Stefania Arasi1, Ulugbek Nurmatov2, Audrey Dunn-Galvin3, Shahd Daher4, Graham Roberts5,6, Paul J Turner7,8, Sayantani B Shinder9, Ruchi Gupta10, Philippe Eigenmann11, Anna Nowak-Wegrzyn12,13, Mario A Sánchez Borges14, Ignacio J Ansotegui15, Montserrat Fernandez-Rivas16, Stavros Petrou4, Luciana Kase Tanno17,18,19, Marta Vazquez-Ortiz20, Brian P Vickery21, Gary Wing-Kin Wong22, Motohiro Ebisawa23, Alessandro Fiocchi1. 1. Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 2. Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK. 3. Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK. 5. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK. 6. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK. 7. National Heart & Lung Institute, Imperial College London, London, UK. 8. Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia. 9. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. 10. Center for Food Allergy and Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine, Department of Pediatrics & Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA. 11. Pediatric Allergy Unit, Department of Women-Children-Teenagers Pediatrics, University Hospitals of Geneva, Geneva, Switzerland. 12. Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA. 13. Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland. 14. Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela. 15. Department Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain. 16. Servicio de Alergia, Hospital Clınico San Carlos, UCM, IdISSC, ARADyAL, Madrid, Spain. 17. Hospital Sírio Libanês, São Paulo, Brazil. 18. University Hospital of Montpellier, Montpellier, France. 19. Sorbonne Universités, Paris, France. 20. Department of Paediatrics, Imperial College London, United Kingdom. 21. Department of Pediatrics, Emory University, Atlanta, GA, USA. 22. Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. 23. Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan.
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).
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).
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