Showing papers by "Scott H. Sicherer published in 2009"

Work Group report: Oral food challenge testing

Abstract: Oral food challenges are procedures conducted by allergists/immunologists to make an accurate diagnosis of immediate, and occasionally delayed, adverse reactions to foods. The timing of the challenge is carefully chosen based on the individual patient history and the results of skin prick tests and food specific serum IgE values. The type of the challenge is determined by the history, the age of the patient, and the likelihood of encountering subjective reactions. The food challenge requires preparation of the patient for the procedure and preparation of the office for the organized conduct of the challenge, for a careful assessment of the symptoms and signs and the treatment of reactions. The starting dose, the escalation of the dosing, and the intervals between doses are determined based on experience and the patient's history. The interpretation of the results of the challenge and arragements for follow-up after a challenge are important. A negative oral food challenge result allows introduction of the food into the diet, whereas a positive oral food challenge result provides a sound basis for continued avoidance of the food.

Food allergy: recent advances in pathophysiology and treatment.

Abstract: Food allergies, defined as an adverse immune response to food proteins, affect as many as 6% of young children and 3%-4% of adults in westernized countries, and their prevalence appears to be rising. In addition to well-recognized acute allergic reactions and anaphylaxis triggered by IgE antibody-mediated immune responses to food proteins, there is an increasing recognition of cell-mediated disorders such as eosinophilic gastroenteropathies and food protein-induced enterocolitis syndrome. We are gaining an increasing understanding of the pathophysiology of food allergic disorders and are beginning to comprehend how these result from a failure to establish or maintain normal oral tolerance. Many food allergens have been characterized at a molecular level, and this knowledge, combined with an increasing appreciation of the nature of humoral and cellular immune responses resulting in allergy or tolerance, is leading to novel therapeutic approaches. Currently, management of food allergies consists of educating the patient to avoid ingesting the responsible allergen and initiating therapy if ingestion occurs. However, numerous strategies for definitive treatment are being studied, including sublingual/oral immunotherapy, injection of anti-IgE antibodies, cytokine/anticytokine therapies, Chinese herbal therapies, and novel immunotherapies utilizing engineered proteins and strategic immunomodulators.

Management of food allergies in schools: A perspective for allergists

Abstract: Epidemiologic studies indicate that food allergy has increased among school-aged children and now affects approximately 1 in 25. Food allergy and other triggers of anaphylaxis pose considerable challenges in the school setting. The cornerstones of management include methods to prevent relevant exposure to allergens and plans to recognize and treat allergic reactions and anaphylaxis. Numerous studies have identified gaps in the implementation of procedures to address these simple tenets. Guidelines and policies have been proposed from various stakeholders to improve the safety and management of schoolchildren with food allergy and anaphylaxis. However, there remain knowledge gaps that preclude suggesting definitive evidence-based guidelines to approach all aspects of management. The allergist plays a key role in guiding families, schools, administrators, and policymakers in developing meaningful plans to improve the safety of the school setting for children with food allergies and anaphylaxis. We review literature that is relevant to key elements that can assist the allergist in addressing patient- and school-specific issues. We additionally focus on areas of current controversy, provide information about available resources, and highlight areas in need of further study.

Audit of manufactured products: Use of allergen advisory labels and identification of labeling ambiguities

Abstract: Background The Food Allergy Labeling and Consumer Protection Act became effective January 1, 2006, and mandates disclosure of the 8 major allergens in plain English and as a source of ingredients in the ingredient statement. It does not regulate advisory labels. Objective We sought to determine the frequency and language used in voluntary advisory labels among commercially available products and to identify labeling ambiguities affecting consumers with allergy. Methods Trained surveyors performed a supermarket survey of 20,241 unique manufactured food products (from an original assessment of 49,604 products) for use of advisory labels. A second detailed survey of 744 unique products evaluated additional labeling practices. Results Overall, 17% of 20,241 products surveyed contain advisory labels. Chocolate candy, cookies, and baking mixes were the 3 categories of 24 with the greatest frequency (≥40%). Categorically, advisory warnings included "may contain" (38%), "shared equipment" (33%), and "within plant" (29%). The subsurvey disclosed 25 different types of advisory terminology. Nonspecific terms, such as "natural flavors" and "spices," were found on 65% of products and were not linked to a specific ingredient for 83% of them. Additional ambiguities included unclear sources of soy (lecithin vs protein), nondisclosure of sources of gelatin and lecithin, and simultaneous disclosure of "contains" and "may contain" for the same allergen, among others. Conclusion Numerous products have advisory labeling and ambiguities that present challenges to consumers with food allergy. Additional allergen labeling regulation could improve safety and quality of life for individuals with food allergy.

Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children.

