Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Biomarkers associated with persistence and severity of IgE-mediated food allergies: a systematic review

Abstract Objective The prevalence of food allergies (FA) has increased worldwide over the last few decades. Milk, eggs, and peanuts are among the most common allergens and can cause anaphylaxis. Therefore, we aimed to identify biomarkers that could predict the persistence and/or severity of IgE-mediated allergies to milk, eggs, and peanuts via a systematic review. Methods This systematic review proceeded according to a protocol registered in the International Prospective Register of Systematic Reviews. Two independent authors extracted studies of interest from PubMed, SciELO, EMBASE, Scopus, and Ebsco databases and assessed their quality using the Newcastle-Ottawa Scale. Results We selected 14 articles describing 1,398 patients. Among eight identified biomarkers, total IgE, specific IgE (sIgE), and IgG4 were the most often cited biomarkers of persistent allergies to milk, eggs, and peanuts. Skin prick tests, endpoint tests, and sIgE cutoff levels may predict positive responses to challenges with these foods. The basophil activation test is a biomarker for the severity and/or threshold of allergic reactions to milk and peanuts. Conclusion Only a few publications identified possible prognostic indicators of the persistence or severity of FA and outcomes of oral food challenges, indicating that more accessible biomarkers are needed to determine the likelihood of having a severe food allergic reaction.

Proctocolite induzida por proteína alimentar - teste de provocação oral deve ser realizado para confirmar o diagnóstico de alergia ao leite de vaca em neonatos? / Induced proctocolitis - oral food challenge should be done to confirm the diagnosis of cow's milk allergy in neonates?

ABSTRACT Background: Suspicion of food protein-induced proctocolitis based on empirical understanding of rectal bleeding can lead to misdiagnosis. Objective: to verify clinical and evaluative characteristics of patients who presented neonatal rectal bleeding and were on a restricted cow's milk diet. Methods: A cross-sectional retrospective study included patients followed up in a tertiary care center, who presented rectal bleeding in the neonatal period. The analyzed data included gender, gestational age, type of delivery, use of antibiotics during the last trimester of pregnancy, use of parenteral nutrition before the first manifestation, use of mechanical ventilation, initial clinical manifestations associated with rectal bleeding, diet before the first manifestation, period of elimination diet, oral food challenge (OFC) results and symptoms presented in cases of positive OFC. Fisher's exact test and Mann-Whitney test were used to analyze the data. The level of significance was set to 5%. Results: Forty-two patients were selected: 30 preterm infants, 34 cesarean deliveries, 10 exclusively breastfed patients before rectal bleeding. Median age at OFC was 6.3 months old. Median of length of the elimination period before OFC was 5.9 months. OFC was negative in 33/42 (79%) patients and positive in 9/42 (21%). There was no association between OFC results and the evaluated data. The main symptom observed in patients with positive OFC was blood in stools. Conclusion: OFC was negative in most cases of suspected cow's milk allergy due to rectal bleeding in neonates, most of them with a history of prematurity.

RESUMO Contexto: A suspeita de proctocolite induzida por proteína alimentar (PCIPA) com base na compreensão empírica de sangramento retal pode levar a diagnósticos equivocados. Objetivo Verificar as características clínicas e evolutivas de pacientes que apresentavam sangramento retal neonatal e faziam uso de dieta restrita com leite de vaca. Métodos: Estudo transversal retrospectivo com pacientes acompanhados em um centro terciário, que apresentaram sangramento retal no período neonatal. Os dados analisados incluíram: sexo, idade gestacional, tipo de parto, uso de antibióticos no último trimestre da gravidez, uso de nutrição parenteral antes da primeira manifestação, uso de ventilação mecânica, manifestações clínicas iniciais associadas ao sangramento retal, dieta antes da primeira manifestação, período de dieta de eliminação, resultados do teste de provocação oral (TPO) e sintomas apresentados em casos de TPO positivo. O teste exato de Fisher e o teste de Mann-Whitney foram usados para analisar os dados. O nível de significância adotado foi de 5%. Resultados: Quarenta e dois pacientes foram selecionados: 30 prematuros, 34 partos cesáreos, 10 pacientes amamentadas exclusivamente antes do sangramento retal. A idade média na ocasião do TPO foi de 6,3 meses. A mediana da duração do período da dieta de eliminação antes do TPO foi de 5,9 meses. O TPO foi negativo em 33/42 (79%) pacientes e positivo em 9/42 (21%). Não houve associação entre os resultados do TPO e os dados avaliados. O principal sintoma observado em pacientes com TPO positivo foi sangue nas fezes. Conclusão: O TPO foi negativo na maioria dos casos de suspeita de alergia ao leite de vaca devido a sangramento retal em neonatos, a maioria deles com história de prematuridade.

