Philippe Bégin

Université de Montréal | UdeM · Department of Medicine

Food oral immunotherapy (FOIT) is newly indicated as an option for the management of food allergies (FAs), including in patients with severe disease and/or those with multiple food allergens. 1 Mild-to-moderate adverse events with food dosing are frequent and often include gastrointestinal (GI) symptoms (abdominal pain, nausea, and emesis). 1 Patie...

Background: While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole. Aim: To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring syste...

Continuing insight into the molecular mechanisms of atopic disorders has enabled the development of biologics to precisely target these diseases. Food allergy (FA) and eosinophilic gastrointestinal disorders (EGIDs) are driven by similar inflammatory molecular mechanisms and exist along the same atopic disease spectrum. Therefore, many of the same...

Background Reports of allergic reactions to COVID-19 vaccines, coupled with an “infodemic” of misinformation carries the potential to undermine confidence in the COVID-19 vaccines among the general population and those with allergic disease. As such, we reviewed academic and grey literature on COVID-19 vaccine hesitancy and allergic reactions. Met...

Background High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy impr...

Background Oral food challenges (OFC) confer the highest sensitivity and specificity in diagnosis; however, uptake has been variable across clinical settings. Numerous barriers were identified in literature from inadequate training to resource access. OFC utilization patterns using billing data have not been previously studied. Objective The objec...

COVID-19 convalescent plasmas (CCPs) are chosen for plasma therapy based on neutralizing titers and anti- Spike immunoglobulin levels. However, CCP characteristics that promote SARS-CoV-2 control are complex and incompletely defined. Using an in vivo imaging approach, we demonstrate that CCPs with low neutralizing (ID50%1:250), but moderate to high...

Background: Multisystem inflammatory syndrome in adults (MIS-A) is an increasingly recognized complication of Covid-19. We assessed risk factors, clinical characteristics, and outcomes of patients with MIS-A compared with other inflammatory conditions. Methods: We analyzed a cohort of patients ≥21 years hospitalized with MIS-A in Quebec, Canada...

Background: Oral Food Challenges (OFC) confer the highest sensitivity and specificity in diagnosis; however, uptake has been variable across clinical settings. Numerous barriers were identified in literature from inadequate training to resource access. OFC utilization patterns using billing data have not been previously studied. Objective: The obje...

Introduction In a recent Phase 3 clinical trial (EPITOPE), treatment with a peanut patch containing 250 µg peanut protein for 12 months was statistically superior to placebo in desensitizing peanut-allergic children aged 1-3 years, with 67% vs 33.5% being treatment responders (difference: 33.4%; 95% CI: 22.4, 33.5 [p<0.001]). The ability of the pea...

Background: Equitable allocation of scarce blood products needed for a randomized controlled trial (RCT) is a complex decision-making process within the blood supply chain. Strategies to improve resource allocation in this setting are lacking. Methods: We designed a custom-made, computerized system to manage the inventory and allocation of COVID...

Despite the advancement of vaccination and therapies currently available, deaths due to the coronavirus disease 2019 (COVID-19) are still heavily documented. Severely infected individuals experience a generalized inflammatory storm, caused by massive secretion of pro-inflammatory cytokines that can lead to endothelial dysfunction, cardiovascular di...

The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk strati...

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 anaphylax...

Food allergy affects approximately 2–4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and th...

Background Co-occurring atopic conditions are common in children with peanut allergy. As such, it is important to examine the safety and efficacy of epicutaneous immunotherapy with Viaskin™ Peanut 250 μg patch (VP250) in peanut-allergic children with these conditions. Objective To compare efficacy and safety of VP250 versus placebo in peanut-aller...

Background Multiple mini-interviews (MMI) are used to assess non-academic attributes for selection in medicine and other healthcare professions. It remains unclear if different MMI station formats (discussions, role-plays, collaboration) assess different dimensions. Methods Based on station formats of the 2018 and 2019 Integrated French MMI (IFMMI...

Background The COVID-19 pandemic has affected the supply, cost, and demand for certain foods, but it is not clear how these changes have affected food-allergic households.Objective To describe the changes in food-related costs that have followed COVID-19, as reported by higher- and lower-income households with a food-allergic member.Methods Between...

Oral immunotherapy (OIT) is a recent and evolving therapeutic option for the treatment of immunoglobulin E (IgE) mediated food allergies. Clinical practice guidelines are starting to emerge to establish the parameters of this new clinical offer. A comparative analysis reveals several areas of consensus, such as the need for an accurate diagnosis wi...

COVID-19 convalescent plasmas (CCPs) are chosen for plasma therapy based on neutralizing titers and anti-Spike immunoglobulin levels. However, specific CCP characteristics that promote SARS-CoV-2 control in recipients are complex and incompletely defined. Using an in vivo imaging approach, we demonstrate that CCPs with low neutralizing and high Fc-...

