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Ruinemans-Koerts J, Brouwer ML, Schmidt-Hieltjes Y, Stevens P, Merkus PJFM, Doggen CMJ, Savelkoul HFJ, van Setten PA. The Indirect Basophil Activation Test Is a Safe, Reliable, and Accessible Tool to Diagnose a Peanut Allergy in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1305-1311.e3. [PMID: 35074603 DOI: 10.1016/j.jaip.2021.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/03/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The gold standard for the diagnosis of a peanut allergy is an oral food challenge (OFC), but it is a time-consuming, patient-unfriendly, and expensive test. The in vitro direct basophil activation test (BAT) for peanuts was shown to be a promising diagnostic tool for replacing the OFC. OBJECTIVE To determine the diagnostic accuracy of the indirect (passive) BAT. Compared with the direct BAT, the timing of the indirect BAT is more flexible, and the problem of nonresponding basophils (unresponsive to IgE receptor-mediated signaling) is circumvented. METHODS In 74 children, suspected of peanut allergy and eligible for an OFC, indirect BAT results for peanut extract, Ara h2, and Ara h6 were compared with the results of a double-blind placebo-controlled food challenge. The reactivity and sensitivity of the basophils in the BAT were correlated to both the allergy status and the threshold dose in the OFC. RESULTS The combined basophil reactivity for Ara h2 and Ara h6 showed the highest accuracy (94%) for the diagnosis of a peanut allergy, with positive and negative predictive values of 96% and 89%, respectively. The sensitivity of the basophils for Ara h2 significantly discriminates between patients who tolerated up to 0.4 g of peanut protein in the OFC and those who did not. CONCLUSIONS Because the indirect BAT showed a high diagnostic accuracy for peanut allergy, it is a promising alternative to the classical direct BAT and could lead to a reduction in OFC use.
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Affiliation(s)
- Janneke Ruinemans-Koerts
- Department of Clinical Chemistry and Haematology, Rijnstate Hospital, Arnhem, The Netherlands; Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, The Netherlands.
| | - Marianne L Brouwer
- Department of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Yvonne Schmidt-Hieltjes
- Department of Clinical Chemistry and Haematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Petra Stevens
- Department of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carine M J Doggen
- Rijnstate Research Centre, Rijnstate Hospital, Arnhem; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Huub F J Savelkoul
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Petra A van Setten
- Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Paediatrics, Rijnstate Hospital, Arnhem, The Netherlands
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2
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Kansen HM, van Erp FC, Meijer Y, Gorissen DMW, Stadermann M, van Velzen MF, Keusters WR, Frederix GWJ, Knulst AC, van der CK, Le TM. Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children. Clin Exp Allergy 2021; 51:1069-1079. [PMID: 34288182 PMCID: PMC8456915 DOI: 10.1111/cea.13987] [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] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
Background Specific IgE to Ara h 2 is a diagnostic test for peanut allergy which may reduce the need for double‐blind placebo‐controlled food challenges (DBPCFC); however, guidance for using Ara h 2 in place of DBPCFCs has not been validated. Objective To prospectively evaluate 1) diagnostic accuracy of previously published Ara h 2 cut‐off levels to diagnose peanut allergy in children and 2) costs. Methods A consecutive series of 150 children age 3.5 to 18 years was evaluated in secondary and tertiary settings in the Netherlands. sIgE to Ara h 2 was the index test, and oral peanut ingestion was the reference test. Oral peanut ingestion was home or supervised introduction for Ara h 2 ≤ 0.1, DBPCFC for 0.1–5.0 and open food challenge for ≥5.0. Costs were calculated using financial healthcare data. Results A conclusive reference test was performed in 113 children (75%). Sixty‐four children (57%) had peanut allergy, as confirmed by a DBPCFC (27/47) or an open challenge (37/50). Forty‐nine children (43%) were considered peanut‐tolerant after peanut introduction (19/19), a DBPCFC (20/47) or an open challenge (10/50). Area under the curve for Ara h 2 was 0.94 (95% CI 0.90–0.98). The diagnostic flow chart correctly classified 26/26 (100%; 84–100) of children with Ara h 2 ≤ 0.1 as peanut‐tolerant and 34/35 (97%; 83–100) of children with Ara h 2 ≥ 5.0 as peanut‐allergic. At a cut‐off of ≤0.1 and ≥5.0, a sensitivity of respectively 100% (93–100) and 53% (38–67) was observed and a specificity of 53% (38–67) and 98% (87–100). Mean annual costs of the flow chart were estimated as €320‐€636 per patient lower than following national allergy guidelines. Conclusions In this diagnostic accuracy study, which did not take into account pretest probability, we have validated previously published Ara h 2 cut‐off levels which are associated with peanut tolerance and allergy.