The immune mechanism and potential biomarkers of non-IgE-mediated food allergy / 中华实用儿科临床杂志

The immune mechanism of non-IgE-mediated food allergy is quite complex.Due to the lack of specific laboratory indicators and limited diagnosis and treatment methods, non-IgE-mediated food allergy is usually misdiagnosed.Therefore, it is urgent to clarify the pathogenesis of the disease and search for specific biomarkers and novel therapeutic targets.This review aims to summarize current research results on the immune mechanism of non-IgE-mediated food allergy from two aspects, including the specific immunity and innate immunity, and to explore the potential diagnostic markers.The results may provide novel ideas for effective therapeutic strategies of non-IgE-mediated food allergy.

Evidence-based guidelines for food allergy of children in China / 中华实用儿科临床杂志

The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.

Retrospective analysis of 120 cases with allergic reactions during oral food challenge test / 中华实用儿科临床杂志

Objective:To discuss the safety of oral food challenge test(OFC).Methods:Clinical data of 120 cases with allergic reactions during OFC in Department of Pediatrics, Peking University Third Hospital from October 2015 to October 2019 were retrospectively analyzed.The relationship between sex, type of allergic foods, type of allergic reactions, involved organ system, serum specific IgE and severe allergic reaction were analyzed.Results:Allergic reactions occurred in 120 cases.There were 95 males and 25 females.The age ranged from 2 months to 10 years.All involved allergens included milk protein(47.5%, 57/120 cases), egg white(22.5%, 27/120 cases), wheat(19.2%, 23/120 cases), peanut(6.7%, 8/120 cases), nut(1.7%, 2/120 cases), and others(2.5%, 3/120 cases). The type of allergic reaction: 107 cases (90.8%) of hypersensitivity reaction occurred, with 24 cases (21.7%) of severe hypersensitivity reaction, and 13 cases (9.2%) of delayed hypersensitivity reaction.The involved systems include skin and mucous membrane, respiratory system, cardiovascular system, digestive system and nervous system.The correlation coefficient between serum specific IgE and severe allergic reaction was 0.315.Conclusions:Children with indications of OFC in the admission hospital have a high risk of OFC allergic reaction.Nearly 90% of them are immediate hypersensiti-vities, even anaphylaxis.Anaphylaxis that is caused by OFC and may lead to life risk or even death should be avoided.

Problems and challenges of oral food challenge test / 中华实用儿科临床杂志

Oral food challenge test (OFC) is necessary for the diagnosis of food allergies, however, this clinical diagnosis method has not been popularized yet in China.Although OFC is very important, the knowledge of it is very insufficient and even biased, which is the root cause of non-standard diagnosis of food allergy and over-dependence on allergen testing.Therefore, the necessity, safety, experiment design and results interpretation of OFC would be elucidated in this paper in order to improve the understanding of OFC.

Expert consensus on diagnosis and management of food allergy in children with atopic dermatitis / 中华皮肤科杂志

In clinical practice, the diagnosis of food allergy has not been standardized, and food allergy is overdiagnosed in patients with atopic dermatitis (AD) . Unnecessary elimination diets due to overdiagnosis of food allergy may exert a potential adverse effect on health in children with AD. Unlike classic IgE-mediated food allergy, food allergy in AD patients may manifest as noneczematous reactions, isolated eczematous reactions and a combination of the two above. The diagnosis of food allergy in children with AD should be made in combination with a thorough clinical history (detailed allergic history and feeding history) , clinical manifestations and a laboratory work-up including skin prick tests, serum specific IgE measurements, atopy patch tests and oral food challenge tests. Once an underlying food allergy is confirmed in AD patients, comprehensive management is generally recommended. Avoidance of the incriminated food is the main treatment approach, but regular clinical follow-up is necessary, including evaluation of nutritional status, and supervision of growth and development. Multi-disciplinary cooperation of dermatologists, nutritionists and pediatricians is required.

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China / 中华医学杂志(英文版)

Background@#Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients.@*Methods@#We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis.@*Results@#We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents.@*Conclusions@#In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.

