Rady Faculty of Health Sciences
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Browsing Rady Faculty of Health Sciences by Author "Abrams, Elissa M."
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- ItemOpen AccessAdherence with epinephrine autoinjector prescriptions in primary care(2017-11-10) Abrams, Elissa M; Singer, Alexander G; Lix, Lisa; Katz, Alan; Yogendran, Marina; Simons, F. E RAbstract Background The aim of this study was to estimate primary adherence for epinephrine autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada. Methods A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new EA prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of filling an EA prescription. Results Of 1212 EA prescriptions written between 2012 and 2014, only 69.9% (N = 847) were filled. An increased number of prescriptions for non-EA mediations was associated with an increased odds ratio of not filling an EA prescription. Interpretation This is the first study in Canada to examine adherence for EA prescriptions. The non-adherence rate identified is higher than rates previously reported in the literature, and indicates that many EA prescriptions for adults seen in primary care may never be filled. It also suggests that prescriptions of EAs for all patients at risk of anaphylaxis in community settings should consistently be accompanied by concise information about the importance of having the EA prescription filled and having the EA readily available.
- ItemOpen AccessBilling fees for various common allergy tests vary widely across Canada(2020-04-22) Protudjer, Jennifer L P; Soller, Lianne; Abrams, Elissa M; Chan, Edmond SAbstract Background The prevalence of food allergy in Canada is high and has increased over time. To date, there are no Canadian data on the healthcare costs of visits to allergists. Methods We sent an anonymous survey to allergist members of the Canadian Society of Allergy and Clinical Immunology (CSACI) between October and December 2019. Survey questions included demographic information and billing fees for various types of allergy visits and diagnostic testing. Results Of 200 allergists who are members of CSACI, 43 allergists responded (21.5% response rate). Billing fees varied widely. The greatest ranges were noted for oral immunotherapy (OIT; both initial consultation [mean $198.70; range $0 to $575] and follow up/build up visits [mean $125.74; range: $0 to $575]). There were significant provincial differences in billing fees, as well as significant billing fee differences between hospital versus community allergists (e.g. oral food challenge [OFC]: $256.38 vs. $134.94, p < 0.01). Billing fees were higher outside of Ontario, with the exception of specific Immunoglubulin E (sIgE) testing and OIT visits. Conclusions Greater standardization of billing fees across provinces and between hospital versus community allergy could result in more consistency of billing fees for OFC and OIT across Canada. Further knowledge of exact costs will help inform practice and policy in the diagnosis and management of food allergy.
- ItemOpen AccessCanadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg(2021-08-05) Chomyn, Alanna; Chan, Edmond S.; Yeung, Joanne; Vander Leek, Timothy K.; Williams, Brock A.; Soller, Lianne; Abrams, Elissa M.; Mak, Raymond; Wong, TiffanyAbstract Food ladders are clinical tools already widely used in Europe for food reintroduction in milk- and egg-allergic children. Previously developed milk and egg ladders have limited applicability to Canadian children due to dietary differences and product availability. Herein we propose a Canadian version of cow’s milk and egg food ladders and discuss the potential role that food ladders may have in the care of children with IgE-mediated allergies to cow’s milk and/or egg, as either a method of accelerating the acquisition of tolerance in those who would outgrow on their own, or as a form of modified oral immunotherapy in those with otherwise persistent allergy.
