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

• Type of Material: Article
• Authors: Stefania Arasi, Bambino Gesù Children's Hospital, IRCCS; Ulugbek Nurmatov, Cardiff University; Audrey Dunn-Galvin, University College Cork; Shahd Daher, University of Oxford; Graham Roberts, University of Southampton; Paul J Turner, Imperial College London; Sayantani B Shinder, Stanford University; Ruchi Gupta, Northwestern University; Philippe Eigenmann, University Hospitals of Geneva; Anna Nowak-Wegrzyn, New York University; Mario Sánchez A Borges, Centro Médico Docente La Trinidad; Ignacio J Ansotegui, Hospital Quironsalud Bizkaia; Montserrat Fernandez-Rivas, Servicio de Alergia, Hospital Clınico San Carlos; Stavros Petrou, University of Oxford; Luciana K Tanno, Hospital Sírio Libanês, São Paulo; Marta Vazquez-Ortiz, Imperial College London; Brian Vickery, Emory University; Gary Wing-Kin Wong, Chinese University of Hong Kong; Motohiro Ebisawa, Sagamihara National Hospital; Alessandro Fiocchi, Bambino Gesù Children's Hospital, IRCC
• Language: English
• Date: 2021-03-11
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.waojou.2020.100503
• Title of Journal or Parent Work: WORLD ALLERGY ORGANIZATION JOURNAL
• Volume: 14
• Issue: 3
• Start Page: 100503
• End Page: 100503
• Grant/Funding Information: This is a project of the World Allergy Organization (WAO), supported by a grant from Novartis, as well as Abbott Laboratories and Food Allergy Research & Education (FARE). WAO funded the systematic review to support the development of the international consensus on the definition of severe food allergy. The funder and supporters had no role in the development of the protocol nor in the conduct of the systematic review or its publication.
• Keywords: EUROPEAN ACADEMY; DOUBLE-BLIND; QUESTIONNAIRE; Food allergy; Definition; Systematic review; ANAPHYLAXIS; PEANUT ALLERGY; Immunology; QUALITY-OF-LIFE; Allergy; CHILDHOOD; Mixed-methods study; Science & Technology; CHALLENGES; CHILDREN; Life Sciences & Biomedicine; Severity; POSITION PAPER
• Research Categories: Health Sciences, Human Development; Health Sciences, Immunology

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).