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de Weger WW, Jansen D, van Lente L, van der Meulen GN, Kamps AWA. Eliciting and stop dose during oral food challenges for peanut and common tree nuts in different age groups. Immun Inflamm Dis 2024; 12:e1152. [PMID: 38270304 PMCID: PMC10797649 DOI: 10.1002/iid3.1152] [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] [Received: 08/29/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Oral food challenges (OFCs) are used to confirm or reject a diagnosis of food allergy. However, younger children may encounter difficulties in consuming all offered doses during an OFC in the absence of symptoms, resulting in inconclusive outcomes. Our aim is to assess the eliciting dose for objective symptoms among various age groups and determine the necessity of consuming the final dose step during an uneventful OFC to avoid false negative outcomes. METHODS OFCs for common food allergens performed between 2012 and 2019 were analyzed retrospectively. The primary outcome was the association of age with stop dose for OFCs with inconclusive outcome. Secondary outcome measures were the association of age with eliciting dose and the potential number of false negative outcomes. RESULTS A total of 1327 OFCs were performed in 707 patients. Of these, 514 (38.7%) were positive, 589 (44.4%) negative, and 224 (16.9%) inconclusive. In OFCs with inconclusive outcome, age appeared to be a significant predictor of the stop dose only for almond (p = .005). Objective symptoms occurred after the last dose step in 2%-13% of all OFCs with positive outcome. In our cohort, potential false negative outcomes may have been drawn in 27.6% of uneventful OFCs. CONCLUSIONS Two third of children under 6 years of age successfully consumed all the provided doses during OFCs with a negative outcome. The eliciting dose for objective symptoms was not associated with age, and in a substantial number of OFCs with positive outcome, symptoms occurred after eating the final dose. These findings suggest that in case of an uneventful OFC, the outcome should be drawn only after a cumulative dose of 4.4 g has been consumed to avoid the risk of a potential false negative outcome.
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Affiliation(s)
| | - Diede Jansen
- Department of PaediatricsMartini HospitalGroningenThe Netherlands
| | - Lidy van Lente
- Department of EpidemiologyMartini HospitalGroningenThe Netherlands
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2
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Nachshon L, Westerhout J, Blom WM, Remington B, Levy MB, Goldberg MR, Epstein-Rigbi N, Katz Y, Elizur A. Sesame eliciting and safe doses in a large sesame allergic population. Allergy 2023; 78:3212-3220. [PMID: 37606275 DOI: 10.1111/all.15863] [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] [Received: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited. METHODS All sesame oral food challenges (OFCs), performed either for diagnosis or for threshold identification before the beginning of sesame oral immunotherapy (OIT) between November 2011 and July 2021 in Shamir medical center were analyzed for reaction threshold distribution. Safe-dose challenges with 90-120 min intervals were also analyzed. RESULTS Two hundred and fifty patients underwent 338 positive OFCs, and additional 158 safe-dose OFCs were performed. The discrete and cumulative protein amounts estimated to elicit an objective reaction in 1% (ED01) of the entire cohort (n = 250) were 0.8 mg (range 0.3-6.3) and 0.7 mg (range 0.1-7.1), respectively, and those for 5% of the population (ED05) were 3.4 mg (range 1.2-20.6) and 4.5 mg (range 1.2-28.8), respectively. Safe-dose OFCs showed similar values of ED01 (0.8, 0.4-7.5 mg) and ED05 (3.4, 1.2-22.9 mg). While doses of ≤1 mg sesame protein elicited oral pruritus in 11.6% of the patients, no objective reaction was documented to this amount in any of the challenges, including safe-dose OFCs. CONCLUSIONS This study provides data on sesame reaction threshold distribution in the largest population of allergic patients studied, with no right or left censored data, and with validation using a safe-dose OFC. It further supports the current methods for ED determination as appropriate for establishing safety precautions for the food industry.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joost Westerhout
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - W Marty Blom
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Benjamin Remington
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Jessen FB, Mortz CG, Eller E, Gudichsen JH, Baekdal EA, Bindslev-Jensen C. A comparison of double-blind, placebo-controlled food challenge and open food challenge. Allergy 2023; 78:3204-3211. [PMID: 37539617 DOI: 10.1111/all.15834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Double-blind, placebo-controlled food challenge (DBPCFC) remains the gold standard for diagnosing food allergy, despite sparse comparisons to open food challenges (OpenFCs). The objective of this retrospective study was to compare severity of symptoms and threshold values (cumulative dose of food allergen eliciting a clinical reaction) in children and adults with peanut allergy, challenged in an open and/or double-blind, placebo-controlled protocol. METHODS This study included patients from the Allergy Centre, Odense University Hospital with a positive oral food challenge, defined as strict objective signs, with peanut during the period 2001-2022. Severity of symptoms was graded using the Sampson's severity score. Distribution models of threshold values were calculated using log-normal interval-censored survival analysis, and the number of placebo reactions was evaluated. RESULTS In total, 318 positive OpenFCs and 86 DBPCFCs were included. There was no difference in severity of symptoms nor threshold values comparing the two challenge types, neither when stratified for age groups. However, a higher proportion of children experienced Grade 3 symptoms in the double-blind group. Only one patient had a positive reaction to a placebo challenge. CONCLUSION Our findings do not advocate for DBPCFC being superior to OpenFC, if the latter is performed with strict objective stop criteria by trained staff.
