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Background Methods Results Conclusions Limited decision‐support tools are available to help shared decision‐making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered.In compliance with International Patient Decision Aid Standards criteria, this pediatric decision‐aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence‐synthesis from the OIT literature to create the prototype decision‐aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self‐efficacy.The decision‐aid underwent 5 iterations, resulting in a 4‐page written aid (Flesch–Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self‐rating for attribute importance for the options and self‐assessment regarding how adequate the information was in decision‐making. A total of n = 135 caregivers of food‐allergic children assessed the decision‐aid, noting good acceptability, high decisional self‐efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a “best choice.” Lower decisional conflict was associated with caregiver‐reported anaphylaxis.This first pediatric OIT decision‐aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self‐efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance. [ABSTRACT FROM AUTHOR]

Purpose of Review: Precautionary allergen labeling (PAL) suggests the risk of unintended allergen presence (UAP) in food but is unregulated in most countries and inconsistently applied by food manufacturers. This review evaluates the current use of PAL, its relevance to allergic consumers, and weighs possible advantages and disadvantages of avoiding products with PAL. Recent Findings: In most countries, manufacturers are free to decide whether, when, and how to apply PAL resulting in inconsistencies and consumer confusion. Patients with food allergy often interpret PAL incorrectly and without guidance from their health care providers. Health care providers are also prone to misinterpreting PAL, indicating a need for better education. Consumers desire guidance on whether to avoid products with PAL or not. Summary: Until further regulatory guidance is available, shared decision-making between patient and provider is required to offer individualized, rather than one–size-fits-all, approaches to PAL. [ABSTRACT FROM AUTHOR]

Aims: Only limited Indian data is available regarding the food allergy pattern among allergic rhinitis patients in Indian population. This study aims to assess the pattern of food allergen sensitivity amongst allergic rhinitis patients in central India. Material and Methods: A total of 218 subjects with allergic rhinitis were enrolled in the study (from May 2018 to August 2022). Skin prick test was done in all subjects with proper technique and precautions by using 125 common food allergens and 75 aero allergens. The test readings were noted after 20 minutes by comparing the wheals so formed with the negative control of Saline and positive control of Histamine. Any reaction with a wheal diameter of 3mm or greater was considered as positive. Results: While test results of both food and inhalant allergens were issued to individual patients, this study was restricted to detection and analysis of pattern of food allergens. Our study observed male preponderance with predominantly a third decade affliction. The most common food allergen in the study population was beetle nut (29.3%) followed by chilli powder and spinach (28.8% each). Conclusion: Along with aeroallergens, food allergens are also important provocateurs of allergic rhinitis. Diagnosing the offending food allergens and its avoidance reduces patient morbidity, need for pharmaceutical agents and subsequently drug dependence and its side effects. Offering subjects a replacement diet with food items of similar taste and nutritive character helps in sustainable avoidance therapy. [ABSTRACT FROM AUTHOR]

Allergen exposure is associated with the development of allergen‐specific sensitization, but their relationship is influenced by other contemporaneous exposures (such as microbial exposure) and the genetic predisposition of the host. Clinical outcomes of the primary prevention studies that tested the effectiveness of allergen avoidance in pregnancy and early life on the subsequent development of sensitization and asthma published to date are inconsistent. Therefore, we cannot provide any evidence‐based advice on the use of allergen avoidance for the primary prevention of these conditions. The evidence about the impact of allergen exposure among and among sensitized children with asthma is more consistent, and the combination of sensitization and high exposure to sensitizing allergen increases airway inflammation, triggers symptoms, adversely impacts upon disease control, and is associated with poorer lung function in preschool age. However, there are differing opinions about the role of inhalant allergen avoidance in asthma management, and recommendations differ in different guidelines. Evidence from more recent high‐quality trials suggests that mite allergen‐impermeable bed encasings reduce hospital attendance with asthma attacks and that multifaceted targeted environmental control improves asthma control in children. We therefore suggest a pragmatic approach to allergen avoidance in the management of childhood asthma for clinical practice, including the recommendations to: (1) tailor the intervention to the patient's sensitization and exposure status by using titer of allergen‐specific IgE antibodies and/or the size of the skin test as indicators of potential response; (2) use a multifaceted allergen control regime to reduce exposure as much as possible; and (3) start intervention as early as possible upon diagnosis. [ABSTRACT FROM AUTHOR]

