Alpha-gal syndrome (AGS) is an IgE-mediated allergy to galactose-α-1,3-galactose (α-Gal), classically presenting with delayed allergic reactions after ingestion of mammalian-derived foods. Fish roe has recently emerged as a potential but under-recognized trigger in α-Gal-sensitized individuals. We describe the first South Asian case series of three patients with AGS who developed anaphylaxis following fish roe ingestion, highlighting this atypical trigger as a possible emerging cause of anaphylaxis associated with AGS in the region. We retrospectively reviewed patients evaluated at a tertiary allergy clinic in Sri Lanka between January 2025 and May 2026 who developed allergic reactions following fish roe ingestion and fulfilled the diagnostic criteria for AGS based on a compatible clinical history, positive skin prick testing, elevated serum α-Gal-specific IgE, and symptom resolution following dietary avoidance. Three women aged 19, 45, and 53 years presented with anaphylaxis 5minutes to 1 hour after fish roe ingestion. All had clinical features suggestive of AGS, including delayed reactions to mammalian meat, gastrointestinal symptoms following dairy consumption, recurrent unexplained allergic episodes, and a history of tick exposure. Skin prick testing demonstrated sensitization to fish roe and mammalian-derived allergens, while serum α-Gal-specific IgE concentrations ranged from 1.55 to 12.7 kUA/L. Oral food challenges were not performed because of the risk of severe reactions. Following avoidance of mammalian meat, dairy products, gelatin and fish roe all patients remained free of further allergic reactions during follow-up. Fish roe may represent an important and under-recognized trigger of immediate anaphylaxis in patients with AGS. Recognition of this atypical presentation is essential for timely diagnosis, appropriate dietary counselling, and prevention of recurrent life-threatening reactions. Larger mechanistic and epidemiological studies are needed to determine the prevalence and elucidate the underlying pathophysiological mechanisms of fish roe-associated reactions in AGS.
Acacia gum (E414), derived from Acacia senegal, is a water-soluble emulsifier used in food and pharmaceuticals for its stabilizing properties [1–3]. Hypersensitivity reactions are mainly reported in occupational settings and are thought to be IgE-mediated, though the specific epitope is unknown [1–5]. No cases of allergic reactions due to ingestion have been documented in the literature. A 37-year-old man with hypothyroidism and migraines presented with a 10-year history of episodic headaches, weakness, nasal congestion, and presyncope. Extensive investigations, including sinus surgery, immunotherapy, migraine and seizure treatments, and dietary changes, were unsuccessful. His symptoms resolved after discontinuing Synthroid, raising suspicion of an excipient-related reaction. Acacia gum, an inactive ingredient in Synthroid, was identified as a potential trigger. Switching to compounded levothyroxine without acacia gum led to sustained symptom resolution. A self-administered challenge to acacia gum induced throat tightness, dyspnea, tongue swelling, and near-syncope within 15 min. Skin prick testing was negative to Synthroid and pure levothyroxine. Intradermal testing was positive to Synthroid (6 mm wheal, 12 mm flare) and acacia gum (50 mm wheal), but negative to pure levothyroxine. A placebo-controlled oral challenge to Synthroid induced symptoms 10 min after ingestion of 7.5 mcg (10
Hereditary angioedema (HAE) is a rare, potentially life-threatening disorder caused by autosomal dominant mutations in the SERPING1 gene, leading to deficiency or dysfunction of C1 esterase inhibitor. Recent estimates of global HAE prevalence are 1.22 per 100,000 individuals. With total fertility rates (TFRs) decreasing worldwide, several developed countries are now well below the population replacement rate in an “ultra-low fertility” group. With the decrease in fertility, how rare diseases are approached should be re-examined. In this letter, we describe how continued and sustained declines in total fertility rate and population may influence the future number of new HAE cases. We also address disease-specific factors that may further influence future case count, including reproductive hesitancy related to autosomal dominant inheritance, estrogen-associated exacerbation of angioedema attacks, and potential fertility effects of complement dysregulation. These demographic considerations are relevant to clinicians, researchers, and pharmaceutical companies involved in HAE care. Better characterizing population changes in the context of reduced fertility rates may help inform long-term clinical planning and the development of novel therapies for HAE and other rare diseases.
