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Ann E. Clarke - One of the best experts on this subject based on the ideXlab platform.
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inadvertent exposures in children with Peanut Allergy
Pediatric Allergy and Immunology, 2012Co-Authors: Nha Uyen Nguyenluu, Lawrence Joseph, Reza Alizadehfar, Moshe Benshoshan, Laurie Harada, Mary Allen, Yvan Stpierre, Ann E. ClarkeAbstract:Objectives: To determine the annual incidence, characterize the severity and management, and identify predictors of accidental exposure among a cohort of children with Peanut Allergy. Methods: From 2004 to November 2009, parents of Canadian children with a physician-confirmed Peanut Allergy completed entry and follow-up questionnaires about accidental exposures over the preceding year. Logistic regression analyses were used to examine potential predictors. Results: A total of 1411 children [61.3% boys, mean age 7.1 yr (SD, 3.9)] participated. When all children were included, regardless of length of observation, 266 accidental exposures occurred over 2227 patient-years, yielding an annual incidence rate of 11.9% (95% CI, 10.6–13.5). When all accidental exposures occurring after study entry and patients providing <1 yr of observation were excluded, 147 exposures occurred over a period of 1175 patient-years, yielding a rate of 12.5% (95% CI, 10.7–14.5). Only 21% of moderate and severe reactions were treated with epinephrine. Age ‡13 yr at study entry (OR, 2.33; 95% CI, 1.20–4.53) and a severe previous reaction to Peanut (OR, 2.04; 95% CI, 1.44–2.91) were associated with an increased risk of accidental exposure, and increasing disease duration (OR, 0.88; 95% CI, 0.83–0.92) with a decreased risk. Conclusion: The annual incidence rate of accidental exposure for children with Peanut Allergy is 12.5%. Children with a recent diagnosis and adolescents are at higher risk. Hence, education of allergic children and their families is crucial immediately after diagnosis and during adolescence. As many reactions were treated inappropriately, healthcare professionals require better education on anaphylaxis management.
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prevalence of Peanut Allergy in primary school children in montreal canada
The Journal of Allergy and Clinical Immunology, 2003Co-Authors: Rhoda Kagan, Lawrence Joseph, Claire Dufresne, Elizabeth Turnbull, Yvan St. Pierre, Katherine Graydonald, Ann E. ClarkeAbstract:Abstract Background Peanut Allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing. Objective We estimated the prevalence of Peanut Allergy in Montreal by administering questionnaires regarding Peanut ingestion to children in kindergarten through grade 3 in randomly selected schools. Methods Respondents were stratified as follows: (1) Peanut tolerant, (2) never-rarely ingest Peanut, (3) convincing history of Peanut Allergy, and (4) uncertain history of Peanut Allergy. Groups 2, 3, and 4 underwent Peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of Peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to Peanut without further testing. Children in groups 2 and 4 with Peanut-specific IgE levels of less than 15 kU/L underwent oral Peanut challenges. Results Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of Peanut Allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the Peanut Allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%). Conclusion Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.
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Peanut Allergy: an overview
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003Co-Authors: Saleh Al-muhsen, Ann E. Clarke, Rhoda KaganAbstract:Peanut Allergy accounts for the majority of severe food-related allergic reactions. It tends to present early in life, and affected individuals generally do not outgrow it. In highly sensitized people, trace quantities can induce an allergic reaction. In this review, we will discuss the prevalence, clinical characteristics, diagnosis, natural history and management of Peanut Allergy.
