Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

Abstract

Background: Severe anaphylactic symptoms can occur during oral food challenges (OFCs). Thus, high-risk patients (e.g., patients with a history of anaphylaxis or high antigen-specific immunoglobulin E [IgE] levels) must carefully undergo OFCs in hospitals. We attempted to identify the risk factors for severe symptoms during OFC testing among high-risk patients. Methods: We retrospectively evaluated patients' characteristics and severe symptoms that were experienced during a double-blind placebo-controlled food challenge test performed before the patients underwent oral immunotherapy between June 2008 and June 2012. Patients were ≥5 years old and had an anaphylactic history or antigen-specific IgE (>30 kUA/L). Severe symptoms were defined using the grading of the Japanese Anaphylaxis Guidelines, which are modified from the European Academy of Allergology and Clinical Immunology Guidelines. Results: We evaluated 393 cases with positive test results, including 98 cases with severe symptoms. The most frequent severe symptoms were respiratory (77%), gastrointestinal (28%), cardiovascular (27%), and neurological (13%) symptoms. Multivariate analysis revealed that the significant factors for a severe reaction were a history of anaphylaxis to the causative food (adjusted odds ratio [OR]: 2.147, p = 0.003), older age (per 1 year increase, adjusted OR: 1.102, p = 0.044), and an egg OFC (adjusted OR: 0.433, p = 0.003). Conclusions: The risk factors for a severe reaction to OFCs were a history of an anaphylactic reaction and older age. An egg OFC was associated with low risk of severe symptoms during OFC. Therefore, OFCs for patients with these risk factors should only be performed under specialist supervision with access to rapid treatment and full resuscitation equipment.

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“…showed that a log-normal (AIC score 8139) was better than either a Weibull (8251) or logistic (10 143) distribution. The ED10 and ED50 derived from the log-normal distribution were 20 mg (95% CI: [15][16][17][18][19][20][21][22][23][24][25] and 300 mg (95% CI: 250-370), respectively. In view of the different age distributions of the Australian and European cohorts, analyses of these two subgroups were performed.…”

Oral Immunotherapy in Japanese Children with Anaphylactic Peanut Allergy

“…material, see www. karger.com/doi/10.1159/000486310) [20,21]. The severity of symptoms was based on the organ with the most severe symptoms.…”

Specific IgE for Fag e 3 Predicts Oral Buckwheat Food Challenge Test Results and Anaphylaxis: A Pilot Study

“…Treatments for provoked reaction were based on the European Academy of Allergy and Clinical Immunology's food allergy and anaphylaxis guidelines [9]. Anaphylaxis was defined according to World Allergy Organization Anaphylaxis Guidelines [10], and severity of symptoms was defined according to Japanese anaphylaxis guidelines [8,11].…”