Abstract: Background Data about epinephrine use and biphasic reactions in childhood food-induced anaphylaxis during oral food challenges are scarce. Objective To determine the prevalence and risk factors of reactions requiring epinephrine and the rate of biphasic reactions during oral food challenges (OFCs) in children. Methods Reaction details of positive OFCs in children between 1999 and 2007 were collected by using a computerized database. Selection of patients for OFCs was generally predicated on ≤50% likelihood of a positive challenge and a low likelihood of a severe reaction on the basis of the clinical history, specific IgE levels, and skin prick tests. Results A total of 436 of 1273 OFCs resulted in a reaction (34%). Epinephrine was administered in 50 challenges (11% of positive challenges, 3.9% overall) for egg (n = 15, 16% of positive OFCs to egg), milk (n = 14, 12%), peanut (n = 10, 26%), tree nuts (n = 4, 33%), soy (n = 3, 7%), wheat (n = 3, 9%), and fish (n = 1, 9%). Reactions requiring epinephrine occurred in older children (median, 7.9 vs 5.8 years; P P = .006) compared with reactions not treated with epinephrine. There was no difference in the sex, prevalence of asthma, history of anaphylaxis, specific IgE level, skin prick tests, or amount of food administered. Two doses of epinephrine were required in 3 of 50 patients (6%) reacting to wheat, cow's milk, and pistachio. There was 1 (2%) biphasic reaction. No reaction resulted in life-threatening respiratory or cardiovascular compromise. Conclusion Older age and reactions to peanuts were risk factors for anaphylaxis during oral food challenges. Reactions requiring multiple doses of epinephrine and biphasic reactions were infrequent.

Probiotic Supplementation in the First 6 Months of Life in at Risk Asian Infants: Effects on Eczema and Atopic Sensitization at the Age of 1 Year

Abstract: Soh SE, Aw M, Gerez I, et al. Clin Exp Allergy. 2009;39(4):571–578 PURPOSE OF THE STUDY. To determine the effect of probiotic supplementation from birth to 6 months of age on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease. STUDY POPULATION. A total of 253 infants with a family history of allergic disease, defined as having a first-degree relative with doctor-diagnosed asthma, allergic rhinitis, or eczema, and positive skin-prick test result to dust mite, were voluntarily recruited prenatally at the clinics at the …

Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity

Abstract: Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Pediatrics . 2009;123(5). Available at: www.pediatrics.org/cgi/content/full/123/5/e808 PURPOSE OF THE STUDY. To determine the rate of methicillin-resistant Staphylococcus aureus (MRSA) colonization in children with moderate-to-severe atopic dermatitis (AD) and to investigate the use of bleach baths and intranasal mupirocin treatment in management. STUDY POPULATION. Patients ( N = 31) 6 months to 17 years of age with moderate-to-severe AD and signs of bacterial skin infection were recruited from a dermatology clinic in Children's …

Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children

Abstract: Renzetti G, Silvestre G, D'Amario C, et al. Pediatrics. 2009;123(3):1051–1058 PURPOSE OF THE STUDY. To investigate whether relocating children with asthma from an environment of high pollution to one of low pollution has an effect on short-term airway inflammation. STUDY POPULATION. This was a case study of 37 children, ≥7 years of age, with untreated, mild, persistent asthma who were recruited from an urban asthma clinic in Italy and followed at a rural school camp for 1 week. The children came from homes that had implemented dust mite precautions, and they stayed in a …

Immunologic therapeutic approaches in the management of food allergy.

Abstract: Food allergy affects up to 6% of children and 3–4% of adults in Westernized countries, and is the most common cause of outpatient anaphylaxis in most studies. The mainstay of treatment is strict avoidance of the offending allergens and education regarding the use of emergency medication in cases of accidental ingestions or exposures. While these approaches are generally effective, there are no definitive treatments that cure or provide long-term remission from food allergy. However, with recent advances in characterizing food allergens and understanding humoral and cellular immune responses in food allergy, several therapeutic strategies are being investigated. Potential treatments include allergen-specific immunotherapy as well as allergen-nonspecific approaches to downregulate the overall allergic response in food-allergic individuals.

Clinical Allergy: Diagnosis and Management

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Food Allergy: Diagnosis of Food Allergy

Abstract: The most definitive test available to determine an adverse reaction to food is the physician-supervised oral food challenge (OFC). This test, in particular when performed in a double-blind, placebo-controlled (DBPC) manner, can confirm or refute adverse reactions or immunologic (allergic) reactions to foods. However, the test is labor-intensive and carries risks; therefore, ancillary tests are used to determine if a food allergy is likely. The primary tests include the clinical history, physical examination, serum and prick skin tests (PSTs) to detect IgE antibodies to particular suspected foods, and additional tests that are emerging with regard to their diagnostic value. The clinician must consider disease pathogenesis, epidemiology of food-related disorders, and the specific clinical history to appropriately select and interpret allergy tests. Table 1 shows essential factors to consider when proceeding toward the diagnosis of food allergy. Adverse reactions to foods may result from immunologic (food allergy) and non-immunologic responses [1, 2]. More than one in five persons alter their diet for a presumed food allergy, but nonimmune causes can often be identified [3]. Toxins or pharmacologically active components of the diet account for a number of nonimmune adverse reactions. The term hypersensitivity has been applied to exaggerated responses to any food component, even nonimmune reactions [1]. Therefore, lactose intolerance, resulting in abdominal discomfort from a reduced ability to digest lactose, may be defined as non-allergic hypersensitivity. A general overview of the approach to diagnosis is shown in Fig. 1.