Clinical and laboratory factors associated with negative oral food challenges

Abstract

Children 2 Oral food challenges (OFCs) are the recommended procedure to document the resolution of food allergy, 3,4 but they are time-consuming, difficult to perform, require resources, and expose the patient to the risk of a significant allergic reaction. Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs.5-10 However, FSIgE levels are less effective in identifying children who experience a negative OFC. 11In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%.3 Previous research 11 has revealed that FSIgE of Յ2 kUa/L (or Յ5 kUa/L for peanuts without a history of previous reaction) are associated with an estimated Յ50% likelihood of reacting to eggs, milk, or peanuts during an OFC, and these FSIgE values have been incorporated into clinical guidelines.11 Identifying additional clinical and laboratory factors associated with negative OFC within this group of patients would improve patient care by decreasing the number of unnecessary (i.e., predictably positive) OFCs.Recently, it was shown that the incorporation of clinical and laboratory data to supplement FSIgE levels effectively diagnosed food allergy and might eliminate the need for some OFCs to confirm the presence of food allergy. 12,13 We extended this approach to the clinical scenario aimed at increasing the accuracy of identifying children who will experience negative OFCs. We aimed to investigate if there are food-specific combinations of clinical and laboratory characteristics that define subgroups of children, undergoing OFC based on the guideline-recommended FSIgE levels, 3 who are most likely to experience a negative OFC.

B‐FAHF‐2 plus oral immunotherapy (OIT) is safer and more effective than OIT alone in a murine model of concurrent peanut/tree nut allergy

“…This might be because a 10 day OIT protocol was used. We, as did Leonard et al, [47] used a 21 day protocol and also found significant protection in the OIT alone group. Importantly, we found that BF2+OIT produced greater and more persistent protection than OIT alone.…”

“…Many previous studies found that OIT causes transient elevation of IgE in patients 47,48,49 and murine models. 30 Our study also found that OIT alone induced higher levels of IgE immediately after com- IL-10/IL-4 ratios have been associated with FA status, and a higher ratio was associated with food tolerance restoration in patients.…”

Total serum IgE level influences oral food challenge tests for IgE‐mediated food allergies

“…Our results demonstrated that the variation in OFC results is mainly due to differences in total serum IgE levels. In fact, nonspecific or low‐affinity IgE suppresses specific IgE‐mediated activation of basophils in vitro , and total serum IgE levels reportedly affect the clinical severity or reactivity of patients with a milk , β‐lactam , or Hymenoptera venom allergy. Most previous studies indicate that older patients show increased total IgE levels , and the present study confirmed this.…”

“…Age is considered a critical confounding factor affecting OFC results , although the precise reason remains unknown. Furthermore, some studies have indicated that total IgE levels could influence the results of an OFC ; therefore, we aimed to determine whether total IgE levels might be a more suitable confounding factor to be controlled than age.…”

Tolerância ao leite processado em altas temperaturas em pacientes com alergia ao leite de vaca mediada pela imunoglobulina E

“…A alergia a proteína do leite de vaca (APLV) é a alergia alimentar (AA) mais comum na infância, com uma prevalência de 2 a 3% nessa população (Bock, 1987;Host et al, 1990;Liu et al, 2010;Sicherer, 2011). É um significante problema de saúde pública pelo risco de reação grave potencialmente fatal (Bock et al, 2007) (Solé et al, 2008;Fiocchi et al, 2010;Chafen et al, 2010;Boyce et al, 2010, Kattan et al, 2011Beigelman et al, 2012).…”