Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology

Bindslev‐Jensen, Carsten; Ballmer‐Weber, Barbara; Bengtsson, Ulf; Blanco, Carlos; Ebner, Christof; Hourihane, Jonathan; Knulst, André C.; Moneret-Vautrin, D. A.; Nékám, K; Niggemann, B.; Østerballe, Morten; Ortolani, Claudio; Ring, Johannes; Schnopp, Christina; Werfel, Thomas

doi:10.1111/j.1398-9995.2004.00466.x

Cited by 588 publications

(551 citation statements)

References 72 publications

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“…12 IgE-mediated food allergy was established on the basis of standardised criteria. 13 Reactions were classified as immediate reactions, which occurred within one hour after antibiotic administration, or nonimmediate reactions, which became apparent one hour after the antibiotic exposure. 14 The Ring and Messmer classification was used for immediate reactions.…”

Section: Data Collectionmentioning

confidence: 99%

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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Background: Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases. Methods: We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed. Results: We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group. Conclusions: DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.

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Section: Data Collectionmentioning

confidence: 99%

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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“…As with other foods, the latter tests do not distinguish very well between clinical allergy and asymptomatic sensitization. For the diagnosis, the gold standard remains DBPCFC, according to international guidelines DBPCFC should not be used in case of a clear-cut history of anaphylaxis after consumption of cashew nuts (32). The fact that this test is time-consuming, labour-intensive, expensive and not entirely without risk has prompted research into the development of models predictive of clinical reactivity based on other parameters.…”

Section: Algorithm For the Diagnosis Of Cashew Nut Allergymentioning

confidence: 99%

Systematic review on cashew nut allergy

Valk

Dubois

Wijk

et al. 2014

Allergy

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Recent studies on cashew nut allergy suggest that the prevalence of cashew nut allergy is increasing. Cashew nut consumption by allergic patients can cause severe reactions, including anaphylaxis. This review summarizes current knowledge on cashew nut allergy to facilitate timely clinical recognition and to promote awareness of this emerging food allergy amongst clinicians. The goal of this study is to present a systematic review focused on the clinical aspects of allergy to cashew nut including the characteristics of cashew nut, the prevalence, allergenic components, cross-reactivity, diagnosis and management of cashew nut allergy. The literature search yielded 255 articles of which 40 met our selection criteria and were considered to be relevant for this review. The 40 articles included one prospective study, six retrospective studies and seven case reports. The remaining 26 papers were not directly related to cashew nut allergy. The literature suggests that the prevalence of cashew nut allergy is increasing, although the level of evidence for this is low. A minimal amount of cashew nut allergen may cause a severe allergic reaction, suggesting high potency comparable with other tree nuts and peanuts. Cashew allergy is clearly an underestimated important healthcare problem, especially in children.Although peanut allergy has been on the increase for two decades or more, studies indicate that cashew nut is also becoming an important food allergen (1, 2). The rapid increase in consumption of cashew nuts and the change in eating and cooking habits may be responsible for the increasing significance of cashew nut allergy (2).In this paper, we summarize the relevant information available on epidemiology, allergen components, clinical features, diagnosis, clinical and in vitro cross-sensitization and management of cashew nut allergy. Data sources and literature searchIn our search, we adhered to the methods and procedures of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for reporting this systematic review, excluding irrelevant items. Registration number in PROSPERO is CRD42013004047.We used Ovid MEDLINE and EMBASE databases to identify relevant articles using the string: (Anacardi* sensitiv*) OR allerg*): de, ab, ti for EMBASE. We also checked references to relevant articles ('snowballing').We aimed to include studies focused on the clinical aspects of cashew nut allergy. We considered only studies in English. There was no restriction on publication date. Mouse model studies were excluded. Initially, all articles on cashew nut allergy or on cashew nuts were included. Thereafter articles on contact dermatitis, genetics, product labelling, poisoning, detection methods and possible medicinal effects of cashew plants were excluded. Forty of 255 articles found with the literature search (244 articles) and by 'snowballing (11 articles) were considered relevant for the review. Of these 40 articles, one article was a prospective study and six articles were retrospective stu...

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“…All children were rechallenged every 6 months according to guidelines (6). A child with a positive challenge was considered food hypersensitive until the first negative challenge with the same food type occurred.…”

Section: Data Management and Statisticsmentioning

confidence: 99%

“…Standardized oral challenges were performed in children suspected with FHS according to EAACI guidelines (6). Adverse reaction to food was classified according to the revised nomenclature (1) and further divided into non-allergic FHS and allergic FHS, when immunological mechanisms were demonstrated, i.e., at least one positive test result (SPT or s-IgE).…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Food allergy and food sensitization in early childhood: results from the DARC cohort

Eller¹,

Kjær²,

Høst

et al. 2009

Allergy

Self Cite

152

121

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Background: The prevalence of food hypersensitivity (FHS) and the relationship with atopic dermatitis (AD) is controversial. The aim of this study was to determine the development of FHS and to correlate this with AD in relation to sensitization and symptoms.Methods: This study combines new data from birth to 18 months of age with previous published results from 3 and 6 years. The Danish Allergy Research Centre cohort, including 562 children, is a unique, population‐based, prospective birth cohort, with clinical examinations at all follow‐ups. All children were examined for the development of AD using Hanifin‐Rajka criteria and for FHS using interviews, skin prick test (SPT), specific immunoglobulin E (IgE), and food challenge according to EAACI guidelines.Results: Twenty children were confirmed with FHS to milk, egg, and peanut. FHS peaked at 18 months (3.6%) and then decreased to 1.2% at 72 months of age. No new cases were found after 3 years. Self‐reporting could only be confirmed in 31% of cases. Among the 122 children with AD, 18 had FHS (14.8%). FHS was IgE‐mediated in 95% of the cases but 16 of 20 children were additionally sensitized to other foods which they tolerated. Children with AD were neither more IgE‐sensitized nor had higher levels of IgE when compared with healthy children but they were more persistently sensitized.Conclusions: Sensitization to foods in young children without food allergy seems to be a normal phenomenon. The discrepancy between sensitization, self‐reported food‐related symptoms and confirmed FHS illustrates the need to perform standardized oral challenges in order to confirm the diagnosis of FHS.

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Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology

Cited by 588 publications

References 72 publications

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Systematic review on cashew nut allergy

Food allergy and food sensitization in early childhood: results from the DARC cohort

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