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Editor's Choice Incomplete and incorrect epinephrine auto‐injector training to food‐allergic patients by pharmacists in the NetherlandsFood‐allergic patients at high risk for (fatal) anaphylaxis should carry an epinephrine auto‐injector at all times. In the community, successful treatment of anaphylaxis relies on early and correct use of epinephrine auto‐injectors (EAI). Therefore, all food‐allergic patients and their family, but also other allergic patients at risk for anaphylaxis, should be provided with educational resources and training about when and how to administer an EAI. In the Netherlands, pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use an EAI. Saleh‐Langenberg et al. conducted the first study to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in Europe and the quality of EAI use instructions. Most pharmacists reported that they are confident that their knowledge is sufficient to care for food‐allergic patients. However, the study revealed suboptimal knowledge about food allergy among pharmacists in the northern Netherlands. This is an important addition to the previously reported international lack of allergy knowledge. The researchers also found that food‐allergic patients at high risk for anaphylaxis who receive their EAI from a pharmacy in the northern Netherlands are often not or incorrectly instructed on how to use an EAI. Given the importance of timely and correct administration of epinephrine in case of a (severe) food‐allergic reaction, improvement of demonstration accuracy is promptly needed. These data suggest that opportunities exist to improve the quality of care provided by pharmacists to food‐allergic patients.Phenotypical characterization of peanut‐allergic children with differences in cross‐allergy to tree nuts and other legumesPeanut allergy (PA), a widely studied allergy in pediatrics, has an estimated prevalence of 1.3% in Europe and tree nut (TN) allergy an estimated prevalence ranging from 0.05 to 4.9%. These conditions are clinically similar, often coexisting.In this study, Cousin et al. studied a large population of 317 children allergic to peanuts. This is one of the largest number of pediatric patients with a diagnosis of clinically significant cross‐allergy to TNs and/or other legumes. A retrospective study has been conducted, including all children with PA with a complete workup for cross‐allergy to TN and other legumes, performed at the Allergy Unit of the Saint Vincent Hospital of Lille (France) from a long period: March 2004 to May 2016. Unlike what is generally found in other studies, an oral food challenge (OFC) is regularly proposed to assess cross‐allergy, as recommended by experts.To identify different disease phenotypes among PA children, cluster analysis has been applied. It is the first time that this strategy has been used to identify peanut cross‐allergic phenotypes.It has led to the discovery of three novel independent clusters: Cluster 1 is characterized by high level of rAra h 2, low threshold reactive doses for peanut, and high proportion of asthma; Cluster 2 is characterized by high threshold reactive doses for peanut and the lowest proportion of cross‐allergy to TN and/or legumes; and Cluster 3 has a high risk of cross‐allergy to TN and/or legumes and most patients suffer from eczema. These phenotypic profiles can be useful for identifying children with high risk of cross‐allergic reaction to TNs and legumes early after PA diagnosis.In conclusion, the three phenotypes identified in this study provide clinicians a means for an essential selection of clinical cases that enable an adapted management and education for both children and their parents, earlier after the diagnosis of PA.The association between parental consanguinity and primary immunodeficiency diseases: A systematic review and meta‐analysisPrimary immunodeficiencies (PIDs) are disorders of immune system caused by genetic defects, leading to increased susceptibility of life‐threatening infections. Most PIDs are inherited with the mode of inheritance as X‐linked recessive, autosomal recessive (AR), or autosomal dominant (AD). Consanguineous marriage—defined as a union between two persons related as second cousins or closer—increases the risk of AR disorders. Although studies have shown regional differences in the prevalence of some gene defects around the world, no study has yet accounted the prevalence of PIDs and consanguinity concurrently in such a large scale.In this study, Hadizadeh et al. conducted a meta‐analysis including 21 studies on a total population of 18901 individuals with PID diseases and calculated the prevalence odds ratio (POR) of parental consanguinity in each study compared to a matched healthy population. By reporting odds ratio, they tried to match variables such as culture and geographic region that are diverse and could contribute to the prevalence of parental consanguinity in PID patients.Results showed that the pooled odds of parental consanguinity are three times in PID patients. More interestingly, studying each disease subtype separately, the PORs were considerably higher in the PID diseases with AR inheritance patterns, with pooled odds of consanguinity even more than five times than the healthy population.Since practicing of consanguinity is still highly prevalent in some parts of the world, especially in the Eastern Mediterranean region, this study shows that increased education and general awareness is needed to inform the mass of the potential risks of inbreeding to reduce the incidence of such serious diseases.ReferencesSaleh‐Langenberg J, de Vries S, Bak E, Kollen BJ, Flokstra‐de Blok BMJ, Dubois AEJ. Incomplete and incorrect epinephrine auto‐injector training to food‐allergic patients by pharmacists in the Netherlands. Pediatr Allergy Immunol 2016: 28: 238–244.Cousin M, Verdun S, Seynave M, et al. Phenotypical characterization of peanut allergic children with differences in cross‐allergy to tree nuts and other legumes. Pediatr Allergy Immunol 2017: 28: 245–250.Hadizadeh H, Salehi M, Khoramnejad S, et al. The association between parental consanguinity and primary immunodeficiency diseases: a systematic review and meta‐analysis. Pediatr Allergy Immunol 2017: 28: 280–287. Published Online First: 28 February 2017. doi:10.1111/pai.12685 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Allergy and Immunology Wiley

Editor's Choice

Pediatric Allergy and Immunology , Volume 28 (3) – May 1, 2017
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References (3)

