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Mortz CG, Eller E, Garvik OS, Kjaer HF, Zuberbier T, Bindslev-Jensen C. Challenge-verified thresholds for allergens mandatory for labeling: How little is too much for the most sensitive patient? Allergy 2024; 79:1306-1316. [PMID: 37661296 DOI: 10.1111/all.15870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND It is mandatory to label food products with the 14 main allergens in the EU. Reasonable allergen labeling requires knowledge of population-based thresholds derived from food challenges. The aim of this study was to evaluate the threshold-distribution in clinically verified food allergic patients for allergens mandatory for labeling. METHODS All positive open oral food challenges and double-blind placebo-controlled food challenges (DBPCFC) performed at the Allergy Center, Odense University Hospital, Denmark (2000-2022) were included. For each included challenge, the cumulative threshold (LOAEL) was obtained and NOAEL estimated. Data were modelled as an interval censored log-normal distribution. RESULTS Overall, 38 of all 2612 challenges (1.5%) in 1229 patients (717 male, 986 children) reacted to <5 mg protein. The majority of the most sensitive patients reacted with a Sampson severity score of 2-3. Using interval censored log-normal models only five groups (hens´ egg, fish, peanut, milk, tree-nuts) elicited reactions after ingestion of 0.5 mg protein and in low frequencies of the population. Hen's egg was the most potent allergen, with reactivity to <0.5 mg protein in 0.24% [0.13-0.44%] of egg allergic patients while the estimated fraction of allergic patients reacting to a eliciting dose on 0.5 mg protein for most other allergens were below 0.04%. CONCLUSION Our data demonstrates that the majority of food allergic patients as expected tolerating traces of allergenic foods without developing severe allergic symptoms and signs. Hen's egg appears to be the food most likely to elicit reactions in the most sensitive individuals at very low doses.
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Affiliation(s)
- Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Olav Sivertsen Garvik
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Henrik Fomsgaard Kjaer
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Institute of Allergology and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP Allergology and Immunology Paul-Ehrlich-Haus Hindenburgdamm 27, Berlin, Germany
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Nair LG, Capucilli P. Peanut oral immunotherapy: Reconsidering a one-size-fits-all approach. Ann Allergy Asthma Immunol 2022; 129:265-266. [PMID: 35817676 DOI: 10.1016/j.anai.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Lakshmi G Nair
- Department of Allergy and Immunology, Rochester Regional Health, Rochester, New York
| | - Peter Capucilli
- Department of Allergy and Immunology, Rochester Regional Health, Rochester, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York.
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The Risk Reduction of Accidental Exposure-Related Systemic Allergic Reactions Extrapolated Based on Food Challenge Data After 1 Year of Peanut Oral Immunotherapy. Adv Ther 2021; 38:4321-4332. [PMID: 34236672 PMCID: PMC8264172 DOI: 10.1007/s12325-021-01843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/23/2021] [Indexed: 01/28/2023]
Abstract
Introduction The phase 3 trial PALISADE, comparing peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) oral immunotherapy versus placebo in peanut-allergic children, reported that a significantly higher percentage of PTAH-treated participants tolerated higher doses of peanut protein after 1 year of treatment. This study used PALISADE data to estimate the reduction in the risk of systemic allergic reaction (SAR) after accidental exposure following 1 year of PTAH treatment. Methods Participants (aged 4–17 years) enrolled in PALISADE were included. Parametric interval-censoring survival analysis with the maximum likelihood estimation was used to construct a real-world distribution of peanut protein exposure using lifetime SAR history and highest tolerated dose (HTD) from a double-blind, placebo-controlled food challenge conducted at baseline. The SAR risk reduction was extrapolated using the exposure distribution and the HTD were collected at baseline and trial exit for PTAH- and placebo-treated participants. Results Assuming a maximum peanut protein intake of 1500 mg, participants were estimated to have < 1% probability of ingesting > 0.01 mg during daily life. The mean annual SAR risk at trial entry was 9.25–9.98%. At trial exit, the relative SAR risk reduction following accidental exposure was 94.9% for PTAH versus 6.4% for placebo. For PTAH-treated participants with exit HTD of 600 or 1000 mg without dose-limiting symptoms, the SAR risk reduction increased to 97.2%. The result was consistent in the sensitivity analysis across different parametric distributions. Conclusion Oral immunotherapy with PTAH is expected to result in a substantially greater reduction in risk of SAR following accidental exposure compared to placebo among children with peanut allergy. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01843-2.
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Maciag MC, Sheehan WJ, Bartnikas LM, Lai PS, Petty CR, Filep S, Chapman MD, Phipatanakul W. Detection of Food Allergens in School and Home Environments of Elementary Students. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3735-3743. [PMID: 34174494 DOI: 10.1016/j.jaip.2021.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known about environmental food allergen exposure on school surfaces. OBJECTIVE To compare the distribution of major food allergens in floor dust and table wipe samples from elementary schools and dust samples from students' homes. METHODS In this substudy of the School Inner-City Asthma Study-II, 103 table wipe samples and 98 floor dust samples from cafeterias and classrooms in 18 elementary schools were analyzed for milk, peanut, cashew, hazelnut, and egg using a multiplex array. Home kitchen floor and bed dust samples from 90 students were also analyzed. RESULTS Food allergens were detectable in schools, but at significantly lower levels than in homes (P < .001). In schools, milk and peanut were detected in all table wipe samples; milk and egg were detected in all floor dust samples. Cafeteria table wipe samples contained significantly higher levels of milk, peanut, hazelnut, and egg, compared with classrooms. Cafeteria floor dust samples contained higher levels milk than classrooms. Peanut-restrictive policies did not consistently reduce environmental peanut exposure in schools. Peanut allergen was lower in dust from homes of students with peanut allergy (n = 5) compared with those without peanut allergy (n = 85) (P < .001). Reassuringly, peanut allergen in the schools of peanut-allergic students was not significantly different than in their homes. CONCLUSION Food allergens were readily detectable on tables and floors in elementary schools, but at levels lower than in students' homes. For peanut-allergic students, the levels of detectable peanut in their schools were not higher than their homes. The low levels of detectable food allergens in school environments are unlikely to result in severe allergic reactions.
