Background Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning ...have impeded a comprehensive description. Objective We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. Methods The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. Results Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom– and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. Conclusions The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
Background The evolution of the IgE response to the numerous allergen molecules of Dermatophagoides pteronyssinus is still unknown. Objectives We sought to characterize the evolutionary patterns of ...the IgE response to 12 molecules of D pteronyssinus from birth to adulthood and to investigate their determinants and clinical relevance. Methods We investigated the clinical data and sera of 722 participants in the German Multicenter Allergy Study, a birth cohort started in 1990. Diagnoses of current allergic rhinitis (AR) related to mite allergy and asthma were based on yearly interviews at the ages of 1 to 13 years and 20 years. IgE to the extract and 12 molecules of D pteronyssinus were tested by means of ImmunoCAP and microarray technology, respectively, in sera collected at ages 1, 2, 3, 5, 6, 7, 10, 13, and 20 years. Exposure to mites at age 6 and 18 months was assessed by measuring Der p 1 weight/weight concentration in house dust. Results One hundred ninety-one (26.5%) of 722 participants ever had IgE to D pteronyssinus extract (≥0.35 kUA /L). At age 20 years, their IgE recognized most frequently Der p 2, Der p 1, and Der p 23 (group A molecules; prevalence, >40%), followed by Der p 5, Der p 7, Der p 4, and Der p 21 (group B molecules; prevalence, 15% to 30%) and Der p 11, Der p 18, clone 16, Der p 14, and Der p 15 (group C molecules; prevalence, <10%). IgE sensitization started almost invariably with group A molecules and expanded sequentially first to group B and finally to group C molecules. Early IgE sensitization onset, parental hay fever, and higher exposure to mites were associated with a broader polymolecular IgE sensitization pattern. Participants reaching the broadest IgE sensitization stage (ie, ABC) had significantly higher risk of mite-related AR and asthma than unsensitized participants. IgE to Der p 1 or Der p 23 at age 5 years or less predicted asthma at school age. Conclusions Parental hay fever and early exposure to D pteronyssinus allergens promote IgE polysensitization to several D pteronyssinus molecules, which in turn predicts current mite-related AR and current/future asthma. These results might inspire predictive algorithms and prevention strategies against the progression of IgE sensitization to mites toward AR and asthma.
Background The lack of longitudinal data analyses from birth to adulthood is hampering long-term asthma prevention strategies. Objective We aimed to determine early-life predictors of asthma ...incidence up to age 20 years in a birth cohort study by applying time-to-event analysis. Methods In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated from birth to age 20 years at 19 time points. Using a Cox regression model, we examined the associations between 36 early-life factors and onset of asthma based on a doctor's diagnosis or asthma medication (primary outcome), typical asthma symptoms, or allergic asthma (including positive IgE measurements). Results Response at 20 years was 71.6%. Two hundred eighteen subjects met the primary outcome criteria within 16,257 person years observed. Asthma incidence was lower in participants who were vaccinated (measles, mumps, and rubella vaccine/tick-borne encephalitis vaccine/BCG vaccine: adjusted hazard ratio HR, 0.66 95% CI, 0.47-0.93). Up to age 20 years, asthma incidence was higher in subjects who had parents with allergic rhinitis (adjusted HR, 2.24 95% CI, 1.67-3.02), started day care early or late (before 18 months: adjusted HR, 1.79 95% CI, 1.03-3.10; after 3 years: adjusted HR, 1.64 95% CI, 0.96-2.79), had mothers who smoked during pregnancy (adjusted HR, 1.79 95% CI, 1.20-2.67), had poor parents (adjusted HR, 1.55 95% CI, 1.09-2.22), and had parents with asthma (adjusted HR, 1.65 95% CI, 1.17-2.31). Not associated with asthma were aspects of diet and breast-feeding, pet ownership, presence of older siblings, and passive smoking. Conclusion Parental asthma and nasal allergy increase asthma incidence in offspring up to adulthood. Avoiding tobacco smoke exposure during pregnancy, receiving vaccinations in early childhood, and starting day care between 1.5 and 3 years of age might prevent or delay the development of asthma.