Publisher
Wiley
Copyright
Copyright © 2017 John Wiley & Sons A/S
ISSN
0905-6157
eISSN
1399-3038
DOI
10.1111/pai.12721
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Abstract

Incomplete and incorrect epinephrine auto‐injector training to food‐allergic patients by pharmacists in the NetherlandsFood‐allergic patients at high risk for (fatal) anaphylaxis should carry an epinephrine auto‐injector at all times. In the community, successful treatment of anaphylaxis relies on early and correct use of epinephrine auto‐injectors (EAI). Therefore, all food‐allergic patients and their family, but also other allergic patients at risk for anaphylaxis, should be provided with educational resources and training about when and how to administer an EAI. In the Netherlands, pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use an EAI. Saleh‐Langenberg et al. conducted the first study to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in Europe and the quality of EAI use instructions. Most pharmacists reported that they are confident that their knowledge is sufficient to care for food‐allergic patients. However, the study revealed suboptimal knowledge about food allergy among pharmacists in the northern Netherlands. This is an important addition to the previously reported international lack of allergy knowledge. The researchers also found that food‐allergic patients at high risk for anaphylaxis who receive their EAI from a pharmacy in the northern Netherlands are often not or incorrectly instructed on how to use an EAI. Given the importance of timely and correct administration of epinephrine in case of a (severe) food‐allergic reaction, improvement of demonstration accuracy is promptly needed. These data suggest that opportunities exist to improve the quality of care provided by pharmacists to food‐allergic patients.Phenotypical characterization of peanut‐allergic children with differences in cross‐allergy to tree nuts and other legumesPeanut allergy (PA), a widely studied allergy in pediatrics, has an estimated prevalence of 1.3% in Europe and tree nut (TN) allergy an estimated prevalence ranging from 0.05 to 4.9%. These conditions are clinically similar, often coexisting.In this study, Cousin et al. studied a large population of 317 children allergic to peanuts. This is one of the largest number of pediatric patients with a diagnosis of clinically significant cross‐allergy to TNs and/or other legumes. A retrospective study has been conducted, including all children with PA with a complete workup for cross‐allergy to TN and other legumes, performed at the Allergy Unit of the Saint Vincent Hospital of Lille (France) from a long period: March 2004 to May 2016. Unlike what is generally found in other studies, an oral food challenge (OFC) is regularly proposed to assess cross‐allergy, as recommended by experts.To identify different disease phenotypes among PA children, cluster analysis has been applied. It is the first time that this strategy has been used to identify peanut cross‐allergic phenotypes.It has led to the discovery of three novel independent clusters: Cluster 1 is characterized by high level of rAra h 2, low threshold reactive doses for peanut, and high proportion of asthma; Cluster 2 is characterized by high threshold reactive doses for peanut and the lowest proportion of cross‐allergy to TN and/or legumes; and Cluster 3 has a high risk of cross‐allergy to TN and/or legumes and most patients suffer from eczema. These phenotypic profiles can be useful for identifying children with high risk of cross‐allergic reaction to TNs and legumes early after PA diagnosis.In conclusion, the three phenotypes identified in this study provide clinicians a means for an essential selection of clinical cases that enable an adapted management and education for both children and their parents, earlier after the diagnosis of PA.The association between parental consanguinity and primary immunodeficiency diseases: A systematic review and meta‐analysisPrimary immunodeficiencies (PIDs) are disorders of immune system caused by genetic defects, leading to increased susceptibility of life‐threatening infections. Most PIDs are inherited with the mode of inheritance as X‐linked recessive, autosomal recessive (AR), or autosomal dominant (AD). Consanguineous marriage—defined as a union between two persons related as second cousins or closer—increases the risk of AR disorders. Although studies have shown regional differences in the prevalence of some gene defects around the world, no study has yet accounted the prevalence of PIDs and consanguinity concurrently in such a large scale.In this study, Hadizadeh et al. conducted a meta‐analysis including 21 studies on a total population of 18901 individuals with PID diseases and calculated the prevalence odds ratio (POR) of parental consanguinity in each study compared to a matched healthy population. By reporting odds ratio, they tried to match variables such as culture and geographic region that are diverse and could contribute to the prevalence of parental consanguinity in PID patients.Results showed that the pooled odds of parental consanguinity are three times in PID patients. More interestingly, studying each disease subtype separately, the PORs were considerably higher in the PID diseases with AR inheritance patterns, with pooled odds of consanguinity even more than five times than the healthy population.Since practicing of consanguinity is still highly prevalent in some parts of the world, especially in the Eastern Mediterranean region, this study shows that increased education and general awareness is needed to inform the mass of the potential risks of inbreeding to reduce the incidence of such serious diseases.ReferencesSaleh‐Langenberg J, de Vries S, Bak E, Kollen BJ, Flokstra‐de Blok BMJ, Dubois AEJ. Incomplete and incorrect epinephrine auto‐injector training to food‐allergic patients by pharmacists in the Netherlands. Pediatr Allergy Immunol 2016: 28: 238–244.Cousin M, Verdun S, Seynave M, et al. Phenotypical characterization of peanut allergic children with differences in cross‐allergy to tree nuts and other legumes. Pediatr Allergy Immunol 2017: 28: 245–250.Hadizadeh H, Salehi M, Khoramnejad S, et al. The association between parental consanguinity and primary immunodeficiency diseases: a systematic review and meta‐analysis. Pediatr Allergy Immunol 2017: 28: 280–287. Published Online First: 28 February 2017. doi:10.1111/pai.12685

Journal

Pediatric Allergy and Immunology – Wiley

Published: May 1, 2017

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