Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Stefania Arasi; Ulugbek Nurmatov; Audrey Dunn-Galvin; Shahd Daher; Graham Roberts; Paul J. Turner; Sayantani B. Shinder; Ruchi Gupta; Philippe Eigenmann; Anna Nowak-Wegrzyn; Mario A. Sánchez Borges; Ignacio J. Ansotegui; Montserrat Fernandez-Rivas; Stavros Petrou; Luciana Kase Tanno; Marta Vazquez-Ortiz; Brian P. Vickery; Gary Wing Kin Wong; Motohiro Ebisawa; Alessandro Fiocchi

doi:10.1016/j.waojou.2020.100503

Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Stefania Arasi^*, Ulugbek Nurmatov, Audrey Dunn-Galvin, Shahd Daher, Graham Roberts, Paul J. Turner, Sayantani B. Shinder, Ruchi Gupta, Philippe Eigenmann, Anna Nowak-Wegrzyn, Mario A. Sánchez Borges, Ignacio J. Ansotegui, Montserrat Fernandez-Rivas, Stavros Petrou, Luciana Kase Tanno, Marta Vazquez-Ortiz, Brian P. Vickery, Gary Wing Kin Wong, Motohiro Ebisawa, Alessandro Fiocchi

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Review article › peer-review

39 Scopus citations

Abstract

Background and aims: The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods: We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. Results: We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. Conclusions: There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. Systematic review registration: A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).

Original language	English (US)
Article number	100503
Journal	World Allergy Organization Journal
Volume	14
Issue number	3
DOIs	https://doi.org/10.1016/j.waojou.2020.100503
State	Published - Mar 2021

Funding

This is a project of the World Allergy Organization (WAO), supported by a grant from Novartis , as well as Abbott Laboratories and Food Allergy Research & Education (FARE) . WAO funded the systematic review to support the development of the international consensus on the definition of severe food allergy. The funder and supporters had no role in the development of the protocol nor in the conduct of the systematic review or its publication. Ruchi Gupta: grants from The National Institute of Health (NIH) (R21 ID # AI135705, R01 ID# AI130348, U01 ID # AI138907), Rho Inc., Stanford Sean N. Parker Center for Allergy Research, UnitedHealth Group, Thermo Fisher Scientific, Genentech, and the National Confectioners Association (NCA); is employed by Ann & Robert H. Lurie Children's Hospital of Chicago; is a Professor of Pediatrics at Northwestern University; and serves as a medical consultant/advisor for Before Brands, Kaléo Inc., Genentech, ICER, FARE, Aimmune Therapeutics, and DBV Technologies; Paul J Turner: grants from UK Medical Research Council , NIHR/Imperial BRC , JM Charitable Foundation and UK Food Standards Agency ; personal fees from UK Food Standards Agency, DBV Technologies, ILSI Europe and Allergenis, non-financial support from Aimmune Therapeutics; Philippe Eigenmann: Research grants and support: Ulrich Muller Gierock Foundation , ThermoFisher Scientific ; Consultant: DBV technologies, Nesté, Danone, Novartis, Abbott; Speaking engagements: ThermoFisher Scientific, ALK, Abbott; Stock options: DBV technologies; Montserrat Fernandez-Rivas: research grants from the Spanish Government ( MINECO , ISCIII) for the project SOLMILK, ARADyAL network and PI19/01095; consultancy fees from Aimmune, DBV, Novartis, SPRIM; lecture fees from ALK, Allergy Therapeutics, Diater, GSK, HAL Allergy, Thermofisher Scientific; This is a project of the World Allergy Organization (WAO), supported by a grant from Novartis, as well as Abbott Laboratories and Food Allergy Research & Education (FARE). WAO funded the systematic review to support the development of the international consensus on the definition of severe food allergy. The funder and supporters had no role in the development of the protocol nor in the conduct of the systematic review or its publication.Paul J Turner: grants from UK Medical Research Council, NIHR/Imperial BRC, JM Charitable Foundation and UK Food Standards Agency; personal fees from UK Food Standards Agency, DBV Technologies, ILSI Europe and Allergenis, non-financial support from Aimmune Therapeutics;Sayantani B Sindher: supported by NIH grants. Involved in clinical trials with Regeneron, Aimmune Therapeutics, DBV Technologies, Adare Pharmaceuticals, Sanofi, Novartis;Ruchi Gupta: grants from The National Institute of Health (NIH) (R21 ID # AI135705, R01 ID# AI130348, U01 ID # AI138907), Rho Inc., Stanford Sean N. Parker Center for Allergy Research, UnitedHealth Group, Thermo Fisher Scientific, Genentech, and the National Confectioners Association (NCA); is employed by Ann & Robert H. Lurie Children's Hospital of Chicago; is a Professor of Pediatrics at Northwestern University; and serves as a medical consultant/advisor for Before Brands, Kaléo Inc., Genentech, ICER, FARE, Aimmune Therapeutics, and DBV Technologies;Philippe Eigenmann: Research grants and support: Ulrich Muller Gierock Foundation, ThermoFisher Scientific; Consultant: DBV technologies, Nesté, Danone, Novartis, Abbott; Speaking engagements: ThermoFisher Scientific, ALK, Abbott; Stock options: DBV technologies;Anna Nowak-Wegrzyn: Grant/Research/Clinical Trial Support: DBV Technologies; ITN/NIAID; Astellas Pharmaceutical; Sanofi-Aventis [Future therapies for food allergy]. International FPIES Association [FPIES, unpaid advisor]. Consultant/Advisory Boards: Gerber Nutrition Institute; Merck. Speaking engagements: Nestle, Thermofisher Scientific;Montserrat Fernandez-Rivas: research grants from the Spanish Government (MINECO, ISCIII) for the project SOLMILK, ARADyAL network and PI19/01095; consultancy fees from Aimmune, DBV, Novartis, SPRIM; lecture fees from ALK, Allergy Therapeutics, Diater, GSK, HAL Allergy, Thermofisher Scientific;Brian P Vickery: Employment: Pediatric Institute of Emory University + Children's Healthcare of Atlant; Consultant/Advisor: Aimmune Therapeutics; AllerGenis, LLC; Food Allergy Research and Education (FARE); Reacta Biosciences; Grant support: NIH-NIAID; FARE; Genentech; Clinical investigator: Aimmune; DBV Technologies; Regeneron; Sayantani B Sindher: supported by NIH grants. Involved in clinical trials with Regeneron, Aimmune Therapeutics, DBV Technologies, Adare Pharmaceuticals, Sanofi, Novartis;

