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Food Allergy & Anaphylaxis
 

Food Allergy & Anaphylaxis

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GRF 2nd One Health Summit 2013: Presentation by Antonella Muraro, Food Allergy Centre Department of Woman and Child Health- University of Padua- Italy

GRF 2nd One Health Summit 2013: Presentation by Antonella Muraro, Food Allergy Centre Department of Woman and Child Health- University of Padua- Italy

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    Food Allergy & Anaphylaxis Food Allergy & Anaphylaxis Presentation Transcript

    • GRF DAVOS ONE HEALTH SUMMIT 2013 Davos , Nov.18th EAACI Food Allergy & Anaphylaxis Initiative Translating knowledge for best practice in healthcare Maria Antonella Muraro Food Allergy Centre Department of Woman and Child Health- University of Padua- Italy muraro@pediatria.unipd.it
    • Disclosure In relation to this presentation, I declare NO conflicts of interest A conflict of interest is any situation in which a speaker or immediate family members have interests, and those may cause a conflict with the current presentation. Conflicts of interest do not preclude the delivery of the talk, but should be explicitly declared. These may include financial interests (eg. owning stocks of a related company, having received honoraria, consultancy fees), research interests (research support by grants or otherwise), organisational interests and gifts.
    • Food Allergy & Anaphylaxis Clinical Practice Guidelines Outline WHAT IS FOOD ALLERGY ? BURDEN OF FOOD ALLERGY EAACI INITIATIVEOR transient v’s per RESEARCH GAPS NEXT STEPS NEXT
    • FOOD ALLERGY The Public Profile of Food Allergy Food Allergy doesn’t exist!!! Food Allergy is the cause of all diseases!!! JO Warner 2005 Pediatr Allergy Immunoll 16: 555 Miles S et al 2005 Allergy; 60:966-1003
    • FOOD ALLERGY ADVERSE HEALTH EFFECT ARISING FROM A SPECIFIC IMMUNE RESPONSE THAT OCCURS REPRODUCIBLY ON EXPOSURE TO A GIVEN FOOD NIH-NIAID Food Allergy Guidelines JACI 2011 EAACI GUIDELINES ON FOOD ALLERGY 2013
    • ADVERSE REACTIONS TO FOODS 2 MAIN GROUPS ACCORDING TO THE MECHANISMS - IMMUNOLOGICAL (IgE/non IgE) =FOOD ALLERGY - NON IMMUNOLOGICAL = INTOLERANCE  enzimatic (lactose intolerance)  toxic ( sgombroid syndrome)  pharmacologic
    • FOOD ALLERGY EAACI Task Force on Nomenclature FOOD HYPERSENSITIVITY NON ALLERGIC HYPERSENSITIVITY FOOD ALLERGY IgE-MEDIATED FOOD ALLERGY NON IgE-MEDIATED FOOD ALLERGY Mixed IgE & nonIgE Allergy, 2001; 56: 813 J Allergy Clin Immunol 2004 113;832-6
    • FOOD ALLERGY Clinical manifestations SINGLE OR ASSOCIATED MANIFESTATIONS SKIN GUT RESPIRATORY TRACT - Urticaria/angioedema Atopic Dermatitis Gastroenteropathies Rhinitis Asthma SYSTEMIC MANIFESTATIONS Anaphylaxis
    • ANAPHYLAXIS A GENERALIZED ALLERGIC REACTION THAT IS RAPID IN ONSET AND MAY PROGRESS TO DEATH 2nd NIH-FAAN Consensus Meeting Attended by allergists/immunologists, emergency department physicians, anesthesiologists, primary care physicians, emergency medical technicians, lay personnel and basic scientists representing over 15 NIH-FAAN Conference July 2005; Bethesda, MD USA organizations Sampson, Munoz-Furlong et al. JACI 2006 EAACI GUIDELINES ON ANAPHYLAXIS 2013
    • Which is the burden of Food Allergy ? Epidemiology Management Community
    • Burden of Food Allergy –A Epidemiology Perceived Prevalence •Adverse reactions to foods: 35% of parents 2 years old children •38,4% school children in Germany •11,6% to 12,4% UK teenagers Eggesbo M et al Pediatr All Immunol 1999; 10: 122-132 Roehr CC et al Esp Allergy 2004;34:1534-41 Pereira B et al J Allergy Clin Immunol 2005; 116:884-92
