Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology最新文献

{"title":"Mindset in food immunotherapy.","authors":"Dora F Zhou, Peter K Smith, Adam Fox","doi":"10.1111/pai.70218","DOIUrl":"https://doi.org/10.1111/pai.70218","url":null,"abstract":"<p><strong>Background: </strong>Mindset-the attitudes, beliefs and expectations an individual holds-plays a critical yet often underappreciated role in managing food allergies, particularly in the context of oral immunotherapy (OIT). Emotional states such as stress and anxiety can amplify allergic responses and shape how patients experience OIT, influencing adherence and perceived risk.</p><p><strong>Evidence: </strong>Experimental studies from behavioural conditioning, neuroimmunology and placebo research demonstrate that psychological factors can modulate immune function, even in the absence of allergens. These effects are mediated through learned associations and expectation-driven physiological responses. Symptom framing also exerts measurable influence on emotional responses. Presenting mild OIT symptoms as 'positive signals' rather than 'side effects' has been shown to improve retention and adherence. The Preparing Patients for Oral Immunotherapy (PPOINT) expert consensus guidelines highlight the importance of recognising both patient and parent mindsets in education and clinical practice. This approach acknowledges the mental challenges inherent in OIT and helps to empower patients and their families in navigating them. Age and developmental stage strongly influence outcomes. Younger children more frequently achieve higher adherence, desensitisation and remission, while older children and adolescents are more prone to anxiety and taste aversion. Parental anxiety can further amplify these psychological barriers. Supportive psychosocial interventions, such as the involvement of medical clowns, have been shown to reduce stress and improve quality of life in children undergoing OIT. Underlying mechanisms offer a biological explanation for these findings. Stress-induced gut barrier dysfunction and expectation-driven placebo effects provide pathways through which mindset can modulate OIT responses. Emerging data also suggest that immune sensing of allergens can directly shape behaviour, driving avoidance even in the absence of anaphylaxis.</p><p><strong>Clinical implications: </strong>Integrating mindset, emotional regulation and communication strategies into OIT protocols may reduce adverse events, enhance adherence and optimise immunological outcomes. Positive framing, psychosocial support and attention to patient and caregiver anxiety are effective strategies to enhance patient experience and treatment outcomes.</p><p><strong>Conclusion: </strong>Mindset is a modifiable factor with direct behavioural and immunological consequences during OIT. Recognising and addressing psychological dimensions alongside clinical protocols can enhance safety, adherence and long-term outcomes, advocating for broader application of behavioural science in allergy management.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 10","pages":"e70218"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-life prediction of school-age asthma among recurrent Wheezers in preschoolers: The WHEEP study.","authors":"Tarik Karramass, Erica Mancino, Walter Balemans, Marianne Brouwer, Eric De Groot, Anna Maria Landstra, Peter J F M Merkus, Laetitia E M Niers, Anja Vaessen-Verberne, David van Klaveren, Hanne Vermeulen, Mariël Verwaal, Mariëlle Pijnenburg, Liesbeth Duijts","doi":"10.1111/pai.70219","DOIUrl":"10.1111/pai.70219","url":null,"abstract":"<p><strong>Background: </strong>Early identification of childhood asthma is critical to prevent over- and undertreatment. Previous asthma prediction models often rely on subjective outcomes, limiting generalizability. This study aimed to develop an asthma prediction model using objective measures.</p><p><strong>Methods: </strong>This study was embedded in a multicenter prospective cohort of children aged 1-4 years with recurrent wheezing presenting at pediatric secondary care clinics who were followed up for 12 months and re-assessed between ages 6 and 12 years. Candidate predictors included demographic, environmental, and asthma-related factors. Asthma at school age was defined as at least two of the three criteria: asthma medication use, spirometry with bronchodilator reversibility, and elevated fractional exhaled nitric oxide levels. LASSO regression was applied to identify the most predictive variables in an optimal and parsimonious model, and model performance was evaluated.