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Affiliation(s)
- Michelle C Maciag
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Asthma & Allergy Affiliates, Salem, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lisa M Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - Carter R Petty
- Biostatistics and Research Design Core, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | | | | | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
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5
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Taylor SL, Houben GF, Blom W, Westerhout J, Remington BC, Crevel RW, Brooke-Taylor S, Baumert JL. The population threshold for soy as an allergenic food – Why did the Reference Dose decrease in VITAL 3.0? Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Manny E, La Vieille S, Dominguez SA, Kos G, Barrère V, Théolier J, Touma J, Godefroy SB. Probabilistic risk assessment for milk in dark chocolate, cookies and other baked goods with PAL sold in Canada. Food Chem Toxicol 2021; 152:112196. [PMID: 33862120 DOI: 10.1016/j.fct.2021.112196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
The risk of having an allergic reaction in milk-allergic individuals consuming products with precautionary allergen labelling (PAL) for milk has been rarely studied in products such as dark chocolate, cookies, and other baked goods. A probabilistic risk assessment model was developed to estimate potential risks. Milk occurrence and contamination levels were reported in a previous article from our group. Dose-response curves for milk were constructed using values (n = 1078) from published double-blind placebo-controlled food challenges. Canadian consumption data was extracted from a national survey, and a homemade survey involving food-allergic Canadians. Milk eliciting doses (ED) were 0.23 (ED01), 1.34 (ED05), 3.42 (ED10), and 16.3 (ED25) mg of milk protein (Log-Normal distribution). Average exposures, per eating occasion, were 24 mg (dark chocolate), 3.9 mg (baked goods), and 0.20 mg (cookies) of milk proteins. The estimated risk of having a milk-induced allergic reaction by consuming foods with PAL for milk was higher for dark chocolate (16%; 15,881/100,000) than baked goods (3.8%; 3802/100,000) or cookies (0.6%; 646/100,000) in milk-allergic Canadians. Dark chocolate, cookies, and baked goods with PAL for milk, should be avoided by milk-allergic Canadians (consuming or not products with PAL) to prevent allergic reactions.
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Affiliation(s)
- Emilie Manny
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada.
| | - Sébastien La Vieille
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada; Health Canada, 251 Sir F. Banting Driveway, Ottawa, Ontario, H1A 0K9, Canada
| | - Silvia A Dominguez
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Gregor Kos
- Department of Chemistry & Biochemistry, 7141 Sherbrooke Street West, Concordia University, Montreal, Quebec, H4B 1R6, Canada
| | - Virginie Barrère
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Jérémie Théolier
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Joseph Touma
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - Samuel Benrejeb Godefroy
- Food Risk Analysis and Regulatory Excellence Platform (PARERA), Institute of Nutrition and Functional Foods and Department of Food Science, Université Laval, Quebec, Quebec, G1V 0A6, Canada
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Haber LT, Reichard JF, Henning AK, Dawson P, Chinthrajah RS, Sindher SB, Long A, Vincent MJ, Nadeau KC, Allen BC. Bayesian hierarchical evaluation of dose-response for peanut allergy in clinical trial screening. Food Chem Toxicol 2021; 151:112125. [PMID: 33722597 DOI: 10.1016/j.fct.2021.112125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 01/01/2023]
Abstract
Risk-based labeling based on the minimal eliciting doses (EDs) in sensitized populations is a potential replacement for precautionary allergen labeling of food allergens. We estimated the dose-response distribution for peanut allergen using data from double-blind placebo-controlled food challenges (DBPCFCs) conducted in the US at multiple sites, testing a population believed to be similar to the general U.S. food allergic population. Our final (placebo-adjusted) dataset included 548 challenges of 481 subjects. Bayesian hierarchical analysis facilitated model fitting, and accounted for variability associated with various levels of data organization. The data are best described using a complex hierarchical structure that accounts for inter-individual variability and variability across study locations or substudies. Bayesian model averaging could simultaneously consider the fit of multiple models, but the Weibull model dominated so strongly that model averaging was not needed. The ED01 and ED05 (and 95% credible intervals) are 0.052 (0.021, 0.13) and 0.49 (0.22, 0.97) mg peanut protein, respectively. Accounting for challenges with severe reactions at the LOAEL, by using the dose prior to the LOAEL as the new LOAEL, the ED01 drops to 0.029 (0.014, 0.074) mg peanut protein. Our results could aid in establishing improved food labeling guidelines in the management of food allergies.
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Affiliation(s)
- Lynne T Haber
- University of Cincinnati, Department of Environmental and Public Health Sciences, 160 Panzeca Way, Cincinnati, OH, 45267, USA.
| | - John F Reichard
- University of Cincinnati, Department of Environmental and Public Health Sciences, 160 Panzeca Way, Cincinnati, OH, 45267, USA
| | - Alice K Henning
- The Emmes Company, LLC, 401 North Washington St., Suite 700, Rockville, MD, 20850, USA
| | - Peter Dawson
- The Emmes Company, LLC, 401 North Washington St., Suite 700, Rockville, MD, 20850, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Stanford, CA, USA
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Stanford, CA, USA
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Stanford, CA, USA
| | - Melissa J Vincent
- University of Cincinnati, Department of Environmental and Public Health Sciences, 160 Panzeca Way, Cincinnati, OH, 45267, USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Stanford, CA, USA
| | - Bruce C Allen
- Independent Consultant, 101 Corbin Hill Circle, Chapel Hill, NC, 27514, USA
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8
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Wheeler MW, Westerhout J, Baumert JL, Remington BC. Bayesian Stacked Parametric Survival with Frailty Components and Interval-Censored Failure Times: An Application to Food Allergy Risk. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2021; 41:56-66. [PMID: 33063372 PMCID: PMC7894991 DOI: 10.1111/risa.13585] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
To better understand the risk of exposure to food allergens, food challenge studies are designed to slowly increase the dose of an allergen delivered to allergic individuals until an objective reaction occurs. These dose-to-failure studies are used to determine acceptable intake levels and are analyzed using parametric failure time models. Though these models can provide estimates of the survival curve and risk, their parametric form may misrepresent the survival function for doses of interest. Different models that describe the data similarly may produce different dose-to-failure estimates. Motivated by predictive inference, we developed a Bayesian approach to combine survival estimates based on posterior predictive stacking, where the weights are formed to maximize posterior predictive accuracy. The approach defines a model space that is much larger than traditional parametric failure time modeling approaches. In our case, we use the approach to include random effects accounting for frailty components. The methodology is investigated in simulation, and is used to estimate allergic population eliciting doses for multiple food allergens.
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Affiliation(s)
- Matthew W Wheeler
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences Research, Triangle Park, NC, USA
| | - Joost Westerhout
- The Netherlands Organization, Utrechtseweg, Zeist, 3704 HE, The Netherlands
| | - Joe L Baumert
- Department of Food Science and Technology, FARRP, University of Nebraska-Lincoln, Lincoln, NE, USA
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9
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Houben GF, Baumert JL, Blom WM, Kruizinga AG, Meima MY, Remington BC, Wheeler MW, Westerhout J, Taylor SL. Full range of population Eliciting Dose values for 14 priority allergenic foods and recommendations for use in risk characterization. Food Chem Toxicol 2020; 146:111831. [PMID: 33166672 DOI: 10.1016/j.fct.2020.111831] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Previously, we published selected Eliciting Dose (ED) values (i.e. ED01 and ED05 values) for 14 allergenic foods, predicted to elicit objective allergic symptoms in 1% and 5%, respectively, of the allergic population (Remington et al., 2020). These ED01 and ED05 values were specifically presented and discussed in the context of establishing Reference Doses for allergen management and the calculation of Action Levels for Precautionary Allergen Labeling (PAL). In the current paper, we publish the full range of ED values for these allergenic foods and provide recommendations for their use, specifically in the context of characterizing risks of concentrations of (unintended) allergenic proteins in food products. The data provided in this publication give risk assessors access to full population ED distribution information for 14 priority allergenic foods, based on the largest threshold database worldwide. The ED distributions were established using broad international consensus regarding suitable datapoints and methods for establishing individual patient's NOAELs and LOAELs and state of the art statistical modelling. Access to these ED data enables risk assessors to use this information for state-of-the-art food allergen risk assessment. This paper contributes to a harmonization of food allergen risk assessment and risk management and PAL practices.