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Prevalence of Peanut Allergy in primary-school children in Montreal, Canada
The Journal of allergy and clinical immunology, 2003Co-Authors: Rhoda Kagan, Lawrence Joseph, Claire Dufresne, Katherine Gray-donald, Elizabeth Turnbull, Yvan St. Pierre, Ann E. ClarkeAbstract:Peanut Allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing. We estimated the prevalence of Peanut Allergy in Montreal by administering questionnaires regarding Peanut ingestion to children in kindergarten through grade 3 in randomly selected schools. Respondents were stratified as follows: (1). Peanut tolerant, (2). never-rarely ingest Peanut, (3). convincing history of Peanut Allergy, and (4). uncertain history of Peanut Allergy. Groups 2, 3, and 4 underwent Peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of Peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to Peanut without further testing. Children in groups 2 and 4 with Peanut-specific IgE levels of less than 15 kU/L underwent oral Peanut challenges. Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of Peanut Allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the Peanut Allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%). Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.
Scott H. Sicherer - One of the best experts on this subject based on the ideXlab platform.
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Peanut Allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis.
The Journal of allergy and clinical immunology, 2020Co-Authors: Matthew Greenhawt, Marcus Shaker, Scott H. Sicherer, Julie Wang, John J. Oppenheimer, Corinne A. Keet, Keri R Swaggart, Matthew A. Rank, Jay M. Portnoy, Jonathan A. BernsteinAbstract:Given the burden of disease and the consequences of a diagnosis of Peanut Allergy, it is important that Peanut Allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is Peanut sensitization present (eg, a "positive" test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated Peanut Allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for Peanut Allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to Peanut.
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Peanut Allergy: New Advances and Ongoing Controversies
Pediatrics, 2020Co-Authors: Elissa M. Abrams, Edmond S. Chan, Scott H. SichererAbstract:Peanut Allergy is one of the most common food allergies in children, with increasing prevalence over time. The dual-allergen exposure hypothesis now supports transcutaneous sensitization to Peanut as a likely pathophysiologic mechanism for Peanut Allergy development. As a result, there is emerging evidence that early Peanut introduction has a role in Peanut Allergy prevention. Current first-line diagnostic tests for Peanut Allergy have limited specificity, which may be enhanced with emerging tools such as component-resolved diagnostics. Although management of Peanut Allergy includes avoidance and carrying an epinephrine autoinjector, risk of fatal anaphylaxis is extremely low, and there is minimal risk related to cutaneous or inhalational exposure. Quality of life in children with Peanut Allergy requires significant focus. Moving forward, oral and epicutaneous immunotherapy are emerging and exciting tools that may have a role to play in desensitization to Peanut.
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Management of Peanut Allergy.
The journal of allergy and clinical immunology. In practice, 2019Co-Authors: Carina Venter, Scott H. Sicherer, Matthew GreenhawtAbstract:Peanut Allergy is a growing public health concern in westernized countries. Peanut Allergy is characterized as an often severe and lifelong Allergy, which can have detrimental effects on quality of life and trigger anxiety. Although multiple therapeutic options are emerging, the focus of current management strategies is strict Peanut avoidance and carriage of self-injectable epinephrine. The greatest risk of reacting to Peanut comes from direct ingestion, whereas casual skin contact or airborne exposure is highly unlikely to provoke significant symptoms. Patients and families must be educated about how to best execute strict Peanut avoidance through careful label reading as well as how to understand and address likely and unlikely risk with regard to Peanut exposure in public, in particular when dining outside of the home and for children attending school or child care. This review discusses the risk of exposure in public such as at school or on an airplane and how such risk can be abated, situations and scenarios when dining out of the house that may pose more risks than others, the essentials of US and EU label reading laws with particular emphasis on precautionary labeling and the risk implied by such, quality of life and psychosocial issues that may affect the Peanut allergic individual and family, and a discussion of how risk may differ and evolve based on the patient's age.
