: media-1vid110.1542/5840360268001PEDS-VA_2018-1235
BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, ...population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use.
A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago's nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors.
Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%-8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E-mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities.
FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.
Epidemiology and Burden of Food Allergy Warren, Christopher M.; Jiang, Jialing; Gupta, Ruchi S.
Current allergy and asthma reports,
02/2020, Letnik:
20, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Purpose of Review
In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the ...epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life.
Recent Findings
Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies.
Summary
While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence—it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs—beyond the physical health burden imposed by anaphylaxis.
Food Allergy from Infancy Through Adulthood Sicherer, Scott H; Warren, Christopher M; Dant, Christopher ...
Journal of allergy and clinical immunology. In practice/The Journal of allergy and clinical immunology. In practice,
06/2020, Letnik:
8, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions ...and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.
To the Editor: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE, cell-mediated food allergy that manifests with repetitive, projectile vomiting within 1 to 4 hours of food ingestion, ...frequently accompanied by pallor and lethargy and may be followed by diarrhea within 6 to 8 hours.1 In about 15% to 20% of the reactions, severe dehydration with hypotension and metabolic derangements is present.1 FPIES diagnosis may be delayed because of the severity, delayed onset of symptoms, and lack of cutaneous and respiratory manifestations (eg, hives and wheezing), typically associated with IgE-mediated food allergy, and food triggers considered to have low allergenic potential, for example, rice, oat, fruits, and vegetables. ...we analyzed the reported physician-diagnosed food allergy (IgE-mediated, IgE-food allergy), asthma, atopic dermatitis, and allergic rhinitis as per the definitions published previously.7-9 Eligible study participants included adults (≥18 years) able to complete the survey in English or Spanish via web or telephone, who resided in a US household. ...it is possible that FPIES diagnosis was used incorrectly because of the poor familiarity of the physicians with FPIES and led to underestimation or overestimation of true FPIES prevalence. Reported physician-diagnosed current or past FPIES Prevalence estimate (95% CI) All ages (N = 374) 0.28 (0.24-0.33) Children Age < 18 y (N = 261) 0.51 (0.42-0.62) <1 y (N = 6) 0.11 (0.04-0.26) 1 y (N = 17) 0.59 (0.32-1.08) 2 y (N = 20) 0.76 (0.39-1.47) 3-5 y (N = 41) 0.52 (0.29-0.93) 6-10 y (N = 74) 0.56 (0.40-0.78) 11-13 y (N = 58) 0.61 (0.43-0.88) 14-17 y (N = 45) 0.37 (0.24-0.57) Adults Age ≥ 18 y (N = 113) 0.22 (0.17-0.28) 18-29 (N = 38) 0.33 (0.22-0.49) 30-39 (N = 29) 0.26 (0.16-0.43) 40-49 (N = 15) 0.21 (0.11-0.43) 50-59 (N = 12) 0.11 (0.06-0.21) 60+ (N = 19) 0.18 (0.10-0.30) Table I Estimated prevalence of FPIES in the US population Characteristic % among those with FPIES (95% CI) % among those without FPIES (95% CI) P value Children Race/ethnicity Asian, non-Hispanic 8.1 (4.2-15.1) 3.2 (2.8-3.7) Black, non-Hispanic 16.3 (10.5-24.3) 13.2 (12.3-14.2) .02 White, non-Hispanic 44.1 (34.9-53.8) 52.9 (51.3-54.4) Hispanic 27.8 (19.4-38.2) 24.1 (22.5-25.7) Multiple/other 3.7 (1.7-8.1) 6.7 (6.1-7.3) Country of origin Born in the United States 95.8 (87.6-98.7) 97.8 (97.4-98.1) .26 Sex Female 47.7 (38.5-57.2) 48.9 (47.8-50.0) .81 Age (y) <1 1.1 (0.5-2.7) 5.4 (4.8-5.9) 1 5.6 (3.1-10.1) 4.9 (4.4-5.3) 2 8.6 (4.5-15.8) 5.7 (5.2-6.3) 3-5 16.7 (9.9-26.8) 16.2 (15.5-17.0) .15 6-10 30.9 (23.1-39.9) 27.8 (26.9-28.8) 11-13 20.1 (14.4-27.3) 16.6 (15.9-17.4) 14-17 17.0 (11.3-25.0) 23.4 (22.4-24.4) Household income ($) <25,000 16.8 (10.2-26.5) 16.1 (14.9-17.3) 25,000-49,000 20.0 (12.5-30.4) 22.2 (20.9-23.5) 50,000-99,999 34.5 (26.6-43.3) 