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Affiliation(s)
- Geert F Houben
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, the Netherlands.
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA
| | - W Marty Blom
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, the Netherlands
| | - Astrid G Kruizinga
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, the Netherlands
| | - Marie Y Meima
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, the Netherlands
| | - Benjamin C Remington
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA; Remington Consulting Group B.V., Utrecht, the Netherlands
| | - Matthew W Wheeler
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health, Research Triangle Park, NC, USA
| | - Joost Westerhout
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, the Netherlands
| | - Steve L Taylor
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA
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10
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Remington BC, Westerhout J, Dubois AEJ, Blom WM, Kruizinga AG, Taylor SL, Houben GF, Baumert JL. Suitability of low-dose, open food challenge data to supplement double-blind, placebo-controlled data in generation of food allergen threshold dose distributions. Clin Exp Allergy 2020; 51:151-154. [PMID: 33030225 DOI: 10.1111/cea.13753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin C Remington
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Joost Westerhout
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, The Netherlands
| | | | - W Marty Blom
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Astrid G Kruizinga
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Steve L Taylor
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE, USA
| | - Geert F Houben
- The Netherlands Organisation for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, NE, USA
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11
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Graham F, Caubet JC, Eigenmann PA. Can my child with IgE-mediated peanut allergy introduce foods labeled with "may contain traces"? Pediatr Allergy Immunol 2020; 31:601-607. [PMID: 32160355 DOI: 10.1111/pai.13244] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 01/19/2023]
Abstract
Peanut IgE-mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut-allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as "may contain traces of peanuts," which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as "may contain traces of peanuts" is a recurring problem that peanut-allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients' risk of reacting to foods with PAL. In clinical practice, a single-dose 30 mg peanut protein oral food challenge may be an option to stratify peanut-allergic patients' risk when introducing foods with PAL, as illustrated by three clinical cases.
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Affiliation(s)
- François Graham
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.,Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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12
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Fukuie T, Nishiura H, Miyaji Y, Matsumoto K, Ohya Y, Saito H. Effect of specific IgE on eliciting dose in children with cow's milk allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3660-3662.e2. [PMID: 32679350 DOI: 10.1016/j.jaip.2020.06.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/06/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
| | - Hiroshi Nishiura
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hirohisa Saito
- Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
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13
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Remington BC, Westerhout J, Meima MY, Blom WM, Kruizinga AG, Wheeler MW, Taylor SL, Houben GF, Baumert JL. Updated population minimal eliciting dose distributions for use in risk assessment of 14 priority food allergens. Food Chem Toxicol 2020; 139:111259. [PMID: 32179163 DOI: 10.1016/j.fct.2020.111259] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 01/08/2023]
Abstract
Food allergy and allergen management are important global public health issues. In 2011, the first iteration of our allergen threshold database (ATDB) was established based on individual NOAELs and LOAELs from oral food challenge in roughly 1750 allergic individuals. Population minimal eliciting dose (EDp) distributions based on this dataset were published for 11 allergenic foods in 2014. Systematic data collection has continued (2011-2018) and the dataset now contains over 3400 data points. The current study provides new and updated EDp values for 14 allergenic foods and incorporates a newly developed Stacked Model Averaging statistical method for interval-censored data. ED01 and ED05 values, the doses at which 1%, and respectively 5%, of the respective allergic population would be predicted to experience any objective allergic reaction were determined. The 14 allergenic foods were cashew, celery, egg, fish, hazelnut, lupine, milk, mustard, peanut, sesame, shrimp (for crustacean shellfish), soy, walnut, and wheat. Updated ED01 estimates ranged between 0.03 mg for walnut protein and 26.2 mg for shrimp protein. ED05 estimates ranged between 0.4 mg for mustard protein and 280 mg for shrimp protein. The ED01 and ED05 values presented here are valuable in the risk assessment and subsequent risk management of allergenic foods.
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Affiliation(s)
- Benjamin C Remington
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands
| | - Joost Westerhout
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands
| | - Marie Y Meima
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands
| | - W Marty Blom
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands.
| | - Astrid G Kruizinga
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands
| | - Matthew W Wheeler
- Risk Evaluation Branch, National Institute for Occupational Safety and Health, Cincinnati, OH, United States
| | - Steve L Taylor
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA
| | - Geert F Houben
- The Netherlands Organisation for Applied Scientific Research TNO, Zeist, the Netherlands
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA
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15
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D'Auria E, Pendezza E, Zuccotti GV. Personalized Nutrition in Food Allergy: Tips for Clinical Practice. Front Pediatr 2020; 8:113. [PMID: 32292770 PMCID: PMC7119223 DOI: 10.3389/fped.2020.00113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Nowadays, food allergies are considered as a wide spectrum of disorders that need different approaches. The "one size fits all" approach is giving way to a "targeted approach," based on the identification of the patient's phenotype. Thus, the approach of nutritional management of food allergy has moved on from simply being "yes or no" to "how much?", "in which form?" and "for which patients?" Different factors should be considered in order to make a patient-tailored nutritional plan in clinical practice. Tailored nutritional plans may help to reduce the nutritional, social and economic burden of food allergy.
