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Rosialzira N. Vera-Berrios

Bio: Rosialzira N. Vera-Berrios is an academic researcher from Hospital Clínico San Carlos. The author has contributed to research in topics: Population & Oral food challenge. The author has an hindex of 1, co-authored 4 publications receiving 2 citations.

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Journal ArticleDOI
TL;DR: In this paper, a single-dose challenge study was conducted to validate a predicted ED05 for cow's milk of 0.5 mg protein, which is the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population.
Abstract: Background There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single-dose challenge study to validate a predicted ED05 for cow's milk of 0.5 mg protein. Methods Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity. Results 172 children (median age 6.0 (IQR 0.7-11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%-11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single-dose challenge using 0.5 mg cow's milk protein. Conclusions These data support an estimated ED05 for cow's milk of 0.5 mg protein. Values for ED05 above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.

14 citations

Journal ArticleDOI
12 Nov 2021-Allergy
TL;DR: In this paper, a multidisciplinary experts consensus was decided to develop a food allergy severity score (FASS) with ordinal (oFASS), and numerical (nFASS): oFASS with 3 and 5 grades, and nFASS by mathematical modeling.
Abstract: Background The heterogeneity and lack of validation of existing severity scores for food allergic reactions limit standardization of case management and research advances. We aimed to develop and validate a severity score for food allergic reactions. Methods Following a multidisciplinary experts consensus, it was decided to develop a food allergy severity score (FASS) with ordinal (oFASS) and numerical (nFASS) formats. oFASS with 3 and 5 grades were generated through expert consensus, and nFASS by mathematical modeling. Evaluation was performed in the EuroPrevall outpatient clinic cohort (8232 food reactions) by logistic regression with request of emergency care and medications used as outcomes. Discrimination, classification, and calibration were calculated. Bootstrapping internal validation was followed by external validation (logistic regression) in 5 cohorts (3622 food reactions). Correlation of nFASS with the severity classification done by expert allergy clinicians by Best-Worst Scaling of 32 food reactions was calculated. Results oFASS and nFASS map consistently, with nFASS having greater granularity. With the outcomes emergency care, adrenaline and critical medical treatment, oFASS and nFASS had a good discrimination (receiver operating characteristic area under the curve [ROC-AUC]>0.80), classification (sensitivity 0.87–0.92, specificity 0.73–0.78), and calibration. Bootstrapping over ROC-AUC showed negligible biases (1.0 × 10−6–1.23 × 10−3). In external validation, nFASS performed best with higher ROC-AUC. nFASS was strongly correlated (R 0.89) to best-worst scoring of 334 expert clinicians. Conclusion FASS is a validated and reliable method to measure severity of food allergic reactions. The ordinal and numerical versions that map onto each other are suitable for use by different stakeholders in different settings.

11 citations

Posted ContentDOI
09 Oct 2020
TL;DR: A single-dose challenge study to validate a predicted eliciting doses (ED05) for cow’s milk of 0.5mg protein and found no baseline predictors of sensitisation which were associated with objective reactivity to the single- dose challenge.
Abstract: Background: There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. EDs can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow’s milk (the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population) range from 0.5mg to 13.9mg cow’s milk protein. We undertook a single-dose challenge study to validate a predicted ED05 for cow’s milk of 0.5mg protein. Methods: Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5mg cow’s milk protein (approximately 0.015ml of fresh cow’s milk). Children over 1 year underwent formal challenge to cow’s milk to confirm clinical reactivity. Results: 172 children (median age 6 (IQR 0.7-11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7-11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis which responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitisation which were associated with objective reactivity to the single-dose challenge using 0.5mg cow’s milk protein. Conclusions: These data support an estimated ED05 for cow’s milk of 0.5mg protein. Values for ED05 above 0.5mg for cow’s milk protein proposed for allergen risk management need to be reviewed.

8 citations

Journal ArticleDOI
06 Aug 2021-Allergy
TL;DR: Information on interval between food intake and onset of reaction, type of symptoms experienced, reproducibility of reactions, association of cofactors, need of treatment, and presence of other allergic comorbidities, especially pollen or latex allergies, should be collected.
Abstract: Plant food allergies are the most common food allergies from school age onwards. Their diagnosis starts with a detailed medical history (Fig 1). Information on interval between food intake and onset of reaction, type of symptoms experienced, reproducibility of reactions, association of cofactors, need of treatment, and presence of other allergic comorbidities, especially pollen or latex allergies, should be collected1,2 .

1 citations


Cited by
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TL;DR: This article conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between 2010 and September 2020.
Abstract: Background Eliciting doses (EDs) (eg, ED01 or ED05 values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown. Objective Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge. Methods We conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between January 2010 and September 2020. Risk of bias was assessed by using National Institute for Clinical Excellence methodologic checklists. Results A total of 19 studies were included (covering a total of 3151 participants, 534 of whom subsequently underwent further peanut challenge). At individual participant data meta-analysis, 4.5% (95% CI, 1.9% to 10.1%) of individuals reacted to 5 mg or less of peanut protein with anaphylaxis (moderate heterogeneity [I2 = 57%]). Intraindividual thresholds varied by up to 3 logs, although this variation was limited to a half-log change in 71.2% (95% CI, 56.2% to 82.6%) of individuals. In all, 2.4% (95% CI, 1.1% to 5.0%) of patients initially tolerated 5 mg of peanut protein but then reacted to this dose at subsequent challenge (low heterogeneity [I2 = 16%]); none developed anaphylaxis. Conclusion Around 5% of individuals reacting to an ED01 or ED05 level of exposure to peanut might develop anaphylaxis in response to that dose. This equates to 1 and 6 anaphylaxis events per 2500 patients exposed to an ED01 or ED05 dose, respectively, in the broader population of individuals with peanut allergy.

