Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy.

BACKGROUND: Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. METHODS: Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. RESULTS: A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p < .05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. CONCLUSIONS: Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.

Multidisciplinary education improves school personnel's self-efficacy in managing food allergy and anaphylaxis.

BACKGROUND: Despite a relatively high risk for allergic reactions, including anaphylaxis, schools are not sufficiently trained and confident in handling children suffering from food allergy. This study aimed to measure the improvement of school personnel's self-efficacy in managing food allergy and anaphylaxis at school after a specific multidisciplinary training course. METHODS: A total of 592 teachers and school caretakers completed the School Personnel Self-Efficacy-Food Allergy and Anaphylaxis Questionnaire (S.PER.SE-FAAQ) before and after the course. The median difference, along with I quartile and III quartile, in scores between baseline and post-intervention assessment was calculated. A conditional regression tree was fitted for each outcome measured after the educational intervention. RESULTS: At baseline, school personnel reported low self-efficacy in anaphylaxis management (AM), especially in recognizing anaphylaxis symptoms and administering proper drugs. After the specific multidisciplinary training course, all scores improved. AM scores particularly showed a significant increase. School personnel's post-training self-efficacy was found to be related to initial levels. Some indicative threshold values emerged. Remarkably, participants with a low self-efficacy at baseline seemed to particularly benefit from the training. CONCLUSIONS: Results highlighted the effectiveness of specific multidisciplinary training courses in improving teachers' and school caretakers' self-efficacy in managing food allergy and anaphylaxis. The S.PER.SE-FAAQ is confirmed to be an easy and helpful tool to assess the level of food allergy and anaphylaxis management in the school staff and training effectiveness.

Food allergy and attitudes to close interpersonal relationships: An exploratory study on attachment.

BACKGROUND: Food allergy is a common immunologic disease that includes potentially fatal reactions. It impacts considerably on patients' social life including close interpersonal relationships. Attachment theory provides a theoretic framework to evaluate the quality of close interpersonal relationships in chronic disorders. Attachment insecurity, mainly characterized by attachment avoidance, has been found in a variety of health conditions, but still needs to be investigated in food allergy. The study aimed to investigate attachment, as attitude to close interpersonal relationships, among food-allergic young patients, compared to healthy controls. METHODS: This is a cross-sectional study involving patients suffering from IgE-mediated food allergy sequentially recruited and matched to healthy controls for age and gender. The Attachment Style Questionnaire (ASQ) was used to assess five factors and two attachment dimensions (Anxiety-Avoidance). Associations with anaphylaxis and adrenaline prescription were explored among patients. RESULTS: 174 participants were assessed (female=45%; mean age=17.51; SD=4.26). Food-allergic patients reported significantly higher levels of Discomfort with Closeness (P<.05), Relationships as Secondary (P<.05) and Attachment Avoidance (P<.0001) compared to controls. CONCLUSIONS: Clinicians should be aware of implications of insecure attachment for health and illness. They should support patients in limiting social impairment finding a balance between safety and psychologic well-being.

School personnel's self-efficacy in managing food allergy and anaphylaxis.

BACKGROUND: Food allergy affects up to 4-7% European schoolchildren. Studies identified important shortcomings on food allergy and anaphylaxis management in schools. In social cognitive theory, personal beliefs in own capabilities influence choices, effort levels, perseverance and performance accomplishments. This study aimed to investigate school personnel's self-efficacy in managing food allergy and anaphylaxis, providing a valid instrument to deeply understand how to support schools to effectively manage students at risk of food reactions. METHODS: A total of 440 schoolteachers and caretakers from north-east Italy completed a questionnaire assessing self-efficacy in managing food allergy and anaphylaxis at school. Exploratory factor analysis was performed. Factors' internal consistency was evaluated using Cronbach's alpha. Factors' scores were estimated using Bartlett approach, and kernel density estimate of distributions was provided. Descriptive statistics explored school personnel's self-efficacy. A regression model assessed the influence of gender, school, job and previous experience. RESULTS: Two factors emerged from exploratory factor analysis related to anaphylaxis management (AM) and food allergy management (FAM). The two subscales both showed good internal consistency. School personnel showed lower self-efficacy in recognizing symptoms, administering drugs and guaranteeing full participation to extra-curricular activities to food-allergic students. Participants who previously had food-allergic students showed a significantly increased self-efficacy in AM and a significantly decreased self-efficacy in FAM. CONCLUSIONS: The study supports the use of self-efficacy scale to identify specific areas where teachers' confidence in their ability to care for food-allergic students is especially weak. This would empower the development of training programs specifically tailored to the needs of teachers and caregivers.

