Core Outcome Set for IgE-mediated food allergy clinical trials and observational studies of interventions: International Delphi consensus study 'COMFA'.

BACKGROUND: IgE-mediated food allergy (FA) is a global health concern with substantial individual and societal implications. While diverse intervention strategies have been researched, inconsistencies in reported outcomes limit evaluations of FA treatments. To streamline evaluations and promote consistent reporting, the Core Outcome Measures for Food Allergy (COMFA) initiative aimed to establish a Core Outcome Set (COS) for FA clinical trials and observational studies of interventions. METHODS: The project involved a review of published clinical trials, trial protocols and qualitative literature. Outcomes found as a result of review were categorized and classified, informing a two-round online-modified Delphi process followed by hybrid consensus meeting to finalize the COS. RESULTS: The literature review, taxonomy mapping and iterative discussions with diverse COMFA group yielded an initial list of 39 outcomes. The iterative online and in-person meetings reduced the list to 13 outcomes for voting in the formal Delphi process. One more outcome was added based on participant suggestions after the first Delphi round. A total of 778 participants from 52 countries participated, with 442 participating in both Delphi rounds. No outcome met a priori criteria for inclusion, and one was excluded as a result of the Delphi. Thirteen outcomes were brought to the hybrid consensus meeting as a result of Delphi and two outcomes, 'allergic symptoms' and 'quality of life' achieved consensus for inclusion as 'core' outcomes. CONCLUSION: In addition to the mandatory reporting of adverse events for FA clinical trials or observational studies of interventions, allergic symptoms and quality of life should be measured as core outcomes. Future work by COMFA will define how best to measure these core outcomes.

Comparative effectiveness of probiotic strains on the prevention of pediatric atopic dermatitis: A systematic review and network meta-analysis.

BACKGROUND: Atopic dermatitis is the most common chronic skin disease affecting the pediatric population. Probiotics have been proposed to be effective in preventing the development of pediatric atopic dermatitis. Although studies show promise for the use of probiotics, the evidence is still inconclusive due to significant heterogeneity and imprecision. OBJECTIVE: To determine the comparative effectiveness of the different types of probiotic strains in preventing the development of atopic dermatitis among pediatric patients. METHODOLOGY: A systematic search of Cochrane Library, MEDLINE, TRIP Database, and Centre for Research and Dissemination was conducted. Manual search of the reference lists and search for unpublished articles were also done. All randomized controlled trials available from inception until April 12, 2020, on the use of probiotics in the prevention of atopic dermatitis among children were included. The comparator groups considered are other probiotic strains and placebo. The primary outcome of interest was the development of atopic dermatitis. Two authors independently searched for articles, screened the articles for inclusion, appraised the articles using the Cochrane risk of bias tool version 2, and extracted the data. In case of disagreement, the two authors discussed the source of disagreement until consensus was reached. If consensus was not reached, an independent third party reviewer was consulted. Frequentist network meta-analysis was conducted using STATA 14 software. The ranking probabilities and surface under the cumulative ranking curve (SUCRA) values were obtained to determine ranking of the different probiotic strains based on efficacy and safety data. RESULTS: We included 21 original studies represented by 35 records and a total of 5406 children with atopic dermatitis as diagnosed by clinicians or fulfillment of validated diagnostic criteria. All studies were randomized placebo-controlled trials. The top 3 probiotic preparations in terms of efficacy in reducing the risk of atopic dermatitis are Mix8 (Lactobacillus paracasei ST11, Bifidobacterium longum BL999), LP (Lactobacillus paracasei ssp paracasei F19) and Mix3 (Lactobacillus rhamnosus GG, Bifidobacterium animalis ssp lactis Bb-12). Mix8 compared with placebo probably reduces the risk of atopic dermatitis based on low-quality evidence (RR = 0.46, 95% CI 0.25-0.85). Mix3 compared with placebo also probably reduces the risk of atopic dermatitis based on low-quality evidence (RR = 0.50, 95% CI 0.27-0.94). It is uncertain whether LP compared with placebo reduces the risk of atopic dermatitis due to very-low-quality certainty of evidence (RR = 0.49, 95% CI 0.20-1.19). In terms of adverse events, LGG may slightly lead to less adverse events compared with placebo based on low-quality evidence (RR = 0.70, 95% CI 0.32-1.52). Mix4 may slightly lead to more adverse events compared with placebo based on low-quality evidence (RR = 1.06, 95% CI 0.02-51.88). Based on subgroup analysis of studies involving infants, Mix3 compared with placebo probably reduces the risk of atopic dermatitis based on low-quality evidence (RR = 0.46, 95% CI 0.22-0.97). In the subgroup analysis of studies where probiotics were administered to pregnant women and to infants, LRH compared with placebo probably reduces the risk of atopic dermatitis based on moderate-quality evidence (RR = 0.54, 95% CI 0.26-1.11). CONCLUSION: Certain probiotic preparations demonstrate efficacy in reducing the risk of developing atopic dermatitis when administered to pregnant women, infants, or both.