Background: Peanut specific IgE (sIgE) can lead to false-positive results. Objective: We aimed to assess whether peanut sIgE to total IgE (tIgE) ratio improves accuracy in predicting clinical reactivity to peanut compared to peanut sIgE alone, which has not been explored in the adult population so far. Method: A retrospective chart review was...

Faced with an evolving pandemic and a lack of clarity of the role of convalescent plasma for patients with COVID‐19, the CONCOR‐1 trial was launched. In 14 months the trial was designed, launched, completed, and submitted for publication. In total, 72 sites in three countries served by four blood suppliers randomised 940 patients. Many enablers fac...

Background: The Food Allergy Quality of Life Questionnaire–Parent Form (FAQLQ-PF) is a commonly used patient-reported outcome measure in food allergy (FA) research. It was developed before FA treatment clinical trials were commonplace and is used as a secondary outcome measure in pivotal FA treatment trials. We examined the psychometric properties...

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 anaphylax...

Background: Abdominal pain is a frequent symptom of IgE-mediated food allergy with limited therapeutic options. Visceral smooth muscle cell relaxation can be induced by activation of the beta-adrenergic receptors. Objective: To evaluate the efficacy of inhaled salbutamol empirically used to relieve abdominal pain caused by IgE-mediated allergic rea...

Convalescent plasma therapy (CPT) has gained significant attention since the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, clinical trials designed to study the efficacy of CPT based on antibody concentrations were inconclusive. Lymphatic transport is at the interplay between the immune response and the resolution of inflammat...

Background: Children whose mothers have autoimmune disease may be at risk of developing immune-mediated disorders. We assessed the association between maternal autoimmune disease and risk of autoimmune disease, allergy, and cancer in offspring. Methods: We analyzed a cohort of 1,011,623 children born in Canada between 2006 and 2019. We identifie...

Background: Health outcomes of children in families affected by cancer are poorly understood. The authors assessed the risk of hospitalization in children who have a sibling with cancer. Methods: This was a longitudinal cohort study in which 1600 children who had a sibling with cancer were matched to 32,000 children who had unaffected siblings i...

Background There is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy. Methods We searched six databases for randomised controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data u...

Oral immunotherapy (OIT) is now widely recognized as a valid option for the management of IgE-mediated food allergies. However, in real-life practice, OIT can lead to a variety of unique situations where the best course of action is undetermined. In patient-centered care, individual patient preferences, needs and values, should guide all clinical d...

Background The Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) is the most widely used quality of life questionnaire in food allergy. The objective of this study was to develop a mapping algorithm to convert FAQLQ-PF scores into health state utilities. Methods The Short-Form Six-Dimensions version 2 (SF-6Dv2) and FAQLQ-PF questio...

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food...

The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with...

Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labelling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allerge...

Treatment of food allergy is a rapidly changing landscape with arguably, the most significant advancement in recent years, the transition of oral immunotherapy (OIT) to clinical practice. As an innovation, OIT is a phase of rapidly increasing demand, particularly for some allergens such as peanut, egg and milk which have substantial evidence of eff...

Background Treatment options for peanut allergy are limited. In previous clinical trials, epicutaneous immunotherapy with a patch containing 250-μg peanut protein (Viaskin™ Peanut 250 μg [VP250]) was well tolerated and statistically superior to placebo in desensitizing peanut-allergic children. Objective To examine the safety of VP250 in children,...

Importance: The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. Objective: To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. Design, setting, and participants: The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial f...

The development and widespread use of vaccination over the past centuries has been the single most impactful intervention in public health, by effectively preventing morbidity and mortality from infectious diseases. Vaccination is generally well tolerated in the vast majority of the population, and the benefits of vaccination largely outweigh the r...

The efficacy of convalescent plasma for COVID-19 is unclear. While most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content may influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen withi...

Epidemics are a serious public health threat, and the resources for mitigating their effects are typically limited. Decision-makers face challenges in forecasting the demand for these resources as prior information about the disease is often not available, the behaviour of the disease can periodically change (either naturally or as a result of publ...

With the recent approval of highly effective COVID-19 vaccines, functional and lasting immunity to SARS-CoV-2 is currently under investigation as antibody levels in plasma were shown to decline during convalescence. Since the absence of antibodies does not equate to absence of immune memory, we evaluate the presence of SARS-CoV-2-specific memory B...

Background Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus; however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 community acquired pneumonia. We have...

Background Abdominal pain is a frequent symptom of IgE-mediated food allergy with limited therapeutic options. Visceral smooth muscle cell relaxation can be induced through beta-adrenergic stimulation. Objective To evaluate the efficacy of inhaled salbutamol empirically used to relieve abdominal pain caused by IgE-mediated allergic reactions at on...

When determining the score given to candidates in multiple mini-interview (MMI) stations, raters have to translate a narrative judgment to an ordinal rating scale. When adding individual scores to calculate final ranking, it is generally presumed that the values of possible scores on the evaluation grid are separated by constant intervals, followin...

Oral immunotherapy (OIT) provides an active treatment option for patients with food allergies. OIT may improve quality of life and raise the threshold at which a patient with food allergy may react to an allergen, but it is a rigorous therapy that requires a high degree of commitment by the clinician, patients, and families. Recent guidelines from...

Background: Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus; however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 community acquired pneumonia. We have...

Background Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge on rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. Objectives A search was conducted on PubMed and Embase in April 2020. Our systematic revie...

Functional and lasting immune responses to the novel coronavirus (SARS-CoV-2) are currently under intense investigation as antibody titers in plasma have been shown to decline during convalescence. Since the absence of antibodies does not equate to absence of immune memory, we sought to determine the presence of SARS-CoV-2-specific memory B cells i...

The advent of biologic therapies has transformed care for severe atopic disorders but their high cost poses new challenges with regards to long‐term sustainability and fair allocation of resources. This article covers the basic concepts of cost‐utility analyses and reviews the available literature on cost‐utility of biologic drugs in atopic disorde...

Background The lack of a value set allowing the calculation of QALY is an important limitation when establishing the value of emerging therapies to treat food allergy. The aim of this study was to develop a Short‐Form Six‐Dimension version 2 (SF‐6Dv2) preference value set for the calculation of health utility from the Canadian food allergic populat...

Background: Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective: To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and eff...

Background: The role and importance of skin barrier as an immunologic organ and as a potent way of sensitization is well known. However, antibiotics anaphylaxis following skin sensitization has not been reported. Case presentation: We describe the first case of intravenous clindamycin anaphylaxis, with likely sensitization due to previous topica...

Abstract Current recommendations for the management of penicillin allergy are to perform penicillin skin testing (PST) with penicilloyl-polylysine (PPL) and benzylpenicillin (BP) prior to drug challenge with amoxicillin. However, the role of PST is increasingly questioned in the pediatric setting. To resolve the question of PST’s diagnostic accurac...

Background Limited data on clinical implementation of oral immunotherapy (OIT) has been reported with incomplete evaluation of barriers. Objective To survey Canadian allergists on their current practice of OIT and barriers to implementation and expansion of OIT. Methods A survey investigating current practice and logistical and clinical barriers...

On ne connaît pas encore avec certitude l’innocuité et l’efficacité du plasma de convalescent comme traitement de la forme grave de la maladie à coronavirus 2019 (COVID-2019). Afin d’appuyer la conception de lignes directrices sur la prise en charge de la COVID-19, nous avons effectué une revue systématique et une méta-analyse sur l’utilisation du...

Background Uterine contractions are recognized as a potential manifestation of anaphylaxis, but literature on their proper management is limited. It is widely recognized that anaphylactic reactions can cause uterine contractions, but little is known about their optimal management. Objective Review potential treatments for painful uterine contracti...

While waiting for an efficient vaccine to protect against SARS-CoV-2 infection, alternative approaches to treat or prevent acute COVID-19 are urgently needed. Transfusion of convalescent plasma to treat COVID-19 patients is currently being explored; neutralizing activity in convalescent plasma is thought to play a central role in the efficacy of th...

Perreault and colleagues examined antibody titers in sequential samples from serum donors recovering from COVID-19 and demonstrated that antibody titers fall over 3-4 months. These results have important implications for convalescent serum collection and seroprevalence studies.

Background: Omalizumab has been shown to improve the safety and feasibility of oral immunotherapy (OIT) but the optimal dosage strategy is unknown. Objective: To identify determinants of omalizumab dose-related efficacy in the context of OIT. Methods: Study sample consisted of a clinical cohort of 181 patients treated with omalizumab-enabled o...

Héma-Québec, the blood supplier in the Province of Québec, Canada, collects and tests convalescent plasma used in a clinical trial to determine the clinical efficacy of this product for the treatment of hospitalized COVID-19 patients. So far, we have collected 1159 plasma units from 282 COVID-19 convalescent donors. The presence of antibodies to th...

In the absence of effective vaccines and with limited therapeutic options, convalescent plasma is being collected across the globe for potential transfusion to COVID-19 patients. The therapy has been deemed safe and several clinical trials assessing its efficacy are ongoing. While it remains to be formally proven, the presence of neutralizing antib...

Background We previously reported the safety and efficacy of epicutaneous immunotherapy (EPIT™) for peanut allergy (250 μg, daily epicutaneous peanut protein; DBV712 250μg) in a 12-month randomized controlled study (PEPITES) of peanut-allergic children aged 4-11 years. Objective To assess interim safety and efficacy of an additional 2 years of EPI...

Background: The safety and efficacy of convalescent plasma in severe coronavirus disease 2019 (COVID-19) remain uncertain. To support a guideline on COVID-19 management, we conducted a systematic review and meta-analysis of convalescent plasma in COVID-19 and other severe respiratory viral infections. Methods: In March 2020, we searched internat...

Background: Previous proof-of-concept studies have shown that a short course of omalizumab can safely accelerate the oral immunotherapy schedule for multiple allergens simultaneously. Considering the high cost of medication, the dose-related efficacy of omalizumab at decreasing the duration of oral immunotherapy up-dosing phase must be objectively...