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Nordlee JA, Baumert JL, Taylor SL. Preparation of Blinded Food Matrixes for Clinical Oral Challenges. Methods Mol Biol 2024; 2717:143-157. [PMID: 37737982 DOI: 10.1007/978-1-0716-3453-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Clinically, oral food challenges have value in the diagnosis and management of food allergy. Oral food challenges are used not only for diagnostic confirmation that ingestion of a specific food elicits an adverse reaction, but also for determining individual threshold doses, tracking the progress toward desensitization during immunotherapy, determining the effect of processing on the allergenicity of a specific food, assessing the allergenicity of an ingredient derived from an allergenic source, and tracking the progress toward development of age-related tolerance to a specific food. To eliminate bias in oral challenges, the food under investigation is masked in a matrix so that it is not sensorially detectable by the patient or the clinical observer. The preparation of oral challenge foods requires care in the selection of the allergenic components, the selection of the components of the matrix, the masking of the allergenic component, and the homogeneity of the allergen in the overall matrix.
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Affiliation(s)
- Julie A Nordlee
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Joe L Baumert
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Steve L Taylor
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska-Lincoln, Lincoln, NE, USA.
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2
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Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, Alvaro-Lozano M, Ballmer-Weber B, Barni S, Beyer K, Bindslev-Jensen C, Brough HA, Buyuktiryaki B, Chu D, Del Giacco S, Dunn-Galvin A, Eberlein B, Ebisawa M, Eigenmann P, Eiwegger T, Feeney M, Fernandez-Rivas M, Fisher HR, Fleischer DM, Giovannini M, Gray C, Hoffmann-Sommergruber K, Halken S, Hourihane JO, Jones CJ, Jutel M, Knol E, Konstantinou GN, Lack G, Lau S, Marques Mejias A, Marchisotto MJ, Meyer R, Mortz CG, Moya B, Muraro A, Nilsson C, Lopes de Oliveira LC, O'Mahony L, Papadopoulos NG, Perrett K, Peters RL, Podesta M, Poulsen LK, Roberts G, Sampson HA, Schwarze J, Smith P, Tham EH, Untersmayr E, Van Ree R, Venter C, Vickery BP, Vlieg-Boerstra B, Werfel T, Worm M, Du Toit G, Skypala I. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy 2023; 78:3057-3076. [PMID: 37815205 DOI: 10.1111/all.15902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.
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Affiliation(s)
- Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Carmen Riggioni
- Department of Allergy and Clinical Immunology, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Alberto Alvarez-Perea
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Montserrat Alvaro-Lozano
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Barbara Ballmer-Weber
- Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, 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, Denmark
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Derek Chu
- McMaster University, Ontario, Hamilton, Canada
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Audrey Dunn-Galvin
- Paediatrics and Child Health, INFANT Centre, HRB-CRF, University College Cork, Cork, Ireland
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Children's Health Ireland, Dublin, Ireland
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Ontario, Toronto, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St.Pölten, Austria
| | - Mary Feeney
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Montserrat Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos, Madrid, Spain
- Facultad de Medicina, IdISSC, ARADyAL, Universidad Complutense, Madrid, Spain
| | - Helen R Fisher
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Claudia Gray
- Red Cross Children's Hospital and Kidsallergy Centre, Cape Town, South Africa
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Karin Hoffmann-Sommergruber
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Christina J Jones
- Faculty of Medical Sciences, School of Psychology, University of Surrey, Surrey, UK
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Edward Knol
- Department of Dermatology/Allergology, Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreina Marques Mejias
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | | | - Rosan Meyer
- Department of Medicine, Imperial College, London, UK
- Department of Nutrition and Dietetics, Winchester University, Winchester, UK
- Department of Medicine, KU Leuven, Leuven, Belgium
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Beatriz Moya
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Antonella Muraro
- Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
| | - Caroline Nilsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Sachs Children and Youth Hospital, South Hospital, Stockholm, Sweden
| | | | - Liam O'Mahony
- Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Lydia Becker Institute, University of Manchester, Manchester, UK
| | - Kirsten Perrett
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Parkville, Australia
- Population Allergy Research Group, Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Rachel L Peters
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Parkville, Australia
- Population Allergy Research Group, Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Marcia Podesta
- EFA - European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Lars K Poulsen
- Allergy Clinic, Copenhagen University Hospital at Herlev-Gentofte, Copenhagen, Denmark
| | - Graham Roberts
- Department of Paediatric Allergy and Respiratory Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
- David Hide Asthma and Allergy Centre, St Mary Hospital, Isle of Wight, UK
| | - Hugh A Sampson
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jürgen Schwarze
- Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Peter Smith
- Clinical Medicine, Griffith University, Queensland, Southport, Australia
- Queensland Allergy Services Private Practice, Queensland, Southport, Australia
| | - Elizabeth Huiwen Tham
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ronald Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngoloy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Carina Venter
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Colorado, Aurora, USA
| | - Brian P Vickery
- Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, Atlanta, USA
| | - Berber Vlieg-Boerstra
- Department of Paediatrics, OLVG Hospital, Amsterdam, the Netherlands
- Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands
- Vlieg Dieticians, Private Practice for Dietary Management of Food Allergy, Arnhem, The Netherlands
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Division of Allergy and immunology, Department of Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
- Department of Inflammation and Repair, Imperial College, London, UK
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Brand HK, Schreurs MWJ, Emons JAM, Gerth van Wijk R, de Groot H, Arends NJT. Peanut components measured by ISAC: comparison with ImmunoCap and clinical relevance in peanut allergic children. Clin Mol Allergy 2021; 19:14. [PMID: 34372856 PMCID: PMC8353733 DOI: 10.1186/s12948-021-00153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Specific IgE (sIgE) against the peanut component Arachis hypogaea (Ara h) 2 has been shown to be the most important allergen to discriminate between peanut allergy and peanut tolerance. Several studies determined sIgE cut off values for Ara h 2, determined by singleplex measurements. However, cut off values for Ara h 2 from multiplex arrays are less well defined. The aim of this study was to evaluate the correlation between Ara h 2 sIgE determined by singleplex versus multiplex measurements and to assess the diagnostic value of the different peanut components included in Immuno Solid-phase Allergen Chip (ISAC) multiplex analysis in children with a suspected peanut allergy. Methods In this retrospective study we analyzed Ara h 2 sIgE values with singleplex Fluorescence Enzyme Immunoassay (FEIA, ImmunoCap) and multiplex microarray (ISAC) measurements in 117 children with a suspected peanut allergy. Also, other peanut components measured by ISAC were analyzed. Double blinded placebo controlled oral food challenges were used as golden standard. Results Among all studied peanut components FEIA Ara h 2 sIgE showed the highest area under the curve (AUC, 0.922), followed by ISAC Ara h 6 and Ara h 2 sIgE with AUCs of respectively 0.906 and 0.902. Best cut off values to diagnose peanut allergy were 4.40 kU/l for FEIA Ara h 2 sIgE and, 7.43 ISU and 8.13 ISU for respectively Ara h 2 and Ara h 6 sIgE in ISAC microarray. Ara h 2 sIgE determined in FEIA and ISAC showed a good correlation (r = 0.88; p < 0.01). Conclusion Ara h 6 and Ara h 2 sIgE in multiplex ISAC are both good predictors of clinical peanut allergy in Dutch children, and their performance is comparable to the use of Ara h 2 in singleplex FEIA. The simultaneous measurement of different peanut components using ISAC is an advantage and clinically useful to detect peanut allergic children that are Ara h 2 negative but sensitized to other peanut proteins such as Ara h 6.
