Imperial College London

Dr Robert Boyle

Faculty of MedicineNational Heart & Lung Institute

Reader in Paediatric Allergy
 
 
 
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Contact

 

+44 (0)20 3312 7892r.boyle Website

 
 
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Location

 

Paediatric Research UnitQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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324 results found

Banerjee J, McLister A, Gourin B, McClure Z, Mariampillai K, Boyle RJ, Hanna GB, Ni MZet al., 2022, Tributyrin ester-impregnated pH strips for confirming neonatal feeding tube placement: a diagnostic test accuracy study., Arch Dis Child Fetal Neonatal Ed

Journal article

Dua S, Ruiz-Garcia M, Bond S, Dowey J, Durham SR, Kimber I, Mills C, Roberts G, Skypala I, Wason J, Ewan P, Boyle RJ, Clark Aet al., 2022, Effects of Exercise and Sleep Deprivation on Reaction Severity During Oral Peanut Challenge: A Randomized Controlled Trial., J Allergy Clin Immunol Pract, Vol: 10, Pages: 2404-2413.e1

BACKGROUND: The severity of allergic reactions to foods can vary markedly. Little is known of variations in reaction severity within or between individuals or the effects of cofactors. OBJECTIVE: We examined the effects of sleep deprivation and exercise and repeat challenges on the severity and patterns of allergic reactions to peanut. METHODS: In a randomized crossover study, adults with peanut allergy underwent 3 open peanut challenges in random order: with exercise after each dose, with sleep deprivation preceding challenge, and with no intervention. The primary outcome was eliciting dose, reported elsewhere. Reaction severity was a secondary outcome, evaluated using a weighted log-transformed numerical severity score. Analyses estimated the difference in severity between nonintervention challenge and challenges with exercise or sleep deprivation, adjusting for challenge order and using the highest dose tolerated by each individual across all their challenges. Symptom pattern reproducibility was assessed by comparing symptom sequences using pairwise sequence alignment to obtain a percentage match in symptom pattern. RESULTS: Eighty-one participants (mean age 25 y) completed at least 1 postbaseline challenge. Sleep deprivation, but not exercise, significantly increased severity score by 48% (95% CI 12%-84%; P = .009) compared with no intervention. A 38% increase in severity was observed between the first and the last postbaseline challenge (95% CI 1%-75%; P = .044). The average pairwise match of symptoms within individuals was 82.4% and across individuals was 78.3%. CONCLUSIONS: A novel severity score demonstrates that sleep deprivation and repeated challenges increase reaction severity. Understanding factors affecting severity is essential for effective risk management. We also show that symptom patterns in repeat peanut challenges are similar within and between individuals.

Journal article

Mehta S, Allen HI, Campbell DE, Arntsen KF, Simpson MR, Boyle Ret al., 2022, Trends in use of specialised formula for managing cow’s milk allergy in young children, Clinical and Experimental Allergy, Vol: 52, Pages: 839-847, ISSN: 0954-7894

Background:Excessive use of specialised formula for cow’s milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialised formula products, especially amino-acid formula, have high free sugars content. We evaluated specialised formula trends in countries with public databases documenting national prescription rates.Methods:Cross-sectional analysis of national prescription databases in United Kingdom, Norway and Australia. Outcomes were volume and cost of specialised formula, and proportion of infants prescribed specialised formula. Expected volumes assumed 1% cow’s milk allergy incidence and similar formula feeding rates between infants with and without milk allergy.Results:Prescribed volumes of specialised formula for infants rose 2.8-fold in England from 2007-2018, with similar trends in other regions of the United Kingdom. Volumes rose 2.2-fold in Norway from 2009-2020 and 3.2-fold in Australia from 2001-2012. In 2020, total volumes were 9.7 to 12.6-fold greater than expected in England, 8.3 to 15.6-fold greater than expected in Norway and 3.3 to 4.5-fold greater than expected in Australia, where prescribing restrictions were introduced in 2012. In Norway the proportion of infants prescribed specialised formula increased from 2.2% in 2009 to 6.9% in 2020, or 11.2 to 13.3-fold greater than expected. In 2020, specialised formula for infants cost US$117 (103 euro) per birth in England, US$93 (82 euro) in Norway and US$27 (23 euro) in Australia. Soya formula prescriptions exceeded expected volumes 5.5 to 6.4-fold in England in 1994 and subsequently declined, co-incident with public health concerns regarding soya formula safety. In 2020, 30-50% of prescribed specialised formula across the three countries was amino-acid formula.Conclusions:In England, Norway and Australia, specialised formula prescriptions increased in the early 21st century and exceeded expected levels. Unneces

