Comparison of Diagnostic Tests with Oral Food Challenge in a Clinical Trial for Adult Patients with Sesame Anaphylaxis

Sesame food allergy (SFA); especially anaphylaxis, is a life-threatening condition. The accurate diagnosis of SFA is done by skin prick test (SPT), skin prick to prick (SPP) or specific IgE (sIgE) and is confirmed by oral food challenge (OFC). Since there are few studies evaluating and comparing the utility of these methods for diagnosis of sesame anaphylaxis in adult patients, we aimed to compare OFC with diagnostic tests, including SPT, SPP, and sesames IgE; using ImmunoCAP considering the sensitivity and specificity issues in patients with sesame anaphylaxis. Twenty patients with sesame anaphylaxis were diagnosed based on OFC. Then SPT, SPP, and sIgE were evaluated. Sixteen patients had positive OFC; while 4 patients had negative results. Out of 16 OFC+ patients, 7 patients were SPT+, 15 patients were SPP+, and 2 patients had detectable sIgE. A positive SPT indicated 44% sensitivity and 50% specificity. A positive SPP showed 87.5% sensitivity and 75% specificity. A positive ImmunoCAP test demonstrated 12.5% sensitivity and 75% specificity. The AUC of SPP was significant for the diagnosis of sesame anaphylaxis (p=0.038). In conclusion, when the OFC is not possible, the SPP test with natural sesame seed may be applicable in patients with a convincing history instead of the artificial or commercial extracts of sesame used for SPT. Positive SPP is a good alternative diagnostic method for patients with sesame anaphylaxis. Also, the poor sensitivity of SPT and sIgE may indicate the poor discriminative capability of these tests.

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Diagnostic Usefulness of the Serum-Specific IgE, the Skin Prick Test and the Atopy Patch Test Compared with That of the Oral Food Challenge Test

Annals of Dermatology ◽

10.5021/ad.2010.22.4.404 ◽

2010 ◽

Vol 22 (4) ◽

pp. 404 ◽

Cited By ~ 20

Author(s):

Bo Young Chung ◽

Hye One Kim ◽

Chun Wook Park ◽

Cheol Heon Lee

Keyword(s):

Skin Prick Test ◽

Patch Test ◽

Challenge Test ◽

Food Challenge ◽

Specific Ige ◽

Oral Food Challenge ◽

Atopy Patch Test ◽

Prick Test ◽

Diagnostic Usefulness ◽

Food Challenge Test

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Predictive Value Of Combining Food-specific IgE Level With Skin Prick Test And Oral Food Challenge Outcome

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2009.12.347 ◽

2010 ◽

Vol 125 (2) ◽

pp. AB88

Author(s):

J. Garrett ◽

D.R. Naimi ◽

T. Le

Keyword(s):

Skin Prick Test ◽

Predictive Value ◽

Food Challenge ◽

Specific Ige ◽

Oral Food Challenge ◽

Prick Test ◽

Food Specific Ige

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The effectiveness of oral immunotherapy in patients with Sesame anaphylaxis using Omalizumab

10.21203/rs.3.rs-882538/v1 ◽

2021 ◽

Author(s):

Fereshteh Salari ◽

Mohammad Hassan Bemanian ◽

Morteza Fallahpour ◽

Seyed Alireza Mahdaviani ◽

Sima Shokri ◽

...

Keyword(s):

Treatment Effectiveness ◽

Sesame Seed ◽

Food Challenge ◽

Maintenance Phase ◽

Specific Ige ◽

Oral Immunotherapy ◽

Open Label ◽

Prick Test ◽

Wheal Diameter ◽

History Of

Abstract Objective Sesame allergy is the most prevalent allergy to seeds. Oral immunotherapy (OIT) is defined as continuous consumption of an allergen at special doses and time. Omalizumab (Anti-IgE) increases tolerance to allergens used in OIT. This study evaluated the effectiveness of a new sesame OIT protocol in patients with sesame anaphylaxis in combination with omalizumab. Methods In this prospective open-label interventional trial study, 11 patients with a history of sesame anaphylaxis were enrolled after approval by Oral Food Challenge (OFC) test. At baseline, skin prick test (SPT) and skin prick to prick (SPP) test were performed. Serum sesame-specific IgE (sIgE) levels were measured. The maintenance phase was continued at home with daily sesame intake for 4 months. At the end of month 4, the OFC and above-mentioned tests were repeated to evaluate the treatment effectiveness. Results All 11 patients who underwent sesame OIT after 4 months could tolerate a dietary challenge of 22 ml tahini (natural sesame seed, equal to 5,000 mg of sesame protein and higher) and the average of wheal diameter in the SPT and SPP tests significantly decreased after desensitization. Conclusion This OIT protocol may be a promising desensitization strategy for patients with sesame anaphylaxis. Also, omalizumab obviously reduced the severity of reactions.