Primary hazelnut allergy is a common cause of anaphylaxis in children, as compared to birch-pollen associated hazelnut allergy. Population-based data on hazelnut and concomitant birch-pollen allergy ...in children are lacking. We aimed to investigate the prevalence of primary and pollen-associated hazelnut allergy and sensitization profiles in school-aged children in Berlin, Germany.
1570 newborn children were recruited in Berlin in 2005–2009. The school-age follow-up (2014–2017) was based on a standardized web-based parental questionnaire and clinical evaluation by a physician including skin prick tests, allergen specific immunoglobulin E serum tests and placebo-controlled double-blind oral food challenges, if indicated.
1004 children (63.9% response) participated in the school-age follow-up assessment (52.1% male). For 1.9% (n = 19, 95%-confidence interval 1.1%–2.9%) of children their parents reported hazelnut-allergic symptoms, for half of these to roasted hazelnut indicating primary hazelnut allergy. Symptoms of birch-pollen allergy were reported for 11.6% (n = 116 95%-CI 9.7%–13.7%) of the children. Both birch-pollen allergy and hazelnut allergy associated symptoms affected 0.6% (n = 6, 95%-CI 0.2%–1.3%) of children. Assessment of allergic sensitization was performed in 261 participants and showed that almost 20% of these children were sensitized to hazelnut, being the most frequent of all assessed food allergens, or birch-pollen, the majority to both.
Based on parental reports hazelnut-allergic symptoms were far less common than sensitization to hazelnut. This needs to be considered by physicians to avoid unnecessary changes in diet due to sensitization profiles only, especially when there is a co-sensitization to hazelnut and birch-pollen.
Artificial intelligence (AI) and data sharing go hand in hand. In order to develop powerful AI models for medical and health applications, data need to be collected and brought together over multiple ...centers. However, due to various reasons, including data privacy, not all data can be made publicly available or shared with other parties. Federated and swarm learning can help in these scenarios. However, in the private sector, such as between companies, the incentive is limited, as the resulting AI models would be available for all partners irrespective of their individual contribution, including the amount of data provided by each party. Here, we explore a potential solution to this challenge as a viewpoint, aiming to establish a fairer approach that encourages companies to engage in collaborative data analysis and AI modeling. Within the proposed approach, each individual participant could gain a model commensurate with their respective data contribution, ultimately leading to better diagnostic tools for all participants in a fair manner.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent‐reported symptoms. We aimed to estimate the frequency of ...FA and sensitization against food allergens in primary school children in eight European countries.
Methods
A follow‐up assessment at age 6‐10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double‐blind, placebo‐controlled oral food challenges (DBPCFC).
Results
A total of 6105 children participated in this school‐age follow‐up (57.8% of 10 563 recruited at birth). For 982 of 6069 children (16.2%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face‐to‐face interviews and/or skin prick testing, 238 (10.4%) were eligible for a DBPCFC. Sixty‐three foods were challenge‐tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy‐one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4% (88 related to all 6105 participants of this follow‐up) and 3.8% (88 related to 2289 with completed eligibility assessment).
Interpretation
In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons.
Prospective observation of more than six thousand newborns estimated the frequency of food allergy, varying considerably by diagnostic approach. One in ten children had positive skin prick against common food allergens, but only few actually suffered from food allergy. This first multinational estimate of food allergy frequency challenges the widespread perception of an increase of allergic diseases.
Abbreviation: SPT, skin prick test
The interpretation of epidemiological data on food hypersensitivities should clearly separate two issues: the disposition to respond symptomatically to certain foods and the actual reactions ...occurring, which can be observed only when there is sufficient consumption or targeted exposure/provocation.The exact specification of the case definition is essential for reporting and interpreting food hypersensitivity frequencies. In Europe, prevalence estimates of self-reported reactions are reported from 5.7 to 61.6 %, and physician-diagnosed hypersensitivities from 0.2 to 4.2 %. Consideration of only double-blind proven immediate-type reactions gave estimates ranging from 0.0 to 2.2 %. The disposition for severe reactions against food might be less frequent, but cannot be estimated robustly from published data. The only data available for Germany estimates a prevalence of IgE-mediated reactions of 2,5% for Berlin.The most common triggers of early childhood food allergy are cow's milk and hen's egg, which usually cause mild symptoms, limited to the skin. Food allergy aquired in infancy usually disappears by early school age.The European Anaphylaxis Registry documents the spectrum of severe allergic reactions. England has a larger case series for fatal reactions. No incidence can be estimated from either approach, because reporting is voluntary. Additionally, the discussed data does not inform about the clinical relevance of severe allergic reactions against foods.Future systematic studies about the incidence and course of food hypersensitivity should examine sufficiently large groups of people using objective diagnostic criteria.