Journal article

Allen HI, Pendower U, Santer M, Groetch M, Cohen M, Murch SH, Williams HC, Munblit D, Katz Y, Gupta N, Adil S, Baines J, Bont EGPMD, Ridd M, Sibson VL, McFadden A, Koplin JJ, Munene J, Perkin MR, Sicherer SH, Boyle RJet al., 2022, Detection and management of milk allergy: Delphi consensus study, Clinical & Experimental Allergy, Vol: 52, Pages: 848-858, ISSN: 0954-7894

BackgroundThere is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialised formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.MethodsDelphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia, and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.FindingsParticipants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding, or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula.InterpretationThese new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding

Journal article

Kelleher MM, Cro S, Phillips R, Williams HC, Lowe AJ, Boyle RJet al., 2022, Correspondence to " Emollients in infancy to prevent atopic dermatitis: A systematic review and meta-analysis", ALLERGY, Vol: 77, Pages: 1931-1933, ISSN: 0105-4538

Journal article

Shamji MH, Boyle RJ, 2022, Biomarkers of airway inflammation and immunotherapy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 726-728, ISSN: 0954-7894

Journal article

Gorman E, Shankar-Hari M, Hopkins P, Tunnicliffe WS, Perkins GD, Silversides J, McGuigan P, Jackson C, Boyle R, McFerran J, McDowell C, Campbell C, McFarland M, Smythe J, Thompson J, Williams B, Curley G, Laffey JG, Clarke M, McAuley DF, O'Kane Cet al., 2022, Repair of acute respiratory distress syndrome by stromal cell administration (REALIST): a structured study protocol for an open-label dose-escalation phase 1 trial followed by a randomised, triple-blind, allocation concealed, placebo- controlled phase 2 trial, TRIALS, Vol: 23

Journal article

Gamirova A, Berbenyuk A, Levina D, Peshko D, Simpson MR, Azad MB, Jaervinen KM, Brough HA, Genuneit J, Greenhawt M, Verhasselt V, Peroni DG, Perkin MR, Warner JO, Palmer DJ, Boyle RJ, Munblit Det al., 2022, Food Proteins in Human Breast Milk and Probability of IgE-Mediated Allergic Reaction in Children During Breastfeeding: A Systematic Review, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, Vol: 10, Pages: 1312-+, ISSN: 2213-2198

Journal article

Boyle RJ, Shamji MH, 2022, Early origins of allergic disease, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 592-594, ISSN: 0954-7894

Journal article

Shamji MH, Boyle RJ, 2022, Immune modulation and the role of innate immune cells in allergy and asthma, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 474-475, ISSN: 0954-7894

Journal article

Blackwood B, Morris KP, Jordan J, McIlmurray L, Agus A, Boyle R, Clarke M, Easter C, Feltbower RG, Hemming K, Macrae D, McDowell C, Murray M, Parslow R, Peters MJ, Phair G, Tume LN, Walsh TS, McAuley DFet al., 2022, Co-ordinated multidisciplinary intervention to reduce time to successful extubation for children on mechanical ventilation: the SANDWICH cluster stepped-wedge RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 26, Pages: I-+, ISSN: 1366-5278

Journal article

Boyle RJ, Krishna MT, Shamji MH, 2022, Allergy in India-a call for submissions, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 364-366, ISSN: 0954-7894