- ItemOpen AccessCOVID-19 vaccine testing & administration guidance for allergists/immunologists from the Canadian Society of Allergy and Clinical Immunology (CSACI)(2021-03-15) Vander Leek, Timothy K; Chan, Edmond S; Connors, Lori; Derfalvi, Beata; Ellis, Anne K; Upton, Julia E M; Abrams, Elissa MAbstract Background Safe and effective vaccines provide the first hope for mitigating the devastating health and economic impacts resulting from coronavirus disease 2019 (COVID-19) and related public health orders. Recent case reports of reactions to COVID-19 vaccines have raised questions about their safety for use in individuals with allergies and those who are immunocompromised. In this document, we aim to address these concerns and provide guidance for allergists/immunologists. Methods Scoping review of the literature regarding COVID-19 vaccination, adverse or allergic reactions, and immunocompromise from PubMed over the term of December 2020 to present date. We filtered our search with the terms “human” and “English” and limited the search to the relevant subject age range with the term “adult.” Reports resulting from these searches and relevant references cited in those reports were reviewed and cited on the basis of their relevance. Results Assessment by an allergist is warranted in any individual with a suspected allergy to a COVID-19 vaccine or any of its components. Assessment by an allergist is NOT required for individuals with a history of unrelated allergies, including to allergies to foods, drugs, insect venom or environmental allergens. COVID-19 vaccines should be offered to immunocompromised patients if the benefit is deemed to outweigh any potential risks of vaccination. Interpretation This review provides the first Canadian guidance regarding assessment of an adolescent and adult with a suspected allergy to one of the COVID-19 vaccines currently available, or any of their known allergenic components, and for patients who are immunocompromised who require vaccination for COVID-19. As information is updated this guidance will be updated accordingly.
- ItemOpen AccessCSACI position statement: transition recommendations on existing epinephrine autoinjectors(2021-12-13) Li, Lucy D. X.; Abrams, Elissa M.; Lavine, Elana; Hildebrand, Kyla; Mack, Douglas P.Abstract Epinephrine is the first line treatment for anaphylaxis, an acute potentially life-threatening allergic reaction. It is typically administered intramuscularly in the anterolateral thigh at a dose of 0.01 mg/kg of 1:1000 (1 mg/ml) solution to a maximum initial dose of 0.5 mg. Currently in Canada, epinephrine autoinjectors (EAI) are available in three doses, 0.15 mg, 0.30 mg, and 0.50 mg. There are currently no published studies comparing 0.3 mg and 0.5 mg EAIs in the paediatric or adult populations to compare clinical effectiveness. However, as weight increases above 30 kg, the percentage of the recommended 0.01 mg/kg epinephrine dose from an existing 0.3 mg EAI decreases resulting in potential underdosing. As such, The Canadian Society of Allergy and Immunology (CSACI) recommends that for those who weigh ≥ 45 kg, physicians could consider prescribing the 0.50 mg EAI based on shared decision making with patients.
- ItemOpen AccessDietary exposures and allergy prevention in high-risk infants(2022-04-30) Abrams, Elissa M.; Watson, Wade; Vander Leek, Timothy K.; Atkinson, Adelle; Primeau, Marie-Noel; Francoeur, Marie-Josee; McHenry, Mary; Lavine, Elana; Orkin, Julia; Cummings, Carl ; Blair, Becky; Chan, Edmond S.Abstract Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow’s milk protein formula has been introduced in an infant’s diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early—at around 6 months, but not before 4 months of age—can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.
- ItemOpen AccessEarly introduction of foods to prevent food allergy(2018-09-12) Chan, Edmond S; Abrams, Elissa M; Hildebrand, Kyla J; Watson, WadeAbstract Food allergy is a growing public health problem, and in many affected individuals, the food allergy begins early in life and persists as a lifelong condition (e.g., peanut allergy). Although early clinical practice guidelines recommended delaying the introduction of peanut and other allergenic foods in children, this may have in fact contributed to the dramatic increase in the prevalence of food allergy in recent decades. In January 2017, new guidelines on peanut allergy prevention were released which represented a significant paradigm shift in early food introduction. Development of these guidelines was prompted by findings from the Learning Early About Peanut Allergy study—the first randomized trial to investigate early allergen introduction as a strategy to prevent peanut allergy. This article will review and compare the new guidelines with previous guidelines on food introduction, and will also review recent evidence that has led to the paradigm shift in early food introduction.
- ItemOpen Access“I want to really crack this nut”: an analysis of parent-perceived policy needs surrounding food allergy(2020-08-01) Abrams, Elissa M; Simons, Elinor; Gerdts, Jennifer; Nazarko, Orla; Povolo, Beatrice; Protudjer, Jennifer L PAbstract Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.
