Dose-time-response relationship in peanut allergy using a human model of passive cutaneous anaphylaxis

Beyond IgE—When Do IgE-Crosslinking and Effector Cell Activation Lead to Clinical Anaphylaxis?

“…Finally, an elegant revival of the old Prausnitz–Küstner method has been used after a rigorous ascertainment of the safety of the sensitizing serum. Here, an inverse relationship between oral dose and onset of skin reaction was demonstrated ( 10 ). The overall conclusions from these studies suggest that less than one part per million of food protein (and thus almost out of reach with the present status of analytical allergen detection) is absorbed systemically.…”

A novel method for quantifying ingested food allergens in human sera

“…Furthermore, the amount of 100 g ingested allergenic peanut or 200 g hazelnut exceeds by far the amount causing an anaphylactic reaction, and this large amount of allergenic food is therefore not clinically relevant. However, this amount has previously been used, 4,12 and it was found that peanut protein could be detected in serum after ingestion. We therefore chose this amount of allergenic food to follow the kinetic of peanut and hazelnut allergens after oral intake.…”

Human passive cutaneous anaphylaxis in the 21st century: Worth the risk?

“…In this issue of the Journal, Mose et al 4 use the PK test to determine whether the serum level of peanut allergen-specific IgE and the oral challenge dose of peanut affect reaction time and wheal size in the IgE-medicated cutaneous PK test. Human sera from 4 peanut-sensitive donors were used to test this hypothesis in 41 healthy nonallergic recipients.…”

“…What about using the PK test as used in the article by Mose et al? 4 Although we cannot speak for all institutional review boards (IRBs) in the United States, most, if not all, IRBs, including that of the University of South Florida, would not today approve the use of a PK test for experimental purposes, regardless of the specifications of the protocol. Discovery of hepatitis B virus and other viruses during the 1960s and early 1970s made the US medical community seriously consider the risks taken when performing experimental PK tests on volunteers and on one another as younger physicians (including one of the authors [R.F.L.…”

“…As with all testing performed in human subjects, the risk/ benefit relationship must be carefully weighed by both the physician-scientists and local and national regulatory agencies. The study by Mose et al 4 was reviewed appropriately before performance, having received approval from their IRB and the Regional Scientific Ethics Committee and having followed the Danish blood safety directives. 5 With these procedures in place, the risk of infectious disease transmission during PK testing was likely very small.…”