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Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs. Mixed methods were applied to data collected between April 14th - 28th, 2020 from the \"Parenting During the Pandemic\" survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions. Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time.

Vegan diets – defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child’s previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).

Risk factors for persistence of food-related symptoms (FRS) and food allergy (FA) from early life to adolescence are incompletely understood. The aim of this study was to identify risk factors for FRS and FA in adolescence amongst children with FRS or FA in the first four years of life (early life). In children enrolled in a Swedish birth cohort and followed to 16 years (n = 2572), we defined children with early life FRS in the absence of FA, and FA. Corresponding phenotypes were defined at 16 years. Associations between potential risk factors at 4 years and FRS and FA at 16 years were investigated using logistic regression. Early life FRS and FA prevalences were 12.2% and 6.8%, respectively. Amongst children with early life FRS, 35.7% had FRS or FA at 16 years, whereas 74.3% of the children with early life FA had FA at 16 years. For each of the early life phenotypes, parental allergy, early life allergic multimorbidity, early life reactions to peanuts/tree nuts and IgE reactivity at 4 years were statistically significantly associated with FRS or FA at 16 years. In contrast, male sex was associated with an increased risk of FA at 16 years among children with early life FA only. In early life, food-related symptoms are twice as common as food allergy. Unlike food allergy, food-related symptoms often remit by adolescence. Yet, these phenotypes have many common risk factors for persistence to adolescence.

Background: Children, including the estimated 7% with food allergy, spend most of their waking hours in school. Variations in school-based food allergy (FA) practices exist. We aimed to examine differences in FA management practices across schools in Canada and the United States (US). Methods: Parents of children with Immunoglobulin E (IgE)-mediated FA were recruited through social media to complete a survey evaluating the schools’ stock epinephrine, epinephrine storage locations, school type, and location. Data were described, analyzed using logistic and linear regressions, and then reported as odds ratios (ORs) and standardized coefficients (b), respectively, with corresponding 95% confidence intervals (95%CIs) and p < 0.05. This study was approved by the University of Manitoba Health Research Ethics Board. Results: Overall, 177 participants (14% [26/177] Canada, 86% [151/177] US) were included. Children were, on average, 4.92 ± 3.12 years and were commonly but not mutually exclusively allergic to tree nuts (50% Canada; 40% US) and peanuts (33% Canada; 29% US). Compared to US parents, Canadian parents were more likely to report epinephrine self-carriage by their children (OR = 4.58; 95%CI = 1.67–12.59). Parents with children age > 5 years were more likely to report epinephrine self-carriage by their children (OR = 3.70; 95%CI = 1.38–9.93) but less likely to report that their children’s school had an allergen-friendly zone (OR = 0.25; 95%CI = 0.06–0.99). Compared to US parents, Canadian parents were more likely to report their child’s school had anaphylaxis management policies (OR = 8.98; 95%CI = 1.11–72.42). Conclusions: Significant in-school FA management differences exist between countries. These findings stress the need for consistent policies and practices to ensure effective care.

Background/Objectives: Findings from the Learning Early About Peanut trial prompted a shift in clinical practice guidelines to support the early and continuous introduction of allergenic foods to reduce the risk of food allergy. Our study aimed to describe the reasoning behind parents’ decisions on the introduction of first foods to their infants and the age at which parents first introduced common allergens. Methods: Parents of a child aged <18 years old with ≥1 food allergy, who lived in either Canada or the United States, were recruited via social media between March 2021 and February 2022 to participate in an online, anonymous survey. Data were analyzed descriptively and using binary logistic regression. Results: A total of 42 parents completed the survey, the majority being mothers (40/42; 95.2%). Children were, on average, 6.9 ± 0.7 years old. In total, 47.6% of parents introduced first foods between ages 4–5 months, whereas 52.4% introduced first foods at 6 months or older. Cereals were the most frequently introduced first food (54.8%; 23/42). Most parents (71.9%) selected first foods to introduce based on guidance from healthcare providers. Conclusions: For many parents, guidance from healthcare providers is the most influential factor in determining when and what to introduce as first foods to their infant. Although the paradigm shift in infant feeding practices has been well accepted by healthcare providers, this information has not been adequately translated to the general population. This emphasizes the need for healthcare providers to educate and reinforce the importance of early introduction to reduce the risk of food allergy.

Food allergy is defined as an adverse immunologic response to a food. Immunoglobulin E (IgE)-mediated reactions to foods are associated with a broad range of signs and symptoms that may involve any of the following body systems: the skin, gastrointestinal tract, respiratory tract, and cardiovascular system. IgE-mediated food allergy is a leading cause of anaphylaxis. Therefore, timely and appropriate diagnosis and treatment are imperative. A diagnosis of food allergy entails a careful history and diagnostic tests, which may include skin prick tests, serum-specific IgE, and oral food challenge. The goal of food allergy care is to empower patients and caregivers to manage the risk of food-allergic reactions, reduce food allergy-related anxiety, and achieve a sense of control over their condition. This can be achieved in different ways for different patients and across different life stages. This article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of IgE-mediated food allergy. Key take-home messages Food allergy is defined as an adverse immunologic response to a food protein. Diagnosis of food allergy requires a detailed history and diagnostic tests, such as SPT and/or food-specific serum IgE measurement, and in some cases, OFCs. Management of food allergy involves avoidance of the culprit food(s) and self-injectable epinephrine for anaphylaxis. For patients with systemic symptoms, the treatment of choice is epinephrine administered by intramuscular injection into the lateral thigh. OIT is indicated as an option for food allergy management, which can be disease-modifying when performed early in the first years of life (see OIT article in this supplement). However, OIT is not readily accessible in many regions.

