Relationship between serum allergen‐specific immunoglobulin E and threshold dose in an oral food challenge

Yanagida, Noriyuki; Sato, Sakura; Nagakura, Ken‐ichi; Takahashi, Kyohei; Fusayasu, Naoko; Miura, Yoko; Itonaga, Takaaki; Ogura, Kiyotake; Ebisawa, Motohiro

doi:10.1111/pai.13926

Cited by 9 publications

(17 citation statements)

References 31 publications

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“…A systematic review of the OFC in Japan suggested that the OFCs for egg and milk help avoid complete elimination [33,34]. Japanese guidelines recommend a stepwise OFC (Table 2) [3,27,35], which is widely practiced. A stepwise OFC allows the determination of the food amount that can be ingested [3,27].…”

Section: Key Pointsmentioning

confidence: 99%

“…Japanese guidelines recommend a stepwise OFC (Table 2) [3,27,35], which is widely practiced. A stepwise OFC allows the determination of the food amount that can be ingested [3,27]. Mitomori et al [36 & ] performed a stepwise OFC for infants sensitized to hen's eggs with no history of immediate symptoms and were able to stratify the egg allergy according to the threshold level.…”

Section: Key Pointsmentioning

confidence: 99%

“…van de Vorst-van der Velde et al [31] reported that 7% of children reacted to 1 mg of protein and that 20% of them experienced severe reactions. Another study showed that 9 and 25% of the study population reacted to 30 mg or less and 100 mg or less of causative food protein, respectively [27]. Among children with allergies to eggs, milk, wheat, peanuts, walnuts and cashews, 0.4, 24, 12, 2, 14 and 29% reacted to 30 mg or less protein of causative food, respectively [27].…”

Section: Stepwise Oral Food Challenge To Evaluate the Threshold And C...mentioning

confidence: 99%

“…A stepwise OFC for common food allergens, such as egg, milk, wheat and peanuts, comprises the following doses: very low dose, 100 mg or less protein; low dose, 300 mg or less protein; medium dose, 1000 mg or less protein; high dose, 3000 mg or less protein; and full dose, more than 3000 mg protein (Table 3). A very low or low dose was implemented during the first step of the OFC [27,35,36 ▪ ,39]. Therefore, a stepwise OFC may safely prevent complete avoidance and accelerate tolerance acquisition because of the continued intake of a small amount of causative foods.…”

Section: Stepwise Oral Food Challenge To Evaluate the Threshold And C...mentioning

confidence: 99%

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Relationship between eliciting doses and the severity of allergic reactions to food

Yanagida

Sato

Ebisawa

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewFood allergies with low thresholds are associated with frequent accidental allergic reactions. Severe reactions attributable to accidental ingestion often result in a poor quality of life. Nevertheless, no evidence of a relationship between a low threshold dose and the severity of symptoms exists. Therefore, we evaluated recent data regarding the threshold of food allergies based on the oral food challenge (OFC). We also proposed a stepwise OFC method to identify threshold and consumable doses. Recent findingsA higher specific IgE level and a history of food-induced anaphylaxis were related to low threshold doses and severe reactions during the OFC. In addition, a low threshold dose was not directly correlated with severe reactions. Performing a stepwise OFC may help safely clarify consumable doses and prevent the complete avoidance of allergy-causing foods. SummarySevere food allergies with high specific IgE levels are associated with lower thresholds and more severe reactions. However, the threshold is not directly related to the severity of food-induced allergic symptoms. Identifying a well tolerated consumable dose using a stepwise OFC may help manage food allergies.