Antiinflammatory and antioxidant effects of H2O2 generated by natural sources in Il1ß-treated human endothelial cells.

Specific reactive oxygen species (ROS) from different sources, might lead to different and even opposite, cellular effects. We studied the production of specific ROS resulting from the exposure of human umbilical veins endothelial cells (HUVEC) to H2O2 derived from the natural antioxidant epigallocathechin gallate (EGCG) or from the exposure to IL-1ß using a fluorogenic probe and flow cytometry, and evaluated by western blot analysis and immunocytochemistry the associated expression of transcription factors sensitive to both inflammatory and oxidative stress, such as NF-κB and Nrf2, and some downstream activated genes such as cyclooxygenase-2 (COX-2) and hemeoxygenase 1 (HO-1). The results obtained showed that exogenously-generated H2O2 induce anti-inflammatory and antioxidant effects in HUVECs counteracting the pro-inflammatory and pro-oxidant effect of IL-1ß related to the production of superoxide anions. The underlying mechanisms resulting from the extracellular production of H2O2, include (1) Nrf2 nuclear translocation and the enhanced expression of antioxidant enzymes such as HO-1, and (2) the previously unreported inhibition of NF-κB and COX-2 expression. Overall, these findings provide evidence that the production of specific reactive oxygen species finely tunes endothelial cell function and might be relevant for the reappraisal of the effects of exogenous antioxidants in the context of cardiovascular diseases.

Prenylated and geranylated flavonoids increase production of reactive oxygen species in mouse macrophages but inhibit the inflammatory response.

In this study, four prenylated and geranylated flavonoids, cudraflavone B (1), pomiferin (2), osajin (3), and diplacone (4), were tested for their antioxidant and anti-inflammatory effects and to identify any potential relationships between chemical structure and antioxidant or anti-inflammatory properties. The selected flavonoids were examined in cell-free models to prove their ability to scavenge superoxide radicals, hydrogen peroxide, and hypochlorous acid. Further, the ability of the flavonoids to influence the formation of reactive oxygen species in the murine macrophage cell line J774.A1 was tested in the presence and absence of lipopolysaccharide (LPS). The ability of flavonoids to inhibit LPS-induced IκB-α degradation and COX-2 expression was used as a model for the inflammatory response. The present results indicated that the antioxidant activity was dependent on the chemical structure, where the catechol moiety is especially crucial for this effect. The most potent antioxidant activities in cell-free models were observed for diplacone (4), whereas cudraflavone B (1) and osajin (3) showed a pro-oxidant effect in J774.A1 cells. All flavonoids tested were able to inhibit IκB-α degradation, but only diplacone (4) also down-regulated COX-2 expression.

VocabulARy: Learning Vocabulary in AR Supported by Keyword Visualisations.

Learning vocabulary in a primary or secondary language is enhanced when we encounter words in context. This context can be afforded by the place or activity we are engaged with. Existing learning environments include formal learning, mnemonics, flashcards, use of a dictionary or thesaurus, all leading to practice with new words in context. In this work, we propose an enhancement to the language learning process by providing the user with words and learning tools in context, with VocabulARy. VocabulARy visually annotates objects in AR, in the user's surroundings, with the corresponding English (first language) and Japanese (second language) words to enhance the language learning process. In addition to the written and audio description of each word, we also present the user with a keyword and its visualisation to enhance memory retention. We evaluate our prototype by comparing it to an alternate AR system that does not show an additional visualisation of the keyword, and, also, we compare it to two non-AR systems on a tablet, one with and one without visualising the keyword. Our results indicate that AR outperforms the tablet system regarding immediate recall, mental effort and task-completion time. Additionally, the visualisation approach scored significantly higher than showing only the written keyword with respect to immediate and delayed recall and learning efficiency, mental effort and task-completion time.

Arigato: Effects of Adaptive Guidance On Engagement and Performance in Augmented Reality Learning Environments.

