J. O'b. Hourihane

Bio: J. O'b. Hourihane is an academic researcher from University College Cork. The author has contributed to research in topics: Food allergy & Population. The author has an hindex of 23, co-authored 53 publications receiving 2196 citations. Previous affiliations of J. O'b. Hourihane include Boston Children's Hospital & Our Lady's Children's Hospital.

Impact of peanut allergy on quality of life, stress and anxiety in the family

Abstract: Background: Peanut allergy (PA) is known to impact on quality of life (QoL) of the sufferer, but little research has focused on all family members. We therefore sought to establish the impact of PA on QoL and reported anxiety of children with clinically confirmed PA, their parents and older siblings. Methods: Forty-six families, who had a child with PA, completed QoL (PedsQLTM or WHOQOL-BREF), anxiety (SCAS or STAI) and perceived stress (PSS) scales. PA children completed a PA specific QoL questionnaire (Pediatr Allergy Immunol 2003;14:378). Parents and sibling also completed QoL proxy questionnaires for the PA child (PedsQLTM, Pediatr Allergy Immunol 2003;14:378). Results: Mothers rated their own psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse than fathers rated theirs, and had higher scores than fathers for anxiety (P < 0.05) and stress (P < 0.001). Children with PA had significantly poorer physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and general QoL (P < 0.05) than their siblings did, and greater separation anxiety (P < 0.05). The majority of differences were between girls with PA and female siblings. Mothers felt that there was a greater impact on QoL for their PA child, compared with that reported by siblings, fathers or the PA children themselves (P < 0.01). Conclusions: Mothers report that they have significantly poorer QoL and suffer more anxiety and stress than fathers do; this inter-parental difference may be an important feature of family stress caused by PA. Siblings have a similar view of how QoL affects the PA child as the PA child does, while mothers may possibly overestimate this impact.

Food allergy QoL questionnaire for children aged 0-12 years : content, construct, and cross-cultural validity

Abstract: Summary Background To date, there is no food allergy-specific questionnaire that allows parents to report children's health-related QoL (HRQL) from the child's perspective. Objective The aim of this study was to develop a sensitive, multi-dimensional measure to assess parental perception of HRQL in children aged 0–12 years with food allergy. Methods The Food Allergy QoL – Parent Form (FAQLQ-PF) was developed and validated in four stages: (1) item generation using focus groups, expert opinion, and literature review; (2) item reduction, using clinical impact and factor analysis; (3) internal and test–retest reliability and construct validity were evaluated using relevant scales of the Child Health Questionnaire (CHQ)-28 and the disease-specific food allergy independent measure (FAIM); and (4) cross-cultural and content validity was examined by administering the questionnaire in a US sample. Results Stage 1: Saturation was reached at 110 items. Stage 2: The reduced instrument has 14 items for children <4 years and 26 and 30 items for children aged 4–6 years and 7–12 years, respectively. Factor analysis revealed three subscales: emotional impact, food anxiety, and social and dietary limitations, accounting for 68% of the variance. Stage 3: Cronbach's α >0.7 for subscales and total score. Construct validity was demonstrated by significant correlations between relevant scales of the CHQ-28 and FAQLQ-PF subscales (r=0.69–0.77, P<0.01), and between FAQLQ-PF subscales and the FAIM. Sensitivity was shown by significant within-group differences in a sample of 124 food-allergic children. Stage 4: The FAQLQ-PF was validated in a sample of US children, Cronbach's α >0.7 for subscales and total score. Construct validity was demonstrated by significant correlations between FAQLQ-PF and the FAIM (parent report) and between the FAQLQ-PF and the FAIM (child report). No differences were observed between the US and Irish scores. Conclusion The FAQLQ-PF is psychometrically robust, with excellent reliability and validity.

Can we identify patients at risk of life-threatening allergic reactions to food?

Abstract: Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

Development and validation of a self‐administered Food Allergy Quality of Life Questionnaire for children

Abstract: Summary Background Having a food allergy may affect health-related quality of life (HRQL). Currently, no validated, self-administered, disease-specific HRQL questionnaire exists for children with food allergy. Objective The aim of this study was to develop and validate the Food Allergy Quality of Life Questionnaire – Child Form (FAQLQ-CF) in the Dutch language. Methods Interviews with food-allergic children (n=13, 8–12 years) generated 139 HRQL items. The most important items were identified by 51 food-allergic children using the clinical impact method. This resulted in the FAQLQ-CF containing 24 items (total score range 1 ‘not troubled’ to 7 ‘extremely troubled’). The FAQLQ-CF, the Food Allergy Independent Measure (FAIM) and a generic HRQL questionnaire (CHQ-CF87) were sent to 115 food-allergic children for cross-sectional validation of the FAQLQ-CF. Results Construct validity was demonstrated by the correlation between the FAQLQ-CF and the FAIM (rho=0.60, P 2 food allergies vs. 2 food allergies; total FAQLQ-CF score, 4.3 vs. 3.6; P=0.036), but did not discriminate between reported anaphylaxis or not. The total FAQLQ-CF score correlated with 8 of the 11 CHQ-CF87 sub-scales which demonstrated convergent/discriminant validity. Conclusion The FAQLQ-CF is the first self-administered disease-specific HRQL questionnaire for food-allergic children. This questionnaire has a strong internal consistency and cross-sectional validity. It discriminates between children who differ in number of food allergies, and it was short and easy to use in the population studied. Therefore, the FAQLQ-CF may be a useful tool in clinical research.

EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community.

Abstract: The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report

Abstract: Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.

EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy

Abstract: Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management.

Abstract: This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.

Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology

Abstract: Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.