Imperial College London

Dr Paul Turner

Faculty of MedicineNational Heart & Lung Institute

Reader in Paediatric Allergy & Clinical Immunology
 
 
 
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Contact

 

+44 (0)20 3312 7754p.turner

 
 
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Location

 

Children's Clinical Research FacilityCambridge WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

247 results found

Turner PJ, Tang MLK, Wood RA, 2022, Food Allergy and Eosinophilic Gastrointestinal Diseases-The Next 10 Years., J Allergy Clin Immunol Pract

The first report of food allergy desensitization was in 1908, at least a few years before the first published description of a diagnostic test for food allergy. It has taken almost 100 years for food allergy to move from passive management of avoidance to a more proactive approach including prevention and treatment. In parallel, this has been matched by recognition of eosinophil gastrointestinal diseases, which were first described in the 1980s (although eosinophilic esophagitis was itself described in 1978). As we celebrate 10 years of The Journal of Allergy and Clinical Immunology: In Practice, we take the opportunity to look into the future and speculate how our practice may develop over the next decade.

Journal article

Shaw RH, Liu X, Stuart ASV, Greenland M, Aley PK, Andrews NJ, Cameron JC, Charlton S, Clutterbuck EA, Collins AM, Dejnirattisai W, Dinesh T, Faust SN, Ferreira DM, Finn A, Green CA, Hallis B, Heath PT, Hill H, Lambe T, Lazarus R, Libri V, Long F, Mujadidi YF, Plested EL, Morey ER, Provstgaard-Morys S, Ramasamy MN, Ramsay M, Read RC, Robinson H, Screaton GR, Singh N, Turner DPJ, Turner PJ, Vichos I, Walker LL, White R, Nguyen-Van-Tam JS, Snape MD, Com-COV Study Groupet al., 2022, Effect of priming interval on reactogenicity, peak immunological response, and waning after homologous and heterologous COVID-19 vaccine schedules: exploratory analyses of Com-COV, a randomised control trial, The Lancet Respiratory Medicine, Vol: 10, Pages: 1049-1060, ISSN: 2213-2600

BACKGROUND: Priming COVID-19 vaccine schedules have been deployed at variable intervals globally, which might influence immune persistence and the relative importance of third-dose booster programmes. Here, we report exploratory analyses from the Com-COV trial, assessing the effect of 4-week versus 12-week priming intervals on reactogenicity and the persistence of immune response up to 6 months after homologous and heterologous priming schedules using the vaccines BNT162b2 (tozinameran, Pfizer/BioNTech) and ChAdOx1 nCoV-19 (AstraZeneca). METHODS: Com-COV was a participant-masked, randomised immunogenicity trial. For these exploratory analyses, we used the trial's general cohort, in which adults aged 50 years or older were randomly assigned to four homologous and four heterologous vaccine schedules using BNT162b2 and ChAdOx1 nCoV-19 with 4-week or 12-week priming intervals (eight groups in total). Immunogenicity analyses were done on the intention-to-treat (ITT) population, comprising participants with no evidence of SARS-CoV-2 infection at baseline or for the trial duration, to assess the effect of priming interval on humoral and cellular immune response 28 days and 6 months post-second dose, in addition to the effects on reactogenicity and safety. The Com-COV trial is registered with the ISRCTN registry, 69254139 (EudraCT 2020-005085-33). FINDINGS: Between Feb 11 and 26, 2021, 730 participants were randomly assigned in the general cohort, with 77-89 per group in the ITT analysis. At 28 days and 6 months post-second dose, the geometric mean concentration of anti-SARS-CoV-2 spike IgG was significantly higher in the 12-week interval groups than in the 4-week groups for homologous schedules. In heterologous schedule groups, we observed a significant difference between intervals only for the BNT162b2-ChAdOx1 nCoV-19 group at 28 days. Pseudotyped virus neutralisation titres were significantly higher in all 12-week interval groups versus 4-week groups, 28 days post-second