Experiential learning (ExL) is the process of learning through experience or more specifically "learning through reflection on doing". In this paper, we propose a simulation of these experiences, in Augmented Reality (AR), addressing the problem of language learning. Such systems provide an excellent setting to support "adaptive guidance", in a digital form, within a real environment. Adaptive guidance allows the instructions and learning content to be customised for the individual learner, thus creating a unique learning experience. We developed an adaptive guidance AR system for language learning, we call Arigato (Augmented Reality Instructional ¯ Guidance & Tailored Omniverse), which offers immediate assistance, resources specific to the learner's needs, manipulation of these resources, and relevant feedback. Considering guidance, we employ this prototype to investigate the effect of the amount of guidance (fixed vs. adaptive-amount) and the type of guidance (fixed vs. adaptive-associations) on the engagement and consequently the learning outcomes of language learning in an AR environment. The results for the amount of guidance show that compared to the adaptive-amount, the fixed-amount of guidance group scored better in the immediate and delayed (after 7 days) recall tests. However, this group also invested a significantly higher mental effort to complete the task. The results for the type of guidance show that the adaptive-associations group outperforms the fixed-associations group in the immediate, delayed (after 7 days) recall tests, and learning efficiency. The adaptive-associations group also showed significantly lower mental effort and spent less time to complete the task.

Psychological needs and support among patients and families undergoing food oral immunotherapy.

BACKGROUND: Oral immunotherapy (OIT) is a promising treatment for food allergy (FA) however it is a challenging process for patients and parents. Induction can generate stress and anxiety. This may in turn affect their motivation and ability to cope with OIT challenges. OBJECTIVE: This study aimed to investigate psychological needs and support to patients/parents undergoing food OIT assessing participants' main characteristics, reasons for seeking psychological support, OIT phase and related psychological difficulties, type and timing of treatments and patients' perception of the effectiveness of the intervention. METHODS: This is an observational, retrospective study. 50 psychological interventions required for OIT related problems were selected consecutively in a Referral Centre in North-Eastern Italy. All patients had a medical diagnosis of FA and were undergoing OIT or had just discontinued it. Data were collected from hospital records. A descriptive statistical analysis was performed. RESULTS: 66% of patients asked for psychological support for the initial phase (e.g., oral food challenge, first maintenance doses), 20% during the up-dosing phase, 8% during maintenance and 6% after discontinuation. 70% of treatments were required mainly because of emotional problems including dysfunctional anxiety and mood disorders, increased distress and excessive worry and/or fear related to OIT; 20% because of difficulties in managing OIT; 10% because of eating difficulties; 50% of patients reported recent anaphylaxis. All patients reported improvement and felt the psychological intervention was helpful. CONCLUSION: It is recommended to evaluate the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed.

Management of Children With Food-Induced Anaphylaxis: A Cross-Sectional Survey of Parental Knowledge, Attitude, and Practices.

Background: Anaphylaxis is a life-threatening event, but it is frequently undertreated in pediatric patients with food allergies. Previous studies showed that auto-injectable adrenaline (AAI) is underused by patients and parents. This is especially troubling since fatal anaphylaxis has been associated with delayed adrenaline administration. Objectives: This study aimed to investigate parental practice and knowledge in anaphylaxis management, and perceived barriers and facilitators in using AAI. Results: A retrospective survey was completed by 75 parents (41 mothers, 34 fathers) of children with food allergy and AAI prescription attending the Food Allergy Referral Center of Veneto, Italy. Results showed poor parental preparedness and reluctance to use AAI despite a high/moderate self-rated knowledge (median total score of 23-min. 3, max. 30). Most parents (77%) declared they were carrying AAI but only 20% used it in case of a severe reaction. Most reported Fear/Fear of making mistakes (46 parents) and Concern about possible side effects as barriers (35), while Poor knowledge of the correct AAI use (1) and Lack of knowledge/ incorrect assessment of symptoms (2) were reported less frequently. Theoretical-practical courses for parents on AAI use (65), Psycho-education/Psychological support (3) for better dealing with the emotional aspects of anaphylaxis and Written instructions (1) have been suggested as main facilitators. Conclusion: Understanding parents' experience and perspective on managing anaphylaxis is crucial to implement effective educational programs. A multidisciplinary approach should be considered.

Alexithymia in food-allergic versus healthy children and young adults.

Alexithymia is a multifaceted personality construct associated with several medical illnesses. However, no studies have focused on food allergy. We investigated alexithymia among food-allergic youths, compared to a matched healthy sample. A total of 220 participants aged 9-25 years were assessed using the Toronto Alexithymia Scale and the Alexithymia Questionnaire for Children. Food-allergic patients reported higher levels of alexithymia compared to a matched healthy sample. Furthermore, an association between alexithymia and a clinical history of anaphylaxis was found among patients. Some possible hypotheses have been discussed considering physiological, psychological, developmental, and cognitive/behavioral factors.