    • Burden of Food Allergy – A Epidemiology US NIAID • Reported Prevalence Prevalence among all age group 1%10% ( meta-analysis). • True: 8% children, 3-4% adults EUROPE • Reported Prevalence EuroPrevall Meta-analysis: overall prevalence rate of self reported: 12% in children and 13% in adults • True : 6% children, 3% adults Chafen JJ et al, JAMA 2010;303(18) Rona R et al JACI 2007 ;120: 638-46
    • Food Allergy as an antecedent to Asthma the Atopic March EAACI Global Atlas on Asthma 2013
    • Food allergy and Asthma increased risk for anaphylaxis
    • Food allergy and Pollen Allergic Rhinitis Cross reactivity
    • Burden of Food Allergy – A Epidemiology  Reported increase in severe allergic reactions from food – 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) – 1Webb in Australia (1993-2003) Ann Allergy 2006, 2Sampson Pediatrics 2003, 3Novembre Pediatrics 1998, 4Bock JACI 2001, 5Mehl Allergy 2005, 6Poulos JACI 2007, 7Gupta Thorax 2007
    • 1 child out of 4 in Europe suffers from food allergy Food Allergy is the leading cause of anaphylaxis in children
    • TRENDS IN HOSPITAL ADMISSION RATES FOR ANAPHYLAXIS BY AGE IN ENGLAND DURING THE PERIOD 1990-2004 Variazione ICD 100 10 1 0-14 15-44 45+ 0-14 7 folds Gupta et al. Thorax 2006; 1:1-6
    • TRENDS IN HOSPITAL ADMISSION RATES FOR SELECTED ALLERGY-RELATED DISORDERS IN THE FINANCIAL YEARS 1993-94 TO 2004-05 Mullins R. MJA 2007; 186:622-25 EAACI Epidemiology of Food Allergy Allergy 2013 , in press 120 100 Atopic dermatitis Food anaphylaxis Angioedema Total Anaphylaxis Urticaria 80 60 40 20 0 2004-05 2003-04 2002-03 2001-02 2000-01 1999-00 1998-99 1997-98 1996-97 1995-96 1994-95 1993-94 YEAR From Australian national hospital morbidity data. Rate per million population
    • Burden of Food Allergy –B Management Birthday Parties Science Projects Art Projects Food Rewards & Incentives is Special Events Everywhere Holiday Parties Field Trips Bus
    • Burden of Food Allergy –B Management 1. Proper diagnosis of food allergy 2. Management of the elimination diet ( avoidance) & Immunotherapy 3. Management of severe reactions 4. Implementation at School and in the Community
    • AVOIDANCE OF THE ALLERGENS LABEL READING Patient must learn the scientific and technical names for foods that appear on labels • 10% of those avoiding milk recognized “milk words”, 54% of those avoiding peanut, 22% of those avoiding soy EU Commission food allergens list as updated 2011 –UPDATE 2012  ISSUE of Precautionary labelling
    • PSYCOSOCIAL IMPACT Food allergies impact Decisions about Food shopping/ Dining out/ Vacation Socializing/Relatives/ Schools and child care/ Travel The entire family follows the restricted diet There is no break from worry and stress Reactions occur frequently in/outside the home in spite of best efforts at avoidance Sicherer SH et al. Ann Allergy Asthma Immunol 2001; 87: 461-4 Elberink JN. Curr Opin Allergy Clin Immunol 2006; 6: 298-302
    • LABELLING Suggested changes of importance for food allergic consumers Approved 2012 EU Parliament    Member States should retain the right, depending on local practical conditions and circumstances, to lay down rules in respect of the provision of information concerning non-prepacked foods. Although in such cases the consumer demand for other information is limited, information on potential allergens is considered very important. Evidence suggests that most food allergy incidents can be traced back to non-prepacked food. Therefore such information should always be provided to the consumer.