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Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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16
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Westerhout J, Baumert JL, Blom WM, Allen KJ, Ballmer-Weber B, Crevel RW, Dubois AE, Fernández-Rivas M, Greenhawt MJ, Hourihane JO, Koplin JJ, Kruizinga AG, Le TM, Sampson HA, Shreffler WG, Turner PJ, Taylor SL, Houben GF, Remington BC. Deriving individual threshold doses from clinical food challenge data for population risk assessment of food allergens. J Allergy Clin Immunol 2019; 144:1290-1309. [DOI: 10.1016/j.jaci.2019.07.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/24/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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17
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Remington BC, Krone T, Kim EH, Bird JA, Green TD, Lack G, Fleischer DM, Koppelman SJ. Estimated risk reduction to packaged food reactions by epicutaneous immunotherapy (EPIT) for peanut allergy. Ann Allergy Asthma Immunol 2019; 123:488-493.e2. [PMID: 31442495 DOI: 10.1016/j.anai.2019.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Peanut allergy is a generally persistent, sometimes life-threatening food allergy. With no treatments demonstrating the ability to cure a food allergy, the focus of drugs in development has been on providing a level of protection against accidental exposure reactions. However, no study has estimated the relative risk reduction of a food-allergic population receiving a specific immunotherapeutic treatment for their allergies. OBJECTIVE To estimate the relative risk reduction when consuming peanut-contaminated packaged food products in a double-blind, placebo-controlled Phase 3 study population of children treated with epicutaneous immunotherapy (EPIT) for 12 months with either a patch containing 250 μg peanut protein (250-μg patch) or a placebo patch. METHODS The probability of an allergic reaction due to the unintended presence of peanut protein in packaged food products was modeled per study group and food category combination using Monte Carlo simulations. Risks per eating occasion of a contaminated packaged food product and the number of individuals per study population predicted to react on a yearly basis were investigated. RESULTS The population treated with the 250-μg patch demonstrated a significantly increased dose-response distribution after 12 months of treatment, which resulted in a relative risk reduction of 73.2% to 78.4% when consuming peanut-contaminated packaged food products. In contrast, no statistically significant change was observed for the placebo group at the 12-month point. CONCLUSION Our study estimates a substantial relative risk reduction for allergic reactions among peanut-allergic children after 12 months of EPIT with the 250-μg patch, supporting the potential real-world clinical relevance of this investigational immunotherapy and its possible role as a future therapy for peanut-allergic children. ClinicalTrials.gov Identifier: NCT02636699.
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Affiliation(s)
- Benjamin C Remington
- Netherlands Organisation for Applied Scientific Research TNO, Zeist, The Netherlands.
| | - Tanja Krone
- Netherlands Organisation for Applied Scientific Research TNO, Zeist, The Netherlands
| | - Edwin H Kim
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Andrew Bird
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Todd D Green
- DBV Technologies, Montrouge, France; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Gideon Lack
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Stef J Koppelman
- DBV Technologies, Montrouge, France; Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska
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18
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Dua S, Ruiz-Garcia M, Bond S, Durham SR, Kimber I, Mills C, Roberts G, Skypala I, Wason J, Ewan P, Boyle R, Clark A. Effect of sleep deprivation and exercise on reaction threshold in adults with peanut allergy: A randomized controlled study. J Allergy Clin Immunol 2019; 144:1584-1594.e2. [PMID: 31319102 DOI: 10.1016/j.jaci.2019.06.038] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peanut allergy causes severe and fatal reactions. Current food allergen labeling does not address these risks adequately against the burden of restricting food choice for allergic patients because of limited data on thresholds of reactivity and the influence of everyday factors. OBJECTIVE We estimated peanut threshold doses for a United Kingdom population with peanut allergy and examined the effect of sleep deprivation and exercise. METHODS In a crossover study, after blind challenge, participants with peanut allergy underwent 3 open peanut challenges in random order: with exercise after each dose, with sleep deprivation preceding challenge, and with no intervention. Primary outcome was the threshold dose triggering symptoms (in milligrams of protein). Primary analysis estimated the difference between the nonintervention challenge and each intervention in log threshold (as percentage change). Dose distributions were modeled, deriving eliciting doses in the population with peanut allergy. RESULTS Baseline challenges were performed in 126 participants, 100 were randomized, and 81 (mean age, 25 years) completed at least 1 further challenge. The mean threshold was 214 mg (SD, 330 mg) for nonintervention challenges, and this was reduced by 45% (95% CI, 21% to 61%; P = .001) and 45% (95% CI, 22% to 62%; P = .001) for exercise and sleep deprivation, respectively. Mean estimated eliciting doses for 1% of the population were 1.5 mg (95% CI, 0.8-2.5 mg) during nonintervention challenge (n = 81), 0.5 mg (95% CI, 0.2-0.8 mg) after sleep, and 0.3 mg (95% CI, 0.1-0.6 mg) after exercise. CONCLUSION Exercise and sleep deprivation each significantly reduce the threshold of reactivity in patients with peanut allergy, putting them at greater risk of a reaction. Adjusting reference doses using these data will improve allergen risk management and labeling to optimize protection of consumers with peanut allergy.
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Affiliation(s)
- Shelley Dua
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Monica Ruiz-Garcia
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Stephen R Durham
- Allergy and Clinical Immunology, Section Inflammation Repair and Development National heart and Lung Institute, Faculty of Medicine, Imperial College, London and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Graham Roberts
- NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Isabel Skypala
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - James Wason
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pamela Ewan
- Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Robert Boyle
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; Centre of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Clark
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom
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19
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Elegbede CF, Papadopoulos A, Just J, Moneret-Vautrin DA, Deschildre A, Crépet A. Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey. Clin Exp Allergy 2019; 49:677-689. [PMID: 30689235 DOI: 10.1111/cea.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach. OBJECTIVE To develop a threshold dose distribution curve model from routinely collected data. METHODS The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach. RESULTS Patients were mainly children (mean age: 9 years [IQR: 6-11]; 87% < 16 years) and males (62%). Median Ara h2 s IgE was of 8kUA/L [IQR: 1-55] and median skin prick test size of 10 mm [IQR: 7-13]. OFC was positive in 204 patients (86%). The median threshold dose was of 67 mg of peanut protein [IQR: 16-244]. The dose at which 1% of the patients are likely to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein. Gender, size of the skin prick test (SPT) and Ara h 2 specific IgE level had a significant impact on the threshold dose distribution curve. The Cox model was the most effective to predict threshold doses with this combination of factors. Girls react to lower doses than boys with a beta coefficient associated to the risk and a 95% credible interval of 0.44 [0.04; 0.77]. The higher the size of the SPT and the Ara h 2 specific IgE level are, the higher the risk of reacting to a small amount of peanut, with beta coefficients associated to the risk and 95% credible intervals of 0.05 [0.02; 0.08] and 0.01 [0.01; 0.02], respectively. CONCLUSION AND CLINICAL RELEVANCE According to the model, routinely collected data could be used to estimate the threshold dose. The consequences could be the identification of high-risk patients who are susceptible to react to small amounts of peanut and a personalized management of peanut allergy integrating the risk of allergic reaction. Limitations of this study are that assessors of OFC outcome were aware of SPT and Arah2 results, and a further validation study is required to confirm the predictive value of these parameters.
