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Food Allergy & Anaphylaxis Antonella MURARO

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Food Allergy & Anaphylaxis
Food Allergy & Anaphylaxis
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Food Allergy & Anaphylaxis Antonella MURARO

  1. 1. Antonella Muraro EAACI President FOOD ALLERGY & ANAPHYLAXIS the new epidemic of 21st century Global One Health Forum 2015 Davos , October 5th
  2. 2. Food Allergy and Anaphylaxis the new epidemic of 21st century OUTLINE 1.Burden of food allergy 1A Methodological pitfalls 2. Burden of anaphylaxis 2A. Methodological pitfalls 3. Conclusions and Next Steps
  3. 3. Which is the burden of food allergy and anaphylaxis ? Food Allergy and Anaphylaxis the new epidemic of 21st century
  4. 4. Prevalence of food allergic reactions is overallPrevalence of food allergic reactions is overall poorly documentedpoorly documented • Disease definition: clinical reaction v’sDisease definition: clinical reaction v’s sensitization v’s self reportedsensitization v’s self reported • Diagnostic criteria not always consistentDiagnostic criteria not always consistent • Role of atopic dermatitisRole of atopic dermatitis • Environment and Iatrogenic effects ?Environment and Iatrogenic effects ? Burden of Food Allergy Epidemiology-I
  5. 5. DIAGNOSIS AND MANAGEMENT SYSTEMATIC REVIEWS QUESTION •What is the epidemiology of Cow’s Milk in Europe? •Epidemiology varies according to the definition of cow’s milk allergy / food allergy
  6. 6. EAACI Food Allergy &Anaphylaxis Guidelines for Clinical Practice 2014 Translating Knowledge for best practice in healthcare
  7. 7. Epidemiology of Cow’s Milk Protein allergy Allergy 2014: DOI: 10.1111/all.12423 Epidemiology of cow’s milk allergy- Criteria Prevalence % Overall lifetime prevalence of self-reported CMA 6.0% (95% CI 5.7-6.4) Overall point prevalence of self- reported CMA 2.3% (95% CI 2.1-2.5) SPT positivity 0.3% (95% CI 0.03-0.6) Specific-IgE positivity 4.7 (95% CI 4.2-5.1) FC positivity 0.6% (95% CI 0.5-0.8) FC or history of CMA 1.6% (95% CI 1.2-1.9)
  8. 8. Prevalence of food allergic reactions is overallPrevalence of food allergic reactions is overall poorly documentedpoorly documented • Disease definition: clinical reaction v’sDisease definition: clinical reaction v’s sensitization v’s self reportedsensitization v’s self reported • Diagnostic criteria not always consistentDiagnostic criteria not always consistent • Role of atopic dermatitisRole of atopic dermatitis • Environment and Iatrogenic effects ?Environment and Iatrogenic effects ? Burden of Food Allergy Epidemiology-I
  9. 9. 9 Prevalence
  10. 10. Prevalence of food allergic reactions is overallPrevalence of food allergic reactions is overall poorly documentedpoorly documented • Disease definition: clinical reaction v’sDisease definition: clinical reaction v’s sensitization v’s self reportedsensitization v’s self reported • Diagnostic criteria not always consistentDiagnostic criteria not always consistent • Role of atopic dermatitisRole of atopic dermatitis • Environment and Iatrogenic effects ?Environment and Iatrogenic effects ? Burden of Food Allergy Epidemiology-I
  11. 11. Prevalence of food allergic reactions is overallPrevalence of food allergic reactions is overall poorly documentedpoorly documented • Disease definition: clinical reaction v’sDisease definition: clinical reaction v’s sensitization v’s self reportedsensitization v’s self reported • Diagnostic criteria not always consistentDiagnostic criteria not always consistent • Role of atopic dermatitisRole of atopic dermatitis • Environment and Iatrogenic effects ?Environment and Iatrogenic effects ? Burden of Food Allergy Epidemiology-I
  12. 12. Guidelines for Introduction of complementay foods Previous recommendations AAP 2004: • General population should avoid: – solid foods 4-6 months & cow’s milk 12 months • Infants at risk should also avoid: – egg for 2 yrs & – peanuts, treenuts and fish 3 yrs
  13. 13. United Kingdom 5171 Israel 5615 Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergyMediangofpeanutprotein/week Peanut Protein Consumption 8 - 14 month 0 g/week 7.1 g/week p < 0.001 Prevalence of Peanut Allergy in Children 4 - 18yrs %PAPrevalence 0.17% p < 0.001 1.85% Du Toit G et al. J Allergy Clin Immunol 2008; 122: 984-91.
