Temporal examination of adult food insecurity amongst Canadian families managing food allergy.

BACKGROUND: Pediatric food allergy is associated with excess familial food costs compared to families without allergy. Since the start of the COVID-19 pandemic, food prices have increased substantially. OBJECTIVE: To understand the temporal pattern of food insecurity amongst Canadian families with food allergy from the year prior to the pandemic, through May 2022. METHODS: Using data collected electronically from families reporting food allergy using a validated food security questionnaire, we estimated food insecurity, including categories of food insecurity (marginal, moderate, secure) in the year prior to the pandemic (2019; Wave 1), and the first (2020; Wave 2) and second years of the pandemic (2022; Wave 3). RESULTS: Participants in all waves were commonly in 2 + adult, 2 child households. Less than half of participants (Waves 1-3: 45.7%, 31.0%, and 22.9%, respectively) reported household incomes below the median Canadian. Common allergies were milk, eggs, peanuts and tree nuts. In Wave 1, 22.9% of families reported food insecurity; corresponding numbers at Waves 2 and 3 were 30.6% and 74.4%, respectively, representing an overall increase of 225.6%, including notable increases in severe food insecurity. CONCLUSION: Canadian families with pediatric food allergy report higher rates of food insecurity compared to the general Canadian population, especially during the pandemic.

Alpha-Gal Syndrome in the Infectious Diseases Clinic: A Series of 5 Cases in Central North Carolina.

Background: Alpha-gal syndrome (AGS) is a recently described allergy to galactose-α-1,3-galactose, an oligosaccharide present in mammalian meat. AGS can present with angioedema, urticaria, and anaphylaxis arising 3-6 hours after ingestion, although symptoms such as gastrointestinal distress, fatigue, and arthralgias are also reported. Because AGS appears to be associated with tick bites, patients may present to infectious diseases (ID) clinics for evaluation. Methods: We documented a series of 5 patients referred to the University of North Carolina ID Clinic between 2020 and 2022 for various tick-borne infections that were found to have symptoms and laboratory testing consistent with AGS. Patients were subsequently referred to the Allergy and Immunology Clinic. Results: Patients were referred to the ID Clinic for persistent symptoms following positive tick-borne disease testing or presumed tick-borne infection. All patients had an elevated alpha-gal immunoglobulin E and clinical presentation consistent with AGS. Common symptoms included episodic gastrointestinal distress (eg, cramping, nausea, diarrhea), fatigue, arthralgias, and subjective cognitive impairment, but a notable absence of severe anaphylaxis. Four patients were seen by at least 1 nonallergy specialist prior to referral to ID. Patients reported substantial improvement in their symptoms following dietary restriction. Conclusions: ID physicians should be aware of AGS as a cause of persistent, nonspecific symptoms following a tick exposure or tick-borne illness. Further research is needed to determine the prevalence of alpha-gal sensitization and AGS following tick-borne bites.

Factors affecting formula compliance of infants with IgE mediated cow's milk protein allergy during the pandemic.

Introduction: Cow's milk protein allergy (CMPA) is the most commonly encountered food allergy in the world, usually seen in infants under the age of 2 years. This study aims to determine the factors including COVID-19 affecting formula compliance of CMPA patients. Methods: This study is a prospective, observational study based on 10 different Paediatric Allergy-Immunology clinics in Turkey. Patients aged between 6 months and 2 years, who were followed up with IgE-mediated CMPA treatment or newly diagnosed and using breast milk and/or formula were included in the study. The sociodemographic characteristics of the patients, their symptoms, the treatments they received, and the effects of the COVID-19 pandemic on adherence to formula were evaluated with a questionnaire administered to the parents. Results: The compliance rate for formula-based treatment was 30.8% (IQR: 28.3, SD: 21.86). The number of patients with a single and multiple food allergy was 127 (51.6%) and 71 (28.9%), respectively. Breastfeeding duration, daily amount of prescribed formula and addition of sweetener to the formula were found to reduce compliance (p = 0.010, p = 0.003, and p = 0.004, respectively). However, it was determined that the patient's height, weight, age at diagnosis, and age of formula onset did not have a significant effect on compliance. Conclusion: It was found that the duration of breastfeeding, the increase in the daily amount of formula requirement, and the addition of sweeteners had adverse effects on formula compliance. There was no significant correlation between the formula adherence of CMPA patients and the pandemic.

