Analysis of Oral Food Challenge Outcomes in IgE-Mediated Food Allergies to Almond in a Large Cohort

: Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP)

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Total serum IgE level influences oral food challenge tests for IgE-mediated food allergies

Allergy ◽

10.1111/all.12562 ◽

2014 ◽

Vol 70 (3) ◽

pp. 334-337 ◽

Cited By ~ 23

Author(s):

K. Horimukai ◽

K. Hayashi ◽

Y. Tsumura ◽

I. Nomura ◽

M. Narita ◽

...

Keyword(s):

Food Challenge ◽

Oral Food Challenge ◽

Food Allergies ◽

Total Serum ◽

Serum Ige ◽

Challenge Tests ◽

Ige Mediated

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Component-Resolved Diagnosis in Food Allergies

Medicina ◽

10.3390/medicina55080498 ◽

2019 ◽

Vol 55 (8) ◽

pp. 498 ◽

Cited By ~ 4

Author(s):

Elisabetta Calamelli ◽

Lucia Liotti ◽

Isadora Beghetti ◽

Valentina Piccinno ◽

Laura Serra ◽

...

Keyword(s):

Clinical Practice ◽

Unmet Needs ◽

Food Challenge ◽

Specific Ige ◽

Oral Food Challenge ◽

Food Allergies ◽

Specificity And Sensitivity ◽

Sensitization Pattern ◽

Molecular Components ◽

Work Up

Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.

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Diagnosis of food allergies: the impact of oral food challenge testing

Asia Pacific Allergy ◽

10.5415/apallergy.2013.3.1.59 ◽

2013 ◽

Vol 3 (1) ◽

pp. 59 ◽

Cited By ~ 15

Author(s):

Komei Ito

Keyword(s):

Food Challenge ◽

Oral Food Challenge ◽

Food Allergies ◽

Challenge Testing ◽

The Impact

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Using oral food challenges to provide clarity and confidence when diagnosing food allergies

Journal of Food Allergy ◽

10.2500/jfa.2021.3.210002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Justin Greiwe

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Food Challenge ◽

Clinical History ◽

The United States ◽

Oral Immunotherapy ◽

Food Allergies ◽

Ige Mediated ◽

Challenge Education ◽

Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

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An algorithm to safely manage oral food challenge in an office-based setting for children with multiple food allergies

Archives of Asthma Allergy and Immunology ◽

10.29328/journal.aaai.1001027 ◽

2021 ◽

Vol 5 (1) ◽

pp. 030-037

Author(s):

Cottel Nathalie ◽

Dieme Aïcha ◽

Orcel Véronique ◽

Chantran Yannick ◽

Bourgoin-Heck Mélisande ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Validation Cohort ◽

Hospital Setting ◽

Food Challenge ◽

Oral Food Challenge ◽

Low Risk ◽

Food Allergies ◽

Machine Learning Approach ◽

High Positive Predictive Value

Background: In France, from 30% to 35% of children suffer from multiple food allergies (MFA). The gold standard to diagnosis a food allergy is the oral food challenge (OFC) which is conducted in a hospital setting due to risk of anaphylaxis. The aim of this study was to evaluate an algorithm to predict OFCs at low risk of anaphylaxis that could safely be performed in an office-based setting. Methods: Children with MFA and at least one open OFC reactive or non-reactive to other allergens were included. The algorithm was based on multiple clinical and biological parameters related to food allergens, and designed mainly to predict “low-risk” OFCs i.e., practicable in an office-based setting. The algorithm was secondarily tested in a validation cohort. Results: Ninety-one children (median age 9 years) were included; 94% had at least one allergic comorbidity with an average of three OFCs per child. Of the 261 OFCs analyzed, most (192/261, 74%) were non-reactive. The algorithm failed to correctly predict 32 OFCs with a potentially detrimental consequence but among these only three children had severe symptoms. One hundred eighty-four of the 212 “low-risk” OFCs, (88%) were correctly predicted with a high positive predictive value (87%) and low negative predictive value (44%). These results were confirmed with a validation cohort giving a specificity of 98% and negative predictive value of 100%. Conclusion: This study suggests that the algorithm we present here can predict “low-risk” OFCs in children with MFA which could be safely conducted in an office-based setting. Our results must be confirmed with an algorithm-based machine-learning approach.

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Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.189 ◽

2021 ◽

Vol 49 (3) ◽

pp. 185-192

Author(s):

Hilal Unsal ◽

Gokce Ozyilmaz Bozat ◽

Melike Ocak ◽

Aysegul Akarsu ◽

Umit Murat Sahiner ◽

...

Keyword(s):

Food Allergy ◽

Preschool Children ◽

Food Challenge ◽

Oral Food Challenge ◽

Cow’S Milk ◽

Cow's Milk ◽

Tree Nuts ◽

Increased Risk ◽

Hen’S Egg ◽

Ige Mediated

Background: The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks.Objective: Documentation of the rate, spectrum, and predictors of positive reactions is instructive.Methods: Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed.Results: A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly consid-ered food groups were cow’s milk (31.8%), hen’s egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow’s milk, 4.9% with hen’s egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03–14.90]), wheat (OR: 3.80, [CI: 1.64–8.84]), and tree nuts (OR: 2.78, [CI: 1.83–4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27–10.28]) was more likely to elicit anaphylaxis.Conclusion: In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC.

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Evaluation of early skin or laryngeal reaction at oral food challenge

10.22541/au.161188994.48818828/v1 ◽

2021 ◽

Author(s):

Toshinori Nakamura ◽

Yuki Okada ◽

Mayu Maeda ◽

Taro Kamiya ◽

Takanori Imai

Keyword(s):

Prediction Models ◽

Immunoglobulin E ◽

Food Challenge ◽

Serum Levels ◽

Oral Food Challenge ◽

Food Allergies ◽

Specific Immunoglobulin E ◽

Allergic Skin ◽

Test Initiation ◽

Skin Signs

Background: An oral food challenge (OFC) is required for diagnosing food allergies; however, uncertain reactions can impair the determination of when to stop the test. We aimed to determine the associations between immediately occurring mild allergic skin signs/laryngeal symptoms and positive OFC results. Methods: We retrospectively included children (aged 6 months to 15 years) who underwent open OFC for hen’s egg (HE), cow’s milk (CM), or wheat at a single centre between May 2012 and March 2020. Participants with mild skin signs or laryngeal symptoms at OFC initiation were classified as “skin” or “laryngeal” cases, respectively. Using logistic regression, the risk of positive OFC results, in a skin or laryngeal case, was assessed using univariate and multivariate analyses. Age, sex, total target dose, and serum levels of total and food-specific immunoglobulin E were used as covariates in prediction models. Results: In total, 2954, 1126, and 850 tests for HE, CM, and wheat, respectively, were included and comprised 115 (4%) and 25 (0.9%), 92 (9%) and 24 (2%), and 7 (1.3%) and 0 (0%) skin and laryngeal cases, respectively. Children with reactions to both HE and CM had a higher risk of a positive OFC than controls (odds ratio [95% confidence interval]: 4.6 [3.3–6.4], 2.9 [2.0–4.1] and 6.5 [3.0–10.9], 4.9 [2.2–10.9], respectively). Areas under the curves of prediction models ranged from 0.61 to 0.71. Conclusions: Uncertain reactions immediately after test initiation could not robustly predict OFC results, indicating the OFC could be continued under careful observation.

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