  14. 14. Prevalence of immediate allergic reactions isPrevalence of immediate allergic reactions is poorly documentedpoorly documented •Lack of agreed working definitionLack of agreed working definition •Uncommon disorder, rapid in onsetUncommon disorder, rapid in onset • International Codes of Disease underusedInternational Codes of Disease underused Sampson HA et al J Allergy Clin Immunol 2006;117: 391-397Sampson HA et al J Allergy Clin Immunol 2006;117: 391-397 Burden of Anaphylaxis Epidemiology-II
  15. 15. •Mortality registries •Hospital admission •ER visits/admissions • GP case records •Allergists •Patients alliances/Voluntary reporting •Expenditure for Self-injectable- epinephrine H ER A P P P P P P P P P P P P LHU GP H ER A P P P P P P P P P P P P LHU GPH ER A P P P P P P P P P P P P LHU GP H ER A P P P P P P P P P P P P LHU GP IFFERENCE 2SOURCE OF INFORMATION
  16. 16. Local Health Unit GP Allergist Emergency Room Hospital WHO KNOWS THE ANSWER? Different stakeholders have a different perception of the disease on: •Prevalence •Incidence •Severity •Natural history •Management Peephole view
  17. 17. H ER A P Regulatory Bodies P P P P P P P P P P LHU GP Food Industry SOURCE OF INFORMATION
  18. 18. Type of StudiesType of Studies • Cross-sectional ( public health records ,Cross-sectional ( public health records , other diseases registry , commercialother diseases registry , commercial insurancesinsurances • Retrospective chart review ( singleRetrospective chart review ( single centre, multicentre)centre, multicentre) 77 Burden of Anaphylaxis Epidemiology-II Yu JE et al 2015 Clinic Rev Allerg ImmunolYu JE et al 2015 Clinic Rev Allerg Immunol
  19. 19. Type of StudiesType of Studies • Population studies ( telephone surveys,Population studies ( telephone surveys, patient’s questionnaire)patient’s questionnaire) • Systematic reviews, meta-analysisSystematic reviews, meta-analysis • Cohort, case controlCohort, case control Yu JE et al 2015 Clinic Rev Allerg ImmunolYu JE et al 2015 Clinic Rev Allerg Immunol Burden of Anaphylaxis Epidemiology-II
  20. 20. Incidence of anaphylaxis (per 100 000 person-years) in different series from the general population (primary care databases or DB of large health maintenance organizations). Clinical & Experimental Allergy,2014; 45 : 1027–1039
  21. 21. Incidence rates of anaphylaxis subtypes according to age. Clinical & Experimental Allergy 2014 , 45 : 1027–1039
  22. 22. Distribution of incidence rates of anaphylaxis according to age group and sex. Clinical & Experimental Allergy 2014, 45 : 1027–1039
  23. 23. Turner P et al JACI 2014
  24. 24. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  25. 25. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  26. 26. Prescriptions of self-injectable epinephrine Burden of Anaphylaxis Epidemiology-II
  27. 27. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  28. 28. Recurrence Rates Burden of Anaphylaxis Epidemiology-II
  29. 29. Percentage of recurrence of anaphylaxis in different series. These percentages are cumulative incidence (follow-up of 1.5 years to 25 years). Clinical & Experimental Allergy 2014, 45 : 1027–1039
  30. 30. Fatal Anaphylaxis Mortality registries Hospital databases Burden of Anaphylaxis Epidemiology-II
  31. 31. Incidence of deaths from anaphylaxis in international series. Clinical & Experimental Allergy 2014 , 45 : 1027–1039
