Rate of food introduction after a negative oral food challenge in the pediatric population

Gau, Jessica; Wang, Julie

doi:10.1016/j.jaip.2016.06.027

Cited by 15 publications

(7 citation statements)

References 7 publications

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“…12,15,124,125 Surprisingly, families might not incorporate the food despite tolerance during an OFC, and counseling to do so should be included in the discussions about the procedure. 128 It might also be helpful for families to know that quality of life often improves, even when the procedure results in an allergic reaction, 129 and that a reaction is not likely to cause an increase in sensitization. 130 It would be preferable to have an improved surrogate test to avoid performing OFCs because they are time-consuming and resource intensive and carry risk.…”

Section: Diagnostic Approachesmentioning

confidence: 99%

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Sicherer

Sampson

2018

Journal of Allergy and Clinical Immunology

1,230

977

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This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.

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Section: Diagnostic Approachesmentioning

confidence: 99%

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Sicherer

Sampson

2018

Journal of Allergy and Clinical Immunology

1,230

977

View full text Add to dashboard Cite

show abstract

“…Previous studies have reported that between 20 and 30% of previously allergic patients continue a food avoidance diet despite a negative challenge. 25,26 Post-challenge guidance is essential to address food avoidance barriers and follow-up after OFCs needs to be strengthened to improve expanding children's diets.…”

Section: Fish (Nmentioning

confidence: 99%

Seafood graded oral food challenge outcomes in a pediatric tertiary care center

Rubin

Polk

2020

World Allergy Organization Journal

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Background: There are sparse data regarding the predictors of positive oral food challenges and reaction severity for seafood in children.Objective: Identify clinical characteristics in children with seafood allergy who were most likely to experience a negative oral food challenge (OFC).Methods: A retrospective chart review was performed for children who had a graded OFC to seafood at a pediatric tertiary care center from 2008 through 2019.Results: Sixty-three (60% male; average age 8 years; range 1-21 years) OFCs were performed, of which 21 were fish and 42 were shellfish. There were 10 (16%) positive OFCs and positive OFC rate was similar between fish (19%) and shellfish (14%). Forty-three children who underwent OFC had a reported history of IgE-mediated symptoms. Five of six children who had a history of anaphylaxis had a negative OFC. There was no difference in positive OFCs due to age, history of atopy, or initial allergic reaction history. The clinical characteristics of the positive OFCs were similar between fish and shellfish. A positive skin prick test to fish or shellfish did not increase the risk of a positive OFC. While the positive OFC rate did not differ for the shellfish food-specific IgE (FSIgE) level, there was a significant difference for fish (median <0.34 kU A /L vs. 1.63 kU A /L for pass and fail, respectively; P ¼ 0.023). Conclusion:A retrospective study of OFCs to seafood showed that the rate of a positive OFC was low. While seafood allergy is thought to be rarely outgrown, children who have a low FsIgE and/or skin testing can successfully tolerate seafood.

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“…Interestingly, when assessing the overall rate of food introduction after a negative OFC result in pediatric patients at this same referral center, investigators found that 20% of children did not incorporate the food into their diet regularly, citing fear of a reaction, disliking the food, or the food not being a routine part of the family's diet. 42 Peanuts and tree nuts were the most common allergens (60%) that were not incorporated regularly into the diet despite a negative OFC result. The effect of allergic reactions on SPTwheal size and milk, egg, and peanut sIgE concentrations was investigated in 377 children before and after OFC or accidental exposure; the authors concluded that allergic reactions during OFC or accidental exposure were not associated with increased sensitization.…”

Section: Epinephrine As First-line Treatment For Anaphylaxismentioning

confidence: 99%

Advances in the approach to the patient with food allergy

Scurlock

Jones

2018

Journal of Allergy and Clinical Immunology

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Advances in food allergy diagnosis, management, prevention, and therapeutic interventions have been significant over the past 2 decades. Evidence-based national and international guidelines have streamlined food allergy diagnosis and management, whereas paradigm-shifting work in primary prevention of peanut allergy has resulted in significant modifications in the approach to early food introduction in infants and toddlers. Innovative investigation of food allergy epidemiology, systems biology, effect, and management has provided important insights. Although active therapeutic approaches to food allergy remain experimental, progress toward licensed therapies has been substantial. Mechanistic understanding of the immunologic processes underlying food allergy and immunotherapy will inform the future design of therapeutic approaches targeting the food-induced allergic response. Global strategies to mitigate the substantial medical, economic, and psychosocial burden of food allergy in affected subjects and families will require engagement of stakeholders across multiple sectors in research, health care, public health, government, educational institutions, and industry. However, the relationship between the well-informed allergy care provider and the patient and family remains fundamental for optimizing the care of the patient with food allergy.

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Rate of food introduction after a negative oral food challenge in the pediatric population

Cited by 15 publications

References 7 publications

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Seafood graded oral food challenge outcomes in a pediatric tertiary care center

Advances in the approach to the patient with food allergy

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