Zusammenfassung
Die Interpretation epidemiologischer Daten zu Nahrungsmittelunverträglichkeiten sollte 2 Aspekte klar trennen: Die Disposition eines Individuums, bei Verzehr bestimmter Nahrungsmittel ...symptomatisch zu reagieren und die tatsächlich stattfindenden Reaktionen, welche nur bei ausreichendem Verzehr oder gezielter Exposition/Provokation beobachtet werden können.
Die genaue Angabe der verwendeten Falldefinition ist für den Bericht und die Interpretation der Häufigkeit von Nahrungsmittelunverträglichkeiten unverzichtbar. In Europa werden Prävalenzschätzer für selbst berichtete Reaktionen von 5,7–61,6 % und für ärztlich diagnostizierte Unverträglichkeiten von 0,2–4,2 % berichtet. Werden nur doppelblind nachgewiesene Soforttypreaktionen berücksichtigt, so ergeben sich Prävalenzen von 0–2,2 %. Die Disposition, mit schweren Symptomen zu reagieren, ist vermutlich seltener, kann aber aus bisher veröffentlichten Daten nicht solide angegeben werden. Die einzigen für Deutschland vorliegenden Daten ergeben eine Prävalenz IgE-vermittelter Reaktionen von 2,5% für Berlin.
Die häufigsten Auslöser im Kleinkindalter sind Kuhmilch und Hühnerei, welche in der Regel milde, auf die Haut beschränkte Symptome bewirken. Die frühkindlich erworbenen Nahrungsmittelallergien verschwinden meist bis zum Schuleintritt. Es gibt bisher keine veröffentlichten Daten zum langfristigen Verlauf der Disposition zur allergischen Reaktion.
Das Europäische Anaphylaxie-Register dokumentiert das Spektrum schwerer allergischer Reaktionen. Für tödlich verlaufende Reaktionen gibt es eine größere Fallserie aus England. Aus beiden Ansätzen lässt sich jedoch keine Inzidenz schätzen, da die Meldungen freiwillig sind. Auch über die Relevanz von schweren allergischen Reaktionen auf Lebensmittel lässt sich aus diesen Daten keine Aussage treffen.
Um differenzierte Aussagen zu Häufigkeit und Verlauf zu erhalten, sind weitere systematische Untersuchungen an ausreichend großen Personengruppen unter Einsatz möglichst objektiver diagnostischer Kriterien erforderlich.
Background Allergic rhinitis (AR) is one of the most common chronic diseases, usually starting in the first 2 decades of life. Information on predictors, risk, and protective factors is missing ...because of a lack of long-term prospective studies. Objective Our aim was to examine early-life environmental and lifestyle determinants for AR up to age 20 years. Methods In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated at 19 time points. A Cox regression model examined the associations between 41 independent early-life factors and onset of AR (as the primary outcome), including sensitization against aeroallergens and the secondary outcomes of nonallergic rhinitis and AR plus asthma. Results Two hundred ninety subjects had AR within 13,179 person years observed. The risk of AR was higher with a parental history of AR (adjusted hazard ratio aHR, 2.49; 95% CI, 1.93-3.21), urticaria (aHR, 1.32; 95% CI, 1.00-1.74), or asthma (aHR, 1.29; 95% CI, 0.95-1.75). Early allergic sensitization (aHR, 4.53; 95% CI, 3.25-6.32), eczema within the first 3 years of life (aHR, 1.83; 95% CI, 1.38-2.42), male sex (aHR, 1.28; 95% CI, 1.02-1.61), and birthday in summer or autumn (aHR, 1.26; 95% CI, 1.00-1.58) were independent predictors of AR up to age 20 years. None of the other socioeconomic, environmental, lifestyle, pregnancy, and birth-related factors were associated with AR. Conclusion Only nonmodifiable factors, particularly early allergic sensitization or eczema and parental AR, predicted AR up to age 20 years. No modifiable aspects of early-life environment or lifestyle were identified as targets for primary prevention.
PDF