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Affiliation(s)
- H K Brand
- Department of Pediatric Pulmonology and Allergology, Emma Children's Hospital, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J A M Emons
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Section of Allergology and Clinical Immunology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - H de Groot
- Department of Allergology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - N J T Arends
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
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4
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Kaminskaite V, Mitchell-Riall H, Costelloe S, Ludman S. Pediatric blinded food challenges: Validating reduced salt and refined sugar recipes. Pediatr Allergy Immunol 2021; 32:1380-1384. [PMID: 33754395 DOI: 10.1111/pai.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/11/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Siân Ludman
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Lafón I, Lampérez M, Navarro M, Gastaminza G, Ferrer M, Tabar AI, Gómez S, Agüeros M, García BE, D'Amelio CM. Validation of novel recipes for masking peanuts in double-blind, placebo-controlled food challenges. Ann Allergy Asthma Immunol 2021; 127:575-578. [PMID: 34233225 DOI: 10.1016/j.anai.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double-blind, placebo-controlled oral food challenges are the gold standard in food allergy diagnosis. Nevertheless, proper masking of peanuts is particularly complex owing to their intense flavor and odor. Thus, it is important to use validated recipes to ensure their adequate masking during oral food challenges. OBJECTIVE To design and validate recipes containing masked peanuts for double-blind, placebo-controlled oral food challenges. METHODS Two types of products (cookies and a custard‑type dessert) containing the masked peanuts and other ingredients with low allergenic potential were designed and validated. For this purpose, of the 24 initial cookie recipes and 12 initial custard recipes developed, those that did not exhibit significant differences in their texture were selected for sensory validation. RESULTS Similarity triangle tests were performed using a panel of 36 selected tasters, enabling the validation of 1 pair of cookie recipes and 1 pair of custard-type dessert recipe, both with low allergenic potential and suitable for those with celiac disease and for vegans. CONCLUSION The validated recipes are of clinical and research interest because they allow to confirm a peanut allergy and detect a wide range of tolerated threshold doses, which makes it possible to provide specific indications for each patient.
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Affiliation(s)
- Iñaki Lafón
- Department of Agronomy, Biotechnology, and Food Science, Public University of Navarra, Pamplona, Navarra, Spain
| | - Marta Lampérez
- Department of Agronomy, Biotechnology, and Food Science, Public University of Navarra, Pamplona, Navarra, Spain
| | - Montserrat Navarro
- Department of Agronomy, Biotechnology, and Food Science, Public University of Navarra, Pamplona, Navarra, Spain
| | - Gabriel Gastaminza
- Department of Allergology, Clínica Universidad de Navarra, Pamplona, Spain; Spanish Research Network on Asthma, Adverse Drug Reactions, and Allergy (ARADyAL, Red Nacional de Asma, Reacciones Adversas a Fármacos y Alergia) of the Carlos III Health Institute of Madrid, Madrid, Spain
| | - Marta Ferrer
- Department of Allergology, Clínica Universidad de Navarra, Pamplona, Spain; Spanish Research Network on Asthma, Adverse Drug Reactions, and Allergy (ARADyAL, Red Nacional de Asma, Reacciones Adversas a Fármacos y Alergia) of the Carlos III Health Institute of Madrid, Madrid, Spain
| | - Ana I Tabar
- Spanish Research Network on Asthma, Adverse Drug Reactions, and Allergy (ARADyAL, Red Nacional de Asma, Reacciones Adversas a Fármacos y Alergia) of the Carlos III Health Institute of Madrid, Madrid, Spain; Allergology Service, Hospital Complex of Navarra, Navarra, Pamplona, Spain
| | - Sara Gómez
- InnoUp Farma S.L., Pamplona, Navarra, Spain
| | | | - Blanca E García
- Spanish Research Network on Asthma, Adverse Drug Reactions, and Allergy (ARADyAL, Red Nacional de Asma, Reacciones Adversas a Fármacos y Alergia) of the Carlos III Health Institute of Madrid, Madrid, Spain; Allergology Service, Hospital Complex of Navarra, Navarra, Pamplona, Spain
| | - Carmen M D'Amelio
- Department of Allergology, Clínica Universidad de Navarra, Pamplona, Spain; Spanish Research Network on Asthma, Adverse Drug Reactions, and Allergy (ARADyAL, Red Nacional de Asma, Reacciones Adversas a Fármacos y Alergia) of the Carlos III Health Institute of Madrid, Madrid, Spain.
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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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7
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Bird JA, Leonard S, Groetch M, Assa'ad A, Cianferoni A, Clark A, Crain M, Fausnight T, Fleischer D, Green T, Greenhawt M, Herbert L, Lanser BJ, Mikhail I, Mustafa S, Noone S, Parrish C, Varshney P, Vlieg-Boerstra B, Young MC, Sicherer S, Nowak-Wegrzyn A. Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:75-90.e17. [PMID: 31950914 DOI: 10.1016/j.jaip.2019.09.029] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
Abstract
Oral food challenges are an integral part of an allergist's practice and are used to evaluate the presence or absence of allergic reactivity to foods. A work group within the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was formed to update a previously published oral food challenge report. The intention of this document was to supplement the previous publication with additional focus on safety, treatment of IgE-mediated allergic reactions, guidance for challenges in infants and adults, psychosocial considerations for children and families participating in an oral food challenge, specific guidance for baked milk or baked egg challenges, masking agents and validated blinding recipes for common food allergens, and recommendations for conducting and interpreting challenges in patients with suspected food protein-induced enterocolitis syndrome. Tables and figures within the report and an extensive online appendix detail age-specific portion sizes, appropriate timing for antihistamine discontinuation, serum and skin test result interpretation, written consents, and instructional handouts that may be used in clinical practice.
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Affiliation(s)
- J Andrew Bird
- University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Stephanie Leonard
- University of California, San Diego, Calif; Rady Children's Hospital, San Diego, Calif
| | - Marion Groetch
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amal Assa'ad
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - David Fleischer
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Todd Green
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Matthew Greenhawt
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Linda Herbert
- Children's National Hospital, Washington, DC; GW School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | - Irene Mikhail
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shahzad Mustafa
- Rochester Regional Health, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sally Noone
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Pooja Varshney
- Dell Children's Medical Center, Austin, Texas; Dell Medical School at University of Texas Austin, Austin, Texas
| | - Berber Vlieg-Boerstra
- OLVG, Department of Pediatrics, Amsterdam, The Netherlands; Department of Nutrition & Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | - Scott Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Milk- and wheat protein drinks for double blind placebo controlled food challenge in adults: a simple tool for diagnosis. Clin Transl Allergy 2019; 9:46. [PMID: 31548879 PMCID: PMC6749670 DOI: 10.1186/s13601-019-0284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022] Open
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9
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Francavilla R, Cristofori F, Dellatte S, Indrio F. Response to Cabrera-Chávez et al. Am J Gastroenterol 2018; 113:1560-1561. [PMID: 30166631 DOI: 10.1038/s41395-018-0235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- R Francavilla
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - F Cristofori
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - S Dellatte
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
| | - F Indrio
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. Tandoi Group Factory, Corato, Italy
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Pettersson ME, Koppelman GH, Schins AMM, van Ginkel CD, Flokstra-de Blok BMJ, Kollen BJ, Dubois AEJ. Greater severity of peanut challenge reactions using a high-fat vs low-fat matrix vehicle. Clin Exp Allergy 2018; 48:1364-1367. [DOI: 10.1111/cea.13210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/11/2018] [Accepted: 05/10/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Maris E. Pettersson
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Afke M. M. Schins
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Cornella D. van Ginkel
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Bertine M. J. Flokstra-de Blok
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of General Practice; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Boudewijn J. Kollen
- Department of General Practice; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Anthony E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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11
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Pettersson ME, Koppelman GH, Flokstra-de Blok BMJ, Kollen BJ, Dubois AEJ. Prediction of the severity of allergic reactions to foods. Allergy 2018; 73:1532-1540. [PMID: 29380392 PMCID: PMC6033096 DOI: 10.1111/all.13423] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/14/2022]
Abstract
Background There is currently considerable uncertainty regarding what the predictors of the severity of diagnostic or accidental food allergic reactions are, and to what extent the severity of such reactions can be predicted. Objective To identify predictors for the severity of diagnostic and accidental food allergic reactions and to quantify their impact. Methods The study population consisted of children with a double‐blind, placebo‐controlled food challenge (DBPCFC)–confirmed food allergy to milk, egg, peanut, cashew nut, and/or hazelnut. The data were analyzed using multiple linear regression analysis. Missing values were imputed using multiple imputation techniques. Two scoring systems were used to determine the severity of the reactions. Results A total of 734 children were included. Independent predictors for the severity of the DBPCFC reaction were age (B = 0.04, P = .001), skin prick test ratio (B = 0.30, P < .001), eliciting dose (B = −0.09, P < .001), level of specific immunoglobulin E (B = 0.15, P < .001), reaction time during the DBPCFC (B = −0.01, P = .004), and severity of accidental reaction (B = 0.08, P = .015). The total explained variance of this model was 23.5%, and the eliciting dose only contributed 4.4% to the model. Independent predictors for more severe accidental reactions with an explained variance of 7.3% were age (B = 0.03, P = .014), milk as causative food (B = 0.77, P < .001), cashew as causative food (B = 0.54, P < .001), history of atopic dermatitis (B = −0.47, P = .006), and severity of DBPCFC reaction (B = 0.12, P = .003). Conclusions The severity of DBPCFCs and accidental reactions to food remains largely unpredictable. Clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk‐related management decisions.