</p><p><strong>Results: </strong>Of 144 children with recurrent wheezing at age 1-4 years, 25% were classified as having asthma at school age. The optimal model for predicting asthma at school age demonstrated good predictive performance (area under the curve (AUC) (95% CI): 0.83 (0.73-0.93), sensitivity: 0.69, specificity: 0.86, positive predictive value (PPV): 0.66, and negative predictive value (NPV): 0.88). The parsimonious model showed slightly lower performance (AUC (95% CI): 0.82 (0.71-0.94), sensitivity: 0.67, specificity: 0.86, PPV: 0.65, NPV: 0.87).</p><p><strong>Conclusion: </strong>Our models highlight the importance of using objectively defined asthma in early prediction of asthma at school age, as demonstrated by their high discriminative performance. Future studies should validate these models and incorporate clearly defined objective outcome measures when developing new models for pediatric secondary care clinics.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 10","pages":"e70219"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of tolerance to food allergens-Younger is better.","authors":"Johanna M Smeekens, Michael D Kulis, Edwin H Kim, Sarita U Patil","doi":"10.1111/pai.70193","DOIUrl":"https://doi.org/10.1111/pai.70193","url":null,"abstract":"<p><p>Durable tolerance, or the ability to safely tolerate allergen ingestion through preventative intervention or modulation of an existing immunoglobulin E (IgE)-mediated food allergy, is vital to the treatment of food allergy. Recent insights through clinical trials and fundamental research have discovered that interventions at younger ages underlie higher frequency and durability of tolerance after treatment. Here, we review highly successful preventive and clinical trials of oral, sublingual, and epicutaneous immunotherapy for food allergy and the evidence that intervention at a younger age is highly successful at the induction of durable tolerance. In parallel, our ability to interrogate the mechanisms of IgE-mediated food allergy has become increasingly sophisticated. Work on IgE diversity has repeatedly established that greater IgE diversity and immune progression with time are associated with poorer clinical outcomes. Durable tolerance, on the other hand, is associated with neutralizing antibodies that block multiple IgE clones, thereby providing protection from a diversified IgE repertoire. Taken together, these advances not only pave an evidence-based pathway for the treatment of IgE-mediated food allergies but also help us understand the mechanism of these interventions, allowing us for the first time to begin to address the wide range of heterogeneity underlying IgE-mediated food allergy to advance therapeutic implementation.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 10","pages":"e70193"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in food allergy among Hong Kong preschoolers: Findings from 2006, 2013, and 2020 surveys.","authors":"Agnes S Y Leung, Oi Man Chan, Noelle Anne Ngai, Hing Yee Sy, Ann W S Au, Rosetta T C Leung, Jaimie Y M Ngai, Edmund Yung, Man Fung Tang, Gary W K Wong, Ting Fan Leung","doi":"10.1111/pai.70188","DOIUrl":"10.1111/pai.70188","url":null,"abstract":"<p><strong>Background: </strong>Food allergy (FA) significantly impacts quality of life and public health, but data on prevalence trends in Asia remain limited. This study investigated trends in FA prevalence and related allergic conditions among preschool Chinese children over a 15-year period.</p><p><strong>Methodology: </strong>Cross-sectional surveys were conducted in 2006, 2013, and 2020, targeting nurseries, preschool, and daycare centers across Hong Kong. Data were collected using a standardized, parent-reported questionnaire adapted from the International Study of Asthma and Allergy in Childhood (ISAAC), assessing the prevalence of perceived (parent-reported) and probable (doctor-diagnosed) FA.</p><p><strong>Results: </strong>A total of 11,537 Chinese children aged 2-7 years from 70 schools were surveyed across the three time points, with response rates ranging from 60% to 80%. The prevalence of perceived FA increased from 6.1% (95% CI, 5.4%-6.9%) in 2006 to 9.5% (95% CI, 8.6%-10.5%) in 2013 but declined to 8.5% (95% CI, 7.7%-9.3%) in 2020. Probable FA prevalence showed nonsignificant change, from 4.4% (95% CI, 3.8%-5.1%) in 2006 to 5.1% (95% CI, 4.5%-5.8%) in 2020. Longitudinal analysis revealed significant sustained increases in egg (doubled to 1.86%), peanut (nearly tripled to 1.52%), tree nut (five-fold increase to 0.68%), and shellfish allergic reactions (increased to 1.99%). Trends in atopic comorbidities included declines in asthma and wheezing, fluctuations in rhinitis, and an increase in eczema.