Publications by authors named "Wade Watson"

42 Publications

Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis.

J Allergy Clin Immunol Pract 2021 Feb 4. Epub 2021 Feb 4.

Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.

Background: Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines.

Objectives: A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis.

Methods: Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis.

Results: Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P = .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine.

Conclusion: The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.
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http://dx.doi.org/10.1016/j.jaip.2021.01.038DOI Listing
February 2021

Infant Peanut Introduction Simplified.

Pediatr Rev 2019 May;40(5):211-218

Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1542/pir.2018-0223DOI Listing
May 2019

Correction to: Eosinophilic esophagitis.

Allergy Asthma Clin Immunol 2019 10;15:22. Epub 2019 Apr 10.

4Division of Allergy, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS Canada.

[This corrects the article DOI: 10.1186/s13223-018-0287-0.].
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http://dx.doi.org/10.1186/s13223-019-0336-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456987PMC
April 2019

Eosinophilic esophagitis.

Allergy Asthma Clin Immunol 2018 12;14(Suppl 2):58. Epub 2018 Sep 12.

4Division of Allergy, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS Canada.

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized over the last 15 years. Diagnosis of the disorder is dependent on the patient's clinical manifestations, and must be confirmed by histologic findings on esophageal mucosal biopsies. Patients with EoE should be referred to an allergist for optimal management, which may include dietary modifications and pharmacologic agents such as corticosteroids, and for the diagnosis and management of comorbid atopic conditions. Mechanical dilation of the esophagus may also be necessary. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review.
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http://dx.doi.org/10.1186/s13223-018-0287-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157152PMC
September 2018

Early introduction of foods to prevent food allergy.

Allergy Asthma Clin Immunol 2018 12;14(Suppl 2):57. Epub 2018 Sep 12.

3Division of Allergy, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS Canada.

Food allergy is a growing public health problem, and in many affected individuals, the food allergy begins early in life and persists as a lifelong condition (e.g., peanut allergy). Although early clinical practice guidelines recommended delaying the introduction of peanut and other allergenic foods in children, this may have in fact contributed to the dramatic increase in the prevalence of food allergy in recent decades. In January 2017, new guidelines on peanut allergy prevention were released which represented a significant paradigm shift in early food introduction. Development of these guidelines was prompted by findings from the Learning Early About Peanut Allergy study-the first randomized trial to investigate early allergen introduction as a strategy to prevent peanut allergy. This article will review and compare the new guidelines with previous guidelines on food introduction, and will also review recent evidence that has led to the paradigm shift in early food introduction.
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http://dx.doi.org/10.1186/s13223-018-0286-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157280PMC
September 2018

Atopic dermatitis.

Allergy Asthma Clin Immunol 2018 12;14(Suppl 2):52. Epub 2018 Sep 12.

2Department of Pediatrics, University of Alberta, Edmonton, AB Canada.

Atopic dermatitis (AD) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents, and immune dysregulation. There are no diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that take into account the patient's history and clinical manifestations. Successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors, the management of pruritus, and the treatment of skin infections. Systemic immunosuppressive agents may also be used, but are generally reserved for severe flare-ups or more difficult-to-control disease. Topical corticosteroids are the first-line pharmacologic treatments for AD, and evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. Although the prognosis for patients with AD is generally favourable, those patients with severe, widespread disease and concomitant atopic conditions, such as asthma and allergic rhinitis, are likely to experience poorer outcomes.
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http://dx.doi.org/10.1186/s13223-018-0281-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157251PMC
September 2018

IgE-mediated food allergy.

Allergy Asthma Clin Immunol 2018 12;14(Suppl 2):55. Epub 2018 Sep 12.

3IWK Health Centre, Division of Allergy, Department of Pediatrics, Dalhousie University, Halifax, NS Canada.

Food allergy is defined as an adverse immunologic response to a food protein. Food-related reactions are associated with a broad range of signs and symptoms that may involve any body system, including the skin, gastrointestinal and respiratory tracts, and cardiovascular system. Immunoglobulin E (IgE)-mediated food allergy is a leading cause of anaphylaxis and, therefore, referral to an allergist for timely and appropriate diagnosis and treatment is imperative. Diagnosis entails a careful history and diagnostic tests, such as skin prick tests, serum-specific IgE and, if indicated, an oral food challenge. Once the diagnosis of food allergy is confirmed, strict elimination of the offending food allergen from the diet is generally necessary; however, in the case of cow's milk and egg allergy, many allergic children are able to eat these foods in their baked form. This article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of IgE-mediated food allergy.
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http://dx.doi.org/10.1186/s13223-018-0284-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156835PMC
September 2018

An introduction to immunology and immunopathology.