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Affiliation(s)
- Hannah M Kansen
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.,Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Francine C van Erp
- Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Yolanda Meijer
- Department of Pediatric Allergology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Willem R Keusters
- Julius Center for Health Sciences and Primary Care, University Medical Center, University of Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center, University of Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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3
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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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4
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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: 95] [Impact Index Per Article: 31.7] [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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5
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Kansen HM, van Erp FC, Knulst AC, Ehlers AM, Lyons SA, Knol EF, Meijer Y, Otten HG, van der Ent CK, Le TM. Accurate Prediction of Peanut Allergy in One-Third of Adults Using a Validated Ara h 2 Cutoff. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1667-1674.e3. [PMID: 33248282 DOI: 10.1016/j.jaip.2020.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnostic value of peanut components is extensively studied in children, but to a lesser extent in adults with suspected peanut allergy. The use of peanut components in daily practice may reduce the need for double-blind placebo-controlled food challenges (DBPCFCs); however, validation studies are currently lacking. OBJECTIVE To evaluate the diagnostic value of (combined) peanut components and validate a previously found Ara h 2 cutoff level with 100% positive predictive value (PPV) in adults with suspected peanut allergy. METHODS Adults who underwent a peanut DBPCFC were included: 84 patients from a previous study (2002-2012) and 70 new patients (2012-2019). Specific IgE (sIgE) to peanut extract, Ara h 1, 2, 3, 6, and 8 was measured using ImmunoCAP. Diagnostic value was assessed with an area under the curve (AUC) analysis. RESULTS In total, 95 (62%) patients were peanut allergic. sIgE to Ara h 2 and Ara h 6 were the best predictors with an AUC (95% confidence interval) of 0.85 (0.79-0.91) and 0.85 (0.79-0.92), respectively. The Ara h 2 cutoff level with 100% PPV (≥1.75 kUA/L) was validated in the 70 new patients. Thirty percent of all included patients could be classified correctly as peanut allergic using this validated cutoff level. CONCLUSION sIgE to Ara h 2 and Ara h 6 have equally high discriminative ability. Peanut allergy can be predicted accurately in one-third of adults using a validated cutoff level of sIgE to Ara h 2.
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Affiliation(s)
- Hannah M Kansen
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, the Netherlands.
| | - Francine C van Erp
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna M Ehlers
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sarah A Lyons
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Edward F Knol
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Henny G Otten
- Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Center, Utrecht University, Utrecht, the Netherlands; Center of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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6
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Vandekerckhove M, Van Droogenbroeck B, De Loose M, Coudijzer K, Van Winckel M, Gevaert P, Lapeere H. A Novel Double-Blind, Placebo-Controlled Food Challenge Matrix for Milk and Raw Egg. Int Arch Allergy Immunol 2019; 179:1-9. [PMID: 30893694 DOI: 10.1159/000494622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The double-blind, placebo-controlled food challenge (DBPCFC) is still considered to be the gold standard in food allergy diagnosis. This test is however not common practice in routine due to several practical limitations, especially for non-IgE-mediated food allergy with its typical delayed food allergic reactions. OBJECTIVE The aim of this study was to develop and evaluate DBPCFC matrices for the diagnosis of milk and egg allergies which can be applied at home for the diagnosis of delayed food allergic reactions. The main focus was the blinding of milk and raw egg and the development of matrices which can be prepared and consumed conveniently at home with a sufficiently long shelf life (+/- 6 months or longer). METHODS A sensory test evaluated the blinding of the egg and milk in the matrices. The microbiological analysis confirmed the safety and stability of the developed matrices. To assess the applicability of the matrices, a pilot DBPCFC study for milk including 7 patients was conducted. RESULTS Sensory tests confirmed that the masking of the allergenic ingredients was sufficient. Microbial safety and stability of the matrices were confirmed up to 6 months of storage at ambient temperatures in the dark. The DBPCFC for milk showed different outcomes and proved its applicability for use at home. CONCLUSION A novel stable DBPCFC matrix for milk and raw egg has been developed that allows convenient use at the patients' home.