Multidimensional analysis of food-allergic children and adolescents' self-concept: A comparison with a healthy matched sample.

The study investigated self-concept in food-allergic youths and matched healthy controls. Global and domain-specific self-concepts were assessed in 154 participants (9-19 years) using the Multidimensional Self-Concept Scale. Statistical analysis assessed differences between the two samples and effects of asthma, dermatitis, age, and gender among patients. Significant differences were found for Total Scale score and for Competence and Physical scores. Patients showed clinically problematic self-concepts in Global, Competence, and Family domains. Age was found to be associated with the Total score. Health professionals should consider food-allergic patients' personality development. Further studies could examine disease-specific consequences and interventions.

Phenotypic activation and pharmacological outcomes of spontaneously differentiated human monocyte-derived macrophages.

Macrophage activation has been observed in vivo under physiological and pathological conditions, and may represent an attractive target for pharmacological modulation. This study tested the hypothesis that human blood-derived macrophages generated in vitro in the absence of specific macrophage growth factors respond flexibly to activation stimuli and pharmacological treatment. Monocytes were differentiated to macrophages for 7 days in culture in RPMI 1640 with 10% FCS. The resulting population showed predominance of the M2 over M1 phenotype as measured by flow cytometry and the expression of M1 vs. M2 markers was not mutually exclusive. Activation with LPS/IFN-γ for 48 h significantly increased the fraction of surface CD68-expressing cells, the CD14(+)/CD16(-)/CD68(+) subset and cell-bound TNF-α levels, whereas expression of the CC chemokine receptor (CCR)-2 was unchanged. Expression of the M2 markers CD206, CD163 and CX3CR1 was down-regulated following M1 activation compared with resting and after pre-exposure to M2-triggers. By contrast, alternative activation with IL-4/IL-13 for 48 h did not increase M2 markers, while CD206 up-regulation was observed after 7 days. Both activation signals induced changes in gene expression profiles as shown by Q-PCR. Treatment with 100 nM dexamethasone enhanced the M2 morphotype and CD163 expression while preventing LPS/IFN-γ-induced CD163 down-regulation. After 1-week dexamethasone treatment, virtually all cells acquired a CD163(+)/CD206(+)/CX3CR1(+) M2 phenotype. Therefore, these protocols appear to be useful to perform screens of pharmacological agents targeting human macrophage activation.

Alternative activation of human macrophages is rescued by estrogen treatment in vitro and impaired by menopausal status.

CONTEXT AND OBJECTIVE: During their reproductive years, women are generally protected from cardiovascular disease events by their estrogen-replete status. Our starting hypothesis was that lower estrogen levels after menopause are associated with macrophage activation profiles skewed toward proinflammatory phenotypes. Research Design and Setting: This was an in vitro and ex vivo study in human blood-derived macrophages. SUBJECTS: We obtained blood from 12 healthy male donors for the in vitro study and from 5 premenopausal and 8 postmenopausal women for the ex vivo study. OUTCOME: We measured macrophage immunophenotypes in the resting state and after activation with M1-associated (lipopolysaccharide [LPS]/interferon-γ [IFN-γ]) or M2-associated (IL-4/IL-13) stimuli and expression of estrogen receptors (ERs) and other transcription factors. RESULTS: Unpolarized macrophages expressed both ERα and ERß, and ERα but not ERß levels were decreased by M1 stimuli. LPS/IFN-γ also induced down-regulation of CD163 and CD206, markers of alternative activation, and increased cell-bound TNF-α and IL-10. These effects were prevented by 17ß-estradiol treatment through impaired nuclear factor-κB liberation. In agreement with a role for 17ß-estradiol in attenuating the inflammatory response, M1/M2 subpopulations in monocytes and unstimulated macrophages from premenopausal and postmenopausal donors were similar. In contrast, M2 activation appeared to be blunted in macrophages from postmenopausal women, leading to an increased M1/M2 response ratio. CONCLUSIONS: Estrogen treatment prevented LPS/IFN-γ action on human M2 macrophage markers and cytokine production, whereas menopausal estrogen loss was associated with an impaired response to alternative activation, suggesting that these mechanisms affect the cardiovascular risk profile in relation to menopausal status.