Allergy Asthma Clin Immunol 2018 12;14(Suppl 2):49. Epub 2018 Sep 12.

4Western University, London, ON Canada.

Beyond structural and chemical barriers to pathogens, the immune system has two fundamental lines of defense: innate immunity and adaptive immunity. Innate immunity is the first immunological mechanism for fighting against an intruding pathogen. It is a rapid immune response, initiated within minutes or hours after aggression, that has no immunologic memory. Adaptive immunity, on the other hand, is antigen-dependent and antigen-specific; it has the capacity for memory, which enables the host to mount a more rapid and efficient immune response upon subsequent exposure to the antigen. There is a great deal of synergy between the adaptive immune system and its innate counterpart, and defects in either system can provoke illness or disease, such as inappropriate inflammation, autoimmune diseases, immunodeficiency disorders and hypersensitivity reactions. This article provides a practical overview of innate and adaptive immunity, and describes how these host defense mechanisms are involved in both heath and illness.
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http://dx.doi.org/10.1186/s13223-018-0278-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156898PMC
September 2018

Wheeze trajectories are modifiable through early-life intervention and predict asthma in adolescence.

Pediatr Allergy Immunol 2018 09 19;29(6):612-621. Epub 2018 Jun 19.

Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.

Background: The objectives of this study were to identify developmental trajectories of wheezing using data-driven methodology, and to examine whether trajectory membership differentially impacts the effectiveness of primary preventive efforts that target modifiable asthma risk factors.

Methods: Secondary analysis of the Canadian Asthma Primary Prevention Study (CAPPS), a multifaceted prenatal intervention among children at high risk of asthma, followed from birth to 15 years. Wheezing trajectories were identified by latent class growth analysis. Predictors, intervention effects, and asthma diagnoses were examined between and within trajectory groups.

Results: Among 525 children, 3 wheeze trajectory groups were identified: Low-Progressive (365, 69%), Early-Transient (52, 10%), and Early-Persistent (108, 21%). The study intervention was associated with lower odds of Early-Transient and Early-Persistent wheezing (P < .01). Other predictors of wheeze trajectories included, maternal asthma, maternal education, city of residence, breastfeeding, household pets, infant sex and atopy at 12 months. The odds of an asthma diagnosis were three-fold to six-fold higher in the Early-Persistent vs Low-Progressive group at all follow-up assessments (P = .03), whereas Early-Transient wheezing (limited to the first year) was not associated with asthma. In the Early-Persistent group, the odds of wheezing were lower among intervention than control children (adjusted odds ratio: 0.67; 95% CI: 0.48; 0.93) at 7 years.

Conclusions: Using data-driven methodology, children can be classified into clinically meaningful wheeze trajectory groups that appear to be programmed by modifiable and non-modifiable factors, and are useful for predicting asthma risk. Early-life interventions can alter some wheeze trajectories (ie, Early-Persistent) in infancy and reduce wheezing prevalence in mid-childhood.
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http://dx.doi.org/10.1111/pai.12922DOI Listing
September 2018

Reply.

J Allergy Clin Immunol 2018 04 1;141(4):1538-1539. Epub 2018 Feb 1.

University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaci.2017.11.039DOI Listing
April 2018

Les arachides devraient-elles être permises dans les écoles? Non.

Can Fam Physician 2017 Oct;63(10):e405-e407

Directeur associé du perfectionnement professoral au Département de pédiatrie de l'Université Dalhousie et directeur de la Division des allergies au Centre de santé IWKI à Halifax, en Nouvelle-Écosse.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638487PMC
October 2017

Les arachides devraient-elles être permises dans les écoles? Oui.

Can Fam Physician 2017 Oct;63(10):e404-e405

Directeur associé du perfectionnement professoral au Département de pédiatrie de l'Université Dalhousie et directeur de la Division des allergies au Centre de santé IWKI à Halifax, en Nouvelle-Écosse.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638486PMC
October 2017

Should peanut be allowed in schools? No.

Can Fam Physician 2017 10;63(10):751-752

Associate Chair of Faculty Development in the Department of Pediatrics at Dalhousie University and Head of the Division of Allergy at IWK Health Centre in Halifax, NS.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638467PMC
October 2017

Should peanut be allowed in schools? Yes.