    • FOOD ALLERGY BURDEN Impact Social Identity Global Health Perception Social Burden Diagnosis & treatment Disease
    • Food Allergy and Anaphylaxis Public Campaign June 2012 – June 2014 • PUBLIC DECLARATION ON FOOD ALLERGY & ANAPHYLAXIS at the EU Parliament • FOOD ALLERGY & ANAPHYLAXIS GUIDELINES • INTERNATIONAL MINIMUM STANDARDS FOR THE ALLERGIC CHILD AT SCHOOL • FOOD ALLERGY & ANAPHYLAXIS MEETING – 3 rd FAAM • Dublin October 7-9,2014 26
    • PUBLIC DECLARATION www.eaaci.net 27
    • PUBLIC DECLARATION KEY ASPECTS Education campaigning on the disease: risks and treatment options • Increased access needed to adrenaline autoinjectors to save lives focusing on school • Clear food labelling policies that will help patients better manage their condition • Availability to research funds to find a cure for food allergy and anaphylaxis
    • EAACI GUIDELINES AIM Development of comprehensive guidelines on FOOD ALLERGY & ANAPHYLAXIS , not only for diagnosis embracing all the different stake -holders ie. Clinicians, Immunologists, Epidemiologist, Food Technologists, Food Industry Research Dept. Representatives, Regulatory Bodies, Allied Health Representatives, Patient Organisations
    • work place School H P ER leisure time A LHU GP other networks
    • GUIDELINES Research Gaps (i) Mechanisms of oral tolerance Possible effects of modified food allergens for tolerance The effect of supplementation with probiotic strains on food allergy Timing of introduction of the allergenic food in the infant Biomarkers to identify patients at risk of severe reactions
    • GUIDELINES Research Gaps (ii) Immunotherapy for food allergy Whether biologicals in food allergen- specific immunotherapy (a) enhance the effectiveness of treatment and/or (b) reduce the risks of severe adverse reactions? Food allergen specific immunotherapy: (a) effectiveness; (b) risks; (c) cost effectiveness and (d) long-term benefits
    • Next steps -Guidelines PASSIVE THE PLAN DISSEMINATION (i) INCLUDES Translation in national languages Distribution across ACTIVE DISSEMINATION (ii) Europe Inclusion of Local Conferences Professionals(20 countries Campaigns represented) EDUCATION Patient’s organizations mediated intervention
    • FOOD ALLERGY & ANAPHYLAXIS PLATFORM Government Specific Policies for Food Allergy Regulatory Bodies & Patient Organisations Food Industry Health & Patient Professionals Organisations Patient
    • Food Allergy & Anaphylaxis EAACI _ Translating knowledge for best practice in healthcare THANK YOU !
    • Centres of Excellence Centres of Excellence Centres of Excellence Centres of Excellence THIS WILL PROMOTE Changes in public health policies creating vertical and horizontal networks Primary Care Networks Primary Care Networks Primary Care Networks Primary Care Networks
    • WHO KNOWS THE ANSWER? Hospital Different stakeholders have a different perception of the disease on: •Prevalence •Incidence •Severity •Natural history Peephole view •Management Emergency Room Allergist Local Health Unit GP
    • WHY do we need Guidelines?  Education needs at Primary Care level  Difficulty to recognise the symptoms of food allergy and anaphylaxis  Lack of standardised treatment throughout Europe  Need to raise awareness at a political level
    • P P H P A P P P P P ER Regulatory Bodies LHU GP Food P P Industry P
    • WHY ? (iii) INDIVIDUAL & LOCAL FACTORS Different NHSs organization Different health needs Different habits WHERE i.E . WHO Different guidelines for each stakeholder?
    • WHY ? (iv) 5 MAJOR PURPOSES 1. Assisting clinical decision making by patients and practitioners 2. educating individual or groups 3. assessing and assuring the quality of care 4. guiding allocation of resources for health care; 5. reducing the risk of legal liability for negligent care
    • WHY ? (v) HARMONIZE PRACTICE FROM «CURE» SHIFTING TO CARE
    • CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING CARING means SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING SHARING
    • WHO are the Guidelines aimed at? Allergist Food Industry Research Departments Immunologist Patient Organisations Epidemiologist Emergency Dept Physician Food Technologist Paediatrician Regulatory Bodies Politicians
    • Structure of the Project  Steering Committee  8 Working Groups  Methodologist’s Group lead by Aziz Shiekh  Experts Group for Peer –Review  Extended Panel: Representatives of Scientific Societies involved gastroenterology, in the dermatology, field (i.e. emergency physicians)  Representatives from Patient’s Organizations
