Publications
361 results found
Scarpone R, Kimkool P, Boyle RJ, 2023, Data Extraction and Handling Issues on Evidence Synthesis of Risk of Immunoglobulin E-Mediated Food Allergy-Reply., JAMA Pediatr, Vol: 177
Boyle RJ, Shamji MH, 2023, Adrenaline auto-injectors for people at risk of anaphylaxis., Clin Exp Allergy, Vol: 53, Pages: 896-898
Sach TH, Lartey ST, Davies C, et al., 2023, Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial., Clin Exp Allergy
BACKGROUND: Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy. OBJECTIVE: To determine the cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children at 2 years from a health service perspective. We also considered a 5-year time horizon as a sensitivity analysis. METHODS: A within-trial economic evaluation using data on health resource use and quality of life captured as part of the BEEP trial alongside the trial data. Parents/carers of 1394 infants born to families at high risk of atopic disease were randomised 1:1 to the emollient group, which were advised to apply emollient (Doublebase Gel or Diprobase Cream) to their child at least once daily to the whole body during the first year of life or usual care. Both groups received advice on general skin care. The main economic outcomes were incremental cost-effectiveness ratio (ICER), defined as incremental cost per percentage decrease in risk of eczema in the primary cost-effectiveness analysis. Secondary analysis, undertaken as a cost-utility analysis, reports incremental cost per Quality-Adjusted Life Year (QALY) where child utility was elicited using the proxy CHU-9D at 2 years. RESULTS: At 2 years, the adjusted incremental cost was £87.45 (95% CI -54.31, 229.27) per participant, whilst the adjusted proportion without eczema was 0.0164 (95% CI -0.0329, 0.0656). The ICER was £5337 per percentage decrease in risk of eczema. Adjusted incremental QALYs were very slightly improved in the emollient group, 0.0010 (95% CI -0.0069, 0.0089). At 5 years, adjusted incremental costs were lower for the emollient group, -£106.89 (95% CI -354.66, 140.88) and the proportion without eczema was -0.0329 (95% CI -0.0659, 0.0002). The 5-year ICER was £3201 per percentage decrease in risk of eczema. However, when inpatient cos
Singh S, Kirtschig G, Anchan VN, et al., 2023, Interventions for bullous pemphigoid., Cochrane Database Syst Rev, Vol: 8
BACKGROUND: Bullous pemphigoid (BP) is the most common autoimmune blistering disease. Oral steroids are the standard treatment. We have updated this review, which was first published in 2002, because several new treatments have since been tried. OBJECTIVES: To assess the effects of treatments for bullous pemphigoid. SEARCH METHODS: We updated searches of the following databases to November 2021: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched five trial databases to January 2022, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: RCTs of treatments for immunofluorescence-confirmed bullous pemphigoid. DATA COLLECTION AND ANALYSIS: At least two review authors, working independently, evaluated the studies against the review's inclusion criteria and extracted data from included studies. Using GRADE methodology, we assessed the certainty of the evidence for each outcome in each comparison. Our primary outcomes were healing of skin lesions and mortality. MAIN RESULTS: We identified 14 RCTs (1442 participants). The main treatment modalities assessed were oral steroids, topical steroids, and the oral anti-inflammatory antibiotic doxycycline. Most studies reported mortality but adverse events and quality of life were not well reported. We decided to look at the primary outcomes 'disease control' and 'mortality'. Almost all studies investigated different comparisons; two studies were placebo-controlled. The results are therefore based on a single study for each comparison except azathioprine. Most studies involved only small numbers of participants. We assessed the risk of bias for all key outcomes as having 'some concerns' or high risk, due to missing data, inappropriate analysis, or insufficient information. Clobetasol propionate cream versus oral prednisone Compared to oral prednisone, clobetasol propionate cream applied over the whole body probably in
Shamji MH, Boyle RJ, 2023, Immunotherapy and prevention of allergic diseases., Clin Exp Allergy, Vol: 53, Pages: 788-790
Allen H, Gupta A, Mundell A, et al., 2023, Featured Cover, Clinical & Experimental Allergy, Vol: 53, ISSN: 0954-7894
Allen H, Gupta A, Mundell A, et al., 2023, Formula milk companies and allergy healthcare professionals in India., Clin Exp Allergy, Vol: 53, Pages: 697-710
