Publications
291 results found
Turner PJ, custovic A, Shamji MH, 2017, Basophils, high-affinity IgE receptors and CCL2 in human anaphylaxis, Journal of Allergy and Clinical Immunology, Vol: 140, Pages: 750-758.e15, ISSN: 1097-6825
Background: The role of basophils in anaphylaxis is unclear.Objective: Toinvestigatewhetherbasophils havean important rolein human anaphylaxis.Methods:In an emergency department study, we recruited 31 patientswith acute anaphylaxis,predominantly to hymenopteravenom. Wemeasuredexpression ofbasophilactivation markers(CD63, CD203c), the absolute number of circulating basophils, whole-bloodFcεRI, CPA3and HDCgene expression, and serum markers(CCL2, CCL5,CCL11, IL-3,TSLP)at threetime points(during the anaphylactic episode, and inconvalescent samples7and 30 days later). We recruited 134 hymenoptera-allergic and76healthy controlsfor comparison. Wetheninvestigated whether the changes observed during venom-related anaphylaxis also occur during allergic reactions to food in 22 peanut-allergic individuals undergoing double-blind placebo-controlled food challenge to peanut(DBPCFC).Results:The number of circulating basophils was significantly lower during anaphylaxis(median 3.5 cells/μl) than7and 30 days later(17.5 and 24.7 cells/μl, P<0.0001), and compared to venom-allergicand healthy controls (21and23.4 cells/μl,P<0.0001). FcεRIexpressionduring anaphylaxiswasalso significantly lower than in convalescent samples (P≤0.002) and venom-allergiccontrols(P<0.0001).CCL2 (but not other serum markers) wassignificantlyhigherduring anaphylaxis(median 658 pg/ml) than in convalescent samples (314and 311 pg/ml, 7 and 30days,P<0.001). Peanut-induced allergic reactions resulted in a significant decrease in circulating basophilscompared to pre-challenge samples(P=0.016), a decrease in FcεRI expression (P=0.007), and anincrease inCCL2(P=0.003).Conclusions: Our findings implyan important and specific role forbasophils in the pathophysiology of human anaphylaxis.
Turner PJ, Campbell DE, 2017, Implementing primary prevention for peanut allergy at a population level, Journal of the American Medical Association, Vol: 317, Pages: 1111-1112, ISSN: 0002-9955
Nowak-Wegrzyn A, Chehade M, Groetch ME, et al., 2017, International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 139, Pages: 1111-1126, ISSN: 0091-6749
Food protein–induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.
Brown SGA, Turner PJ, 2017, Anaphylaxis, Middleton's Allergy Essentials: First Edition, Pages: 345-360, ISBN: 9780323375795
Anaphylaxis is a severe, immediate-type generalized hypersensitivity reaction affecting multiple organ systems and characterized at its most severe by bronchospasm, upper airway angioedema, hypotension and collapse. Lifetime prevalence is estimated to be 0.05-2%, but while anaphylaxis can be life-threatening, fatal anaphylaxis is rare. Drugs, foods and insect stings are the commonest triggers. The cornerstones of emergency management are support of the airway and/or ventilation, a supine position, epinephrine, and volume expansion. In the community setting, early administration of rescue epinephrine and contact with Emergency Services are of equal importance. Following an episode of anaphylaxis, prevention of further episodes requires identification of likely trigger(s) and co-factors, optimizing the management of comorbidities, allergen avoidance strategies, and immunotherapy if available. Patient education including an Anaphylaxis Action Plan and an epinephrine auto-injector should be considered where an allergen may be encountered unexpectedly (food and insect sting anaphylaxis, idiopathic anaphylaxis).
Turner PJ, Campbell DE, 2017, Egg allergy, Food Allergy: Molecular and Clinical Practice, Pages: 70-94, ISBN: 9781498722445
71Allergy to hen’s egg is perhaps the most common paediatric food allergy worldwide. This is certainly true for Australia and North America. It is unclear what makes this otherwise nutritious, innocuous and widely consumed food quite so allergenic. In this chapter we will examine the molecular characteristics and biochemistry of hen’s egg and the epidemiology, diagnosis, management and prevention of both IgE- and non-IgE mediated egg allergies.