Journal article

Szeto MD, Hassan S, Hamp A, Anderson J, Sivesind TE, Anderson JB, Laughter MR, Makrygeorgou A, Boyle RJ, Dellavalle RPet al., 2022, From the Cochrane Library: Probiotics for treating eczema, JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, Vol: 86, Pages: E127-E132, ISSN: 0190-9622

Journal article

Shamji MH, Boyle RJ, 2022, Biomarker strategies for perioperative hypersensitivity reactions and severe eosinophilic asthma, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 216-218, ISSN: 0954-7894

Journal article

Turner P, Durham S, Skypala I, Boyle RBet al., 2022, No apparent impact of incremental dosing on eliciting dose at double-blind, placebo-controlled peanut challenge, Allergy, Vol: 77, Pages: 667-670, ISSN: 0105-4538

Journal article

Griffin S, Watt J, Wedekind S, Bramer S, Hazemi-Jebelli Y, Boyle R, Weaver G, Shenker NSet al., 2022, Establishing a novel community-focussed lactation support service: a descriptive case series, INTERNATIONAL BREASTFEEDING JOURNAL, Vol: 17, ISSN: 1746-4358

Journal article

Allen H, Boyle RJ, 2022, Dietary management of breastfed children with food allergy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 29-32, ISSN: 0954-7894

Journal article

Boyle RJ, Shamji MH, 2022, Milk allergy over-diagnosis, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 4-6, ISSN: 0954-7894

Journal article

Van Vogt E, Cro S, Cornelius VR, Williams HC, Askie LM, Phillips R, Kelleher MM, Boyle RJet al., 2021, Individual participant data meta-analysis versus aggregate data meta-analysis: a case study in eczema and food allergy prevention., Clinical and Experimental Allergy, Vol: 52, ISSN: 0954-7894

INTRODUCTION: Meta-analysis traditionally uses aggregate data from published reports. Individual Participant Data (IPD) meta-analysis, which obtains and synthesises participant-level data, is potentially more informative, but resource-intensive. The impact on the findings of meta-analyses using IPD in comparison to aggregate data has rarely been formally evaluated. METHODS: We conducted a secondary analysis of a Cochrane systematic review of skin care interventions for preventing eczema and food allergy in infants to identify the impact of the analytical choice on the review's findings. We used aggregate data meta-analysis only and contrasted the results against those of the originally published IPD meta-analysis. All meta-analysis used random effects inverse variance models. Certainty of evidence was evaluated using GRADE. RESULTS: The pooled treatment effects for the Cochrane systematic review's co-primary outcomes of eczema and food allergy were similar in IPD meta-analysis (eczema RR 1.03, 95% CI 0.81, 1.31; I2 41%, 7 studies 3075 participants), and aggregate meta-analysis (eczema RR 1.01 95% CI 0.77, 1.33; I2 53%, 7 studies, 3089 participants). In aggregate meta-analysis the statistical heterogeneity could not be explained but using IPD it was explained by one trial which used a different, bathing intervention. For IPD meta-analysis, risk of bias was assessed as lower and more adverse event data were available compared with aggregate meta-analysis. This resulted in higher certainty of evidence, especially for adverse events. IPD meta-analysis enabled analysis of treatment interactions by age and hereditary eczema risk; and analysis of the effect of treatment adherence using pooled complier-adjusted-causal-effect analysis, none of which was possible in aggregate meta-analysis. CONCLUSIONS: For this systematic review, IPD did not significantly change primary outcome risk ratios compared with aggregate data meta-analysis. However, certainty of evidence, safety out

Journal article

Smith TDH, Townsend R, Hussain HS, Santer M, Boyle RJet al., 2021, Milk allergy guidelines for infants in England promote over-diagnosis: A cross-sectional survey, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 52, Pages: 188-191, ISSN: 0954-7894