Abstract Introduction Hereditary angioedema (HAE), characterized by unpredictable attacks of subcutaneous or submucosal edema, can significantly impact patient quality of life (QoL). Despite advances in long-term prophylaxis (LTP), achieving complete control of HAE is challenging, making shared decision-making (SDM) critical for tailored HAE management. This investigation explores the dynamics of healthcare professional (HCP)–patient conversations concerning HAE management, and identifies barriers to SDM, LTP initiation and strategies that may overcome these to optimize patient QoL. Methods The investigation was conducted in Germany. HCPs managing patients with HAE participated in 60 min interviews and led simulated patient consultations. 30 min interviews with patients with HAE were also conducted. Results Ten HCPs and eight patients with HAE were interviewed. In the simulated consultations, most HCPs recommended LTP based on high attack frequency and substantial impact on QoL. Interviews revealed that HCPs typically initiate discussions on LTP by assessing disease burden, focusing on attack frequency and QoL. These treatment discussions also highlighted the need for improved communication with patients about the LTP treatments that are available to them. However, many HCPs lacked awareness of updated treatment guidelines and faced challenges in reassuring patients about the long-term safety and efficacy of newer LTP options. All patients who were initiated on LTP experienced positive results, including improved QoL and reduced fear of attacks. Those who declined LTP cited low attack frequency on their acute treatment and concerns about burden of treatment and long-term effects. Key barriers to effective SDM included time constraints during routine consultations, absence of clear SDM guidance, and a lack of jargon-free information to foster proactive patient engagement. Conclusion This research highlights opportunities to enhance HCP–patient conversations concerning the management of HAE. Inconsistencies between positive patient experiences with LTP and real-world prescription rates emphasize the need for improved SDM practices. Enhancing HCP awareness of patient perspectives, managing time constraints in consultations, and providing unbiased, patient-friendly information may help bridge these gaps and improve communication and ultimately patient QoL. The findings underscore the importance of further research to develop guidelines that prioritize SDM and patient empowerment in HAE management.
Mastocytosis imposes a considerable burden on patients’ quality of life. While validated QoL instruments are available for adults with systemic mastocytosis, no disease-specific quality-of-life measure has yet been developed for pediatric populations. This study aimed to develop and validate two disease-specific quality of life instruments—the Pediatric Mastocytosis Quality of Life (PedMQLS) and the Pediatric Mastocytosis Quality of Life–Parent (PedParentMQLS) scales—for use in pediatric mastocytosis. A total of 51 children and their parents were recruited from two specialized tertiary centers in Turkey. Scale items were generated based on expert opinion and literature review. Content validity was evaluated using the Davis method, and construct validity was assessed through exploratory factor analysis (EFA). Internal consistency was measured using Cronbach’s alpha, and convergent validity was examined by correlating results with established dermatology-specific quality of life instruments. Both scales consisted of 14 items and revealed a two-factor structure covering social and emotional domains. Pediatric Mastocytosis Quality of Life-Parent Scale showed high internal consistency (α = 0.909), while the Pediatric Mastocytosis Quality of Life Scale demonstrated acceptable reliability (α = 0.785). Significant correlations with comparable instruments supported the scales’ convergent validity. These newly developed scales are the first validated quality of life instruments specific for pediatric mastocytosis. This study is preliminary; validation through multicenter studies with larger sample.