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Affiliation(s)
- M. E. Pettersson
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - G. H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - B. M. J. Flokstra-de Blok
- GRIAC Research Institute; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
- Department of General Practice; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - B. J. Kollen
- Department of General Practice; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
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12
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Ginkel CD, Pettersson ME, Dubois AEJ, Koppelman GH. Association of STAT6 gene variants with food allergy diagnosed by double-blind placebo-controlled food challenges. Allergy 2018; 73:1337-1341. [PMID: 29457221 PMCID: PMC6032865 DOI: 10.1111/all.13432] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
This study describes the role of two STAT6 gene variants in food allergy using data of patients and their parents who underwent double‐blind placebo‐controlled food challenges (DBPCFCs). After quality control, 369 trios were analysed including 262 children (71.0%) with food allergy. Associations were tested by the Family based association test. The A alleles of both SNPs were associated with food allergy (P = .036 and P = .013 for rs324015 and rs1059513, respectively). Furthermore, these A alleles were associated with peanut allergy, higher sIgE levels to both peanut and cow's milk, more severe symptoms and higher eliciting doses during peanut and cow's milk DBPCFCs (all P < .05). In silico analysis indicates that the identified risk variants increase STAT6 expression which stimulates the differentiation of CD4 + T cells to the Th2 subset. In conclusion, STAT6 variants may be involved in the pathophysiology of food allergy and their role seems to be independent of the allergenic food.
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Affiliation(s)
- C. D. Ginkel
- University Medical Center Groningen Department of Paediatric Pulmonology and Paediatric Allergy GRIAC Research Institute University of Groningen Groningen The Netherlands
| | - M. E. Pettersson
- University Medical Center Groningen Department of Paediatric Pulmonology and Paediatric Allergy GRIAC Research Institute University of Groningen Groningen The Netherlands
| | - A. E. J. Dubois
- University Medical Center Groningen Department of Paediatric Pulmonology and Paediatric Allergy GRIAC Research Institute University of Groningen Groningen The Netherlands
| | - G. H. Koppelman
- University Medical Center Groningen Department of Paediatric Pulmonology and Paediatric Allergy GRIAC Research Institute University of Groningen Groningen The Netherlands
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13
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Retrospective observational cohort study regarding the effect of breastfeeding on challenge-proven food allergy. Eur J Clin Nutr 2018; 72:557-563. [PMID: 29459789 DOI: 10.1038/s41430-018-0117-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Human breast milk is generally regarded as the best nutrition for infants in their first months of life. Whether breastfeeding has a protective effect on food allergy is a point of debate and the subject of this study. SUBJECTS/METHODS This retrospective study was conducted in 649 children who underwent a double-blind placebo-controlled food challenge (DBPCFC) as part of routine care in a tertiary care clinic. Food allergy was defined as having at least one positive DBPCFC to any food. The association between both "any" breastfeeding (yes/no) and its duration in months with food allergy was studied by logistic regression analysis with correction for confounding variables. RESULTS The prevalence of food allergy was 58.9% (n = 382). Of all subjects, 75.8% (n = 492) was breastfed and 24.2% (n = 157) bottle-fed. There was no significant association between food allergy and breastfeeding versus bottle-feeding after correction for the confounding effect of increased breastfeeding by atopic parents and a history of asthma in the child (OR = 1.24, 95% CI = 0.85-1.79, p = 0.27). However, in breastfed children, every additional month of breastfeeding lowered the risk for food allergy by ~4% (OR = 0.96, 95% CI = 0.93-0.99, p = 0.02). No confounders were identified in this association. CONCLUSION These results show for the first time that in children investigated for possible food allergy, every additional month of breastfeeding is associated with a lower risk of developing clinical food allergy as diagnosed by DBPCFC. However, overall, there was no association between the prevalence of food allergy and breastfeeding versus bottle-feeding in this tertiary care population.
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14
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Pettersson ME, Koppelman GH, Flokstra-de Blok BMJ, van Ginkel CD, Roozendaal C, Muller-Kobold AC, Kollen BJ, Dubois AEJ. Apolipoprotein B: a possible new biomarker for anaphylaxis. Ann Allergy Asthma Immunol 2017; 118:515-516. [PMID: 28274733 DOI: 10.1016/j.anai.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/10/2017] [Accepted: 01/22/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Eleonore Pettersson
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bertine M J Flokstra-de Blok
- GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cornelia Doriene van Ginkel
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Caroline Roozendaal
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke C Muller-Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Boudewijn J Kollen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anthony E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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15
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Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber BK, Worm M, Werfel T, Jappe U, Biedermann T, Schmitt J, Brehler R, Kleinheinz A, Kleine-Tebbe J, Brüning H, Ruëff F, Ring J, Saloga J, Schäkel K, Holzhauser T, Vieths S, Simon JC. Standardization of double blind placebo controlled food challenge with soy within a multicentre trial. Clin Transl Allergy 2016; 6:39. [PMID: 27826414 PMCID: PMC5098282 DOI: 10.1186/s13601-016-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a standardized approach for identifying patients with birch related soy allergy by means of DBPCFC to soy, including determination of threshold levels, in a multicentre setting. Methods Microbiologically stable soy challenge meals were composed of protein isolate with consistent Gly m 4 levels. Patients sensitized to main birch allergen Bet v 1 and concomitant sensitization to its soy homologue Gly m 4 underwent DBPCFC. Outcome was defined according to presence and/or absence of ten objective signs and intensity of eight subjective symptoms as measured by visual analogue scale (VAS). Results 138 adult subjects (63.8% female, mean age 38 years) underwent DBPCFC. Challenge meals and defined evaluation criteria showed good applicability in all centres involved. 45.7% presented with objective signs and 65.2% with subjective symptoms at soy challenge. Placebo challenge meals elicited non-cardiovascular objective signs in 11.6%. In 82 (59.4%) subjects DBPCFC was judged as positive. 70.7% of DPBCFC+ showed objective signs and 85.4% subjective symptoms at soy challenge. Subjective symptoms to soy challenge meal in DBPCFC+ subjects started at significantly lower dose levels than objective signs (p < 0.001). Median cumulative eliciting doses for first objective signs in DBPCFC+ subjects were 4.7 g [0.7–24.7] and 0.7 g [0.2–4.7] total soy protein for first subjective symptoms (p = 0.01). Conclusions We present the hitherto largest group of adults with Bet v 1 and Gly m 4 sensitization being investigated by DBPCFC. In this type of food allergy evaluation of DBPCFC outcome should not only include monitoring of objective signs but also scoring of subjective symptoms. Our data may contribute to standardize DBPCFC in pollen-related food allergy in multicentre settings. Trial registration EudraCT: 2009-011737-27.
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Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
| | - A Franke
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - A Schmiedeknecht
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - B K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - M Worm
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Werfel
- Department of Dermatology and Allergology, MH Hannover, Hannover, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology Research Center Borstel, Airway Research Center North (ARCN), Borstel, Germany ; Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - T Biedermann
- Department of Dermatology, Universität Tübingen, Tübingen, Germany ; Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Schmitt
- Department of Dermatology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany ; Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Brehler
- Department of Dermatology, Universität Münster, Münster, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbekliniken Buxtehude, Buxtehude, Germany
| | | | - H Brüning
- Day Care Clinic for Allergy and Dermatology, Kiel, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - St Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
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16
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Saleh-Langenberg J, Flokstra-de Blok BMJ, AlAgla N, Kollen BJ, Dubois AEJ. Late reactions in food-allergic children and adolescents after double-blind, placebo-controlled food challenges. Allergy 2016; 71:1069-73. [PMID: 27121602 DOI: 10.1111/all.12923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
The time during which children are observed following a double-blind, placebo-controlled food challenge (DBPCFC) varies in clinical practice. There are little data on late reactions (LRs) following DBPCFCs. Therefore, we determined the prevalence, severity and clinical characteristics of late reactions in food-allergic children and adolescents after DBPCFC, and ascertained which factors are associated with, and may predict, LRs. Logistic regression analyses were performed to investigate which factors were associated with LRs and to develop the association and prediction models. A total of 1142 children underwent DBPCFCs (child-test combinations). Of these 1142 child-test combinations, 400 reported LRs following the DBPCFC. LRs in food-allergic children after DBPCFC are poorly predictable and are generally not severe. All LRs, including those on the placebo day, are more frequently reported in younger children. Children who do not experience severe immediate reactions may be safely discharged home 2 h after a DBPCFC.