Nutrition and immunity: perspectives on key issues and next steps.

In January 2022, a group of experts came together to discuss current perspectives and future directions in nutritional immunology as part of a symposium organized by the Canadian Nutrition Society. Objectives included (1) creating an understanding of the complex interplay between diet and the immune system from infants through to older adults, (2) illustrating the role of micronutrients that are vital to the immune system, (3) learning about current research comparing the impact of various dietary patterns and novel approaches to reduce inflammation, autoimmune conditions, allergies, and infections, and (4) discussing select dietary recommendations aimed at improving disease-specific immune function. The aims of this review are to summarize the symposium and to identify key areas of research that require additional exploration to better understand the dynamic relationship between nutrition and immune function.

Current status of probiotic and related health benefits

This review is aimed to explore the health beneficial effects of probiotics which are live microorganisms that provide a positive health influence on humans when taken in sufficient quantity. Lactic acid bacteria, bifidobacteria, and yeast are frequently used as probiotics. These health-beneficial bacteria could compete with pathogens and modulate the gut microbiota, and exhibit immunomodulatory, anti-obesity, anti-diabetic, and anti-cancer activities which are discussed in this review. Moreover, recent studies showed that probiotics could neutralize COVID-19 infections. Hence, probiotics have become an alternative to several drugs including antibiotics. In addition, probiotic efficacy also depends on the delivery system as the delivery agents help the bacteria to survive in the harsh environment of the human gut. Considering these health benefits of probiotics, now it has been applied to different food materials which are designated as functional food. This review explored a portrait of the beneficial effects of probiotics on human health.Copyright © 2022 The Author(s)

Allergology assessment prior to administration of COVID-19 vaccine in patients with allergy history

Background: The diagnosis of drug allergy requires a previous medical history suggestive of a Drug Hypersensitivity Reaction (DHR). DHRs caused by vaccines are rare (< 1/100.000 doses) and are mainly due to excipients. At the beginning of the COVID-19 vaccination, occasional cases of severe reactions were reported in patients with allergy history. This warning led to an increased demand for allergy testing to evaluate pre-vaccination risk assessment, especially due to the refusal of allergic patients to receive the vaccine. Method(s): Twenty patients were evaluated between May to July 2021, referred for allergology study prior to receiving the vaccine against COVID-19. All patients tested had allergy history. Skin tests were performed with the available excipients of the COVID-19 vaccine: polyethylene glycol (PEG-1500, 10% prick ROXALL), polysorbate 80 (tween 80 prick 0.04 -ID 0.004 mg/ml), and trometamol (prick 1 -ID 0.1 mg/ml). A telephone follow-up was subsequently performed to assess tolerance to the vaccine. Result(s): The median age of the patients was 54.5 years and ninety percent were female. (Table 1) The most frequent allergy history was adverse drug reactions (ADRs) in 18 patients (90%), followed by bronchial asthma (35%), rhinitis (25%), food allergy (25%), and dermatitis (15%). 12 patients (60%) had multiple allergic diseases. The drugs implicated in these ADRs were beta-lactam antibiotics (40%), NSAIDs (20%), radiographic contrast media (15%), and vaccines (15%). Skin tests with the excipients studied were negative in all cases. Subsequently, the COVID-19 vaccine was administered in 16 patients (80%). Six patients (30%) reported side effects expected from the vaccine and no DHRs were described. Although vaccination was recommended to all patients after the study, 4 patients (20%) refused the administration. Conclusion(s): Patients with atopic history do not require an allergology study prior to the administration of the COVID-19 vaccine. Exceptionally, it may be necessary if the patient has a history of suspected DHRs to the excipients involved. The previous allergology assessment did not prevent refusal of vaccination in 20% of the patients. (Table Presented).