India is a low-middle income country with a population of 1.4 billion and home to one quarter of the world's children. Exclusive breastfeeding until 6 months and continued breastfeeding until at least 2 years as per global recommendations are common practice. The Indian government and associated organisations have strived to protect breastfeeding, which is important in a country with high under-5 mortality, malnutrition and stunting. Allergic disease is under-recognised in India, but despite the absence of a dedicated allergy medical specialty, awareness of allergy is increasing among healthcare practitioners and in the general population. In high-income countries, overdiagnosis of allergy has become recognised as an issue in recent years. Allergy healthcare professionals have also attracted criticism for close relationships with the formula industry, which appear to have contributed to excessive use of specialised formula products and undermining of breastfeeding. Specialised formula has been used unnecessarily for preventing allergy, based on fraudulent and selectively reported science; and for managing normal infant symptoms which are mislabelled as milk allergy. This forms part of a broader formula industry corporate strategy to widen the boundaries of illness in order to expand sales and markets. In India, allergic disease management is hindered by limited understanding of the disease entity among practitioners, low access to diagnostics, limited healthcare resources, high exposure to air pollution and a large, diverse population. Data specific to India on allergic disease prevalence and interpreting allergy diagnostics are incomplete. The knowledge gaps mean allergy management in India is often extrapolated from guidance developed in high-income countries with low breastfeeding rates. As the allergy specialty develops in India, local guidance and practice will need to recognise the threat that current allergy practice poses to India's normative i
Krishna MT, Shamji MH, Boyle RJ, 2023, Allergy in India., Clin Exp Allergy, Vol: 53, Pages: 690-692
Banerjee J, McLister A, Gourin B, et al., 2023, Tributyrin ester-impregnated pH strips for confirming neonatal feeding tube placement: a diagnostic test accuracy study, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 433-434, ISSN: 1359-2998
Shamji MH, Boyle RJ, 2023, Novel diagnostics and therapeutic approaches for allergic diseases., Clin Exp Allergy, Vol: 53, Pages: 602-604
Tomlinson E, Pardo Pardo J, Sivesind T, et al., 2023, Prioritising Cochrane reviews to be updated with health equity focus., Int J Equity Health, Vol: 22
BACKGROUND: The prioritisation of updating published systematic reviews of interventions is vital to prevent research waste and ensure relevance to stakeholders. The consideration of health equity in reviews is also important to ensure interventions will not exacerbate the existing inequities of the disadvantaged if universally implemented. This study aimed to pilot a priority setting exercise based on systematic reviews of interventions published in the Cochrane Library, to identify and prioritise reviews to be updated with a focus on health equity. METHODS: We conducted a priority setting exercise with a group of 13 international stakeholders. We identified Cochrane reviews of interventions that showed a reduction in mortality, had at least one Summary of Findings table and that focused on one of 42 conditions with a high global burden of disease from the 2019 WHO Global Burden of Disease report. This included 21 conditions used as indicators of success of the United Nations Universal Health Coverage in attaining the Sustainable Development Goals. Stakeholders prioritised reviews that were relevant to disadvantaged populations, or to characteristics of potential disadvantage within the general population. RESULTS: After searching for Cochrane reviews of interventions within 42 conditions, we identified 359 reviews that assessed mortality and included at least one Summary of Findings table. These pertained to 29 of the 42 conditions; 13 priority conditions had no reviews with the outcome mortality. Reducing the list to only reviews showing a clinically important reduction in mortality left 33 reviews. Stakeholders ranked these reviews in order of priority to be updated with a focus on health equity. CONCLUSIONS: This project developed and implemented a methodology to set priorities for updating systematic reviews spanning multiple health topics with a health equity focus. It prioritised reviews that reduce overall mortality, are relevant to disadvantaged population
Boyle RJ, Shamji MH, 2023, Food anaphylaxis in older people., Clin Exp Allergy, Vol: 53, Pages: 488-490
Lloyd M, Loke P, Mack DP, et al., 2023, Varying Approaches to Management of IgE-Mediated Food Allergy in Children Around the World., J Allergy Clin Immunol Pract, Vol: 11, Pages: 1010-1027.e6
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
Scarpone R, Kimkool P, Ierodiakonou D, et al., 2023, Timing of allergenic food introduction and risk of IgE-mediated food allergy: systematic review and meta-analysis, JAMA Pediatrics, Vol: 177, Pages: 489-497, ISSN: 1072-4710