</p><p><strong>Conclusions: </strong>Perceived FA increased over time, while probable FA remained stable, with shifts in allergens. Further research should explore this divergence and focus on enhancing allergy services and improving public awareness.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70188"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma diagnosis is not associated with reduced beta-cell function in children and adolescents with obesity.","authors":"Hannes Manell, Rasmus Stenlid, Kjell Alving","doi":"10.1111/pai.70198","DOIUrl":"10.1111/pai.70198","url":null,"abstract":"","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70198"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food allergy-related social anxiety: Novel conceptualization of an important but overlooked construct.","authors":"Melissa L Engel, Linda J Herbert, Ashley Ramos, Ruchi S Gupta, Christopher M Warren","doi":"10.1111/pai.70189","DOIUrl":"10.1111/pai.70189","url":null,"abstract":"<p><p>Accumulating literature has highlighted the substantial psychosocial burden experienced by many young people with food allergy (FA), with growing attention to FA-related anxiety. To date, research and clinical practice addressing FA-related anxiety have focused specifically on understanding and alleviating the fear of allergic reaction, which can sometimes even lead to a specific phobia of anaphylaxis. Here, we propose an additional construct of FA-related social anxiety, which we define as fear of social scrutiny or negative evaluation by others due to FA. In social situations involving food, patients high in FA-related social anxiety often worry about judgment from others. For example, they may fear appearing different when eating alternative safe food, seeming demanding when asking to speak with a manager at a restaurant, or being perceived as difficult and unappreciative when declining offered but potentially unsafe food. We distinguish fear of social scrutiny from fear of anaphylaxis and illustrate how each fear may present in various social contexts across development. We offer a conceptual model of the broader construct of FA-related anxiety, as well as behavioral conceptualizations of FA-related social anxiety. When unrecognized or untreated, high levels of FA-related social anxiety may lead to maladaptive social impacts (e.g., missed social opportunities) or adverse allergy outcomes (e.g., reluctance to carry epinephrine or engage in self-advocacy, increasing propensity for allergic reaction). We discuss potential treatment implications, as well as the importance of future consideration of this construct in both research and clinical contexts.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70189"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children with confirmed nonimmediate allergic reactions to beta-lactam antibiotics can develop tolerance after a long period of drug avoidance.","authors":"Isabel Torres-Rojas, María Vázquez De La Torre, Diana Pérez-Alzate, Elisa Haroun-Díaz, Maria Luisa Somoza-Álvarez, Paula López González, Ana Prieto-Moreno Pfeifer, Francisco Javier Fernández Sánchez, Miguel Blanca Gómez, Francisco Javier Ruano Pérez, Natalia Blanca-López","doi":"10.1111/pai.70184","DOIUrl":"https://doi.org/10.1111/pai.70184","url":null,"abstract":"<p><strong>Background: </strong>Allergic reactions to beta-lactam antibiotics (βLs) can fade over time, the length of which depends on the effector mechanism and the culprit drug. Most studies investigating this subject included people with immediate reactions (IRs). There is little evidence on (T-cell dependent) non-immediate reactions (NIRs), particularly in children.</p><p><strong>Methods: </strong>We used drug provocation tests (DPT) to evaluate children with suspected allergies to βLs. Reactions were classified as IR or NIR. Previously evaluated children with confirmed NIRs to amoxicillin and amoxicillin/clavulanate were offered a 5-year follow-up DPT to assess loss of sensitivity. We compared children who tolerated the drug and those who were still allergic on rechallenge according to the age of appearance of reactions, sex, and atopic status.</p><p><strong>Results: </strong>Of 665 children evaluated, 80 (12%) were confirmed as allergic: 54 NIRs (68%) and 26 IRs (32%). Regarding the type of rash, 59% had urticaria and 41% exanthem. Of the children with NIRs, 34 completed the study (62% female, 60% atopic). In the rechallenge, 50% showed tolerance. Among the children who had a reaction, 9 had urticaria and 8 exanthem. The children who showed tolerance were significantly younger than those who remained positive (p < .05). Among these children, 15 reported taking the same drug again, prescribed by their pediatrician, with good tolerance.