Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study.

The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4-6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.

Correction: Quake et al. Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study. Nutrients 2022, 14, 737

In the original publication [...].

Determinants of long-acting reversible contraceptive (LARC) use by adolescent girls and young women.

OBJECTIVES: To identify factors relevant for adolescents and young women in their selection of a contraceptive method and reasons for acceptance or rejection of long-acting reversible contraceptives (LARCs). METHOD: Questionnaire survey among 194 women attending an integrated young people service. RESULTS: Compared to the number of those who had heard about all LARCs (71%), the number of respondents who had used a LARC was low (28%). Awareness of intrauterine methods was the lowest, compared to other LARCs. High efficacy, protection against sexually transmitted infections and non interference with sex were the three most important factors when choosing a contraceptive method, whereas the possibility of altering the menstrual pattern and reversibility were not considered important. Qualities of LARCs such as reliability and long duration of action would encourage young women to accept LARCs. Knowledge of peers' good experience with a LARC fosters, but fear of pain and needle (most obvious for intrauterine methods) restrains use of these methods. CONCLUSIONS: Despite reliability and long-term use being important advantages, fear of pain and needles make LARCs less appealing to young people. Current LARCs meet some, but not all expectations of adolescents and young women.

Non-contraceptive benefits and risks of contraception.

Contraception is primarily used to prevent pregnancy. However, a user should be aware of both the possible non-contraceptive benefits she/he may experience and any potential risks to her/his health. These issues should be discussed as fully as possible, using current, evidence-based information prior to commencing a method. Some methods may be prescribed solely for their non-contraceptive benefits for a woman who does not require it for contraception. Potential risks to a woman's health may make certain methods unacceptable if concurrent medical problems or lifestyle issues exist. This chapter discusses the main non-contraceptive benefits and risks for each contraceptive method in turn.

Randomised controlled trial assessing the acceptability of GyneFix versus Gyne-T380S for emergency contraception.

OBJECTIVE: To assess insertion-linked pain and the short-term user-acceptability and safety of the GyneFix as compared with T-framed intrauterine devices (IUDs). DESIGN: A randomised controlled trial in an outpatient clinic setting. METHOD: Women requesting an IUD for emergency contraception (EC) were allocated to either the short-term arm (GyneFix versus Nova-T200, or the long-term arm (GyneFix versus Gyne-T380S, and then randomised within each group. Visual analogue scores were used to assess the women's perception of the pain associated with insertion, which was patient-blinded. Follow-up was double-blinded, at 6 weeks, with bleeding and pain recorded over this time. RESULTS: A total of 175 women received an IUD in the long-term arm. The short-term arm was discontinued due to low recruitment (17 women at 20 months) and therefore the results relate to the long-term arm only. Outcome was known in 98% of subjects. The actual insertion procedure was scored as more painful for the GyneFix, both by the women (p = 0.013) and the doctors making their assessment of the women's pain (p = 0.04). The women with GyneFix described less pain in the subsequent 30 days after insertion (p = 0.005). Only 13% of women with GyneFix requested removal as compared with 20% with Gyne-T380S, with the difference being attributed to removal due to pain. The bleeding pattern was similar for those using GyneFix and Gyne-T380S. CONCLUSIONS: Our study suggests that although the actual fitting may be more painful, pain is less during the 6 weeks after insertion of GyneFix and fewer women discontinue its use because of pain, as compared with Gyne-T380S. The high overall continuation rate of all emergency IUDs at 6 weeks and low morbidity seen in this study favours more frequent IUD insertion where unprotected intercourse has occurred, given also its higher efficacy over oral hormonal EC.

Comparative trial of the force required for, and pain of, removing GyneFix versus Gyne-T380S following randomised insertion.

OBJECTIVE: To assess the force required for, and pain of, removal of the GyneFix as compared with T-framed intrauterine devices (IUDs). DESIGN: A comparative trial following patient-blinded randomisation in an outpatient clinic setting. METHOD: Women requesting an IUD for emergency contraception were fitted with either a GyneFix or a Gyne-T380S. For those requesting removal of the IUD, visual analogue scores were used to assess their perception of the associated pain, and a Newton dynamometer was used to measure the force required to remove the device. RESULTS: Removal required significantly more force for GyneFix as compared with Gyne-T380S (p = 0.004), but there was no significant difference in pain perceived by women during removal. Interestingly, anticipated pain was worse than actual pain experienced. CONCLUSION: Although more force is needed to remove the GyneFix as compared with the Gyne-T380S, this does not translate into more pain.

Risks and benefits of oral contraceptive pills.

In the more than 40 years since the combined oral contraceptive pill was first marketed, much information has been obtained as to its risks. Considerably less publicity has been given to the balancing benefits that have also emerged. There has been an increasing realization that the risks are focused in those women with recognised risk factors, meaning that the remainder can use the product with increasing reassurance. The doses of both hormones have also been lowered considerably since the early years. Thus, it can be a rational decision by a fully informed woman to use this form of contraception.