Rituximab can cause immediate and delayed immune reactions, including rituximab-induced serum sickness (RISS). However, the temporal and mechanistic relationship between these reactions is unclear. We report a case in which RISS developed several days after rituximab-induced anaphylaxis. A 70-year-old woman with stage I mucosa-associated lymphoid tissue lymphoma was initially treated with weekly rituximab monotherapy. Four days after the third infusion, she developed fever, nonpruritic erythema, and arthralgia, which resolved spontaneously. When rituximab was re-administered, she immediately developed symptoms consistent with anaphylaxis, prompting treatment discontinuation. One year later, rituximab was re-started due to slight disease progression. The infusion induced nasal congestion and hoarseness but was completed under hydrocortisone. Eight days later, she presented with fever, widespread pruritic plaques, vomiting, diarrhea, and hypotension. Laboratory testing revealed elevated inflammatory markers without evidence of bacterial infection. Human anti-chimeric antibody levels were markedly elevated (> 5000 ng/mL). Intradermal testing with rituximab induced both an immediate wheal and a delayed erythematous flare lasting several days, indicating coexisting immediate-type hypersensitivity and RISS. This case demonstrates that RISS may occur several days after the resolution of rituximab-induced anaphylaxis. When immediate reactions occur after rituximab administration, patient education to ensure prompt reporting of delayed reactions is essential. Skin testing supported the identification of sequential immediate and delayed rituximab hypersensitivity in this case.
Omalizumab and mepolizumab are effective biologic therapies for severe asthma. However, their comparative effectiveness in patients eligible for both treatments remains unclear in routine care. Therefore, the aim of this study was to compare the real-world effectiveness of mepolizumab and omalizumab in these patients. This retrospective cohort study included patients with asthma who were treated with omalizumab or mepolizumab. Eligible patients had a blood eosinophil count ≥ 150 cells/μL (or ≥ 300 cells/μL within the prior year), total Immunoglobulin E (IgE) ≥ 30 IU/mL, and sensitization to a perennial inhalant allergen. The primary endpoint was the adjusted incidence rate ratios (IRRs) for asthma exacerbation during the first year of treatment. Secondary endpoints were IRRs for emergency room (ER) visits and hospitalizations, subgroup IRRs stratified by baseline eosinophil count (< 300 cells/μL vs. ≥ 300 cells/μL), and change in oral corticosteroid (OCS) dose. Poisson regression models were adjusted for BMI, eosinophil count, and prior-year exacerbations; ER and hospitalization models additionally adjusted for prior ER visits and hospitalizations. Follow-up time was accounted for via an offset term. We included 49 patients (omalizumab, n = 25; mepolizumab, n = 24). Mepolizumab significantly reduced asthma exacerbations compared with omalizumab (IRR, 0.37; 95
Incidence of chronic obstructive pulmonary disease and asthma diagnosis were lower during and after the Coronavirus disease 2019 pandemic in Alberta, Canada. However, it is unknown whether incidences were actually lower or if the pandemic created circumstances where patients did not seek care. As such, the objective of the current study was to explore the impact of COVID-19 on patient and clinician experiences of healthcare access and delivery. The study was conducted between October 2023 and July 2024. We used interpretive description, a qualitative approach with the end-goal of informing clinical decisions. Analysis was informed by Braun and Clarke’s six phases of reflexive thematic analysis. We completed thirteen interviews. Two key themes were generated: (1) The pandemic impacted care-seeking behaviours; and (2) A time and place for virtual and in-person care. Clinicians discussed how access to entry points to the health system were impacted by the pandemic and highlighted how strategies to manage health and stressors impacted symptoms and subsequent care-seeking behaviours. Participants highlighted the positives of virtual and in-person care with the consensus that both are valuable. Future use of virtual care modalities should include a visual element at minimum and prioritize the therapeutic relationship.