Importance Earlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.Objective To investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy.Data Sources In this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes.Study Selection Randomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)–mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors.Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence.Main Outcomes and Measures Primary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.Results Of 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was −
Arasi S, Nurmatov U, Dunn-Galvin A, et al., 2023, WAO consensus on DEfinition of Food Allergy SEverity (DEFASE)., The World Allergy Organization Journal, Vol: 16, Pages: 1-23, ISSN: 1939-4551
BACKGROUND: While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole. AIM: To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally. METHODS PHASE 1: We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts. PHASE 2: Based on our findings in Phase 1, we drafted statements for a two-round modified electronic Delphi (e-Delphi) survey. A purposefully selected multidisciplinary international expert panel on food allergy (n = 60) was identified and sent a structured questionnaire, including a set of statements on different domains of food allergy severity related to symptoms, health-related quality of life, and economic impact. Participants were asked to score their agreement on each statement on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Median scores and percentage agreements were calculated. Consensus was defined a priori as being achieved if 70% or more of panel members rated a statement as "strongly agree" to "agree" after the second round. Based on feedback, 2 additional online voting rounds were conducted. RESULTS: We received responses from 92% of Delphi panel members in round 1 and 85% in round 2. Consensus was achieved on the overall score and in all of the 5 specific key domains as essential components of the DEFASE score. CONCLUSIONS: The DEFASE score is the first comprehensive grading of food allergy severity that considers not only the severity of a single reaction, but the whole disease spectrum. An international consensus has been achieved regarding a scoring system for food allergy disease. It offers an
Boyle RJ, Flohr C, Shamji MH, 2023, Global trends in eczema prevalence during early life., Clin Exp Allergy, Vol: 53, Pages: 252-254
Munblit D, Petrou L, Boyle R, 2023, Health and nutrition claims for infant formula: international cross sectional survey, BMJ: British Medical Journal, Vol: 380, Pages: 1-10, ISSN: 0959-535X
Objectives To review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims.Design International cross sectional survey.Setting Public facing and healthcare professional facing company owned or company managed formula industry websites providing information about products marketed for healthy infants delivered at full term in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States in 2020-22.Main outcome measures Number and type of claims made for each product and ingredient. References cited were reviewed and risk of bias was assessed for registered clinical trials using the Cochrane risk of bias tool, and for systematic reviews using the Risk Of Bias in Systematic reviews tool.Results 757 infant formula products were identified, each with a median of two claims (range from 1 (Australia) to 4 (US)), and 31 types of claims across all products. Of 608 products with ≥1 claims, the most common claim types were “helps/supports development of brain and/or eyes and/or nervous system” (323 (53%) products, 13 ingredients), “strengthens/supports a healthy immune system” (239 (39%) products, 12 ingredients), and “helps/supports growth and development” (224 (37%) products, 20 ingredients). 41 groups of ingredients were associated with ≥1claims, but many claims were made without reference to a specific ingredient (307 (50%) products). The most common groups of ingredients cited in claims were long chain polyunsaturated fatty acids (278 (46%) products, 9 different claims); prebiotics, probiotics, or synbiotics (225 (37%) products, 19 claims); and hydrolysed protein (120 (20%) products, 9 claims). 161/608 (26%) products with ≥1 claims provided a scientific reference to support the claim—266 unique refer
Shamji MH, Boyle RJ, 2023, Biological therapy practice, biomarkers of severe asthma and novel approaches for attaining immunomodulation in upper airway disease., Clin Exp Allergy, Vol: 53, Pages: 130-131
The hybrid rDer p 2231 stimulated in PBMCs isolated from atopic patients, higher levels of IL-2, IL-10, IL-15 and IFN-γ, as well as lower levels of IL-4, IL-5, IL-13, TNF-α and GM-CSF. The use of hybrid molecules as a therapeutic model in D. pteronyssinus allergic mice led to the reduction of IgE production and lower eosinophilic peroxidase activity in the airways. We found increased levels of IgG antibodies, which blocked the IgE binding to the parental allergens in serum of atopic patients. Furthermore, the stimulation of splenocytes from mice treated with rDer p 2231 induced higher levels of IL-10 and IFN-γ and decreased the secretion of IL-4 and IL-5, when compared to parental allergens and D. pteronyssinus extract. (7).