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Maternal Peanut consumption and risk of Peanut Allergy in childhood.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018Co-Authors: Elissa M. Abrams, Scott H. SichererAbstract:KEY POINTS Peanut Allergy in children is on the rise in North America, with a self-reported prevalence of 1.4% in 2008, up from 0.4% in 1997 ( p < 0.001).[1][1] As a result, prevention of Peanut Allergy has become an important public health goal. A recent guideline recommends early introduction of
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the benefits of new guidelines to prevent Peanut Allergy
Pediatrics, 2017Co-Authors: Scott H. Sicherer, Hugh A. Sampson, Lawrence F Eichenfield, Daniel RotrosenAbstract:* Abbreviations: AAP — : American Academy of Pediatrics EP — : expert panel LEAP — : Learning Early About Peanut Allergy NIAID — : National Institute of Allergy and Infectious Diseases sIgE — : serum food-specific IgE antibody SPT — : skin prick test Peanut Allergy appears to have tripled in prevalence in the United States since 1997 and now affects 1% to 2% of children.1 The high prevalence, severity, and life-long persistence of Peanut Allergy have generated intense interest in prevention strategies. Initially, such strategies focused on allergen avoidance, but a key observation, the 10-fold higher rate of Peanut Allergy among Jewish children in the United Kingdom compared with Israeli children of similar ancestry, suggested an alternative approach.2 A notable difference between these populations was the almost complete lack of Peanut ingestion in the first year of life in the United Kingdom compared with substantial consumption among Israeli infants. Based on this observation, the National Institutes of Health–sponsored Learning Early About Peanut Allergy (LEAP) trial randomized 640 infants between 4 and 11 months of age with severe eczema and/or egg Allergy to consume or avoid Peanut-containing foods until 60 months of age.3 The study excluded infants with large (>4 mm) positive skin prick tests (SPTs) to Peanut, assuming many were already allergic, and stratified the enrolled infants as having no Peanut SPT wheal or having one that was 1 to 4 mm in diameter. In the intention-to-treat population with negative SPT ( n = 530), the prevalence of Peanut Allergy at 60 months of age was 13.7% in the avoidance group versus 1.9% in the consumption group ( P < .001; 86.1% relative risk reduction), and among those in the SPT positive group ( n = 98), the prevalence of Peanut Allergy was 35.3% in the avoidance group and … Address correspondence to Scott H. Sicherer, MD, Department of Pediatrics, Mount Sinai Hospital, Box 1198, 1 Gustave L Levy Pl, New York, NY 10029. E-mail: scott.sicherer{at}mssm.edu
A Wesley Burks - One of the best experts on this subject based on the ideXlab platform.
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Immunotherapy approaches for Peanut Allergy
Expert review of clinical immunology, 2020Co-Authors: Edwin H. Kim, Chirag Patel, A Wesley BurksAbstract:Introduction: Peanut Allergy has continued to increase in prevalence and despite efforts to prevent the Allergy with early Peanut introduction, treatments for those already with the Allergy have been lacking. While the physical effects of Peanut Allergy have been well known, what has more recently begun to be discussed are the broad psychosocial and financial implications that are also related to the Allergy. Oral (OIT), epicutaneous (EPIT), and sublingual (SLIT) immunotherapy have been developed as potential treatments for Peanut Allergy.Areas covered: Pivotal clinical trials in OIT, EPIT, and SLIT from the past 10 years are reviewed in this manuscript. Peanut OIT has been shown to induce strong desensitization; however, side effects and safety of the treatment have remained a concern. Peanut EPIT has demonstrated a reassuring safety profile but with a more modest protective effect. Peanut SLIT has remained behind in development but recent studies have suggested a balance of desensitization, safety, and convenience.Expert opinion: There are no perfect treatments for Peanut Allergy and OIT, EPIT, and SLIT each has its unique pros and cons. Shared decision-making between patients and providers will be essential to achieve optimal care for patients with Peanut Allergy.