27 citations

Journal ArticleDOI
TL;DR: A review of the potential approaches to those who are not highly allergic can be found in this paper , where the authors consider the risks, benefits, shared decision making, and research needs.

18 citations

Journal ArticleDOI
22 Jun 2022-Allergy
TL;DR: Significant strides into the advancement of FA diagnosis, prevention, and treatment have been made in recent years, and current efforts have turned toward the use of probiotics, biologic agents, and modified allergens to optimize and improve upon existing paradigms.
Abstract: The incidence of food allergy (FA) has continued to rise over the last several decades, posing significant burdens on health and quality of life. Significant strides into the advancement of FA diagnosis, prevention, and treatment have been made in recent years. In an effort to lower reliance on resource‐intensive food challenges, the field has continued work toward the development of highly sensitive and specific assays capable of high‐throughput analysis to assist in the diagnosis FA. In looking toward early infancy as a critical period in the development of allergy or acquisition of tolerance, evidence has increasingly suggested that early intervention via the early introduction of food allergens and maintenance of skin barrier function may decrease the risk of FA. As such, large‐scale investigations are underway evaluating infant feeding and the impact of emollient and steroid use in infants with dry skin for the prevention of allergy. On the other end of the spectrum, the past few years have been witness to an explosive increase in clinical trials of novel and innovative therapeutic strategies aimed at the treatment of FA in those whom the disease has already manifested. A milestone in the field, 2020 marked the approval of the first drug, oral peanut allergen, for the indication of peanut allergy. With a foundation of promising data supporting the safety and efficacy of single‐ and multi‐allergen oral immunotherapy, current efforts have turned toward the use of probiotics, biologic agents, and modified allergens to optimize and improve upon existing paradigms. Through these advancements, the field hopes to gain footing in the ongoing battle against FA.

15 citations

Journal ArticleDOI
Stephanie Dramburg, Christiane Hilger, Alexandra F. Santos, Leticia De las Vecillas, Rob C. Aalberse, Nathalie Acevedo, Lorenz Aglas, Friedrich Altmann, Karla Arruda, Riccardo Asero, Barbara Ballmer-Weber, Domingo Barber, Kirsten Beyer, Tilo Biedermann, M. B. Bilò, Simon Blank, Philipp P. Bosshard, Heimo Breiteneder, Helen A. Brough, Merima Bublin, Dianne E. Campbell, Luis Caraballo, Jean-Christoph Roger J-P Caubet, Giorgio Celi, Martin D. Chapman, Maksymilian Chruszcz, Adnan Custovic, R. Czolk, Janet M. Davies, Nikolaos Douladiris, Bernadette Eberlein, Motohiro Ebisawa, Anna M. Ehlers, Philippe Eigenmann, Gabriele Gadermaier, M. Giovannini, Francisca Gómez, R. Grohman, Carole Guillet, Christine Hafner, Robert G. Hamilton, Michael Hauser, Thomas Hawranek, Hans Hoffmann, Thomas Holzhauser, T. Iizuka, Alain Jacquet, Thilo Jakob, Bente Janssen-Weets, Uta Jappe, Marek Jutel, Tanja Kalic, Sandip D. Kamath, S. Kespohl, Jörg Kleine-Tebbe, Edward F. Knol, André C. Knulst, Jon R Konradsen, Peter Korošec, Annette Kuehn, Gideon Lack, T. M. Le, Andreas L. Lopata, Olga Luengo, Mika J. Mäkelä, Alessandro Marra, Clare Mills, Martine Morisset, Antonella Muraro, Anna Nowak-Wegrzyn, Roni Nugraha, Markus Ollert, Kati Palosuo, Elide A. Pastorello, Sarita U. Patil, Thomas A.E. Platts-Mills, Anna Pomés, Pascal Poncet, Ekaterina Potapova, Lars K. Poulsen, Christian Radauer, Suzana Radulovic, Monika Raulf, Pierre Rougé, Joaquín Sastre, Sakura Sato, Enrico Scala, Johannes Schmid, Peter Schmid-Grendelmeier, Denise Schrama, Hélène Sénéchal, Claudia Traidl-Hoffmann, Marcela Valverde-Monge, Marianne van Hage, Ronald van Ree, Kitty C.M. Verhoeckx, Stefan Vieths, Magnus Wickman, Josefina Zakzuk, Paolo Maria Matricardi, Karin Hoffmann-Sommergruber 
TL;DR: The EAACI Molecular Allergology User's Guide 2.0 as discussed by the authors summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice.
Abstract: Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE‐mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE‐mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well‐defined, highly pure molecules for component‐resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the “EAACI Molecular Allergology User's Guide” (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state‐of‐the‐art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.

13 citations

Journal ArticleDOI
TL;DR: In this paper, the authors present a rapid evidence assessment and meta-analysis for the risk of anaphylaxis to a low-level allergen exposure for priority allergens.

12 citations