Journal article

Turner PJ, Patel N, Campbell DE, Sampson HA, Maeda M, Katsunuma T, Westerhout J, Blom WM, Baumert JL, Houben GF, Remington BCet al., 2022, Reproducibility of food challenge to cow’s milk: a systematic review with individual participant data meta-analysis, Journal of Allergy and Clinical Immunology, Vol: 150, Pages: 1135-1143.e8, ISSN: 0091-6749

Background: Cow’s milk (CM) is an increasingly common cause of severe allergic reactions, but there is uncertainty with respect to severity of reactions at low level CM exposure, as well as the reproducibility of reaction thresholds. Objective: To undertake an individual participant data (IPD) meta-analysis of studies reporting double-blind, placebo-controlled food challenges (DBPCFC) in CM, to determine the rate of anaphylaxis to low level exposures and the reproducibility of reaction thresholds. Methods: Systematic review and individual participant data (IPD) meta-analysis of studies reporting relevant data. Authors were contacted to provide additional data and/or clarifications as needed. Risk of bias was assessed using the National Institute for Clinical Excellence methodological checklists. Results: 34 studies were included, representing data from over 1000 participants. The cumulative ED01 and ED05 (cumulative doses causing objective symptoms in 1% and 5% of the at-risk allergic population) were 0.3 (95%CI 0.2-0.5) and 2.9 (95%CI 1.6-5.4) mg, respectively. At meta-analysis, 4.8% (95%CI 2.0-10.9%) and 4.8% (95%CI 0.7-27.1%) of individuals reacting to ≤5mg and ≤0.5mg of CM protein (respectively) had anaphylaxis (minimal heterogeneity,I2 =0%). 110 individuals subsequently underwent a repeat DBPCFC: the intra-individual variation in reaction threshold was limited to a ½-log change in 80% (95%CI 65-89%) of participants. Two individuals initially tolerated 5mg CM protein but then reacted to this dose at a subsequent challenge, although neither had anaphylaxis. Conclusions: Around 5% of CM-allergic individuals reacting to an ED01 or ED05 exposure might have anaphylaxis to that dose. This equates to 5 and 24 anaphylaxis events per 10,000 patients exposed to an ED01 or ED05 dose respectively, in the broader CM-allergic population. The vast majority of these anaphylactic reactions would be at the more mild end of the spectrum of anaphylaxis severity

Journal article

Turner PJ, Patel N, Mäkelä MJ, Kukkonen K, Deschildre A, Blumchen K, Rodríguez Del Río P, Fernández-Rivas M, Alvaro-Lozano M, Beyer Ket al., 2022, Improving the reporting of allergic adverse events during immunotherapy for food allergy., J Allergy Clin Immunol, Vol: 150, Pages: 1242-1244

Journal article

Suprun M, Kearney P, Butler H, Getts R, Sicherer SH, Turner P, Campbell D, Sampson HAet al., 2022, Predicting probability of tolerating discrete amounts of peanut protein in allergic children using epitope-specific IgE antibody profiling, Allergy, Vol: 77, Pages: 3061-3069, ISSN: 0105-4538

