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).

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.

A Study of Food Allergy in Patients with Urticaria / 대한피부과학회지

BACKGROUND: Although urticaria is a common skin reaction pattern occuring at some time in the life of approximately 15% to 20% of the population, the exact prevalence of food-induced acute or chronic urticaria remains unknown. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in patients with urticaria and the potential utility of the skin prick test and CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred patients with urticaria were evaluated for food hypersensitivity by history, eosinophil count, IgE, skin prick test, CAP-RAST FEIA, and open food challenge test (OFCT). RESULTS: 1) The prevalence of specific food allergies in the study population was 35% in history and 8, 18 and 6% in prick, CAP-RAST FEIA and OFCT, respectively. 2) The frequent food allergens were milk, egg, peanut, and wheat. 3) There were no correlations between the duration of urticaria and prick test, CAP-RAST FEIA and OFCT results. 4) Serum IgE levels were correlated with the prick test and CAP-RAST FEIA results, but not the OFCT results. 5) According to the history, 35 patients with urticaria answered that their symptoms were related to food, and of the 35 patients, positive reactions to the prick test and CAP-RAST FEIA were observed in 6 and 10 patients, respectively. Among the other 65 patients who answered that there was no relation between urticaria and food, 2 patients reacted positively to the prick test and 8 patients showed positive result to CAP-RAST FEIA. CONCLUSION: In contrast to high prevalence of food history, the prevalence of food-induced allergic urticaria in Korean patients is only 6%. In contrast to the prick test, CAP-RAST FEIA provides a standardized measurement of food specific IgE antibodies, which may be more useful diagnostic test than prick test to diagnose food allergy in urticaria.

A Study of Food Allergy in Atopic Dermatitis Using CAP-RAST FEIA and Open Food Challenge Test / 대한피부과학회지

BACKGROUND: The role of dietary factors in atopic dermatitis has been the subject of debate for several decades. Recently it has received convincing support from a double-blind controlled trial of an exclusion diet, showing benefit from careful avoidance of egg and milk in a group of atopic children. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in Korean atopic dermatitis and the potential utility of the Pharmacia CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred ten patients with atopic dermatitis were evaluated for food hypersensitivity by history, skin prick test, CAP-RAST FEIA, and open food challenge test(OFCT). RESULTS: The prevalence of specific food allergies in the study population was 28.2% in history and 18.2% in CAP-RAST FEIA and OFCT. The frequent food allergens were milk, egg, peanut, and wheat. There was no correlation between the clinical severity of atopic dermatitis and CAP-RAST FEIA and OFCT results. Plasma eosinophil and IgE levels were correlated with CAP-RAST FEIA results, but not OFCT results. According to the history, 31 atopic dermatitis patients answered that their dermatitis was related to food, and of the 31 patients, positive reactions to prick test and CAP-RAST FEIA were observed in 8 and 22 patients, respectively. Among the other 79 patients who answered that there was no relation between atopic dermatitis and food, 14 patients reacted positively to prick test and 47 patients showed positive result to CAP-RAST FEIA. CONCLUSION: The CAP-RAST FEIA provides standardized measurement of food specific IgE antibodies which may be useful to diagnose food allergy in atopic dermatitis.

The necessity of diet therapy for successful interferon-gamma therapy in atopic dermatitis

The avoidance of incriminated foods is one of the principal therapies for atopic dermatitis (AD). Recently, interferon (IFN)-gamma therapy has been tried in AD with limited success. The necessity of diet therapy for the success of IFN-gamma therapy in AD was evaluated. A total of 524 AD patients participated in this study and 316 patients among them were entered into open food challenge tests. As the first step, an elimination diet was administered to 43 AD patients and 30 AD patients were enrolled as an untreated control group. As the second step, 45 AD patients were treated by both IFN-gamma therapy and elimination diet alone, 30 AD patients by elimination diet alone, 50 AD patients by IFN-gamma therapy, and 43 AD patients as controls. Clinical severity reduced significantly by using only the elimination diet in 58.1% patients with varying degrees of AD. Elimination diet improved the clinical results of IFN-gamma therapy in AD. In regard to the food challenge test, 77.8% of AD patients showed an adverse reaction to at least one food. Diet therapy itself had therapeutic effects on AD and an elimination diet might be essential for the success of IFN-gamma therapy in AD.

Immediate Type Reaction of Food Allergy Confirmed by Open Food Challenge Test: Diagnostic Value of History and Skin Test in Food Allergy / 소아알레르기및호흡기학회지

PURPOSE: Food allergy is one of the common allergic diseases and elicits various clinical manifestations in children. Although the offending food could be suspected by history of food allergy and skin test with food allergen, it should be confirmed by food challenge test. We investigated the result of open food challenge test(OFCT) with offending food as suspected by history and/or skin test. Thereafter we analyzed the relationship between positive history of food allergy and positive skin test to food allergen, and positive food challenge test. METHODS: The subjects consisted of 208 children (age range, 3-15 years) with history of food allergy and/or positive skin test to food allergen. Open food challenge test was performed in 276 cases with 33 kinds of suspected foods. Increasing doses of natural food were given every 20 minutes, and the clinical manifestations elicited by challenge test were observed for 1 hour. RESULTS: 1) One-hundred twenty eight of 276 cases were positive for OFCT, and the provocation rate was 46.4%. 2) The provocation rate of individual food was highest in buckwheat flour(72.3%), followed by crab(60.0%), shrimp(45.8%), milk(41.6%), and egg(41.4%). 3) OFCT elicited allergic manifestations in 44.8% of positive history alone and 31.1% of positive skin test alone. Allergic manifestations were elicited in 91.2% when both the positive history and skin test were positive for the same food. 4) Positive and negative predictive values for OFCT were 67.8% and 68.9% in history, 46.8% and 55.2% in skin test, and 91.2% and 65.3% in history and skin test respectively. 5) Urticaria was the most common symptom(84.4%) elicited by OFCT. There were various allergic manifestations such as asthma, rhinitis, conjunctivitis and burning sensation in throat. Anaphylactic shock was observed in 3 cases with buckwheat flour allergy. 6) For the most cases(51.5%) symptoms occurred by the ingestion of small amount(1-100gm) of offending food. But symptoms in 27 cases were elicited just by scrubbing the food on lips or licking it by tongue. CONCLUSIONS: Open food challenge test showed the highest positive provocation rate with buckwheat. The most common symptom was urticaria, which was elicited with only a small amount of offending food. In predicting the result of OFCT, food allergy history was more reliable than the positive skin test, and if both the history and the skin test were positive for the same food, almost all the cases showed positive results with OFCT.