31.1 (29.7-32.5) .85 100,000-149,000 20.3 (13.6-29.1) 19.2 (18.0-20.5) ≥150,000 8.4 (4.4-15.6) 11.4 (10.3-12.7) Physician-diagnosed comorbid atopic conditions† Current IgE-mediated food allergy∗ 65.3 (55.2-74.2) 7.3 (6.9-7.8) <.001 Lifetime Asthma 25.2 (18.5-33.4) 12.1 (11.3-13.0) <.001 Atopic dermatitis/eczema 9.6 (5.8-15.5) 5.9 (5.3-6.5) .06 Allergic rhinitis 32.6 (24.4-42.0) 12.7 (11.9-13.5) <.001 Insect sting allergy 5.0 (2.8-9.1) 2.2 (1.9-2.6) .007 Latex allergy 8.9 (5.3-14.6) 1.0 (0.8-1.2) <.001 Medication allergy 6.9 (4.1-11.4) 4.1 (3.7-4.6) .06 Urticaria 3.4 (1.0-7.3) 0.5 (0.4-0.6) <.001 Adults Race/ethnicity Asian, non-Hispanic 5.0 (2.4-10.2) 3.9 (3.6-4.1) Black, non-Hispanic 13.8 (7.6-23.7) 11.7 (11.3-12.1) White, non-Hispanic 53.2 (41.2-65.0) 64.9 (64.2-65.6) .18 Hispanic 24.4 (14.6-37.9) 15.5 (14.9-16.1) Multiple/other 3.6 (1.2-9.8) 4.1 (3.8-4.4) Country of origin Born in the United States 87.1 (77.0-93.1) 91.6 (91.2-92.0) .18 Sex Female 53.5 (41.5-65.1) 51.7 (51.0-52.4) .77 Age (y) 18-29 32.3 (22.4-44.2) 21.4 (20.8-22.1) 30-39 20.5 (12.8-31.4) 17.0 (16.5-17.4) 40-49 16.6 (8.6-29.4) 16.8 (16.3-17.3) .1 50-59 8.9 (4.5-16.9) 18.0 (17.6-18.5) 60+ 21.7 (13.1-33.6) 26.8 (26.2-27.4) Household income ($) <25,000 19.7 (12.2-30.2) 16.6 (16.2-17.1) 25,000-49,000 24.5 (16.0-35.5) 21.9 (21.4-22.5) 50,000-99,999 29.6 (19.7-41.9) 30.9 (30.3-31.5) .75 100,000-149,000 19.9 (11.3-32.7) 19.6 (19.0-20.2) ≥150,000 6.3 (2.4-15.3) 10.9 (10.4-11.5) Physician-diagnosed comorbid atopic conditions† Current IgE-mediated food allergy∗ 42.5 (31.6-54.3) 10.7 (10.3-11.1) <.001 Lifetime Asthma 37.4 (26.7-49.5) 12.2 (11.8-12.7) <.001 Atopic dermatitis/eczema 22.3 (13.8-34.0) 6.7 (6.4-7.0) <.001 Allergic rhinitis 31.1 (21.5-42.7) 21.4 (20.9-22.0) .047 Insect sting allergy 10.1 (4.5-21.0) 3.8 (3.6-4.1) .01 Latex allergy 13.1 (7.0-23.2) 2.3 (2.1-2.5) <.001 Medication allergy 17.6 (9.4-30.5) 13.4 (13.0-13.9) .38 Urticaria 16.0 (8.5-28.1) 0.8 (0.7-1.0) <.001 Table II Sociodemographic characteristics and comorbidities in children and adults
Tumour heterogeneity in primary prostate cancer is a well-established phenomenon. However, how the subclonal diversity of tumours changes during metastasis and progression to lethality is poorly ...understood. Here we reveal the precise direction of metastatic spread across four lethal prostate cancer patients using whole-genome and ultra-deep targeted sequencing of longitudinally collected primary and metastatic tumours. We find one case of metastatic spread to the surgical bed causing local recurrence, and another case of cross-metastatic site seeding combining with dynamic remoulding of subclonal mixtures in response to therapy. By ultra-deep sequencing end-stage blood, we detect both metastatic and primary tumour clones, even years after removal of the prostate. Analysis of mutations associated with metastasis reveals an enrichment of TP53 mutations, and additional sequencing of metastases from 19 patients demonstrates that acquisition of TP53 mutations is linked with the expansion of subclones with metastatic potential which we can detect in the blood.
Even after a decade or so of research, the direct synthesis of highly crystalline mesoporous transition-metal oxides that are thermally stable and well ordered still constitutes a major challenge. ...Although various soft- and hard-templating approaches have been developed in the past, they usually suffer from multiple, tedious steps and often result in poor structure control. For many applications including power generation and energy conversion, however, high crystallinity and controlled mesoporosity are a prerequisite. To this end, here we report on an approach established for group-IV (titanium) and group-V (niobium) oxides, with potential applications to photovoltaic cells and fuel cells, respectively, which overcomes previous limitations. It gives direct access to the desired materials in a 'one-pot' synthesis using block copolymers with an sp2-hybridized carbon-containing hydrophobic block as structure-directing agents which converts to a sturdy, amorphous carbon material under appropriate heating conditions. This in situ carbon is sufficient to act as a rigid support keeping the pores of the oxides intact while crystallizing at temperatures as high as 1,000 degrees C.