Transition practice for primary immunodeficiency diseases in Southeast Asia: a regional survey.

Introduction: With increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians' opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries. Methods: We adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries. Results: Regionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer. Discussion and conclusion: Our study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.

Primary immunodeficiency from B-cell defect: a case series of 6 patients seen in a national tertiary hospital in the Philippines.

Primary immunodeficiency disorders, although rare, pose a significant burden in the quality of life of afflicted patients and their families. The most common of these disorders are caused by B-cell defects. A total of 6 patients were seen and diagnosed in a national tertiary hospital in the Philippines from 1996 to 2018. These patients were admitted due to various infections, and were subsequently diagnosed to have B-cell defects. Four out of the 6 patients have genetic studies confirming the diagnosis of X-linked agammaglobulinemia. One patient succumbed to sepsis at 10 years of age, while the rest are on follow-up at the Philippine General Hospital for intravenous immunoglobulin infusion.

Eosinophilic gastroenteritis in an adolescent male with history of chronic bullous disease.

Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract. Although commonly associated with allergic diseases, it is also rarely associated with autoimmune disorders. This case report describes a 17-year-old Filipino male with eosinophilic gastroenteritis, manifesting as abdominal pain, vomiting and diarrhoea. He had no allergic diseases, but he was previously diagnosed with chronic bullous disease. His symptoms improved with the initiation of corticosteroids. To date, this is the first case report of a patient with eosinophilic gastroenteritis and chronic bullous disease.

Predictors of serious outcomes among patients with anaphylaxis seen in the Philippine national tertiary hospital.

BACKGROUND: Anaphylaxis is a severe and life-threatening systemic hypersensitivity reaction. The incidence of anaphylaxis has increased significantly in recent years. OBJECTIVE: To identify predictors of serious outcomes among patients with anaphylaxis seen in the national tertiary hospital of the Philippines from 2015 to 2019. METHODS: Data was collected retrospectively through search of the medical records section and census reports on all patients diagnosed with anaphylaxis seen at the national tertiary hospital from 2015 to 2019. The patients' clinical profile, management, and outcome were extracted. Multiple logistic regression analysis was used to determine the association of clinical characteristics and physicians' management with the development of serious outcomes. Variable selection procedure through backward elimination method was used to determine significant predictors of serious outcomes of anaphylaxis. Data analysis was done using Stata 14 software. RESULTS: There were 300 patients with anaphylaxis seen at the Philippine national tertiary hospital from 2015 to 2019. Of the 300 patients, 179 were female (57.9%). The median age of the patients was 26 years old, with an interquartile range of 33 years. Only 75 patients (25%) had a past history of allergic disease. Majority of the patients (70%) had comorbidities. Drugs were the most common trigger of anaphylaxis (81.3%). Antibiotics were the most common type of drugs implicated (27%). Serious outcomes were noted in a total of 31 patients (10.3%). The significant predictors of serious outcomes in anaphylaxis are age (p = 0.034) and cofactors including use of beta-blockers and presence of acute infection (p < 0.001). CONCLUSION: In the Philippine national tertiary hospital, the incidence of anaphylaxis increased by 240% in the past decade. Predictors of serious outcome in anaphylaxis include increased age and presence of cofactors such as beta-blocker use and presence of acute infection.

Dietary primary prevention of allergic diseases in children: the Philippine guidelines.

Allergic diseases, such as asthma, allergic rhinitis, eczema, and food allergy, are preventable diseases. Primary prevention strategies of allergic diseases have been in scrutiny. Effective prevention strategies maybe started prenatally, postnatally, during infancy, and even during childhood. These guidelines have been prepared by the Philippine Society of Allergy, Asthma and Immunology and the Philippine Society for Pediatric Gastroenterology, Hepatology and Nutrition. They aim to provide evidence-based recommendations for the dietary primary prevention of allergic diseases in children. The primary audience of these guidelines is all healthcare practitioners who manage patients with potential allergic conditions. These guidelines are based on an exhaustive review of evidences, mostly systematic reviews, randomized controlled trials, and cohort studies. However, there are still many gaps in the evidence of dietary primary prevention of allergic diseases.

Prevalence of allergic rhinitis in Filipino adults based on the National Nutrition and Health Survey 2008.