Background The impact of childhood food allergy on household costs has not been examined in Canada. The current study sought to examine differences in direct, indirect, and intangible costs among Canadian families with and without a food-allergic child. Methods Families with a child with a specialist-diagnosed food allergy (cases) were recruited from two tertiary pediatric allergy clinics in the Province of Manitoba, Canada, and matched, based on age and sex, to families without a food-allergic child (controls). Cost data for the two groups were collected via an adapted version of the Food Allergy Economic Questionnaire (FA-EcoQ). Consideration was given to income, defined as above vs. below the provincial annual median income. Results Results from 35 matched case/control pairs revealed that while total household costs did not significantly differ between cases and controls, food-allergic families did incur higher direct costs ($12,455.69 vs. $10,078.93, p = 0.02), which were largely attributed to spending on food. In contrast, cases reported lower, but not statistically significant, total indirect costs compared to controls ($10,038.76 vs. $12,294.12, p = 0.06). Families also perceived their food-allergic child as having poorer quality of life relative to their healthy peers. Lastly, stratification of the analyses by annual income revealed several differences between the higher and lower income groups. Conclusions Relative to families without a food-allergic child, food-allergic families incurred higher direct costs across a number of different areas.

Food insecurity is a growing concern, that is currently estimated to affect 1 in 4 Canadian children. Due to the additional effort required for management and the disproportionate cost of allergy friendly foods, households with food allergy may be at increased risk of experiencing food insecurity. With this in mind, we aimed to describe and compare the prevalence of food insecurity amongst children in households managing pediatric food allergy between 2019, 2020 and 2022 using a repeated cross-sectional design. A total of 117 participants were recruited via social media between these three distinct timepoints, referred to as waves. All participants completed an anonymous online survey consisting of demographic questions and the Household Food Security Module from the Canadian Community Health Survey. Rates of child food insecurity were comparable between Waves 1 and 2 (34% and 35%, respectively; p=0.75), but, increased significantly between Waves 2 and 3 (35% and 56%, respectively; p=0.005). Amongst children identified as food insecure, the proportion who were marginally food insecure remained relatively stable, whereas, levels of moderate food insecurity appeared to increase, although not significantly. Conversely, the proportion classified as severely food insecure decreased across the waves, but again, this difference was not statistically significant. Our findings demonstrate an upward trend in child food insecurity levels, showcasing the need for a larger scale, longitudinal evaluation of the intersection between food allergy and food insecurity. We call on researchers and policy makers to attend to this important issue.

Background Oral food challenges (OFCs) are considered the gold standard for diagnosis of food protein–induced enterocolitis syndrome (FPIES), a non-immunoglobulin E mediated gastrointestinal food allergy characterized by delayed, repetitive vomiting, lethargy, and sometimes diarrhea, primarily affecting infants and young children. Our modified approach to OFCs involves smaller, gradually increased doses to mitigate the risk of severe reactions. We aimed to measure the successful completion of this OFC protocol. Methods In a retrospective chart review, patients age < 18 years, who had 1 + episode of acute FPIES between 2015 and 2023 were identified using an allergy clinic database. Patients underwent OFCs with home up dosing every 2–4 weeks. Steps included 1%, 2%, 5%, 10%, 20%, 30%, 40%, 60%, 80%, and 100% of the final serving amount. The primary outcome was successful completion, i.e. absence of severe reactions during the OFC protocol and 1 year after. Data were analysed using logistic regression and reported as odds ratios (OR) and 95% confidence intervals (95% CI). Results were adjusted for multiple allergic comorbidities, age of FPIES onset, and biological sex. Results Among 47 patients who began the OFC protocol, 38 (80.85%) completed it without significant reactions. Of the 9 (19.14%) who did not complete the protocol, 4 (44.4%) paused due to reactions, and 5 (55.6%) paused due to non-FPIES symptoms. The 4 reactors paused due to mild-to-moderate reactions; there were no severe reactions during the protocol. There were no significant associations identified between OFC completion and severity of symptoms (OR 1.05; 95% CI 0.24–4.71; p  = 0.94); age at onset of symptoms (OR 0.99; 95% CI 0.94–1.02; p  = 0.58); or age of starting OFC (OR 1.00; 95% CI 0.98–1.02; p  = 0.90). Patients who reacted to milk tended to be less likely to complete the protocol than those reacting to other foods (OR 0.28; 95% CI 0.07–1.06; p  = 0.06). Conclusions This study supports the potential for a home-based gradual approach to OFCs in FPIES, evidenced by a high completion rate and no severe reactions.