Can Fam Physician 2017 10;63(10):750-751

Associate Chair of Faculty Development in the Department of Pediatrics at Dalhousie University and Head of the Division of Allergy at IWK Health Centre in Halifax, NS.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638466PMC
October 2017

Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction.

J Allergy Clin Immunol 2018 02 12;141(2):620-625.e1. Epub 2017 Sep 12.

Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada. Electronic address:

Background: Recent trials have shown that avoiding peanuts during infancy increases the risk of peanut allergy; however, these studies did not address maternal peanut consumption.

Objective: We sought to investigate the relationship between maternal peanut consumption while breast-feeding, timing of direct peanut introduction, and peanut sensitization at age 7 years.

Methods: Secondary analysis of a nested cohort within the 1995 Canadian Asthma Primary Prevention Study intervention study was performed. Breast-feeding and maternal and infant peanut consumption were captured by repeated questionnaires during infancy. Skin prick testing for peanut sensitization was performed at age 7 years.

Results: Overall, 58.2% of mothers consumed peanuts while breast-feeding and 22.5% directly introduced peanuts to their infant by 12 months. At 7 years, 9.4% of children were sensitized to peanuts. The lowest incidence (1.7%) was observed among children whose mothers consumed peanuts while breast-feeding and directly introduced peanuts before 12 months. Incidence was significantly higher (P < .05) if mothers consumed peanuts while breast-feeding but delayed introducing peanuts to their infant beyond 12 months (15.1%), or if mothers avoided peanuts themselves but directly introduced peanuts by 12 months (17.6%). Interaction analyses controlling for study group and maternal atopy confirmed that maternal peanut consumption while breast-feeding and infant peanut consumption by 12 months were protective in combination, whereas either exposure in isolation was associated with an increased risk of sensitization (P interaction = .003).

Conclusions: In this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.
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http://dx.doi.org/10.1016/j.jaci.2017.06.024DOI Listing
February 2018

Symptomatic adrenal suppression among children in Canada.

Arch Dis Child 2017 04 9;102(4):338-339. Epub 2016 Nov 9.

Department of Pediatrics (Endocrinology), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.

Background: Adrenal suppression (AS) is an under-recognised side effect of glucocorticoid (GC) use. AS may go undetected until a physiological stress precipitates an adrenal crisis. The incidence of AS has not been established. We sought to estimate the minimum national incidence and presenting features of paediatric AS.

Methods: Through the established methodology of the Canadian Paediatric Surveillance Program, over 2500 paediatricians were surveyed monthly for 2 years (April 2010-March 2012) to report new cases of symptomatic AS.

Results: Forty-six cases of symptomatic AS were confirmed. The estimated annual incidence is 0.35/100 000 children aged 0-18 years (95% CI 0.26 to 0.47). The most common presentations were growth failure (35%), non-specific symptoms (28%) or both (13%). Adrenal crisis occurred in six cases (13%). Thirty-seven children (80%) had received inhaled corticosteroid (ICS) alone or in combination with other GC forms. Many children received high but commonly prescribed doses of ICS.

Conclusions: AS is responsible for significant morbidity in children, including susceptibility to adrenal crisis. The minimal estimated incidence reported is for the entire paediatric population and would be much higher in the at-risk group (ie, children treated with GCs). Close monitoring of growth and possible symptoms of AS, which may be non-specific, are important in children on all forms of GC therapy including ICS. To reduce the risk of AS, physicians must be aware of the risk of AS, revisit GC doses frequently and use the lowest effective dose.
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http://dx.doi.org/10.1136/archdischild-2016-311223DOI Listing
April 2017

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

Paediatr Child Health 2015 Oct;20(7):353-71

Department of Pediatrics, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Dalhousie University, Halifax, Nova Scotia.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614088PMC
http://dx.doi.org/10.1093/pch/20.7.353DOI Listing
October 2015

CSACI position statement: epinephrine auto-injectors and children < 15 kg.

Allergy Asthma Clin Immunol 2015 12;11(1):20. Epub 2015 Jun 12.

Western University, London, ON Canada ; McMaster University, Hamilton, ON Canada.