Background: IgE-epitope profiling can accurately diagnose clinical peanut allergy. Objective: We sought to determine whether sequential (linear) epitope-specific IgE (ses-IgE) profiling can provide probabilities of tolerating discrete doses of peanut protein in allergic subjects undergoing double-blind, placebo-controlled food challenges utilizing PRACTALL dosing.Methods: 64 ses-IgE antibodies were quantified in blood samples using a bead-based epitope assay. A pair of ses-IgEs that predicts Cumulative Tolerated Dose (CTD) was determined using regression in 75 subjects from the discovery cohort. This epitope-based predictor was validated on 331 subjects from five independent cohorts (ages 4-25 years). Subjects were grouped based on their predicted values and probabilities of reactions at each CTD threshold were calculated. Results: In discovery, an algorithm using two ses-IgE antibodies was correlated with CTDs (rho=0.61, p<0.05); this correlation was 0.51 (p<0.05) in validation. Using the ses-IgE-based predictor, subjects were assigned into “high”, “moderate”, or “low” dose reactivity groups. On average, subjects in the “high” group were 4 times more likely to tolerate a specific dose, compared to the “low” group. For example, predicted probabilities of tolerating 4, 14, 44 and 144 or 444mg in the “low” group were 92%, 77%, 53%, 29% and 10% compared to 98%, 95%, 94%, 88% and 73% in the “high” group. Conclusions: Accurate predictions of food challenge thresholds are complex due to factors including limited responder sample sizes at each dose and variations in study-specific challenge protocols. Despite these limitations, an epitope-based predictor was able to accurately identify CTDs and may provide a useful surrogate for peanut challenges.

Journal article

Turner PJ, Gretzinger M, Patel N, Brough HA, Chinthrajah RS, Ebisawa M, Elizur A, Koplin JJ, Peters RL, Purington N, Nowak-Wegrzyn A, Saf S, Sampson HA, Westerhout J, Blom WM, Baumert JL, Houben GF, Remington BCet al., 2022, Updated threshold dose-distribution data for sesame, Allergy, Vol: 77, Pages: 3124-3162, ISSN: 0105-4538

Journal article

Mack DP, Greenhawt M, Turner P, Wasserman RL, Hanna MA, Shaker M, Hughes SW, Rodriguez del Rio Pet al., 2022, Information needs of patients considering oral immunotherapy for food allergy, Clinical and Experimental Allergy, ISSN: 0954-7894

While the historic management of food allergy includes avoidance strategies and allergic reaction treatment, oral immunotherapy (OIT) approaches have become more commonly integrated into therapeutic approaches. International guidelines, phase 3 trials and real-world experience have supported the implementation of this procedure. However, OIT is an elective, rarely curative procedure with inherent risks that necessitates an increased degree of health literacy for the patients and families. Families assume the responsibility of amateur health care providers to ensure the daily safe administration of the allergenic food. As such, it is incumbent upon physicians to ensure that families are prepared for this role. A thorough educational and shared decision-making approach is necessary during the counseling and consent process to adequately inform the families. Educated discussion about the efficacy and patient-centred effectiveness, therapeutic alternatives, and family goals is required to align physician and patient expectations. A frank discussion about the struggles, practical challenges, risks and contraindications can help to develop an understanding of the risk mitigation strategies employed to maintain safety. Physicians should develop a proactive approach to educate families about this, at times, burdensome procedure. This educational approach should encourage ongoing support starting prior to consent through the maintenance visits. By preparing families for their unique management role, physicians can help ensure the safe and successful integration of OIT into the therapeutic offering for the management of food allergies.

Journal article

Muraro A, de Silva D, Halken S, Worm M, Khaleva E, Arasi S, Dunn-Galvin A, Nwaru BI, De Jong NW, Rodríguez Del Río P, Turner PJ, Smith P, Begin P, Angier E, Arshad H, Ballmer-Weber B, Beyer K, Bindslev-Jensen C, Cianferoni A, Demoulin C, Deschildre A, Ebisawa M, Fernandez-Rivas MM, Fiocchi A, Flokstra-de Blok B, Gerdts J, Gradman J, Grimshaw K, Jones C, Lau S, Loh R, Alvaro Lozano M, Makela M, Marchisotto MJ, Meyer R, Mills C, Nilsson C, Nowak-Wegrzyn A, Nurmatov U, Pajno G, Podestà M, Poulsen LK, Sampson HA, Sanchez A, Schnadt S, Szajewska H, Van Ree R, Venter C, Vlieg-Boerstra B, Warner A, Wong G, Wood R, Zuberbier T, Roberts G, GA2LEN Food Allergy Guideline Group, GALEN Food Allergy Guideline Groupet al., 2022, Managing food allergy: GA2LEN guideline 2022, The World Allergy Organization Journal, Vol: 15, ISSN: 1939-4551

Food allergy affects approximately 2-4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.

