Oral food challenges: result of a 16-year experience at a major teaching hospital in Thailand

Abstract

BackgroundPrevalence of food allergy is increasing all over the world including in Asia. Diagnosis of food allergy in Asia is usually made after family complaints or by elimination and/or reintroduction foods. This could lead to an inaccurate diagnosis and to incorrect information on epidemiology of food allergy. We, herein, reported results of a 16-year experience (1996–2012) of oral food challenge (OFC) performed in pediatric patients at a major teaching hospital in Thailand.ObjectiveThe major objectives of this report are to review types of foods selected for oral challenges, frequency of positive/negative challenges to these foods and the clinical reactions during challenges among these children.MethodsMedical records of 206 children underwent OFC between 1996 and 2012 for various indications at the Allergy clinic of Pediatric Department, Siriraj Hospital, Mahidol University (age range, 4 months to 17 years) were retrospectively reviewed. Data including clinical data, skin prick test results and specific IgE levels were analyzed with respect to challenge results (positive/negative). During the period of the study, 2 separate investigations on shrimp allergy and wheat allergy were conducted.ResultsSixty of 206 children (29%) had positive OFC, whereas 84 out of 306 OFC (27.5%) were positive. The most common food giving positive challenges in this study was shrimp (40%). Among children less than 3 years of age, the most common food with positive challenge was wheat (70%) whereas among children 3 years of age or older, shellfish was the most common food (42%). Cutaneous reactions were the most common reactions observed.ConclusionOnly 1 out of 3 children underwent OFC in this study had positive challenges. Shrimp was the most common food causing challenge in this study especially among children older than 3 years of age. Wheat has become another leading food besides cow's milk and egg in causing positive OFC in younger children in Thailand.

Challenges of managing food allergy in the developing world

“…In addition, wheat is emerging as an important cause of FA in Thailand, Korea, Japan, and Pakistan, and it is a common cause of anaphylaxis in these countries. Table 2 displays some selected data on food allergens in the Asian continent 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85Table 2Some published data on food allergens from Asia.Country (alphabet)AllergensStudy DesignReferenceChinaShrimp; crab; mango; cow's milk; dairy products; eggPopulation-based surveyZeng et al 68 …”

“…Cow's milk; Egg >5 years - ShellfishPopulation-based (survey)Santadusit et al 82 <3 years – wheat >3 years – shellfishOral food challenges in an allergy clinicSrisuwatchari et al 83 1.…”

“…Shellfish is the leading cause of anaphylaxis in adolescents and adults in Singapore, Hong Kong, and Pakistan 69 , 73 , 78, 79, 80. It is also one of the most common triggers of food-induced anaphylaxis in Thai children and adults 83 , 84 , 106 . Wheat allergy is the leading cause of food-dependent exercise-induced anaphylaxis (FDEIA) in Japan 108 and Korea 92 and is currently replacing shellfish as a prominent trigger of FDEIA 109 in Thailand 110 and Singapore 111 …”

Wheat allergy

“…8 In a major teaching hospital in Thailand, it was found that among children less than 3 years of age, the most common food with positive challenge was wheat (70%) whereas among children 3 years of age or older, shellfish, as a cause of FA, prevailed (42%). 5 In Germany and Finland, it has been reported as the third most common allergen, after milk and egg. 9 In Brazil, wheat sensitization was as high as 20% in allergic children versus 8.1% in healthy controls.…”

Spring and allergy

“…This issue also contains a study on self-reported prevalence of food allergy to nuts, seeds, and seafood from Mexico [ 7 ]. Readers would be interested in an article that described 16-year experience of oral food provocation test at a teaching hospital in Thailand [ 8 ], and an unusual case of infant seizures with anaphylaxis to wheat [ 9 ].…”