- ItemOpen AccessMaternal food allergy is associated with daughters’ menarche in early adolescence(2019-09-11) Protudjer, Jennifer L P; Abrams, Elissa M; Kozyrskyj, Anita L; Becker, Allan BAbstract Rationale Associations between allergic disease and puberty amongst females have been widely studied. However, this association has received less attention in multigenerational populations. To this end, we sought to examine maternal allergic disease status ever, and daughters’ menarche. Methods In a cohort of children born in 1995, in Manitoba, Canada, we considered maternal allergic disease ever to daughters’ age 7–8 years, and daughters’ menarche at ages 12–14 years. We included all participants for whom we had information on both the exposure and the outcome of those eligible. Data were analysed using descriptive statistics and logistic regression, with adjustment for confounding variables. Results Overall, the prevalences of maternal allergic diseases were 28.6% for asthma 18.8% for food allergy, 27.3% for eczema and 45.5% for rhinitis. By age 12–14 years, 41.6% (64/159) girls had reached menarche. Maternal food allergy was significantly associated with daughters’ menarche (OR 4.39, 95% CI 1.51–12.73), whereas no association was found for maternal asthma, eczema or rhinitis. With consideration to comorbid disease, a combination of maternal asthma + food allergy was associated with daughters’ menarche by age 12–14 years (OR 6.41; 95% CI 1.32–31.01). Conclusions Maternal food allergy ever is associated with daughters’ menarche by age 12–14 years.
- ItemOpen AccessOral food challenge outcomes in a pediatric tertiary care center(2017-09-22) Abrams, Elissa M; Becker, Allan BAbstract Background Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. Methods A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. Results 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge failures. Children were more likely to fail an oral challenge if they were older (P = .04), had asthma (P = .001) or had atopic dermatitis (P = .03). Risk of challenge failure was significantly different between food allergens, with more failures noted for peanut than for tree nuts, milk or egg (P = .001). Among challenge failures, 19% met criteria for anaphylaxis. Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P < .001). Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). The highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis. Conclusion The risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.
- ItemOpen AccessPatient selection for milk and egg ladders using a food ladder safety checklist(2022-06-12) Chua, Gilbert T.; Chan, Edmond S.; Yeung, Joanne; Cameron, Scott B.; Soller, Lianne; Williams, Brock A.; Chomyn, Alanna; Vander Leek, Timothy K.; Abrams, Elissa M.; Mak, Raymond; Wong, TiffanyAbstract A food ladder is a form of home-based dietary advancement therapy that gradually increases exposure to an allergenic food through the gradual introduction of egg or milk containing food with increasing quantity and allergenicity from extensively heated forms, such as baked goods, to less processed products. While widely considered safe, the food ladder is not risk-free and most of the egg and milk ladder studies only included preschoolers with mild egg and milk allergies, and with no or well-controlled asthma. We propose a Food Ladder Safety Checklist to assist with patient selection using “4 A's” based on available evidence for food ladders, including Age, active or poorly controlled Asthma, history of Anaphylaxis, and Adherence.
- ItemOpen AccessPractical guide for evaluation and management of beta-lactam allergy: position statement from the Canadian Society of Allergy and Clinical Immunology(2020-11-10) Jeimy, Samira; Ben-Shoshan, Moshe; Abrams, Elissa M; Ellis, Anne K; Connors, Lori; Wong, TiffanyAbstract The vast majority of individuals labelled as allergic are not deemed truly allergic upon appropriate assessment by an allergist. A label of beta-lactam allergy carries important risks for individual and public health. This article provides an overview of beta-lactam allergy, implications of erroneous beta-lactam allergy labels and the impact that can be provided by structured allergy assessment. We provide recommendations on how to stratify risk of beta-lactam allergy, beta lactam challenge protocols as well as management of patients at high risk of beta-lactam allergy.
- ItemOpen AccessPrimary prescription adherence for obstructive lung disease in a primary care population(2021-06-12) Singer, Alexander G.; Katz, Alan; LaBine, Lisa; Lix, Lisa M.; Yogendran, Marina; Sinha, Ian; Abrams, Elissa M.Abstract Background The objective of this study was to determine primary prescription adherence for obstructive lung diseases (e.g., asthma, COPD) in an adult primary care patient population over a 3-year period. Methods A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of prescription primary adherence. Results Of 13,220 prescriptions for obstructive airway disease, 75.9% (N = 10,038) were filled. In multivariate analysis, depression, certain age groups (18–44 years), higher income quartile were associated with reduced prescription adherence. However, 1–2 ER visits in the previous year (compared to no ER visits), number of ambulatory visits in the previous year, and number of hospitalizations in the previous year, did not increase the likelihood of prescription adherence. Interpretation This study provides important insights about factors associated with prescription nonadherence and is the first study examining primary medication adherence with medications for obstructive lung disease in adults, providing indications of prescription nonadherence patterns among a broad population.