Brown SGA, Turner PJ, 2017, Critical Criteria for Diagnosing Anaphylaxis, Middleton's Allergy Essentials, Pages: 345-360, ISBN: 9780323392730
Anaphylaxis is a severe, immediate-type generalized hypersensitivity reaction affecting multiple organ systems and characterized at its most severe by bronchospasm, upper airway angioedema, hypotension and collapse. Lifetime prevalence is estimated to be 0.05–2%, but while anaphylaxis can be life-threatening, fatal anaphylaxis is rare. Drugs, foods and insect stings are the commonest triggers. The cornerstones of emergency management are support of the airway and/or ventilation, a supine position, epinephrine, and volume expansion. In the community setting, early administration of rescue epinephrine and contact with Emergency Services are of equal importance. Following an episode of anaphylaxis, prevention of further episodes requires identification of likely trigger(s) and co-factors, optimizing the management of comorbidities, allergen avoidance strategies, and immunotherapy if available. Patient education including an Anaphylaxis Action Plan and an epinephrine auto-injector should be considered where an allergen may be encountered unexpectedly (food and insect sting anaphylaxis, idiopathic anaphylaxis).
Nowak-Węgrzyn A, Cehade M, Groetch JM, et al., 2016, International consensus guidelines for the diagnosis and management of food protein-induced Enterocolitis syndrome, Journal of Allergy and Clinical Immunology, ISSN: 1097-6825
Food protein-induced enterocolitis (FPIES) is a non-IgE, cell- mediated food allergic disorder that can be severe and lead to shock. 1 In spite of the potential seriousness of reactions, awareness of FPIES is low, high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking, and clinical outcomes are poorly established. Unmet needs in the field include identification of the non-invasive biomarkers, clear understanding of the disease mechanisms, data regarding prevalence, and having uniform approaches to diagnosis and management. This document is the first international consensus based on the available evidence and aims to assist practitioners in their care for the patients with FPIES.
Turner PJ, Wainstein BK, 2016, Crossing the threshold: can outcome data from food challenges be used to predict risk of anaphylaxis in the community?, Allergy, Vol: 72, Pages: 9-12, ISSN: 1398-9995
There is increasing interest in using data from oral food challenges (OFC) performed under medical supervision to assist in allergy risk management, both in industry (allergen risk management) (1) and in the clinical management of the allergic individual (2). Data relating to the minimum eliciting dose (MED) needed to trigger symptoms can inform the need for precautionary allergen labelling (PAL) on food (1). However, given that “zero risk” for food-allergic individuals is not considered to be a realistic proposition (3), it is also important to consider the severity of symptoms which might be experienced: for example, a pragmatic approach, using a level of exposure that causes only minimal, transient oral symptoms in under 1% of the food-allergic population, may be acceptable to guide the use of PAL (4). However, there is often an assumption that individuals with a lower MED (i.e. who react to a lower doses of allergen) are at a greater risk of anaphylaxis (5).
Rosenberg S, Walker L, Fitzsimons R, et al., 2016, A novel smart phone based digital triage tool for children with allergies, Annual Meeting of the British-Society-for-Allergy-and-Clinical-Immunology (BSACI), Publisher: WILEY-BLACKWELL, Pages: 1662-1662, ISSN: 0954-7894
Turner PJ, DunnGalvin A, O'B Hourihane J, 2016, Guidance to Patients for Anaphylaxis Management: No Blanket Approach Reply, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 4, Pages: 1269-1270, ISSN: 2213-2198
Mehr S, Allen R, Boros C, et al., 2016, Cryopyrin-associated periodic syndrome in Australian children and adults: Epidemiological, clinical and treatment characteristics., Journal of Paediatrics and Child Health, Vol: 52, Pages: 889-895, ISSN: 1440-1754
AIM: Cryopyrin-associated periodic syndromes (CAPS) encapsulate three auto-inflammatory conditions, ranging in severity from mild (familial cold auto-inflammatory syndrome: FCAS), moderate (Muckle-Wells syndrome: MWS) and severe (neonatal onset multi-inflammatory disorder: NOMID). We aimed to describe the epidemiology, clinical features and outcomes of Australian children and adults with CAPS. METHODS: Patients were identified and clinical data collected through a questionnaire sent during 2012-2013 to clinicians reporting to the Australian Paediatric Surveillance Unit and subscribing to the Australasian Societies for Allergy/Immunology, Rheumatology and Dermatology. RESULTS: Eighteen cases of CAPS were identified (8 NOMID; 8 MWS, 2 FCAS); 12 in children <18 years of age. The estimated population prevalence of CAPS was 1 per million persons. Diagnostic delay was frequent, particularly in those with milder phenotypes (median diagnostic delay in MWS/FCAS 20.6 years compared with NOMID 2.1 years; P = 0.04). Common presenting features included urticaria (100%), periodic fever (78%), arthralgia (72%) and sensorineural hearing loss (61%). Almost all (90%) MWS patients had a family member similarly affected compared with none in the NOMID group (P = 0.004). A significant proportion of patients on anti-interleukin (IL)-1 therapy (n = 13) no longer had systemic inflammation. Only 50% with sensorineural hearing loss had hearing restored on anti-IL-1 therapy. CONCLUSIONS: Although CAPS are rare, patients often endured prolonged periods of systemic inflammation. This is despite almost all MWS patients having family members with similar symptoms and children with NOMID presenting with chronic infantile urticaria associated with multi-system inflammation. Hearing loss in NOMID/MWS was frequent, and reversible in only 50% of cases.
