Risk of oral food challenges

Perry, Tamara T.; Matsui, Elizabeth C.; Conover-Walker, Mary Kay; Wood, Robert A.

doi:10.1016/j.jaci.2004.07.063

Cited by 234 publications

(195 citation statements)

References 16 publications

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“…[5][6][7] Literature regarding food-allergic reactions and response to symptoms primarily include retrospective chart reviews, 10,11 patient recall, 6,[12][13][14] or oral food challenge data. 15,16 Errors have been identified including misreading labels, poor communication in restaurants, cross-contact of allergens, and lack of vigilance. [5][6][7] In our comprehensive prospective study, we identified a number of pitfalls, including novel ones (purposeful exposure, high frequency of reactions from food not provided by parents), and their relative frequency, that warrant attention for anticipatory guidance and have implications for education (Table 4).…”

Section: Figurementioning

confidence: 99%

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data are available on the frequency, severity, and circumstances of reactions and caretaker medical response. WHAT THIS STUDY ADDS:This study describes food allergy reaction frequency, circumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental allergen feeding, and underutilization of epinephrine for severe reactions. abstract OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. METHODS:We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions. , with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P , .0001) and higher foodspecific immunoglobulin E (P , .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration. RESULTS:CONCLUSIONS: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers. Pediatrics 2012;130:e25-e32 AUTHORS:

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Section: Figurementioning

confidence: 99%

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

et al. 2012

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“…A positive challenge was defined as the presence of objective symptoms (oral, skin, gastrointestinal, respiratory, and/or cardiovascular) noted by the allergist during the challenge. 3,16 In a case of nonobjective symptoms such as itchiness, abdominal pain, or throat tightness, OFC was temporarily paused until either complete resolution of symptoms or appearance of typical objective symptoms of food allergy. If symptoms promptly resolved spontaneously, then the previous dose was repeated.…”

Section: Oral Challengesmentioning

confidence: 99%

Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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Children 2 Oral food challenges (OFCs) are the recommended procedure to document the resolution of food allergy, 3,4 but they are time-consuming, difficult to perform, require resources, and expose the patient to the risk of a significant allergic reaction. Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs.5-10 However, FSIgE levels are less effective in identifying children who experience a negative OFC. 11In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%.3 Previous research 11 has revealed that FSIgE of Յ2 kUa/L (or Յ5 kUa/L for peanuts without a history of previous reaction) are associated with an estimated Յ50% likelihood of reacting to eggs, milk, or peanuts during an OFC, and these FSIgE values have been incorporated into clinical guidelines.11 Identifying additional clinical and laboratory factors associated with negative OFC within this group of patients would improve patient care by decreasing the number of unnecessary (i.e., predictably positive) OFCs.Recently, it was shown that the incorporation of clinical and laboratory data to supplement FSIgE levels effectively diagnosed food allergy and might eliminate the need for some OFCs to confirm the presence of food allergy. 12,13 We extended this approach to the clinical scenario aimed at increasing the accuracy of identifying children who will experience negative OFCs. We aimed to investigate if there are food-specific combinations of clinical and laboratory characteristics that define subgroups of children, undergoing OFC based on the guideline-recommended FSIgE levels, 3 who are most likely to experience a negative OFC.

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“…In the present study, we had a positive reaction rate of 5.1%, which was considerably lower than that reported in other studies. (16) This may be attributed to the fact that avoidance due to fear rather than true allergy was the diagnosis in the majority of our patients; that is, these children may not have been allergic to the abstained foods in the first place. These children can be classified as a low-risk cohort whose pretest probability of clinical reactivity to foods is low.…”

Section: Discussionmentioning

confidence: 84%

A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

Thalayasingam

Tan

Bever

2015

smedj

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INTRODUCTIONThe prevalence of perceived food allergies exceeds that of true food allergies, especially if the estimates are based on selfreported surveys.(1) A substantial number of parents perceive food allergies in their children based on subjective reactions or allergy tests alone.(2) Others readily draw a connection between certain foods and chronic illnesses such as eczema.(2) In addition, cross-reactive foods are avoided in children with certain food allergies, as parents fear that their children will react even if they have not been tested for or eaten these foods. This is seen in many peanut-allergic children who avoid tree nuts but have not been tested for clinical reactivity to tree nuts. Similarly, demonstrating sensitisation alone, via positive skin prick tests (SPTs) or raised serum immunoglobulin E (IgE) levels, does not necessarily equate to having an allergy; (3) and eczema flare-ups are also not always related to foods.(4) Thus, it is not uncommon for children seen at allergy clinics to be on strict elimination diets based on incomplete information regarding potential food allergies. While the vast majority of these children are not allergic to the omitted foods, they are made to adhere to diets that are similar to those of patients with life-threatening reactions to these foods; this results in unnecessary food avoidance, an impaired quality of life, potentially poor weight gain and malnutrition. (5) An oral food challenge (OFC) can be used to provide parents with an objective measure of their child's true food allergies. As no local data is available on the use of OFCs to measure the presence or absence of food allergies, a retrospective chart review was carried out to describe the indications that prompted OFCs and the outcomes of the OFCs conducted. METHODSThis study was a retrospective review conducted on patients aged ≤ 18 years who underwent OFCs at the Paediatric Allergy Clinic of the National University Hospital, Singapore, from 2008 to 2010. Most of the patients were self-referred, followed by those referred from private clinics and polyclinics. The diagnostic workup of suspected food-related reactions is shown in Fig. 1. Our centre uses published diagnostic decision thresholds for serum IgE tests and SPTs that can help predict the likelihood of an allergic reaction if a particular food is ingested. (6,7) The decision to perform the challenge was based on these thresholds and the patient's clinical history. Patients generally did not proceed with an OFC if the treating physician felt that there was a high likelihood of a positive challenge, such as in the context of a recent life-threatening reaction to that food. Some patients underwent challenges for more than one food and a few patients were challenged repeatedly for the same food if their reactions were deemed to be subjective.

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Risk of oral food challenges

Cited by 234 publications

References 16 publications

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Clinical and laboratory factors associated with negative oral food challenges

A review of oral food challenges in children presenting to a single tertiary centre with perceived or true food allergies

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