Author
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.
Topics: Population, Oral food challenge, Outpatient clinic
Papers
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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
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Hospital Clínico San Carlos1, Humboldt University of Berlin2, University of Zurich3, Kantonsspital St. Gallen4, Charité5, University of Strasbourg6, Boston Children's Hospital7, University of Amsterdam8, Vilnius University9, University of Southampton10, Salford Royal NHS Foundation Trust11, Medical University of Vienna12, Royal College of Surgeons in Ireland13, Medical University of Łódź14, Utrecht University15, University of Manchester16, National and Kapodistrian University of Athens17, Copenhagen University Hospital18, University College London19, Manchester Academic Health Science Centre20, University Hospital Southampton NHS Foundation Trust21, St Mary's Hospital22, National Institutes of Health23
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
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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
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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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National Institutes of Health1, Baylor College of Medicine2, Boston Children's Hospital3, University of Nebraska–Lincoln4, Netherlands Organisation for Applied Scientific Research5, Children's Hospital at Westmead6, DBV Technologies7, Stanford University8, University of Manchester9, Icahn School of Medicine at Mount Sinai10, Food Standards Agency11
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
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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
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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
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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
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Lung Institute1, National Institutes of Health2, Kantonsspital St. Gallen3, University of Zurich4, University of Nebraska–Lincoln5, Netherlands Organisation for Applied Scientific Research6, Boston Children's Hospital7, King's College London8, Children's Hospital at Westmead9, DBV Technologies10, Nanchang University11, Stanford University12, University Medical Center Groningen13, Tel Aviv University14, Royal College of Surgeons in Ireland15, University Medical Center Utrecht16, Health Canada17, University of Manchester18, International Trademark Association19, Icahn School of Medicine at Mount Sinai20, Thermo Fisher Scientific21
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