Environmental allergen control is recommended as an essential part of allergic rhinitis (AR) management guidelines. In this scoping review, our objective is to identify measures of allergen avoidance and to evaluate their effectiveness in the management of AR. We conducted systematic searches for randomized controlled trials and observational studies in PubMed, the Cochrane Central Register of Controlled Trials, and the Web of Science databases. We included all types of control measures based on allergen eviction or reduction in exposure. Overall, 18 studies satisfied our criteria and were thus included for further analysis. The majority of the studies (15 out of 18) reported decreases in overall AR symptom scores, improvements in quality of life, or reductions in medication usage. However, due to the low number of participants and the limitations in study designs, it is not possible to make a definitive recommendation on the use of these interventions in the management of AR. A multifaceted approach, including treatment, prevention, and eradication of allergens from the environment, may be necessary to effectively reduce symptoms. [ABSTRACT FROM AUTHOR]

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Omalizumab was recently approved by the US Food and Drug Administration for treatment of any single food allergy or multiple food allergies in children aged 1 year and older and adults. There is currently no formal guidance regarding recommended best practices for omalizumab use in food allergy, including patient selection, anticipated goals and outcomes of therapy, procedure for monitoring patients who elect to start omalizumab therapy, and ways in which omalizumab can be incorporated into the landscape of food allergy management and daily clinical practice. This work group report was developed by the food allergy therapies subcommittee of the Adverse Reactions to Foods Committee within the American Academy of Allergy, Asthma & Immunology. Consensus, evidence-based guidance regarding experts' recommendations for using omalizumab to treat children and adults with food allergy was developed by using modified Delphi methodology. In iterative fashion, a total of 8 statements regarding how to use omalizumab to treat patients with food allergy were developed by 16 clinical experts. This guidance provides the clinician with a suggested approach to patient selection, initiation of therapy, monitoring of efficacy, and long-term follow-up care. The role of preference-sensitive care is emphasized, with most statements offering care recommendations relevant to the culture and values of a particular practice setting., Competing Interests: Disclosure statement Disclosure of potential conflict of interest: A. Anagnostou reports institutional funding from Novartis; advisory board service for of Genentech, Novartis, Bryn, and Ready, Set, Food!; and consultation/speaker fees from ALK, Adelphi, Bryn, Novartis, Genentech, Medscape, Food Allergy Research and Education (FARE), MHJ, and EPG Health. J. A. Bird reports consultancy for Allergenis, DBV Technologies, FARE, Genentech, Hanimmune Therapeutics, HAL Allergy, Infinant Health, Novartis, Nutricia, and Parexel, as well as research for Aimmune, DBV Technologies, Genentech, the National Institute of Allergy and Infectious Diseases (NIAID), Novartis, Regeneron, and Siolta. S. Chinthrajah receives grant support from the Consortium for Food Allergy Research (CoFAR), NIAID, and FARE and is an advisory board member for Alladapt, Novartis, Allergenis, IgGenix, Intrommune Therapeutics, Phylaxis, and Genentech. T. E. Dribbin has received funding and is supported by NIH (K23 AI175525). D. M. Fleischer has received research support from ARS Pharmaceuticals and DBV Technologies; serves as an unpaid advisory board member for the Food Allergy and Anaphylaxis Connection Team and the National Peanut Board; receives royalties from UpToDate; and has received personal fees as a consultant to Aquestive, ARS Pharmaceuticals, Bryn Pharma, DBV Technologies, Genentech, and Nasus outside the submitted work. E. Kim reports grants to his institution from NIAID and FARE; personal fees from ALK, Ukko, Cellergy Pharma, DBV Technologies, Genentech, Hanimumme Therapeutics, Novartis, Phylaxis, Revolo Biotherapeutics; and safety review board service for Allergy Therapeutics. A. Nowak-Wegrzyn receives research support from NIAID, DBV Technologies, and Siolta Therapeutics; speaking fees from Nestle, Danone, Medscape, and Genentech; and royalties from UpToDate. In addition, A. Nowak-Wegrzyn serves as an associate editor for the Annals of Allergy, Asthma and Immunology; as director of the AAAAI board; and as chair of the medical advisory board of the International Food Protein Induced Enterocolitis Syndrome Association. M. S. Shaker is a member and cochair of the Joint Task Force on Practice Parameters, serves on the