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Affiliation(s)
- Chabi Fabrice Elegbede
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France.,French National Institute for Agricultural Research (INRA), Paris Institute of Technology for Life, Food and Environmental Sciences (AgroParisTech), UMR Economie Publique INRA-AgroParisTech, Thiverval-Grignon, France
| | - Alexandra Papadopoulos
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
| | - Jocelyne Just
- Asthma and Allergy Center, Hôpital d'Enfants Armand-Trousseau, Paris, France.,INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - Denise Anne Moneret-Vautrin
- Allergy Department, Centre Hospitalier E Durckheim, Epinal, France.,Allergyvigilance Network, Vandoeuvre les Nancy, France.,Lorraine University, Nancy, France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | - Amélie Crépet
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
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20
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Sensitivity analysis to derive a food consumption point estimate for deterministic food allergy risk assessment. Food Chem Toxicol 2019; 125:413-421. [DOI: 10.1016/j.fct.2019.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
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21
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Arkwright PD, MacMahon J, Koplin J, Rajput S, Cross S, Fitzsimons R, Davidson N, Deshpande V, Rao N, Lumsden C, Lacy D, Allen KJ, Vance G, Mwenechanya J, Fox AT, Erlewyn-Lajeunesse M, Mistry H, Hourihane JO. Severity and threshold of peanut reactivity during hospital-based open oral food challenges: An international multicenter survey. Pediatr Allergy Immunol 2018; 29:754-761. [PMID: 30022517 DOI: 10.1111/pai.12959] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Peanut allergy is classically managed by food avoidance. Immunotherapy programs are available at some academic centers for selected patients reacting to small amounts of peanut during food challenge. We aimed to determine and compare reaction thresholds and prevalence of anaphylaxis during peanut oral challenges at multiple specialist allergy centers. METHODS A retrospective, international survey of anonymized case records from seven specialist pediatric allergy centers from the UK and Ireland, as well as the Australian HealthNuts study. Demographic information, allergy test results, reaction severity and threshold during open oral peanut challenges were collated and analyzed. RESULTS Of the 1634 children aged 1-18 years old included, 525 (32%) failed their peanut challenge. Twenty-eight percent reacted to 25 mg, while 38% only reacted after consuming 1 g or more of whole peanut. Anaphylaxis (55 [11%]) was 3 times more common in teenagers than younger children and the likelihood increased at all ages as children consuming more peanut at the challenge. Children who developed anaphylaxis to 25-200 mg of whole peanut were significantly older. Previous history of reaction did not predict reaction threshold or severity. CONCLUSIONS More than a third of the children in this large international cohort tolerated the equivalent of one peanut in an oral challenge. Anaphylaxis, particularly to small amounts of peanut, was more common in older children. Tailored immunotherapy programs might be considered not only for children with low, but also higher reaction thresholds. Whether these programs could prevent heightened sensitivity and anaphylaxis to peanut with age also deserves further study.
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Affiliation(s)
- Peter D Arkwright
- Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | | | - Jennifer Koplin
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Shelly Rajput
- Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | | | | | - Neil Davidson
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | | | - Naveen Rao
- University Hospital of South Manchester, Manchester, UK
| | | | - David Lacy
- Wirral University Teaching Hospital, Wirral, UK
| | - Katrina J Allen
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Gillian Vance
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | | | - Adam T Fox
- Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Hitesh Mistry
- Division of Pharmacy, University of Manchester, Manchester, UK
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22
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Chaudhari M, Kim EH, Withana Gamage PW, McMahan CS, Kosorok MR. Study design with staggered sampling times for evaluating sustained unresponsiveness to peanut sublingual immunotherapy. Stat Med 2018; 37:3944-3958. [PMID: 29974494 DOI: 10.1002/sim.7857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 11/08/2022]
Abstract
In this work, we delineate an altered study design of a pre-existing clinical trial that is currently being implemented in the Department of Pediatrics at the University of North Carolina at Chapel Hill. The purpose of the ongoing investigation of the desensitized pediatric cohort is to address the effectiveness of sublingual immunotherapy in achieving sustained unresponsiveness (SU) as assessed by repeated double-blind placebo-controlled food challenges (DBPCFC). With scarce published literature characterizing SU, the length of time off-therapy that would represent clinically meaningful benefit remains undefined. We use the new design features to assess time to loss of SU, an important efficacy endpoint, that to our knowledge, no prior study has investigated. Our work has two-fold objectives: first is to propose and discuss aspects of the altered design that would allow us to study SU and second is to explore methodology to evaluate the time to loss of SU and its association with risk factors in the context of the data originating from the trial. The salient feature of the new design is the allocation scheme of study subjects to staggered sampling timepoints when a subsequent DBPCFC is administered. Due to this feature, the time to loss of SU is either left or right censored. Additionally, some participants at study entry fail the DBPCFC, leading to what can be construed as an instantaneous failure. Through in-depth numerical studies, we examine the performance and power of a recently proposed mixture proportional hazards model specifically designed for the analysis of interval-censored data subject to instantaneous failures.
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Affiliation(s)
- Monica Chaudhari
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edwin H Kim
- Division of Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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23
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Dubois AEJ, Turner PJ, Hourihane J, Ballmer-Weber B, Beyer K, Chan CH, Gowland MH, O'Hagan S, Regent L, Remington B, Schnadt S, Stroheker T, Crevel RWR. How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop. Allergy 2018; 73:1383-1392. [PMID: 29331070 PMCID: PMC6032860 DOI: 10.1111/all.13405] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single-dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice.
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Affiliation(s)
- A. E. J. Dubois
- University Medical Centre Groningen; Groningen The Netherlands
| | | | | | | | - K. Beyer
- Charité Universitätsmedizin Berlin; Berlin Germany
| | | | | | | | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - B. Remington
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - S. Schnadt
- German Allergy and Asthma Association (DAAB); Mönchengladbach DE
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24
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Graham F, Eigenmann PA. Clinical implications of food allergen thresholds. Clin Exp Allergy 2018; 48:632-640. [DOI: 10.1111/cea.13144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- F. Graham
- Pediatric Allergy Unit; University Hospitals of Geneva and University of Geneva; Geneva Switzerland
| | - P. A. Eigenmann
- Pediatric Allergy Unit; University Hospitals of Geneva and University of Geneva; Geneva Switzerland
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25
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Allen KJ, Taylor SL. The Consequences of Precautionary Allergen Labeling: Safe Haven or Unjustifiable Burden? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018. [DOI: 10.1016/j.jaip.2017.12.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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26
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Uotila R, Kukkonen AK, Blom WM, Remington B, Westerhout J, Pelkonen AS, Mäkelä MJ. Component-resolved diagnostics demonstrates that most peanut-allergic individuals could potentially introduce tree nuts to their diet. Clin Exp Allergy 2018; 48:712-721. [PMID: 29377469 DOI: 10.1111/cea.13101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nut allergy varies from pollen cross-allergy, to primary severe allergy with life-threatening symptoms. The screening of IgE antibodies to a wide spectrum of allergens, including species-specific and cross-reactive allergens, is made possible via microarray analysis. OBJECTIVE We sought to study the association of variable IgE sensitization profiles to clinical response in peanut-challenged children and adolescents in a birch-endemic region. In addition, we studied the avoidance of tree nuts and species-specific sensitizations. METHODS We studied 102 peanut-sensitized patients who underwent a double-blind placebo-controlled challenge to peanut. We analysed ISAC ImmunoCAP microarray to 112 allergens, singleplex ImmunoCAPs for hazelnut Cor a 14 and cashew Ana o 3, and performed skin prick tests to peanut, tree nuts and sesame seed. We surveyed avoidance diets with a questionnaire. RESULTS Sensitization to PR-10 proteins was frequent (Bet v 1 90%), but equally high in the challenge negatives and positives. IgE to Ara h 2 and Ara h 6 discriminated peanut allergic (n = 69) and tolerant (n = 33) the best. Avoidance of tree nuts was common (52% to 96%), but only 6% to 44% presented species-specific sensitizations to tree nuts, so a great number could potentially introduce these species into their diet. CONCLUSIONS AND CLINICAL RELEVANCE PR-10-sensitizations were frequent and strong regardless of peanut allergy status. Component-resolved diagnostics can be employed to demonstrate to patients that sensitization to seed storage proteins of tree nuts is uncommon. Several tree nuts could potentially be reintroduced to the diet.