Journal article

Turner PJ, Makwana N, Roberts G, Fox ATet al., 2022, NICE and easy? Ensuring equitable access to NICE-approved treatments in children and young people, Archives of Disease in Childhood, Vol: 107, Pages: 778-779, ISSN: 0003-9888

Journal article

Turner P, 2022, Updated full range of Eliciting Dose values for Cow’s Milk for use in food allergen risk assessment, Food and Chemical Toxicology, Vol: 168, ISSN: 0278-6915

Access to Eliciting Doses (ED) for allergens enables advanced food allergen risk assessment. Previously, the full ED range for 14 allergenic foods, including milk, and recommendations for their use were provided (Houben et al. 2020). Additional food challenge studies with cow’s milk-allergic patients added 247 data points to the original dataset. Using the Stacked Model Averaging statistical method for interval-censored data on the 697 individual NOAELs and LOAELs for milk generated an updated full ED distribution. The ED01 and ED05, the doses at which 1% and 5% of the milk-allergic population would be predicted to experience any objective allergic reaction, were 0.3 and 3.2 mg milk protein for the discrete and 0.4 mg and 4.3 mg milk protein for the cumulative dose distribution, respectively. These values are slightly higher but remain within the 95% confidence interval ofpreviously published EDs. We recommend using the updated EDs for future characterization of risks of exposure of milk-allergic individuals to milk protein. This paper contributes to the discussion on the Reference Dose for milk in the recent Ad hoc Joint FAO/WHO Expert Consultation on Risk Assessment of Food Allergens. It will also benefit harmonization of food allergen risk assessment and risk management globally.

Journal article

Turner PJ, 2022, Is allergen absorption a key determi- nant of severity in food-induced reactions?, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 150, Pages: 489-489, ISSN: 2213-2198

Journal article

Whyte AF, Soar J, Dodd A, Hughes A, Sargant N, Turner PJet al., 2022, Emergency treatment of anaphylaxis: concise clinical guidance., Clinical medicine (London, England), Vol: 22, Pages: 332-339, ISSN: 1470-2118

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway and/or breathing and/or circulation problems. Intramuscular adrenaline is the most important treatment, although, even in healthcare settings, many patients do not receive this intervention contrary to guidelines. The Resuscitation Council UK published an updated guideline in 2021 with some significant changes in recognition, management, observation and follow-up of patients with anaphylaxis. This is a concise version of the updated guideline.

Journal article

Ratcliffe H, Tiley KS, Andrews N, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley P, Galiza EP, Faust SN, Hughes S, Murray CS, Roderick M, Shackley F, Oddie SJ, Lees T, Turner DPJ, Raman M, Owens S, Turner P, Cockerill H, Lopez Bernal J, Linley E, Borrow R, Brown K, Ramsay ME, Voysey M, Snape MDet al., 2022, Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019–2021, Archives of Disease in Childhood, ISSN: 0003-9888

Objective To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation.Design We conducted a community-based cross-sectional seroprevalence study in participants aged 0–18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region.Results Post-first wave (June–August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10–14 years old) to 9.5% (participants 5–9 years old). By April–June 2021, this had increased to 19.9%, varying from 13.9% (participants 0–4 years old) to 32.7% (participants 15–18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit.Conclusions Approximately one-third of participants aged 15–18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children.Trial registration number NCT0

Journal article

Dhar A, Haboubi HN, Attwood SE, Auth MKH, Dunn JM, Sweis R, Morris D, Epstein J, Novelli MR, Hunter H, Cordell A, Hall S, Hayat JO, Kapur K, Moore AR, Read C, Sami SS, Turner PJ, Trudgill NJet al., 2022, British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults, Gut, Vol: 71, Pages: 1459-1487, ISSN: 0017-5749