editorial board of The Journal of Allergy and Clinical Immunology: In Practice, is an associate editor of Annals of Allergy, Asthma & Immunology, and serves on the board of directors of the AAAAI (all views expressed are his own). W. Shreffler reports grants to his institution from NIAID, the Food Allergy Science Initiative, and FARE; contract research support to his institution from Genentech, DBV, Allergy Therapeutics, Aravax, Novartis; personal consulting fees from Aimmune, DBV, Novartis, ALK, Allergy Therapeutics, FARE; and royalty payments from UpToDate. S. Sicherer reports royalty payments from UpToDate and Johns Hopkins University Press; grants to his institution from tNIAID, FARE, and Pfizer; and personal fees from the AAAAI as deputy editor of the Journal of Allergy and Clinical Immunology: In Practice outside of the submitted work. B. P. Vickery reports grants from Alladapt, AstraZeneca, Genentech, NIAID, and Siolta; personal fees from Allergenis, Aravax, Reacta Biosciences, and Sanofi Regeneron; both grants and personal fees from Aimmune, DBV, FARE, Novartis, and Regeneron; and stock options from Moonlight Therapeutics outside the submitted work. J. Wang is a member of the Joint Task Force on Practice Parameters; receives research support from NIAID, Aimmune, DBV, and Siolta; and receives consultancy fees from ALK-Abelló, DBV, and Novartis. M. Greenhawt is a consultant for Aquestive; is a member of physician/medical advisory boards for DBV Technologies, Takeda, Griffols, Nutricia, Novartis, Aquestive, Allergy Therapeutics, AstraZeneca, ALK-Abelló, Bryn, Genentech, and Prota; is a speaker for Genentech; is an unpaid member of the scientific advisory council for the National Peanut Board and medical advisory board of the International Food Protein–Induced Enterocolitis Syndrome Association; is a member of the Brighton Collaboration Criteria Vaccine Anaphylaxis 2.0 working group; is the senior associate editor for the Annals of Allergy, Asthma, and Immunology; and is member of the Joint Taskforce on Allergy Practice Parameters. In addition, J. Wang has received honoraria for lectures from ImSci, Red Nucleus, Medscape, Paradigm Medical Communications, Kaplan, Food Allergy Research and Education, and multiple state and local allergy societies. The rest of the authors declare that they have no relevant conflicts of interest., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Environmental allergen control is recommended as an essential part of allergic rhinitis (AR) management guidelines. In this scoping review, our objective is to identify measures of allergen avoidance and to evaluate their effectiveness in the management of AR. We conducted systematic searches for randomized controlled trials and observational studies in PubMed, the Cochrane Central Register of Controlled Trials, and the Web of Science databases. We included all types of control measures based on allergen eviction or reduction in exposure. Overall, 18 studies satisfied our criteria and were thus included for further analysis. The majority of the studies (15 out of 18) reported decreases in overall AR symptom scores, improvements in quality of life, or reductions in medication usage. However, due to the low number of participants and the limitations in study designs, it is not possible to make a definitive recommendation on the use of these interventions in the management of AR. A multifaceted approach, including treatment, prevention, and eradication of allergens from the environment, may be necessary to effectively reduce symptoms.

Allergic contact dermatitis (ACD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. Patch testing (PT) is considered the gold standard for diagnosing ACD. Unfortunately, PT may not be available to some patients due to insurance and financial limitations, contributing to health care disparity and leaving patients with undiagnosed, incompletely managed dermatitis that can have further detrimental health and occupational effects. For other patients, PT is precluded by lack of availability of specialist/expert care, comorbid medications, or diffuse disease. This article will present a patient with ACD and will work through the differential diagnosis and share strategies for empiric avoidance of suspected/common triggers. The epidemiology of ACD with respect to race and ethnicity, considerations for affordability of hypoallergenic products, access to testing, and the need for future research are addressed in this article., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

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Abstract Background Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out. Methods Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach. Results Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options. Conclusions The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out.