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Strategies to Mitigate Peanut Allergy: Production, Processing, Utilization, and Immunotherapy Considerations
Annual review of food science and technology, 2014Co-Authors: Brittany L. White, A Wesley Burks, Xiaolei Shi, Caitlin M. Burk, Michael D. Kulis, Timothy H. Sanders, Jack P. DavisAbstract:Peanut (Arachis hypogaea L.) is an important crop grown worldwide for food and edible oil. The surge of Peanut Allergy in the past 25 years has profoundly impacted both affected individuals and the Peanut and related food industries. In response, several strategies to mitigate Peanut Allergy have emerged to reduce/eliminate the allergenicity of Peanuts or to better treat Peanut-allergic individuals. In this review, we give an overview of Peanut Allergy, with a focus on Peanut proteins, including the impact of thermal processing on Peanut protein structure and detection in food matrices. We discuss several strategies currently being investigated to mitigate Peanut Allergy, including genetic engineering, novel processing strategies, and immunotherapy in terms of mechanisms, recent research, and limitations. All strategies are discussed with considerations for both Peanut-allergic individuals and the numerous industries/government agencies involved throughout Peanut production and utilization.
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Recent advances in the diagnosis and therapy of Peanut Allergy
Expert review of clinical immunology, 2013Co-Authors: Saira Z. Sheikh, A Wesley BurksAbstract:Peanut Allergy is a life-threatening, IgE-mediated allergic disease. In developed countries, the prevalence rate of Peanut Allergy in school-aged children is reported to be in excess of 1% and continues to rise, representing a major public health concern. Peanut Allergy is diagnosed on the basis of a relevant clinical history combined with results of skin-prick testing and/or Peanut-specific IgE levels. A double-blind placebo-controlled oral food challenge is the gold standard for diagnosis. Currently, there is no approved treatment or disease-modifying therapy for Peanut Allergy. This review discusses recent advances in molecular diagnostic techniques for Peanut Allergy and highlights advances in Peanut Allergy therapeutics, discussing allergen-specific and allergen-nonspecific treatments that are currently in Phase I/II clinical trials.
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Peanut Allergy.
Lancet (London England), 2008Co-Authors: A Wesley BurksAbstract:Peanut Allergy has become a major health concern worldwide, especially in developed countries. However, the reasons for this increasing prevalence over the past several decades are not well understood. Because of the potentially severe health consequences of Peanut Allergy, those suspected of having had an allergic reaction to Peanuts deserve a thorough evaluation. All patients with Peanut Allergy should be given an emergency management plan, as well as epinephrine and antihistamines to have on hand at all times. Patients and families should be taught to recognise early allergic reactions to Peanuts and how to implement appropriate Peanut-avoidance strategies. It is imperative that severe, or potentially severe, reactions be treated promptly with intramuscular epinephrine and oral antihistamines. Patients who have had such a reaction should be kept under observation in a hospital emergency department or equivalent for up to 4 h because of the possible development of the late-phase allergic response. This Seminar looks at the changing epidemiology of this Allergy--and theories as to the rise in prevalence, diagnosis, and management of the Allergy, and potential new treatments and prevention strategies under development.
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Peanut Allergy: Recurrence and its management
The Journal of allergy and clinical immunology, 2004Co-Authors: David Fleischer, A Wesley Burks, Mary Kay Conover-walker, Lynn Christie, Robert A. WoodAbstract:Although Peanut Allergy may recur, the frequency with which this occurs is unknown. The goals of this study were to determine the rate of Peanut Allergy recurrence, identify risk factors for recurrent Peanut Allergy, and develop specific recommendations for the treatment of patients with resolved Peanut Allergy. Children who outgrew Peanut Allergy were evaluated with questionnaires, skin tests, and Peanut-specific IgE levels. Patients were invited to undergo a double-blind, placebo-controlled food challenge (DBPCFC) unless the history of a possible recurrence reaction was so convincing that a challenge would be potentially dangerous. Sixty-eight patients were evaluated. Forty-seven patients continued to tolerate Peanut, of whom 34 ingested concentrated Peanut products at least once per month and 13 ate Peanut infrequently or in limited amounts but passed a DBPCFC. The status of 18 patients was indeterminate because they ate Peanut infrequently or in limited amounts and declined to have a DBPCFC. After excluding 12 patients originally diagnosed with Peanut Allergy based solely on a positive skin prick test or Peanut-specific IgE level, 3 of 15 patients who consumed Peanut infrequently or in limited amounts had recurrences, compared with no recurrences in the 23 patients who ate Peanut frequently ( P = .025). The recurrence rate was 7.9 (95% CI, 1.7% to 21.4%). Children who outgrow Peanut Allergy are at risk for recurrence, and this risk is significantly higher for patients who continue largely to avoid Peanut after resolution of their Allergy. On the basis of these findings, we now recommend that patients eat Peanut frequently and carry epinephrine indefinitely until they have demonstrated ongoing Peanut tolerance.