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Affiliation(s)
- Frederik Bloch Jessen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Julie H Gudichsen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Emil A Baekdal
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
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Krutz NL, Kimber I, Winget J, Nguyen MN, Limviphuvadh V, Maurer-Stroh S, Mahony C, Gerberick GF. Application of AllerCatPro 2.0 for protein safety assessments of consumer products. FRONTIERS IN ALLERGY 2023; 4:1209495. [PMID: 37497076 PMCID: PMC10367106 DOI: 10.3389/falgy.2023.1209495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
Foreign proteins are potentially immunogenic, and a proportion of these are able to induce immune responses that result in allergic sensitization. Subsequent exposure of sensitized subjects to the inducing protein can provoke a variety of allergic reactions that may be severe, or even fatal. It has therefore been recognized for some time that it is important to determine a priori whether a given protein has the potential to induce allergic responses in exposed subjects. For example, the need to assess whether transgene products expressed in genetically engineered crop plants have allergenic properties. This is not necessarily a straightforward exercise (as discussed elsewhere in this edition), but the task becomes even more challenging when there is a need to conduct an overall allergenicity safety assessment of complex mixtures of proteins in botanicals or other natural sources that are to be used in consumer products. This paper describes a new paradigm for the allergenicity safety assessment of proteins that is based on the use of AllerCatPro 2.0, a new version of a previously described web application model developed for the characterization of the allergenic potential of proteins. Operational aspects of AllerCatPro 2.0 are described with emphasis on the application of new features that provide improvements in the predictions of allergenic properties such as the identification of proteins with high allergenic concern. Furthermore, the paper provides a description of strategies of how AllerCatPro 2.0 can best be deployed as a screening tool for identifying suitable proteins as ingredients in consumer products as well as a tool, in conjunction with label-free proteomic analysis, for identifying and semiquantifying protein allergens in complex materials. Lastly, the paper discusses the steps that are recommended for formal allergenicity safety assessment of novel consumer products which contain proteins, including consideration and integration of predicted consumer exposure metrics. The article therefore provides a holistic perspective of the processes through which effective protein safety assessments can be made of potential allergenic hazards and risks associated with exposure to proteins in consumer products, with a particular focus on the use of AllerCatPro 2.0 for this purpose.
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Affiliation(s)
- Nora L. Krutz
- NV Procter & Gamble Services Company SA, Global Product Stewardship, Strombeek-Bever, Belgium
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jason Winget
- The Procter & Gamble Company, Mason, OH, United States
| | - Minh N. Nguyen
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- IFCS Programme, Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Vachiranee Limviphuvadh
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- IFCS Programme, Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- IFCS Programme, Singapore Institute for Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- YLL School of Medicine and Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Catherine Mahony
- Procter & Gamble, Global Product Stewardship, Reading, United Kingdom
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5
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Turner PJ, Gretzinger M, Patel N, Brough HA, Chinthrajah RS, Ebisawa M, Elizur A, Koplin JJ, Peters RL, Purington N, Nowak‐Wegrzyn A, Saf S, Sampson HA, Westerhout J, Blom WM, Baumert JL, Houben GF, Remington BC. Updated threshold dose-distribution data for sesame. Allergy 2022; 77:3124-3162. [PMID: 35531634 PMCID: PMC9790362 DOI: 10.1111/all.15364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Paul J. Turner
- National Heart & Lung InstituteImperial College LondonLondonUK
| | | | - Nandinee Patel
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Helen A. Brough
- Children's Allergy ServiceEvelina Children's Hospital, Guy's and St. Thomas' NHS Foundation HospitalLondonUK,Department of Paediatric AllergyKing's College LondonLondonUK
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma ResearchStanford University School of MedicineStanfordCAUSA
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and RheumatologyNational Hospital Organization Sagamihara National HospitalSagamiharaJapan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric PulmonologyYitzhak Shamir Medical CenterZerifinIsrael,Department of Pediatrics, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Jennifer J. Koplin