</p><p><strong>Conclusion: </strong>T cell responses to βLs can subside. Children who experience NIRs to amoxicillin or amoxicillin/clavulanate can develop tolerance.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70184"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Control of Allergic Rhinitis and Asthma Test for Children (CARATkids): A systematic review and meta-analysis of its measurement properties.","authors":"Hadla Sami El Didi, Ana Margarida Pereira, Cristina Jácome, Rita Amaral, Gustavo F Wandalsen, Joyce Emons, Stefania La Grutta, Giovanna Cilluffo, Sehra Birgül Batmaz, Daniela Linhares, Dirceu Sole, Bernardo Sousa-Pinto, João Almeida Fonseca, Rafael José Vieira","doi":"10.1111/pai.70191","DOIUrl":"10.1111/pai.70191","url":null,"abstract":"<p><p>Control of Allergic Rhinitis and Asthma Test for Children (CARATkids) is the first patient-reported outcome measure (PROM) designed to assess both allergic rhinitis and asthma simultaneously in children aged 6 to 12 years. CARATkids has been validated in several languages and countries, highlighting the need for a review of its psychometric properties. This study aims to evaluate the measurement properties of CARATkids. This systematic review follows PRISMA and COSMIN guidelines. A systematic search was performed across three databases (Ovid/MEDLINE, Web of Science, and Scopus in October 2023, updated in June 2025). We included studies focused on the development, cultural adaptation, or validation of CARATkids, as well as studies comparing CARATkids with other PROMs. We evaluated the quality of CARATkids development, the methodological quality of primary studies, the overall rating, and the certainty of evidence for each CARATkids measurement property and performed a meta-analysis of its measurement properties. Our search retrieved 193 results. We included nine studies. CARATkids displayed sufficient content validity. Regarding internal consistency, we found a meta-analytical Cronbach alpha of 0.81 (95% CI = 0.79; 0.83). CARATkids displayed sufficient reliability (meta-analytical intraclass correlation coefficient 0.86 [95% CI = 0.61; 0.96]). The minimal clinically important difference was 2.76. Construct validity had sufficient evidence for most correlations, with absolute meta-analytical Spearman coefficients from 0.37 to 0.71. Responsiveness showed strong correlations between CARATkids and most outcome measurement instruments. These findings support CARATkids as a suitable tool for assessing asthma and allergic rhinitis in children aged 6 to 12 years who present both conditions simultaneously.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70191"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hidden price of food allergy: Understanding the social and financial burdens on families.","authors":"Jennifer L P Protudjer","doi":"10.1111/pai.70192","DOIUrl":"10.1111/pai.70192","url":null,"abstract":"<p><p>Food plays a unique role in culture and identity. For families managing food allergy, the role of food is complex and juxtaposed against the need to avoid known allergens, lest they risk an accidental exposure. While avoidance is simple in its instruction, the hidden prices of food allergy, namely the social and financial burdens on families, are substantial and fluid across the lifespan and in an era of rapid change in food allergy management and therapy. Families face significant impairments in quality of life, health-related quality of life, and food allergy anxiety, in addition to disproportionately higher food costs. The emergence of new food allergy therapies is exciting, but similarly carries high costs, which may not be in the financial reach of many families. Indeed, as a result of excess food costs compared to families not managing food allergy, families managing food allergy are at theoretically higher risk of being food insecure. Owing to these hidden prices, it behooves all involved in the care of patients with food allergy to ensure appropriate diagnoses (i.e., by an Allergist), alongside an allied health team committed to supporting the psychological and nutritional needs of the family.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70192"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world evidence in pediatrics.","authors":"Mattia Giovannini, Francesco Catamerò, Ioana Agache, Antonio Bognanni, Giorgio Walter Canonica, Stefano Del Giacco, Enrico Heffler, Matteo Lenge, Maria Carmela Leo, Francesca Mori, Nikolaos G Papadopoulos, Giovanni Paoletti, Holger Schünemann, Bernardo Sousa-Pinto, Mich Erlewyn-Lajeunesse","doi":"10.1111/pai.70183","DOIUrl":"https://doi.org/10.1111/pai.70183","url":null,"abstract":"","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":"36 9","pages":"e70183"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}