Michel Erlewyn-Lajeunesse

Management of nut allergy influences quality of life and anxiety in children and their mothers

Cummings AJ, Knibb RC, Erlewyn‐Lajeunesse M, King RM, Roberts G, Lucas JSA. Management of nut allergy influences quality of life and anxiety in children and their mothers.
Pediatr Allergy Immunol 2010: 21: 586–594.
© 2010 John Wiley & Sons A/S

How do teenagers manage their food allergies

Background The peak incidence of deaths from anaphylaxis associated with nut allergy occurs in teenagers and young adults. During adolescence, the management of food allergy shifts from being the responsibility of parents to that of the young person. This is a group who therefore need special attention in the clinic.

Highly accurate prediction of food challenge outcome using routinely available clinical data

BACKGROUND Serum specific IgE or skin prick tests are less useful at levels below accepted decision points. OBJECTIVES We sought to develop and validate a model to predict food challenge outcome by using routinely collected data in a diverse sample of children considered suitable for food challenge. METHODS The proto-algorithm was generated by using a limited data set from 1 service (phase 1). We retrospectively applied, evaluated, and modified the initial model by using an extended data set in another center (phase 2). Finally, we prospectively validated the model in a blind study in a further group of children undergoing food challenge for peanut, milk, or egg in the second center (phase 3). Allergen-specific models were developed for peanut, egg, and milk. RESULTS Phase 1 (N = 429) identified 5 clinical factors associated with diagnosis of food allergy by food challenge. In phase 2 (N = 289), we examined the predictive ability of 6 clinical factors: skin prick test, serum specific IgE, total IgE minus serum specific IgE, symptoms, sex, and age. In phase 3 (N = 70), 97% of cases were accurately predicted as positive and 94% as negative. Our model showed an advantage in clinical prediction compared with serum specific IgE only, skin prick test only, and serum specific IgE and skin prick test (92% accuracy vs 57%, and 81%, respectively). CONCLUSION Our findings have implications for the improved delivery of food allergy-related health care, enhanced food allergy-related quality of life, and economized use of health service resources by decreasing the number of food challenges performed.

Recommendations for the administration of influenza vaccine in children allergic to egg.

#### Summary points Egg allergy affects about 2.6% of preschool children by 3 years of age, and influenza immunisation using egg based vaccines has been classified as a “relative contraindication” (prescribe with extra caution) in this patient group.1 Until now the numbers of children with egg allergy requiring immunisation has been low, but this may change with the potential for a mass immunisation campaign. This article reviews the literature on the safety of flu vaccines and provides guidelines for the administration of these vaccines to children with egg allergy. Although egg-free flu vaccines are expected to be available for this season, the provision of sufficient amounts of this vaccine cannot be guaranteed at the time of writing, and a pragmatic strategy for the safe immunisation of children with egg allergy is required. We identified articles using PubMed and the search terms “influenza” and “egg allergy”. We identified further references within relevant papers. We found two randomised clinical trials, but most evidence comes from small case series. This season two varieties of flu vaccine will be available: a pandemic A/H1N1 strain and the normal trivalent seasonal flu vaccine that will contain an A/H1N1 virus but will not protect against the pandemic …

The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy

Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge.

Safety of live attenuated influenza vaccine in atopic children with egg allergy

Background Live attenuated influenza vaccine (LAIV) is an intranasal vaccine recently incorporated into the United Kingdom immunization schedule. However, it contains egg protein and, in the absence of safety data, is contraindicated in patients with egg allergy. Furthermore, North American guidelines recommend against its use in asthmatic children. Objective We sought to assess the safety of LAIV in children with egg allergy. Methods We performed a prospective, multicenter, open-label, phase IV intervention study involving 11 secondary/tertiary centers in the United Kingdom. Children with egg allergy (defined as a convincing clinical reaction to egg within the past 12 months and/or >95% likelihood of clinical egg allergy as per published criteria) were recruited. LAIV was administered under medical supervision, with observation for 1 hour and telephone follow-up 72 hours later. Results Four hundred thirty-three doses were administered to 282 children with egg allergy (median, 4.9 years; range, 2-17 years); 115 (41%) had experienced prior anaphylaxis to egg. A physicians diagnosis of asthma/recurrent wheezing was noted in 67%, and 51% were receiving regular preventer therapy. There were no systemic allergic reactions (upper 95% CI for population, 1.3%). Eight children experienced mild self-limiting symptoms, which might have been due an IgE-mediated allergic reaction. Twenty-six (9.4%; 95% CI for population, 6.2% to 13.4%) children experienced lower respiratory tract symptoms within 72 hours, including 13 with parent-reported wheeze. None of these episodes required medical intervention beyond routine treatment. Conclusions In contrast to current recommendations, LAIV appears to be safe for use in children with egg allergy. Furthermore, the vaccine appears to be well tolerated in children with a diagnosis of asthma or recurrent wheeze.

Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study.

Study question How safe is live attenuated influenza vaccine (LAIV), which contains egg protein, in young people with egg allergy? Methods In this open label, phase IV intervention study, 779 young people (2-18 years) with egg allergy were recruited from 30 UK allergy centres and immunised with LAIV. The cohort included 270 (34.7%) young people with previous anaphylaxis to egg, of whom 157 (20.1%) had experienced respiratory and/or cardiovascular symptoms. 445 (57.1%) had doctor diagnosed asthma or recurrent wheeze. Participants were observed for at least 30 minutes after vaccination and followed-up by telephone 72 hours later. Participants with a history of recurrent wheeze or asthma underwent further follow-up four weeks later. The main outcome measure was incidence of an adverse event within two hours of vaccination in young people with egg allergy. Study answer and limitations No systemic allergic reactions occurred (upper 95% confidence interval for population 0.47% and in participants with anaphylaxis to egg 1.36%). Nine participants (1.2%, 95% CI 0.5% to 2.2%) experienced mild symptoms, potentially consistent with a local, IgE mediated allergic reaction. Delayed events potentially related to the vaccine were reported in 221 participants. 62 participants (8.1%, 95% CI for population 6.3% to 10.3%) experienced lower respiratory tract symptoms within 72 hours, including 29 with parent reported wheeze. No participants were admitted to hospital. No increase in lower respiratory tract symptoms occurred in the four weeks after vaccination (assessed with asthma control test). The study cohort may represent young people with more severe allergy requiring specialist input, since they were recruited from secondary and tertiary allergy centres. What this study adds LAIV is associated with a low risk of systemic allergic reactions in young people with egg allergy. The vaccine seems to be well tolerated in those with well controlled asthma or recurrent wheeze. Funding, competing interests, data sharing This report is independent research commissioned and funded by a Department of Health policy research programme grant to the National Vaccine Evaluation Consortium. Additional funding was provided by the NIHR Clinical Research Networks, Health Protection Scotland (Edinburgh site), and Health & Social Care Services in Northern Ireland (Belfast site). PJT and MEL had support from the Department of Health for the submitted work; PJT has received research grants from the Medical Research Council and NIHR. No additional data available. Study registration ClinicalTrials.gov (NCT02111512) and the EU Clinical Trials Register EudraCT (2014-001537-92).

What factors affect the carriage of epinephrine auto-injectors by teenagers?

BackgroundTeenagers with allergies are at particular risk of severe and fatal reactions, but epinephrine auto-injectors are not always carried as prescribed. We investigated barriers to carriage.MethodsPatients aged 12-18 years old under a specialist allergy clinic, who had previously been prescribed an auto-injector were invited to participate. Semi-structured interviews explored the factors that positively or negatively impacted on carriage.ResultsTwenty teenagers with food or venom allergies were interviewed. Only two patients had used their auto-injector in the community, although several had been treated for severe reactions in hospital. Most teenagers made complex risk assessments to determine whether to carry the auto-injector. Most but not all decisions were rational and were at least partially informed by knowledge. Factors affecting carriage included location, who else would be present, the attitudes of others and physical features of the auto-injector. Teenagers made frequent risk assessments when deciding whether to carry their auto-injectors, and generally wanted to remain safe. Their decisions were complex, multi-faceted and highly individualised.ConclusionsRather than aiming for 100% carriage of auto-injectors, which remains an ambitious ideal, personalised education packages should aim to empower teenagers to make and act upon informed risk assessments.

Influenza immunization in egg allergy: an update for the 2011-2012 season.

Flu vaccines contain detectable amounts of egg protein, which may pose a risk to egg‐allergic individuals. The 2009 H1N1 influenza pandemic required mass vaccination in many countries, and the safety of flu immunization in egg allergy became of increasing public health importance. This article reviews recent literature and provides an updated guideline for immunization during the 2011–2012 flu season. Recent experience suggests that some vaccines with very low ovalbumin concentrations may be safe for use in primary care in carefully assessed low‐risk individuals.

Validation of the Paediatric Food Allergy Quality of Life Questionnaire (PFA‐QL)

The Paediatric Food Allergy Quality of Life Questionnaire (PFA‐QL) was the first tool to be developed for assessing health‐related quality of life (QoL) in children with food allergy. It has been used in a number of published studies, but has not been validated.