Abstract Background For parents and caregivers of food hypersensitive (FH) children, accommodating their child’s dietary needs when eating out can be a challenging experience. This study explored caregivers’ experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences. Methods A cross-sectional, qualitative design was used. In depth, semi-structured interviews were carried out with 15 caregivers of children with FH. Interviews were analysed using framework analysis. Results Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of ‘family context’, ‘child-focused concerns’, and ‘venue issues’, caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members. Conclusions Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians and support charities can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences.

Purpose: Evaluation of a new individual wearable air purifier (Respiray Wear A+) for birch pollen, house dust mite (HDM), and cat-allergic rhinoconjunctivitis (ARC) patients in a standardized allergen exposure chamber (AEC)., Materials and Methods: Eligible allergic patients were exposed to birch pollen, HDM raw material, and cat allergen in an AEC for 60 minutes without (V1) and with (V3) the use of the Respiray device. Nasal, ocular, bronchial, and other symptoms were rated by the patients every 10 minutes, and their wellbeing, peak nasal inspiratory flow (PNIF), and lung function parameters were assessed every 30 minutes. The primary endpoint was the change in the median of the total symptom score (TSS) at V3 compared to V1 at 60 minutes of exposure. The secondary endpoints consisted of the total nasal symptom score (TNSS) and total eye symptom score (TESS)., Results: 23 patients with birch pollen allergy, 37 patients with HDM allergy, and 41 patients with cat allergy were included in the analysis. Significant reduced symptom scores of ~ 49% were observed when using Respiray Wea A+ under birch pollen exposure (p < 0.05) in the primary endpoint TSS (V3 2.43 compared to V1 4.78). An 48% reduction of symptoms was seen in TSS in case of HDM exposure (V3 3.59; V1 6.92, (t-test: p < 0.01)) and the highest reduction of TSS (60%) under Respiray A+ using cat allergens (V3 2.95, V1 7.44, (t-test p < 0.01) after 60 minutes of exposure. The personal wellbeing revealed clinically meaningful improvements over time in all three studies which manifested in a lower symptom increase during the final allergen exposures., Conclusion: The individual wearable air purifier Respiray Wear A+ protects significantly against airborne pollen, HDM, and cat allergens and may be a very useful device for avoiding indoor allergens in a new way., Competing Interests: The authors declare no conflict of interest. Table 1.Characteristics of probands at the studies with birch pollen, house dust mite, and cat allergens. Subject dataBirch pollen (n = 23)Dust mites (n = 37)Cat allergens (n = 41)Age (years), mean (SD)39.4 (12.5)40.4 (13.6)35.4 (11.8)Female, n (%)17 (73.9)31 (83.8)32 (78)Male, n (%)6 (26.1)6 (16.2)9 (22)Weight (kg), mean (SD)74.7 (27.8)76.4 (20.4)71,7 (13.6)Prick test (mm), mean (SD)9.3 (3.5)7.5 (2.7)6.4 (1.8) Table 2.Flow chart of the entire study. At least 7 days prior to V1Day 1Day 2Day 7Day 8Screening V0Baseline exposure without Respiray V1Safety call V2Exposure with Respiray V3Safety call V4 Figure 1.Components of Respiray Wear A+. 1 = Air is drawn into the device through the intake grille. 2 = Large particles are filtered using the pre-filter. 3 = The body of the device houses fans, battery, and electronics. 4 = The HEPA filter blocks allergens and allows only clean air to pass through. 5 = Clean air is blown out from the output grilles. 6 = The device is worn on the user’s chest using straps.Figure 2.Capture from a CFD simulation depicting the streamlines exiting the device. Table 3.Total symptom score values V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percentage. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch4.782.43490.01149House dust mite6.923.59480.00236Cat7.442.95600.00308 Figure 3.Mean values of the sums of total symptom score (TSS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens.Figure 4.Mean values of the sums of total eye symptom score (TESS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens.Figure 5.Mean values of the sums of total nose symptom score (TNSS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens. Table 4.Total eye symptom scores for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2.481.35460.03390House dust mite3.732.00460.00519Cat4.001.66590.00308 Table 5.Total nasal symptom scores for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2.301.09530.00307HDM3.191.59500.00098Cat3.441.29620.00311 Table 6.Visual analog scale well-being values for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2114310.5192House dust mite3118400.2556Cat3116460.2565 Figure 6.Mean values of the visual analog scale scores at minutes 0, 30, and 60 at baseline and final exposure to all different allergens without Respiray (V1) and with Respiray (V3). Table 7.Total symptom score values for V1 and V3 over the measured time frame. The mean value of all investigated subjects as well as the standard deviation are depicted. AllergenMoment0 minutes10 minutes20 minutes30 minutes40 minutes50 minutes60 minutesMeanSDMeanSDMeanSDMeanSDMeanSDMeanSDMeanSDBirchBaseline (V1)1.742.801.351.072.701.493.522.003.962.314.302.844.783.22BirchWith filter (V3)1.041.021.571.242.091.472.131.222.221.382.351.612.431.56House dust miteBaseline (V1)1.651.773.382.304.782.656.243.156.703.136.733.176.923.23House dust miteWith filter (V3)1.411.382.051.842.971.643.382.143.272.293.572.573.592.67CatBaseline (V1)1.241.483.201.854.932.606.202.856.712.877.393.537.443.65CatWith filter (V3)1.001.181.801.472.561.663.001.973.122.143.222.662.952.48, (© Dustri-Verlag Dr. K. Feistle.)

