Vicki McWilliam

Nut allergy prevalence and differences between Asian-born children and Australian-born children of Asian descent: a state-wide survey of children at primary school entry in Victoria, Australia

Asian infants born in Australia are three times more likely to develop nut allergy than non‐Asian infants, and rates of challenge‐proven food allergy in infants have been found to be unexpectedly high in metropolitan Melbourne. To further investigate the risk factors for nut allergy, we assessed the whole‐of‐state prevalence distribution of parent‐reported nut allergy in 5‐year‐old children entering school.

An Australian Consensus on Infant Feeding Guidelines to Prevent Food Allergy: Outcomes From the Australian Infant Feeding Summit

BACKGROUND Infant feeding in the first postnatal year of life has an important role in an infants risk of developing food allergy. Consumer infant feeding advice is diverse and lacks consistency. AIM The Australian Infant Feeding Summit was held with the aim of achieving national consensus on the wording of guidelines for infant feeding and allergy prevention. METHODS Two meetings were hosted by the Centre for Food and Allergy Research, the Australasian Society of Clinical Immunology and Allergy, and the Australian National Allergy Strategy. The first meeting of 30 allergy researchers, clinicians, and consumers assessed the evidence. The second consensus meeting involved 46 expert stakeholders including state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health. RESULTS Partner stakeholders agreed on consensus wording for infant feeding advice: CONCLUSIONS: Consensus was achieved in a context in which there is a high prevalence of food allergy. Guidelines for other countries are being updated. Provision of consistent wording related to infant feeding to reduce food allergy risk will ensure clear consumer advice.

Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study

Background: Rising rates of food‐induced anaphylaxis have recently been shown in the adolescent age group, following earlier descriptions of a rise in children younger than 5 years. However, few population‐based studies have examined the prevalence of food allergy in adolescence using objective measures such as oral food challenge (OFC). Objective: We sought to determine the prevalence of food allergy among a population‐based sample of 10‐ to 14‐year‐old adolescents using clinical evaluation including OFC to confirm the diagnosis. Methods: Schools were randomly selected from greater metropolitan Melbourne, Australia. Students aged 10 to 14 years, and their parents, were asked to complete a questionnaire regarding the adolescents food allergy or food‐related reactions. Clinic evaluation, which consisted of skin prick tests and OFC where eligible, was undertaken if students were suspected to have current food allergy from parent response. Among 9816 students assessed, 5016 had complete parent response and clinic evaluation when eligible. An additional 4800 students had student questionnaires only. Results: The prevalence of clinic‐defined current food allergy based on history, sensitization data, and OFC results was 4.5% (95% CI, 3.9‐5.1), with the most common food triggers being peanut, 2.7% (95% CI, 2.3‐3.2), and tree nut, 2.3% (95% CI, 1.9‐2.8). Among the additional group of 4800 adolescents who had only self‐reported food allergy status available, the prevalence of self‐reported current food allergy was 5.5% (95% CI, 4.9‐6.2), with peanut, 2.8% (95% CI, 2.3‐3.3), and tree nut, 2.3% (95% CI, 1.9‐2.8), the most common. Conclusions: Approximately 1 in 20 10‐ to 14‐year‐old school students in Melbourne has current food allergy. This high prevalence suggests that the previously reported rise in food‐induced anaphylaxis in this age group may reflect an increasing prevalence of food allergy rather than simply increased reporting of anaphylaxis.

Persistent Food Allergy and Food Allergy Coexistent with Eczema Is Associated with Reduced Growth in the First 4 Years of Life.

BACKGROUND Food allergy has been associated with lower weight and height in cross-sectional studies in children; however, this has not been investigated in longitudinal studies to explore growth over time, and previous studies have not accounted for coexisting eczema. OBJECTIVE The objective of this study was to examine the association of IgE-mediated food allergy and eczema with anthropometric measures at 1 and 4 years of age. METHODS In the HealthNuts population-based cohort, infants recruited at age 1 year underwent a skin prick test to egg, peanut, and sesame; those sensitized had oral food challenges. Food challenges repeated at 4 years determined food allergy persistence or resolution. Eczema was defined as parent report of eczema diagnosis. Parent-reported weight and height and child health record data were used to calculate age- and sex-adjusted percentiles from World Health Organization charts. Multivariable linear regression models were fitted to examine the effect of food allergy and eczema on weight and height controlling for potential confounders. RESULTS Children with both food allergy and eczema at age 1 had lower percentiles for mean weight (51.3 vs 58.3 percentile, P = .001) and height (48.4 vs 53.4, P = .028) at age 1 compared with those with neither condition. There was no difference for children with only food allergy or eczema at age 1. By age 4, children with persistent food allergy and persistent eczema, but not those with resolved food allergy, were still shorter and lighter. CONCLUSIONS Children with both food allergy and eczema were shorter and lighter throughout early childhood, with more pronounced differences in those with persistent food allergy.