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Affiliation(s)
- R Uotila
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - A K Kukkonen
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - W M Blom
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - B Remington
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - J Westerhout
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - A S Pelkonen
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - M J Mäkelä
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
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27
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Remington BC, Westerhout J, Campbell DE, Turner PJ. Minimal impact of extensive heating of hen's egg and cow's milk in a food matrix on threshold dose-distribution curves. Allergy 2017; 72:1816-1819. [PMID: 28474471 PMCID: PMC5655912 DOI: 10.1111/all.13198] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
We analyzed reaction threshold data from 352 children undergoing open food challenges to hen's egg or cow's milk, either fresh or extensively heated into a muffin. There was no significant shift in dose-distribution curves due to the baking process, implying that existing threshold data for these allergens can be applied to allergen risk management, even when these allergens are heat-processed into baked foods.
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Affiliation(s)
| | | | - D. E. Campbell
- Department of Allergy & ImmunologyChildren's Hospital at WestmeadSydneyAustralia
- Discipline of Child and Adolescent HealthUniversity of SydneySydneyAustralia
| | - P. J. Turner
- Discipline of Child and Adolescent HealthUniversity of SydneySydneyAustralia
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of AsthmaImperial College LondonLondonUK
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28
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Sayers RL, Gethings LA, Lee V, Balasundaram A, Johnson PE, Marsh JA, Wallace A, Brown H, Rogers A, Langridge JI, Mills ENC. Microfluidic Separation Coupled to Mass Spectrometry for Quantification of Peanut Allergens in a Complex Food Matrix. J Proteome Res 2017; 17:647-655. [DOI: 10.1021/acs.jproteome.7b00714] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rebekah L. Sayers
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
| | - Lee A. Gethings
- Waters Corporation, Stamford Avenue, Altrincham Road, Wilmslow, U.K. SK9 4AX
| | - Victoria Lee
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
| | - Anuradha Balasundaram
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
| | - Philip E. Johnson
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
| | - Justin A. Marsh
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
| | - Antonietta Wallace
- Waters Corporation, Stamford Avenue, Altrincham Road, Wilmslow, U.K. SK9 4AX
| | - Helen Brown
- Campden BRI (Chipping Campden) Ltd, Chipping Campden, U.K. GL55 6LD
| | - Adrian Rogers
- Romer Labs U.K., The Heath Business and Technical Park, Runcorn, Cheshire, U.K. WA7 4QX
| | - James I. Langridge
- Waters Corporation, Stamford Avenue, Altrincham Road, Wilmslow, U.K. SK9 4AX
| | - E. N. Clare Mills
- School of Biological Sciences, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, U.K. M1 7DN
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Foong RX, Brough H. The role of environmental exposure to peanut in the development of clinical allergy to peanut. Clin Exp Allergy 2017; 47:1232-1238. [PMID: 28779526 DOI: 10.1111/cea.12992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 01/17/2023]
Abstract
The prevalence of peanut allergy has increased over the years and still remains one of the most common causes of food-related anaphylaxis. The way in which peanut sensitization occurs has been explored, such as via maternal consumption in pregnancy, via breastmilk and through a disrupted skin barrier. It has previously been shown that environmental exposure to aeroallergens in household dust can be a risk factor for the development of allergic asthma. There is an increasing body of evidence that the combination of cutaneous sensitization via a disrupted skin barrier (ie children with eczema or with filaggrin mutations) and environmental peanut exposure influences the development of peanut allergy. This review aims to explore routes of peanut sensitization and the current evidence on how environmental exposure to peanut affects the development of peanut allergy.
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Affiliation(s)
- R X Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - H Brough
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
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30
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Blom WM, Kruizinga AG, Rubingh CM, Remington BC, Crevel RW, Houben GF. Assessing food allergy risks from residual peanut protein in highly refined vegetable oil. Food Chem Toxicol 2017; 106:306-313. [DOI: 10.1016/j.fct.2017.05.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 11/25/2022]
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Peanut Allergen Threshold Study (PATS): Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy. J Allergy Clin Immunol 2017; 139:1583-1590. [DOI: 10.1016/j.jaci.2017.01.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/22/2016] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
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Home-based induction of sustained unresponsiveness in children with mild reactions to high doses of peanut. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1757-1759. [PMID: 28460846 DOI: 10.1016/j.jaip.2017.03.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/13/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
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Blankestijn MA, Remington BC, Houben GF, Baumert JL, Knulst AC, Blom WM, Klemans RJB, Taylor SL. Threshold Dose Distribution in Walnut Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:376-380. [PMID: 28110058 DOI: 10.1016/j.jaip.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In food allergy, eliciting doses (EDs) of foods on a population level can improve risk management and labeling strategies for the food industry and regulatory authorities. Previously, data available for walnut were unsuitable to determine EDs. OBJECTIVE The objective of this study was to determine EDs for walnut allergic adults and to compare with previously established threshold data for peanut and tree nuts. METHODS Prospectively, adult subjects with a suspected walnut allergy underwent a low-dose double-blind, placebo-controlled food challenge. Individual no observed and lowest observed adverse effect levels were determined and log-normal, log-logistic, and Weibull models were fit to the data. Estimated ED values were calculated for the ED5, ED10, and ED50, the dose respectively predicted to provoke an allergic reaction in 5%, 10%, and 50% of the walnut allergic population. RESULTS Fifty-seven subjects were challenged and 33 subjects were confirmed to be walnut allergic. Objective symptoms occurred in 20 of the positive challenges (61%). The cumulative EDs in the distribution models ranged from 3.1 to 4.1 mg for the ED05, from 10.6 to 14.6 mg walnut protein for the ED10, and from 590 to 625 mg of walnut protein for the ED50. CONCLUSIONS Our data indicate that population EDs for walnut are slightly higher compared with those for peanut and hazelnut allergy. Currently available data indicate that the ED values for hazelnut could be used as a conservative temporary placeholder when implementing risk management strategies for other tree nuts where little or no food challenge data are available.