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Affiliation(s)
- J. Saleh-Langenberg
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - B. M. J. Flokstra-de Blok
- GRIAC Research Institute; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- Department of General Practice; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - N. AlAgla
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - B. J. Kollen
- Department of General Practice; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- GRIAC Research Institute; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
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17
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van Veen LN, Heron M, Batstra M, van Haard PMM, de Groot H. The diagnostic value of component-resolved diagnostics in peanut allergy in children attending a Regional Paediatric Allergology Clinic. BMC Pediatr 2016; 16:74. [PMID: 27255511 PMCID: PMC4891901 DOI: 10.1186/s12887-016-0609-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/26/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To date, diagnosing food allergies in children still presents a diagnostic dilemma, leading to uncertainty concerning the definite diagnosis of peanut allergy, as well as to the need for strict diets and the potential need for adrenalin auto-injectors. This uncertainty in particular is thought to contribute to a lower quality of life. In the diagnostic process double-blind food challenges are considered the gold standard, but they are time-consuming as well as potentially hazardous. Other diagnostic tests have been extensively studied and among these component-resolved diagnostics appeared to present a promising alternative: Ara h2, a peanut storage protein in previous studies showed to have a significant predictive value. METHODS Sixty-two out of 72 children, with suspected peanut allergy were analyzed using serum specific IgE and/or skin prick tests and specific IgE to several components of peanut (Ara h 1, 2, 3, 6, 8, 9). Subsequently, double-blind food challenges were performed. The correlation between the various diagnostic tests and the overall outcome of the double-blind food challenges were studied, in particular the severity of the reaction and the eliciting dose. RESULTS The double-blind provocation with peanut was positive in 33 children (53 %). There was no relationship between the eliciting dose and the severity of the reaction. A statistically significant relationship was found between the skin prick test, specific IgE directed to peanut, Ara h 1, Ara h 2 or Ara h 6, and the outcome of the food challenge test, in terms of positive or negative (P < .001). However, we did not find any relationship between sensitisation to peanut extract or the different allergen components and the severity of the reaction or the eliciting dose. There was no correlation between IgE directed to Ara h 3, Ara h 8, Ara h 9 and the clinical outcome of the food challenge. CONCLUSIONS This study shows that component-resolved diagnostics is not superior to specific IgE to peanut extract or to skin prick testing. At present, it cannot replace double-blind placebo-controlled food challenges for determination of the eliciting dose or the severity of the peanut allergy in our patient group.
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Affiliation(s)
- Leonieke N van Veen
- Department of Paediatric Allergology, Reinier de Graaf Hospital, Delft, PO Box 5011, 2600, GA, The Netherlands.
| | - Michiel Heron
- Department of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Manou Batstra
- Medical Laboratories, Department of Immunology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Paul M M van Haard
- Medical Laboratories, Department of Clinical Chemistry, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Hans de Groot
- Department of Paediatric Allergology, Reinier de Graaf Hospital, Delft, PO Box 5011, 2600, GA, The Netherlands
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18
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Johnson PE, Sayers RL, Gethings LA, Balasundaram A, Marsh JT, Langridge JI, Mills ENC. Quantitative Proteomic Profiling of Peanut Allergens in Food Ingredients Used for Oral Food Challenges. Anal Chem 2016; 88:5689-95. [DOI: 10.1021/acs.analchem.5b04466] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Philip E. Johnson
- Manchester
Institute of Biotechnology, Institute of Inflammation and Repair,
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom M17DN
| | - Rebekah L. Sayers
- Manchester
Institute of Biotechnology, Institute of Inflammation and Repair,
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom M17DN
| | - Lee A. Gethings
- Waters
Corporation, Stamford Avenue, Altrincham
Road, Wilmslow, United Kingdom SK9 4AX
| | - Anuradha Balasundaram
- Manchester
Institute of Biotechnology, Institute of Inflammation and Repair,
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom M17DN
| | - Justin T. Marsh
- Manchester
Institute of Biotechnology, Institute of Inflammation and Repair,
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom M17DN
| | - James I. Langridge
- Waters
Corporation, Stamford Avenue, Altrincham
Road, Wilmslow, United Kingdom SK9 4AX
| | - E. N. Clare Mills
- Manchester
Institute of Biotechnology, Institute of Inflammation and Repair,
Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom M17DN
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19
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Schots M, de Mol AC, Vermeer HJ, Roosen YM, Vriesman AW. Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children? Diagnosis (Berl) 2016. [DOI: 10.1515/dx-2015-0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractSpecific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.Children (n=52) with peanut sensitization were retrospectively included. An oral food challenge (OFC) confirmed peanut allergy or tolerance, as primary outcome. Individual candidate predictors were identified by univariate regression analysis and used in a prediction model. Different cut-off values were obtained and receiver operating characteristic curves were plotted.Multivariate analyses resulted in Ara h 2 as best predictor, with a discriminative ability of 0.87 (95% confidence interval, 0.77–0.97). Sensitivity and specificity of 55% and 95%, respectively, were found for a sIgE to Ara h 2 cut-off value of 4.25 kU/L. The highest positive predictive value of 100% was reached at 5.61 kU/L. No absolute relation was found between the value of Ara h 2 and the severity of the reaction during OFC.This study developed a prediction model in which sIgE to Ara h 2 was the best predictor for peanut allergy in sensitized children in a general hospital. Therefore depending on the history and the Ara h 2 results, an OFC is not always needed to confirm the diagnosis.
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20
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Oral Food Challenges: The Design must Reflect the Clinical Question. Curr Allergy Asthma Rep 2015; 15:51. [PMID: 26183500 DOI: 10.1007/s11882-015-0549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Oral food challenges are the gold-standard diagnostic investigation for diagnosing food allergy. They allow a subject to consume an age-appropriate portion of allergenic food under surveillance to assess whether a reproducible immune-mediated adverse response is demonstrated. The specific design of food challenge must closely reflect the anticipated management step being considered. In clinical practice, food challenges are most commonly used to investigate the subject's status of allergy or tolerance to a food. However, other characteristics of food allergy are increasingly being investigated through recent studies. In particular, studies investigating food allergy prevention strategies, the impact of oral immunotherapy on subjects' threshold for allergic reactions and also their potential acquisition of long-term tolerance each utilize differing designs of oral food challenges to investigate their specific hypothesis. We examine how oral food challenges may be designed to assess specific characteristics of the food allergic response.
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21
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van Ginkel CD, Flokstra-de Blok BMJ, Kollen BJ, Kukler J, Koppelman GH, Dubois AEJ. Loss-of-function variants of the filaggrin gene are associated with clinical reactivity to foods. Allergy 2015; 70:461-4. [PMID: 25620092 DOI: 10.1111/all.12569] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2014] [Indexed: 12/01/2022]
Abstract
The aim of this study was to assess the genetic association of Filaggrin loss-of-function (FLG LOF) genetic variants with food allergy, and to investigate the added value of this test in diagnosing food allergy. Clinical reactivity to foods was diagnosed by the gold standard, the double-blind, placebo-controlled food challenge. Of 155 children, 33 (21.3%) children had at least one FLG LOF variant, and of these, 29 (87.9%) were clinically reactive to at least one food, compared to 73 of 122 children (59.8%) carrying wild-type alleles. The odds ratio for having at least one FLG LOF variant and clinical reactivity to at least one food was 4.9 (CI = 1.6-14.7, P = 0.005), corresponding to a relative risk of 1.5, compared to carriers of wild-type alleles. Prediction of food allergy improved when FLG LOF variants were included in the model. Therefore, genetic markers may be useful as an addition to clinical assessment in the diagnosis of food allergy.