Consensus of stakeholders on precautionary allergen labelling: A report from the Centre for Food and Allergy Research

Consensus of stakeholders on precautionary allergen labelling: A report from the Centre for Food and Allergy Research Giovanni A Zurzolo, Jennifer J Koplin, Anne-Louise Ponsonby, Vicki McWilliam, Shyamali Dharmage, Ralf G Heine, Mimi LK Tang, Susan Prescott, Dianne E Campbell, Richard Loh, Kristina Rueter, Merryn Netting, Katie Frith, Wendy Norton, Maria Said, Michael Gold, N Alicec Lee, Michael Mathai, Maximilian deCourten and Katrina J Allen Murdoch Children’s Research Institute, Centre for Food and Allergy Research, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Department of Paediatrics and Melbourne School of Population and Global Health, University of Melbourne, Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Victoria School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth, Western Australia, The Children’s Hospital at Westmead, Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Allergy and Anaphylaxis, ARC Training Centre for Advanced Technologies in FoodManufacture, The University of New SouthWales, Sydney, New SouthWales, Women’s and Children’s Health Research Institute and Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia

Food Allergy Is an Important Risk Factor for Childhood Asthma, Irrespective of Whether It Resolves

BACKGROUND The risk of developing asthma in those with early food allergy is unknown, particularly when early life food allergy has resolved. OBJECTIVE To understand whether challenge-proven food allergy in infancy increases the risk of asthma at age 4 years, using data from a population-based cohort. METHODS A total of 5,276 12-month-old infants were recruited using a population-based sampling frame. Infants underwent skin prick test to egg, peanut, and sesame and those with a detectable skin prick test result had oral food challenges. At age 4 years, food challenges were repeated to determine persistence or resolution of food allergy. The association between food allergy and doctor-diagnosed asthma was examined using binomial regression in 2,789 participants. RESULTS Children with food allergy at age 1 year had an increased risk of asthma (1 food allergy: relative risk [RR], 1.69; 95% CI, 1.29-2.21; 2 or more food allergies: RR, 2.76; 95% CI, 1.94-3.92). The risk of asthma was highest in children with food allergy and coexistent eczema in infancy (RR, 2.87; 95% CI, 2.22-3.70). Transient food allergy and persistent food allergy were both associated with an increased risk of asthma (transient egg allergy: RR, 1.92; 95% CI, 1.46-2.51; persistent egg allergy: RR, 2.60; 95% CI, 1.76-3.85). CONCLUSIONS Asthma at age 4 years is twice as common in those with challenge-proven food allergy at age 1 year, irrespective of whether the food allergy subsequently resolves. Children with 2 or more food allergies and those with coexistent eczema were almost 3 times as likely to develop asthma compared with those with no food allergies.

Self-reported adverse food reactions and anaphylaxis in the SchoolNuts study: A population-based study of adolescents

Background: Adolescents are at the highest risk of death from anaphylaxis, yet few population‐based studies have described the frequencies and risk factors for allergic reactions caused by accidental allergen ingestion in this group. Methods: We describe the prevalence, frequency, and associated risk factors for recent adverse food reactions in 10‐ to 14‐year‐olds in Melbourne, Australia, recruited from a stratified, random, population‐based sample of schools (SchoolNuts, n = 9663; 48% response rate). Self‐reported food allergy and adverse reaction details, including anaphylaxis, were identified by using a student questionnaire over the past year. Results: Of 547 students with possible IgE‐mediated food allergy, 243 (44.4%; 95% CI, 40.3% to 48.7%) reported a reaction to a food. Fifty‐three (9.7%; 95% CI, 7.2% to 12.2%) students reported 93 anaphylaxis episodes. Peanut and tree nuts were the most common food triggers. Among students with current IgE‐mediated food allergy, those with resolved or current asthma (adjusted odds ratio [aOR], 1.9 [95% CI, 1.1–1.3] and 1.7 [95% CI, 1.1–2.6]) and those with more than 2 food allergies (aOR, 1.9 [95% CI, 1.1–3.1]) were at greatest risk of any adverse food reaction, and those with nut allergy were most at risk of severe reactions (aOR, 2.9 [95% CI, 1.1–4.4]). Resolved or current asthma was not associated with increased risk of severe reactions (aOR, 0.8 [95% CI, 0.3–2.2] and 1.6 [95% CI, 0.7–3.7]). Conclusions: Adolescents with food allergy are frequently exposed to food allergens. Those with asthma and more than 2 food allergies were at the greatest risk for adverse food reactions. Those with nut allergies were most at risk of severe reactions.