Lawrence Joseph - One of the best experts on this subject based on the ideXlab platform.
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inadvertent exposures in children with Peanut Allergy
Pediatric Allergy and Immunology, 2012Co-Authors: Nha Uyen Nguyenluu, Lawrence Joseph, Reza Alizadehfar, Moshe Benshoshan, Laurie Harada, Mary Allen, Yvan Stpierre, Ann E. ClarkeAbstract:Objectives: To determine the annual incidence, characterize the severity and management, and identify predictors of accidental exposure among a cohort of children with Peanut Allergy. Methods: From 2004 to November 2009, parents of Canadian children with a physician-confirmed Peanut Allergy completed entry and follow-up questionnaires about accidental exposures over the preceding year. Logistic regression analyses were used to examine potential predictors. Results: A total of 1411 children [61.3% boys, mean age 7.1 yr (SD, 3.9)] participated. When all children were included, regardless of length of observation, 266 accidental exposures occurred over 2227 patient-years, yielding an annual incidence rate of 11.9% (95% CI, 10.6–13.5). When all accidental exposures occurring after study entry and patients providing <1 yr of observation were excluded, 147 exposures occurred over a period of 1175 patient-years, yielding a rate of 12.5% (95% CI, 10.7–14.5). Only 21% of moderate and severe reactions were treated with epinephrine. Age ‡13 yr at study entry (OR, 2.33; 95% CI, 1.20–4.53) and a severe previous reaction to Peanut (OR, 2.04; 95% CI, 1.44–2.91) were associated with an increased risk of accidental exposure, and increasing disease duration (OR, 0.88; 95% CI, 0.83–0.92) with a decreased risk. Conclusion: The annual incidence rate of accidental exposure for children with Peanut Allergy is 12.5%. Children with a recent diagnosis and adolescents are at higher risk. Hence, education of allergic children and their families is crucial immediately after diagnosis and during adolescence. As many reactions were treated inappropriately, healthcare professionals require better education on anaphylaxis management.
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prevalence of Peanut Allergy in primary school children in montreal canada
The Journal of Allergy and Clinical Immunology, 2003Co-Authors: Rhoda Kagan, Lawrence Joseph, Claire Dufresne, Elizabeth Turnbull, Yvan St. Pierre, Katherine Graydonald, Ann E. ClarkeAbstract:Abstract Background Peanut Allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing. Objective We estimated the prevalence of Peanut Allergy in Montreal by administering questionnaires regarding Peanut ingestion to children in kindergarten through grade 3 in randomly selected schools. Methods Respondents were stratified as follows: (1) Peanut tolerant, (2) never-rarely ingest Peanut, (3) convincing history of Peanut Allergy, and (4) uncertain history of Peanut Allergy. Groups 2, 3, and 4 underwent Peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of Peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to Peanut without further testing. Children in groups 2 and 4 with Peanut-specific IgE levels of less than 15 kU/L underwent oral Peanut challenges. Results Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of Peanut Allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the Peanut Allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%). Conclusion Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.
