Predictors of health-related quality of life of European food-allergic patients.

BACKGROUND: Although food allergy has universally been found to impair HRQL, studies have found significant differences in HRQL between countries, even when corrected for differences in perceived disease severity. However, little is known about factors other than disease severity which may contribute to HRQL in food-allergic patients. Therefore, the aim of this study was to identify factors which may predict HRQL of food-allergic patients and also to investigate the specific impact of having experienced anaphylaxis and being prescribed an EAI on HRQL. METHODS: A total of 648 European food-allergic patients (404 adults, 244 children) completed an age-specific questionnaire package including descriptive questions. Multivariable regression analyses were performed to develop models for predicting HRQL of these patients. RESULTS: For adults, the prediction model accounted for 62% of the variance in HRQL and included perceived disease severity, type of symptoms, having a fish or milk allergy, and gender. For children, the prediction model accounted for 28% of the variance in HRQL and included perceived disease severity, having a peanut or soy allergy, and country of origin. For both adults and children, neither experiencing anaphylaxis nor being prescribed an epinephrine auto-injector (EAI) contributed to impairment of HRQL. CONCLUSIONS: In this study, food allergy-related HRQL may be predicted to a greater extent in adults than in children. Allergy to certain foods may cause greater HRQL impairment than others. Country of origin may affect HRQL, at least in children. Experiencing anaphylaxis or being prescribed an EAI has no impact on HRQL in either adults or children.

The impact of double-blind placebo- controlled food challenge (DBPCFC) on the socioeconomic cost of food allergy in Europe.

BACKGROUND: Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias. OBJECTIVE: To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy. METHODS: A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year. RESULTS: Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group's spending decreased by a median of $87.3 (P = .031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P = .040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3). CONCLUSION: DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food.

Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population.

Diabetes mellitus (DM) and also anemia are common in the elderly and have a negative impact on the clinical outcomes of patients. The coexistence of anemia and DM seems to be insufficiently recognized; therefore, the aim of our study is to analyze the incidence and clinical consequences of this coexistence, including mortality, in the population of people aged ≥60. A retrospective study was conducted on 981 primary care clinic patients aged ≥60 during 2013-2014. The prevalence of coexistence of DM and anemia (defined in accordance with WHO) and data on the incidence of comorbidities, hospitalization, medical procedures, and all-cause mortality were analyzed. In the study population, 25% had DM, while 5.4% had both DM and anemia. Peripheral artery disease (PAD) was found in 48 patients (4.89%) of the entire study population, more often in men (p < 0.001). Diabetic patients with anemia compared to nonanemic diabetics had more comorbidities (median 4 (4, 5) vs. 3 (2-4); p < 0.001)-PAD more often (p = 0.004), more hospitalization (median 2 (0-11) vs. 0 (0-11); p < 0.001), and more frequent medical procedures (e.g., percutaneous coronary intervention (p < 0.001), coronary artery bypass surgery (p = 0.027), arteriography (p < 0.001), and bypass surgery or endovascular treatments of lower limb ischemia (p < 0.001)). The cumulative survival of patients with both DM and anemia vs. nonanemic diabetics at 36 months was 86.4% vs. 99.3% (p < 0.001). A multivariate logistic regression model showed anemia to be a significant risk factor for death in diabetic patients (p = 0.013). Patients with both DM and anemia have more comorbidities than nonanemic diabetic patients; they are more often hospitalized, require medical procedures more frequently, and are at a higher risk of death. Effective treatment of anemia in patients with DM is advisable and may well improve the prognosis of patients.

The impact of double-blind placebo-controlled food challenge (DBPCFC) on the socioeconomic cost of food allergy in Europe

Background: Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias. Objective: To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy. Methods: A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year. Results: Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group’s spending decreased by a median of $87.3 (P=.031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P=.040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3). Conclusion: DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food (AU)

Introducción: La provocación oral doble ciego controlada con placebo (PODCCP) es prueba diagnóstica "gold standard" en alergia a alimentos. Objetivo: El objetivo de este estudio es investigar el efecto del diagnóstico en los costes socioeconómicos de la alergia a alimentos (AA). Métodos: Estudio prospectivo longitudinal de análisis de costes llevado a cabo en España y Polonia en el contexto de proyecto EuroPrevall. Se seleccionaron pacientes con AA y en todos los casos el diagnóstico fue estandarizado a través de una PODCCP estandarizada. Se utilizaron cuestionarios autoadministrados para recoger datos del uso de recursos sociosanitarios, coste de vida y coste de actividades de ocio. Los costes se midieron en dos puntos, antes y 6 meses después de PODCCP, expresados en dólares internacionales (nivel de costes 2007). Resultados: Se incluyeron 42 pacientes. 21 pacientes tuvieron una PODCCP negativa y se reintrodujo el alimento. Comparando los costes directos antes y después de PODCCP, el gasto en el grupo de pacientes reactivos fue significativamente mayor (mediana de incremento $813,1 a los 6 meses), mientras que en el grupo de pacientes tolerantes disminuyó una mediana de $87,3 (p=0,031). Los pacientes con una provocación positiva gastaron también más dinero en comida a los 6 meses del diagnóstico (p=0,040). Por último, los costes indirectos disminuyeron, aunque de forma no estadísticamente significativa, en el grupo de pacientes tolerantes comparado con los reactivos ($ 538,3 versus $32,3). Conclusión: La PODCCP tiene un impacto en los costes directos e indirectos, en su mayor parte debido al dinero gastado en comida (AU)