Keywords

Definition
Food allergy
Mixed-methods study
Severity
Systematic review

ASJC Scopus subject areas

Immunology and Allergy
Immunology
Pulmonary and Respiratory Medicine

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10.1016/j.waojou.2020.100503

Cite this

Arasi, S., Nurmatov, U., Dunn-Galvin, A., Daher, S., Roberts, G., Turner, P. J., Shinder, S. B., Gupta, R., Eigenmann, P., Nowak-Wegrzyn, A., Sánchez Borges, M. A., Ansotegui, I. J., Fernandez-Rivas, M., Petrou, S., Tanno, L. K., Vazquez-Ortiz, M., Vickery, B. P., Wong, G. W. K., Ebisawa, M., & Fiocchi, A. (2021). Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review. World Allergy Organization Journal, 14(3), Article 100503. https://doi.org/10.1016/j.waojou.2020.100503

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title = "Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review",

abstract = "Background and aims: The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods: We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. Results: We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. Conclusions: There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. Systematic review registration: A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).",

keywords = "Definition, Food allergy, Mixed-methods study, Severity, Systematic review",

author = "Stefania Arasi and Ulugbek Nurmatov and Audrey Dunn-Galvin and Shahd Daher and Graham Roberts and Turner, {Paul J.} and Shinder, {Sayantani B.} and Ruchi Gupta and Philippe Eigenmann and Anna Nowak-Wegrzyn and {S{\'a}nchez Borges}, {Mario A.} and Ansotegui, {Ignacio J.} and Montserrat Fernandez-Rivas and Stavros Petrou and Tanno, {Luciana Kase} and Marta Vazquez-Ortiz and Vickery, {Brian P.} and Wong, {Gary Wing Kin} and Motohiro Ebisawa and Alessandro Fiocchi",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = mar,

doi = "10.1016/j.waojou.2020.100503",

language = "English (US)",

volume = "14",

journal = "World Allergy Organization Journal",

issn = "1939-4551",

publisher = "Elsevier Inc.",

number = "3",

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Arasi, S, Nurmatov, U, Dunn-Galvin, A, Daher, S, Roberts, G, Turner, PJ, Shinder, SB, Gupta, R, Eigenmann, P, Nowak-Wegrzyn, A, Sánchez Borges, MA, Ansotegui, IJ, Fernandez-Rivas, M, Petrou, S, Tanno, LK, Vazquez-Ortiz, M, Vickery, BP, Wong, GWK, Ebisawa, M & Fiocchi, A 2021, 'Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review', World Allergy Organization Journal, vol. 14, no. 3, 100503. https://doi.org/10.1016/j.waojou.2020.100503

TY - JOUR

T1 - Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

AU - Arasi, Stefania

AU - Nurmatov, Ulugbek

AU - Dunn-Galvin, Audrey

AU - Daher, Shahd

AU - Roberts, Graham

AU - Turner, Paul J.

AU - Shinder, Sayantani B.

AU - Gupta, Ruchi

AU - Eigenmann, Philippe

AU - Nowak-Wegrzyn, Anna

AU - Sánchez Borges, Mario A.

AU - Ansotegui, Ignacio J.

AU - Fernandez-Rivas, Montserrat

AU - Petrou, Stavros

AU - Tanno, Luciana Kase

AU - Vazquez-Ortiz, Marta

AU - Vickery, Brian P.

AU - Wong, Gary Wing Kin

AU - Ebisawa, Motohiro

AU - Fiocchi, Alessandro

PY - 2021/3

Y1 - 2021/3

N2 - Background and aims: The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods: We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. Results: We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. Conclusions: There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. Systematic review registration: A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).

AB - Background and aims: The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods: We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. Results: We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. Conclusions: There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. Systematic review registration: A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).

KW - Definition

KW - Food allergy

KW - Mixed-methods study

KW - Severity

KW - Systematic review

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U2 - 10.1016/j.waojou.2020.100503

DO - 10.1016/j.waojou.2020.100503

M3 - Review article

C2 - 33767801

AN - SCOPUS:85102309990

SN - 1939-4551

VL - 14

JO - World Allergy Organization Journal

JF - World Allergy Organization Journal

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ER -

Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

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