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Affiliation(s)
- Marjolein Vandekerckhove
- Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food, Merelbeke, Belgium,
| | - Bart Van Droogenbroeck
- Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food, Merelbeke, Belgium
| | - Marc De Loose
- Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food, Merelbeke, Belgium
| | - Katleen Coudijzer
- Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food, Merelbeke, Belgium
| | - Myriam Van Winckel
- Department of Pediatrics and Medical Genetics, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Hilde Lapeere
- Department of Dermatology, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
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7
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Kansen HM, Le TM, Meijer Y, Flokstra-de Blok BMJ, Welsing PMJ, van der Ent CK, Knulst AC, van Erp FC. The impact of oral food challenges for food allergy on quality of life: A systematic review. Pediatr Allergy Immunol 2018; 29:527-537. [PMID: 29660855 DOI: 10.1111/pai.12905] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food allergy significantly impairs health-related quality of life (HRQL). Currently, it is still unknown whether diagnostic interventions for food allergy improve HRQL. We aim to assess the impact of diagnostic interventions for food allergy on HRQL. METHODS A systematic search was performed in MEDLINE, Embase, Cochrane Library, and CINAHL focused on patients with a (suspected) food allergy who underwent diagnostic interventions (ie, skin prick test, specific IgE, or oral food challenges [OFC]) and in whom HRQL was assessed. The mean difference between HRQL before and after the diagnostic intervention was calculated. A minimal clinically important difference of 0.5 was considered clinically relevant for the food allergy quality of life questionnaire. RESULTS Seven of 1465 original identified publications were included in which the impact of an OFC on HRQL was investigated (total patients n = 1370). No other diagnostic interventions were investigated. Food allergy-specific parent-reported HRQL improved significantly after an OFC irrespective of the outcome in children with a suspected food allergy in two publications. The change was considered clinically relevant in one of two publications. In addition, parent-reported HRQL improved after an OFC to assess the eliciting dose in children with a confirmed food allergy. The parental burden was significantly reduced after an OFC to assess resolution of food allergy. A meta-analysis could not be performed due to the limited numbers of, and considerable heterogeneity between, eligible publications. CONCLUSION An OFC is associated with an improved food allergy-specific HRQL and a reduced parental burden of food allergy.
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Affiliation(s)
- Hannah M Kansen
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Thuy-My Le
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, 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 and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paco M J Welsing
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Francine C van Erp
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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8
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Mäntylä J, Thomander T, Hakulinen A, Kukkonen K, Palosuo K, Voutilainen H, Pelkonen A, Kauppi P. The effect of oral immunotherapy treatment in severe IgE mediated milk, peanut, and egg allergy in adults. Immun Inflamm Dis 2018; 6:307-311. [PMID: 29542268 PMCID: PMC5946145 DOI: 10.1002/iid3.218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/23/2018] [Accepted: 02/15/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The standard care of severe food allergy in both adults and children means avoidance of allergens. In recent years promising results of oral immunotherapy (OIT) have been reported in children. In adults, information on OIT in severe food allergy is very limited. OBJECTIVE We aimed to study if OIT is possible in adults. METHODS We report OIT results in 10 adult patients with milk OIT, nine adult patients with peanut OIT, and four adult patients with egg OIT. The allergy was confirmed with allergen specific IgE tests and oral food challenges (open in milk allergy and double-blind in peanut and egg allergy). The OIT was performed as open. RESULTS The median dose of protein that led to discontinuation of allergen challenge because of symptoms was 7.5 mg in milk allergy, 25 mg in peanut allergy, and 15 mg in egg allergy. The median period of OIT was 515 days. Currently on OIT are 6/10 milk allergic patients, 4/9 peanut allergic patients and 3/4 egg allergic patients. The median dose of milk protein increased by 60-fold during OIT compared to the allergen challenge dose. In peanut OIT the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35-fold. Local itching was the most common side effect of OIT (73.9% of the patients), four patients reported having used epinephrine autoinjector and three patients having needed emergency room treatment. CONCLUSIONS AND CLINICAL RELEVANCE OIT can be given in adult patients with severe milk, peanut, or egg allergy only in selected cases. OIT leads into desensitization but it is not clear whether persistent tolerance can be achieved. Mild adverse events during OIT are common.
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Affiliation(s)
- Jarkko Mäntylä
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Tuuli Thomander
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
- University of Eastern FinlandKuopioFinland
| | - Auli Hakulinen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Kaarina Kukkonen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Kati Palosuo
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Helena Voutilainen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Anna Pelkonen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Paula Kauppi
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
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9