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Affiliation(s)
- C. D. van Ginkel
- University of Groningen; University Medical Center Groningen; Department of Pediatric Pulmonology and Pediatric Allergology; Groningen The Netherlands
- University of Groningen; University Medical Center Groningen; GRIAC Research Institute; Groningen The Netherlands
| | - B. M. J. Flokstra-de Blok
- University of Groningen; University Medical Center Groningen; GRIAC Research Institute; Groningen The Netherlands
- University of Groningen; University Medical Center Groningen; Department of General Practice; Groningen the Netherlands
| | - B. J. Kollen
- University of Groningen; University Medical Center Groningen; Department of General Practice; Groningen the Netherlands
| | - J. Kukler
- University of Groningen; University Medical Center Groningen; Department of Pediatric Pulmonology and Pediatric Allergology; Groningen The Netherlands
| | - G. H. Koppelman
- University of Groningen; University Medical Center Groningen; Department of Pediatric Pulmonology and Pediatric Allergology; Groningen The Netherlands
- University of Groningen; University Medical Center Groningen; GRIAC Research Institute; Groningen The Netherlands
| | - A. E. J. Dubois
- University of Groningen; University Medical Center Groningen; Department of Pediatric Pulmonology and Pediatric Allergology; Groningen The Netherlands
- University of Groningen; University Medical Center Groningen; GRIAC Research Institute; Groningen The Netherlands
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Can children discriminate sugar-sweetened from non-nutritively sweetened beverages and how do they like them? PLoS One 2014; 9:e115113. [PMID: 25551758 PMCID: PMC4281215 DOI: 10.1371/journal.pone.0115113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background Replacement of sugar-sweetened by non-nutritively sweetened beverages or water may reduce excess weight gain in children. However, it is unclear whether children like non-nutritively sweetened beverages as much as sugar-sweetened beverages. We examined whether children could taste a difference between non-nutritively sweetened beverages and matching sugar-sweetened beverages, and which of the two types of beverage they liked best. Methods 89 children aged 5 to 12 tasted seven non-nutritively sweetened beverages and matching sugar-sweetened beverages, for a total of 14 beverages. We used Triangle tests to check their ability to discriminate between the matched versions, and a 5-point scale to measure how much the children liked each individual beverage. Results Overall, 24% of children appeared to be genuinely capable of distinguishing between non-nutritively sweetened and sugar-sweetened beverages. The mean ± SD score for how much the children liked the non-nutritively sweetened beverages was 3.39±0.7 and that for the sugar-sweetened beverages 3.39±0.6 (P = 0.9) on a scale running from 1 (disgusting) to 5 (delicious). The children preferred some beverages to others irrespective of whether they were sugar-sweetened or non-nutritively sweetened (P = 0.000). Children who correctly identified which of three drinks contained the same sweetener and which one was different also showed no preference for either type. Conclusion We found that about one in four children were able to discriminate between non-nutritively sweetened and sugar-sweetened beverages but children liked both varieties equally. Non-nutritively sweetened beverages may therefore be an acceptable alternative to sugar-sweetened beverages although water remains the healthiest beverage for children.
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Brand PLP, Landzaat-Berghuizen MA. Differences between observers in interpreting double-blind placebo-controlled food challenges: a randomized trial. Pediatr Allergy Immunol 2014; 25:755-9. [PMID: 25403147 DOI: 10.1111/pai.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Interpretation of double-blind placebo-controlled food challenges (DBPCFC) can be difficult, particularly with ambiguous subjective symptoms. Early opening of the challenge key (which day is verum and which placebo) may influence the clinician's interpretation of the DBPCFC result. METHODS Fifty-one clinicians reviewing results of 19 DBPCFCs with ambiguous clinical symptoms were randomized into a key first strategy (opening the DBPCFC key before reviewing the symptoms on both challenge days and deciding on the DBPCFC result) or a symptoms first strategy (reviewing symptoms and interpreting both test days as positive or negative before opening the key and deciding on the DBPCFC result). RESULTS The proportion of DBPCFCs considered inconclusive was comparable between the two strategy groups (p = 0.791). Participants in the symptoms first group were more likely to consider a DBPCFC as positive (in 14 tests, 73.7%) than subjects in the key first group (four tests, 21.1%). The number of positive tests was higher in the symptoms first group (median 50.0%, interquartile range [IQR] 23.1-76.9%) than in the key first groups (44.0%, IQR 12.0-68.0%, p = 0.031). This was independent of the participant's profession (pediatrician or other), age, gender, or years of experience (p > 0.3). CONCLUSIONS Clinicians differ in their interpretation of DBPCFC results when symptoms are ambiguous. Opening the key of a DBPCFC before reviewing and interpreting symptoms significantly reduces the likelihood of the challenge being interpreted as positive. Guidelines for performing DBPCFCs should standardize the moment of opening the challenge key.
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Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
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Oole-Groen C, Brand P. Double-blind food challenges in children in general paediatric practice: useful and safe, but not without pitfalls. Allergol Immunopathol (Madr) 2014; 42:269-74. [PMID: 23972404 DOI: 10.1016/j.aller.2013.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/06/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe results of double-blind placebo-controlled food challenges (DBPCFC) with cow's milk, hen's egg, soy, peanut and hazelnut in general paediatric practice. METHODS Food challenges were performed between January 2006 and June 2011, in children 0-18 years of age, on two half-day hospital admissions with a one-week interval. Tests were performed in a double-blind fashion following a standardised protocol with validated recipes. RESULTS Overall, 234 food challenges were performed in 209 children: 160 with cow's milk, 35 with peanut, 21 with hen's egg, 11 with hazelnuts, and 7 with soy. In two thirds of the cases, the DBPCFC was negative (cow's milk: 57.5%; peanut: 40.0%; hen's egg: 66.7%, hazelnut: 90.9%, soy: 100%). The only patient characteristic significantly associated with a positive DBPCFC was the presence of symptoms from three different organ systems (p=0.007). Serious systemic allergic reactions with wheeze or anaphylaxis occurred in only two children (0.9%). Symptoms were recorded on 29.3% of placebo days. In 30/137 children with a negative test (22%), symptoms returned when reintroducing the allergen into the diet, mostly (66.7%) transient. Of the 85 tests regarded as positive by the attending physician, 19 (22.4%) did not meet predefined criteria for a positive test. This was particularly common with non-specific symptoms. CONCLUSION A DBPCFC can be safely performed in a general hospital for a range of food allergens. The test result is negative in most cases except for peanut. Non-specific symptoms may hamper the interpretation of the DBPCFC, increasing the risk of a false-positive result.
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van Veen WJ, Dikkeschei LD, Roberts G, Brand PL. Predictive value of specific IgE for clinical peanut allergy in children: relationship with eczema, asthma, and setting (primary or secondary care). Clin Transl Allergy 2013; 3:34. [PMID: 24112405 PMCID: PMC3852137 DOI: 10.1186/2045-7022-3-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 10/01/2013] [Indexed: 02/03/2023] Open
Abstract
The usefulness of peanut specific IgE levels for diagnosing peanut allergy has not been studied in primary and secondary care where most cases of suspected peanut allergy are being evaluated. We aimed to determine the relationship between peanut-specific IgE levels and clinical peanut allergy in peanut-sensitized children and how this was influenced by eczema, asthma and clinical setting (primary or secondary care). We enrolled 280 children (0-18 years) who tested positive for peanut-specific IgE (> 0.35 kU/L) requested by primary and secondary physicians. We used predefined criteria to classify participants into three groups: peanut allergy, no peanut allergy, or possible peanut allergy, based on responses to a validated questionnaire, a detailed food history, and results of oral food challenges.Fifty-two participants (18.6%) were classified as peanut allergy, 190 (67.9%) as no peanut allergy, and 38 (13.6%) as possible peanut allergy. The association between peanut-specific IgE levels and peanut allergy was significant but weak (OR 1.46 for a 10.0 kU/L increase in peanut-specific IgE, 95% CI 1.28-1.67). Eczema was the strongest risk factor for peanut allergy (aOR 3.33, 95% CI 1.07-10.35), adjusted for demographic and clinical characteristics. Asthma was not significantly related to peanut allergy (aOR 1.93, 95% CI 0.90-4.13). Peanut allergy was less likely in primary than in secondary care participants (OR 0.46, 95% CI 0.25-0.86), at all levels of peanut-specific IgE.The relationship between peanut-specific IgE and peanut allergy in children is weak, is strongly dependent on eczema, and is weaker in primary compared to secondary care. This limits the usefulness of peanut-specific IgE levels in the diagnosis of peanut allergy in children.
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Affiliation(s)
- Wilma J van Veen
- Princess Amalia Children's Centre, Isala hospital, PO Box 10400, 8000 GK, Zwolle, the Netherlands.