Epinephrine (adrenaline) is the treatment of choice for anaphylaxis. While other medications, including H1-antihistamines, H2-antihistamines, corticosteroids, and inhaled beta-2 agonists are often used to treat anaphylaxis in the emergency setting, none of these medications has been shown to reverse anaphylaxis. Fatal anaphylaxis is related to the delayed use of epinephrine. In community settings, epinephrine is available as an auto-injector in two doses, 0.15 mg and 0.3 mg. The recommended dose for children is 0.01 mg per kilogram. For infants at risk of anaphylaxis in the community, there are few options with regard to providing an optimal epinephrine dose for first-aid treatment. The Canadian Society of Allergy and Immunology (CSACI) therefore recommends, for the child weighing less than 15 kg, given the lack of a suitable alternative, prescribing the 0.15 mg epinephrine autoinjector. Adverse effects of an epinephrine dose of 0.15 mg given intramuscularly in infants or children weighing less than 15 kg are expected to be mild and transient at the plasma epinephrine concentrations achieved; therefore, these effects need to be measured against the consequences of not receiving epinephrine at all, which can include fatality.
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http://dx.doi.org/10.1186/s13223-015-0086-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485331PMC
July 2015

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

Can Respir J 2015 May-Jun;22(3):135-43. Epub 2015 Apr 20.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470545PMC
http://dx.doi.org/10.1155/2015/101572DOI Listing
March 2016

Removal of peanut allergen Ara h 1 from common hospital surfaces, toys and books using standard cleaning methods.

Allergy Asthma Clin Immunol 2015 23;11(1). Epub 2015 Jan 23.

Department of Pediatrics, Dalhousie University, Halifax, NS Canada ; IWK Health Centre, 5850/5980 University Avenue, Halifax, NS Canada B3K 6R8.

Background: In children, a diagnosis of peanut allergy causes concern about accidental exposure because even small amounts of peanut protein could trigger an allergic reaction. Contamination of toys, books or other items by peanut butter in areas where individuals have eaten may occur in hospital waiting rooms and cafeterias. It is not known if hospital cleaning wipes are effective in removing peanut allergen.

Objectives: The purpose of this study was to determine whether cleaning peanut contaminated items with common household and hospital cleaning wipes would remove peanut allergen.

Methods: 5 mL of peanut butter was evenly smeared on a 12 inch by 12 inch (30.5 by 30.5 cm) square on a nonporous (laminated plastic) table surface, a plastic doll, and a textured plastic ball, and 2.5 mL was applied to smooth and textured book covers. Samples for measurement of Ara h 1 were collected prior to the application of the peanut butter (baseline), and after cleaning with a common household wipe and two commercial hospital wipes. A monoclonal-based ELISA for arachis hypogaea allergen 1 (Ara h 1), range of detection 1.95-2000 ng/mL, was used to assess peanut allergen on each item. The samples were diluted 1:50 for testing.

Results: At baseline, there was no detectable Ara h 1 allergen on any item at baseline. Detectable Ara h 1 was detected on all products after applying peanut butter (range 1.2-19.0 micrograms/mL). After cleaning with any product, no Ara h 1 was detected on any item.

Conclusions: Table surfaces, book covers and plastic toys can be cleaned to remove peanut allergen Ara h 1 using common household and hospital cleaning wipes. Regular cleaning of these products or cleaning prior to their use should be promoted to reduce the risk of accidental peanut exposure, especially in areas where they have been used by many children.
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http://dx.doi.org/10.1186/s13223-015-0069-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312450PMC
February 2015

Impact of primary food allergies on the introduction of other foods amongst Canadian children and their siblings.

Allergy Asthma Clin Immunol 2014 27;10(1):26. Epub 2014 May 27.

Division of Allergy, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada.

Background: Food-allergic children frequently avoid other highly allergenic foods. The NIAID 2010 guidelines state that individuals with an IgE-mediated food allergy should avoid their specific allergens and physicians should help patients to decide whether certain cross-reactive foods also should be avoided. Patients at risk for developing food allergy do not need to limit exposure to foods that may be cross-reactive with the major food allergens. The purpose of this study was to determine if parents of food-allergic children are given advice regarding introduction of allergenic foods; if these foods are avoided or delayed; if there is anxiety when introducing new foods; and if introducing other allergenic foods leads to any allergic reaction. The study also determined if there was a similar pattern seen amongst younger siblings.

Methods: An online survey was administered between December 2011 and March 2012 via Anaphylaxis Canada's website, available to Canadian parents and caregivers who are registered members of the organization and who have a child with a food allergy.

