288 results found
Boyle RJ, Shamji MH, 2021, Asthma management and impact on COVID-19 outcomes, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 1100-1102, ISSN: 0954-7894
Helfer B, Leonardi-Bee J, Mundell A, et al., 2021, Conduct and reporting of formula milk trials: systematic review, BMJ: British Medical Journal, ISSN: 0959-535X
Importance: Formula milk is consumed by most European and North American infants and global consumption is rising. New formula products need to be tested in clinical trials, but concerns have been raised that such trials are biased and may undermine breastfeeding.Objective: To systematically review the conduct and reporting of formula trials. Trial primary outcomes were evaluated for risk of bias, and reported trial procedures were evaluated for risk of undermining breastfeeding.Data sources: MEDLINE, EMBASE and CENTRAL databases were searched from 1st January 2006 to 31st December 2020. Study selection: Intervention trials comparing at least two formula products in children under 3 years were included, but not trials of human breastmilk or breastmilk fortifiers. Data extraction and synthesis: Data were extracted in duplicate and primary outcome data were synthesised for meta-analysis using a random-effects model weighted by the inverse variance method. Main outcomes and measures: Risk of bias was evaluated using Cochrane Risk of Bias 2.0, risk of undermining breastfeeding was evaluated using published consensus guidance. Primary outcomes of included trials were identified from clinical trial registries, protocols or trial publications. Results: We screened 22,201 titles and identified 307 trials published between 2006 and 2020, of which seventy-three (24%) trials in 13,197 children were prospectively registered. A further 111 unpublished but registered trials in 17,411 children were identified. Detailed analysis was undertaken for the 125 trials (23,757 children) published since 2015. Seventeen (14%) of these recent published trials were conducted independently from formula companies, 26 (21%) were prospectively registered with a clear aim and primary outcome, and authors or sponsors shared prospective protocols for 11 (9%). Risk of bias was low in five (4%) and high in 100 (80%) recent published trials, mainly due to inappropriate exclusions from analysis and sele
Shamji MH, Boyle RJ, 2021, Biomarkers in asthma and allergic diseases, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 982-984, ISSN: 0954-7894
Boyle RJ, Shamji MH, 2021, Evidence Synthesis in Allergy - A call for submissions, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 868-869, ISSN: 0954-7894
Shamji MH, Boyle RJ, 2021, Real word evidence studies: Is it the way forward?, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 748-750, ISSN: 0954-7894
Argiz L, Infante S, Machinena A, et al., 2021, Children with acute food protein-induced enterocolitis syndrome from Spain and Italy usually tolerate all other food groups, CLINICAL AND EXPERIMENTAL ALLERGY, ISSN: 0954-7894
Allan PJ, Ambrose T, Mountford C, et al., 2021, COVID-19 infection in patients with intestinal failure: UK experience, JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, ISSN: 0148-6071
Genuneit J, Boyle RJ, 2021, Hydrolysed formula and allergy prevention, PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 32, Pages: 667-669, ISSN: 0905-6157
Boyle RJ, Shamji MH, 2021, What does it mean to be food allergic?, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 634-635, ISSN: 0954-7894
Turner P, Ruiz-Garcia M, Patel N, et al., 2021, Delayed symptoms and orthostatic intolerance following peanut challenge, Clinical and Experimental Allergy, Vol: 51, Pages: 696-702, ISSN: 0954-7894
BackgroundClinical reactions to Oral Food Challenge (OFC) in peanut‐allergic individuals have been well‐characterised, but rates and phenotypes of symptom recurrence beyond the first hour after objective symptoms are less well‐characterised.ObjectiveTo evaluate the rate of new‐onset symptoms occurring at least 1 h after stopping OFC in peanut‐allergic children and adults undergoing peanut‐OFC.MethodsWe prospectively collected data relating to adverse events following positive reactions at double‐blind, placebo‐controlled food challenges (DBPCFC) to peanut in children and adults evaluated for eligibility to participate in two clinical trials (NCT02149719, NCT02665793). The trials included people aged 8 to 45 with primary, IgE‐mediated peanut allergy at DBPCFC. The challenge protocol included consumption of a light meal 1 h after reaction.ResultsA total of 121 participants (64 children, 57 adults) had immediate, objective symptoms at DBPCFC, 25 (17 children, 8 adults) with anaphylaxis. Thirty‐three (27%) had progression or recurrence of symptoms ≥ 1 h after objective clinical reaction, of whom 8 developed anaphylaxis. In 23 cases, the onset of new symptoms was associated with consumption of a light meal. In eight cases, symptoms were limited to a symptomatic postural fall in blood pressure noted in preparation for discharge, without any other new features of an allergic reaction.Conclusions & Clinical RelevanceProgressive or new‐onset symptoms ≥1 h following initial allergic reaction at OFC are common and can include orthostatic hypotension. Recurrent symptoms may be temporally associated with food consumption.
Patel N, Chong KW, Yip AYG, et al., 2021, Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis, Journal of Allergy and Clinical Immunology, 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.