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Prevalence of Peanut Allergy in primary-school children in Montreal, Canada
The Journal of allergy and clinical immunology, 2003Co-Authors: Rhoda Kagan, Lawrence Joseph, Claire Dufresne, Katherine Gray-donald, Elizabeth Turnbull, Yvan St. Pierre, Ann E. ClarkeAbstract:Peanut Allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing. We estimated the prevalence of Peanut Allergy in Montreal by administering questionnaires regarding Peanut ingestion to children in kindergarten through grade 3 in randomly selected schools. Respondents were stratified as follows: (1). Peanut tolerant, (2). never-rarely ingest Peanut, (3). convincing history of Peanut Allergy, and (4). uncertain history of Peanut Allergy. Groups 2, 3, and 4 underwent Peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of Peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to Peanut without further testing. Children in groups 2 and 4 with Peanut-specific IgE levels of less than 15 kU/L underwent oral Peanut challenges. Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of Peanut Allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the Peanut Allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%). Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.
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The psychological burden of Peanut Allergy as perceived by adults with Peanut Allergy and the parents of Peanut-allergic children.
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 2000Co-Authors: M. N. Primeau, Rhoda Kagan, Lawrence Joseph, H. Lim, C. Dufresne, Ciarán M. Duffy, D. Prhcal, A.e. ClarkeAbstract:Background Peanut-allergic patients are affected by a condition which forces them and their families to exercise extreme dietary vigilance and experience constant uncertainty throughout their lives. Objective To compare the quality of life and family relations of children and adults with a Peanut Allergy to that of children and adults with a rheumatological disease. Methods Patients with a confirmed diagnosis of Peanut Allergy or a rheumatological disease completed (for children less than 18 years, by proxy) self-report questionnaires regarding the impact of their condition on their quality of life and family relations. A vertical visual analogue scale and the Impact on Family Questionnaire (IFQ) served as outcome measures. Results One hundred and fifty-three Peanut-allergic children were compared with 69 children with a rheumatological disease while 37 Peanut-allergic adults were compared with 42 adults with a rheumatological disease. The parents of Peanut-allergic children, compared to the parents of children with a rheumatological disease, reported that their children had significantly more disruption in their daily activities. Furthermore, the parents of Peanut-allergic children reported more impairment in the familial-social dimension of the IFQ. Conversely, adults with a chronic rheumatological disease reported more disruption in their family relations than Peanut-allergic adults. Conclusion Given the considerable disruption in daily activities and family relations reported by the parents of Peanut-allergic children, accurate diagnosis of Peanut Allergy is essential. Our work should make health care professionals dealing with children with confirmed Peanut Allergy more aware of the support that these families may require. Furthermore, we hope to motivate food industries to offer more ‘Peanut free’ products to decrease the dietary restrictions of these patients while minimizing their potential for accidental ingestion.
Hugh A. Sampson - One of the best experts on this subject based on the ideXlab platform.
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Diagnosing Peanut Allergy with Fewer Oral Food Challenges.
The journal of allergy and clinical immunology. In practice, 2018Co-Authors: Jennifer J. Koplin, Kirsten P. Perrett, Hugh A. SampsonAbstract:Diagnosis of Peanut Allergy presents a significant clinical challenge. Accurate diagnosis is critical for patient management and prevention of allergic reactions, whereas overdiagnosis or failure to diagnose tolerance in a previously allergic patient can lead to unnecessary dietary restrictions and impaired quality of life. Oral food challenges, the criterion standard for diagnosis, pose a risk of potentially severe allergic reactions, and are time- and resource- intensive. In this article, we review other currently available tests for Peanut Allergy and present the strengths and weaknesses of each to assist the clinician in determining which test might be appropriate for their patients, as well as highlighting emerging tests currently in development. Traditional tests for Peanut-specific IgE (skin prick testing and specific IgE) remain useful as first-line tests—a negative test result is useful for excluding Peanut Allergy and a high positive result has a high specificity for Peanut Allergy. For those with an intermediate positive test result, Ara h 2 testing might be useful as a second step. Basophil activation tests and Peanut protein epitope-specific IgE analyses appear promising in recent studies; however, further research is required into standardization, validation, and cost-effectiveness. Given the limitations of existing tests for Peanut Allergy, there remains a clear need for improvement. Finding a safe and affordable method for Peanut Allergy diagnosis that is both sensitive and specific remains an active area of research.