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Vandekerckhove M, Van Droogenbroeck B, De Loose M, Coudijzer K, Coppens M, Gevaert P, Lapeere H. Development and validation of a standardized double-blind, placebo-controlled food challenge matrix for raw hazelnuts. Clin Transl Allergy 2018; 8:3. [PMID: 29416847 PMCID: PMC5785854 DOI: 10.1186/s13601-017-0181-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Double-blind, placebo-controlled food challenge (DBPCFC) is considered the gold standard for food allergy diagnosis. However, this test is rarely performed routinely in clinical practice because of various practical issues, e.g. the lack of a standardized matrix preparation. The aim of this study was to develop and validate a convenient DBPCFC matrix, that can easily be implemented in daily clinical practice. The focus of this study was the blinding of hazelnuts, whereby the hazelnuts retained as much as possible their allergenicity and could be mixed homogenously in low-doses to the matrices. Methods A basophil-activation test (BAT), microbial tests and an LC-MS/MS test were performed to assess respectively the allergenicity of the used hazelnuts, the microbial stability of the novel developed matrices and the homogeneity of the hazelnuts in the matrices. A sensory test was conducted to validate the blinding of the hazelnuts in the matrices. A pilot DBPCFC study included eight patients as proof of concept. Results The BAT-test gave the first insights concerning the retained allergenicity of the hazelnuts. The microbial safety could be assured after 12 months of storage. Sufficient masking was assessed by several sensory tests. Homogeneous hazelnut distribution could be achieved for the different hazelnut concentrations. The DBPCFC’s results showed diverse allergic responders (from no reactions to distinct objective symptoms). Conclusion A novel stable and validated DBPCFC matrix using raw hazelnuts has been developed that allows easy preparation in a standardized way for convenient use in daily clinical practice. Trial registration EC Project number: EC/2015/0852; Date of registration: 13 Oct 2015; End date: 01 Feb 2017 Electronic supplementary material The online version of this article (10.1186/s13601-017-0181-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjolein Vandekerckhove
- 1Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food (ILVO), Burg. Van Gansberghelaan 115, 9820 Merelbeke, Belgium
| | - Bart Van Droogenbroeck
- 1Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food (ILVO), Burg. Van Gansberghelaan 115, 9820 Merelbeke, Belgium
| | - Marc De Loose
- 1Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food (ILVO), Burg. Van Gansberghelaan 115, 9820 Merelbeke, Belgium
| | - Katleen Coudijzer
- 1Technology and Food Science Unit, Research Institute for Agriculture, Fisheries, and Food (ILVO), Burg. Van Gansberghelaan 115, 9820 Merelbeke, Belgium
| | - Marc Coppens
- 3Faculty of Medicine and Health Science, Department of Anesthesiology and Perioperative Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Philippe Gevaert
- 4Faculty of Medicine and Health Science, Department of Otorhinolaryngology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Hilde Lapeere
- 2Faculty of Medicine and Health Science, Department of Dermatology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
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10
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Reier-Nilsen T, Michelsen MM, Lødrup Carlsen KC, Carlsen KH, Mowinckel P, Nygaard UC, Namork E, Borres MP, Håland G. Predicting reactivity threshold in children with anaphylaxis to peanut. Clin Exp Allergy 2018; 48:415-423. [DOI: 10.1111/cea.13078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- T. Reier-Nilsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - M. M. Michelsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - K. C. Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - K.-H. Carlsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - P. Mowinckel
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - U. C. Nygaard
- Division of Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - E. Namork
- Division of Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - M. P. Borres
- Thermo-Fisher Scientific; Uppsala Sweden
- Institute of Maternal & Child Health; Uppsala University; Uppsala Sweden
| | - G. Håland
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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11
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van der Valk JPM, Berends I, Gerth van Wijk R, Arends NJT, van Maaren MS, de Groot H, Wichers HJ, Emons JAM, Dubois AEJ, de Jong NW. Small percentage of anaphylactic reactions treated with epinephrine during food challenges in Dutch children. Ann Allergy Asthma Immunol 2017; 120:300-303. [PMID: 29017902 DOI: 10.1016/j.anai.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Severe allergic reactions, including anaphylaxis, occur during oral food challenges (OFCs) and the first-line treatment of anaphylaxis is epinephrine. OBJECTIVE To evaluate the percentage of anaphylactic reactions treated with epinephrine during OFCs and to identify associated factors for the administration of epinephrine. METHODS Children who underwent an OFC with peanut, hazelnut, cow's milk, hen's egg, or cashew nut from 2005 through 2015 in the Netherlands were evaluated. Children with reactions meeting the criteria for anaphylaxis according to the European Academy of Allergy and Clinical Immunology guidelines for food allergy and anaphylaxis were included. Children with an anaphylactic reaction treated with vs without epinephrine were compared. Possible factors associated with the administration of epinephrine, such as age, sex, symptoms consistent with asthma, history of an allergic reaction to the tested allergen, and symptom types during the anaphylactic reaction, were evaluated using logistic regression analysis. RESULTS Eighty-three children in clinical and research settings (43% boys; median age, 7 years; range, 1-17) who met the criteria for anaphylaxis were included in this study. Thirty-two of 83 children (39%) with anaphylaxis were treated with epinephrine. Respiratory symptoms during the OFC were treated significantly more often with epinephrine than gastrointestinal symptoms (P = .01). CONCLUSION Only 39% of children with anaphylaxis, according to the guideline criteria, were treated with epinephrine during the OFC and most of these children had respiratory symptoms. There is need for an easy-to-use international guideline for the treatment of allergic symptoms during OFCs.