  32. 32. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  33. 33. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  34. 34. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  35. 35. Turner et al., J Allergy Clin Immunol, Vol 135, n. 4, 956-963
  36. 36. J ALLERGY CLIN IMMUNOL VOLUME 136, NUMBER 2 Burden of Anaphylaxis Epidemiology-II
  37. 37. Cause of anaphylaxis admission by age group: 1998-1999 to 2011-2012. A, Anaphylaxis admissions by attributed cause and age group. Mullins R et al JACI 2015
  38. 38. Cause of anaphylaxis admission by age group: 1998-1999 to 2011-2012. B, Time trends for food-associated anaphylaxis as a proportion of total admissions by age group. Mullins R et al JACI 2015
  39. 39. Australian hospital morbidity data: 1998- 1999 to 2011-2012. Age-specific admission rates to Australian hospitals (per 100,000 population per year) for total anaphylaxis (A) Mullins R et al JACI 2015
  40. 40. Australian hospital morbidity data: 1998-1999 to 2011-2012. Relative rates of admission (per 100,000 total admissions) for food-related anaphylaxis (B) Mullins R et al JACI 2015
  41. 41. Australian hospital morbidity data: 1998-1999 to 2011-2012. Relative rates of admission (per 100,000 total admissions) for asthma Mullins R et al JACI 2015
  42. 42. Conclusions (i) •The prevalence is overall increasing mainly in the pediatric age •Food anaphylaxis appears on the rise and the leading cause •Data vary hugely depending on the source and type of study Food Allergy and Anaphylaxis the new epidemic of 21st century
  43. 43. Conclusions (ii) •Need of common agreement on diagnostic criteria across health professionals and community •Need good quality data •Need of real-time study population capturing acute episodes Food Allergy and Anaphylaxis the new epidemic of 21st century
  44. 44. • Conclusions (iii) Educational efforts to improve networking among stakeholders Networks of Research Consortia for real –time surveillance studies AND for developing biomarkers risk of recurrences and fatalities Food Allergy and Anaphylaxis the new epidemic of 21st century
  45. 45. EAACI Anaphylaxis Guidelines Implementation Next Steps •Anaphylaxis Severity Score TF •Anaphylaxis project for GPs and patients •Research Consortia platforms Food Allergy and Anaphylaxis the new epidemic of 21st century
  46. 46. Antonella Muraro EAACI President THANK YOU Global One Health Forum 2015 Davos , October 5th
  47. 47. Thank you
  48. 48. Changes in age-specific anaphylaxis admission rates Mullins R JACI 2015
  49. 49. Burden of Food Anaphylaxis Epidemiology -III • Food-induced anaphylaxis is a leading cause of outpatient anaphylaxis • Food-related anaphylaxis increased 13% per year in a 12-year period • Food-induced anaphylaxis admissions have increased in the UK (1990-2004) and in Australia (1993-2003) 1 Webb Ann Allergy 2006, 2 Sampson Pediatrics 2003, 3 Novembre Pediatrics 1998, Bock JACI 2001, 5 Mehl Allergy 2005, 6 Poulos JACI 2007, 7 Gupta Thorax 2007 Decker WW, Campbell RL, Manivannan V, et al. J Allergy Clin Immunol. 2008;122:1161–5.
  50. 50. Ordered logistic regression model: probability of experiencing a recurrence of anaphylaxis Clinical & Experimental Allergy 2014, 45 : 1027–1039
  51. 51. Ordered logistic regression model: probability of experiencing a recurrence of anaphylaxis Clinical & Experimental Allergy 2014, 45 : 1027–1039

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