Bio

Clinical Focus


  • Pediatrics
  • Family Medicine

Academic Appointments


Professional Education


  • Residency:University of Toronto (2007) ONCanada
  • Medical Education:University of Toronto (2003) Canada
  • Board Certification: Family Medicine, The College of Physicians and Surgeons of Ontario (2007)

Publications

All Publications


  • Multiple-allergen oral immunotherapy improves quality of life in caregivers of food-allergic pediatric subjects ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Otani, I. M., Begin, P., Kearney, C., Dominguez, T. L., Mehrotra, A., Bacal, L. R., Wilson, S., Nadeau, K. 2014; 10
  • Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using Omalizumab ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Begin, P., Dominguez, T., Wilson, S. P., Bacal, L., Mehrotra, A., Kausch, B., Trela, A., Tavassoli, M., Hoyte, E., O'Riordan, G., Blakemore, A., Seki, S., Hamilton, R. G., Nadeau, K. C. 2014; 10
  • Safety and feasibility of oral immunotherapy to multiple allergens for food allergy ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Begin, P., Winterroth, L. C., Dominguez, T., Wilson, S. P., Bacal, L., Mehrotra, A., Kausch, B., Trela, A., Hoyte, E., O'Riordan, G., Seki, S., Blakemore, A., Woch, M., Hamilton, R. G., Nadeau, K. C. 2014; 10
  • Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology Bégin, P., Winterroth, L. C., Dominguez, T., Wilson, S. P., Bacal, L., Mehrotra, A., Kausch, B., Trela, A., Hoyte, E., O'Riordan, G., Seki, S., Blakemore, A., Woch, M., Hamilton, R. G., Nadeau, K. C. 2014; 10 (1): 1-?

    Abstract

    Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time.Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary.Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001).Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT.Clinicaltrial.gov NCT01490177.

    View details for DOI 10.1186/1710-1492-10-1

    View details for PubMedID 24428859

  • Multiple-allergen oral immunotherapy improves quality of life in caregivers of food-allergic pediatric subjects. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology Otani, I. M., Bégin, P., Kearney, C., Dominguez, T. L., Mehrotra, A., Bacal, L. R., Wilson, S., Nadeau, K. 2014; 10 (1): 25-?

    Abstract

    Food allergy (FA) negatively affects quality of life in caregivers of food-allergic children, imposing a psychosocial and economic burden. Oral immunotherapy (OIT) is a promising investigational therapy for FA. However, OIT can be a source of anxiety as it carries risk for allergic reactions. The effect of OIT with multiple food allergens (mOIT) on FA-specific health-related quality of life (HRQL) has never been studied in participants with multiple, severe food allergies. This study is the first to investigate the effects of mOIT on FA-related HRQL in caregivers of pediatric subjects.Caregiver HRQL was assessed using a validated Food Allergy Quality of Life - Parental Burden (FAQL-PB) Questionnaire (J Allergy Clin Immunol 114(5):1159-1163, 2004). Parents of participants in two single-center Phase I clinical trials receiving mOIT (n = 29) or rush mOIT with anti-IgE (omalizumab) pre-treatment (n = 11) completed the FAQL-PB prior to study intervention and at 2 follow-up time-points (6 months and 18 months). Parents of subjects not receiving OIT (control group, n = 10) completed the FAQL-PB for the same time-points.HRQL improved with clinical (change < -0.5) and statistical (p < 0.05) significance in the mOIT group (baseline mean 3.9, 95% CI 3.4-4.4; 6-month follow-up mean 2.5, 95% CI 2.0-3.0; 18-month follow-up mean 1.8, 95% CI 1.4-2.1) and rush mOIT group (baseline mean 3.9, 95% CI 3.1-4.7; 6-month follow-up mean 1.7, 95% CI 0.9-2.6; 18-month follow-up mean 1.3, 95% CI 0.3-2.4). HRQL scores did not significantly change in the control group (n = 10).Multi-allergen OIT with or without omalizumab leads to improvement in caregiver HRQL, suggesting that mOIT can help relieve the psychosocial and economic burden FA imposes on caregivers of food-allergic children.

    View details for DOI 10.1186/1710-1492-10-25

    View details for PubMedID 24860608

  • Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using Omalizumab. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology Bégin, P., Dominguez, T., Wilson, S. P., Bacal, L., Mehrotra, A., Kausch, B., Trela, A., Tavassoli, M., Hoyte, E., O'Riordan, G., Blakemore, A., Seki, S., Hamilton, R. G., Nadeau, K. C. 2014; 10 (1): 7-?

    Abstract

    Up to 30% of patients with food allergies have clinical reactivity to more than one food allergen. Although there is currently no cure, oral immunotherapy (OIT) is under investigation. Pilot data have shown that omalizumab may hasten the ability to tolerate over 4 g of food allergen protein.To evaluate the safety and dose tolerability of a Phase 1 Single Site OIT protocol using omalizumab to allow for a faster and safe desensitization to multiple foods simultaneously.Participants with multiple food allergies received OIT for up to 5 allergens simultaneously with omalizumab (rush mOIT). Omalizumab was administered for 8 weeks prior to and 8 weeks following the initiation of a rush mOIT schedule. Home reactions were recorded with diaries.Twenty-five (25) participants were enrolled in the protocol (median age 7 years). For each included food, participants had failed an initial double-blind placebo-controlled food challenge at a protein dose of 100 mg or less. After pre-treatment with omalizumab, 19 participants tolerated all 6 steps of the initial escalation day (up to 1250 mg of combined food proteins), requiring minimal or no rescue therapy. The remaining 6 were started on their highest tolerated dose as their initial daily home doses. Participants reported 401 reactions per 7,530 home doses (5.3%) with a median of 3.2 reactions per 100 doses. Ninety-four percent (94%) of reactions were mild. There was one severe reaction. Participants reached their maintenance dose of 4,000 mg protein per allergen at a median of 18 weeks.These phase 1 data demonstrate that rush OIT to multiple foods with 16 weeks of treatment with omalizumab could allow for a fast desensitization in subjects with multiple food allergies. Phase 2 randomized controlled trials are needed to better define safety and efficacy parameters of multi OIT experimental treatments with and without omalizumab.

    View details for DOI 10.1186/1710-1492-10-7

    View details for PubMedID 24576338

  • The Impact of Food Allergies on Quality of Life PEDIATRIC ANNALS Bacal, L. R., Nadeau, K. C. 2013; 42 (7): 141-145
  • The impact of food allergies on quality of life. Pediatric annals Bacal, L. R. 2013; 42 (7): 141-145

    Abstract

    CME EDUCATIONAL OBJECTIVES 1. Recognize and appreciate the impact of food allergies on psychosocial health. 2. List the factors that have been shown to negatively affect health-related quality of life. 3. Understand how physicians can directly help to improve a child's quality of life while living with food allergies. Food allergy is a serious problem affecting a growing number of children worldwide. There is a large body of evidence supporting the detrimental effects that food allergy can have on a child's quality of life. With validated tools, we can identify these children and focus on how to protect, guide, and help them to live a safe life. Recent research articulates how food allergies impact health-related quality of life (HRQL). There are studies reported from the child's perspective, as well as studies reported from the parent's perspective. With the development of validated disease and age-specific questionnaires, researchers can reliably gather data on the psychological aspect of children with food allergies. The purpose of this article is to provide a review of the literature examining the psycho-social impact of food allergies on children. This article was designed to outline suggestions to help physicians care for the whole child - both mind and body.

    View details for DOI 10.3928/00904481-20130619-12

    View details for PubMedID 23805962

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