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Affiliation(s)
- Johanna P M van der Valk
- Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Irene Berends
- Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nicolette J T Arends
- Department of Pediatric Allergology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maurits S van Maaren
- Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands
| | - Harry J Wichers
- Wageningen UR Food and Biobased Research, Wageningen, The Netherlands
| | - Joyce A M Emons
- Department of Pediatric Allergology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Anthony E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - Nicolette W de Jong
- Department of Internal Medicine, Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
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12
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van der Valk JPM, Vergouwe Y, Gerth van Wijk R, Steyerberg EW, Reitsma M, Wichers HJ, Savelkoul HFJ, Vlieg-Boerstra B, de Groot H, Dubois AEJ, de Jong NW. Prediction of cashew nut allergy in sensitized children. Pediatr Allergy Immunol 2017; 28:487-490. [PMID: 28423473 DOI: 10.1111/pai.12726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Yvonne Vergouwe
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Marit Reitsma
- Wageningen UR Food & Biobased Research, Wageningen, The Netherlands
| | - Harry J Wichers
- Wageningen UR Food & Biobased Research, Wageningen, The Netherlands
| | - Huub F J Savelkoul
- Laboratory of Cell Biology and Immunology, Wageningen University, Wageningen, The Netherlands
| | - Berber Vlieg-Boerstra
- Department of Paediatrics, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Hans de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands
| | - Anthony E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen the Netherlands, Groningen, The Netherlands
| | - Nicolette W de Jong
- Department of Internal Medicine, Allergology, Erasmus MC, Rotterdam, The Netherlands
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13
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van der Valk JPM, Bouche RE, Gerth van Wijk R, de Groot H, Wichers HJ, Dubois AEJ, de Jong NW. Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children. Clin Transl Allergy 2017; 7:8. [PMID: 28321292 PMCID: PMC5357817 DOI: 10.1186/s13601-017-0145-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/03/2017] [Indexed: 11/23/2022] Open
Abstract
Background Cashew nut, pistachio nut and mango belong to the Anacardiaceae family and are botanically related. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts from their diet. The ‘Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572) study showed that cashew nut sensitised children were co-sensitised to pistachio nut in 98% of cases and to mango in 21% of cases. The aim of this follow-up study to IDEAL is to assess the clinical relevance of co-sensitisation to pistachio nut and mango in cashew nut sensitised children. Methods Children were recruited from the study: ‘Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572). Inclusion criterion for the IDEAL study was sensitization to cashew nut as demonstrated by either SPT or sIgE, and a clinical history of reactions to cashew nuts or no previous (known) exposure. Sensitized children who were tolerant to cashew nuts were excluded. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the DBPCFC with cashew nut. In this follow-up study a double-blind placebo-controlled food challenge with pistachio nut and an open food challenge with mango were performed. Results Twenty-nine children (mean age of 11.6 years, 62% male) were included. Pistachio nut sensitisation was clinically relevant in only 34% of cashew-sensitised children and only 31% of cashew challenge positive children. None of the children was challenge positive to mango. Conclusion Although co-sensitisation between cashew nut and pistachio nut was observed in 98%, pistachio nut sensitisation was only clinically relevant in 34% of the children. Therefore, a challenge test with pistachio nut is recommended in children with cashew nut and pistachio nut sensitisation. Trial registration The study was registered in the Dutch trial register (registration number 3572) on 10 August 2012 (retrospectively registered)
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Affiliation(s)
- J P M van der Valk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - R El Bouche
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H de Groot
- Department of Paediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands
| | - H J Wichers
- Food and Biobased Research, Wageningen University and Research Centre, Wageningen, The Netherlands
| | - A E J Dubois
- Department of Paediatric Pulmonology and Paediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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14
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Guided introduction after negative double-blind placebo-controlled peanut challenges in children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:489-493.e1. [DOI: 10.1016/j.jaip.2016.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
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15
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van der Valk JPM, Gerth van Wijk R, Flokstra-de Blok BMJ, van der Velde JL, de Groot H, Wichers HJ, Dubois AEJ, de Jong NW. No difference in health-related quality of life, after a food challenge with cashew nut in children participating in a clinical trial. Pediatr Allergy Immunol 2016; 27:812-817. [PMID: 27495003 DOI: 10.1111/pai.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies showed that health-related quality of life (HRQL) significantly improved after the food challenge, with greater improvements in HRQL after a negative outcome than after a positive outcome. It is currently unknown whether this also occurs in patients undergoing DBPCFCs with cashew nut in the context of a clinical trial. METHODS Quality of life was studied in children enrolled in a cashew nut study using Food Allergy Quality of Life Questionnaires (FAQLQs). Children, teenagers and parents of the children completed the questionnaires before the challenge test and 6 months after the DBPCFC with cashew nut. The difference in the change in HRQL between the children with a positive and negative DBPCFC outcome was studied by Mann-Whitney U-test. RESULTS In total, 112 children (67 boys, median age of 9 years) were included. The children, teenagers and parents of the children completed 143 sets of questionnaires in total. There were no significant differences in baseline total and domain scores compared to the follow-up scores in the FAQLQ-CF, FAQLQ-TF and FAQLQ-PF. In children, the delta FAIM score in the negative DBPCFC tested group was significantly better than the delta FAIM score in the positive challenged group (p = 0.026). There were no significant differences in the changes in the scores of the FAQLQ-CF and FAQLQ-PF in the children with a positive challenge outcome, compared to the children with a negative challenge result. However, there was a significant difference in the change in score between the latter groups in the domain 'accidental exposure' of the FAQLQ-TF (p = 0.049). CONCLUSION This study showed no difference in the change in HRQL scores after a DBPCFC with cashew nut in children participating in a clinical trial. The utility of HRQL as an outcome for clinical trials in food allergy may be limited if participant baseline HRQL is relatively unimpaired.
