Le savoir expérientiel des enfants aux prises avec des allergies alimentaires

Les familles d’enfants aux prises avec des allergies alimentaires font souvent face à des besoins éducationnels non comblés. La reconnaissance du savoir expérientiel émanant du vécu d’une maladie chronique ainsi que l’attribution de plus amples responsabilités aux patients pourraient être bénéfiques au système de santé et répondre davantage aux besoins des familles. À ce jour, le savoir expérientiel des enfants aux prises avec des maladies chroniques n’est cependant pas documenté. L’objectif de ce projet est alors d’explorer qualitativement le savoir expérientiel des enfants de moins de 13 ans vivant avec des allergies alimentaires afin de pouvoir inclure leur perspective dans notre pratique clinique. Ainsi, 33 participants ont témoigné de leur expérience par entrevue. Parmi ceux-ci se trouvaient 14 enfants âgés de 8 et 12 ans ainsi que 19 parents. Les entrevues ont été analysées en utilisant une approche inductive générale. Notre étude démontre que le développement du savoir expérientiel dans cette population débute tôt dans l’enfance. Ce savoir est surtout acquis par la mise en pratique des enseignements parentaux ainsi que par l’expérimentation de réactions allergiques. Les perspectives distinctes de la maladie entre l’enfant et ses parents mènent à des différences sur le plan de leur savoir expérientiel respectif. Chez ces enfants, le savoir expérientiel promeut la gestion autonome de la maladie ainsi qu’un degré de normalité ainsi que d’équilibre ce qui contribue a une amélioration de leur qualité de vie. En conclusion, le savoir expérientiel des enfants aux prises avec des allergies alimentaires existe et doit être reconnu. Ce savoir est distinct de celui des parents et influence positivement les habiletés de gestion autonome de l’enfant ainsi que leur perspective de la maladie. Les professionnels de la santé ainsi que les parents bénéficieraient d’accompagnement afin de comprendre et mobiliser ce savoir expérientiel chez l’enfant.Families with a food-allergic child often mention unmet education needs. Recognizing the experiential knowledge from living with the illness and entrusting the patient with greater responsibilities could better the health care and respond to the families’ needs. However, experiential knowledge is not well documented in children with chronic health conditions. Therefore, the objective in our study was to explore the experiential knowledge of children under 13 years old living with food allergies as recounted by them and their families to include their views in clinical practice. Thirty-three participants were interviewed including 14 children between eight and twelve years old and 19 parents. Interviews were analyzed using a general inductive approach. Our study shows that the development of experiential knowledge in food-allergic children starts in childhood. Children’ experiential knowledge is mostly acquired by applying teachings and experiencing reactions. The different illness perspectives between the child and his parents explain the distinctive properties of the children’s experiential knowledge. In food-allergic children, experiential knowledge promotes self-management skills and also senses of normality and balance thus contributing to better quality of life. In conclusion, experiential knowledge of food-allergic children exists and should be recognized. This knowledge is distinctive from their parent’s and impacts positively the children’s self-management skills and their own illness perspective. Clinicians and parents would benefit of support and methods to understand and mobilize the food-allergic child’s experiential knowledge

Cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients : two systematic reviews and meta-analyses

BACKGROUND: There is no recent systematic review on therisk of cross-reactivity to cephalosporins and carbapenems inpenicillin-allergic patients despite many new studies on thesubject. All past reviews have several limitations such as notincluding any patient with a T-cellemediated penicillin allergy.OBJECTIVES: To determine the risk of cross-reactivity tocephalosporins and carbapenems in patients with a proven IgE-or T-cellemediated penicillin allergy. To measure the associa-tion between R1 side chain similarity on cephalosporins andpenicillins and the risk of cross-reactivity.METHODS: MEDLINE and EMBASE were searched fromJanuary 1980 to March 2019. Studies had to include at least 10penicillin-allergic subjects whose allergy had been confirmed bya positive skin test (ST) or drug provocation test (DPT) result.Cross-reactivity had to be assessed to at least 1 cephalosporin orcarbapenem through ST or DPT. Both random-effects andfixed-effect models were used to combine data. A bioinformaticmodel was used to quantify the similarity between R1 sidechains.RESULTS: Twenty-one observational studies on cephalosporincross-reactivity involving 1269 penicillin-allergic patientsshowed that the risk of cross-reactivity varied with the degree ofsimilarity between R1 side chains: 16.45% (95% CI, 11.07-23.75) for aminocephalosporins, which share an identical sidechain with a penicillin (similarity score[1), 5.60% (95% CI,3.46-8.95) for a few cephalosporins with an intermediate simi-larity score (range, 0.563-0.714), and 2.11% (95% CI, 0.98-4.46) for all those with low similarity scores (below 0.4), irre-spective of cephalosporin generation. The higher risk associatedwith aminocephalosporins was observed whether penicillin al-lergy was IgE- or T-cellemediated. Eleven observational studieson carbapenem cross-reactivity involving 1127 penicillin-allergicpatients showed that the risk of cross-reactivity to any carba-penem was 0.87% (95% CI, 0.32-2.32). CONCLUSIONS: Although it remains possible that these meta-analyses overestimated the risk of cross-reactivity, cliniciansshould consider the increased risk of cross-reactivity associatedwith aminocephalosporins, and to a lesser extent withintermediate-similarity-score cephalosporins, compared with thevery low risk associated with low-similarity-score cephalosporinsand all carbapenems when using beta-lactams in patients with asuspected or proven penicillin allergy

Correction to: Protocol for a double-blind, randomized controlled trial on the dose-related efficacy of omalizumab in multi-food oral immunotherapy

An amendment to this paper has been published and can be accessed via the original article

Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality