Review

. 2021 Mar 11;14(3):100503.

doi: 10.1016/j.waojou.2020.100503. eCollection 2021 Mar.

Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Stefania Arasi¹, Ulugbek Nurmatov², Audrey Dunn-Galvin³, Shahd Daher⁴, Graham Roberts^{5

6}, Paul J Turner^{7

8}, Sayantani B Shinder⁹, Ruchi Gupta¹⁰, Philippe Eigenmann¹¹, Anna Nowak-Wegrzyn^{12

13}, Mario A Sánchez Borges¹⁴, Ignacio J Ansotegui¹⁵, Montserrat Fernandez-Rivas¹⁶, Stavros Petrou⁴, Luciana Kase Tanno^{17

18

19}, Marta Vazquez-Ortiz²⁰, Brian P Vickery²¹, Gary Wing-Kin Wong²², Motohiro Ebisawa²³, Alessandro Fiocchi¹

Affiliations

¹ Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
² Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
³ Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK.
⁵ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
⁷ National Heart & Lung Institute, Imperial College London, London, UK.
⁸ Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
⁹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA.
¹⁰ Center for Food Allergy and Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine, Department of Pediatrics & Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
¹¹ Pediatric Allergy Unit, Department of Women-Children-Teenagers Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
¹² Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA.
¹³ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
¹⁴ Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.
¹⁵ Department Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹⁶ Servicio de Alergia, Hospital Clınico San Carlos, UCM, IdISSC, ARADyAL, Madrid, Spain.
¹⁷ Hospital Sírio Libanês, São Paulo, Brazil.
¹⁸ University Hospital of Montpellier, Montpellier, France.
¹⁹ Sorbonne Universités, Paris, France.
²⁰ Department of Paediatrics, Imperial College London, United Kingdom.
²¹ Department of Pediatrics, Emory University, Atlanta, GA, USA.
²² Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
²³ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan.

PMID: 33767801
PMCID: PMC7966874
DOI: 10.1016/j.waojou.2020.100503

Review

Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Stefania Arasi et al. World Allergy Organ J. 2021.

. 2021 Mar 11;14(3):100503.

doi: 10.1016/j.waojou.2020.100503. eCollection 2021 Mar.

Authors

Affiliations

¹ Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
² Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
³ Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK.
⁵ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
⁷ National Heart & Lung Institute, Imperial College London, London, UK.
⁸ Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
⁹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA.
¹⁰ Center for Food Allergy and Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine, Department of Pediatrics & Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
¹¹ Pediatric Allergy Unit, Department of Women-Children-Teenagers Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
¹² Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA.
¹³ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
¹⁴ Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.
¹⁵ Department Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹⁶ Servicio de Alergia, Hospital Clınico San Carlos, UCM, IdISSC, ARADyAL, Madrid, Spain.
¹⁷ Hospital Sírio Libanês, São Paulo, Brazil.
¹⁸ University Hospital of Montpellier, Montpellier, France.
¹⁹ Sorbonne Universités, Paris, France.
²⁰ Department of Paediatrics, Imperial College London, United Kingdom.
²¹ Department of Pediatrics, Emory University, Atlanta, GA, USA.
²² Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
²³ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan.

PMID: 33767801
PMCID: PMC7966874
DOI: 10.1016/j.waojou.2020.100503

Abstract

Background and aims: The term "Food Allergy" refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders.

Methods: We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed.

Results: We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate.

Conclusions: There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy.

Systematic review registration: A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (https://www.crd.york.ac.uk/prospero/#recordDetails).

Keywords: Definition; Food allergy; Mixed-methods study; Severity; Systematic review.

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Conflict of interest statement

The following authors declared no potential interests: Ignacio J Ansotegui; Stefania Arasi; Shahd Daher; Alessandro Fiocchi; Ulugbek Nurmatov; Stavros Petrou; Graham Roberts; Mario Sánchez-Borges; Luciana Kase Tanno; Marta Vazquez Ortiz; Gary Wing-Kin Wong. Some of the authors have professional affiliations related to the content of the systematic review as set out below: Audrey Dunn-Galvin: consultancy fee from Aimmune and DBV; Paul J Turner: grants from UK 10.13039/501100000265Medical Research Council, 10.13039/501100013342NIHR/Imperial BRC, JM Charitable Foundation and UK 10.13039/501100000354Food Standards Agency; personal fees from UK Food Standards Agency, DBV Technologies, ILSI Europe and Allergenis, non-financial support from Aimmune Therapeutics; Sayantani B Sindher: supported by 10.13039/100000002NIH grants. Involved in clinical trials with Regeneron, Aimmune Therapeutics, DBV Technologies, Adare Pharmaceuticals, Sanofi, Novartis; Ruchi Gupta: grants from The 10.13039/100000002National Institute of Health (NIH) (R21 ID # AI135705, R01 ID# AI130348, U01 ID # AI138907), Rho Inc., Stanford Sean N. Parker Center for Allergy Research, UnitedHealth Group, Thermo Fisher Scientific, Genentech, and the National Confectioners Association (NCA); is employed by Ann & Robert H. Lurie Children's Hospital of Chicago; is a Professor of Pediatrics at Northwestern University; and serves as a medical consultant/advisor for Before Brands, Kaléo Inc., Genentech, ICER, FARE, Aimmune Therapeutics, and DBV Technologies; Philippe Eigenmann: Research grants and support: Ulrich Muller Gierock Foundation, 10.13039/100011033ThermoFisher Scientific; Consultant: DBV technologies, Nesté, Danone, Novartis, Abbott; Speaking engagements: ThermoFisher Scientific, ALK, Abbott; Stock options: DBV technologies; Anna Nowak-Wegrzyn: Grant/Research/Clinical Trial Support: DBV Technologies; ITN/NIAID; 10.13039/100004324Astellas Pharmaceutical; 10.13039/100004339Sanofi-Aventis [Future therapies for food allergy]. International FPIES Association [FPIES, unpaid advisor]. Consultant/Advisory Boards: Gerber Nutrition Institute; Merck. Speaking engagements: Nestle, Thermofisher Scientific; Montserrat Fernandez-Rivas: research grants from the Spanish Government (10.13039/501100003329MINECO, ISCIII) for the project SOLMILK, ARADyAL network and PI19/01095; consultancy fees from Aimmune, DBV, Novartis, SPRIM; lecture fees from ALK, Allergy Therapeutics, Diater, GSK, HAL Allergy, Thermofisher Scientific; Brian P Vickery: Employment: Pediatric Institute of Emory University + Children's Healthcare of Atlant; Consultant/Advisor: Aimmune Therapeutics; AllerGenis, LLC; Food Allergy Research and Education (FARE); Reacta Biosciences; Grant support: NIH-NIAID; 10.13039/100006423FARE; 10.13039/100004328Genentech; Clinical investigator: Aimmune; DBV Technologies; Regeneron; Motohiro Ebisawa: lecture fees: DBV technologies and Mylan.

Figures

**Fig. 2**
Roadmap to develop and reach the DEFASE international consensus

See this image and copyright information in PMC

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Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Affiliations

Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

Grants and funding

LinkOut - more resources

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