Reproducibility of food challenge to cow’s milk: Systematic review with individual participant data meta-analysis

Turner, Paul J.; Patel, Nandinee; Campbell, Dianne; Sampson, Hugh A.; Maeda, Mayu; Katsunuma, Toshio; Westerhout, Joost; Blom, W. Marty; Baumert, Joseph L.; Houben, Geert F.; Remington, Benjamin C.

doi:10.1016/j.jaci.2022.04.035

Cited by 14 publications

(12 citation statements)

References 59 publications

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“…Therefore, a history (or not) of anaphylaxis is a poor predictor of future anaphylaxis 6,10–20 . Reassuringly, there is no robust evidence that food‐allergic individuals who react to very low levels of allergen are at greater risk of anaphylaxis 3,115–118 …”

Section: Methodsmentioning

confidence: 99%

“…6,[10][11][12][13][14][15][16][17][18][19][20] Reassuringly, there is no robust evidence that food-allergic individuals who react to very low levels of allergen are at greater risk of anaphylaxis. 3,[115][116][117][118] A history of reaction to only relatively large exposures (with no or minimal symptoms to smaller doses) may be useful in informing the approach to allergen avoidance in any given individual, particularly given more recent data suggesting that reaction thresholds for an food-allergic person are fairly reproducible under typical challenge conditions, at least for peanut and cow's milk. 116,118…”

Section: Dosementioning

confidence: 99%

“…3,[115][116][117][118] A history of reaction to only relatively large exposures (with no or minimal symptoms to smaller doses) may be useful in informing the approach to allergen avoidance in any given individual, particularly given more recent data suggesting that reaction thresholds for an food-allergic person are fairly reproducible under typical challenge conditions, at least for peanut and cow's milk. 116,118…”

Section: Dosementioning

confidence: 99%

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Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Turner

Arasi

Ballmer‐Weber

et al. 2022

Allergy

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This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking,

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Section: Methodsmentioning

confidence: 99%

Section: Dosementioning

confidence: 99%

Section: Dosementioning

confidence: 99%

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Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Turner

Arasi

Ballmer‐Weber

et al. 2022

Allergy

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“…During milk OFCs, the ED05 was reported at 2-7 mg of protein [13][14][15][16]; however, a previous systematic review showed that approximately 5% of individuals with a cow's milk allergy react to less than 2.9 mg of protein and that 5% of those with allergic reactions will experience anaphylaxis [15 && ]. Furthermore, children who are allergic to raw milk or egg but are tolerant to baked products containing milk or egg have higher thresholds than those who cannot tolerate baked products [17].…”

Section: Recent Studies Regarding the Threshold Dosementioning

confidence: 99%

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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“…Further analyses have concluded that these thresholds are relatively stable over time periods of up to 2 years for the majority of individuals, at least for peanut and cow's milk. 141,142 An important evidence gap, however, is whether thresholds change over longer periods of time, especially in children. The shift in threshold is limited to a half-log change dose in 70%-80% of individuals-equivalent to a single dosing interval with a PRACTALL-based semi-log dosing regimen (e.g., a change in threshold from 100 mg to 300 mg of peanut protein).…”

Section: Population-based Dose-distribution Curves Have Been Publishedmentioning

confidence: 99%

The future of food allergy: Challenging existing paradigms of clinical practice

Anagnostou

Lieberman

Greenhawt

et al. 2023

Allergy

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The field of food allergy has seen tremendous change over the past 5–10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food‐allergic patients and their families. Additionally, novel diagnostic tools are making their way into clinical practice with the goal to reduce the need for food challenges and assist physicians in the—often complex—diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision‐making has become a key part of medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments as well as the evolution of the field of food allergy in the next decade.

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Reproducibility of food challenge to cow’s milk: Systematic review with individual participant data meta-analysis

Cited by 14 publications

References 59 publications

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

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

The future of food allergy: Challenging existing paradigms of clinical practice

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