Results: 644 parents completed the online survey. 51% of families were given advice regarding the introduction of other allergenic foods. 72% were told to avoid certain foods, and 41% to delay certain foods. 58% of parents did avoid or delay other highly allergenic foods, mainly due to a fear of allergic reaction. 69% of children did not have an allergic reaction when these foods were subsequently introduced. 68% of parents felt moderate or high levels of anxiety when introducing other foods. A similar pattern was seen amongst the younger siblings.

Conclusions: Canadian parents and caregivers of children with food allergies receive varied advice from health care professionals regarding the introduction of new allergenic foods, and feel moderate to high levels of anxiety. A similar pattern may be seen amongst younger siblings. While the majority of children in our study did not have an allergic reaction to a new food, a significant proportion of children did react. A more consistent approach to the advice given by health care professionals may decrease parental anxiety. Further research to support the 2010 NIAID guidelines may be necessary to clarify recommendations.
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http://dx.doi.org/10.1186/1710-1492-10-26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063690PMC
June 2014

Dietary exposures and allergy prevention in high-risk infants: a joint position statement of the Canadian Society of Allergy and Clinical Immunology and the Canadian Paediatric Society.

Allergy Asthma Clin Immunol 2014 2;10(1):45. Epub 2014 Sep 2.

Department of Pediatrics, Dalhousie University, Division of Allergy, IWK Health Centre, Halifax, NS Canada.

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk of developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula-feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. This article has already been published (Paediatr Child Health. 2013 Dec;18(10):545-54), and is being re-published with permission from the original publisher, the Canadian Paediatric Society.
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http://dx.doi.org/10.1186/1710-1492-10-45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407306PMC
April 2015

Persistence of peanut allergen on a table surface.

Allergy Asthma Clin Immunol 2013 Feb 18;9(1). Epub 2013 Feb 18.

Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.

Background: A diagnosis of peanut allergy has a major impact on an individual's quality of life. Exposure to even small amounts of peanut can trigger serious reactions. Common cleaning agents can easily remove peanut allergen from surfaces such as table tops. Parents of children with peanut allergy frequently ask if peanut allergen can persist on surfaces if they have not been cleaned.

Objectives: The purpose of this study was to determine the persistence of peanut allergen on a typical table surface over time.

Methods: Five mL of peanut butter was evenly smeared on a 12 inch by 12 inch (30.5 by 30.5 cm) square on a nonporous (laminated plastic) table surface. Five squares were prepared in the same manner. The table was kept in a regular hospital office at room temperature and ambient lighting. No cleaning occurred for 110 days. Samples were taken at regular intervals from different areas each time. A monoclonal-based ELISA for arachis hypogaea allergen 1 (Ara h 1), range of detection 1.95-2000 ng/mL, was used to assess peanut allergen on the table surface.

Results: At baseline, there was no detectable Ara h 1 allergen. Immediately post application and for 110 days of collecting, detectable Ara h 1 was found each time a sample was taken. There was no obvious allergen degradation over time. Active cleaning of the contaminated surface with a commercial cleaning wipe resulted in no detectable Ara h 1 allergen.

Conclusions: Peanut allergen is very robust. Detectable Ara h 1 was present on the table surface for 110 days. Active cleaning of peanut contaminated surfaces easily removed peanut residue and allergen. Regular cleaning of surfaces before and after eating should be reinforced as a safety measure for all individuals with peanut allergy.
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http://dx.doi.org/10.1186/1710-1492-9-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599460PMC
February 2013

Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors.

Ann Allergy Asthma Immunol 2013 Jan 8;110(1):24-8. Epub 2012 Nov 8.

Chan-Yeung Centre for Occupational and Environmental Lung Disease Unit, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Background: Atopic dermatitis (AD) is commonly associated with asthma and other atopic disorders in childhood.

Objective: To evaluate the natural history of AD and its association with other allergic outcomes in a high-risk cohort through the age of 7 years.

Methods: A total of 373 high-risk infants, who had undergone a randomized controlled trial with intervention measures for primary prevention of asthma applied during the first year of life, were assessed for asthma, AD, and allergic sensitization at 1, 2, and 7 years.

