Health disparities in pediatric food allergy.

OBJECTIVE: To review the current literature regarding the health disparities in the prevalence, diagnosis, and management of pediatric food allergy and discuss possible interventions. DATA SOURCES: Literature search of PubMed and Google Scholar databases regarding pediatric food allergy and health disparities. STUDY SELECTIONS: Original research articles, reviews, and guidelines on health disparities in pediatric food allergy were included in this review. RESULTS: The overall prevalence of food allergy appears to be increasing and disproportionately affecting minority groups. Racial and socioeconomic disparities are evident across all aspects of food allergy care: diagnosis, prevention, acute management (eg, access to epinephrine autoinjectors, visits to emergency department), and long-term management (eg, oral immunotherapy). Children of minority populations and those of low socioeconomic status are at a greater risk of food insecurity, which is further exacerbated by the high cost of allergen-free foods and limited support from food assistance programs. CONCLUSION: Racial, ethnic, and socioeconomic disparities in food allergy among children in the United States are evident and negatively affect the outcomes of children with food allergies. Active efforts to decrease racial and socioeconomic disparities, through education, research, and advocacy, will be important to help improve health outcomes in food allergy for all children, regardless of their race, ethnicity, or socioeconomic status.

Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management.

OBJECTIVE: Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES: A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS: Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS: Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION: There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.

Elementary School Teachers' Perceptions of COVID-19-Related Restrictions on Food Allergy Management.

(1) Background: Approximately 7% of Canadian children live with a food allergy (FA). Pre-COVID-19, ~20% of anaphylactic reactions occurred in schools. Yet, teachers reported poor FA-related knowledge, and experiences during the COVID-19 pandemic are not well-studied. Additionally, teachers' management approaches vary widely. We aimed to describe elementary school teachers' perceptions about FA management during the COVID-19 pandemic; (2) Methods: Using a semi-structured interview guide, English-speaking elementary school teachers in Winnipeg, Canada were interviewed virtually. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically; (3) Results: Most teachers were female and taught in public schools. Two themes were identified. Theme 1, COVID-19 restrictions made mealtimes more manageable, capturing the positive impacts of pandemic restrictions such as seating arrangements and enhanced cleaning. Limited lunchtime supervision prompted some teachers to assume this role. Theme 2, Food allergy management was indirectly adapted to fit changing COVID-19 restrictions, describing how changing restrictions influenced FA-related practices. FA training was offered virtually with less nursing support. Class cohorts and remote learning decreased teachers' perceived risk and FA-related management responsibility; (4) Conclusions: COVID-19-related practices were perceived as positively influencing in-school FA management, although unintended consequences, such as increased supervisory roles for teachers and reduced nursing support, were described.

Evaluating an online self-help intervention for parents of children with food allergies.

BACKGROUND: Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA. METHODS: In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained. RESULTS: A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL. CONCLUSION: While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention.

Management of Allergic Diseases During COVID-19 Outbreak.

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. RECENT FINDINGS: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.

Paediatric allergy practice in the era of coronavirus disease 2019.

PURPOSE OF REVIEW: To summarize the impact of the COVID-19 pandemic on the practice of paediatric allergy. RECENT FINDINGS: Given significant overlap in symptoms, care must be taken to differentiate routine allergic conditions from COVID-19 infection but it appears that most allergic diseases are not risk factors for a severe COVID-19 course. The full impact of restricted allergy/immunology ambulatory services will take months to years to fully understand. One benefit of having to adapt practice style is greater awareness and acceptance of shared decision-making and recognition of preference-sensitive care options in food allergy, in particular for approaches towards allergy prevention, treatment, and anaphylaxis care. Social distancing and masks have helped reduce spread of common respiratory viruses, which may be helping to lower the incidence of viral-associated wheezing episodes, enhancing evidence of the effects of preventing exposure of young children to respiratory viruses on asthma pathogenesis, as well as on allergic rhinitis. There has been a revolution in the rise of telemedicine to increase access to high-quality allergy/immunology specialty care. SUMMARY: Although the field has adapted to remain operational in the face of a significant challenge, it is important to apply lessons learned to evolve patient care and optimize treatment in the aftermath of the pandemic.

Managing food allergy immunotherapy in children during the COVID-19 pandemic.

Food allergy immunotherapy is a promising allergen-specific approach to manage food allergy in children, although it is not exempt from adverse events, even severe. The adverse events are not predictable and furthermore cofactors can play a role in triggering them. During the COVID-19 pandemic, patients on food allergy immunotherapy should be provided with suggestions on how to proceed in the event of COVID-19 infection occurring or is suspected. These recommendations would be of support to clinical practitioners dealing with patients on food allergy immunotherapy since there is little data in the literature on the topic.

Probiotics: Versatile Bioactive Components in Promoting Human Health.

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease's diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control.