Persistent allergic respiratory symptoms induced by food allergy: Report of two cases

Case report Dust is a known mixture and carrier of multiple allergens and an epidemiologic study demonstrated the presence of peanut proteins in school cafeterias and classrooms, suggesting that schools may play an important role in exposure to environmental food allergens. While inhalation of food allergens is a known trigger of IgE-mediate acute respiratory reaction as rhinitis and wheezing, little is known about persistent allergic asthma and/or rhinitis induced by chronic inhalation of food allergens. Here we report two cases of teenagers with nuts allergy presenting with persistent respiratory symptoms when exposed to closed and dusty environments. The first case concerns a 12-year-old boy allergic to walnut and hazelnut (specific IgE > 100 and 81.70 kU/l, respectively). For some years he has had a persistent mild asthma, frequent nasal occlusion and rhinorrhea, without any allergic sensitization to aeroallergens. Symptoms occurred exclusively during school period when he required maintenance therapy with inhaled and nasal steroids. He was asymptomatic and did not need any treatment during summer. During the lockdown period due to Covid-19 pandemic, he did not attend school for several months and he was able to discontinue inhaled corticosteroid therapy without recurrence of asthma and rhinitis symptoms. Asthma recurred after he returned to school, but with only mild intermittent symptoms, probably thanks to the use of masks and the frequent airing of the classrooms. On a single occasion he experienced nasal occlusion and rhinorrhea after that a parent had eaten hazelnut cream in the same room where he was. The second case deals with a 17-year-old boy with a history of several food allergies (milk, egg, wheat, banana, nuts, hazelnuts) and mild persistent asthma in absence of sensitization to aeroallergens. He successfully underwent oral desensitization for milk, egg and wheat in previous years. Asthma symptoms improved over the years together with progressive development of oral tolerance to food allergens for which oral immunotherapy had been done. On the other hand, he referred persistence of allergic rhinitis especially during the school year and his symptoms got worse in classroom. Exhaled nitric oxide was quite increased with evidence of eosinophils in nasal smears. In-vitro and in-vivo tests only detected food allergens sensitizations, in particolar to walnuts and hazelnuts (specific IgE were 61.00 and 55.50 kU/l respectively). These two clinical cases suggest that food allergens might be causative agents of allergic persistent asthma and/or rhinitis as aeroallergens do.

CASE REPORT: Immigrants and evolving food allergies

Case report Background: We present a case of coconut allergy as a rare evolving food allergy among immigrants. Case presentation: A 3-year-old girl, on treatment for asthma, was referred to the allergy clinic due to possible reactions to salmon and coconut. Due to COVID restrictions, the initial consultation was conducted by telephone. Reportedly, she developed hives and wheeze after eating salmon and coconut products. During the face-to-face review, it was noted that the child's paternal side of the family was of ethnic minorities. The patient had cradle cap as a baby, and coconut oil was applied for treatment as advised by family back home. During a hospital-based coconut challenge, she developed puffy eyes, and on subsequent consumption of coconut macaroon, she developed hives. The child was diagnosed with coconut allergy. Face-to-face assessment and food cultural awareness are essential for clinical diagnosis. Discussion(s): Allergy is a multifactorial illness affected by epigenetic, environmental factors, eczema during infancy and food culture. Studies suggest that the risk of allergy can be highest in immigrants to culturally stable food, particularly with delayed early taste during weaning. The dual allergen hypothesis proposes that early cutaneous exposure to food protein through damaged skin barrier can lead to sensitisation and allergy and that early oral exposure to food induces tolerance. Conclusion(s): Further research on understanding the interaction between epigenetics of the allergic disease and the environment is needed as is an understanding of how the movement of populations and different culture habits can affect the incidence of food allergy. In the meantime, is promoting healthy skin barrier and early food introduction enough to prevent food allergies.