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Libbers L, Flokstra - de Blok BMJ, Vlieg - Boerstra BJ, van der Heide S, van der Meulen GN, Kukler J, Kerkhof M, Dubois AEJ. No matrix effect in double-blind, placebo-controlled egg challenges in egg allergic children. Clin Exp Allergy 2013; 43:1067-70. [DOI: 10.1111/cea.12164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- L. Libbers
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
| | | | - B. J. Vlieg - Boerstra
- Emma Children's Hospital; Pediatric Respiratory Medicine and Allergy; Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | | | - G. N. van der Meulen
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
| | - J. Kukler
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
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Winberg A, Nordström L, Strinnholm Å, Nylander A, Jonsäll A, Rönmark E, West CE. New validated recipes for double-blind placebo-controlled low-dose food challenges. Pediatr Allergy Immunol 2013; 24:282-7. [PMID: 23590418 DOI: 10.1111/pai.12061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/27/2022]
Abstract
Double-blind placebo-controlled food challenges are considered the most reliable method to diagnose or rule out food allergy. Despite this, there are few validated challenge recipes available. The present study aimed to validate new recipes for low-dose double-blind placebo-controlled food challenges in school children, by investigating whether there were any sensory differences between the active materials containing cow's milk, hen's egg, soy, wheat or cod, and the placebo materials. The challenge materials contained the same hypoallergenic amino acid-based product, with or without added food allergens. The test panels consisted of 275 school children, aged 8-10 and 14-15 yr, respectively, from five Swedish schools. Each participant tested at least one recipe. Standardized blinded triangle tests were performed to investigate whether any sensory differences could be detected between the active and placebo materials. In our final recipes, no significant differences could be detected between the active and placebo materials for any challenge food (p > 0.05). These results remained after stratification for age and gender. The taste of challenge materials was acceptable, and no unfavourable side effects related to test materials were observed. In summary, these new validated recipes for low-dose double-blinded food challenges contain common allergenic foods in childhood; cow's milk, hen's egg, soy, wheat and cod. All test materials contain the same liquid vehicle, which facilitates preparation and dosing. Our validated recipes increase the range of available recipes, and as they are easily prepared and dosed, they may facilitate the use of double-blind placebo-controlled food challenges in daily clinical practice.
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Affiliation(s)
- Anna Winberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Nwaru BI, Panesar SS, Hickstein L, Rader T, Werfel T, Muraro A, Hoffmann-Sommergruber K, Roberts G, Sheikh A. The epidemiology of food allergy in Europe: protocol for a systematic review. Clin Transl Allergy 2013; 3:13. [PMID: 23547766 PMCID: PMC3762068 DOI: 10.1186/2045-7022-3-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/23/2013] [Indexed: 11/18/2022] Open
Abstract
Background The European Academy of Allergy and Clinical Immunology is in the process of
developing its Guideline for Food Allergy and Anaphylaxis, and this protocol
of a systematic review is one of seven inter-linked evidence syntheses that
are being undertaken in order to provide a state-of-the-art synopsis of the
current evidence base in relation to epidemiology, prevention, diagnosis and
clinical management and impact on quality of life, which will be used to
inform the formulation of clinical recommendations. The aims of the systematic review will be to understand and describe the
epidemiology of food allergy, i.e. frequency, risk factors and outcomes of
patients suffering from food allergy, and to describe how these
characteristics vary by person, place and time. Methods A highly sensitive search strategy has been developed to retrieve articles
that have investigated the various aspects of the epidemiology of food
allergy. The search will be implemented by combining the concepts of food
allergy and its epidemiology from electronic bibliographic databases. Discussion This systematic review will provide the most up to date estimates of the
frequency of food allergy in Europe. We will attempt to break these down by
age and geographical region in Europe. Our analysis will take into account
the suitability of the study design and the respective study biases that
could affect exposure and outcome. We will examine the different methods to
diagnose food allergy and the associated measures of occurrence.
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Affiliation(s)
- Bright I Nwaru
- University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol 2013. [PMID: 23195525 DOI: 10.1016/j.jaci.2012.10.017] [Citation(s) in RCA: 488] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dambacher WM, de Kort EHM, Blom WM, Houben GF, de Vries E. Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses. Nutr J 2013; 12:22. [PMID: 23394146 PMCID: PMC3599188 DOI: 10.1186/1475-2891-12-22] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/09/2013] [Indexed: 12/05/2022] Open
Abstract
Background Children with cow’s milk allergy (CMA) need a cow’s milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. Methods All children with suspected CMA under our care (Oct’05 - Jun’09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the ‘lowest observed adverse effect level’ (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. Results 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Conclusions Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.
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Affiliation(s)
- Wendy M Dambacher
- Department Pediatrics, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, `s-Hertogenbosch, The Netherlands
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Blom WM, Vlieg-Boerstra BJ, Kruizinga AG, van der Heide S, Houben GF, Dubois AE. Threshold dose distributions for 5 major allergenic foods in children. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.10.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paşaoğlu G, Mungan D, Misirligil Z. Allergy to hazelnut in adults: a two-step study. Allergol Immunopathol (Madr) 2012; 40:288-94. [PMID: 21862196 DOI: 10.1016/j.aller.2011.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 04/19/2011] [Accepted: 05/02/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although hazelnut consumption is very high in Turkey, the prevalence of hazelnut allergy is still unknown. This study's objective was to investigate the prevalence of hazelnut sensitisation and to verify its clinical importance using double-blind, placebo-controlled challenge (DBPCFC) in an adult population. METHODS Prick-to-prick skin tests were performed with fresh hazelnut in 904 patients admitted to the allergy department. Among the 904 subjects, 20 patients with a history of allergic reactions to hazelnut and/or positive skin tests were recalled for further evaluation. Specific IgE was measured in these subjects. Eleven (11/20) patients accepted to undergo DBPCFC with hazelnut. RESULTS Among the 904 individuals, the history of reactions to hazelnut was positive in 16 subjects (1.8%); prick-to-prick skin tests were positive in 13 (1.4%); prick tests with the commercial product were positive in nine (0.9%); and history plus skin tests were positive in 16 (1.8%). Specific IgE to hazelnut was positive in only three patients. DBPCFC was conducted in 11 subjects with a positivity rate of 63.6% (7/11). We observed six mild and one moderate systemic reactions during the DBPCFC. Among seven subjects with a positive DBPCFC, six (85.7%) had a history of hazelnut allergy, and five (71.4%) had both history and skin test positivity. CONCLUSION Skin test sensitisation to hazelnut was found to be 1.76% (16/904) which is similar to the sensitisation rate in previous reports. However, DBPCFC was positive in 63% of cases with a history of hazelnut allergy and/or positive skin tests in this study. These results indicate that the presence of history with a positive skin test can be suggestive of hazelnut allergy; however an oral food challenge is needed to confirm the diagnosis.
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Affiliation(s)
- G Paşaoğlu
- Ankara University, School of Medicine, Department of Allergy, Ankara, Turkey.