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Affiliation(s)
- Mark A Blankestijn
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Ben C Remington
- The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Geert F Houben
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Joe L Baumert
- Food Allergy Research & Resource Program (FARRP), University of Nebraska, Lincoln, Neb
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Marty Blom
- The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Rob J B Klemans
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steve L Taylor
- Food Allergy Research & Resource Program (FARRP), University of Nebraska, Lincoln, Neb
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Houben G, Burney P, Chan CH, Crevel R, Dubois A, Faludi R, Klein Entink R, Knulst A, Taylor S, Ronsmans S. Prioritisation of allergenic foods with respect to public health relevance. Food Chem Toxicol 2016; 89:8-18. [DOI: 10.1016/j.fct.2015.12.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/27/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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Sayers RL, Johnson PE, Marsh JT, Barran P, Brown H, Mills ENC. The effect of thermal processing on the behaviour of peanut allergen peptide targets used in multiple reaction monitoring mass spectrometry experiments. Analyst 2016; 141:4130-41. [DOI: 10.1039/c6an00359a] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Identification of processing-stable targets provides important validation when developing targeted mass spectrometry methods for quantifying peanut allergens.
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Affiliation(s)
- R. L. Sayers
- Institute of Inflammation and Repair
- Manchester Academic Health Science Centre
- Manchester Institute of Biotechnology
- The University of Manchester
- UK
| | - P. E. Johnson
- Institute of Inflammation and Repair
- Manchester Academic Health Science Centre
- Manchester Institute of Biotechnology
- The University of Manchester
- UK
| | - J. T. Marsh
- Institute of Inflammation and Repair
- Manchester Academic Health Science Centre
- Manchester Institute of Biotechnology
- The University of Manchester
- UK
| | - P. Barran
- School of Chemistry
- Michael Barber Centre
- Manchester Institute of Biotechnology
- The University of Manchester
- UK
| | - H. Brown
- Campden BRI (Chipping Campden) Limited - part of the Campden BRI group
- Gloucestershire
- UK
| | - E. N. C. Mills
- Institute of Inflammation and Repair
- Manchester Academic Health Science Centre
- Manchester Institute of Biotechnology
- The University of Manchester
- UK
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36
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Peanut traces in packaged food products consumed by allergic individuals: Results of the MIRABEL project. J Food Compost Anal 2015. [DOI: 10.1016/j.jfca.2015.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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A retrospective analysis of allergic reaction severities and minimal eliciting doses for peanut, milk, egg, and soy oral food challenges. Food Chem Toxicol 2015; 80:92-100. [DOI: 10.1016/j.fct.2015.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
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38
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Dano D, Remington BC, Astier C, Baumert JL, Kruizinga AG, Bihain BE, Taylor SL, Kanny G. Sesame allergy threshold dose distribution. Food Chem Toxicol 2015; 83:48-53. [PMID: 26032633 DOI: 10.1016/j.fct.2015.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/30/2015] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sesame is a relevant food allergen in France. Compared to other allergens there is a lack of food challenge data and more data could help sesame allergy risk management. The aim of this study is to collect more sesame challenge data and investigate the most efficient food challenge method for future studies. METHOD Records of patients at University Hospital in Nancy (France) with objective symptoms to sesame challenges were collected and combined with previously published data. An estimation of the sesame allergy population threshold was calculated based on individual NOAELs and LOAELs. Clinical dosing schemes at Nancy were investigated to see if the optimal protocol for sesame is currently used. RESULTS Fourteen patients (10 M/4 F, 22 ± 14.85 years old) with objective symptoms were added to previously published data making a total of 35 sesame allergic patients. The most sensitive patient reacted to the first dose at challenge of 1.02 mg sesame protein. The ED05 ranges between 1.2 and 4.0 mg of sesame protein (Log-Normal, Log-Logistic, and Weibull models) and the ED10 between 4.2 and 6.2 mg. The optimal food challenge dosing scheme for sesame follows semi-log dose increases from 0.3 to 3000 mg protein. CONCLUSION This article provides a valuable update to the existing clinical literature regarding sesame NOAELs and LOAELs. Establishment of a population threshold for sesame could help in increasing the credibility of precautionary labelling and decrease the costs associated with unexpected allergic reactions. Also, the use of an optimal dosing scheme would decrease time spent on diagnostic and thereafter on the economic burden of sesame allergy diagnosis.
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Affiliation(s)
- D Dano
- EA 7299, Laboratory of Medical Hydrology and Climatology, Faculty of Medicine, Lorraine University, France; Genclis, SAS, Vandoeuvre-les-Nancy, France.
| | - B C Remington
- Netherlands Organisation of Applied Scientific Research TNO, Utrechtseweg 48, P.O. Box 360, 3704 HE Zeist, Netherlands
| | - C Astier
- EA 7299, Laboratory of Medical Hydrology and Climatology, Faculty of Medicine, Lorraine University, France
| | - J L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - A G Kruizinga
- Netherlands Organisation of Applied Scientific Research TNO, Utrechtseweg 48, P.O. Box 360, 3704 HE Zeist, Netherlands
| | - B E Bihain
- Genclis, SAS, Vandoeuvre-les-Nancy, France
| | - S L Taylor
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - G Kanny
- EA 7299, Laboratory of Medical Hydrology and Climatology, Faculty of Medicine, Lorraine University, France; Internal Medicine, Clinical Immunology and Allergology, University Hospital, Nancy, France
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Ballmer-Weber BK, Fernandez-Rivas M, Beyer K, Defernez M, Sperrin M, Mackie AR, Salt LJ, Hourihane JO, Asero R, Belohlavkova S, Kowalski M, de Blay F, Papadopoulos NG, Clausen M, Knulst AC, Roberts G, Popov T, Sprikkelman AB, Dubakiene R, Vieths S, van Ree R, Crevel R, Mills EC. How much is too much? Threshold dose distributions for 5 food allergens. J Allergy Clin Immunol 2015; 135:964-971. [DOI: 10.1016/j.jaci.2014.10.047] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
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Costa J, Mafra I, Carrapatoso I, Oliveira MBPP. Hazelnut Allergens: Molecular Characterization, Detection, and Clinical Relevance. Crit Rev Food Sci Nutr 2015; 56:2579-2605. [DOI: 10.1080/10408398.2013.826173] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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41
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Mirabel: An integrated project for risk and cost/benefit analysis of peanut allergy. Regul Toxicol Pharmacol 2015; 71:178-83. [DOI: 10.1016/j.yrtph.2014.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/22/2022]
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42
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Long KD, Yu H, Cunningham BT. Smartphone instrument for portable enzyme-linked immunosorbent assays. BIOMEDICAL OPTICS EXPRESS 2014; 5:3792-806. [PMID: 25426311 PMCID: PMC4242018 DOI: 10.1364/boe.5.003792] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/28/2014] [Accepted: 09/29/2014] [Indexed: 05/23/2023]
Abstract
We demonstrate the utilization of a smartphone camera as a spectrometer that is capable of measuring Enzyme Linked Immunosorbent Assays (ELISA) at biologically-relevant concentrations with the aid of a custom cradle that aligns a diffraction grating and a collimating lens between a light source and the imaging sensor. Two example biomarkers are assayed using conventional ELISA protocols: IL-6, a protein used diagnostically for several types of cancer, and Ara h 1, one of the principle peanut allergens. In addition to the demonstration of limits of detection at medically-relevant concentrations, a screening of various cookies was completed to measure levels of peanut cross-contamination in local bakeries. The results demonstrate the utility of the instrument for quantitatively performing broad classes of homogeneous colorimetric assays, in which the endpoint readout is the color change of a liquid sample.