Allergic disease and risk of hospitalization in patients with COVID-19

Background: SARS-Cov- 2 is a new respiratory virus that causes COVID-19 disease. It is a new infectious agent and knowledge is still very limited, particularly its interaction with allergic disease. The aim of this study was to assess the effect of allergic disease on the risk of hospitalization for COVID-19. Method(s): A total of 7542 SARS-CoV- 2 infections were diagnosed from 1 March to 31 December 2020 at the Centro Hospitalar Universitario de Sao Joao. A total of 1727 (22.9%) patients were hospitalized (31% in intensive care) and 5815 were followed up by an outpatient clinic. Of this group, 3479 (65%) answered a telephone questionnaire, 3 to 6 months after acute infection, about sociodemographic, clinical, behavioral and psychological characteristics. They were also asked about a previous diagnosis of allergic disease. Individuals aged < 18 years and those with asymptomatic infection were excluded. Result(s): A sample of 2702 participants was analyzed, 33.5% reported allergic disease prior to the diagnosis of COVID-19: 215 (8%) asthma, 517 (19.2%) rhinitis, 138 (5.1%) drug allergy, 36 (1.3%) food allergy, 22 (0.8%) atopic dermatitis and 2 (0.1%) hymenoptera venom allergy. The proportion of participants with asthma is not statistically different across age groups, but when grouping other allergic diseases other than asthma, a reduction was observed with age (21.5% of 18-29 years old vs. 4.9 % with >=80 years, p > 0.001). Allergic disease was significantly more prevalent in women (asthma 9.8% vs. 5.2%;other allergies: 17.9% vs. 12.7%, p < 0.001). In a univariate analysis, the risk of hospitalization of patient with COVID-19 was significantly lower in those with allergic disease (OR = 0.7;95% CI: 0.55-0.92), but for asthma the effect was not significant. Gender was an interaction factor in this association, so in a separate multivariate model for women and men and adjusted for the other significant risk factors -age, obesity and comorbidities -the effect on risk reduction remained only in the men (adjusted OR = 0.6;95% CI:0.33-1.07). Conclusion(s): In this study, allergic disease, excluding asthma, was associated with a decrease in the severity of COVID-19, especially in men. However, further studies, namely prospective studies, are needed to better characterize this effect and the underlying mechanisms.

Nutrition during the preschool years

The preschool years are a period of rapid growth and development, and children are at vulnerable to any amount and duration of nutritional shortfall. Globally, undernutrition remains a leading cause of death in this age group, with the prevalence of obesity rising in parallel. Young children need to be provided with a diet that is sufficiently nutrient dense and qualitatively diverse to meet their micronutrient needs but challenges with food shortage, access, and affordability often make this difficult. In this article, we present the current state of the evidence along with highlighting knowledge gaps on some of these topics. © 2023 Elsevier Ltd. All rights reserved

Vaccination against COVID-19 virus for the allergic population in Israel -The experience in a tertiary hospital, Sheba Medical Center in Israel