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Affiliation(s)
- J P M van der Valk
- Department Of Internal Medicine, Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department Of Internal Medicine, Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - B M J Flokstra-de Blok
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J L van der Velde
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands
| | - H J Wichers
- Wageningen UR Food & Biobased Research, Wageningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - N W de Jong
- Department Of Internal Medicine, Allergology, Erasmus MC, Rotterdam, The Netherlands
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16
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van der Valk JPM, Gerth van Wijk R, Baumert JL, Nordlee JA, Vlieg-Boerstra BJ, de Groot H, Dubois AEJ, de Jong NW. Threshold dose distribution and eliciting dose of cashew nut allergy. Ann Allergy Asthma Immunol 2016; 117:712-714. [PMID: 27773603 DOI: 10.1016/j.anai.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Allergology, Erasmus MC, Rotterdam, the Netherlands
| | - J L Baumert
- Food Allergy Research & Resource Program, University of Nebraska, Lincoln, Nebraska
| | - J A Nordlee
- Food Allergy Research & Resource Program, University of Nebraska, Lincoln, Nebraska
| | | | - Hans de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, the Netherlands
| | - Anthony E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen, Groningen, the Netherlands
| | - Nicolette W de Jong
- Department of Internal Medicine, Allergology, Erasmus MC, Rotterdam, the Netherlands
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17
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van der Valk JPM, Gerth van Wijk R, Vergouwe Y, Steyerberg EW, Reitsma M, Wichers HJ, Savelkoul HFJ, Vlieg-Boerstra B, de Groot H, Dubois AEJ, de Jong NW. sIgE Ana o 1, 2 and 3 accurately distinguish tolerant from allergic children sensitized to cashew nuts. Clin Exp Allergy 2016; 47:113-120. [DOI: 10.1111/cea.12794] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - R. Gerth van Wijk
- Department of Internal Medicine, Allergology; Erasmus MC; Rotterdam The Netherlands
| | - Y. Vergouwe
- Center for Medical Decision Making; Department of Public Health; Erasmus MC; Rotterdam The Netherlands
| | - E. W. Steyerberg
- Center for Medical Decision Making; Department of Public Health; Erasmus MC; Rotterdam The Netherlands
| | - M. Reitsma
- Wageningen UR Food & Biobased Research; Wageningen The Netherlands
| | - H. J. Wichers
- Wageningen UR Food & Biobased Research; Wageningen The Netherlands
| | - H. F. J. Savelkoul
- Laboratory of Cell Biology and Immunology; Wageningen University; Wageningen The Netherlands
| | - B. Vlieg-Boerstra
- Department of Paediatrics; Onze Lieve Vrouwe Gasthuis (OLVG); Amsterdam The Netherlands
| | - H. de Groot
- Department of Pediatric Allergology; Diaconessenhuis Voorburg; RdGG; Delft The Netherlands
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology; University Medical Centre Groningen; GRIAC Research Institute; University of Groningen; Groningen The Netherlands
| | - N. W. de Jong
- Department of Internal Medicine, Allergology; Erasmus MC; Rotterdam The Netherlands
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18
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van der Valk JPM, Gerth van Wijk R, Dubois AEJ, de Groot H, de Jong NW. Failure of introduction of cashew nut after a negative oral food challenge test in children. Pediatr Allergy Immunol 2016; 27:654-8. [PMID: 27145177 DOI: 10.1111/pai.12591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J P M van der Valk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands.
