets
(6) requesting a peanut/tree nut-free buffer zone
(7) requesting other passengers not consume peanut/tree nut-containing products 
(8) not consuming airline-provided food"

Have more questions? Contact your board certified allergist about the risks of commercial flying for your food allergic loved one. You can find allergists through your health insurer, American Academy of Allergy, Asthma & Immunology or American College of Allergy, Asthma and Immunology.

And, Allergic Living magazine had an updated airline and allergen policies chart here.

Detail: International Study, Flying with Food Allergies

0 Initiative seeks global accord on recognition and management of allergies, asthma and immune deficiencies, 2012

Another press release from AAAAI.org:

 ***

Initiative seeks global accord on recognition and management of allergies, asthma and immune deficiencies

iCAALL will release international consensus reports to positively impact care, cost-containmentand policy decisions.

ORLANDO—Hundreds of millions of people in the world suffer from allergies, and it is estimated that 300 million have asthma. Inadequate or improper diagnosis and treatment of these chronic diseases and of immunodeficiency disorders results in lost productivity and substantial medical and socioeconomic burdens throughout the world.

Recognizing a lack of consensus-driven information and general recommendations, four of the most influential allergy/immunology professional organizations have joined forces to launch the International Collaboration in Asthma, Allergy and Immunology (iCAALL). The effort was announced during the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology in Orlando, FL.

Participating in iCAALL are the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology (ACAAI), the European Academy of Allergy and Clinical Immunology (EAACI) and the World Allergy Organization (WAO).

“iCAALL is designed to collect and disseminate consensus-driven information about allergies, asthma and immunological diseases,” according to iCAALL’s Chair, Dennis Ledford, MD, FAAAAI. “We are confident that communicating this knowledge can positively impact diagnosis and treatment, as well as cost-containment and policy decisions.”

A major focus of this new initiative is the production of a series of International Consensus (ICON) reports. These documents will offer general recommendations based on global challenges in caring for patients with allergic and immunologic diseases. The first ICON on food allergy is set to be published in The Journal of Allergy and Clinical Immunology (JACI) and is available at http://www.jacionline.org/article/S0091-6749%2812%2900254-0/fulltext.

Detail: Initiative seeks global accord on recognition and management of allergies, asthma and immune deficiencies, 2012

0 Prolonged Exposure to Sublingual Immunotherapy Improves Safety of Oral Immunotherapy study, JACI

Interesting press release from the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI):

March 5, 2012 - Follow up story on CNN.com: Experimental treatment may help food allergies

***

One step closer to treatment for food allergy

ORLANDO – Currently, there is no cure for food allergy and no medication to prevent reactions. The only way to avoid a reaction is strictly avoiding the trigger food. This can be tricky because you have to carefully read food labels and ask about ingredients when eating food prepared by another person.
Yet, thanks to research from the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), more clues are falling into place regarding the prospects for safe treatments for food allergy.
 
Two potential treatments are sublingual immunotherapy and oral immunotherapy. The goal of immunotherapy is to build up your immune system. Your body responds to gradually increasing doses of the allergen by developing immunity or tolerance to it. The difference between sublingual and oral immunotherapy is that the allergen is held under the tongue with sublingual, where the allergen is simply swallowed with oral immunotherapy.

New research from the 2012 AAAAI Annual Meeting found that children with severe milk allergy who received a longer schedule of sublingual immunotherapy and then moved to oral immunotherapy had less respiratory reactions along with less frequent use of certain medications.

“While the overall result of the study, which was recently published in The Journal of Allergy and Clinical Immunology, found that oral was far more effective than sublingual immunotherapy, it was also clear that oral was associated with more significant allergic reactions to the treatment,” said senior study author Robert A. Wood, MD, FAAAAI, director of Allergy & Immunology at Johns Hopkins Children’s Center.
 
In their previous research, sublingual was compared to oral immunotherapy after a short period of increasing sublingual doses. To add another piece to the puzzle, the same researchers from Johns Hopkins and Duke University decided to see if a longer period on sublingual and then oral immunotherapy would improve the safety of the treatment.
 