Paraprobiotics, the non-viable microbial cells with health benefits, have gained interest as candidates for preventing food allergies owing to their safety and stability. Heat-killed Lactiplantibacillus plantarum FM8 (FM8) has been reported to induce interleukin (IL)-10 production in dendritic cells in vitro; however, its in vivo efficacy as a standalone intervention remains unexplored. We investigated the preventive effect of heat-killed FM8 in a murine model of ovalbumin (OVA)-induced food allergy. BALB/c mice were assigned to control, OVA-induced allergy, or three FM8 treatment groups receiving FM8 at low (2 × 10⁹ CFU/day), medium (1 × 10¹⁰ CFU/day), or high (5 × 10¹⁰ CFU/day) doses. Food allergy was induced by repeated OVA sensitization and challenge. Allergy symptoms, OVA-specific immunoglobulin E (IgE), and IL-10 levels were measured. Tight junction gene expression, mucin production, gut microbiota composition, and short-chain fatty acids (SCFAs) were also analyzed. FM8 supplementation attenuated allergic responses in a dose-dependent manner. Allergy symptom scores were reduced in the High group, and the rectal temperature decline following OVA challenge was ameliorated in both the Med and High groups. The sensitization-induced increase in OVA-specific IgE was also attenuated in these groups. IL-4 expression in Peyer’s patches was reduced, whereas colonic IL-10 expression and serum IL-10 levels were increased in the High group. FM8 supplementation was further associated with increased ileal expression of tight junction-related genes (Occludin, Claudin-1 and Zo-1) and Muc2, along with a trend toward increased fecal mucin levels; however, no comparable changes in tight junction-related gene expression were observed in the colon. Although taxa with reported SCFA-producing potential were enriched in the High group, cecal acetate and propionate levels remained unchanged, while butyrate levels were decreased. FM8 may prevent food allergy by promoting IL-10-associated immunoregulation and enhancing gut barrier-related responses, without a corresponding increase in cecal SCFA concentrations. The contribution of SCFA-related mechanisms remains to be clarified, and further studies are needed to determine clinically feasible dosing and efficacy in humans.
Real-world evidence on the effectiveness of mepolizumab at reducing healthcare resource utilization (HCRU) and clinical symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is limited. This real-world study used linked electronic medical record and claims data from the OM1 Real-World Data Cloud of clinician networks in the US, including an ear, nose and throat physician registry. CRSwNP-related HCRU, procedures, concomitant medications, and sign and symptom outcomes were assessed in adult patients with CRSwNP who initiated mepolizumab on/after July 29, 2021 (index date), with ≥1 mepolizumab record, data available for ≥12 months pre- and ≥6 months post-index (follow-up/post-mepolizumab period). There was a significant difference in CRSwNP-related HCRU 6-months post- versus pre-mepolizumab initiation (N = 245), mean difference in outpatient visits (95
Abstract Purpose Anaphylaxis is a potentially life-threatening systemic hypersensitivity reaction. While triggers, clinical manifestations, and severity are influenced by age and sociocultural factors, most evidence regarding the impact of comorbidities and cofactors comes from adult studies. This study aimed to characterize the triggers, clinical features, and outcomes of pediatric anaphylaxis in a tertiary care center, with a particular emphasis on risk factors for severity. Methods We retrospectively reviewed records from August 2023–August 2024 at the European Allergy Academy and Clinical Immunology Center of Excellence in Istanbul. Children aged 0–18 years ( n = 100) with anaphylaxis as defined by the 2020 World Allergy Organization (WAO) criteria were included. Demographic, clinical, and follow-up data were collected. The updated 2024 (WAO) grading system was used to classify severity. Results Of the 3,959 records, 100 children fulfilled the inclusion criteria. A female predominance was noted in those ≤ 4 years, with males predominating thereafter. Medications were the leading trigger, followed by food, venom, and idiopathic causes. Foods were more prevalent among outpatients, and drugs were more prevalent among inpatients. Comorbidities were more common in hospital-onset anaphylaxis. Atopy was more common in food-induced anaphylaxis, whereas infections and polypharmacy were more common in drug-induced cases. Food-related reactions with endogenous factors were typically milder, whereas drug-related reactions—especially in older patients with polypharmacy or hospital-onset—tended to be more severe. Biphasic reactions were associated with delayed presentation, elevated WBC/ANC, and older age. Intramuscular adrenaline was administered in 95% of the patients, but prehospital autoinjector use was rare. Conclusion Our findings underscore the need for early recognition and management, systematic evaluation of contributing factors, risk-adapted monitoring, and individualized follow-up in pediatric anaphylaxis patients.
