Faculty Bibliography

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.

INTRODUCTION/BACKGROUND:Introducing baked milk into the diet of children with cow's milk protein allergy (CMPA) has been shown to potentially accelerate the development of tolerance to non-heated milk. However, there is no standardised milk ladder (ML) protocol, and different scientific societies across countries recommend varying versions. This study aims to assess the effectiveness and safety of the four-step ML (4-ML) compared with the six-step ML (6-ML) in children with IgE-mediated CMPA. METHODS AND ANALYSIS/METHODS:We will perform an open-label randomised trial with two parallel arms in two departments of the same academic hospital. A total of 92 children with IgE-mediated CMPA will be allocated in a 1:1 ratio to introduce cow's milk into their diet according to either 4-ML or 6-ML with a 4-week break period between subsequent steps. Oral food challenge (OFC) with tested products at each subsequent step of the ML will be conducted in hospital settings. The primary outcome will be the percentage of children with tolerance to non-heated cow's milk proteins defined as no allergic reaction to raw cow's milk (120-240 mL depending on the age of the patient) during the last OFC; measured at the end of the 12-week observation period for the 4-ML and 20-week observation period for the 6-ML. Secondary outcomes will include the percentage of children with a negative OFC to each ML step; the percentage of children with anaphylaxis (both those who were treated and those who were not treated with epinephrine); the percentage of children with exacerbation of atopic dermatitis; growth; compliance; and quality of life of the caregivers and parents' anxiety about adverse events during their child's OFC. ETHICS AND DISSEMINATION/BACKGROUND:The bioethics committee of the Medical University of Warsaw, Poland, approved this protocol (KB/107/2024). The findings will be published in a peer-reviewed journal and submitted to relevant conferences no later than 1 year after data collection. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT06664918.

This article explores food allergy and the nascent field of nutritional psychiatry. Individuals with food allergy experience lower levels of "food freedom" than their non-allergic counterparts, which can create cognitive, emotional, social, nutritional, and financial burdens. Patterns of food avoidance may influence neuroinflammatory states as well as the gut microbiome; these changes may be associated with neuropsychiatric symptoms. Food restriction may promote disruption of the microbiome neuroimmune axis, which has been linked to various allergic diseases. Targeted psychological counseling strategies can provide benefit. Food allergy and restricted diets may impact dietary health benefits.