Background: Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.Methods: The Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.Results: Fifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.Conclusions: These comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

Journal article

Turner PJ, Patel N, Rodriguez del Rio P, 2022, Clarifying the categorization of anaphylaxis as an adverse event during oral immunotherapy, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 150, Pages: 229-230, ISSN: 0091-6749

Journal article

Shaker M, Turner PJ, Greenhawt M, 2022, Reply to "Food allergy: One more book rather than one less pen'', JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 10, Pages: 1670-1671, ISSN: 2213-2198

Journal article

Turner PJ, 2022, Mechanisms of Anaphylaxis, Publisher: WILEY, Pages: S87-S88, ISSN: 8755-6863

Conference paper

Turner PJ, Baumert JL, Beyer K, BrookeTaylor S, Comberiati P, Crevel RWR, Gerdts JD, Gowland MH, Houben GF, Hourihane JO, Konstantinou GN, La Vieille S, Moya B, Muraro A, Mills ENC, Patel N, Podestà M, Popping B, Reese I, Roberts G, Said M, Santos AF, Schnadt S, Taylor SL, VliegBoerstra B, Remington BCet al., 2022, “Too high, too low”: the complexities of using thresholds in isolation to inform precautionary allergen (“may contain”) labels, Allergy, Vol: 77, Pages: 1661-1666, ISSN: 0105-4538

Journal article

Shaw RH, Liu X, Stuart ASV, Greenland M, Aley PK, Andrews NJ, Cameron JC, Charlton S, Clutterbuck EA, Collins AM, Dejnirattisai W, Dinesh T, Faust SN, Ferreira DM, Finn A, Green CA, Hallis B, Heath PT, Hill H, Lambe T, Lazarus R, Libri V, Long F, Mujadidi YF, Plested EL, Morey ER, Provstgaard-Morys S, Ramasamy MN, Ramsay M, Read RC, Robinson H, Screaton GR, Singh N, Turner DPJ, Turner P, Vichos J, Walker LL, White R, Nguyen-Van-Tam JS, Snape MD, Com-COV Study Groupet al., 2022, Impact of priming interval on reactogenicity, peak immunological response and waning after homologous and heterologous COVID-19 vaccine schedules: Exploratory analyses of Com-COV, a randomised control trial, The Lancet Respiratory Medicine, ISSN: 2213-2600

Background:Priming COVID-19 vaccine schedules have been deployed at variable intervals globally, which may influence immune persistence and the relative importance of third-dose ‘booster’ programmes. Here, we report on the impact of 4- versus 12-week priming intervals on reactogenicity and the persistence of immune response up to 6 months following homologous and heterologous priming schedules using BNT162b2 (BNT, tozinameran, Comirnaty, Pfizer/BioNTech) and ChAdOx1 nCoV-19 (ChAd, Vaxzevria, AstraZeneca).Methods:Com-COV is a participant-blinded, randomised immunogenicity trial. Results are reported here for the ‘General’ cohort, in which adults aged over 50 years were randomised to four homologous and heterologous schedules using BNT and ChAd with 4- or 12-week priming intervals. Immunogenicity analyses were on the intention-to-treat population (ITT), without evidence of COVID-19 infection at baseline or for the trial duration, with the purpose of describing the effect of priming interval on humoral and cellular immune response at peak and later timepoints, in addition to the effects on reactogenicity and safetyFindings:Between 11th–26th Feb 2021, 730 participants were randomised in the general cohort, with 77-89 per arm in the ITT analysis. At 28-days and 6-months post-second dose, the geometric mean concentration (GMC) of anti-SARS-CoV-2 spike IgG was significantly higher in 12- versus 4-week interval arms for homologous schedules. In heterologous arms, there was only a significant difference between intervals for the BNT/ChAd arm at 28-days. Pseudotyped virus neutralisation titres were significantly higher in all 12-week versus 4-week schedules, 28-days post-second dose, with geometric mean ratios 1.4 (95%CI: 1.1-1.8, BNT/BNT), 1.5 (95%CI: 1.2-1.9, ChAd/BNT), 1.6 (95%CI 1.3-2.1, BNT/ChAd) and2.4 (95%CI: 1.7-3.2, ChAd/ChAd). At 6 months post-second dose, anti-spike IgG GMCs fell to 0.17-0.24 of the 28-day post-second dose value acr

