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Background: Various biomarkers are used to define peanut allergy (PA). We aimed to observe changes in PA resolution and persistence over time comparing biomarkers in PA and peanut sensitised but tolerant (PS) children in a population‐based cohort. Methods: Participants were recruited from the EAT and EAT‐On studies, conducted across England and Wales, and were exclusively breastfeed babies recruited at 3 months old and followed up until 7–12 years old. Clinical characteristics, skin prick test (SPT), sIgE to peanut and peanut components and mast cell activation tests (MAT) were assessed at 12 months, 36 months and 7–12 years. PA status was determined at the 7–12 year time point. Results: The prevalence of PA was 2.1% at 7–12 years. Between 3 and 7–12 year, two children developed PA and one outgrew PA. PA children had larger SPT, higher peanut‐sIgE, Ara h 2‐sIgE and MAT (all p <.001) compared to PS children from 12 months onwards. SPT, peanut‐sIgE, Ara h 2‐sIgE and MAT between children with persistent PA, new PA, outgrown PA and PS were statistically significant from 12 months onwards (p <.001). Those with persistent PA had SPT, peanut‐sIgE and Ara h 2‐sIgE that increased over time and MAT which was highest at 36 months. New PA children had increased SPT and peanut‐sIgE from 36 months to 7–12 years, but MAT remained low. PS children had low biomarkers across time. Conclusions: In this cohort, few children outgrow or develop new PA between 36 months and 7–12 years. Children with persistent PA have raised SPT, peanut‐sIgE, Ara h 2‐sIgE and MAT evident from infancy that consistently increase over time. [ABSTRACT FROM AUTHOR]

A study published in the Archives of Disease in Childhood found that only 32.9% of pediatric randomized controlled trials (RCTs) in the UK reported participant ethnicity, compared to 79.4% in the US. The study emphasizes the need for better reporting of ethnicity in research to ensure inclusive evidence-based medicine. The authors suggest that researchers advocate for strategies to improve inclusion and make ethnicity reporting standard practice. The document "Improving Inclusion of Under-Served Groups in Clinical Research: Guidance from the Include Project" provides practical recommendations for researchers to enhance the representation of under-served groups, such as engaging with community organizations and addressing cultural sensitivities. Following these guidelines can lead to more equitable healthcare outcomes for all. [Extracted from the article]

Background: The Learning Early About Peanut allergy (LEAP) study has shown the effectiveness of early peanut introduction in prevention of peanut allergy (PA). In the Enquiring About Tolerance (EAT) study, a statistically significant reduction in PA was present only in per‐protocol (PP) analyses, which can be subject to bias. Objective: The aim of this study was to combine individual‐level data from the LEAP and EAT trials and provide robust evidence on the bias‐corrected, causal effect of early peanut introduction. Method: As part of the European Union‐funded iFAAM project, this pooled analysis of individual pediatric patient data combines and compares effectiveness and efficacy estimates of oral tolerance induction among different risk strata and analysis methods. Results: An intention‐to‐treat (ITT) analysis of pooled data showed a 75% reduction in PA (p <.0001) among children randomized to consume peanut from early infancy. A protective effect was present across all eczema severity groups, irrespective of enrollment sensitization to peanut, and across different ethnicities. Earlier age of introduction was associated with improved effectiveness of the intervention. In the pooled PP analysis, peanut consumption reduced the risk of PA by 98% (p <.0001). A causal inference analysis confirmed the strong PP effect (89% average treatment effect relative risk reduction p <.0001). A multivariable causal inference analysis approach estimated a large (100%) reduction in PA in children without eczema (p =.004). Conclusion: We demonstrate a significant reduction in PA with early peanut introduction in a large group of pooled, randomized participants. This significant reduction was demonstrated across all risk subgroups, including children with no eczema. Furthermore, our results point to increased efficacy of the intervention with earlier age of introduction. [ABSTRACT FROM AUTHOR]

Background: Non‐IgE‐mediated Cow's Milk Allergy (CMA) has a prevalence of less than 1% in children. Guidelines developed to help non‐specialists diagnose CMA may lead to misattribution of normal symptoms and contribute to overdiagnosis of CMA. We sought to establish the frequency of symptoms during infancy associated with non‐IgE‐mediated CMA, using the international Milk Allergy in Primary Care (iMAP) guideline as representative of CMA guidelines more generally. Method: Secondary analysis of the Enquiring About Tolerance (EAT) randomized controlled trial (ISRCTN 14254740; 1303 exclusively breastfed 3‐month‐old healthy infants). Key outcomes were ≥2 iMAP symptoms associated with 'mild‐moderate' and 'severe' non‐IgE‐mediated CMA. Results: Whilst breastfeeding and parental atopy rates were higher than the general population, participants were otherwise similar to the population of England and Wales. Two or more non‐IgE CMA symptoms were reported by 25% families for mild‐moderate and 1.4% for severe symptoms each month between ages 3 and 12 months, peaking at 38% with ≥2 mild‐moderate and 4.3% ≥2 severe symptoms at three months, when participants were not directly consuming cow's milk. 74% of participants reported ≥2 mild‐moderate symptoms and 9% ≥2 severe symptoms in at least one month during this period. At six months there was no evidence of difference in the proportion of children with ≥2 symptoms between those consuming (29.5% mild‐moderate, 1.8% severe) and not consuming cow's milk (35.3% mild‐moderate, 2.2% severe). Mean monthly reporting of ≥2 symptoms was also no different between those with (15.8% mild‐moderate, 1.1% severe) or without eczema at baseline (16.7% mild‐moderate, 1.3% severe). Conclusions: Guideline‐defined symptoms of non‐IgE‐mediated CMA are very common in infants. Guidelines may promote milk allergy overdiagnosis by labelling normal infant symptoms as possible milk allergy. [ABSTRACT FROM AUTHOR]

Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy. [ABSTRACT FROM AUTHOR]

Background: The prevention of food allergy is a key priority for reducing the burden of allergic disease. Environmental exposures modulate the risk of developing food allergy and some of this may be mediated by the infants' developing microbiome. However, the role of potentially protective environmental exposures, such as pet ownership, is largely uninvestigated with respect to food allergy. Methods: We performed a secondary cohort analysis in the Enquiring About Tolerance (EAT) study, which enrolled 1303 three‐month infants onto a randomized trial to prevent food allergy. A survey elicited domestic animal ownership and participants were examined for atopic dermatitis (AD) at enrolment. Sensitization to foods and aeroallergens were elicited by skin and serum testing at 3, 12 and 36 months. Food allergy status was determined by double‐blind placebo‐controlled food challenges between 1 and 3 years. Results: Food allergy was diagnosed amongst 6.1% (68/1124) of participants with complete data. No significant relationships were demonstrated between food allergy and caesarean delivery, infections or antibiotic exposure in early life. After adjusting for familial atopic disease, maternal dog/cat sensitization and participant AD, living with dogs was associated with a 90% reduction in the odds of infants developing food allergy (adjusted odds ratio (aOR) 0.10 (confidence interval (CI) 0.01‐0.71), P = 0.02). None of the 49 infants living with at least two dogs developed food allergy, suggesting a dose‐response relationship (each dog owned aOR 0.12 (CI 0.02‐0.81), P = 0.03). No relationship was demonstrated between owning dogs or cats and the development of AD. Conclusion: Dog ownership in infancy may prevent food allergy. [ABSTRACT FROM AUTHOR]

A literary criticism of the book " The Gloaming" is presented. It outlines that the author offers in sparkling creative prose the subtle ways of Scottish enchantment stories and the manner in which creatures from the ‘outside' intrude upon mortal folk. It examines girls who were raised on fairy tales and the kind of books that would curdle blood.

Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals. The review was undertaken as part of the European Union funded Integrated Approaches to Food Allergy and Allergen Management (iFAAM) study. This is a wide ranging project bringing together expertise across the breadth of food allergy research. Specifically, the review discusses dietary manipulation in food allergy prevention, and covers the possible preventive strategies of allergen avoidance, early allergen introduction, general nutrition and supplements, as well as other strategies, such as prebiotics and probiotics. The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4-6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic. [ABSTRACT FROM AUTHOR]

Background Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests ( SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests ( IDT) and drug provocation challenges ( DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy. Methods Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children. Results Eighty-one clinicians, practising in 16 countries, completed the questionnaire. There is variability in the selection of diagnostic tests used by clinicians around the world and poor agreement on positive cut-off values (sp-IgE, SPT and IDT) and practical techniques used to measure SPT or IDT wheal diameters. DPC were considered the gold standard investigation with 94% of respondents undertaking DPC over the last 12 months; 64% of respondents considered DPC extremely useful for both exclusion and confirmation of beta-lactam allergy. However, there is a lack of consensus on when and how DPC should be performed. Overall, DPC are safe - only 3% of our respondents had patients who required intramuscular adrenaline and none had patients requiring admission to intensive care. Conclusions There is lack of consistency amongst clinicians in different countries in the diagnosis and management of suspected beta-lactam allergy. The development of a standardized approach is a priority. [ABSTRACT FROM AUTHOR]

The environmental factors driving the recent increase in the prevalence of food allergy ( FA) are unclear. Since associations have been demonstrated between microbial exposure and the likelihood of eczema and respiratory allergies, we reviewed the evidence for FA. Medline was systematically searched from inception to the end of July 2012 for studies investigating links between FA and environmental exposures, likely to influence microbial exposure, such as Caesarean delivery, family size, day-care attendance, childhood infections, immunizations and antibiotic use. We selected studies reporting food challenge data, reported doctor-diagnosed ( RDD) FA and food sensitization. Methodological differences and study heterogeneity precluded meta-analysis. A total of 46 studies were identified, of which 28 (60.9%) were prospective and 13 (28.3%) used food challenges to diagnose FA. Caesarean delivery was investigated in 13 studies, of which three infant cohorts demonstrated an increase in challenge-proven FA (one cohort) and food sensitization (two cohorts), and one cross-sectional study reported increased RDDFA. Four studies investigated the effect of having siblings, with one infant cohort demonstrating less challenge-proven FA and a cross-sectional study showing a decrease in RDDFA. Attending childcare before 6 months was associated with less challenge-proven FA in one cohort. A cross-sectional survey identified an inverse relationship between hepatitis A serology and peanut sensitization. One of eleven trials investigating probiotics demonstrated a quicker acquisition of milk tolerance amongst allergic infants. Factors influencing microbial exposure may be partly responsible for rising FA burden, but further prospective studies using double-blind placebo controlled food challenges as an outcome are required. [ABSTRACT FROM AUTHOR]

The article offers brief information on the Advanced and Specialist Healthcare course based on various modules including evidence based practice, mentorship and dissertation, offered by the University of Kent Centre for Professional Practice, England for dental professionals.