Boyle RJ, Shamji MH, 2023, What does Clinical and Experimental Allergy mean by Trusted Evidence in Allergy'?, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 53, Pages: 4-6, ISSN: 0954-7894
Ghio D, Muller I, Vestergren S, et al., 2022, Parents’ concerns and understandings around excessive infant crying: Qualitative study of discussions in online forums, SSM - Qualitative Research in Health, Vol: 2
Crying is an essential behaviour in infants, occurring on a continuum, and only rarely indicates serious underlying diagnosis. Searching online for information about excessive crying has become common, using the internet to seek health information and support through forums. The aim of this study was to examine data systematically derived from discussion threads on two online parent forums to explore discussions around excessive infant crying. This study utilised two qualitative approaches; the first, a thematic analysis to explore concerns around excessive crying, and the second, discursive psychology, to explore how diagnostic labels (underlying medical cause of crying) are negotiated within an online thread. The thematic analysis identified a tension between interpreting what is ‘normal’ crying and when crying is a sign of an ‘underlying problem’ leading to a search for a diagnostic label. This tension seemed to be heightened when expectations that infancy should be a ‘happy time’ were threatened by excessive crying. Responses to original posts offered support for parents/caregivers to ‘trust their instincts' and to explore different diagnostic labels. The discursive psychology analysis explored responders' accounts of their experiences to increase credibility and showcase expertise. Forums play an important social role, meeting needs for reassurance, validation, and empowerment. This study suggests that labels are used interchangeably, and further work is needed to understand how perceptions are developed and acted on in the community, as well as online. Furthermore, this study suggests there is a need for supporting parents/caregivers in understanding and managing common behaviours such as excessive crying.
Shamji MH, Boyle RJ, 2022, Mepolizumab for eosinophilic chronic rhinosinusitis, loss of smell and challenges with accessibility to allergen immunotherapy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 1358-1360, ISSN: 0954-7894
Kelleher MM, Phillips R, Brown SJ, et al., 2022, Skin care interventions in infants for preventing eczema and food allergy., Cochrane Database of Systematic Reviews, Vol: 11, Pages: 1-177, ISSN: 1469-493X
BACKGROUND: Eczema and food allergy are common health conditions that usually begin in early childhood and often occur in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective for preventing eczema or food allergy. OBJECTIVES: Primary objective To assess the effects of skin care interventions such as emollients for primary prevention of eczema and food allergy in infants. Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy. SEARCH METHODS: We performed an updated search of the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase in September 2021. We searched two trials registers in July 2021. We checked the reference lists of included studies and relevant systematic reviews, and scanned conference proceedings to identify further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA: We included RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (≤ 12 months) without pre-existing eczema, food allergy, or other skin condition. Eligible comparisons were standard care in the locality or no treatment. Types of skin care interventions could include moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required. DATA COLLECTION AND ANALYSIS: This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes wer
Bradshaw LE, Wyatt LA, Brown SJ, et al., 2022, Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial, ALLERGY, ISSN: 0105-4538
Boyle RJ, Shamji MH, 2022, Are paediatric allergy services promoting or harming public health?, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 1238-1240, ISSN: 0954-7894
Shamji MH, Boyle RJ, 2022, Immunophenotyping and leukocyte redistribution in corticosteroid resistant severe asthma, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 1126-1128, ISSN: 0954-7894
Boyle RJ, Munblit D, Shamji MH, 2022, Patient-oriented allergy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 1012-1014, ISSN: 0954-7894
Dua S, Ruiz-Garcia M, Bond S, et al., 2022, Effects of Exercise and Sleep Deprivation on Reaction Severity During Oral Peanut Challenge: A Randomized Controlled Trial, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 10, Pages: 2404-+, ISSN: 2213-2198
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Mehta S, Allen H, Campbell D, et al., 2022, Trends in use of specialized formula for managing cow's milk allergy in young children, Joint Conference of the British-Society-for-Allergy-and-Immunology (BSACI) and World-Allergy-Organization (WAO), Publisher: WILEY, Pages: 1053-1053, ISSN: 0954-7894
Shamji MH, Boyle RJ, 2022, Immune modulation an COVID 19 in the Asia-Pacific region, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 922-923, ISSN: 0954-7894
Allen H, Pendower U, Santer M, et al., 2022, An international Delphi consensus study on the detection and management of milk allergy, Publisher: WILEY, Pages: 1043-1044, ISSN: 0954-7894
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