Shamji MH, Boyle RJ, 2021, New innovations in allergy treatment and phenotyping, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 514-517, ISSN: 0954-7894
Bramer S, Boyle R, Weaver G, et al., 2021, Use of donor human milk in nonhospitalized infants: An infant growth study, Maternal and Child Nutrition, Vol: 17, Pages: 1-9, ISSN: 1740-8695
When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health.
Halken S, Muraro A, de Silva D, et al., 2021, EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update), PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 32, Pages: 843-858, ISSN: 0905-6157
Gilbertson A, Boyle RJ, MacNeill S, et al., 2021, Healthcare professionals' beliefs and practices regarding food allergy testing for children with eczema, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 735-739, ISSN: 0954-7894
Perkin MR, Logan K, Marrs T, et al., 2021, Association of frequent moisturizer use in early infancy with the development of food allergy, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 147, Pages: 967-+, ISSN: 0091-6749
Boyle RJ, Shamji MH, 2021, Aetiology and prevention of eczema, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 380-381, ISSN: 0954-7894
Kelleher MM, Cro S, Van Vogt E, et al., 2021, Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis, Clinical and Experimental Allergy, Vol: 51, Pages: 402-418, ISSN: 0954-7894
ObjectiveEczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare interventions can prevent eczema or food allergy.DesignA prospectively planned individual participant data meta‐analysis was carried out within a Cochrane systematic review to determine whether skincare interventions in term infants prevent eczema or food allergy.Data sourcesCochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020.Eligibility criteria for selected studiesIncluded studies were randomized controlled trials of infants <1 year with healthy skin comparing a skin intervention with a control, for prevention of eczema and food allergy outcomes between 1 and 3 years.ResultsOf the 33 identified trials, 17 trials (5823 participants) had relevant outcome data and 10 (5154 participants) contributed to IPD meta‐analysis. Three of seven trials contributing to primary eczema analysis were at low risk of bias, and the single trial contributing to primary food allergy analysis was at high risk of bias. Interventions were mainly emollients, applied for the first 3–12 months. Skincare interventions probably do not change risk of eczema by age 1–3 years (RR 1.03, 95% CI 0.81, 1.31; I2=41%; moderate certainty; 3075 participants, 7 trials). Sensitivity analysis found heterogeneity was explained by increased eczema in a trial of daily bathing as part of the intervention. It is unclear whether skincare interventions increase risk of food allergy by age 1–3 years (RR 2.53, 95% CI 0.99 to 6.47; very low certainty; 996 participants, 1 trial), but they probably increase risk of local skin infections (RR 1.34, 95% CI 1.02, 1.77; I2=0%; moderate certainty; 2728 participants, 6 trials).ConclusionRegular emollients during infancy probably do not prevent eczema and probably increase local skin infections.
Turner P, Boyle R, Baseggio Conrado A, 2021, Food Anaphylaxis in the United Kingdom: an analysis of national data, 1998-2018, BMJ: British Medical Journal, Vol: 372, ISSN: 0959-535X
Objective To describe time trends for hospital admissions due to food anaphylaxis in the United Kingdom over the past 20 years.Design Analysis of national data, 1998-2018.Setting Data relating to hospital admissions for anaphylaxis and deaths, and prescription data for adrenaline autoinjector devices.Participants UK population as a whole and devolved nations (England, Scotland, Wales, and Northern Ireland).Main outcome measures Time trends, age, and sex distributions for hospital admissions for anaphylaxis due to food and non-food triggers, and how these admission rates compare with the case fatality rate (number of fatalities as a proportion of hospital admissions).Results Between 1998 and 2018, 101 891 people were admitted to hospital for anaphylaxis. Of these admissions, 30 700 (30.1%) were coded as due to a food trigger. Food anaphylaxis admissions increased from 1.23 to 4.04 per 100 000 population per year (from 1998 to 2018), an annual increase of 5.7% (95% confidence interval 5.5% to 5.9%, P<0.001). The largest increase in hospital admissions was observed in children younger than 15 years, with an increase from 2.1 to 9.2 admissions per 100 000 population per year (an annual increase of 6.6%, 95% confidence interval 6.3% to 7.0%). For comparison, the annual increase was 5.9% (5.6% to 6.2%) in people aged 15-59 years and 2.1% (1.8% to 3.1%) in those aged 60 years and older. 152 deaths were identified where the fatal event was probably caused by food induced anaphylaxis. The case fatality rate decreased from 0.7% to 0.19% for confirmed fatal food anaphylaxis (rate ratio 0.931, 95% confidence interval 0.904 to 0.959, P<0.001) and to 0.30% for suspected fatal food anaphylaxis (0.970, 0.945 to 0.996, P=0.024). At least 46% (86 of 187, which also includes 35 deaths in 1992-98) of deaths were triggered by peanut or tree nut. Cow’s milk was responsible for 17 of 66 (26%) deaths in school aged children. Over the same time period
