Faculty Bibliography

BACKGROUND:Pollen food allergy syndrome (PFAS), also called oral allergy syndrome, results from cross-reactivity between pollen allergens and plant-derived foods. While typically mild, PFAS can occasionally cause systemic reactions. A 2003 U.S. survey characterized its epidemiology and management; this study repeated the survey in 2023 to assess changes. OBJECTIVE:To evaluate changes in prevalence, clinical patterns, diagnostic practices, and management of PFAS among U.S. allergists over two decades. METHODS:A 16-question survey (7 original, 9 new) was electronically distributed to 737 randomly selected AAAAI members in October 2023, and results were compared with 2003 survey responses RESULTS: Sixty-seven allergists (9%) responded. Reported prevalence of PFAS increased in children (median 5% to 10%, p = 0.01) and adults (8% to 20%, p < 0.001). The proportion of allergists with patients experiencing systemic PFAS rose from 20% to 67%, though the median percentage of affected patients declined (5% to 1%). Grass pollen emerged as a key sensitizer, alongside birch and ragweed. Nut-induced PFAS was increasingly recognized, cited as a frequent trigger of systemic symptoms and a reason for epinephrine auto-injector (EAI) prescription. Overall, EAI prescribing declined, with 0% of allergists "always" prescribing in 2023 vs 30% in 2003. Diagnostic practices showed increased but limited use of component-resolved diagnostics, while dietary advice remained variable, especially for nut PFAS. CONCLUSION/CONCLUSIONS:Allergists report higher estimated prevalence of PFAS, greater recognition of nut-induced and systemic PFAS, and evolving diagnostic and management practices. Findings underscore the need for updated guidelines on PFAS diagnosis and management.

Complementary feeding (CF) influences infants' long-term dietary preferences, growth, and food allergy (FA) risk. However, guidance given to families and the implementation of FA prevention guidelines by healthcare professionals (HCPs) remain unclear. This study explored HCPs' perspectives and practices regarding CF strategies in the context of FA prevention across different regions and professional backgrounds. An online survey conducted by an EAACI task force between December 2023 and May 2024 assessed CF timing, allergenic food introduction, nutrient supplementation, and FA preventive measures. 550 HCPs (pediatricians, allergists, dietitians), 68% from Europe, participated. HCPs recommended CF initiation at a median of six months for breastfed infants and five months for formula-fed and FA high-risk infants. Atopic dermatitis (94%) and family history of allergies (87%) were the most recognized FA risk factors. Vitamin D (49%), probiotics (28%), and omega-3 fatty acids (18%) were commonly recommended supplements. Regional, professional, and educational influences differences emerged, with Northern European HCPs favoring earlier CF and allergen introduction, often without structured guidance. Southern European HCPs preferred a structured sequence and later CF initiation. A flexible, evidence-based framework is needed to guide FA prevention while accommodating cultural and geographical differences.

There has been substantial growth of advanced practice practitioners (APPs) in health care since their inception in the 1960s with APPs providing high-quality and cost-effective care in a variety of medical settings. Although most of the growth is in primary care, APPs are becoming increasingly leveraged in subspecialty care, including allergy and immunology (A&I). At present, there is limited literature on APPs in A&I specifically, but there is growing literature on APP utilization and training in other specialties. Structured transition-to-practice programs (including onboarding programs and formal residency/fellowships) for APPs in other specialties are increasingly common and are associated with improved clinical productivity, practice autonomy, expertise, confidence, and decreased turnover. It would benefit A&I to adopt a similar approach, as at present, the training and educational experiences APPs receive in A&I are quite varied. This article will review the training/certification of APPs, lessons learned from other specialties, what is known about the role of APPs in A&I, and next steps for the future.

The current standard management of anaphylaxis recommends immediate activation of emergency medical services after epinephrine administration. Recently the American Academy of Allergy, Asthma & Immunology 2023 anaphylaxis practice parameter has provided a conditional recommendation that patients at low risk may observe initial response to epinephrine at home.