Turner PJ, Gowland MH, 2016, Precautionary Allergy Labelling: NO MORE TRACES!, Allergy, Vol: 71, Pages: 1505-1507, ISSN: 1398-9995
Moonesinghe H, Mackenzie H, Venter C, et al., 2016, Prevalence of fish and shellfish allergy: a systematic review, Annals of Allergy, Asthma & Immunology, Vol: 117, Pages: 264-272.e4, ISSN: 1534-4436
BACKGROUND: Accurate information on the prevalence of food allergy facilitates a more evidence-based approach to planning of allergy services and can identify important geographic variations. OBJECTIVE: To conduct a systematic review to assess the age-specific prevalence of fish and shellfish allergy worldwide. METHODS: Searches were conducted using Web of Science and PubMed. Population-based cross-sectional studies and cohort studies that examined the prevalence of fish and shellfish allergy (IgE mediated and non-IgE mediated) at an identifiable point in time were eligible for inclusion in the study. Reviewers extracted general study information and study design, type of food allergy considered, food(s) assessed, method of diagnosis, sampling strategy, and sample characteristics. Raw data were extracted and percentage prevalence and 95% confidence intervals calculated. RESULTS: A total of 7,333 articles were identified of which 61 studies met the inclusion criteria and were included in this review. The prevalence of fish allergy ranged from 0% to 7% and the prevalence of shellfish allergy from 0% to 10.3%, depending on the method of diagnosis. Where food challenges were used, the prevalence for fish allergy was found to be 0% to 0.3% and for shellfish allergy was 0% to 0.9%. CONCLUSION: Few studies have established the prevalence of fish or shellfish allergy using the gold standard double-blind, placebo-controlled challenge criteria, with most instead relying on self-reported questionnaire-based methods. The limited data available suggest that fish allergy prevalence is similar worldwide; however, shellfish allergy prevalence may be higher in the Southeast Asia region.
Ludman S, Aston A, Noimark L, et al., 2016, Diagnostic utility of lip dose challenges for diagnosis of food allergy: a prospective study, Meeting of the European-Academy-of-Allergy-and-Clinical-Immunology, Publisher: WILEY-BLACKWELL, Pages: 285-285, ISSN: 0105-4538
Ludman S, Vazquez-Ortiz M, Aston A, et al., 2016, Lip dose challenges: practice and perceptions in the United Kingdom, Meeting of the European-Academy-of-Allergy-and-Clinical-Immunology, Publisher: WILEY-BLACKWELL, Pages: 285-286, ISSN: 0105-4538
Garcia RM, Belgrave D, Clark A, et al., 2016, Cardiac haemodynamic changes during acute IgE-mediated peanut allergic reactions in man, Meeting of the European-Academy-of-Allergy-and-Clinical-Immunology, Publisher: WILEY-BLACKWELL, Pages: 287-288, ISSN: 0105-4538
Turner PJ, Campbell DE, 2016, Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis?, Current Opinion in Allergy and Clinical Immunology, Vol: 16, Pages: 441-450, ISSN: 1528-4050
Purpose of review:The observed increase in incidence of allergic disease in many regions over the past 3decades has intensified interest in understanding the epidemiology of severe allergicreactions. We discuss the issues in collecting and interpreting these data, and highlightcurrent deficiencies in the current methods of data gathering.Recent findings:Anaphylaxis, as measured by hospital admission rates, is not uncommon and has increasedin the UK, USA, Canada and Australia over the last 10-20 years. All large datasets arehampered by a large proportion of uncoded “unspecified” causes of anaphylaxis. Fatalanaphylaxis remains a rare event, but appears to be increasing for medication in AustraliaCanada and the USA. The rate of fatal food anaphylaxis is stable in the UK and USA, but hasincreased in Australia. The age-distribution for fatal food anaphylaxis is different to othercauses, with data suggesting an age-related predisposition to fatal outcomes in teenagersand adults to the fourth decade of life.Summary:The increasing rates of food and medication allergy (the latter exacerbated by an ageingpopulation) has significant implications for future fatality trends. An improved ability toaccurately gather and analyse population level anaphylaxis data in a harmonised fashion isrequired, so as to ultimately minimise risk and improve management.