BACKGROUND: There has been no documented data on the prevalence of allergic rhinitis among Filipino adults. OBJECTIVE: The objective of this study is to determine the prevalence of allergic rhinitis among adults in the Philippines. METHODS: Using a multi-staged cluster sampling methodology, this study evaluated 7,202 adults from 3,744 households, 79 provinces and 17 regions. A pre-validated written questionnaire for allergic rhinitis based on the International Study of Asthma and Allergies of Childhood was used as the survey instrument. RESULTS: The response rate obtained from the interview was 94.1%. The overall prevalence of nose symptoms in the past 12 months was 20% while prevalence of nose symptoms at any time in the past was 23.8%. The proportion among both sexes was similar. The prevalence was highest among the respondents 40-49 years old. The overall prevalence of nose and eye symptoms for the past twelve months was 14.0%. The prevalence of respondents who reported presence of nose problems for the past twelve months was similar across the 12 months of the year with highest rates noted in the months of June and May. Respondents from the rural area (22.1%) reported a higher prevalence of nose symptoms for the past twelve months compared to respondents from urban area (18%). There was no significant difference in prevalence of nose symptoms among residents living in coastal and/or inland areas. CONCLUSION: The overall prevalence of allergic rhinitis in the Philippines based on the 2008 National Nutrition and Health Survey is 20.0%.

Prevalence of asthma among Filipino adults based on the National Nutrition and Health Survey (NNHeS)

BACKGROUND: Prevalence surveys are important to aid in assessing the current burden of diseases, which will impact on the public health agenda as well as preventive interventions and health policies. Three previous local surveys on asthma prevalence of Filipino adults have been carried out. This is the fourth local survey and is also a part of the second NNHeS study, which is carried out every five years. The purpose of the survey is to determine the trend in asthma prevalence and to aid in formulating and evaluating local initiatives.OBJECTIVE: To determine the prevalence of asthma among Filipino adultsMETHODOLOGY: Using a multi-staged cluster sampling methodology, this study evaluated 7,202 adults at least 20 years old, from 3,744 households, 79 provinces and 17 regions. A pre-validated written questionnaire for wheezing among children based on the International Study of Asthma and Allergies of Childhood (ISAAC) was used as the survey instrument. This instrument was adopted since it has been widely used as a case definition for asthma, which allows for comparison of prevalence outcomes across time and population.RESULTS: The overall prevalence of asthma based on wheezing for the past 12 months was 8.7% (SE 0.4%). Males had a higher prevalence of wheezing for the past 12 months at 9.4% (SE 0.5%) compared to females at 8.2% (SE 0.5%). The overall prevalence of asthma based on wheezing at any time was 14.3% (SE 0.5%). Males had a higher prevalence of wheezing at any time of 14.8% (SE 0.7%) compared to females at 13.8% (SE 0.6%). The prevalence of adult asthma in the rural area was slightly higher than in the urban area (15.3% vs 13.3%), but the difference was not statistically significant.CONCLUSION: The overall prevalence of adult asthma in the Philippine based on the second NHHeS is 8.7%. This figure is lower than previous reported local prevalence data. The prevalence of adult asthma in the rural and urban setting is almost similar.

Partial Characterization of bermuda, carabao, cogon, and talahib grass pollen extracts

@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Grass pollen grains are important causes of respiratory allergies. The Philippines has a different grass flora compared to that of western countries, so pollen extracts have to be processed for use in the diagnosis and treatment of respiratory allergies. The local pollen extracts available in clinical practice have not yet been characterized, which is important in improving extract quality.<br /><strong>OBJECTIVE:</strong> This study aims to perform physicochemical characterization through protein content determination and gradient sodium-dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of extracts from four grasses: Cynodon dactylon (bermuda grass), Axonopus compressus (carabao grass), Imperata cylindrica (cogon), and Saccharum spontaneum (talahib) and immunologic characterization by identifying its IgE-binding component through immunoblot.<br /><strong>METHODS</strong>: This is a descriptive study. The pollen grains were processed into allergen extracts and protein contents were determined. The extracts were separated by gradient SDS-PAGE and subjected to immunoblotting. Bands were visualized using Fluorchem C2 aided with Alpha View Software.<br /><strong>RESULTS:</strong> Total protein in the pollen extracts ranged from 281.3-968.61 µg/ml. Protein bands of bermuda were in the 14.4-66.3 kDa range, carabao grass at 3.5-66.3 kDa, cogon at 3.5-200 kDA, and talahib at 21.5-66.3 kDa. A single IgE-binding protein band was seen on immunoblot at 55.4 kDa using a single serum sample.<br /><strong>CONCLUSION</strong>: Protein contents of the allergen extracts vary. The molecular weights of the different protein bands seem to correspond to known groups of grass pollen allergens. There was only one IgE-binding protein band seen on preliminary immunoblot.</p>