- ItemOpen AccessThe excess costs of childhood food allergy on Canadian families: a cross-sectional study(2021-03-10) Golding, Michael A; Simons, Elinor; Abrams, Elissa M; Gerdts, Jennifer; Protudjer, Jennifer L PAbstract 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.
- ItemOpen AccessThe value of clinical observation: sleuthing for allergies on the front lines(2022-08-24) Abrams, Elissa M.; Becker, Allan
- ItemOpen AccessUse of electronic medical records to describe the prevalence of allergic diseases in Canada(2021-08-18) Singer, Alexander G.; Kosowan, Leanne; Nankissoor, Nerissa; Phung, Ryan; Protudjer, Jennifer L. P.; Abrams, Elissa M.Abstract Background Leveraging the data management resources of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a viable approach for describing the prevalence of allergic disease documented in primary care settings. Methods The dataset used for this study was inclusive of data from EMR initiation up to Dec 31st 2018. The sample included 1235 primary care providers representing 1,556,472 patients across Canada. Results In total, there were 536,005 patients with a documented allergy that fit into one of the 10 suggested categories. The allergy table includes 718,032 distinct entries representing 564,242 unique patients, which is 36.3% of the patients within the CPCSSN repository. The most common allergies recorded were drug allergy (39.0%), beta-lactam allergy (14.4%), environmental allergy (11.0%), and food allergy (8.0%). Anticipated upcoming studies include physician-documented drug allergy with a focus on beta-lactam allergy, as well as stinging insect allergy, among others. To our knowledge, these will also be the first such prevalence studies of primary care physician-documented allergic disease done in Canada. Interpretation The CPCSSN dataset represents electronic medical records from 1.5 million patients across Canada including documentation of allergic diseases. This dataset provides a national representative population to describe and characterize Canadian patients with common allergic conditions. This robust dataset provides the opportunity for health surveillance, and in particular data to explore the impact of allergic disease on primary care practice. Trial registration Not applicable.
- ItemOpen AccessvACcine COnfidence amongst those living with alleRgy during the COVID pandemic (ACCORD): a scoping review protocol(2022-09-18) Golding, Michael A.; Askin, Nicole; Batac, Ayel L. R.; Merrill, Kaitlyn A.; Abrams, Elissa M.; Bégin, Philippe; Ben-Shoshan, Moshe; Ladouceur, Erika; Roos, Leslie E.; Protudjer, Vladan; Protudjer, Jennifer L. P.Abstract Background Reports of allergic reactions to the COVID-19 vaccines have been documented, which may also contribute to hesitancy. Despite the low likelihood that the COVID-19 vaccine will trigger an allergic reaction, we and others have reported that families with allergy remain vaccine hesitant due to concerns of COVID-19-vaccine-triggered anaphylaxis. Objective To present our scoping review protocol, that will inform a forthcoming living scoping review in which we will investigate the peer-reviewed and grey literature on COVID-19 vaccine hesitancy and allergic disease and/or allergic reactions following a COVID-19 vaccine. Methods Informed by Arksey and O’Malley framework for methodological review, we have developed a search strategy with content and methodological experts, and which has undergone Peer Review of Electronic Search Strategies review. A search of four scientific databases, as well as gray literature, will be performed without restriction to articles by type of COVID-19 vaccine, or country of study, and will include publications in the ten languages our team can handle. Bi-monthly search alerts based on the search strategy will be generated. Results The first search will result in a stand alone peer reviewed scoping review. Bi-monthly updates will be posted on a pre-print server. Depending on the volume of literature, these updates will be synthesized and submitted for peer-review at 6 and/or 12 months. Conclusion COVID-19 vaccine hesitancy amongst individuals with allergy persists, despite very low risk of serious adverse reactions. Our living scoping review, which includes multiple forms of knowledge translation, will be a rigorous way to address hesitancy.