Bloomfield SF, Rook GA, Scott EA, et al., 2016, Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene, Perspectives in Public Health, Vol: 136, Pages: 213-224, ISSN: 1757-9139
Aims: To review the burden of allergic and infectious diseases and the evidence for a link to microbial exposure, the human microbiome and immune system, and to assess whether we could develop lifestyles which reconnect us with exposures which could reduce the risk of allergic disease while also protecting against infectious disease.Methods: Using methodology based on the Delphi technique, six experts in infectious and allergic disease were surveyed to allow for elicitation of group judgement and consensus view on issues pertinent to the aim.Results: Key themes emerged where evidence shows that interaction with microbes that inhabit the natural environment and human microbiome plays an essential role in immune regulation. Changes in lifestyle and environmental exposure, rapid urbanisation, altered diet and antibiotic use have had profound effects on the human microbiome, leading to failure of immunotolerance and increased risk of allergic disease. Although evidence supports the concept of immune regulation driven by microbe–host interactions, the term ‘hygiene hypothesis’ is a misleading misnomer. There is no good evidence that hygiene, as the public understands, is responsible for the clinically relevant changes to microbial exposures.Conclusion: Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life. The term ‘hygiene hypothesis’ must be abandoned. Promotion of a risk assessment approach (targeted hygiene) provides a framework for maximising protection against pathogen exposure while allowing spread of essential microbes between family members. To build on these findings, we must change public, public health and professional perceptions about the micr
Venter C, Stowe J, Andrews NJ, et al., 2016, No association between atopic outcomes and type of pertussis vaccine given in children born on the Isle of Wight 2001-2002, Journal of Allergy and Clinical Immunology, Vol: 4, Pages: 1248-1250, ISSN: 1097-6825
Turner PJ, DunnGalvin A, Hourihane J, 2016, The Emperor has no symptoms: the risks of a blanket approach to using epinephrine auto-injectors for all allergic reactions, Journal of Allergy and Clinical Immunology: In Practice, Vol: 4, Pages: 1143-1146, ISSN: 2213-2198
Fatal anaphylaxis in humans is rare and unpredictable. We note a trend to provide allergic individuals with care plans that recommend immediate use of epinephrine autoinjectors if allergen ingestion is suspected, even in the absence of any allergic symptoms, without any supporting evidence base. Instructions to use an autoinjector device, irrespective of reaction severity and especially when symptoms are actually absent, are likely to add to parental and patient anxiety. Of greater concern is the possibility of epinephrine being administered “too early” to treat initial, mild symptoms that then progress to severe anaphylaxis. It is not hard to visualize a scenario where one or both epinephrine autoinjectors have been deployed for mild symptoms, yet the reaction progresses to a severe reaction and no further epinephrine is available for administration. Epinephrine needs to be available as a rescue treatment for anaphylaxis, potentially buying valuable minutes while emergency medical services are activated to attend. Food-allergic individuals and their carers need to be provided with more constructive strategies and support than merely being told to “use your pen.”
