Changes in patient quality of life during oral immunotherapy for food allergy

Epstein‐Rigbi, Naama; Goldberg, Michael R.; Levy, Michael B.; Nachshon, Liat; Golobov, Keren; Elizur, Arnon

doi:10.1111/all.13211

Cited by 56 publications

(72 citation statements)

References 38 publications

(56 reference statements)

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“…Similarly, health‐related QoL changes were not statistically different after a double‐blind placebo‐controlled OFC with cashew nut among children participating in a clinical trial . Discordances have been found in a study examining changes in QoL of children with FA during the updosing phase of OIT with improvement in 35%‐50% of patients, but deterioration in 25%‐30% . Certainly, a lower maximal tolerated dose during OIT induction is associated with worse indices of QoL primarily in children .…”

Section: Therapeutic Approachesmentioning

confidence: 99%

“…107 Discordances have been found in a study examining changes in QoL of children with FA during the updosing phase of OIT with improvement in 35%-50% of patients, but deterioration in 25%-30%. 108 Certainly, a lower maximal tolerated dose during OIT induction is associated with worse indices of QoL primarily in children. 109 Consequently, if the outcome of OFC or desensitization protocol does not change children's diet, and the fear for accidental exposure does not drive the need for accurate diagnosis, and then part of the beneficial effect of the food reintroduction might be lacking.…”

Section: Therapeutic Approachesmentioning

confidence: 99%

See 1 more Smart Citation

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Mastrorilli

Caffarelli

Hoffmann‐Sommergruber

2017

Pediatric Allergy Immunology

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The rising burden of allergic diseases in childhood requires a compelling need to identify individuals at risk for atopy very early in life or even predict the onset of food allergy and atopic dermatitis since pregnancy. The development and clinical phenotypes of atopic diseases in childhood depend on a complex interaction between genetic and environmental factors, such as allergen exposure, air pollution, and infections. Preventive strategies may include avoidance measures, diet supplements, and early complementary food introduction. Overall, the management of allergic diseases has been improving to date toward a patient's tailored approach. This review will cover the current understanding of risk factors, prediction, and management of food allergy and atopic dermatitis in childhood and discuss how these may contribute to the modification of the natural history of food allergy and atopic dermatitis.

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Section: Therapeutic Approachesmentioning

confidence: 99%

Section: Therapeutic Approachesmentioning

confidence: 99%

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Mastrorilli

Caffarelli

Hoffmann‐Sommergruber

2017

Pediatric Allergy Immunology

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“…Neither perception of treatment burden, level of desensitization, maintenance dose, nor AEs influenced change in QoL from baseline to 2 years OIT, in line with previous reports. 10,16,27 Thus, perceived treatment burden may be disassociated from the number and severity of AEs during OIT. 10,16 Reduced QoL in parents by ineligibility for OIT is in contrast to a previous report of improved QoL after OFC.…”

Section: Discussionmentioning

confidence: 99%

“…10,16,27 Thus, perceived treatment burden may be disassociated from the number and severity of AEs during OIT. 10,16 Reduced QoL in parents by ineligibility for OIT is in contrast to a previous report of improved QoL after OFC. 26 The poorer QoL may reflect the finding of severe peanut allergy with a very low reactivity threshold, including loss of hope for therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Improved QoL has been reported in children after OIT despite adverse events (AEs) . Most studies on QoL after OIT are based on parents' assessments of their child's QoL, sometimes referred to as proxy reports . In a recent study of 0‐ to 18‐year‐old children with peanut, hazelnut, or egg allergy, parents assessed their children's QoL better than did the children themselves, questioning the appropriateness of relying on parental proxy reports alone.…”

Section: Introductionmentioning

confidence: 99%

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Parent and child perception of quality of life in a randomized controlled peanut oral immunotherapy trial

Reier‐Nilsen

Carlsen

Michelsen

et al. 2019

Pediatric Allergy Immunology

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Background Improved quality of life (QoL) after oral immunotherapy (OIT) in peanut allergic children is often reported by their parents, while the child's perspective is less clear. Objective We aimed to explore whether 2 years of OIT improved QoL in children with peanut allergy and to identify factors influencing change in QoL. Methods In the open‐labeled TAKE‐AWAY peanut OIT trial including children with anaphylaxis to peanuts, 57 were randomized to OIT and 20 to observation. The Pediatric Quality of Life Inventory Version 4.0 was completed by parents and children at enrollment (Y0), after 1 year (end of updosing; Y1) and after 2 years (Y2) of OIT. Minimally clinically important difference (MCID) is ≥5.3. Perceived treatment burden was recorded by visual analogue scales, including adverse events (AEs). An open food challenge (OFC) was performed at Y2. Results At Y2, 18 children had discontinued OIT and 2 of 39 OIT children refused OFC, while 35 of 37 were desensitized to 7500 mg peanut protein. From Y0 to Y2, the mean change (95% confidence intervals) in QoL was 4.4 (0.5, 8.3) among child self‐reports and twice as large among parental proxy reports (9.3 [4.3, 14.3]; both P < 0.0001), without significant improvement among the controls. The change in QoL was significantly different from the controls for the parental proxy reports only (P = 0.002). Neither treatment burden nor AEs significantly predicted changes in QoL. Conclusion Two years of OIT improved child‐QoL as reported by parents, but not by the children, suggesting that parents may overestimate improvement in child‐QoL by OIT.

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Psychological needs and support among patients and families undergoing food oral immunotherapy

Polloni

Muraro²,

Bonaguro³

et al. 2022

Clinical & Translational All

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Background Oral immunotherapy (OIT) is a promising treatment for food allergy (FA) however it is a challenging process for patients and parents. Induction can generate stress and anxiety. This may in turn affect their motivation and ability to cope with OIT challenges. Objective This study aimed to investigate psychological needs and support to patients/parents undergoing food OIT assessing participants' main characteristics, reasons for seeking psychological support, OIT phase and related psychological difficulties, type and timing of treatments and patients' perception of the effectiveness of the intervention. Methods This is an observational, retrospective study. 50 psychological interventions required for OIT related problems were selected consecutively in a Referral Centre in North‐Eastern Italy. All patients had a medical diagnosis of FA and were undergoing OIT or had just discontinued it. Data were collected from hospital records. A descriptive statistical analysis was performed. Results 66% of patients asked for psychological support for the initial phase (e.g., oral food challenge, first maintenance doses), 20% during the up‐dosing phase, 8% during maintenance and 6% after discontinuation. 70% of treatments were required mainly because of emotional problems including dysfunctional anxiety and mood disorders, increased distress and excessive worry and/or fear related to OIT; 20% because of difficulties in managing OIT; 10% because of eating difficulties; 50% of patients reported recent anaphylaxis. All patients reported improvement and felt the psychological intervention was helpful. Conclusion It is recommended to evaluate the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed.

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Changes in patient quality of life during oral immunotherapy for food allergy

Abstract: QOL of patients with food allergy improves in some but deteriorates in others during OIT. Patients with impaired QOL at baseline improve significantly despite the treatment burden. Some patients with better QOL at baseline might deteriorate during OIT.

Cited by 56 publications

References 38 publications

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Parent and child perception of quality of life in a randomized controlled peanut oral immunotherapy trial

Psychological needs and support among patients and families undergoing food oral immunotherapy

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