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Real-World Data Evaluation Of Total IgE, Specific IgE And Omalizumab Therapy In A Cohort Of Allergic Asthma Patients Treated In A Community-Based Practice

Journal of Immunology and Allergy ◽

10.37191/mapsci-2582-6549-1(3)-016 ◽

2020 ◽

Author(s):

Fortune O Alabi

Keyword(s):

Allergic Asthma ◽

Specific Ige ◽

Forced Expiratory Volume ◽

Act Scores ◽

Asthma Control Test ◽

Real World Data ◽

Total Ige ◽

Prick Test ◽

Negative Results ◽

Asthma Patients

Objective: In this study, we: (1) evaluated the correlation between total IgE and the presence of specific IgE; (2) compared the characteristics of patients with positive specific IgE to those with negative specific IgE; and, (3) analyzed the allergic testing results of patients on omalizumab and reported the effect of omalizumab on forced expiratory volume (FEV1) and asthma control test (ACT) results. Methods: Data from patients diagnosed with allergic asthma and seen at Florida Lung, Asthma & Sleep Specialists (FLASS) between January 2016 and June 2019 were analyzed. Parameters evaluated were total IgE, and levels of specific IgE to antigens in the ImmunoCAP test and skin prick test (SPT). Additional parameters for patients on omalizumab therapy for at least 6 months were FEV1, % predicted FEV1 and ACT results. Results: A total of 475 patients (114 males, 361 females) met the inclusion criteria. The mean age was 53 years (range: 17 to 89 years). Of these, 36 patients were not included in the analysis due to incomplete data. Mean total IgE was higher in patients with positive ImmunoCAP results compared to those with negative results (396 KU/L vs. 81.3 KU/L). There was a significant positive correlation between total IgE and levels of positive specific IgE in the ImmunoCAP test (p<0.0001, r=0.36, n=213 patients). The correlation between total IgE and levels of positive allergens in SPT was not significant (p=0.15, n=44 patients) Two positive reactions to allergens were seen in 22% of ImmunoCAP tests and 13% of SPT tests. There was no statistically significant improvement in FEV1 (p=0.097, CI -0.17 to 0.02) and % predicted FEV1 (p=0.109, CI -6.63 to 0.70) in patients who used omalizumab for at least 6 months. There was a statistically significant improvement in ACT scores (p=0.031, CI -4.21 to -0.21) in patients who used omalizumab for at least 6 months. Conclusion: Allergic asthma could be seen in patients who had an absence of specific IgE in ImmunoCAP and a negative reaction to SPT. The benefit of omalizumab therapy is not limited to allergic asthma patients with positive specific IgE.

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Evaluation of oral food challenge doses adjusted by egg white specific IgE for diagnosing egg allergy in infants: case series study

Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology ◽

10.3388/jspaci.35.426 ◽

2021 ◽

Vol 35 (5) ◽

pp. 426-435

Author(s):

Koji Yamasaki ◽

Yutaka Takemura ◽

Tomoyuki Arima ◽

Hiroki Masumi ◽

Megumi Nagai ◽

...

Keyword(s):

Case Series ◽

Food Challenge ◽

Specific Ige ◽

Egg White ◽

Oral Food Challenge ◽

Egg Allergy ◽

Case Series Study ◽

Series Study

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Anaphylaxis following the consumption of pumpkin seeds in a two-year-old child tolerant to its pulp – a case study and a minireview

10.21203/rs.3.rs-112102/v1 ◽

2020 ◽

Author(s):

Julia Gawryjołek ◽

Hanna Ludwig ◽

Magdalena Żbikowska-Gotz ◽

Zbigniew Bartuzi ◽

Aneta Krogulska

Keyword(s):

Storage Proteins ◽

Sesame Seed ◽

Specific Ige ◽

Elimination Diet ◽

Cross Reactivity ◽

Amino Acid Sequences ◽

Pumpkin Seed ◽

Potential Health ◽

Prick Test ◽

Pumpkin Seeds

Abstract BackgroundPumpkin and its seeds are increasingly consumed by children for their potential health benefits. Each day, around 30% of teenagers consume nuts and seeds, including pumpkin seeds. However, there is some evidence that pumpkin seeds may exert allergenic effects and induce severe life-threatening anaphylaxis. Allergy for melon, cucumber, and zucchini, which belong to the same Cucurbitaceae family as pumpkin, are well known, opposite to pumpkin allergy. Few descriptions of allergic reactions associated with pumpkin have been published, especially in children. To date, three cases of pumpkin pulp and two seed cases have been reported among children. Our case report describes a case of pumpkin seed anaphylaxis in a child with good tolerance of pulp.Case presentationIn the present study, a two-year-old child experienced anaphylaxis: generalized urticaria, swollen lips and increasing dyspnea following the consumption of pumpkin seeds. The history showed that although the child had been receiving elimination diet because of atopic dermatitis, the basic dietary element was pumpkin pulp. The skin-prick test was positive for pumpkin seeds (5 mm) but negative for pumpkin pulp (1 mm); allergen-specific IgE was 1.34 kUA/L for seed, and 0.37 kUA/L for pulp. The component resolved diagnosis found IgE to sesame seed, buckwheat and walnut (storage proteins). Based on these findings, severe anaphylactic reaction to pumpkin seeds was identified.ConclusionsIt is possible to develop pumpkin seed anaphylaxis in a child with a tolerance to pumpkin pulp. Pumpkin seeds allergens have not been well characterized. Homology between the amino acid sequences in storage proteins may indicate cross reactivity between different edible seeds and nuts.

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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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