Publications by authors named "Victoria E Cook"

Non-immunoglobulin E (IgE)-mediated food allergies are characterized by delayed gastrointestinal (GI) manifestations that occur after exposure to an inciting food protein; they include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and food protein-induced enterocolitis syndrome (FPIES). Although the exact mechanisms underlying these disorders are not well understood, non-IgE-mediated food allergies likely represent a spectrum of disease with shared pathophysiological processes. Typically, these non-IgE-mediated food allergies begin in infancy or early childhood, although FPIES can present across the lifespan, with increasing reports in adults in recent years.

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Background: Oral immunotherapy (OIT) is an increasingly utilized management strategy for IgE-mediated food allergy. Despite promising efficacy and effectiveness, there is still a lack of data surrounding the reasons for discontinuation of OIT. The primary reason stated in the literature for discontinuation is adverse gastrointestinal effects.

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Tree nut (TN) allergy is common, with a global prevalence of up to 4.9%. TN allergy is persistent in most patients, and accidental reactions are common.

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Background: Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective.

Objective: We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians.

Methods: A survey in Canada and the United States involved families currently enrolled in food OIT programs.

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Article Synopsis
  • Previous studies showed that sesame oral immunotherapy (S-OIT) is effective in children over 4 years using high doses, but preschoolers may find tahini unappetizing and tolerate lower doses.
  • This study focused on the safety and effectiveness of a lower dose (200 mg) S-OIT for preschoolers with sesame allergies.
  • Results indicated that this lower maintenance dose is both safe and effective, with a majority of participants successfully tolerating higher amounts of sesame protein after treatment.
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Background: Current management of food protein-induced enterocolitis syndrome (FPIES) involves strict avoidance of the offending food for 12-18 months, followed by oral food challenge (OFC) under physician supervision. OFCs are resource-intensive and there is a lack of a universal standardized protocol for FPIES. Prolonged avoidance may increase the risk of IgE-mediated allergy, particularly in atopic patients.

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Article Synopsis
  • The study investigates how patient characteristics like age, initial reactions, and specific IgE levels influence safety outcomes during peanut oral immunotherapy (P-OIT), aimed at improving decision-making between clinicians and families.
  • Data from the Food Allergy Immunotherapy (FAIT) registry were analyzed, revealing that certain factors, including previous reactions and higher IgE levels, are linked to more severe reactions during treatment.
  • Key findings emphasize the importance of individualized risk assessment for patients undergoing P-OIT to ensure safer therapeutic outcomes.
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Background: Our group previously described preschool peanut oral immunotherapy (OIT) in a real-world, multicenter setting, suggesting that this therapy is safe for most preschoolers.

Objective: To examine the safety and tolerability of tree nut (TN) OIT in preschoolers in the real world.

Methods: As part of a Canada-wide quality improvement project, TN-OIT (cashew/pistachio, walnut/pecan, hazelnut, almond, and macadamia nut) was performed in preschoolers who had (1) a skin prick test wheal diameter greater than or equal to 3 mm or a specific IgE level greater than or equal to 0.

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Article Synopsis
  • Allergists may focus too much on oral immunotherapy (OIT) as the cause for gastrointestinal (GI) symptoms, potentially overlooking other non-OIT related issues.
  • A proposed management algorithm for handling GI symptoms during OIT is presented, designed to assist new providers like allergists and trainees who may encounter these symptoms.
  • Input from various allergy clinics in Canada shaped the algorithm, but more research is necessary to establish comprehensive treatment recommendations for GI symptoms in OIT patients.
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Article Synopsis
  • * Infants with severe eczema, who are at the highest risk for peanut allergies, often do not benefit from this approach due to hesitancy about introducing peanuts and challenges in maintaining regular ingestion.
  • * Peanut oral immunotherapy (OIT) is emerging as a safe and effective treatment for infants who develop peanut allergies, and it is proposed that it should be offered as a proactive solution following failed early introduction.
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The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT.

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Most Canadian food allergy data has focused on Health Canada's priority food allergens. This study describes which non-priority (emerging) food allergens were most commonly reported by Canadian parents and categorized/confirmed by allergists. A secondary aim was to describe severity of allergic reactions to emerging allergens.

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Article Synopsis
  • A study examined the safety and effectiveness of peanut oral immunotherapy (P-OIT) for preschoolers, noting that only a small percentage (0.4%) experienced severe reactions during the treatment period.
  • After one year of P-OIT maintenance, 78.6% of participants showed successful desensitization, indicating a negative follow-up oral food challenge (OFC), while the majority tolerated high doses of peanuts.
  • The findings suggest that P-OIT is an effective option for preschoolers with peanut allergies, as it increases their tolerance and offers a potential alternative to strict peanut avoidance.
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Article Synopsis
  • - In a 2017 trial, preschool peanut oral immunotherapy (P-OIT) was deemed safe, with mostly mild reactions and only 1 moderate case needing epinephrine.
  • - A follow-up study in Canada involved 270 preschool children receiving P-OIT, where 243 reached the maintenance dose over 16 to 22 weeks, and 67.8% experienced some reactions, primarily mild.
  • - The results suggest that while P-OIT is safe for most children, a small percentage (0.4%) may still experience severe reactions, highlighting the need for caution.
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Key Points: Smn transgenic mouse is a model of the mildest form of spinal muscular atrophy. Although there is a loss of spinal motoneurons in 11-month-old animals, muscular force is maintained. This maintained muscular force is mediated by reinnervation of the denervated fibres by surviving motoneurons.

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Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children's Hospital during the 2014 outbreak.

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