Improving the management of allergic disease in adults.

Historically, there has been a strong focus clinically and in research on the impact of allergy in children but not adults. It is often attributed to the idea that the nature of one’s allergy in childhood is fixed for life past a certain age. Subsequently, significant gaps have developed in how we care for adults with allergy. The aim of this thesis is to investigate these gaps, explore how to best address the issues raised, and attempt to translate some of the advances seen in the paediatric sphere to adults. The current management of anaphylaxis in the emergency department is described in Chapter 2. Through an audit of presentations over a 10-year period, risk factors pertinent to adults with allergy have been described, and gaps in the cascade of care after their acute presentation identified. Chapter 3 assesses the current evidence base for the diagnosis and management of beta-lactam allergy via a systematic review. This is an issue of significance in the adult population due to the erroneous persistence of beta-lactam allergy labels that were given in childhood. The review demonstrates that the current evidence base is poor, and reliant on data that is highly biased and of poor quality. Chapter 4 describes data from the 'De-labelling patients with antibiotic allergy in Sydney adult and paediatric hospital allergy services' study. This study first demonstrated that after testing and de-labelling, most patients still did not have a clear understanding of their allergy status. In the second phase, it was shown that standardised testing procedures and communication to patients was associated with significant improvements in patient understanding. In Chapter 5, the screened population of the Combining Peanut Oral Immunotherapy and Omalizumab in Adults with Peanut Allergy (the OPAL study) is described, looking at baseline characteristics in demographics, allergic background and immunological biomarkers. Chapter 6 describes the progress of participants who were enrolled into the OPAL study and completed their Week 24 study visits. These participants have become tolerant of at least 300mg of peanut protein and have demonstrated changes in specific IgE, skin tests and basophil activation tests. There are significant gaps in the management of adults with allergy, and there is room for advancement. With a greater focus on the specific needs of this cohort we can improve safety and care for these patients.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2023

Author dc:creator

• Loprete, Jacqueline

• Allergy
• Immunology
• Allergen Immunotherapy
• Allergy Diagnosis
• anzsrc-for: 320401 Allergy

Statement dc:rights

• open access
• CC BY 4.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by/4.0/

Language dc:language

en

Identifier

https://doi.org/10.26190/unsworks/25178

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/101471