Background: In December 2020, the vaccination campaign against COVID-19 virus started around the world. The Israel Ministry of Health decided to use vaccines for COVID-19 from Pfizer/Biontech. Early studies with Pfizer COVID-19 vaccines reported that there was a risk of allergic reactions in Britan and several in USA. The patients who had allergic reactions to the vaccine reported prior history of various allergies. Due to these reports Israel Ministry of Health issued warnings cautioning patients with allergies regarding receiving the vaccine. The leading hypothesis was that one of the components of the vaccine, PEG or polyethylene glycol, was the cause of allergic reactions. This substance if found in many other medications.Following these developments, there was a flood of inquiries from the allergic patients in Israel Method: We established a call center in Sheba Medical Center that provided preliminary screening for inquiries from the public. The patients were divided into 3 groups: 1. Patients at low/medium risk level -These patients were vaccinated in the local clinics. Example of patients in this category included patients with allergic rhinitis, well controlled asthma, food allergies, insect venom allergy and mild drug allergy;2. Patients at high risk -These were the patients with more serious drug allergies, not related to PEG. These patients received COVID-19 vaccination under supervision at the Sheba Medical Center;3. Patients at very high risk -These patients had anaphylaxis or severe allergic reactions to IV medications, prior vaccines or PEG. They had a full evaluation at our allergy department including a thorough history and physical and specific allergy testing for PEG and Pfizer COVID-19 vaccine. Result(s): There were 810 patients over the age of 16, who were in high-risk group, and received vaccination in the hospital under supervision of a medical team including allergy physicians and nurses. 217 of these patients were categorized as very high risk and had a full allergy evaluation prior to the vaccination. Out of the patients in the very high risk group, only 5/217 (2.3%) were found to be allergic due to positive skin tests to the vaccine or one of its components. Of all the high risk patients 794/810 (98%) were vaccinated with no immediate response to the vaccine. The 16 patients (2%) had immediate allergic reactions and out of this group 6 (0.7% of total) had an anaphylactic reaction. Conclusion(s): This project describes how an effective algorithm can be established to deal with an urgent need to vaccinate majority of the population.Our data show that the risk of allergic reactions to the Pfizer COVID-19 vaccine is small even within allergic population and that most of the patients can receive the vaccine safely.

The school nurse talks about how to keep your body healthy. Doesn't really talk about food allergies. I'd like to change that

Food allergies are increasingly common and affect approximately one in thirteen students in the United States (US). Anaphylactic reactions can be unpredictable, severe, and sometimes life-threatening if not treated quickly and appropriately. School health policies and education surrounding food allergies vary substantially within and between states, as do guidelines that influence policy, and influence students' experiences of school with food allergies. Additionally, the COVID-19 pandemic has influenced students' experiences of their school communities. There is a limited research exploring student perspectives regarding food allergy policies, and none published to-date reflecting perspectives during the pandemic. Students' voices are not always included in food allergy management and policy research. The current study was conducted to elicit elementary students' voices during a unique moment in world history, the beginning of the COVID-19 pandemic. Elementary school students' stories, attitudes, and perspectives regarding food allergy management and school policies in New England were explored through semistructured, individual interviews (n = 7). A descriptive phenomenological approach was applied to the conceptualization of this project and thematic analysis of views shared. Parent (n = 29) and student (n = 11) questionnaire data were collected to supplement interview findings. Questionnaire results reflected student and parent experiences of variability in school-based food allergy policies and attitudes. Interview findings reflected that many students experienced COVID-19 precautions as protective against opportunities for exposure to allergens in school, wished that others knew more about food allergies, and reflected the general sense that food allergies were usually met with respect in school. Some called for increased education to promote awareness and practical knowledge within their school communities. Student impressions of food allergy management have diverse implications for policy. Student openness to improvements to education, in combination with the shared comfort expressed in others knowing about their unique food allergies, suggests that elementary school could be an appropriate place to integrate food allergy education. Additionally, food-allergy related comfort afforded by COVID-19 precautions indicates room for development in food allergy policy development and education to enhance perceptions of safety at school among students with food allergies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Exploring the impacts of FDA temporary food labeling flexibility among the food allergy community during the Covid-19 pandemic

In an attempt to improve access to food distribution systems during the Covid-19 pandemic, the United States Food and Drug Administration (FDA) issued temporary flexibility in food labeling requirements. This requirement affects the Top 8 allergens and could lead to accidental allergen ingestion. The purpose of this study was to utilize a qualitative method to collect and analyze comments to FDA that were available via Allergic Living's website from May 22, 2020, to June 18, 2020, following the release of the food labeling change. In total, 3,033 comments were analyzed using the thematic analysis six-phase framework approach. Various themes were extracted relating to the emotional responses of the new labeling including fear, safety concerns, and trust of certain food product brands among the food allergy community. This research has implications for a broad spectrum of the U.S. food industry including restaurants, grocery stores, specialty food associations, and consumers. Stakeholders and experts in the food allergy community should be consulted when a policy change is occurring, especially during a pandemic affecting access to safe food.

Food Insecurity and Food Allergy in Children of an Urban Minority Community: A Cross-Sectional Study

Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.

Asthma Management Among Children With Food Allergy in the FORWARD Study During COVID-19

Rationale: Asthma remains a significant comorbidity among children with food allergy (FA). Longitudinal data on the course of asthma in this population, particularly during the COVID-19 pandemic, is lacking. This study aims to describe asthma management and control among children with FA during the COVID-19 pandemic. Methods: Children with FA (≤12 years old at enrollment) were enrolled into FORWARD, a prospective, observational cohort study. Data from participants with FA and asthma who completed a 12-month and 24-month post-enrollment asthma therapy assessment were included (n=125). Surveys were administered between January 2019 - July 2022, which includes the onset and duration of COVID-19. Responses to the same questions at the two time points were analyzed using tests of exact symmetry. Results: Compared to the 12-month survey, caregivers at the 24-month survey more frequently reported that their children were not using their inhaler for quick relief (1.6% vs. 9.4%, p = 0.008) and were using their medication incorrectly (3.2% vs. 8.7%, p = 0.003). They less frequently reported that they were unsure whether their medications were useful (3.2% vs. 0.0%, p = 0.016). A similar distribution was observed when non-Hispanic Black and non-Hispanic White participants were compared. No significant differences were evident when comparing symptoms. Conclusions: The symptom burden of asthma remained stable even during the pandemic. However, during this time, children with asthma were less likely to need a rescue inhaler and to be adherent to their maintenance regimen. Further longitudinal research on asthma management is necessary to better understand the potential impact of COVID-19.

Virtual Healthcare Is Everywhere, But Are Caregivers Satisfied With Virtual Learning And Does It Have A Role Moving Forward?

Rationale: Covid-19 introduced a shift towards telemedicine in paediatric healthcare. In-person education opportunities were therefore reduced. Virtual education opportunities are developing, but do caregivers want these permanently? This study assesses caregivers' experiences following an online anaphylaxis education session. Methods: This project uses data collected as part of the ongoing TEAAM study (Telemedicine as an Educational tool for caregivers regarding Auto-Injectors and Anaphylaxis Management). TEAAM examines the efficacy of online education in improving caregiver anaphylaxis knowledge using a virtual session (with a trainer and video resources), and pre- and post- intervention surveys. The TEAAM population consists of a convenience sample of caregivers of children attending allergy clinic, who have a food allergy and have been prescribed adrenaline. 65 caregivers have completed a post-intervention questionnaire in which we assessed their satisfaction level, perceived benefits, issues and comparison to in-person education. Results: 98.5%(64) of caregivers found participation beneficial (mean satisfaction score 4.7/5). Benefits included time saved (n=55,84.6%), and money saved (n=33,50.8%) due to less travel, having access to education while awaiting appointments (n=54,83.1%), and reduced exposure to infection (n=28,43.1%). During sessions, 78.5%(50) expressed no issues. 3.1%(2) had issues logging in. 9.2%(6) mentioned trainer difficulties in sharing screens. Qualitative comments showed confidence in online education platforms e.g., "I definitely think sessions like this are the way forward”. Only 1 caregiver believed it would be more useful if delivered in-person. Conclusions: Caregivers found online allergy education sessions worthwhile and would like them to continue. Moving forward, we need to build user-friendly, distance-learning resources and ensure staff are adequately trained.

