Introduction
Probiotic and Peanut Oral Immunotherapy (PPOIT) is effective at inducing sustained unresponsiveness (SU) at end‐of‐treatment and this effect persists up to 4 years post‐treatment, referred to as persistent SU. We sought to evaluate (i) how PPOIT altered peanut‐specific humoral immune indices, and (ii) how such longitudinal indices relate to persistent SU.
Methods
Longitudinal serum/plasma levels of whole peanut‐ and peanut component‐ (Ara‐h1, ‐h2, ‐h3, ‐h8, ‐h9) specific‐IgE (sIgE) and specific‐IgG4 (sIgG4) antibodies were measured by ImmunoCAP and salivary peanut‐specific‐IgA (sIgA) by ELISA in children (n = 62) enrolled in the PPOIT‐001 randomized trial from baseline (T0) to 4 years post‐treatment (T5). Multivariate regression analyses of log‐transformed values were used for point‐in‐time between group comparisons. Generalized estimating equations (GEE) were used for longitudinal comparisons between groups.
Results
Probiotic and Peanut Oral Immunotherapy was associated with changes in sIgE and sIgG4 over time. sIgE levels were significantly reduced post‐treatment [T5, PPOIT vs. Placebo ratio of geometric mean (GM): Ara‐h1 0.07, p = .008; Ara‐h2 0.08, p = .007; Ara‐h3 0.15, p = .021]. sIgG4 levels were significantly increased by end‐of‐treatment (T1, PPOIT vs. Placebo ratio of GM: Ara‐h1 3.77, p = .011; Ara‐h2 17.97, p < .001; Ara‐h3 10.42, p < .001) but levels in PPOIT group decreased once treatment was stopped and returned to levels comparable with Placebo group by T5. Similarly, salivary peanut sIgA increased during treatment, as early as 4 months of treatment (PPOIT vs. Placebo, ratio of GM: 2.04, p = .014), then reduced post‐treatment.
Conclusion
Probiotic and Peanut Oral Immunotherapy was associated with broad reduction in peanut‐specific humoral responses which may mediate the clinical effects of SU that persists to 4 years post‐treatment.
Objectives: The purpose of the study was to survey carers regarding their food allergic child's reactions, carer confidence to manage reactions, personal time impact of mitigating risk and personal psychological impacts.Methodology: A 6-month single centre prospective study surveyed all carers attending their child's first food allergen challenge admission for the period 1 July 2015 to 31 December 2015. The questionnaire captured carer and child characteristics and allergic reaction data. A Likert-type 5-point scale obtained carer rating of time and psychological impacts of mitigating risks and managing allergic reactions.Results: 55 (65%) of children had a mean of 3 (range 1-12) accidental food allergen exposures, triggering allergic reaction in 49 (89%) and requiring adrenaline in 8 (15%).For prior reactions, carer confidence to recognise severity was high for 47 (59%) and low for 8 (10%). Confidence to manage the reaction was high for 45 (57%) and low for 7 (8%). Where prescribed, confidence to use adrenaline auto-injectors was high for 14/27 (52%) and low for 8/27 (30%).65 children attended formal care settings. 17 (26%) had one or more allergic reactions in these settings. 21 (32%) carers had discussed safety concerns.Time impact of checking the safety of care settings and food preparation was high in 21 (25%) and 31 (37%) respectively and personal psychological impact was high for fear of a dangerous reaction in 35 (42%) and worry for the child's physical and emotional health in 18 (22%) and 13 (15%) respectively. 10 (12%) felt highly burdened and 8 (10%) highly exhausted.Conclusions: Accidental allergic reactions were common, including in formal care settings. A substantial minority of carers lacked confidence to recognise and manage allergic reactions including administering adrenaline. Carers experienced significant time and psychological impacts, exhaustion and sense of burden, relating to childhood food allergy. Objectives: The purpose of the study was to obtain the carer rating of the impact of their child's food allergy on their personal psychological wellbeing and to ascertain supports and services accessed, given carers' unremitting responsibility to manage their child's allergic reaction risks and chronic disease burden.Methodology: A 6-month single centre prospective study was conducted, surveying all carers attending their child's first food allergen challenge admission from 1 July 2015 to 31 December 2015. The questionnaire captured data regarding carer and child characteristics and supports accessed. A Likert-type 5-point scale, obtained the carer rating of personal psychological impacts and services accessed.Results: 85 carers completed questionnaires. Carer fear of their child experiencing a dangerous reaction was high in 35 (42%). Worry levels for their child's physical and emotional health were high in 18 (22%) and 13 (15%) respectively. Frustration levels regarding food allergy impacts on family relationships, friendships and employment were high in 5 (6%), 8 (10%) and 7(8%) respectively...
The addition of long-acting β2-agonists (LABAs) to inhaled corticosteroid for the treatment of asthma in children over 5 years of age is highly beneficial in the short term at improving lung function and day-to-day symptoms. Unfortunately, the effect wanes with time in some children. In addition, some children may still experience severe exacerbations while on LABAs. It is therefore important to ensure that these children are receiving adequate doses of inhaled corticosteroid before consideration be given to stopping LABA therapy. Further research is required in order to determine whether the rapid onset of action observed in formoterol therapy can be beneficially used in a combination single inhaler for both reliever and maintenance therapy.
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