Placebo reactions in double‐blind, placebo‐controlled food challenges in children

Vlieg‐Boerstra, Berber; Heide, S. van der; Bijleveld, Cma; Kukler, J.; Duiverman, Eric J.; Dubois, Anthony

doi:10.1111/j.1398-9995.2007.01430.x

Cited by 62 publications

(80 citation statements)

References 35 publications

(65 reference statements)

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“…In addition, the frequent use of homeopathy in children (31)-beyond the question of whether homeopathy is placebo treatment per se (32)-and placebo response rates in food challenges (33) argue in favor of higher placebo responses in children as compared with adults.…”

Section: Are Placebo Responses Different Between Children and Adults?mentioning

confidence: 99%

Placebo effects in children: a review

Weimer¹,

et al. 2013

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Of more than 155,000 PubMed citations found with the search term "placebo, " only ~9,000 (5.8%) included the terms "children" or "adolescents. " When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.

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Section: Are Placebo Responses Different Between Children and Adults?mentioning

confidence: 99%

Placebo effects in children: a review

Weimer¹,

et al. 2013

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“…Adequate blinding of test material was validated by sensory testing in a food laboratory [5]. The challenge doses were administered according to incremental scales for the suspected food as described by Vlieg-Boerstra et al [6]. The challenge was stopped when objective symptoms occurred or when subjective allergic symptoms occurred twice upon two consecutive administrations of the same dose.…”

Section: Methodsmentioning

confidence: 99%

“…Two days after both challenge sessions, late-onset reactions were recorded by telephone questionnaire. Two days after the second challenge session, the code was broken and the outcome of the DBPCFC was assessed as previously described [6]. We selected challenges for the most frequently tested foods, i.e.…”

Section: Methodsmentioning

confidence: 99%

Parental Eczema Increases the Risk of Double-Blind, Placebo-Controlled Reactions to Milk but Not to Egg, Peanut or Hazelnut

Berg

Blok

Vlieg‐Boerstra

et al. 2011

Int Arch Allergy Immunol

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Background: While genetic factors are known to be important in the development of sensitization to foods, it is not known whether they also play a role in clinical allergic reactivity to foods. Objective: We aimed to determine whether parental atopic diseases are associated with a higher risk of a reaction to common allergenic foods when tested in a double-blind, placebo-controlled food challenge (DBPCFC). Methods: Parents of children suspected of being food allergic were interviewed about their own and their child’s atopic history. Specific IgE and skin prick tests to food allergens and the outcome of food challenges in the child were recorded. Results: Data from 553 double-blind food challenges performed in 396 children were analyzed. The foods tested were milk (n = 185), egg (n = 110), peanut (n = 198) and hazelnut (n = 60). Only parental eczema was significantly associated with positive outcomes for food challenges with milk after correction for age, sex, atopic comorbidity in the child and milk-specific IgE test results (odds ratio 3.1, 95% confidence interval 1.5–6.3). Conclusions: Children with a positive DBPCFC to milk more frequently have parents with eczema than children with a negative test. This effect of parental eczema was not seen in children challenged with egg, peanut or hazelnut. Clinical reactivity to milk may be caused by genetic factors which are shared with parental eczema to a greater extent than clinical reactivity to other foods.

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“…Entende-se por sintomas subjetivos aqueles que podem ser influenciados por fatores psicológicos, como aversão ao alimento ou ansiedade. Como exemplos podem ser citados: dor ou desconforto abdominal, náuseas, vômito, mal-estar geral, palpitação, exacerbação de prurido cutâneo (no caso de dermatite atópica), prurido labial, prurido em orofaringe, queimação na língua, sensação de aperto na garganta, dificuldade em engolir e outros sintomas, como sonolência e irritabilidade (10,26,27) . O TPO simples cego pode ser feito com ou sem placebo, na dependência do protocolo adotado (9) .…”

Section: Tipos De Teste De Provocação Oralunclassified

“…O local envolvido na preparação deve ser limpo e livre de risco de contaminação com leite ou outros alimentos que possam causar reações no paciente (9) . É importante lembrar que, em protocolos científicos, independentemente do alimento escolhido, deve-se padronizar a qualidade e a quantidade de proteína que está sendo oferecida para permitir a comparação dos resultados com o mesmo rigor metodológico (27) .…”

Section: Protocolos De Testes Alimento Ofertadounclassified

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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Placebo reactions in double‐blind, placebo‐controlled food challenges in children

Cited by 62 publications

References 35 publications

Placebo effects in children: a review

Placebo effects in children: a review

Parental Eczema Increases the Risk of Double-Blind, Placebo-Controlled Reactions to Milk but Not to Egg, Peanut or 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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