Normative Data for the Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool (IMPAACT) in a Canadian Sample

Rationale: The Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool (IMPAACT) is a food-allergy anxiety questionnaire for parents of children with food allergy. While the measure has been recently validated, normative data has not yet been presented. As such, the current study provides preliminary cut-scores and percentiles to help facilitate its use as a screening tool. Methods: Parents of children with food allergy were largely recruited through national and local patient organizations and were asked to complete questionnaires aimed at assessing their demographics and IMPAACT scores pre/post COVID-19. While the data was primarily analyzed descriptively (n/N, %, mean, SD, percentiles), inferential statistics were used to assess the relationship between the IMPAACT and various participant characteristics. Results: The final sample consisted of 281 parents (mothers=92%) and ranged in age from 27-64 years. The majority of participants reported having one child with a food allergy (85%). Allergies to peanuts were most common (79%), followed by tree nuts (56%), eggs (33%), and cow's milk (24%). IMPAACT scores were significantly lower following the outbreak of COVID-19 relative to the period prior to the outbreak (mean 87.89 [SD=36.44] vs. 102.97 [SD=33.71], p<0.001;maximum possible score: 196). Given these differences in food allergy anxiety before and after the pandemic, percentiles and cut-scores for both periods are presented. IMPAACT scores greater than 125, or 112 during periods of public health restrictions/reduced socialization, may merit further evaluation. Conclusions: Findings provide preliminary cut-points and percentiles that may help identify parents with elevated levels of food allergy anxiety.

Rates of New Peanut Allergy and Discontinuation Following Introduction in High-Risk Infants

Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.

Is antenatal or early-life vitamin D associated with eczema or food allergy in childhood? A systematic review.

OBJECTIVE: To summarise the associations between antenatal or early-life blood vitamin D and the development of eczema/food allergy in childhood. DESIGN: A systematic review and meta-analyses were conducted to synthesize the published literature. Two reviewers independently performed the study selection and data extraction on Covidence. We assessed the risk of bias for observational studies by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool for clinical trials. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DATA SOURCES: We systematically searched PubMed and Embase from inception and April 2022. ELIGIBILITY CRITERIA: Human studies that investigated prospective associations between antenatal or early-life blood vitamin D levels, dietary intake or supplementation and childhood eczema/food allergy. RESULTS: Forty-three articles including six randomised controlled trials (RCTs) were included. Four RCTs of vitamin D supplementation during pregnancy showed no evidence of an effect on the incidence of eczema (pooled odds ratio [OR] = 0.85; 0.67-1.08, I2  = 6.7%, n = 2074). Three RCTs reported null associations between supplementation in pregnancy/infancy and food allergy. From six cohort studies, increasing cord blood vitamin D levels were associated with reduced prevalence of eczema at/close to age one (OR per 10 nmol/L increase = 0.89; 0.84-0.94, I2  = 0%, 2025 participants). We found no evidence of an association between maternal antenatal or infant vitamin D level or dietary intake and the development of food allergy or eczema in offspring. CONCLUSIONS: We found an association between higher vitamin D levels in cord blood and reduced risk of eczema in cohort studies. Further trials with maternal and infant supplementation are needed to confirm if vitamin D supplementation can effectively prevent eczema or food allergy in childhood. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, No. CRD42013005559.

New considerations of health disparities within allergy and immunology.

The pandemic, political upheavals, and social justice efforts in our society have resulted in attention to persistent health disparities and the urgent need to address them. Using a scoping review, we describe published updates to address disparities and targets for interventions to improve gaps in care within allergy and immunology. These disparities-related studies provide a broad view of our current understanding of how social determinants of health threaten patient outcomes and our ability to advance health equity efforts in our field. We outline next steps to improve access to care and advance health equity for patients with allergic/immunologic diseases through actions taken at the individual, community, and policy levels, which could be applied outside of our field. Key among these are efforts to increase the diversity among our trainees, providers, and scientific teams and enhancing efforts to participate in advocacy work and public health interventions. Addressing health disparities requires advancing our understanding of the interplay between social and structural barriers to care and enacting the needed interventions in various key areas to effect change.