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Järvinen KM, Sicherer SH. Diagnostic oral food challenges: Procedures and biomarkers. J Immunol Methods 2012; 383:30-8. [DOI: 10.1016/j.jim.2012.02.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 02/15/2012] [Accepted: 02/29/2012] [Indexed: 12/30/2022]
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Abolhassani H, Aghamohammadi A, Imanzadeh A, Mohammadinejad P, Sadeghi B, Rezaei N. Malignancy phenotype in common variable immunodeficiency. J Investig Allergol Clin Immunol 2012; 158:77-83. [PMID: 22533236 DOI: 10.1159/000330645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 06/22/2011] [Indexed: 01/15/2023] Open
Affiliation(s)
- H Abolhassani
- Research Centerfor Immunodeficiencies, Children's Medical Center Tehran University of Medical Sciences, Tehran, Iran
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Cochrane SA, Salt LJ, Wantling E, Rogers A, Coutts J, Ballmer-Weber BK, Fritsche P, Fernández-Rivas M, Reig I, Knulst A, Le TM, Asero R, Beyer K, Golding M, Crevel R, Clare Mills EN, Mackie AR. Development of a standardized low-dose double-blind placebo-controlled challenge vehicle for the EuroPrevall project. Allergy 2012; 67:107-13. [PMID: 22092081 DOI: 10.1111/j.1398-9995.2011.02715.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing food allergy. Standardized materials and protocols are essential for comparing DBPCFC results for multicentre studies such as EuroPrevall. This required the development and piloting of a standardized vehicle and low-dose protocol for confirming food allergy and determination of minimum eliciting doses (MEDs). METHODS A low-dose DBPCFC protocol was developed, with eight titrated protein doses from 3 μg to 1 g. This was delivered using a simple, microbiologically stable food base incorporating allergenic food ingredients manufactured at three sites and centrally distributed to clinical centres. Allergen blinding was assessed by a professional sensory testing panel using a triangle test. Homogeneity and allergen content were confirmed by ELISA and clinical efficacy was assessed in a pilot study, using celeriac and hazelnut as exemplars. RESULTS Celeriac and hazelnut ingredients were sufficiently blinded in the dessert. The dessert meals were successfully piloted with hazelnut in allergy clinics in Spain, the Netherlands and Italy and with celeriac and hazelnut in Zurich. The challenges elicited a range of subjective and objective reactions ranging in severity from mild itching of the oral mucosa to bronchospasm. CONCLUSIONS A standardized challenge vehicle proven to sufficiently blind processed, powdered hazelnut and celeriac ingredients and that can be reproducibly manufactured has been developed. This pilot study shows that the vehicle is promising for the confirmation of food allergy and determination of MEDs in adults and children with body weight >28.8 kg (approximately 7-11 years old).
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Affiliation(s)
- S A Cochrane
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Sharnbrook, Bedfordshire, UK.
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Vissers YM, Wichers HJ, Savelkoul HFJ. Influence of Food Processing, Digestion and the Food Matrix on Allergenicity & Cellular Measures of Allergenicity. MULTIDISCIPLINARY APPROACHES TO ALLERGIES 2012. [DOI: 10.1007/978-3-642-31609-8_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mendonça RB, Cocco RR, Sarni ROS, Solé D. Teste de provocação oral aberto na confirmação de alergia ao leite de vaca mediada por IgE: qual seu valor na prática clínica? REVISTA PAULISTA DE PEDIATRIA 2011. [DOI: 10.1590/s0103-05822011000300017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Revisar os principais protocolos de padronização para o teste de provocação oral aberto aplicado a crianças com suspeita de alergia ao leite de vaca mediada por imunoglobulina E. FONTES DE DADOS: Foram selecionados artigos publicados, nos últimos dez anos, nas bases de dados Medline, Lilacs e SciELO, utilizando-se os descritores de assunto: "hipersensibilidade alimentar", "leite de vaca", "alergia ao leite de vaca", "teste de provocação oral", "crianças" e "diagnóstico". SÍNTESE DOS DADOS: O teste de provocação oral é o método mais fidedigno para estabelecer ou excluir o diagnóstico de alergia alimentar e sua forma aberta pode ser a primeira opção, quando apenas reações objetivas são esperadas. O local para realizar o teste deve possuir todos os recursos para tratamento de emergência. Como preparo, o paciente deve seguir dieta de exclusão do alimento suspeito e descontinuar o uso de medicamentos que possam interferir no resultado do teste. Habitualmente, utilizam-se 8 a 10g de leite em pó ou 100mL de leite fluido, oferecidos em volumes progressivos, a intervalos de dez a 60 minutos. Apesar da rigidez do método, ainda existem situações em que há dificuldade de interpretação dos resultados; por isso, médicos bem treinados devem aplicar o teste, sendo cautelosos ao julgarem as reações. CONCLUSÕES: Mesmo considerando as limitações que dificultam a aplicação do teste de provocação oral na prática clínica, a implementação do teste nos serviços de saúde poderia reduzir diagnósticos falsos-positivos de alergias.
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The eliciting dose of peanut in double-blind, placebo-controlled food challenges decreases with increasing age and specific IgE level in children and young adults. J Allergy Clin Immunol 2011; 128:1031-6. [PMID: 21885095 DOI: 10.1016/j.jaci.2011.07.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 06/27/2011] [Accepted: 07/05/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several risk factors for severe anaphylactic reactions to food in daily life are known. However, to date, it is not possible to predict the severity of allergic reactions to food in the individual patient with accuracy. Some studies show that a history of severe reactions is associated with a lower eliciting dose in double-blind, placebo-controlled food challenges (DBPCFCs). Therefore, in this study, the eliciting dose was used as a measure of clinical sensitivity. OBJECTIVES To study whether risk factors for severe allergic reactions to food in daily life such as age, degree of sensitization, and coexistent atopic disease influence the eliciting dose in DBPCFCs in children allergic to peanut. METHODS Data from children who had clinical reactions to peanut during DBPCFCs at the University Medical Center Groningen (2001-2009) were analyzed. A Cox regression model was used to analyze the association of the determinants with the eliciting dose. RESULTS One hundred twenty-six positive DBPCFCs with peanut were analyzed. Age older than 10 years, a specific IgE level above the lowest tertile (≥ 5.6 kU/L), and the absence of atopic dermatitis were associated with reactions to lower doses: respective hazard ratios 1.89 (95% CI, 1.28-2.81; P = .001), 2.03 (95% CI, 1.37-3.00; P < .0001), and 0.45 (95% CI, 0.29-0.71; P = .001) present versus absent. No significant associations with the eliciting dose were found for sex, the presence of asthma and rhinitis, and the severity of food reactions by history. CONCLUSIONS Using the eliciting dose as a measure of clinical sensitivity, greater clinical sensitivity in DBPCFCs to peanut was found to be associated with increasing age, higher specific IgE level, and the absence of atopic dermatitis. This finding may explain why adolescents experience severe allergic reactions in daily life to peanut more often than do younger children.
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van Bilsen J, Ronsmans S, Crevel R, Rona R, Przyrembel H, Penninks A, Contor L, Houben G. Evaluation of scientific criteria for identifying allergenic foods of public health importance. Regul Toxicol Pharmacol 2011; 60:281-9. [DOI: 10.1016/j.yrtph.2010.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/23/2010] [Accepted: 08/31/2010] [Indexed: 10/19/2022]
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Vlieg-Boerstra BJ, Herpertz I, Pasker L, van der Heide S, Kukler J, Jansink C, Vaessen W, Beusekamp BJ, Dubois AEJ. Validation of novel recipes for double-blind, placebo-controlled food challenges in children and adults. Allergy 2011; 66:948-54. [PMID: 21255039 DOI: 10.1111/j.1398-9995.2010.02539.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In double-blind, placebo-controlled food challenges (DBPCFCs), the use of challenge materials in which blinding is validated is a prerequisite for obtaining true blinded conditions during the test procedure. Therefore, the aim of this study was to enlarge the available range of validated recipes for DBPCFCs to facilitate oral challenge tests in all age groups, including young children, while maximizing the top dose in an acceptable volume. METHODS Recipes were developed and subsequently validated by a panel recruited by a matching sensory test. The best 30% of candidates were selected to participate in sensory testing using the paired comparison test. RESULTS For young children, three recipes with cow's milk and one recipe with peanut could be validated which may be utilized in DBPCFCs. For children older than 4 years and adults, one recipe with egg, two with peanut, one with hazelnut, and one with cashew nut were validated for use in DBPCFCs. CONCLUSIONS All recipes contained larger amounts of allergenic foods than previously validated. These recipes increase the range of validated recipes for use in DBPCFCs in adults and children.
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Affiliation(s)
- B J Vlieg-Boerstra
- Department Paediatric Pulmonology and Allergy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Vassilopoulou E, Douladiris N, Sakellariou A, Cortes SV, Sinaniotis A, Rivas MF, Papadopoulos NG. Evaluation and standardisation of different matrices used for double-blind placebo-controlled food challenges to fish. J Hum Nutr Diet 2010; 23:544-9. [DOI: 10.1111/j.1365-277x.2010.01046.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications. Curr Opin Allergy Clin Immunol 2010; 9:379-85. [PMID: 19483616 DOI: 10.1097/aci.0b013e32832d9049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The double-blind, placebo-controlled food challenge (DBPCFC) is widely considered as the 'gold standard' for the diagnosis of food allergy. However, in adult patients, this procedure is rather rarely performed outside the academic context. This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice. RECENT FINDINGS There are many data showing that the DBPCFC poses a number of critical problems that are difficult to overcome in normal outpatient clinics and hospitals, and that are generally not addressed in most articles dealing with this issue. SUMMARY Performing DBPCFC poses a number of practical problems and has several pitfalls, which make its routine use in normal clinical settings generally impossible. This review article shows that the need for this procedure in adult patients seems in effect very little and specifies new, more limited indications to its use in everyday practice. Further, it suggests a role for the open challenge, which lacks several of the disadvantages of DBPCFC.