Journal article

Turner P, Patel N, Baseggio Conrado A, 2022, Risk factors for severe reactions in food allergy: rapid evidence review with meta‐analysis, Allergy, Vol: 77, Pages: 2634-2652, ISSN: 0105-4538

This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food-dependent exercise-induced anaphylaxis may be an exception. Some medications such as beta-blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life-threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk.

Journal article

Turner P, Duca B, Vazquez-Ortiz M, 2022, IgE sensitisation predicts threshold but not anaphylaxis during oral food challenges to cow’s milk, Allergy, Vol: 77, Pages: 1291-1293, ISSN: 0105-4538

Journal article

Nagendran S, Patel N, Turner P, 2022, Oral immunotherapy for food allergy in children: is it worth it?, Expert Review of Clinical Immunology, Vol: 18, Pages: 363-376, ISSN: 1744-666X

Introduction:Oral immunotherapy (OIT) is effective at inducing desensitization in food-allergic individuals, and is a valid therapeutic option for those allergic to peanut, cow’s milk and egg. However, there is a high rate of dose-related adverse events, and at least one fatality to OIT has been reported.Areas covered:We provide an update on the broader framework of issues which will impact on the availability and uptake of OIT.Expert opinion:The need for standardized products remains controversial. A licensed product exists for peanut-OIT, but OIT can also be safely achieved using peanut-containing foods at much lower cost. For other allergens, OIT can only be done with non-pharma products – something which has been done safely for over 2 decades. There is a need to develop personalized protocols for OIT, particularly for the 20% of patients unable to tolerate standard OIT. Cost-effectiveness is dependent on improved quality of life, but evidence for this is currently lacking, and is a key evidence gap. OIT is likely to be cost-effective, particularly if noncommercial products are used. There may be a trade-off: in patients with lower reaction thresholds, a commercial product may be needed for initial updosing, until a level of desensitization is achieved when they can be switched to natural food products.

Journal article

Dribin TE, Schnadower D, Wang J, Camargo CA, Michelson KA, Shaker M, Rudders SA, Vyles D, Golden DBK, Spergel JM, Campbell RL, Neuman MI, Capucilli PS, Pistiner M, Castells M, Lee J, Brousseau DC, Schneider LC, Assa'ad AH, Risma KA, Mistry RD, Campbell DE, Worm M, Turner PJ, Witry JK, Zhang Y, Sobolewski B, Sampson HAet al., 2022, Anaphylaxis knowledge gaps and future research priorities: a consensus report, Journal of Allergy and Clinical Immunology, Vol: 149, Pages: 999-1009, ISSN: 0091-6749