Thirty children with cow’s milk allergy were randomly placed into two groups that received either a short or longer sublingual schedule followed by oral immunotherapy. Eight sublingual subjects 
moved over to oral immunotherapy. After comparing reactions across the doses, the study authors concluded that the longer sublingual schedule before moving to oral immunotherapy appeared to improve safety although it did not eliminate all symptoms. Symptoms occurred with approximately 25% of 2,251 doses.
 
While the overall rates of reaction between the two groups were similar, the longer sublingual immunotherapy group followed by oral immunotherapy had fewer lower and upper respiratory reactions and used antihistamines and inhaled beta-agonists less frequently.
 
“We continue to search for the best approach for the treatment of food allergy. This study shows that for at least some children, especially those with more frequent or severe reactions to oral immunotherapy, beginning treatment with sublingual might be beneficial,” emphasized Dr. Wood.
 
The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

###
 
Editorial notes:
•    This study was presented during the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on March 2-6 in Orlando. However, it does not necessarily reflect the policies or the opinions of the AAAAI.
 
•    A link to all abstracts presented at the Annual Meeting is available at www.annualmeeting.aaaai.org


***
Abstract 478:

Prolonged Exposure to Sublingual Immunotherapy Improves Safety of Oral Immunotherapy 
S. Seopaul1, C. A. Keet1, P. A. Frischmeyer-Guerrerio1, A. Thyagarajan2,J. T. Schroeder1, R. Hamilton1, S. Boden2, P. Steele2, S. Driggers1, A. W.Burks2, R. A. Wood1;1Johns Hopkins University, Baltimore, MD,2DukeUniversity, Durham, NC.

RATIONALE: We recently compared sublingual (SLIT) to oral immunotherapy (OIT) following a short SLIT escalation for treatment of cow’s milk (CM)-allergy and found that while SLIT was safer than OIT, it was less efficacious. This analysis sought to determine if a more prolonged period on SLIT could improve safety of subsequent OIT.

METHODS: 30 children with IgE-mediated-CM-allergy were randomized to either SLIT (goal 7mg daily, N510) or 4 weekly SLITescalations to a dose of 3.7mg followed by OIT (goal 1000 or 2000mg daily, N520). 

After 60 weeks of maintenance, SLIT subjects who reacted to less than 4gm CM-protein on food challenge crossed-over to OIT. Dose escalation started at less than ¼ the tolerated food challenge dose and escalated to 2000mg daily for one year. The rates of adverse events across dosing regimens were compared using negative binomial analysis with generalized estimating equations.

RESULTS: 8 SLIT subjects crossed over to OIT. Symptoms occurred with 24.4% of 2251 doses (oral 23.1%, skin 0.84%, GI 0.89%, lower respiratory 0.27% and upper respiratory 0.13%). One subject withdrew due to persistent GI symptoms. Antihistamines and inhaled beta-agonists were given for 1.3% and 0.04% of doses. Although the overall rates of reactions with OIT following brief versus prolonged SLIT were similar (p50.976), lower and upper respiratory reactions were significantly less common (p50.02 and p50.006, respectively) and antihistamines and inhaled betaagonists used less frequently (p50.002 and p50.001, respectively) in the prolonged SLIT group.

CONCLUSION: Prolonged SLIT before OIT dosing appeared to improve safety, but did not eliminate all symptoms.

Detail: Prolonged Exposure to Sublingual Immunotherapy Improves Safety of Oral Immunotherapy study, JACI

0 Pediatrics, Food Allergy

Last year Pediatrics, the journal of the American Academy of Pediatrics published a groundbreaking study.   

From FAI: According to a national survey of 38,480 families, 8 percent of children in the United States suffer from a food allergy – a considerably higher number than reported in previous studies. In addition to estimating that 5.9 million children under age 18 now have a food allergy, the new study, published in the July 2011 issue of Pediatrics, the journal of the American Academy of Pediatrics, provides a wealth of important new information.
The study’s findings include:
·       8% of children had at least one food allergy, a projected total of 5.9 million children across the U.S. population
·       2.4% of the children in the study had multiple food allergies, nearly one-third of those with allergies.
·       The prevalence of severe food allergies among the children studied was 3.1%, or 38.7% of the children with allergies.


And here's a copy of the study itself through a PDF copy.

Detail: Pediatrics, Food Allergy