RESUMEN
BACKGROUND: Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective. OBJECTIVE: We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians. METHODS: A survey in Canada and the United States involved families currently enrolled in food OIT programs. RESULTS: Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a "very significant" barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with a slower buildup (P = .02) and a reduction in dose (P = .002). Taste aversion was a strongly age-dependent barrier for initiation (P < .001) and continuation (P < .002), with older children over 6 years of age reporting it as a very significant barrier (P < .001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (P < .05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (P < .001). CONCLUSIONS: Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success.
RESUMEN
BACKGROUND: Physical urticaria (PU) is a subset of chronic urticaria (CU) induced by physical stimuli. To date, there is no consensus in the literature on the prevalence of PU among patients with CU. OBJECTIVES: Our objective was to review the clinical presentation, diagnosis and management of PU and to estimate the prevalence of PU in CU patients. METHODS: We performed a narrative review of PU and conducted a systemic review and meta-analysis to determine the pooled estimates of the prevalence of PU among patients with CU in the literature up to September 2014. We searched four databases (PubMed, Ovid MEDLINE and Web of Science) of published work for which full text was available in English or French. Studies were eligible if they measured the prevalence of PU in adults or children with CU worldwide and ineligible if CU cases were not differentiated from total urticaria cases. Meta-analysis was conducted using Stata, version 12.0 (StataCorp, College Station, TX). In addition, the quality and validity of the articles included in the meta-analysis was assessed. RESULTS: Ten studies were included in our meta-analysis. Sample sizes ranged from 202 to 4157 patients. The pooled prevalence estimate of PU including and excluding cholinergic forms among all cases of CU were 13.1% (95% CI: 12.5, 13.6) and 14.9% (95% CI: 14.3, 15.7), respectively. CONCLUSION: Our results must be viewed with circumspection because of the small number of eligible articles and heterogeneity among studies. Even so, the results suggest that PU is an important subset of CU and that physicians should be aware of this important condition in order to manage patients appropriately.