The adaptive regulation of the trade-off between pursuing a known reward (exploitation) and sampling lesser-known options in search of something better (exploration) is critical for optimal ...performance. Theory and recent empirical work suggest that humans use at least two strategies for solving this dilemma: a directed strategy in which choices are explicitly biased toward information seeking, and a random strategy in which decision noise leads to exploration by chance. Here we examined the hypothesis that random exploration is governed by the neuromodulatory locus coeruleus-norepinephrine system. We administered atomoxetine, a norepinephrine transporter blocker that increases extracellular levels of norepinephrine throughout the cortex, to 22 healthy human participants in a double-blind crossover design. We examined the effect of treatment on performance in a gambling task designed to produce distinct measures of directed exploration and random exploration. In line with our hypothesis we found an effect of atomoxetine on random, but not directed exploration. However, contrary to expectation, atomoxetine reduced rather than increased random exploration. We offer three potential explanations of our findings, involving the non-linear relationship between tonic NE and cognitive performance, the interaction of atomoxetine with other neuromodulators, and the possibility that atomoxetine affected phasic norepinephrine activity more so than tonic norepinephrine activity.
Food allergy is a costly, potentially life-threatening condition. Although studies have examined the prevalence of childhood food allergy, little is known about prevalence, severity, or health care ...utilization related to food allergies among US adults.
To provide nationally representative estimates of the distribution, severity, and factors associated with adult food allergies.
In this cross-sectional survey study of US adults, surveys were administered via the internet and telephone from October 9, 2015, to September 18, 2016. Participants were first recruited from NORC at the University of Chicago's probability-based AmeriSpeak panel, and additional participants were recruited from the non-probability-based Survey Sampling International (SSI) panel.
Demographic and allergic participant characteristics.
Self-reported food allergies were the main outcome and were considered convincing if reported symptoms to specific allergens were consistent with IgE-mediated reactions. Diagnosis history to specific allergens and food allergy-related health care use were also primary outcomes. Estimates were based on this nationally representative sample using small-area estimation and iterative proportional fitting methods. To increase precision, AmeriSpeak data were augmented by calibration-weighted, non-probability-based responses from SSI.
Surveys were completed by 40 443 adults (mean SD age, 46.6 20.2 years), with a survey completion rate of 51.2% observed among AmeriSpeak panelists (n = 7210) and 5.5% among SSI panelists (n = 33 233). Estimated convincing food allergy prevalence among US adults was 10.8% (95% CI, 10.4%-11.1%), although 19.0% (95% CI, 18.5%-19.5%) of adults self-reported a food allergy. The most common allergies were shellfish (2.9%; 95% CI, 2.7%-3.1%), milk (1.9%; 95% CI, 1.8%-2.1%), peanut (1.8%; 95% CI, 1.7%-1.9%), tree nut (1.2%; 95% CI, 1.1%-1.3%), and fin fish (0.9%; 95% CI, 0.8%-1.0%). Among food-allergic adults, 51.1% (95% CI, 49.3%-52.9%) experienced a severe food allergy reaction, 45.3% (95% CI, 43.6%-47.1%) were allergic to multiple foods, and 48.0% (95% CI, 46.2%-49.7%) developed food allergies as an adult. Regarding health care utilization, 24.0% (95% CI, 22.6%-25.4%) reported a current epinephrine prescription, and 38.3% (95% CI, 36.7%-40.0%) reported at least 1 food allergy-related lifetime emergency department visit.
These data suggest that at least 10.8% (>26 million) of US adults are food allergic, whereas nearly 19% of adults believe that they have a food allergy. Consequently, these findings suggest that it is crucial that adults with suspected food allergy receive appropriate confirmatory testing and counseling to ensure food is not unnecessarily avoided and quality of life is not unduly impaired.
Charitable donations are an altruistic behavior whereby individuals donate money or other resources to benefit others while the recipient is normally absent from the context. Several psychological ...factors have been shown to influence charitable donations, including a cost-benefit analysis, the motivation to engage in altruistic behavior, and the perceived psychological benefits of donation. Recent work has identified the ventral medial prefrontal cortex (MPFC) for assigning value to options in social decision making tasks, with other regions involved in empathy and emotion contributing input to the value computation (e.g. Hare et al., 2010; Hutcherson et al., 2015; Tusche et al., 2016). Most impressively, multivariate pattern analysis (MVPA) has been applied to fMRI data to predict donation behavior on a trial-by-trial basis from ventral MPFC activity (Hare et al., 2010) while identifying the contribution of emotional processing in other regions to the value computation (e.g. Tusche et al., 2016). MVPA of EEG data may be able to provide further insight into the timing and scalp topography of neural activity related to both value computation and emotional effects on donation behavior. We examined the effect of incidental emotional states and the perceived urgency of the charitable cause on donation behavior using support vector regression on EEG data to predict donation amount on a trial by trial basis. We used positive, negative, and neutral pictures to induce incidental emotional states in participants before they made donation decisions concerning two types of charities. One category of charity was oriented toward saving people from current suffering, and the other was to prevent future suffering. Behaviorally, subjects donated more money in a negative emotional state relative to other emotional states, and more money to alleviate current over future suffering. The data-driven multivariate pattern analysis revealed that the electrophysiological activity elicited by both emotion-priming pictures and charity cues could predict the variation in donation magnitude on a trial-by-trial basis.
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