Development and validation of challenge materials for double-blind, placebo-controlled food challenges in children☆

Vlieg‐Boerstra, Berber; Bijleveld, Cma; Heide, S. van der; Beusekamp, BJ; Wolt-Plompen, S. A. A.; Kukler, J.; Brinkman, Joep.; Duiverman, Eric J.; Dubois, Anthony

doi:10.1016/j.jaci.2003.10.039

Cited by 95 publications

(102 citation statements)

References 39 publications

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“…In those with clear clinical history but only one episode to peanut, DBPCFC was performed to confirm the diagnosis. DBPCFC was performed as described previously (31). Briefly, meals containing 5g of amount of flour peanut with a mixture of yogurt, orange juice, dried coffee and oatmeal flakes were prepared.…”

Section: Subject Selectionmentioning

confidence: 99%

Influence of age on IgE response in peanut‐allergic children and adolescents from the Mediterranean area

García-Blanca

Aranda

Blanca‐López

et al. 2015

Pediatric Allergy Immunology

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Background Peanut allergens are common triggers of food allergy. Analyses of sensitization patterns, relationships with other allergens, clinical symptoms, and variation with age are needed. We studied sensitization to Ara h 2, Ara h 9, and Pru p 3 in a peanut allergic children/adolescents and the relationship with peach and pollen. Methods Peanut allergic patients aged between 1 and 20 years old were classified into two groups: A) allergic to peanut only and B) allergic to peach and peanut. The IgE response was measured to Ara h 2, Ara h 9, and Pru p 3. Results Of 964 subjects evaluated, 28% were allergic to peanut. From this group, 68% were also sensitized to pollen. Urticaria was the most frequent entity followed by anaphylaxis and OAS. Fifty‐eight percent had Ara h 2‐ and/or Ara h 9‐specific IgE. More than half reported symptoms with peanut alone (Group A) and 35% to peanut and peach (Group B). We observed significant differences in sex, age, onset of symptoms, and sensitization to Artemisia between groups. IgE response to Ara h 2 was more frequent in Group A, and Ara h 9 and Pru p 3 in Group B. We observed a decrease in sensitization to Ara h 2 and an increase to Ara h 9 and Pru p 3 with increasing age. Conclusion Peanut allergy is frequent in subjects with allergy to plant foods, with Ara h 2 and Ara h 9 being two important allergens. In younger patients, Ara h 2 predominates over Ara h 9. The reverse was observed in older patients.

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Section: Subject Selectionmentioning

confidence: 99%

Influence of age on IgE response in peanut‐allergic children and adolescents from the Mediterranean area

García-Blanca

Aranda

Blanca‐López

et al. 2015

Pediatric Allergy Immunology

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“…However, this is a very expensive and time-consuming procedure that requires special facilities and is affordable to very few groups [4,8,9]. Our study included 197 volunteers related to the field of allergy, 141 of whom (71.6%) were allergists, allergy residents, or allergy nurses who understood the aim and relevance of the study.…”

Section: Discussionmentioning

confidence: 99%

“…To perform a DBPCFC, the food must be truly blinded. Sensory testing to identify differences between samples has been used to validate food recipes for DBPCFCs [4][5][6][7][8][9][10][11]. Discrimination tests are commonly used in sensory science for application in market research and the food industry.…”

Section: Introductionmentioning

confidence: 99%

Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut

González-Mancebo¹,

Durana²,

Estringana³

et al. 2017

J Investig Allergol Clin Immunol

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Background: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. Methods: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. Results: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. Conclusions: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.

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“…De qualquer forma, os critérios para o mascaramento são os mesmos adotados para o duplo cego controlado por placebo, ou seja, a preparação deve mascarar o sabor, o odor, a aparência e a consistência do alimento testado e, se houver placebo, este deve ser indistinguível do alimento testado. A elaboração de tais preparações é um desafio para os nutricionistas (28,29) . Como o TPO simples cego possui as mesmas dificuldades do duplo cego controlado por placebo, o último é preferível por afastar a influência por parte do observador (16) .…”

Section: Tipos De Teste De Provocação Oralunclassified

Teste de provocação oral aberto na confirmação de alergia ao leite de vaca mediada por IgE: qual seu valor na prática clínica?

Mendonça¹,

Cocco²,

Sarni³

et al. 2011

Rev. paul. pediatr.

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REsumoObjetivo: Revisar os principais protocolos de padronização para o teste de provocação oral aberto aplicado a crianças com suspeita de alergia ao leite de vaca mediada por imunoglobulina E.Fontes de dados: Foram selecionados artigos publicados, nos últimos dez anos, nas bases de dados Medline, Lilacs e SciELO, utilizando-se os descritores de assunto: "hipersensibilidade alimentar", "leite de vaca", "alergia ao leite de vaca", "teste de provocação oral", "crianças" e "diagnóstico".Síntese dos dados: O teste de provocação oral é o méto-do mais fidedigno para estabelecer ou excluir o diagnóstico de alergia alimentar e sua forma aberta pode ser a primeira opção, quando apenas reações objetivas são esperadas. O local para realizar o teste deve possuir todos os recursos para tratamento de emergência. Como preparo, o paciente deve seguir dieta de exclusão do alimento suspeito e descontinuar o uso de medicamentos que possam interferir no resultado do teste. Habitualmente, utilizam-se 8 a 10g de leite em pó ou 100mL de leite fluido, oferecidos em volumes progressivos, a intervalos de dez a 60 minutos. Apesar da rigidez do método, ainda existem situações em que há dificuldade de interpretação dos resultados; por isso, médicos bem treinados devem aplicar o teste, sendo cautelosos ao julgarem as reações.Conclusões: Mesmo considerando as limitações que dificultam a aplicação do teste de provocação oral na prática clínica, a implementação do teste nos serviços de saúde poderia reduzir diagnósticos falsos-positivos de alergias.Palavras-chave: hipersensibilidade alimentar; substitutos do leite humano; diagnóstico. AbsTRAcTObjective: To review the main standardization protocols of the open oral food challenge applied to children with suspicion of cow's milk allergy mediated by immunoglobulin E.Data source: Medline, Lilacs and SciELO databases were searched for articles published in the last ten years using the following descriptors: "food hypersensitivity", "cow's milk", "cow's milk allergy", "oral food challenge", "children" and "diagnosis".Data synthesis: The oral food challenge test is the most reliable method to establish or exclude the diagnosis of food allergy and the open challenge can be the first option when only objective reactions are expected. All medications and equipment needed for emergency treatment should be available. Before being submitted to the test, the patient must follow a diet excluding the suspected food and discontinue the use of medications that may interfere with the results of the test. Usually, it is performed using 8-10g of powdered milk or 100mL of fluid milk, offered in progressive volumes

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Development and validation of challenge materials for double-blind, placebo-controlled food challenges in children☆

Cited by 95 publications

References 39 publications

Influence of age on IgE response in peanut‐allergic children and adolescents from the Mediterranean area

Influence of age on IgE response in peanut‐allergic children and adolescents from the Mediterranean area

Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut

Teste de provocação oral aberto na confirmação de alergia ao leite de vaca mediada por IgE: qual seu valor na prática clínica?

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