| | - R Gerth van Wijk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - H de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, The Netherlands
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The IgE and basophil responses to Ara h 2 and Ara h 6 are good predictors of peanut allergy in children. J Allergy Clin Immunol 2016; 139:358-360.e8. [PMID: 27516216 DOI: 10.1016/j.jaci.2016.06.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022]
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20
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van der Valk JPM, Gerth van Wijk R, Dubois AEJ, de Groot H, Reitsma M, Vlieg-Boerstra B, Savelkoul HFJ, Wichers HJ, de Jong NW. Multicentre Double-Blind Placebo-Controlled Food Challenge Study in Children Sensitised to Cashew Nut. PLoS One 2016; 11:e0151055. [PMID: 26967158 PMCID: PMC4788393 DOI: 10.1371/journal.pone.0151055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Few studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut. The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to study the clinical reaction patterns in double-blind placebo-controlled food challenge tests and to establish the amount of cashew nuts that can elicit an allergic reaction. Methods and Findings A total of 179 children were included (median age 9.0 years; range 2–17 years) with cashew nut sensitisation and a clinical history of reactions to cashew nuts or unknown exposure. Sensitised children who could tolerate cashew nuts were excluded. The study included three clinical visits and a telephone consultation. During the first visit, the medical history was evaluated, physical examinations were conducted, blood samples were drawn and skin prick tests were performed. The children underwent a double-blind placebo-controlled food challenge test with cashew nut during the second and third visits. The study showed that 137 (76.5%) of the sensitised children suspected of allergy to cashew nut had a positive double-blind placebo-controlled food challenge test, with 46% (63) manifesting subjective symptoms to the lowest dose of 1 mg cashew nut protein and 11% (15) developing objective symptoms to the lowest dose. Children most frequently had gastro-intestinal symptoms, followed by oral allergy and skin symptoms. A total of 36% (49/137) of the children experienced an anaphylactic reaction and 6% (8/137) of the children were treated with epinephrine. Conclusion This prospective study demonstrated a strikingly high percentage of clinical reactions to cashew nut in this third line population. Severe allergic reactions, including anaphylaxis requiring epinephrine, were observed. These reactions were to minimal amounts of cashew nut, demonstrated the high potency of this allergens. Trial Registration www.ncbi.nlm.nih.gov/pubmed NTR3572
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Affiliation(s)
| | - Roy Gerth van Wijk
- Department Of Internal Medicine, Allergology, Erasmus MC, Rotterdam, the Netherlands
| | - Anthony E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen, Groningen, the Netherlands
| | - Hans de Groot
- Department of Pediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, the Netherlands
| | - Marit Reitsma
- Food and Biobased Research, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Berber Vlieg-Boerstra
- Emma Children’s Hospital, Pediatric Respiratory Medicine and Allergy, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Huub F. J. Savelkoul
- Laboratory of Cell Biology and Immunology, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Harry J. Wichers
- Food and Biobased Research, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Nicolette W. de Jong
- Department Of Internal Medicine, Allergology, Erasmus MC, Rotterdam, the Netherlands
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van der Valk JPM, Gerth van Wijk R, Hoorn E, Groenendijk L, Groenendijk IM, de Jong NW. Measurement and interpretation of skin prick test results. Clin Transl Allergy 2016; 6:8. [PMID: 26909142 PMCID: PMC4763448 DOI: 10.1186/s13601-016-0092-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/17/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods. METHODS Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot. RESULTS Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC. CONCLUSIONS The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC. TRIAL REGISTRATION Trial number NTR3572.
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Affiliation(s)
- J P M van der Valk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Burg. St. Jacobsplein 51, 3015CA Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Burg. St. Jacobsplein 51, 3015CA Rotterdam, The Netherlands
| | - E Hoorn
- ICT Services, Erasmus MC, Rotterdam, The Netherlands
| | - L Groenendijk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Burg. St. Jacobsplein 51, 3015CA Rotterdam, The Netherlands
| | - I M Groenendijk
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Burg. St. Jacobsplein 51, 3015CA Rotterdam, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Burg. St. Jacobsplein 51, 3015CA Rotterdam, The Netherlands
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22
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Pignatti P, Yacoub MR, Testoni C, Pala G, Corsetti M, Colombo G, Meriggi A, Moscato G. Evaluation of basophil activation test in suspected food hypersensitivity. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 92:279-285. [DOI: 10.1002/cyto.b.21264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Mona-Rita Yacoub
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Claudia Testoni
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianni Pala
- Occupational Physician's Division, Local Health Authority of Sassari; Sassari Italy
| | - Maura Corsetti
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID); University of Leuven; Leuven Belgium
| | - Giselda Colombo
- Internal Medicine and Clinical Immunology Unit; San Raffaele Hospital, IRCCS; Milan Italy
| | - Antonio Meriggi
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
| | - Gianna Moscato
- Allergy and Immunology Unit; Fondazione Salvatore Maugeri, IRCCS; Pavia, Italy
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23
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Johnson PE, Rigby NM, Dainty JR, Mackie AR, Immer UU, Rogers A, Titchener P, Shoji M, Ryan A, Mata L, Brown H, Holzhauser T, Dumont V, Wykes JA, Walker M, Griffin J, White J, Taylor G, Popping B, Crevel R, Miguel S, Lutter P, Gaskin F, Koerner TB, Clarke D, Sherlock R, Flanagan A, Chan CH, Mills EC. A multi-laboratory evaluation of a clinically-validated incurred quality control material for analysis of allergens in food. Food Chem 2014; 148:30-6. [DOI: 10.1016/j.foodchem.2013.09.115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/17/2013] [Accepted: 09/21/2013] [Indexed: 10/26/2022]
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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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25
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Gushken AKF, Castro APM, Yonamine GH, Corradi GA, Pastorino AC, Jacob CMA. Double-blind, placebo-controlled food challenges in Brazilian children: adaptation to clinical practice. Allergol Immunopathol (Madr) 2013; 41:94-101. [PMID: 22326568 DOI: 10.1016/j.aller.2011.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND A double-blind, placebo-controlled food challenge (DBPCFC) is considered the gold standard for diagnosing food allergy, but because of methodological difficulties it is rarely conducted in clinical practice, especially in paediatric patients. The purpose of the study was to propose a DBPCFC protocol that is adapted to our conditions for the diagnosis of an IgE-mediated cow's milk allergy (CMA) in a Brazilian reference centre for paediatric allergies. METHODS This study includes the experimental phase (choice of materials, adjustments made to protocols described in the literature) and the test execution phase. DBPCFCs were performed in 58 patients aged 1-15 years who were separated into two groups: Group 1 (n=39), sex 1.6 M:F, 5.3 years median age, suggestive history of IgE-mediated CMA; and Group 2 (n=19), sex 1.4 M:F, 8.3 years median age with symptoms not associated with milk ingestion and laboratory data not compatible with IgE-mediated CMA. RESULTS The materials were standardised for testing: containers and disposable products, low-lactose cow's milk (CM) and vehicles, such as natural fruit juice, vegetable soup and soybean-based beverages. Each DBPCFC was performed in a single day with two blind, randomised phases with a 2-h interval between them. The milk doses were gradually increased and offered in regular intervals of 15-30 min. Following negative or inconclusive results, patients underwent an open oral challenge test with 200 mL of low-lactose CM. CONCLUSIONS The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision.