Turner PJ, Baumert JL, Beyer K, et al., 2016, Can we identify patients at risk of life-threatening allergic reactions to food?, Allergy, Vol: 71, Pages: 1241-1255, ISSN: 1398-9995
Anaphylaxis has been defined as a “severe, life-threatening generalized or systemic hypersensitivityreaction”. However, data indicate that the vast majority of food-triggered anaphylactic reactions arenot life-threatening. Nonetheless, severe life-threatening reactions do occur, and are unpredictable.We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions tofood by different stakeholders, with particular reference to the inclusion of clinical severity as afactor in allergy and allergen risk management. We review the evidence regarding factors whichmight be used to identify those at most risk of severe allergic reactions to food, and theconsequences of misinformation in this regard. For example, a significant proportion of food-allergicchildren also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma isnot, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergenexposure and symptom severity is unclear. While dose appears to be a risk factor in at least asubgroup of patients, studies report that individuals with prior anaphylaxis do not have a lowereliciting dose than those reporting previous mild reactions. It is therefore important to considerseverity and sensitivity as separate factors, as a highly sensitive individual will not necessarilyexperience severe symptoms during an allergic reaction. We identify the knowledge gaps whichneed to be addressed to improve our ability to better identify those most at risk of severe foodinducedallergic reactions.
Turner PJ, Warner JO, 2016, Allergy, The Science of Paediatrics Mrcpch Mastercourse, Publisher: Elsevier, ISBN: 9780702063138
This book is "innovative and original in assisting the reader to apply the principles of science to paediatric practice".
Turner PJ, 2016, No association between atopic outcomes and type of pertussis vaccine given in children born on the Isle of Wight 2001-2, Journal of Allergy and Clinical Immunology: In Practice, Vol: 137, Pages: AB60-AB60, ISSN: 2213-2198
Mohseni YR, Turner PJ, Boyle RJ, et al., 2016, Intracellular Expression of Fluorochrome Labelled-Diamine Oxidase in Basophils: A Novel Diagnostic Tool for Peanut Allergy, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB137-AB137, ISSN: 0091-6749
Turner PJ, Southern J, Andrews N, et al., 2016, Nasal Influenza Immunisation with LAIV (FluMist) Is Safe in Egg-Allergic Children with Asthma or Recurrent Wheeze: Data from the Sniffle-2 Study, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB87-AB87, ISSN: 0091-6749
Vyas D, Ierodiakonou D, Harrison DA, et al., 2016, Increase in Intensive Care Unit Admissions for Anaphylaxis in the United Kingdom 2008-2012, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB57-AB57, ISSN: 0091-6749
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Ntavli E, Turner PJ, Boyle RJ, et al., 2016, Group 2 Innate Lymphoid Cells: New Players in Peanut Allergy, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB74-AB74, ISSN: 0091-6749
Ruiz-Garcia M, Hayward C, Tang A, et al., 2016, Effects of Intramuscular Epinephrine on Cardiovascular Parameters during IgE-Mediated Allergic Reactions to Peanut, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB50-AB50, ISSN: 0091-6749
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Turner PJ, Vazquez-ortiz M, 2015, Improving the safety of oral immunotherapy for food allergy, Pediatric Allergy and Immunology, Vol: 27, Pages: 117-125, ISSN: 1399-3038
Food allergy is a major public health problem in children, impacting upon the affected individual, their families and others charged with their care, for example educational establishments, and the food industry. In contrast to most other paediatric diseases, there is no established cure: current management is based upon dietary avoidance and the provision of rescue medication in the event of accidental reactions, which are common. This strategy has significant limitations and impacts adversely on health-related quality of life. In the last decade, research into disease-modifying treatments for food allergy has emerged, predominantly for peanut, egg and cow's milk. Most studies have used the oral route (oral immunotherapy, OIT), in which increasing amounts of allergen are given over weeks–months. OIT has proven effective to induce immune modulation and ‘desensitization’ – that is, an increase in the amount of food allergen that can be consumed, so long as regular (typically daily) doses are continued. However, its ability to induce permanent tolerance once ongoing exposure has stopped seems limited. Additionally, the short- and long-term safety of OIT is often poorly reported, raising concerns about its implementation in routine practice. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Long-term adherence is unclear, which rises concerns given the low rates of long-term tolerance induction. Current research focuses on improving current limitations, especially safety. Strategies include alternative routes (sublingual, epicutaneous), modified hypoallergenic products and adjuvants (anti-IgE, pre-/probiotics). Biomarkers of safe/successful OIT are also under investigation.
Turner PJ, 2015, Anaphylaxis, Middleton's Allergy Essentials, Publisher: Elsevier Health Sciences, ISBN: 9780323392730
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