Background Food allergy diagnosis in clinical studies can be challenging. Oral food challenges (OFC) are time‐consuming, carry some risk and may, therefore, not be acceptable to all study participants. Objective To design and evaluate an algorithm for detecting IgE‐mediated food allergy in clinical study participants who do not undergo OFC. Methods An algorithm for trial participants in the Barrier Enhancement for Eczema Prevention (BEEP) study who were unwilling or unable to attend OFC was developed. BEEP is a pragmatic, multi‐centre, randomized‐controlled trial of daily emollient for the first year of life for primary prevention of eczema and food allergy in high‐risk infants (ISRCTN21528841). We built on the European iFAAM consensus guidance to develop a novel food allergy diagnosis algorithm using available information on previous allergenic food ingestion, food reaction(s) and sensitization status. This was implemented by a panel of food allergy experts blind to treatment allocation and OFC outcome. We then evaluated the algorithm's performance in both BEEP and Enquiring About Tolerance (EAT) study participants who did undergo OFC. Results In 31/69 (45%) BEEP and 44/55 (80%) EAT study control group participants who had an OFC the panel felt confident enough to categorize children as “probable food allergy” or “probable no food allergy”. Algorithm‐derived panel decisions showed high sensitivity 94% (95%CI 68, 100) BEEP; 90% (95%CI 72, 97) EAT and moderate specificity 67% (95%CI 39, 87) BEEP; 67% (95%CI 39, 87) EAT. Sensitivity and specificity were similar when all BEEP and EAT participants with OFC outcome were included. Conclusion We describe a new algorithm with high sensitivity for IgE‐mediated food allergy in clinical study participants who do not undergo OFC. Clinical Relevance This may be a useful tool for excluding food allergy in future clinical studies where OFC is not conducted.
Mice which bear the lpr gene spontaneously develop autoimmune syndromes characterized by massive expansion of an unusual T cell subset which is phenotypically Thy-1+, L3T4-, Lyt-2-, B220+. The mutant T cells are refractory to stimulation with mitogenic lectins and, by implication, are thought to be solely responsible for the defects in lymphokine production manifested by lpr mice. The contribution of the remaining L3T4+ T cell subset to the latter derangements has not been previously examined and is the focus of this study. We found that abnormalities in concanavalin A-induced interleukin 2 and 3 production in the spleens of MRL-lpr/lpr and C57BL/6.lpr mice occurred in the presence of limited infiltration with B220+, L3T4- T cells. Mixing experiments indicated that B220+ T cells were not suppressive. Furthermore, lpr spleen cells enriched for L3T4+ cells and depleted of sIg+, B220+ and Lyt-2+ cells demonstrated reductions in lymphokine production which were comparable to those seen in unfractionated preparations. Spleen cells from C57BL/6.lpr mice, enriched for L3T4+ cells, were also markedly impaired in a mixed leukocyte reaction in response to stimulator cells from the class II major histocompatibility complex mutant bm12. The results indicate that the aberrations in lymphokine production and proliferation in the spleen cells of lpr mice involve not only B220+ T cells but also L3T4+ cells and suggest a potential role for the L3T4+ subset in the pathogenesis of lupus in lpr-bearing mice.
Seasonal Allergy Rebecca Batt discusses the effects of seasonal allergic rhinitis on children and the treatment options available
Seasonal allergic rhinitis (SAR) is a common disorder affecting up to 20% of the population ( Scadding et al, 2008 ). Symptoms include nasal irritation, sneezing, itching, rhinorrhoea and nasal blockage, which may be intermittent or persistent. These symptoms may lead to sleep disturbance, adversely affecting quality of life (QoL) and learning ability, and can contribute to a drop in grades in examinations taken in the summer months. An accurate diagnosis and optimal management of SAR is essential to minimise the effects of this common allergic disease on the individual. This clinical case will focus on a teenager with SAR. The immunological implications and therapeutic management of this disease will be discussed and the effect SAR has had on his QoL and education will be considered.
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