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Affiliation(s)
- A K F Gushken
- Allergy and Immunology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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26
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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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Mackie A, Knulst A, Le TM, Bures P, Salt L, Mills EC, Malcolm P, Andreou A, Ballmer-Weber BK. High fat food increases gastric residence and thus thresholds for objective symptoms in allergic patients. Mol Nutr Food Res 2012; 56:1708-14. [DOI: 10.1002/mnfr.201200330] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/29/2012] [Accepted: 07/30/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Alan Mackie
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
| | - Andre Knulst
- Allergy Unit,; Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - Thuy-My Le
- Allergy Unit,; Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - Peter Bures
- Department of Dermatology/Allergology; University Medical Centre; Utrecht The Netherlands
| | - Louise Salt
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
| | - E.N. Clare Mills
- Manchester Interdisciplinary Biocentre; University of Manchester; Manchester UK
| | - Paul Malcolm
- Norfolk & Norwich University Hospital; Colney Lane; Norwich UK
| | - Adrian Andreou
- Norfolk & Norwich University Hospital; Colney Lane; Norwich UK
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28
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van der Velde JL, Flokstra-de Blok BMJ, de Groot H, Oude-Elberink JNG, Kerkhof M, Duiverman EJ, Dubois AEJ. Food allergy-related quality of life after double-blind, placebo-controlled food challenges in adults, adolescents, and children. J Allergy Clin Immunol 2012; 130:1136-1143.e2. [PMID: 22835403 DOI: 10.1016/j.jaci.2012.05.037] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 05/15/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Currently, the longitudinal validity (validity over time) and responsiveness (ability to measure change over time) of the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF), the Food Allergy Quality of Life Questionnaire-Teenager Form (FAQLQ-TF), and the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) are unknown. Additionally, the self-reported impact of a double-blind, placebo-controlled food challenge (DBPCFC) on health-related quality of life (HRQL) in adults (≥18 years of age), adolescents (13-17 years of age), and children (8-12 years of age) is unknown. OBJECTIVE The aims of this study were to assess the longitudinal validity and responsiveness of the FAQLQ-AF, FAQLQ-TF, and FAQLQ-CF and to assess the impact of a DBPCFC on HRQL. METHODS Two hundred twenty-one participants suspected of food allergy were included from Dutch allergy centers. Participants undergoing a DBPCFC (experimental group) completed the FAQLQ and Food Allergy Independent Measure (FAIM) 1 month before (baseline) and 6 months after (follow-up) a DBPCFC. Participants not undergoing a DBPCFC (control group) completed the questionnaire package twice with a 7-month interval. RESULTS HRQL scores improved after a DBPCFC, with greater improvements in HRQL scores after a negative outcome (food allergy ruled out) than a positive outcome (food allergy confirmed), demonstrating responsiveness of the FAQLQs. Significant correlations were shown between the change (follow-up minus baseline) in FAQLQ and FAIM scores supporting longitudinal validity of these questionnaires: FAQLQ-AF (Pearson correlation coefficient = 0.71, P < .001), FAQLQ-TF (Pearson correlation coefficient = 0.35, P = .018), and FAQLQ-CF (Pearson correlation coefficient = 0.51, P < .001). CONCLUSIONS Our findings demonstrate the longitudinal validity and responsiveness of the FAQLQs. Greater improvements in HRQL scores were shown after a negative outcome than after a positive outcome.
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Affiliation(s)
- Jantina L van der Velde
- Department of Pediatrics, Division of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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29
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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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