Journal article

Mehta S, Allen HI, Simpson MR, Campbell DE, Arntsen KF, Boyle RJet al., 2021, Patterns of specialised formula consumption in Australia, England and Norway suggest significant milk allergy over-diagnosis, Publisher: WILEY, Pages: 1661-1661, ISSN: 0954-7894

Conference paper

Shamji MH, Boyle RJ, 2021, Allergic diseases and novel targets in allergen immunotherapy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1526-1528, ISSN: 0954-7894

Journal article

Pendower UM, Allen HI, Boyle RJ, 2021, A Delphi consensus project to guide the safe detection and management of cow's milk allergy in infants and children, Publisher: WILEY, Pages: 1689-1689, ISSN: 0954-7894

Conference paper

Shamji MH, Boyle RJ, Fox AT, 2021, Prize-winning abstracts from BSACI 2021 meeting, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1529-1530, ISSN: 0954-7894

Journal article

Boyle RJ, Shamji MH, 2021, Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1531-1537, ISSN: 0954-7894

Journal article

Helfer B, Leonardi-Bee J, Mundell A, Parr C, Ierodiakonou D, Garcia-Larsen V, Kroeger CM, Dai Z, Man A, Jobson J, Dewji F, Kunc M, Bero L, Boyle RJet al., 2021, Conduct and reporting of formula milk trials: systematic review (vol 375, n2202, 2021), BMJ: British Medical Journal, Vol: 375, Pages: 1-1, ISSN: 0959-535X

Journal article

Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJet al., 2021, Psychological and educational interventions for managing eczema, Cochrane Database of Systematic Reviews, Vol: 2021, ISSN: 1465-1858

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. 1. To assess the clinical outcomes of psychological and educational interventions in children and adults with eczema. 2. To summarise the availability and principal findings of relevant economic evaluations.

Journal article

Genuneit J, Jayasinghe S, Riggioni C, Peters RL, Chu DK, Munblit D, Boyle RJ, Du Toit G, Skypala I, Santos AFet al., 2021, Protocol for a systematic review of the diagnostic test accuracy of tests for IgE-mediated food allergy, PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 33, ISSN: 0905-6157

Journal article

Boyle RJ, Shamji MH, 2021, Making causal inferences in allergy epidemiology studies, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1404-1406, ISSN: 0954-7894

Journal article

Patel N, Chong KW, Yip AYG, Ierodiakonou D, Bartra J, Boyle RJ, Turner PJet al., 2021, Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis, Journal of Allergy and Clinical Immunology, Vol: 148, Pages: 1307-1315, ISSN: 0091-6749

Background:Regulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times. This is in contrast to some guidelines. The proportion of anaphylaxis reactions that are treated with multiple doses of epinephrine has not been systematically evaluated.Objective:Our aim was to undertake a systematic review and meta-analysis of published studies reporting epinephrine treatment for anaphylaxis in which data relating to the number of doses administered were available.Methods:We searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events (due to food or venom) from 1946 until January 2020. Data were extracted in duplicate for the meta-analysis, and the risk of bias was assessed. The study was registered under the PROSPERO identifier CRD42017069109.Results:A total of 86 studies (36,557 anaphylaxis events) met the inclusion criteria (20 of the studies [23%] were prospective studies; 64 [74%] reported reactions in the community, and 22 [26%] included food challenge data). Risk of bias was assessed as low in 50 studies. Overall, 7.7% of anaphylaxis events from any cause (95% CI = 6.4-9.1) were treated with multiple doses of epinephrine. When only epinephrine-treated reactions for which subsequent doses were administered by a health care professional were considered, 11.1% of food-induced reactions (95% CI = 9.4-13.2) and 17.1% of venom-induced reactions (95% CI = 11.3-25.0) were treated with at least 1 epinephrine dose. Heterogeneity was moderate to high in the meta-analyses, but at sensitivity analysis it was not affected by study design or anaphylaxis definition.Conclusion:Around 1 in 10 anaphylaxis reactions are treated with at least 1 dose of epinephrine.

Journal article

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