BACKGROUND/UNASSIGNED:Data on severity of food allergy across nations are lacking. Building on the World Allergy Organization (WAO) DEFASE (Definition of Food Allergy Severity) score, we aim to explore its global applicability as a grading system for IgE-mediated food allergy (FA) severity. METHODS/UNASSIGNED:An international survey (WAO FASE Project) was conducted using an online questionnaire distributed to WAO members. The survey collected detailed data on diagnostic practices, therapeutic options, characteristics of FA patients, severity of reactions (including anaphylaxis), and eliciting doses of allergenic foods. In addition, FA management costs were examined (medical expenses, medication costs, and impact on quality of life and productivity). RESULTS/UNASSIGNED:We obtained information from 157 centers in 50 countries. FA management varied significantly across regions. Oral immunotherapy and omalizumab are widely used in Europe and North America. The use of advanced diagnostic tests (molecular diagnostics) vary widely between these regions. Thirty-five percent of patients with anaphylaxis exhibited severe symptoms (respiratory or cardiovascular compromise), with marked regional differences: more frequent in Western Asia (55.83%), Southern Africa (50%), and less frequent in South-Eastern Asia (12.5%) and Central America (21.72%). Approximately 1 in 4 patients reacted to less than half an age-appropriate portion of the allergenic food. Depending on the region, peanut, milk, egg, wheat, hazelnut, and peach allergies varied considerably. Economic resources and healthcare systems play an important role in determining access to diagnostic tests and therapeutic options, which have a direct impact on the severity and management of FA. CONCLUSIONS/UNASSIGNED:With wide global disparities in access to diagnostic and therapeutic tools for food allergies, this condition entails a vast healthcare and economic commitment. The percentage of patients receiving a high severity diagnosis using DEFASE could be around 3%, similar to that of asthma patients diagnosed with severe refractory asthma.

The field of allergy and immunology (A/I) has transformed modern medicine with the development of diagnostic and therapeutic advances in all areas of health. This Work Group Report from the Division Directors Committee of the American Academy of Allergy, Asthma & Immunology describes the current state of 5 mission areas (clinical, educational, research, equity, and advocacy) within the A/I divisions/subdivisions of academic medical centers (AMCs) in the United States. The current states of the clinical and educational mission areas in AMCs in A/I are strong, with an increasing prevalence of atopic/immunologic disorders and novel therapeutics, solid trainee interest, and tremendous potential for research, equity, and advocacy efforts. The interest in the field of A/I has outpaced the creation of new positions, leading to an increase in unmatched applicants yearly. Weaknesses and threats include decreasing federal research and educational funding, changing health care insurance policies, the dynamic legislative environment, and the negative impact of the business focus in academic institutions. The future of A/I will depend on the preservation of a strong academic foundation with improved recruitment to academic positions, increased training positions, and greater incentives for development of career opportunities in research and education, utilizing artificial intelligence tools and strong advocacy strategies.

Allergic diseases, particularly food allergy, can be associated with significant psychosocial impairment. Allergist-immunologists can provide evidence-based information to correct misperceptions and misunderstandings regarding food allergy that may perpetuate cycles of fear and anxiety. While motivational interviewing can be an empathetic approach to empower patients to actualize health goals, cognitive behavioral therapy (CBT) aims to provide disease-state insight to facilitate an understanding of risk which can facilitate transformation of health beliefs and behavior. Brief CBT (bCBT) is a clinical approach that can help address ineffective management paradigms through conversations that begin with curious questions. In this review we discuss evidence supporting implementation of an integrated method of CBT in the allergy-immunology clinic and provide resources for this approach.

BACKGROUND:Food allergen immunotherapy (FAIT) is a consolidated treatment included in clinical guidelines that has shown efficacy in terms of researcher-defined variables, but little work has been done yet to evaluate patient´s perspectives. OBJECTIVE:We aimed to understand and explore the relevance of different patient-reported outcomes (PROs) METHODS: An EAACI Taskforce designed a questionnaire to prospectively collect information from parents or caregivers of patients below 18 years on FAIT. Participants from North America and several European countries were invited to provide data regarding socioeconomic aspects, allergic background, FAIT modality, burden, safety and food allergy quality of life (FAQoL). As primary outcome, 19 proposed PROs were ranked according to their relevance (5-point Likert scale). A descriptive and cluster analysis of the data was performed. RESULTS:84 FAIT prescribers recruited 857 patients suitable for analysis, 41.5%, 39.7% and 18.8% were on milk, peanut, and egg AIT, respectively. Patients were grouped into regions, South Europe (46.2%), North America (24.3%), Western Europe (20.7%) and United Kingdom (8.9%). Total FAQoL questionnaire score was 4.1 (±SD1.4), significantly higher among South Europeans [4.7 (±SD1.3), p<0.0001]. Worse FAQoL scores were found for milk and egg FAIT vs peanut. Cluster analysis identified 5 different phenotypes of patients considering similar replies to the proposed PROs, labeled: "High expectations", "Beyond protection", "Social Functioning", "Aiming at normalization" and "Low motivations". CONCLUSIONS:The data-driven analysis provided novel information on the level of complexity and personalization that patient´s desires display and opens the field to future research lines to improve FAIT patient-perceived value.