Aim: To investigate teachers' knowledge and preparedness of schools about food allergy and anaphylaxis in elementary schools in Edirne city. Material and Methods: The study was performed as a cross sectional survey study. Questionnaires were answered by 560 teachers, all of them were working in 35 public elementary schools in Edirne. In addition to questions concerning food allergies, teachers were asked about their attitudes in the case of a life-threatening food-induced allergic reaction. The presence of a nurse or other trained personnel, an action plan for management of anaphylaxis, and/or epinephrine availability and use in these schools in the case of such a reaction were also evaluated. Results: The vast majority of teachers (97.3%) reported they had not been informed about food allergies, and only 19.1% stated that "shock" may be related to a food allergy situation. Only 4 schools (11.4%) employed a nurse. Examination of school drugs cabinets revealed no epinephrine in any school, and none of the students were found to carry epinephrine autoinjectors. Furthermore, none of the schools had an emergency action plan related to food-induced allergic reactions. Conclusion: The current study revealed an urgent need to inform elementary school teachers of Edirne about food allergies and their treatment and to improve access to emergency treatments and action plans. [ABSTRACT FROM AUTHOR]

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Latest forecasts predict that half of the European population will be allergic within the coming 15 years, with food allergies contributing substantially to the total burden; preventive measures are urgently needed. Unfortunately, all attempted alimentary strategies for primary prevention of allergic diseases through allergen avoidance so far have failed. This also holds true for the prevention of food allergies in breastfed infants by the common practice of excluding certain foods with allergenic potential from the maternal diet. As a preventive measure, therefore, exclusion diets should be discouraged. They can exhaust nursing mothers and negatively impact both their nutritional status as well as their motivation to breastfeed. A prolonged exclusion diet may be indicated solely in cases of doctor-diagnosed food allergy following rigid medical tests (e.g. double-blind placebo-controlled food challenges). Indicated cases usually involve exclusion of only a few food items. Continued breastfeeding is generally important for many aspects of the infant's health, including the training of the infant's immune responses to foreign compounds and avoidance of overshooting inflammatory responses. Recent studies suggest that the presence of maternal dietary proteins in amniotic fluid, cord blood, and human milk might support the induction of tolerance towards solid foods in infants. These are exactly the same species of proteins or remnants thereof that, in comparatively few cases, trigger allergic responses. However, the insight that the proteins of maternal dietary origin in human milk are more likely to be cure (or, more precise, directing prevention) than curse has still largely evaded the attention of health care professionals consulted by worried breastfeeding mothers. In this paper, we summarize recent literature on the importance of exposure to dietary proteins in the establishment of immunological tolerance and hence prevention of allergic disease. Multiple organizations have used the scientific knowledge to build (local) guidelines (e.g. AAAAI, EAACI, BSACI) that can support health care professionals to provide the best strategy to prevent the onset of allergic diseases. We thus hope to clarify existing confusion about the allergenic propensities of dietary proteins during early life, which has contributed to exaggerated fears around the diet of pregnant and breastfeeding mothers. [ABSTRACT FROM AUTHOR]

