Outcomes of office-based, open food challenges in the management of food allergy

Lieberman, Jay; Cox, Amanda; Vitale, Michelle; Sampson, Hugh A.

doi:10.1016/j.jaci.2011.07.012

Cited by 60 publications

(68 citation statements)

References 7 publications

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“…(14) In the present study, 187 of the 197 (94.9%) OFCs performed were negative and safe (162 of these 197 OFCs were conducted in an outpatient setting). The incidence of negative OFCs is consistent with that published in other reports, (13,15) suggesting that OFCs in carefully selected populations are safe and practical, unlike the traditional double-blind, placebo-controlled challenges that are more time-consuming and less cost-effective. However, physicians should ensure that the safety of the patient is not compromised in the quest for aggressive challenges.…”

Section: Discussionsupporting

confidence: 89%

“…However, it is in this exact population that the risk-to-benefit ratio is optimal for performing an OFC, a finding that is corroborated by other studies. (13) None of the patients in the present study experienced lifethreatening reactions and no epinephrine was dispensed. This may in part be due to patient selection.…”

Section: Discussionmentioning

confidence: 76%

“…A controlled setting, such as the one provided by our centre, gives highly anxious patients and their parents objective evidence of their allergy status. (13) After the OFC, physicians should continue providing support to these patients and their parents, to help them to reintroduce the foods into their diets. (14) In the present study, 187 of the 197 (94.9%) OFCs performed were negative and safe (162 of these 197 OFCs were conducted in an outpatient setting).…”

Section: Discussionmentioning

confidence: 99%

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A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

Thalayasingam

Tan

Bever

2015

smedj

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INTRODUCTIONThe prevalence of perceived food allergies exceeds that of true food allergies, especially if the estimates are based on selfreported surveys.(1) A substantial number of parents perceive food allergies in their children based on subjective reactions or allergy tests alone.(2) Others readily draw a connection between certain foods and chronic illnesses such as eczema.(2) In addition, cross-reactive foods are avoided in children with certain food allergies, as parents fear that their children will react even if they have not been tested for or eaten these foods. This is seen in many peanut-allergic children who avoid tree nuts but have not been tested for clinical reactivity to tree nuts. Similarly, demonstrating sensitisation alone, via positive skin prick tests (SPTs) or raised serum immunoglobulin E (IgE) levels, does not necessarily equate to having an allergy; (3) and eczema flare-ups are also not always related to foods.(4) Thus, it is not uncommon for children seen at allergy clinics to be on strict elimination diets based on incomplete information regarding potential food allergies. While the vast majority of these children are not allergic to the omitted foods, they are made to adhere to diets that are similar to those of patients with life-threatening reactions to these foods; this results in unnecessary food avoidance, an impaired quality of life, potentially poor weight gain and malnutrition. (5) An oral food challenge (OFC) can be used to provide parents with an objective measure of their child's true food allergies. As no local data is available on the use of OFCs to measure the presence or absence of food allergies, a retrospective chart review was carried out to describe the indications that prompted OFCs and the outcomes of the OFCs conducted. METHODSThis study was a retrospective review conducted on patients aged ≤ 18 years who underwent OFCs at the Paediatric Allergy Clinic of the National University Hospital, Singapore, from 2008 to 2010. Most of the patients were self-referred, followed by those referred from private clinics and polyclinics. The diagnostic workup of suspected food-related reactions is shown in Fig. 1. Our centre uses published diagnostic decision thresholds for serum IgE tests and SPTs that can help predict the likelihood of an allergic reaction if a particular food is ingested. (6,7) The decision to perform the challenge was based on these thresholds and the patient's clinical history. Patients generally did not proceed with an OFC if the treating physician felt that there was a high likelihood of a positive challenge, such as in the context of a recent life-threatening reaction to that food. Some patients underwent challenges for more than one food and a few patients were challenged repeatedly for the same food if their reactions were deemed to be subjective.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

Thalayasingam

Tan

Bever

2015

smedj

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“…To minimize potential measurement bias, data were collected by a trained research assistant using a predefined questionnaire. Finally, we did not perform double-blind placebo-controlled OFCs because graded OFCs are considered to be an adequate and cost-effective method in the clinical setting, 3,4,19 and we took efforts to minimize potential measurement bias resulting from nonobjective symptoms during the challenge, as described in the Methods section. Moreover, to minimize potential false negative results of the graded challenge, each negative graded challenge was followed by an open consumption of a mealsized portion of the food.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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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.

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“…Screening usually relies on an open or single-blind OFC proven to be safe, provided it is carried out in an allergist’s office [49], whereas the double-blind, placebo-controlled OFC is usually restricted to clinical studies or to conditions where the result of the open challenge remains dubious. Numerous reviews have outlined the procedures involved in OFC [50,51].…”

Section: Diagnosing Food Allergens: the Different Testsmentioning

confidence: 99%

Food Allergy: Recent Advances in Pathophysiology and Diagnosis

Dupont

2011

Ann Nutr Metab

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Approximately 5% of young children and 3–4% of adults exhibit adverse immune responses to foods in westernized countries, with a tendency to increase. The pathophysiology of food allergy (FA) relies on immune reactions triggered by epitopes, i.e. small amino-acid sequences able to bind to antibodies or cells. Some food allergens share specific physicochemical characteristics that allow them to resist digestion, thus enhancing allergenicity. These allergens encounter specialized dendritic cell populations in the gut, which leads to T-cell priming. In case of IgE-mediated allergy, this process triggers the production of allergen-specific IgE by B cells. Tissue-resident reactive cells, including mast cells, then bind IgE, and allergic reactions are elicited when these cells, with adjacent IgE molecules bound to their surface, are re-exposed to allergen. Allergic reactions occurring in the absence of detectable IgE are labeled non-IgE mediated. The abrogation of oral tolerance which leads to FA is likely favored by genetic disposition and environmental factors (e.g. increased hygiene or enhanced allergenicity of some foods). For an accurate diagnosis, complete medical history, laboratory tests and, in most cases, an oral food challenge are needed. Noticeably, the detection of food-specific IgE (sensitization) does not necessarily indicate clinical allergy. Novel diagnostic methods currently under study focus on the immune responses to specific food proteins or epitopes of specific proteins. Food-induced allergic reactions represent a large array of symptoms involving the skin and gastrointestinal and respiratory systems. They can be attributed to IgE-mediated and non-IgE-mediated (cellular) mechanisms and thus differ in their nature, severity and outcome. Outcome also differs according to allergens.

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Outcomes of office-based, open food challenges in the management of food allergy

Abstract: This letter reports the largest series of open oral food challenges in the literature to date. It describes the feasibility and utility of oral food challenge, further justifying its use in the everyday practice of allergy.

Cited by 60 publications

References 7 publications

A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

Clinical and laboratory factors associated with negative oral food challenges

Food Allergy: Recent Advances in Pathophysiology and Diagnosis

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