Oral food challenges: result of a 16-year experience at a major teaching hospital in Thailand

BACKGROUND: Prevalence of food allergy is increasing all over the world including in Asia. Diagnosis of food allergy in Asia is usually made after family complaints or by elimination and/or reintroduction foods. This could lead to an inaccurate diagnosis and to incorrect information on epidemiology of food allergy. We, herein, reported results of a 16-year experience (1996–2012) of oral food challenge (OFC) performed in pediatric patients at a major teaching hospital in Thailand. OBJECTIVE: The major objectives of this report are to review types of foods selected for oral challenges, frequency of positive/negative challenges to these foods and the clinical reactions during challenges among these children. METHODS: Medical records of 206 children underwent OFC between 1996 and 2012 for various indications at the Allergy clinic of Pediatric Department, Siriraj Hospital, Mahidol University (age range, 4 months to 17 years) were retrospectively reviewed. Data including clinical data, skin prick test results and specific IgE levels were analyzed with respect to challenge results (positive/negative). During the period of the study, 2 separate investigations on shrimp allergy and wheat allergy were conducted. RESULTS: Sixty of 206 children (29%) had positive OFC, whereas 84 out of 306 OFC (27.5%) were positive. The most common food giving positive challenges in this study was shrimp (40%). Among children less than 3 years of age, the most common food with positive challenge was wheat (70%) whereas among children 3 years of age or older, shellfish was the most common food (42%). Cutaneous reactions were the most common reactions observed. CONCLUSION: Only 1 of 3 of children underwent OFC in this study had positive challenges. Shrimp was the most common food causing challenge in this study especially among children older than 3 year of age. Wheat has become another leading food besides cow's milk and egg in causing positive OFC in younger children in Thailand.

Evaluation of the results of oral food challenges conducted in specialized and general hospitals

BACKGROUND: Oral food challenge (OFC) tests are conducted in both specialized institutions and general hospitals. We aimed to compare the severity of the conditions of the patients between these 2 types of institutions in order to consider the role of such institutions in society. OBJECTIVE: We evaluated the results of OFC tests for hen's egg, cow's milk, and wheat that were conducted in a specialized institution (Aichi Children's Health and Medical Center [ACHMC], n = 835) and in 4 general hospitals (n = 327) in Aichi prefecture, Japan. METHODS: The symptoms provoked were scored using the total score (TS) of the Anaphylaxis Scoring Aichi scoring system in combination with the total ingested protein dose (Pro) before the appearance of allergic symptoms. RESULTS: The total ingested dose of the challenge-positive patients in ACHMC was significantly less than that in the general hospitals (p < 0.01). The median TS of the provoked symptoms in ACHMC and the general hospitals did not differ to a statistically significant extent in the hen's egg or cow's milk challenges; however, the median TS in ACHMC was significantly lower than that in the general hospitals for the wheat challenge (p = 0.02). The median TS/Pro values in ACHMC were almost identical to the upper 25% of the TS/Pro values in the general hospitals, suggesting that the specialized institution usually managed more severe patients. CONCLUSION: The specialized institution performed OFC tests at a lower threshold dose, but provoked similar TSs to the general hospitals. This evaluation may help in optimizing the distribution of patients to general hospitals and specialized institutions.

Accurate Determination of Childhood Food Allergy Prevalence and Correction of Unnecessary Avoidance

PURPOSE: Because the true prevalence of food allergy (FA), as based on the results of an oral food challenge test (OFC), is unknown, it is likely that children with suspected FA unnecessarily eliminate potentially causative foods. This study aimed to identify the prevalence of FA and to determine the proportion of children who unnecessarily eliminate food. METHODS: To identify children with FA, a primary survey was conducted via a questionnaire with all children aged 0-18 years in Niijima village (remote islands of Japan). In the secondary survey, a detailed medical interview was conducted by doctors with children who currently did not eat some foods. The third survey involved serum food-specific immunoglobulin E (IgE) tests and an OFC for children with suspected FA. RESULTS: Of 376 enrolled children, 374 (99.5%) completed the questionnaire. Some foods were eliminated by 18.6% and 13.0% of all children and those ≥6 years old, respectively. The target population for the secondary survey included 69 children who all completed the medical interview. The target population for the third survey consisted of 35 children, of whom 26 (74.3%) underwent the blood test. An OFC was performed 35 times with 20 children. As a result, the prevalence of FA was 4.9% in children of all ages and 4.7% in those ≥6 years old. Moreover, 55.0% children were able to cease eliminating food intake. CONCLUSIONS: It is possible that a considerable number of children unnecessarily eliminate food because of suspected FA.