Fecal microbial transplantation in a pediatric case of recurrent Clostridium difficile infection and specific antibody deficiency.

Fecal microbial transplantation (FMT) has been shown to be more effective than antimicrobial therapy in the treatment of recurrent Clostridium difficile infection (CDI) in adults, with a randomized control trial (RCT) showing resolution of symptoms and clearance of CDI in 81% of subjects compared to 31% with standard antibiotic therapy (1). This article is protected by copyright. All rights reserved.

Multiple Food Protein Intolerance of Infancy or Severe Spectrum of Non-IgE-Mediated Cow's Milk Allergy? - a Case Series

NoneIgE-mediated cow’s milk allergy usually presents in the first year of life and is often associated with soy intolerance. Treatment requires cow’s milk elimination and replacement with medicalized formula—usually extensively hydrolyzed formula as first line, if intolerant to soy and older than age 6 months. Between 10% and 20% of infants with this condition require transition to a second-line treatment formula that is amino acidebased to become symptom free. In this group of infants we have noted a subset with a more extreme presentation who although asymptomatic on a diet consisting of amino acidebased formula (AAF) alone become symptomatic with the introduction of most solid foods. It is unclear whether this condition is a complication of severe noneIgE-mediated cow’s milk allergy, a failure of generalized oral tolerance, a chronic form of food proteineinduced enterocolitis syndrome (FPIES), or simply due to the development of a fermenting pattern of gastrointestinal dysbiosis. Here, we describe a consecutive case series of these patients ascertained by review of consecutive patients referred to the allergy dietitian (V.McW.) between January 2008 and December 2013 in the Department of Allergy and Clinical Immunology, Royal Children’s Hospital Melbourne, Australia. Patients were eligible if they fulfilled the following criteria:

Patterns of Carriage of Prescribed Adrenaline Autoinjectors in 10- to 14-Year-Old Food-Allergic Students: A Population-Based Study

BACKGROUND Adolescence is well recognized as a period of increased risk for severe and fatal food-induced anaphylaxis. Current Australian adrenaline autoinjector (AAI) prescription guidelines therefore suggest that consideration be given to AAI prescription in all adolescents with a food allergy. To date, however, few studies have assessed the AAI carriage behavior of adolescents prescribed AAI devices. OBJECTIVE To determine the carriage behavior of prescribed AAI devices in a population-based sample of young Australian adolescents. METHODS Students aged 10 to 14 years (and their parents) from randomly selected schools in metropolitan Melbourne completed self-administered questionnaires regarding the history and management of food allergy, including prescription and carriage of AAI device in different domains of school and social life. RESULTS A total of 9816 students completed the questionnaire (46% response): 620 students were assessed to have likely IgE-mediated food allergy and 234 (38%) of these had been prescribed an AAI. Most students (93%; 95% CI, 89%-96%) who were prescribed AAIs reported that they provided their AAI and anaphylaxis action plan to their school. Adherence to AAI carriage in other domains of social life was poor, with 49% (95% CI, 42%-56%) never carrying their AAI in 1 or more locations. Carriage of the AAI device was particularly poor when students were independent of parental supervision: 32% (95% CI, 25%-39%) never carried it when they were by themselves, 28% (95% CI, 22%-36%) never carried it while out with friends, and 36% (95% CI, 30%-43%) never carried their AAI to sporting activities. CONCLUSIONS Carriage of AAI devices is suboptimal in young adolescents prescribed AAIs, particularly when young adolescents are independent of parental supervision.