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the benefits of new guidelines to prevent Peanut Allergy
Pediatrics, 2017Co-Authors: Scott H. Sicherer, Hugh A. Sampson, Lawrence F Eichenfield, Daniel RotrosenAbstract:* Abbreviations: AAP — : American Academy of Pediatrics EP — : expert panel LEAP — : Learning Early About Peanut Allergy NIAID — : National Institute of Allergy and Infectious Diseases sIgE — : serum food-specific IgE antibody SPT — : skin prick test Peanut Allergy appears to have tripled in prevalence in the United States since 1997 and now affects 1% to 2% of children.1 The high prevalence, severity, and life-long persistence of Peanut Allergy have generated intense interest in prevention strategies. Initially, such strategies focused on allergen avoidance, but a key observation, the 10-fold higher rate of Peanut Allergy among Jewish children in the United Kingdom compared with Israeli children of similar ancestry, suggested an alternative approach.2 A notable difference between these populations was the almost complete lack of Peanut ingestion in the first year of life in the United Kingdom compared with substantial consumption among Israeli infants. Based on this observation, the National Institutes of Health–sponsored Learning Early About Peanut Allergy (LEAP) trial randomized 640 infants between 4 and 11 months of age with severe eczema and/or egg Allergy to consume or avoid Peanut-containing foods until 60 months of age.3 The study excluded infants with large (>4 mm) positive skin prick tests (SPTs) to Peanut, assuming many were already allergic, and stratified the enrolled infants as having no Peanut SPT wheal or having one that was 1 to 4 mm in diameter. In the intention-to-treat population with negative SPT ( n = 530), the prevalence of Peanut Allergy at 60 months of age was 13.7% in the avoidance group versus 1.9% in the consumption group ( P < .001; 86.1% relative risk reduction), and among those in the SPT positive group ( n = 98), the prevalence of Peanut Allergy was 35.3% in the avoidance group and … Address correspondence to Scott H. Sicherer, MD, Department of Pediatrics, Mount Sinai Hospital, Box 1198, 1 Gustave L Levy Pl, New York, NY 10029. E-mail: scott.sicherer{at}mssm.edu
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a bioinformatics approach to identify patients with symptomatic Peanut Allergy using peptide microarray immunoassay
The Journal of Allergy and Clinical Immunology, 2012Co-Authors: Jing Lin, Francesca M Bruni, Jennifer M Maloney, Ludmilla Bardina, Attilio L Boner, Gustavo Gimenez, Hugh A. SampsonAbstract:Background Peanut Allergy is relatively common, typically permanent, and often severe. Double-blind, placebo-controlled food challenge is considered the gold standard for the diagnosis of food Allergy–related disorders. However, the complexity and potential of double-blind, placebo-controlled food challenge to cause life-threatening allergic reactions affects its clinical application. A laboratory test that could accurately diagnose symptomatic Peanut Allergy would greatly facilitate clinical practice. Objective We sought to develop an Allergy diagnostic method that could correctly predict symptomatic Peanut Allergy by using peptide microarray immunoassays and bioinformatic methods. Methods Microarray immunoassays were performed by using the sera from 62 patients (31 with symptomatic Peanut Allergy and 31 who had outgrown their Peanut Allergy or were sensitized but were clinically tolerant to Peanut). Specific IgE and IgG 4 binding to 419 overlapping peptides (15 mers, 3 offset) covering the amino acid sequences of Ara h 1, Ara h 2, and Ara h 3 were measured by using a peptide microarray immunoassay. Bioinformatic methods were applied for data analysis. Results Individuals with Peanut Allergy showed significantly greater IgE binding and broader epitope diversity than did Peanut-tolerant individuals. No significant difference in IgG 4 binding was found between groups. By using machine learning methods, 4 peptide biomarkers were identified and prediction models that can predict the outcome of double-blind, placebo-controlled food challenges with high accuracy were developed by using a combination of the biomarkers. Conclusions In this study, we developed a novel diagnostic approach that can predict Peanut Allergy with high accuracy by combining the results of a peptide microarray immunoassay and bioinformatic methods. Further studies are needed to validate the efficacy of this assay in clinical practice.