Results: The multifaceted intervention program did not reduce AD despite reducing the prevalence of asthma significantly. Sixty-two children (16.6%) had AD during the first 2 years (early-onset AD); of these, 26 continue to have AD at the age of 7 years (persistent), whereas 36 no longer had the disease (nonpersistent) at the age of 7 years. Twenty-three children (6.2%) developed AD only after the age of 2 years (late-onset AD). Early-onset AD, persistent or nonpersistent, was associated with increased risk of allergic sensitization to food allergens within the first 2 years of life and asthma diagnosis at year 7. However, only persistent AD was associated with an increased risk of other atopic diseases and allergic sensitization to food and aeroallergens at year 7. Late-onset AD was not associated with atopic diseases or allergic sensitization at year 7 with the exception of Alternaria alternans.

Conclusion: In this cohort of infants at high risk of asthma, early-onset persistent AD, which was highly associated with atopic sensitization, increased the risk of atopic diseases in later childhood and thus appears to be part of the atopic march.
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http://dx.doi.org/10.1016/j.anai.2012.10.005DOI Listing
January 2013

Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults.

Can Respir J 2012 Mar-Apr;19(2):127-64

Background: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and⁄or gaps in the previous guidelines.

Methods: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations.

Results: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified.

Conclusions: The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee's new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373283PMC
http://dx.doi.org/10.1155/2012/635624DOI Listing
September 2012

Introduction from the editors.

Allergy Asthma Clin Immunol 2011 Nov 10;7 Suppl 1:I1. Epub 2011 Nov 10.

McMaster University, Hamilton, Ontario, Canada.

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http://dx.doi.org/10.1186/1710-1492-7-S1-I1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245431PMC
November 2011

Food allergy.

Allergy Asthma Clin Immunol 2011 Nov 10;7 Suppl 1:S7. Epub 2011 Nov 10.

Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.

Food allergy is defined as an adverse immunologic response to a dietary protein. Food-related reactions are associated with a broad array of signs and symptoms that may involve many bodily systems including the skin, gastrointestinal and respiratory tracts, and cardiovascular system. Food allergy is a leading cause of anaphylaxis and, therefore, referral to an allergist for appropriate and timely diagnosis and treatment is imperative. Diagnosis involves a careful history and diagnostic tests, such as skin prick testing, serum-specific immunoglobulin E (IgE) testing and, if indicated, oral food challenges. Once the diagnosis of food allergy is confirmed, strict elimination of the offending food allergen from the diet is generally necessary. For patients with significant systemic symptoms, the treatment of choice is epinephrine administered by intramuscular injection into the lateral thigh. Although most children "outgrow" allergies to milk, egg, soy and wheat, allergies to peanut, tree nuts, fish and shellfish are often lifelong. This article provides an overview of the epidemiology, pathophysiology, diagnosis, management and prognosis of patients with food allergy.
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http://dx.doi.org/10.1186/1710-1492-7-S1-S7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245440PMC
November 2011

Atopic dermatitis.

Allergy Asthma Clin Immunol 2011 Nov 10;7 Suppl 1:S4. Epub 2011 Nov 10.

Dalhousie University, Division of Allergy, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.

Atopic dermatitis (AD) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents, and immune abnormalities. There are no specific diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that take into account the patient's history and clinical manifestations. Successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors (TCIs), the use of first-generation antihistamines to help manage sleep disturbances, and the treatment of skin infections. Systemic corticosteroids may also be used, but are generally reserved for the acute treatment of severe flare-ups. Topical corticosteroids are the first-line pharmacologic treatments for AD, and evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. Although the prognosis for patients with AD is generally favourable, those patients with severe, widespread disease and concomitant atopic conditions, such as asthma and allergic rhinitis, are likely to experience poorer outcomes.
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http://dx.doi.org/10.1186/1710-1492-7-S1-S4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245437PMC
November 2011

Eosinophilic esophagitis.

Allergy Asthma Clin Immunol 2011 Nov 10;7 Suppl 1:S8. Epub 2011 Nov 10.

University of Alberta, Division of Clinical Immunology & Allergy, Edmonton, Alberta, Canada.

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized over the last decade. Diagnosis of the disorder is dependent on the patient's clinical manifestations and histologic findings on esophageal mucosal biopsies. Patients with eosinophilic esophagitis should be referred to both an allergist and gastroenterologist for optimal management, which may include dietary modifications, pharmacologic agents such as corticosteroids, leukotriene modifiers and biologics as well as mechanical dilatation of the esophagus. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review.
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http://dx.doi.org/10.1186/1710-1492-7-S1-S8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245441PMC
November 2011