Abstract Background A largely unknown proportion of Hymenoptera venom-allergic patients do not undergo venom immunotherapy (VIT) despite positive allergy testing and counselling. We aimed to identify factors associated with the refusal of VIT, and evaluate the natural course of venom allergy in untreated individuals. Methods Out of 1163 candidates for VIT, 271 (23.3%) declined or postponed treatment for at least 12 months. Complete data from 166 of these patients, who were interviewed and counselled during routine follow-up, were available for retrospective evaluation. Results Patients declining VIT were significantly more likely to be female (P = 0.012) and had a lower grade of index sting-induced anaphylaxis (P < 0.001) compared to those who accepted treatment. Main reasons for deciding against VIT were that it was considered too time-consuming (39.8%) or perceived as unnecessary (24.1%). A minority of patients (6.6%) declined VIT due to fear of side effects; 7.2% perceived the VIT-associated risk as high to extremely high. Most (69.9%) reported routinely carrying an epinephrine autoinjector. The re-sting rate was 39.2% over a median follow-up of 5 years. Among 65 re-exposed patients, 13 (20%) reported an anaphylactic sting-reaction, with only two cases classified as severe. In no case did a severe relapse occur following a mild index sting reaction. Conclusion In venom-allergic patients hesitant about VIT, treatment choices should be guided by a shared decision-making process considering risk factors for severe anaphylaxis and the degree of sting exposure, together with the patient’s personal needs and preferences.
Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of type 2 inflammation with potential for personalized asthma management. However, the longitudinal patterns of FeNO and their association with childhood asthma control remain insufficiently characterized. This cohort study enrolled children with newly diagnosed asthma from Shanghai Children’s Medical Center. Participants underwent baseline assessments and serial FeNO measurements at diagnosis and at 3-month intervals over 12 months. Asthma control was assessed at 12 months using Global Initiative for Asthma (GINA) criteria. Longitudinal trajectories of FeNO were identified using group-based trajectory modeling (GBTM). Associations of time-specific FeNO levels and FeNO trajectory group with uncontrolled asthma at 12 months were analyzed using logistic regression. Among 142 children (mean age 6.92 ± 2.08 years; 71.1
Abstract Background Pumpkin seed, a member of the Cucurbitaceae family, is increasingly consumed because of its high protein content and perceived health benefits. Along with its growing use, cases of pumpkin seed allergy are being reported. However, data on pumpkin seed allergy and oral immunotherapy (OIT) remain scarce. Methods We conducted a retrospective chart review at a tertiary pediatric center (Sainte-Justine University Hospital Center, Montreal, Canada) including all patients who initiated or completed pumpkin seed OIT since 2019. OIT protocols were individualized, with dose increases typically performed every four weeks. Target maintenance doses were at least 300 mg of pumpkin seed protein. Results Eleven patients (median age at OIT initiation: 6.5 years; range 1–12) underwent pumpkin seed OIT. Ten patients (91%) reached maintenance dosing within a median of 9.5 months (range 6–22) while one patient discontinued OIT due to persistent abdominal pain. No anaphylactic reactions occurred at home during treatment. Two anaphylactic reactions requiring epinephrine occurred during in-clinic up-dosing visits in a single patient, despite this, the patient ultimately achieved maintenance. Gastrointestinal and oral symptoms were the most frequent adverse events and were generally managed with temporary premedication. Most patients (91%) underwent concomitant multi-food OIT. Patients with significant adverse reactions had high ratios of pumpkin-specific IgE to total IgE. Conclusion Pumpkin seed OIT appears feasible in a highly atopic pediatric population, with a safety profile comparable to that reported for OIT to other food allergens. Given the increasing dietary exposure to pumpkin seeds, larger prospective studies are needed to better define risk factors and long-term outcomes.