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Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Stepwise Oral Food Challenge To Evaluate the Threshold And C...mentioning

confidence: 99%

Section: Stepwise Oral Food Challenge To Evaluate the Threshold And C...mentioning

confidence: 99%

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Relationship between eliciting doses and the severity of allergic reactions to food

Yanagida

Sato

Ebisawa

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Hospital oral food challenge tests in the coronavirus disease 2019 pandemic: A nationwide survey

Yanagida

Sugizaki

Sato

et al. 2023

Clinical & Translational All

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Oral food challenge (OFC) tests are necessary in food allergy practice. [1][2][3][4] The spread of the Omicron variant of severe acute respiratory syndrome coronavirus 2 significantly affected food allergy practice. 5,6 Universal pre-admission screening for coronavirus disease 2019 (COVID-19) may effectively identify patients with asymptomatic COVID-19. 7 However, no studies have reported the influence of the COVID-19 pandemic and pre-admission screening for COVID-19 on the number of inpatient OFC tests conducted at hospitals. This multicenter nationwide cross-sectional survey aimed to determine the number of inpatient OFC tests conducted at hospitals, infection control measures undertaken, number of nosocomial COVID-19 infections, and positive rates for coronavirus disease 2019 (COVID-19) following universal pre-admission screening. This study was approved by the Ethics Committee of the National Hospital Organization, Sagamihara National Hospital (Approval no. 2022-013). Additional details related to the methods are presented in Supplementary Materials. Of 373 pediatric training facilities contacted (Figure S1), 186 facilities responded to our online questionnaire (response rate, 50%), five were excluded due to missing data, and four were excluded because OFC tests had been suspended during the COVID-19 pandemic. The data from 177 facilities were then analyzed. Concerning OFC tests, all 177 facilities (100%) had checked body temperature, 176 (99%) had checked interview sheets, 172 (97%) had undertaken a medical check-up prior to OFC testing, and 136 (77%) had undertaken universal masking. Concerning inpatient OFC tests, 15,858 OFC tests were conducted, including 12,503 in shared rooms and 3355 in private rooms. Of 177 facilities, 110 (73%) had conducted universal preadmission screening tests for COVID-19 for patients prior to an OFC test and 64 (37%) had conducted universal pre-admission screening tests for COVID-19 for both patients and family members. Of 110 facilities that conducted universal pre-admission screening tests for COVID-19, 55 had performed polymerase chain reaction (PCR) tests, 48 had performed rapid antigen tests, and 10 had performed nucleic acid amplification (loop-mediated isothermal amplification [LAMP]) tests (including duplications). Samples were no role in the study design, collection, analysis, and interpretation of data, writing of the report, or decision to submit the article for publication. CONFLICT OF INTEREST STATEMENT

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Timing of initial symptom onset during milk and wheat challenges: A retrospective study

Yanagida,

Minoura,

Sato

et al. 2024

Immunity Inflam & Disease

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BackgroundAllergic reactions to milk appear sooner than those to hen's eggs, irrespective of the total dose of the oral food challenges (OFCs) and type of matrices. The reported median times for the first symptom occurrence are 20–30 min with milk and 50–60 min with eggs. However, allergic reactions due to wheat have not yet been fully investigated.MethodsThis study retrospectively collected data from OFC for milk and wheat conducted at Sagamihara National Hospital and Sendai Medical Center from 2009 to 2023. The time from the start of the OFC to the onset of symptoms was compared between children with cow's milk and wheat allergy.ResultsTwenty‐five and 13 children reacted to single‐dose OFCs with milk products equivalent to 25 mL of raw cow's milk or 15 g of udon noodles, respectively. The median ages of patients with positive challenges were 1.4 and 2.8 years for milk and wheat, respectively, and the median times for the first symptom occurrence were 20 min and 53 min, respectively (p = .006).ConclusionThis multicenter study was the first to examine the time of symptom appearance during single‐medium‐dose milk and wheat challenges. Allergic reactions to wheat appear later than those for milk during OFC. For multiadministration OFC for wheat, the dosing interval should be longer than 60 min. Our findings can help improve the safety of OFCs.

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Relationship between serum allergen‐specific immunoglobulin E and threshold dose in an oral food challenge

Cited by 9 publications

References 31 publications

Relationship between eliciting doses and the severity of allergic reactions to food

Relationship between eliciting doses and the severity of allergic reactions to food

Hospital oral food challenge tests in the coronavirus disease 2019 pandemic: A nationwide survey

Timing of initial symptom onset during milk and wheat challenges: A retrospective study

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