Background and Objective: Airway macrophages perform the crucial functions of presenting antigens, clearing pathogens, and apoptotic cells. Macrophage phagocytosis is increased in adults with mild asthma and allergen exposure is known to activate macrophages. However, it is not clear whether the mechanism behind this is due to a primary defect or environmental factors such as allergen or lipopolysaccaride (LPS) exposure. Our aim was to assess the phagocytic function of airway macrophages in children with mild to moderate asthma after residence in a low allergen\LPS environment at high altitude.Methods: Sputum induction was performed in children with asthma at baseline and after residence for a 3 weeks' period at a high-altitude asthma center that has very low ambient allergen levels. The markers of eosinophilic inflammation (including percentage of macrophage cytoplasm with red hue) and phagocytosis of fluorescein isothiocyanate-labeled, heat-killed Staphylococcus aureus by airway macrophages was analyzed. Internalized bacteria were quantified using confocal microscopy.Results: The median bacterial count [mean (standard deviation)] per macrophage was significantly lower [39.55 (4.51) vs. 73.26 (39.42) (p = 0.006)] after residence at high altitude. No association was observed between markers of eosinophilic inflammation and bacterial phagocytosis.Conclusions: The results suggest that the mechanism behind the enhanced phagocytosis of bacteria in childhood asthma may be secondary to allergen or possibly LPS exposure.

Background: Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out.Methods: Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach.Results: Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options.Conclusions: The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out. [ABSTRACT FROM AUTHOR]

Introduction: The first therapeutic choice for food allergy is avoidance of the responsible food, but when this approach is not possible, specific oral desensitization could be considered as a good alternative. It is not clear yet whether the acquired tolerance is transient or persistent. Aim: We report on a subset of 13 patients of a larger study, treated successfully with specific oral tolerance induction who experienced secondary loss of tolerance after a period of allergen avoidance. Material and methods: Thirteen patients affected by IgE-mediated food allergy: to cow milk (3 patients), to hen egg (3 patients), to cod fish (2 patients), to peanuts (1 patient) and to corn (1 patient) confirmed by a complete allergological workup and a double-blind placebo-controlled food challenge (DBPCFC), were treated with sublingualoral desensitization. After the interruption of the maintenance phase, the laboratory tests were performed and 12 of 13 patients underwent DBPCFC. Results: Oral specific desensitization was completed successfully in all the 13 reported patients. At different times after the end of treatment, they decided, on their own initiative, to stop the ingestion of incriminated food. A new food allergen re-exposure caused adverse reactions in 12 of 13 patients. The detection of specific IgE and IgG4 during the period of allergen avoidance showed an increase in or a stable level of specific IgE and a decrease in specific IgG4 in 8 patients. Conclusions: According to our experience, the tolerance obtained through the desensitizing treatment is transient and so the regular allergen intake is necessary for its maintenance. [ABSTRACT FROM AUTHOR]

