C. Gore

Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis

Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population.

The information needs and preferred roles in treatment decision‐making of parents caring for infants with atopic dermatitis: a qualitative study

Background:  Information needs and preferences in treatment decision‐making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information‐giving and involvement of health‐care users in treatment decisions.

Can we prevent allergy

Allergic conditions continue to increase steeply. The last two decades have seen many prevention trials, studying the effect of dietary and environmental interventions. These trials have yielded invaluable information about the atopic march and also highlighted the need for a clear and commonly used nomenclature as well as a need for better outcome measures. This review discusses primary and secondary prevention studies and their results.

Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial

Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices.

Anxiety and stress in mothers of food-allergic children

Previous reports suggest that parents especially mothers of food‐allergic children may have increased anxiety. Studies with an appropriate control group have not been undertaken, and the determinants of such anxiety are not known. We compared measures of anxiety and stress in mothers of food‐allergic children and atopic non‐food‐allergic children, with anxiety and stress in mothers of children with no chronic illness.

Urinary eosinophilic protein X, atopy, and symptoms suggestive of allergic disease at 3 years of age

BACKGROUND Urinary eosinophilic protein X (U-EPX) measurement is easy to perform in children. However, its use for prediction, diagnosis, and monitoring of asthma and atopy is unclear. OBJECTIVE We sought to investigate the relationship between U-EPX and clinical phenotypes suggestive of allergic diseases. METHODS U-EPX measurement (RIA), respiratory questionnaires, and skin testing were completed at age 3 years in 903 children followed prospectively from birth. Specific airway resistance was measured in 503 currently asymptomatic children by using whole-body plethysmography during tidal breathing. RESULTS Nonatopic children with wheezing or eczema had slightly increased U-EPX levels compared with nonatopic asymptomatic children. U-EPX levels (geometric mean EPX/creatinine ratio) were as follows: nonatopic asymptomatic children (n = 313), 61.3 microg/mmol (95% CI, 56.4-66.6 microg/mmol); nonatopic children with wheezing (n = 148), 71.2 microg/mmol (95% CI, 63.2-80.1 microg/mmol); nonatopic children with eczema (n = 90), 65.7 microg/mmol (95% CI, 56.7-76.2 microg/mmol); and nonatopic children with wheezing and eczema (n= 86), 79.7 microg/mmol (95% CI, 67.4-94.3 microg/mmol). Children who had persistent atopy early in life had significantly higher U-EPX levels at age 3 years (nonatopic at 1 and 3 years [n = 263], 63.4 microg/mmol [95% CI, 58.4-69.0 microg/mmol]; atopic at 1 but not 3 years [n = 24], 65.1 microg/mmol [95% CI, 43.8-96.7 microg/mmol]; nonatopic at 1 year and atopic at 3 years [n = 62], 90.0 microg/mmol [95% CI, 74.6-108.4 microg/mmol]; atopic at 1 and 3 years [n = 35], 111.5 microg/mmol [95% CI, 89.2-139.3 microg/mmol]; P <.002). Atopy alone and with wheezing, eczema, or both was associated with significantly increased U-EPX levels (P <.0001). Wheezing appeared to be associated with higher U-EPX levels compared with eczema in both atopic and nonatopic children. The highest U-EPX level was found in atopic children with a history of wheezing and eczema (P <.0001). There was no relationship between U-EPX level and lung function. CONCLUSION U-EPX level reflects the presence of atopy and associated symptoms and might be useful for monitoring the progression of allergic disease.

High prevalence of food sensitisation in young children with liver disease: a clue to food allergy pathogenesis?

The pathogenesis of food allergy is not completely understood – animal models suggest hepatic mechanisms may be important for immune tolerance to orally ingested antigens, but there is little direct evidence for this in humans.

Primary and secondary prevention of allergic airway disease

The incidence of atopic conditions is continuing to rise. The number of primary prevention cohorts is increasing and results are becoming available. There is a lack of true secondary prevention trials, however. This article reviews the results currently available from primary and secondary prevention studies.

New patient-reported experience measure for children with allergic disease: development, validation and results from integrated care

Objectives To develop and validate a new allergy-specific patient-reported experience measure (PREM) for children and their parents, and to collect feedback in an integrated care setting. Design Two allergy-specific PREMs were produced using focus groups, cognitive testing, two prospective validation studies (collaboration: Royal College of Paediatrics and Child Health, Picker Institute Europe, Imperial College/London): ‘Your Allergy Care’, for children aged 8–16 years; ‘Your Childs Allergy Care’, for parents of children aged 0–7 years. Setting Community event, primary/secondary/tertiary allergy care settings. Main outcome measures Performance of PREMs in validation study; reported experience of allergy care. Participants 687 children with allergic conditions and their parents/carers. Results In total, 687 questionnaires were completed; 503/687 (253 child; 250 parent) for the final survey. In both surveys, demographic variations were not associated with differences in results. Although 71% of patients reported one or more allergic conditions (food allergy/eczema/hay fever/asthma), 62% required multiple visits before receiving final diagnosis. Overall, patient experience was good for communication with patient/parent, competence and confidence in ability, and 73% felt looked after ‘very well’ and 23% ‘quite well’. Areas for improvement included communication with nurseries/schools, more information on side effects, allergic conditions and allergen/irritant avoidance. Allergy care in primary/emergency care settings was associated with higher problem-scores (worse experience) than in specialist clinics. Conclusions These new PREMs will allow allergy-specific patient experience reporting for children and parents and help identification of priority areas for improvement and commissioning of care. Efforts towards better allergy care provision must be targeted at primary and emergency care settings and underpinned by improving communication between healthcare providers and the community.

Temperature-controlled laminar airflow (TLA) device in the treatment of children with severe atopic eczema: Open-label, proof-of-concept study

Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression.