Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

Background: The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims: This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre. A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion: The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

Manifestations of heavenly light and fire and the construction of a saint: sanctity, mission and salvation in Adomnán's Vita Columbae

This thesis examines the late seventh-century Latin Life of Columba (Vita Columbae) in a context sympathetic to the spiritual aims and formative intellectual background of its author, Adomnán of Iona. It argues that the Vita Columbae is a sophisticated work, shaped by Adomnán’s spiritual and theological concerns. This sophistication is revealed by a forensic examination of Adomnán’s representation of Columba’s sanctity through a series of miracles, in particular, miracle stories depicting divine manifestations of fire and light. This thesis considers the form and function of these miracle stories in the context of biblical, patristic and medieval interpretations of their archetypes, towards revealing the underlying influence of scriptural, hagiographical and monastic models of sanctity. Chapter one evaluates the function of the Vita Columbae, and outlines the core themes of sanctity which pervade the work, by considering the technical terminology and literary devices found in the opening prefaces in the context of the wider monastic tradition. Chapter two examines Adomnán’s use of biblical models of sanctity to establish Columba’s sanctity, and their relationship between these models and certain miraculous episodes in the Vita Columbae. Chapter three investigates Adomnán’s description of the Holy Spirit as an illuminating fire, and its significance for his portrayal of the saint, by means of a forensic examination of biblical, exegetical and hagiographical treatments of the image. Chapter four examines the missiological, soteriological and providential elements contributing to Adomnán’s portrayal of Columba’s sanctity, as conveyed through the presence of biblical models, particularly the image of the column of fire. Chapter five establishes the influence of monastic examinations of the contemplative life on Adomnán’s portrayal of Columba’s sanctity, and shows how that sanctity is confirmed in terms of his ability to contemplate divine light.