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The natural history of Peanut Allergy.
The Journal of allergy and clinical immunology, 2001Co-Authors: Helen S. Skolnick, Hugh A. Sampson, Mary Kay Conover-walker, Wesley Burks, Celide B. Koerner, Robert A. WoodAbstract:Abstract Background: It has traditionally been assumed that Peanut Allergy is rarely outgrown. Objective: The goal of this study was to determine the number of children with Peanut Allergy who become tolerant of Peanut. Methods: Patients aged 4 to 20 years with a diagnosis of Peanut Allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a Peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kU A /L) were offered an open or double-blind, placebo-controlled Peanut challenge. Results: A total of 223 patients were evaluated, and of those, 85 (PN-IgE A /L [median 1.42 kU A /L]) participated in an oral Peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their Peanut Allergy (aged 4-17.5 years [median 6 years]; PN-IgE A /L [median 0.69 kU A /L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST A /L [median 2.06 kU A /L]). Forty-one patients with PN-IgE levels less than 20 kU A /L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kU A /L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kU A /L and 61% with levels less than 5 kU A /L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge ( P = .009), but not at the time of diagnosis ( P = .25). Conclusion: This study demonstrates that Peanut Allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a Peanut challenge in a medical setting to demonstrate whether they can now tolerate Peanuts. (J Allergy Clin Immunol 2001;107:367-74.)
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Genetics of Peanut Allergy: a twin study.
Journal of Allergy and Clinical Immunology, 2000Co-Authors: Scott H. Sicherer, Terence J. Furlong, Hermine H. Maes, Robert J. Desnick, Hugh A. Sampson, Bruce D. GelbAbstract:Background: The role of genetics in the etiology of Peanut Allergy is unknown. For complex genetic traits, twin studies can provide information on the relative contribution of genetic factors to a disease, as the relative confounding effects of environmental factors are markedly decreased. Objective: This study was performed to search for evidence that genetic factors influence Peanut Allergy by comparing the concordance rate for this Allergy among monozygotic and dizygotic twins. Methods: Twin pairs with at least one member with Peanut Allergy were ascertained through the Food Allergy Network by advertisements in the organization’s newsletters and Web site. Individuals with Peanut Allergy or parental surrogates were interviewed by telephone. A full atopic history was obtained, and Peanut Allergy and zygosity were determined using previously validated questionnaires. Heritability of Peanut Allergy was determined using univariate genetic model fitting by maximum likelihood with the Mx statistical modeling software package. Results: Seventy-five twin pairs were recruited. Seventeen pairs were excluded because of unconvincing Peanut Allergy histories (9 pairs, including 4 of uncertain zygosity) or because one twin had reportedly never ingested Peanut (8 pairs). The median age of the 58 remaining twin pairs was 5 years (range 1 to 58 years). Seventy individuals had Peanut Allergy. In addition to convincing histories of Peanut Allergy, 52 (74%) had been tested (skin prick testing with or without radioallergosorbent assay) and all had positive reactions to Peanut. Twentynine of the 70 had experienced >1 reaction to Peanut; 29 of 70 had multisystem reactions. Among the monozygotic pairs (n = 14), 9 were concordant for Peanut Allergy (pairwise concordance, 64.3%) and among dizygotic pairs (n = 44), 3 were concordant for Peanut Allergy (pairwise concordance, 6.8%; χ2 = 21.38, P < .0001). Heritability of Peanut Allergy was estimated at 81.6% (95% confidence interval 41.6% to 99.7%) with model fitting using a population prevalence of Peanut Allergy of 0.4%. Conclusions: The significantly higher concordance rate of Peanut Allergy among monozygotic twins suggests strongly that there is a significant genetic influence on Peanut Allergy. (J Allergy Clin Immunol 2000;106:53-6.)