Hereditary angioedema (HAE) is a rare, chronic disorder that requires coordinated, multidisciplinary care extending beyond acute attack management. Drawing on the successful comprehensive care framework established in Hemophilia Treatment Centers, this manuscript proposes a structured model for HAE care that emphasizes centralized care coordination, multidisciplinary teams, emergency preparedness, patient and caregiver education, psychosocial support, equitable access to emerging therapies, and integrated research and advocacy. By adapting lessons learned from hemophilia care, the proposed model aims to improve patient outcomes, empower individuals living with HAE, and provide a roadmap for implementing standardized, patient-centered care in rare disease management.
Abstract Introduction Unintentional ocular exposure to epinephrine nasal spray (10 mg/mL epinephrine) is a potential safety concern. Although epinephrine is used in multiple ocular formulations, unintentional ocular administration of epinephrine nasal spray was assessed to determine tolerability and support the overall safety profile. Methods A non-GLP ocular tolerability study was conducted using six naïve New Zealand White rabbits (3 males, 3 females). Vehicle control or epinephrine nasal spray (1 mg) was applied to the right or left eye, respectively, once on Day 1. Animals were monitored over seven days for mortality, clinical signs, body weight changes, ophthalmic findings, ocular irritation (using the Modified Hackett-McDonald Scoring System), and gross necropsy findings. Results Epinephrine nasal spray was well tolerated with no mortality, clinical abnormalities, or changes in body weight. Ophthalmic examinations via indirect ophthalmoscopy and slit-lamp biomicroscopy revealed no signs of irritation or ocular toxicity. No gross pathological changes were noted at necropsy. Conclusion A single topical administration of epinephrine nasal spray (10 mg/mL) in rabbit eyes was not associated with any adverse effects, indicating a low risk of ocular toxicity. These results support the safety of epinephrine nasal spray in the event of unintentional ocular exposure and taken together with epinephrine’s use in other ocular formulations, suggest that no further nonclinical ocular studies are necessary.
Abstract Background Reduced intensity and diversity of microbial stimulation and decreased intake of anti-inflammatory ω-3 polyunsaturated fatty acids (PUFAs) in Western diets may contribute to impaired postnatal immune development and increased allergy risk. Here, we hypothesize that early supplementation with probiotics and ω-3 PUFAs, starting during pregnancy and continuing during infancy, may promote appropriate immune maturation and thereby potentially prevent allergy development. Methods In this study, 117 mother‒baby pairs were randomized into four groups receiving the following supplements: Limosilactobacillus reuteri (L. reuteri), ω-3 PUFA, double supplementation, or placebo. Supplementation started from gestational week 20 until 3 months of age (3 mo) for ω-3 PUFA and continued until 12 mo for L. reuteri. Peripheral blood mononuclear cells (PBMCs) from infants were isolated at birth and at 6, 12, and 24 mo, and stimulated ex vivo with several allergens and ligands of Toll-like receptors (TLRs). Cytokines and chemokines related to Th1/Th2/Th17/Treg responses were quantified. Results Probiotic supplementation modulated the pattern of cytokine and chemokine secretion over time, whereas no clear effects were observed for ω-3 PUFA supplementation. L. reuteri supplementation led to a significant increase in Th1-associated C-X-C motif chemokine ligand 10 (CXCL10) levels induced by birch and cat allergens at 6 mo. Furthermore, L. reuteri induced more significant age-dependent changes under several types of stimulation than did the placebo, indicating enhanced immune maturation. Conclusion Pre- and postnatal probiotic supplementation may promote immune maturation during early childhood.