Kelleher MM, Cro S, Cornelius V, et al., 2021, Skin care interventions in infants for preventing eczema and food allergy., Cochrane Database of Systematic Reviews, Vol: 2021, Pages: 1-165, ISSN: 1469-493X
BACKGROUND: Eczema and food allergy are common health conditions that usually begin in early childhood and often occur together 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 in preventing eczema or food allergy. OBJECTIVES: Primary objective To assess 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 searched the following databases up to July 2020: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two trials registers and checked reference lists of included studies and relevant systematic reviews for further references to relevant randomised controlled trials (RCTs). We contacted field experts to identify planned trials and to seek information about unpublished or incomplete trials. SELECTION CRITERIA: RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (0 to 12 months) without pre-existing diagnosis of eczema, food allergy, or other skin condition were included. Comparison was standard care in the locality or no treatment. Types of skin care interventions included 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 ana
Ruiz-Garcia M, Bartra J, Alvarez O, et al., 2021, Cardiovascular changes during peanut-induced allergic reactions in human subjects, Journal of Allergy and Clinical Immunology, Vol: 147, Pages: 633-642, ISSN: 0091-6749
Background: Food allergy is the commonest cause of anaphylaxis. Changes in posture during acute reactions can trigger fatal outcomes, but the impact of allergic reactions on the cardiovascular system in non-fatal reactions remains poorly understood. Objective: To systematically evaluate changes in cardiovascular function during acute allergic reactions to peanut. Methods: Participants underwent double-blind placebo-controlled food challenge topeanut as part of a clinical trial. Changes in hemodynamic parameters (heart rate, stroke volume, blood pressure, peripheral blood flow) and electrocardiogram during food challenges were assessed using continuous monitoring. ClinicalTrials.gov Identifier: NCT02665793 Results: 57 adults (median age 24 (IQR 20-29) years, 53% female) participated; 22 (39%) had anaphylaxis. Acute reactions were associated with significant changes in stroke volume (mean decrease 4.2%, 95%CI 0.8 to 7.6; p=0.03), heart rate (mean increase 11.6%, 95%CI 8.4 to 14.8; p<0.0001) and peripheral blood flow (mean increase 19.7%, 95%CI 10.8 to 28.6; p<0.0001), irrespective of reaction severity. These changes were reproduced at subsequent repeat peanut challenge in 26 participants, and could be reversed with administration of intravenous fluids which resulted in faster resolution of abdominal symptoms. Conclusions: In this first detailed human study of cardiovascular changes during food-allergic reactions, we found evidence for significant fluid redistribution, independent of reaction severity. This provides a sound rationale for optimizing venous return during significant allergic reactions to food. Finally, these data provide a new paradigm for understanding severity in anaphylaxis, where poor outcomes occur due to a failure in compensatory mechanisms.Ruiz-Garcia et al 5 Clinical Implication: Significant changes in cardiovascular function, including decreased stroke volume, occur during peanut-induced allergic reactions in adults irrespective of severit
Shamji MH, Boyle RJ, 2021, What does climate change mean for people with pollen allergy?, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 202-205, ISSN: 0954-7894
Ridd MJ, Webb D, Roberts K, et al., 2021, Test-guided dietary management of eczema in children: A randomized controlled feasibility trial (TEST), CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 51, Pages: 452-462, ISSN: 0954-7894
Munblit D, Palmer DJ, Boyle RJ, 2021, Maternal Elimination Diet and Symptoms of Cow's Milk Allergy in Breastfed Infants-Reply, JAMA PEDIATRICS, Vol: 175, Pages: 426-427, ISSN: 2168-6203
Smires S, Afach S, Mazaud C, et al., 2021, Quality and Reporting Completeness of Systematic Reviews and Meta-Analyses in Dermatology, JOURNAL OF INVESTIGATIVE DERMATOLOGY, Vol: 141, Pages: 64-71, ISSN: 0022-202X
Boyle RJ, Shamji MH, 2021, Allergy prevention, Clinical and Experimental Allergy, Vol: 51, Pages: 4-5, ISSN: 0954-7894
Turner P, Boyle R, Durham S, 2021, Limited effect of intramuscular epinephrine on cardiovascular parameters during peanut-induced anaphylaxis: an observational cohort study, Journal of Allergy and Clinical Immunology: In Practice, Vol: 9, Pages: 527-530.e1, ISSN: 2213-2198
Roberts G, Almqvist C, Boyle R, et al., 2020, Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 50, Pages: 1302-1312, ISSN: 0954-7894
Roberts G, Almqvist C, Boyle R, et al., 2020, Developments allergy in 2019 through the eyes of clinical and experimental allergy, part I mechanisms, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 50, Pages: 1294-1301, ISSN: 0954-7894
Boyle R, Brown N, Chiang WC, et al., 2020, Partially hydrolysed, prebiotic supplemented whey formula for the prevention of allergic manifestations in high risk infants: a multicentre double-blind randomised controlled trial (Retraction of Vol 5, art no P30, 2015), Clinical and Translational Allergy, Vol: 10, ISSN: 2045-7022
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