Summary: Background: Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression. Objective: To evaluate the effect of the temperature‐controlled laminar airflow (TLA) treatment in children/adolescents with severe AE. Methods: We recruited 15 children aged 2‐16 years with long‐standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run‐in period of 6‐10 weeks (3 visits) was followed by 12‐month treatment with overnight TLA (Airsonett®, Sweden). The primary outcome was eczema severity (SCORAD‐Index and Investigator Global Assessment‐IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient‐oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773. Results: There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12‐month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75‐45.15] at Baseline to 17.2 [12.95‐32.3] at the final visit, and IGA improved significantly from 4 [3‐4] to 2 [1‐3]. We observed a significant improvement in FDQLI (16.0 [12.25‐19.0] to 12 [8‐18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6‐month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non‐responders. Conclusion and Clinical Relevance: Addition of TLA device to standard pharmacological treatment may be an effective add‐on to the management of difficult‐to‐control AE. [ABSTRACT FROM AUTHOR]

Background: For parents and caregivers of food hypersensitive (FH) children, accommodating their child's dietary needs when eating out can be a challenging experience. This study explored caregivers' experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences.Methods: A cross-sectional, qualitative design was used. In depth, semi-structured interviews were carried out with 15 caregivers of children with FH. Interviews were analysed using framework analysis.Results: Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of 'family context', 'child-focused concerns', and 'venue issues', caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members.Conclusions: Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians and support charities can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences. [ABSTRACT FROM AUTHOR]

Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation. Thus, if efficient reductions in allergen exposure could be achieved during sleep, it might be expected that this would result in significant improvements in control of asthma. The temperature-controlled laminar airflow (TLA) is a system which can be employed over beds in a domestic environment and results in massive reductions in particulate exposure of recumbent subjects, including highly respirable allergens such as Fel. D1 from cats. Trials of TLA have demonstrated highly significant improvements in asthma quality of life and reductions on airway inflammation as monitored by exhaled nitric oxide levels. Furthermore, in patients with the worst disease, severe exacerbation frequency was significantly reduced. Based on UK health-service costs, the use of TLA falls well below the National Institute for Health and Care Excellence (NICE) threshold for the incremental cost effectiveness ratio (ICER) per quality adjusted life year (QALY). Indeed, for those with frequent exacerbations, it is cost saving and should be prescribed for such allergic asthmatic patients. [ABSTRACT FROM AUTHOR]

Objective: We investigated the best strategy for adult asthmatics to avoid exposure toDermatophagoidesgroup (Der-1) allergens.Methods: Adult atopic asthmatics (n= 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August–October 2010 and August–October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention.Results: Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels.Conclusions: This environmental and bedding maintenance program may help manage adult atopic asthma. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is an IgE-mediated disease, leading to inflammation of the nasal mucosa. Typical symptoms of allergic rhinitis are nasal congestion, rhinorrhea, sneezing, and/or nasal itching. Allergic rhinitis is a major health problem worldwide that causes illness and disability in daily life, affecting social life, sleep, school, and work. The economic cost of allergic rhinitis is substantial. Management of allergic rhinitis can be categorized largely into allergen avoidance, pharmacotherapy, immunotherapy, and surgical treatment. Although the general consensus is that allergen avoidance should lead to an improvement of symptoms, it is nearly impossible to completely avoid all allergens in real life. The importance of allergen avoidance is that minimizing allergen exposure can decrease medication dosage. Pharmacotherapy of allergic rhinitis may include any of histamine antagonist, topical/oral corticosteroid, leukotriene antagonist, decongestant, mast cell stabilizer, and cholinergic antagonist alone or in combination. Oral and intranasal spray of these medications are the main routes of administration. Immunotherapy is the medical procedure that uses controlled exposure to known allergens to reduce the severity of allergic disease. There are two ways of administering this treatment: subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Surgical treatment of the allergic rhinitis patient aims to resolve nasal obstruction by performing septoplasty or turbinoplasty. [ABSTRACT FROM AUTHOR]

To evaluate the extent of exposure to airborne mite allergens, we measured major mite allergens in indoor environments with an immunoassay using allergen-specific antibodies. The levels of mite allergens trapped by the sampler were measured with a highly sensitive immunoassay. We found heavy exposure to mite allergens from bedding during sleep. Bedding is likely one of the major reservoirs of mite allergens. When the used bedding was replaced with new allergen-free bedding, we detected a decrease in the airborne allergen levels. The use of new bedding seems to be an effective countermeasure against airborne mite allergen exposure.