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Kneepkens CMF, Meijer Y. Clinical practice. Diagnosis and treatment of cow's milk allergy. Eur J Pediatr 2009; 168:891-6. [PMID: 19271238 PMCID: PMC2694929 DOI: 10.1007/s00431-009-0955-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/18/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cow's milk allergy (CMA) is thought to affect 2-3% of infants. The signs and symptoms are nonspecific and may be difficult to objectify, and as the diagnosis requires cow's milk elimination followed by challenge, often, children are considered cow's milk allergic without proven diagnosis. DIAGNOSIS Because of the consequences, a correct diagnosis of CMA is pivotal. Open challenges tend to overestimate the number of children with CMA. The only reliable way to diagnose CMA is by double-blind, placebo-controlled challenge (DBPCFC). THERAPY At present, the only proven treatment consists of elimination of cow's milk protein from the child's diet and the introduction of formulas based on extensively hydrolysed whey protein or casein; amino acid-based formula is rarely indicated. The majority of children will regain tolerance to cow's milk within the first 5 years of life. CONCLUSIONS Open challenges can be used to reject CMA, but for adequate diagnosis, DBPCFC is mandatory. In most children, CMA can be adequately treated with extensively hydrolysed whey protein or casein formulas.
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Affiliation(s)
- C. M. Frank Kneepkens
- Department of Paediatrics, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Yolanda Meijer
- Centre for Paediatric Allergology, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
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Ballmer-Weber B, Fernández-Rivas M. Food allergy: A clinician’s criteria for including sera in a serum bank. Food Chem Toxicol 2008; 46 Suppl 10:S2-5. [DOI: 10.1016/j.fct.2008.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Crevel RWR, Ballmer-Weber BK, Holzhauser T, Hourihane JO, Knulst AC, Mackie AR, Timmermans F, Taylor SL. Thresholds for food allergens and their value to different stakeholders. Allergy 2008; 63:597-609. [PMID: 18394134 DOI: 10.1111/j.1398-9995.2008.01636.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thresholds constitute a critical piece of information in assessing the risk from allergenic foods at both the individual and population levels. Knowledge of the minimum dose that can elicit a reaction is of great interest to all food allergy stakeholders. For allergic individuals and health professionals, individual threshold data can inform allergy management. Population thresholds can help both the food industry and regulatory authorities assess the public health risk and design appropriate food safety objectives to guide risk management. Considerable experience has been gained with the double-blind placebo-controlled food challenge (DBPCFC), but only recently has the technique been adapted to provide data on thresholds. Available data thus vary greatly in quality, with relatively few studies providing the best quality individual data, using the low-dose DBPCFC. Such high quality individual data also form the foundation for population thresholds, but these also require, in addition to an adequate sample size, a good characterization of the tested population in relation to the whole allergic population. Determination of thresholds at both an individual level and at a population level is influenced by many factors. This review describes a low-dose challenge protocol developed as part of the European Community-funded Integrated Project Europrevall, and strongly recommends its wider use so that data are generated that can readily increase the power of existing studies.
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Affiliation(s)
- R W R Crevel
- Safety & Environmental Assurance Centre, Unilever, Colworth Science Park, Bedford, UK
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46
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Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Gant C, Higgins B, Dean T. Comparison of open and double-blind placebo-controlled food challenges in diagnosis of food hypersensitivity amongst children. J Hum Nutr Diet 2008; 20:565-79. [PMID: 18001378 DOI: 10.1111/j.1365-277x.2007.00828.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Correct diagnosis of food hypersensitivity (FHS) is important to ensure appropriate patient care and to accurately establish the population prevalence and incidence. Food challenges play a very important role in the diagnosis of FHS, but it is unclear when open food challenges (OFCs) opposed to double-blind placebo-controlled food challenges (DBPCFCs) should be used. This study investigated the use of OFCs and DBPCFCs when diagnosing FHS. METHODS Children with a reported history of FHS or with sensitization to a food without known previous consumption were invited to undergo food challenges. Children of consenting parents underwent an OFC and those with a positive OFC were approached to undergo a DBPCFC. Food challenges were either performed as 1-day or 1-week challenges depending on sensitization status and clinical history. RESULTS Forty-one children underwent both OFCs and DBPCFCs. The positive predictive values for 1-day and 1-week OFCs were 73% (8/11; 95% CI: 39-94%) and 57% (20/35; 95% CI: 39-74%) respectively. There was no evidence to indicate that the younger children were more likely to have a positive OFC confirmed by a DBPCFC compared to older children (Fisher's exact P = 0.53). In the 1-day challenges parents indicated a preference for OFC rather than DBPCFC. By contrast, in the 1-week challenge parents indicated a preference for DBPCFC (P = 0.0192). CONCLUSION Open food challenge may be suitable for diagnosing immediate objective symptoms, whereas DBPCFC may be needed for the diagnosis of delayed and mainly subjective symptoms, irrespective of the child's age.
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Affiliation(s)
- C Venter
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
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Brand PLP, Vlieg-Boerstra BJ, Dubois AEJ. Dietary prevention of allergic disease in children: are current recommendations really based on good evidence? Pediatr Allergy Immunol 2007; 18:475-9. [PMID: 17561932 DOI: 10.1111/j.1399-3038.2007.00541.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to 'high risk' families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted.
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Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
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Vlieg-Boerstra BJ, van der Heide S, Bijleveld CMA, Kukler J, Duiverman EJ, Dubois AEJ. Placebo reactions in double-blind, placebo-controlled food challenges in children. Allergy 2007; 62:905-12. [PMID: 17620068 DOI: 10.1111/j.1398-9995.2007.01430.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A cardinal feature of the double-blind, placebo-controlled food challenge (DBPCFC) is that placebo administration is included as a control. To date, the occurrence and diagnostic significance of placebo events have not extensively been documented. OBJECTIVE To analyse the occurrence and features of placebo events in DBPCFCs and to assess their contribution to the diagnostic accuracy of the DBPCFC in children. METHODS The study population consisted of 132 challenges in 105 sensitized children (age range 0.7-16.6 years, median 5.3 years), who underwent DBPCFCs with cow's milk, egg, peanut, hazelnut and soy. Placebo and active food challenges were performed on different days. RESULTS A total number of 17 (12.9%) positive placebo events occurred, which could be classified as immediate (9/17), late-onset (8/17), objective (11/17) or subjective (6/17). Four of 74 (5.4%) positive active food challenges were revealed to be false positive by administration of a placebo challenge. This is 3% (4/132) of all challenges. When computed by a statistical model, the false positive rate was 0.129 (12.9% of all challenges). CONCLUSION Placebo events with diverse clinical characteristics occur in DBPCFCs in a significant number of children. The diagnostic significance of the administration of a placebo challenge is first, to identify false positive diagnoses in DBPCFCs by refuting false positive tests in individual patients. Secondly, to allow for blinding of the active food challenge. Thirdly, applying a statistical model demonstrates that some positive challenges may be false positive and that the test may need to be repeated in selected cases.
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Affiliation(s)
- B J Vlieg-Boerstra
- Division of Paediatric Pulmonology and Paediatric Allergy, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, McBride D, Madsen C. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 2007; 120:638-46. [PMID: 17628647 DOI: 10.1016/j.jaci.2007.05.026] [Citation(s) in RCA: 811] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 05/16/2007] [Accepted: 05/17/2007] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is uncertainty about the prevalence of food allergy in communities. OBJECTIVE To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. METHODS The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish, and an overall estimate of food allergy. We summarized the information in 5 categories: self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies. We systematically searched MEDLINE and EMBASE for publications since 1990. The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. RESULTS A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared with objective measures. There was marked heterogeneity between studies regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. CONCLUSION There is a marked heterogeneity in the prevalence of food allergy that could be a result of differences in study design or methodology, or differences between populations. CLINICAL IMPLICATIONS We recommend that measurements be made by using standardized methods, if possible food challenge. We need to be cautious in estimates of prevalence based only on self-reported food allergy.
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Affiliation(s)
- Roberto J Rona
- Division of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom
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