    • 2013 April Guideline chapters sent to Peer Review for comments 2012 SeptemberDecember literature research for the systematic reviews 2011Sept- January 2012 Zurich workshop with all the Guidelines members with AGREE methodologist 1 2013 February Face-to-face meeting 3 2 2012 JuneSeptember the questions for the systematic Review 2013 May collection of comments and review of guidelines chapters 7 5 4 6 8 9 2013 February–April 1st draft of the Guidelines chapters 2012 December workshop and evaluation of the systematic reviews- refining of the systematic reviews 2013 June: Publication on EAAI Website
    • Food Allergy Clinical Practice Guidelines Prevention, Diagnosis & Management, Anaphylaxis, Co mmunity, Quality of Life 7 systematic review protocols published in CTA 7 systematic review ready for submission 5 guidelines on the EAACI website for review
    • http://www.eaaci.org/resources/foodallergy-and-anapyhlaxis-campaign.html 1. FOOD ALLERGY DIAGNOSIS AND MANAGEMENT 2. FOOD ALLERGY QUALITY OF LIFE 3. FOOD ALLERGY IN THE COMMUNITY 4. FOOD MANUFACTURERS ISSUES 5. PREVENTION OF FOOD ALLERGY 6. ANAPHYLAXIS Chapters 3 and 4 on line from Oct.2013
    • EAACI WEBSITE http://www.eaaci.org/resources/foodallergy-and-anapyhlaxis-campaign.html
    • GUIDELINES Systematic reviews QUESTIONS (i) DIAGNOSIS & MANAGEMENT What is the epidemiology of FA in Europe? What is the diagnostic accuracy of tests in supporting the clinical diagnosis? What the effectiveness of pharmacological / non – pharmacological interventions in acute and long term management ? http://www.eaaci.org/resources/food-allergyand-anapyhlaxis-campaign.html
    • GUIDELINES Systematic reviews QUESTIONS (ii) Prevention What is the effectiveness of approaches for the primary prevention of food allergy? http://www.eaaci.org/resources/food-allergyand-anapyhlaxis-campaign.html
    • GUIDELINES Systematic reviews QUESTIONS (ii) Quality of life Which disease-specific , validated instruments can be employed to enable assessment of the impact of ,and investigations and interventions, for food allergy on HRQL? http://www.eaaci.org/resources/food-allergyand-anapyhlaxis-campaign.html
    • GUIDELINES Systematic reviews QUESTIONS (iii) ANAPHYLAXIS What is the epidemiology of Anaphylaxis in Europe? What is the effectiveness of interventions for the acute management of anaphylaxis? What the effectiveness of interventions for the long term management of those at high risk of further episodes of aanaphylaxis ? http://www.eaaci.org/resources/food-allergyand-anapyhlaxis-campaign.html
    • GUIDELINES Recommendations KEY MESSAGES MULTIDISCIPLINARY & MULTIFACETED APPROACH DIETARY AVOIDANCE PROACTIVE TREATMENT EDUCATION CENTRES OF EXCELLENCE & NETWORKING
    • DIAGNOSIS OF FOOD ALLERGY 1 Recommendation (Boxes) • To ensure correct avoidance of the correct allergens To ensure timely recognition of subjects at high risk of anaphylaxis To avoid unneccessary diets To avoid delay in proper diagnosis of a different disease
    • Primary Care Networks Centres of Excellence Centres of Excellence Centres of Excellence Centres of Excellence THIS WILL PROMOTE Primary Care Networks Changes in public health policies in order to create vertical and horizontal networks Primary Care Networks Primary Care Networks
    • 2013 April Guideline chapters sent to Peer Review for comments 2012 SeptemberDecember literature research for the systematic reviews 2011Sept- January 2012 Zurich workshop with all the Guidelines members with AGREE methodologist 1 2013 February Face-to-face meeting 3 2 2012 JuneSeptember the questions for the systematic Review 2013 May collection of comments and review of guidelines chapters 4 I 7 5 6 8 9 2013 February–April 1st draft of the Guidelines chapters 2012 December workshop and evaluation of the systematic reviews- refining of the systematic reviews JUNE 23 JULY 10 PUBLIC COMMENT 2013 June: Publication on EAAI Website
    • Thank you!! Antonella Muraro Graham Roberts Thomas Werfel Karin Hoffman-Sommergruber Susanne Halken Vicky Cardona Nikos Papadopoulos Phillippe Eigenmann Ronald Van Ree Berber Vlieg–Boerstra Pascal Demoly Anthony Dubois Lars Poulsen Carsten Bindslev Jensen Gideon Lack Andrew Clark Bodo Niggeman Philippe Eigenmann Margitta Worm Montserrat Fernandez Rivas Holger Mosbech Knut Brockow Vicky Cardona Pascal Demoly Beatrice Bilo Frans Timmermans Laurie Harada Abdel Bellou Aziz Sheikh Quiza Zolkipli - Junior Audrey DunnGalvin Franziska Reuff Alexandra Figueira Santos Berber Vlieg–Boerstra Valérie Verhasselt Liam o Mahony Anthony Dubois Andrey DunnGalvin Jonathan Hourihane Bertine Flokstra-de Blok Jacquelien Saleh- Langenberg Breda Flood Lynne Regent Nicolette De Jong Kirsten Beyer Carina Venter Andrea von Berg Syed Hasan Arshad Mikael Kuitunen Susan Prescott Gideon Lack Susanne Lau Nicolette De Jong Yanne Boloh Harald Renz Ulrich Wahn Arne Host Bright Nwaru Sarah Salvilla Sangeeta Dhami Karla Soares-Weiser Sukhmeet panesar Debra de Silva Lennart Hickstein Cezmi Akdis
    • School work place H P ER leisure time A LHU GP other networks