H. van Os-Medendorp

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

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.

E-health in caring for patients with atopic dermatitis: A randomized controlled cost-effectiveness study of internet-guided monitoring and online self-management training

Background  The Dermatology Department of the University Medical Centre Utrecht, the Netherlands, developed an e‐health portal for patients with atopic dermatitis (AD), consisting of e‐consultation, a patient‐tailored website, monitoring and self‐management training.

Diagnostic accuracy of specific IgE to components in diagnosing peanut allergy: a systematic review

The diagnostic accuracy of skin prick test (SPT) and specific IgE (sIgE) to peanut extract in diagnosing peanut allergy is suboptimal. Recent studies have evaluated sIgE to peanut components as a possible new diagnostic tool. The aim of our review was to systematically search the literature to assess the diagnostic value of sIgE to peanut components in diagnosing peanut allergy. A literature search was performed in PubMed, Embase and the Cochrane Library. Results were subsequently screened for in‐ and exclusion criteria. The quality of eligible studies was assessed using a standardized quality assessment tool (QUADAS‐2). Data on sensitivity, specificity, and positive and negative likelihood ratios were extracted or calculated for a descriptive analysis. Twenty‐two studies were eligible, of which 21 studies in paediatric populations. Most studies reported on sIgE to peanut extract (15) and sIgE to Ara h 2 (12), followed by SPT (9) and sIgE to Ara h 1 (7). All studies were at risk of bias or caused applicability concerns on at least one item of the quality assessment tool. The best combination of diagnostic accuracy measures of all diagnostic tests was found for sIgE to Ara h 2. This finding was independent of geographical location. Compared to SPT and sIgE to peanut extract, sIgE to Ara h 2 was mainly superior in diagnosing peanut allergy in case of a positive test result. Worst diagnostic accuracy measures were found in general for sIgE to Ara h 8 and sIgE to Ara h 9. sIgE to Ara h 2 showed the best diagnostic accuracy of all diagnostic tests to diagnose peanut allergy. Compared to the currently used SPT and sIgE to peanut extract, sIgE to Ara h 2 was superior in diagnosing peanut allergy and should therefore replace these tests in daily clinical practice, especially in children.

Prevalence and predictors of psychosocial morbidity in patients with chronic pruritic skin diseases.

Background  Itch is a major symptom of many skin diseases and causes patients considerable distress, adversely affecting quality of life. Feelings of helplessness and lack of control can influence the perceived itch and psychosocial complaints.

Effectiveness of the nursing programme 'Coping with itch': A randomized controlled study in adults with chronic pruritic skin disease

Background  The nursing programme ‘Coping with Itch’ aims at reducing itch and at helping patients with chronic pruritic skin diseases cope with itch. The programme consists of educational and cognitive behavioural interventions. Dermatology nurses carry out the programme, which supplements standard medical treatment given by a dermatologist, in individual sessions at a nurse clinic organized by the dermatology outpatient department.

Costs and cost-effectiveness of the nursing programme 'Coping with itch' for patients with chronic pruritic skin disease

Background Itch, a major symptom of many skin diseases, has a great impact on quality of life. The nursing programme ‘Coping with itch’ aims at reducing itch and at helping patients to cope with itch.

Parental treatment management skills in paediatric atopic dermatitis

ciclosporin 150 mg/day was started, which was mildly effective. Psoriasis restricted to the nail is rare. In the present case, nail dystrophy was observed in all 20 nails, whereas no psoriasis lesion was observed in any area other than the nail. Histological examination revealed a number of mast cells below the nail epidermis, as well as intraepithelial mast cells, which were positive for toluidine blue. It is known that tryptaseand chymase-positive mast cells are increased in number in the upper dermis of psoriatic lesions at an early phase. Furthermore, upon activation, degranulated mast cells release various growth factors and mediators. However, there are only a few reports on epidermal mast cells in psoriasis. Using the Gomori–Giemsa stain, Green et al. examined epidermal mast cells in biopsy specimens from patients with neurodermatitis and prurigo, pseudoepitheliomatous hyperplasia (tuberculosis verrucosa cutis, blastomycosis, bromoderma), pemphigus, and urticaria pigmentosa. They suggested that the inflammatory conditions that show numerous dermal mast cells within an area of the chronic dermal inflammation and epidermal proliferation may allow the migration of mast cells into the epidermis. By contrast, there are no reports of intraepidermal mast cells in nail psoriasis to date. The possible mechanisms of mast cell invasion into the epidermis are related to mast cell-derived proteases. Tryptase can affect the basement membrane, because it degrades fibronectin and activates matrix metalloproteinase (MMP)-3, MMP-9, pro-urokinase, and gelatinase. Tryptase can modify the extracellular matrix and basement membrane, which subsequently allows mast cells to migrate into the epidermis. Mast cells may contribute to the pathogenesis of nail psoriasis by T-cell activation and angiogenesis, via mast cell-derived cytokines such as interferon-c and interleukin-17, because various inflammatory cytokines are expressed in psoriatic nails.

Online self management training for patients with food allergy

Background Patients with food allergy generally have a strong need for information on their disease and disease management. Their daily life is full of uncertainties. Therefore an online self management training “Living with food allergy” has been developed for patients with a physician’s diagnosed food allergy to increase patient’s self management. The training was developed by a multidisciplinary team of a dietician, dermatologist, nurse and researcher in collaboration with patients’ organizations: the Dutch Food Allergy Foundation and the Netherlands Anaphylaxis Network; The Netherlands Nutrition Centre Foundation and ICT experts. Financial support for development of the training was obtained from the Innovation Fund of insurance companies. The training consists of information, video’s, patient’s stories and exercises about food allergy, diagnostics, coping with unexpected reactions, diet and consequences of food allergy in daily life.