Abstract Background The prevalence of IgE-mediated cow’s milk allergy in Canada has been increasing and is recognized as the leading cause of fatal anaphylaxis in school aged children. Experts are unable to predict which individuals will have spontaneous resolution of cow’s milk allergy and who will have a persistent phenotype, therefore primary prevention is key. Objective The aim of this study was to identify risk factors leading to the development of an IgE mediated cow’s milk allergy. Methods A 54-item survey was provided to parents of children aged 0–4 years with an allergist diagnosed IgE mediated cow’s milk allergy. Results Out of the 24 participants who completed the survey, 21 were used in the analysis. All infants were term and 57% of participants reported intermittent exposure to cow’s milk formula. Of the infants with intermittent cow’s milk exposure, majority (75%) experienced the exposure prior to hospital discharge. Infants with both atopic dermatitis and intermittent exposure to cow’s milk formula had more severe reactions. Conclusion This is the first study to our knowledge that found an association between reaction severity and having multiple risk factors- atopic dermatitis and intermittent exposure to cow’s milk formula. Majority of the intermittent cow’s milk exposure occurs prior to discharge from hospital. Further research in the area is required, however policy changes to mitigate associated risk could include use of donor breast milk or extensively hydrolyzed formula for supplementation, or recommendations to continue regular cow’s milk formula following introduction.
Abstract Hypersensitivity to beta-lactams (BL) is the most frequent drug allergy, and skin testing (ST) remains the first-line diagnostic tool. Although generally safe, systemic reactions (SR) during ST are a concern. We conducted a 7-year ambispective study (2018–2025) including 216 adults with confirmed immediate hypersensitivity reactions (HSR) to BL, established by positive skin tests (ST) or drug challenge tests (DCT). Among them, 138 (63.9%) had positive ST, predominantly intradermal tests (IDT; 93.5%). Five patients (3.6% of ST-positive; 2.3% of the entire cohort) developed SR during ST, all after IDT following negative skin prick tests (SPT). Reactions were mostly mild (urticaria, generalized pruritus, erythema), although one anaphylaxis occurred. All were rapidly controlled with symptomatic treatment. Surprisingly, all patients with SR had urticaria–angioedema as their index reaction; none had experienced prior anaphylaxis. A significant shorter time interval between the index reaction and allergy evaluation was observed in SR patients (mean 23.6 vs. 48.8 months, p = 0.02). No significant associations were identified for age, sex, culprit BL, or specific IgE. SR during BL ST are infrequent but clinically relevant. SPT appears highly safe, whereas IDT requires particular caution, especially when performed shortly after the index reaction.
Abstract Background Early allergen immunotherapy (AIT), including oral immunotherapy (OIT), is increasingly recognized as a disease-modifying intervention for infants with Immunoglobulin E (IgE)-mediated food allergy. However, limited access to allergy specialists and long wait times often prevent timely initiation during the critical early-life window. Guided self-care models could offer alternative care pathways, yet parents’ perspectives on such approaches remain poorly understood. Objective To explore parents’ perceptions of the acceptability, feasibility, and conditions required for guided self-care approaches to to early-life food allergen immunotherapy in infants, drawing on parental experiences managing food allergy in their children in their early years. Methods A qualitative study was conducted using semi-structured videoconference interviews (Zoom) with 11 parents of children with food allergies in Québec, Canada, between June and August 2024. Participants were recruited through purposive sampling to capture a range of experiences. Interviews were conducted in French, transcribed verbatim, and analyzed using thematic analysis to identify key themes and constructs in French, translated into English for publication. Rigor was enhanced through independent coding by two analysts, iterative interim analyses, and team discussions to resolve discrepancies. Results The mean age of the index child at food allergy diagnosis was 0.8 years (range 0.2–2); four participants were still parents of infants at the time of interview. Three major themes emerged: (1) acceptability of self-care driven by barriers to timely access to AIT and the perceived benefits of early intervention; (2) parental confidence in self-management shaped by experience, preparedness, and education; and (3) the necessity of professional support and clear protocols. Participants expressed strong motivation to initiate early treatment to avoid missing a critical therapeutic window, even in the absence of direct allergist supervision. However, guided self-care was consistently viewed as requiring diagnostic validation, structured protocols, and access to trained healthcare professionals for support, particularly at treatment initiation. Conclusion Parents of children with food allergy are receptive to guided self-care approaches for early infant AIT when timely access to specialists is limited. Developing low-risk AIT modalities, standardized protocols, and training for non-allergist healthcare professionals may facilitate earlier intervention and improve outcomes for infants with food allergy.