- Population HealthThe Murdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rachel L. Peters
- Population HealthThe Murdoch Children’s Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Natasha Purington
- Department of Medicine, Quantitative Sciences UnitStanford University School of MedicineStanfordCAUSA
| | - Anna Nowak‐Wegrzyn
- Allergy and Immunology, Department of PediatricsNew York University Langone HealthNew YorkNYUSA,Department of Pediatrics, Gastroenterology and Nutrition, Collegium MedicumUniversity of Warmia and MazuryOlsztynPoland
| | - Sarah Saf
- Division of Pediatric Allergy and ImmunologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA,Department of Allergology‐Centre de l'Asthme et des AllergiesHôpital d'Enfants Armand TrousseauParisFrance
| | - Hugh A. Sampson
- Division of Pediatric Allergy and ImmunologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Joost Westerhout
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
| | - W. Marty Blom
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
| | - Joseph L. Baumert
- Food Allergy Research and Resource ProgramUniversity of NebraskaLincolnNebraskaUSA
| | - Geert F. Houben
- TNO, The Netherlands Organisation of Applied Scientific ResearchUtrechtThe Netherlands
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Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- and Egg-Allergic Children. Nutrients 2021; 13:nu13124540. [PMID: 34960092 PMCID: PMC8709061 DOI: 10.3390/nu13124540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/20/2023] Open
Abstract
Extremely sensitive food-allergic patients may react to very small amounts of allergenic foods. Precautionary allergen labelling (PAL) warns from possible allergenic contaminations. We evaluated by oral food challenge the reactivity to a brand of PAL-labelled milk- and egg-free biscuits of children with severe milk and egg allergy. We explored the ability of proteomic methods to identify minute amounts of milk/egg allergens in such biscuits. Traces of milk and/or egg allergens in biscuits were measured by two different liquid-chromatography-mass spectrometry methods. The binding of patient’s serum with egg/milk proteins was assessed using immunoblotting. None of the patients reacted to biscuits. Egg and milk proteins were undetectable with a limit of detection of 0.6 µg/g for milk and egg (method A), and of 0.1 and 0.3 µg /g for milk and egg, respectively (method B). The immunoblots did not show milk/egg proteins in the studied biscuits. Milk/egg content of the biscuits is far lower than 4 µg of milk or egg protein per gram of product, the minimal doses considered theoretically capable of causing reactions. With high sensitivity, proteomic assessments predict the harmlessness of very small amount of allergens in foods, and can be used to help avoiding unnecessary PAL.
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Byrne AM, Trujillo J, Fitzsimons J, Mohammed T, Ghent R, O'Carroll C, Coghlan D, Hourihane JO, Alsalemi A, Cassidy A, Corbet E, Creighton R, d'Art Y, Farren L, Flanagan R, Flynn N, Franklin R, Gray C, Harding P, Hendrick C, Heraghty F, Hurley S, Kavanagh V, Lad D, Leddy K, Lewis S, McGlynn T, O'Connor D, O'Neill P, O'Shea O, O'Toole A, Quinn R, Reid A, Russell A, Ruth E, Rynne A, Sanneerappa PB, Sheehan M, Thompson C, Tobin C, Trayer J, Wallace A, Walsh N, Wilson F. Mass food challenges in a vacant COVID-19 stepdown facility: Exceptional opportunity provides a model for the future. Pediatr Allergy Immunol 2021; 32:1756-1763. [PMID: 34152649 PMCID: PMC8420236 DOI: 10.1111/pai.13580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi-elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short-term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll-out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards. METHODS The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established. RESULTS After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. CONCLUSIONS Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality-of-life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy-in-even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.
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Affiliation(s)
- Aideen M Byrne
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | | | | | | | | | - Cathryn O'Carroll
- Children's Health Ireland, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - David Coghlan
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | - Jonathan O'B Hourihane
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Eva Corbet
- Children's Health Ireland, Dublin, Ireland
| | | | | | | | | | | | - Ruth Franklin
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | - Sadhbh Hurley
- Children's Health Ireland, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Emma Ruth
- Children's Health Ireland, Dublin, Ireland
| | - Anne Rynne
- Children's Health Ireland, Dublin, Ireland
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