Clinical investigation of neonate food allergy in 10 cases / 中华实用儿科临床杂志

Objective To find out the clinical characteristics related to neonate food allergy.Methods Ten subjects were diagnosed as neonate food allergy at the Third Hospital of Peking University from January 201 3 to January 201 5.The following clinical data:the gestational age,genter,age of onset,feeding,clinical manifestations,white blood cell count,eosinophilic granulocyte count,C -reactive protein(CRP),routine stool test and occult blood test,blood spe-cific IgE of cow′s milk and clinical outcomes were investigated.Results There were 4 term infants,and 6 preterm in-fants,including 2 very -preterm subjects.The gender ratio between male and female cases was 73.The age of onset from 1 day after birth to 43 days after birth,clinical investigation of neonate food allergy in 1 0 cases,and the average time was 20.3 d,the median age was 1 8.5 d,and the SD was 1 3.38 d.Their rectified gestational ages were from 30 to 37 weeks in 6 cases at onset.Four infants received breast feeding,3 infants received formula milk feeding,and the other 3 infants received mixed feeding.At onset,the symptoms were almost involved in the digestive system.The white blood cell counts of lab test were almost normal in 1 0 subjects.And eosinophilic granulocytes were elevated in 8 subjects.CRP elevated in 1 case,and those of the other 9 subjects were normal.The cow′s milk specific IgE antibody was elevated in 1 subject,and that of the other 9 subjects was normal.Two subjects were performed opened food challenge test and the finding were positive.Conclusions Both the term infants and the preterm infants can have food allergy,but the age of onset ranged widely.Breast feeding infants can also be attacked.The symptoms of the digestive tract were the main clinical manifestations of such neonates.The open -food challenge test is beneficial to diagnose but difficult to practice in the neonates.Dietetic treatment is the only method can therapy the disease.And mostly the clinical outcomes are desirable.

Diagnostic and therapeutic value of open food challenge in children of cow′s milk protein allergy / 中国免疫学杂志

Objective:To study the diagnostic and therapeutic value of open food challenge in children with cow ′s milk protein allergy.Methods:It is a retrospective analysis of 55 children with suspected cow′s milk protein allergy ( CMPA ) who attended the clinic of the pediatric gastroenterology department ,the First Hospital of Jilin University from March 2014 to March 2015.These children were fed by a mino acid based formulae ( AAF) for 2-4 weeks and then open food challenge ( OFC) test was performed.Those children who tested positive , were diagnosed as having CMPA.They were then fed with AAF for further 3 months and OFC was performed again.Then discusse the diagnostic and therapeutic value of open food challenge in children with cow ′s milk protein allergy.Results:Out of 55 CMPA suspected children ,52 tested positive with OFC yielding a positive rate of 94.55%.These 52 children were fed with AAF for further 3 months and then tested with OFC ,9 children tested positive yielding a positive rate of 17.30%.These 9 children were again fed with AAF for 3 months and then tested with OFC.This time 2 children tested positive yielding a positive rate of 3.85%.Con-clusion:Open food challenge teats are of great significance in the diagnosis of CMPA ,and evaluation of tolerance to cow′s milk protein ( CMP).

Application of oral food challenge in the diagnosis of gastrointestinal food allergy in the children / 中华实用儿科临床杂志

Food allergy is a common illness in children,which is divided into IgE-mediated,non-IgE mediated and mixed-mediated food allergy.Gastrointestinal tract is the mainly affected organ,mostly mediated by non-IgE mechanism.Gastrointestinal food allergy are lack of unified diagnostic criteria currently,whose mechanism is also elusive.Moreover,the double-blind placebo-controlled food challenge is the gold standard for the diagnosis of food allergy.This review focuses on the procedure for the oral food challenge and its application in the diagnosis of gastrointestinal food allergy.

Prevalence and Clinical Impact of IgE-Mediated Food Allergy in School Children With Asthma: A Double-Blind Placebo-Controlled Food Challenge Study