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Affiliation(s)
- Kenneth D. Long
- Department of Bioengineering, Micro and Nanotechnology Laboratory, University of Illinois at Urbana-Champaign, 208 N. Wright Street, Urbana, IL, 61801,
USA
| | - Hojeong Yu
- Department of Electrical and Computer Engineering, Micro and Nanotechnology Laboratory, University of Illinois at Urbana-Champaign, 208 N. Wright Street, Urbana, IL, 61801,
USA
| | - Brian T. Cunningham
- Department of Bioengineering, Micro and Nanotechnology Laboratory, University of Illinois at Urbana-Champaign, 208 N. Wright Street, Urbana, IL, 61801,
USA
- Department of Electrical and Computer Engineering, Micro and Nanotechnology Laboratory, University of Illinois at Urbana-Champaign, 208 N. Wright Street, Urbana, IL, 61801,
USA
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43
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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44
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Costa J, Carrapatoso I, Oliveira MBPP, Mafra I. Walnut allergens: molecular characterization, detection and clinical relevance. Clin Exp Allergy 2014; 44:319-41. [PMID: 24382327 DOI: 10.1111/cea.12267] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Food-induced allergies have been regarded as an emergent problem of public health. Classified as important allergenic ingredients, the presence of walnut and other nuts as hidden allergens in processed foods constitutes a risk for sensitized individuals, being a real problem of allergen management. Attending to the increasing importance dedicated to walnut allergy, this review intends to provide the relevant and up-to-date information on main issues such as the prevalence of walnut allergy, the clinical threshold levels, the molecular characterization of walnut allergens and their clinical relevance, as well as the methodologies for walnut allergen detection in foods. As the walnut used in human diet comes from Juglans regia and Juglans nigra, the molecular characterization of the allergens from both species included in the prolamins (Jug r 1, Jug n 1 and Jug r 3), cupins (Jug r 2, Jug n 2 and Jug r 4) and profilins (Jug r 5), together with respective clinical relevance, were compiled in this review. The most recent progresses on walnut allergen detection techniques (protein- and DNA-based) are described and critically compared, including the emergent multitarget approaches.
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Affiliation(s)
- J Costa
- REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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45
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Blumchen K, Beder A, Beschorner J, Ahrens F, Gruebl A, Hamelmann E, Hansen G, Heinzmann A, Nemat K, Niggemann B, Wahn U, Beyer K. Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy. J Allergy Clin Immunol 2014; 134:390-8. [DOI: 10.1016/j.jaci.2014.03.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 02/02/2014] [Accepted: 03/12/2014] [Indexed: 12/26/2022]
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46
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Klein Entink RH, Remington BC, Blom WM, Rubingh CM, Kruizinga AG, Baumert JL, Taylor SL, Houben GF. Food allergy population thresholds: an evaluation of the number of oral food challenges and dosing schemes on the accuracy of threshold dose distribution modeling. Food Chem Toxicol 2014; 70:134-43. [PMID: 24815821 DOI: 10.1016/j.fct.2014.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/31/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
For most allergenic foods, limited availability of threshold dose information within the population restricts the advice on action levels of unintended allergenic foods which should trigger advisory labeling on packaged foods. The objective of this paper is to provide guidance for selecting an optimal sample size for threshold dosing studies for major allergenic foods and to identify factors influencing the accuracy of estimation. A simulation study was performed to evaluate the effects of sample size and dosing schemes on the accuracy of the threshold distribution curve. The relationships between sample size, dosing scheme and the employed statistical distribution on the one hand and accuracy of estimation on the other hand were obtained. It showed that the largest relative gains in accuracy are obtained when sample size increases from N=20 to N=60. Moreover, it showed that the EuroPrevall dosing scheme is a useful start, but that it may need revision for a specific allergen as more data become available, because a proper allocation of the dosing steps is important. The results may guide risk assessors in minimum sample sizes for new studies and in the allocation of proper dosing schemes for allergens in provocation studies.
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Affiliation(s)
| | | | - W Marty Blom
- TNO, PO Box 360, 3700 AJ, Zeist, The Netherlands
| | | | | | - Joseph L Baumert
- Department of Food Science & Technology, University of Nebraska-Lincoln, P.O. Box 830955, Lincoln, NE 68583-0955, USA
| | - Steve L Taylor
- Department of Food Science & Technology, University of Nebraska-Lincoln, P.O. Box 830955, Lincoln, NE 68583-0955, USA
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An electrochemical peptide-based Ara h 2 antibody sensor fabricated on a nickel(II)-nitriloacetic acid self-assembled monolayer using a His-tagged peptide. Anal Chim Acta 2014; 828:85-91. [DOI: 10.1016/j.aca.2014.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/30/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022]
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48
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Hattersley S, Ward R, Baka A, Crevel RW. Advances in the risk management of unintended presence of allergenic foods in manufactured food products – An overview. Food Chem Toxicol 2014; 67:255-61. [DOI: 10.1016/j.fct.2014.01.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/29/2013] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
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49
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Crevel RW, Baumert JL, Baka A, Houben GF, Knulst AC, Kruizinga AG, Luccioli S, Taylor SL, Madsen CB. Development and evolution of risk assessment for food allergens. Food Chem Toxicol 2014; 67:262-76. [DOI: 10.1016/j.fct.2014.01.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/23/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
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50
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Taylor SL, Baumert JL, Kruizinga AG, Remington BC, Crevel RW, Brooke-Taylor S, Allen KJ, Houben G. Establishment of Reference Doses for residues of allergenic foods: Report of the VITAL Expert Panel. Food Chem Toxicol 2014; 63:9-17. [DOI: 10.1016/j.fct.2013.10.032] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/01/2013] [Accepted: 10/23/2013] [Indexed: 11/30/2022]
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