BACKGROUND: Despite a better understanding of the epidemiology, pathogenesis, and management of patients with anaphylaxis, there remain knowledge gaps. Enumerating and prioritizing these gaps would allow limited scientific resources to be directed more effectively. OBJECTIVE: To systematically describe and appraise anaphylaxis knowledge gaps and future research priorities based on their potential impact and feasibility. METHODS: We convened a 25-member multidisciplinary panel of anaphylaxis experts. Panelists formulated knowledge gaps/research priority statements in an anonymous electronic survey. Four anaphylaxis themed writing groups were formed to refine statements: 1) Population Science, 2) Basic & Translational Sciences, 3) Emergency Department Care/Acute Management, and 4) Long-Term Management Strategies & Prevention. Revised statements were incorporated into an anonymous electronic survey and panelists were asked to rate the impact and feasibility of addressing statements on a continuous 0-100 scale. RESULTS: The panel generated 98 statements across the four anaphylaxis themes: Population Science (29), Basic & Translational Sciences (27), Emergency Department Care/Acute Management (24), and Long-Term Management Strategies & Prevention (18). Median scores for impact and feasibility ranged from 50.0-95.0 and from 40.0-90.0. Key statements based on median rating for impact/feasibility included the need to refine anaphylaxis diagnostic criteria, identify reliable diagnostic, predictive, and prognostic anaphylaxis bioassays, develop clinical prediction models to standardize post-anaphylaxis observation periods and hospitalization criteria, and determine immunotherapy best practices. CONCLUSIONS: We identified and systematically appraised anaphylaxis knowledge gaps and future research priorities. This study reinforces the need to harmonize scientific pursuits to optimize the outcomes of patients with and at risk of anaphylaxis.

Journal article

Turner P, Custovic A, 2022, Life-threatening anaphylaxis to peanut – impossible to predict?, Journal of Allergy and Clinical Immunology, Vol: 149, Pages: 1128-1129, ISSN: 0091-6749

Journal article

Panwar K, Godi A, Cocuzza CE, Andrews N, Southern J, Turner P, Miller E, Beddows Set al., 2022, Binding antibody levels to vaccine (HPV6/11/16/18) and non-vaccine (HPV31/33/45/52/58) HPV antigens up to 7 years following immunization with either Cervarix® or Gardasil® vaccine, Vaccine, Vol: 40, Pages: 1198-1202, ISSN: 0264-410X

Human Papillomavirus (HPV) bivalent (Cervarix®) and quadrivalent (Gardasil®) vaccines demonstrate robust efficacy against vaccine types and cross-protection against related non-vaccine types. Here we evaluate the breadth, magnitude and durability of the vaccine-induced antibody response against vaccine (HPV6/11/16/18) and non-vaccine (HPV31/33/45/52/58) type antigens up to 7 years following vaccination of 12-15 year old girls in a three dose schedule and contrast these data with the levels of antibody typically seen in natural infection. Vaccine-type antibody levels waned over the 7-year follow up period but remained at least an order of magnitude above the typical antibody levels elicited by natural infection. Seropositivity to non-vaccine types remained high 7 years after initial vaccination, but antibody levels approached those typically generated following natural infection. Empirical data on the breadth, magnitude, specificity and durability of the immune response elicited by the HPV vaccines contribute to improving the evidence base supporting this important public health intervention.

Journal article

Kotsapas C, Nicolaou N, Haider S, Kerry G, Turner PJ, Murray CS, Simpson A, Custovic Aet al., 2022, Early-life predictors and risk factors of peanut allergy, and its association with asthma in later-life: Population-based birth cohort study, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 646-657, ISSN: 0954-7894

Journal article

Turner P, Darbar R, Shamji M, Campbell D, Patel Net al., 2022, Longer Duration Of Peanut Oral Immunotherapy At A Reduced Dosing Frequency Increases The Rate Of Sustained Unresponsiveness Without Reducing Clinical Efficacy, Publisher: MOSBY-ELSEVIER, Pages: AB139-AB139, ISSN: 0091-6749

Conference paper

Layhadi J, Palmer E, Drazdauskaite G, Filipaviciute P, Devine A, Wu L, Turner P, Patel N, Oluwayi K, Rusyn O, Skinner M, Heath M, de Kam P-J, Shamji Met al., 2022, Modulation of T and B cell Responses by Virus-like particle (VLP) Expressing Peanut Allergen Ara h 2: A Novel Vaccine Candidate for Peanut Allergy, Publisher: MOSBY-ELSEVIER, Pages: AB320-AB320, ISSN: 0091-6749

Conference paper

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