PURPOSE: Recent studies indirectly suggest a possible link between food allergy (FA) and asthma. Most of them have evaluated the occurrence of FA in asthmatic children, especially in the first year of life, using questionnaire-based studies or specific IgE (sIgE) assay. The aim of this study was to evaluate the prevalence and clinical impact of IgE-mediated FA in school children with asthma using a double-blind placebo-controlled food challenge (DBPCFC). METHODS: The study group consisted of school children with atopic asthma who were admitted to the Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, for the evaluation of food hypersensitivity. The diagnosis of FA was established using questionnaires, sIgE analysis, and the DBPCFC. Asthma severity and asthma control state were also assessed. RESULTS: A relationship between consumed food and complaints was reported in 180 children (49.7%). Seventy children (19.3%) were sensitized to food allergens. IgE-mediated FA was confirmed in 24 children (6.6%), while 11 children (3%) demonstrated respiratory symptoms. Food-induced asthma exacerbations were observed in 9 patients (2.5%). Statistically significant differences in the prevalence of atopic dermatitis (P<0.002), urticaria (P<0.03), digestive symptoms (P<0.03), rhinitis (P<0.02), sIgE level (P<0.001), positive family history of atopy (P<0.001) and FA in history (P<0.001) were found between asthmatic children with FA and those without. Children with food-induced asthma exacerbations demonstrated significantly greater severity, poorer controls, and worse morbidity compared to those without. CONCLUSIONS: Although food-induced respiratory reactions in children with asthma were rare, they were classified as severe and associated with worse morbidity, greater severity, and poorer control. As the most commonly observed symptoms were coughing and rhinitis, which can be easily misdiagnosed, a proper diagnosis is essential for improving the management of both clinical conditions.

Diagnosis of food allergies: the impact of oral food challenge testing

A diagnosis of food allergies should be made based on the observation of allergic symptoms following the intake of suspected foods and the presence of allergen-specific IgE antibodies. The oral food challenge (OFC) test is the most reliable clinical procedure for diagnosing food allergies. Specific IgE testing of allergen components as well as classical crude allergen extracts helps to make a more specific diagnosis of food allergies. The Japanese Society of Pediatric Allergy and Clinical Immunology issued the 'Japanese Pediatric Guideline for Food Allergy 2012' to provide information regarding the standardized diagnosis and management of food allergies. This review summarizes recent progress in the diagnosis of food allergies, focusing on the use of specific IgE tests and the OFC procedure in accordance with the Japanese guidelines.

Food Hypersensitivity in Patients with Childhood Atopic Dermatitis in Korea

BACKGROUND: It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method. OBJECTIVE: To examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea. METHODS: A total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity. RESULTS: Forty-two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05+/-9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions. CONCLUSION: The overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork.

Guidelines for the Oral Food Challenges in Children / 소아알레르기및호흡기학회지

Oral food challenge is a definitive diagnostic test for immediate and occasionally delayed adverse reaction to foods. The gold standard for diagnosing food allergy is still the double-blind, placebo-controlled food challenge, but it is time-consuming, expensive and troublesome for physician and patients. Open oral food challenge controlled by trained personnel is useful and sufficient methods when concern of bias is low. We aimed to provide a practical guideline for oral food challenge in children for the diagnosis of suspected food allergy or the evaluation of food tolerance. We considered reasons, types, indications, contraindications, risks, benefits, detailed methods, practical performance, interpretations of test results, and treatments for the adverse reactions of oral food challenge.

Use of Specific IgE and Skin Prick Test to Determine Clinical Reaction Severity.

Aims: To determine whether specific IgE and skin prick test correlate better in predicting reaction severity during a double-blinded placebo controlled food challenge (DBPCFC) for egg, milk, and multiple tree nut allergens. Study design: Prospective study. Place and Duration of Study: Department of Pediatrics, Stanford University School of Medicine, August 2009 and ongoing. Methodology: We examined the reaction severity of twenty-four subjects to nine possible food allergens: milk, egg, almond, cashew, hazelnut, peanut, sesame, pecan and walnut. Specific IgE and SPT were performed before each DBPCFC. DBPCFC results were classified into mild (1), moderate (2), or severe (3) reactions using a modified Bock’s criteria. Results: Twenty four subjects underwent a total of 80 DBPCFC. Eighty percent of all DBPCFCs resulted in a positive reaction. A majority, 71%, were classified as mild. No reactions occurred with a SPT of zero mm while three reactions occurred with a negative specific IgE. All reactions were reversible with medication. Conclusion: These data suggest that SPT and specific IgE levels are not associated with reaction severity (p<0.64 and 0.27, respectively). We also found that combining specific IgE and SPT improved specificity but did not help to achieve clinically useful sensitivity. For instance, an SPT > 5mm had a sensitivity of 91% and specificity of 50%. Combining SPT > 5mm and IgE > 7 resulted in a reduced sensitivity of 64%. Unexpectedly, a history of anaphylaxis 70% (n=17) was not predictive of anaphylaxis on challenge 4% (n=2).