scholarly journals Evaluation of early skin or laryngeal reaction at oral food challenge

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.

scholarly journals Skin Prick Tests and Patch Tests in Children with Food Allergies.

2020 ◽  
pp. 1-4
Keyword(s):  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Food Challenge ◽  
Diagnostic Methods ◽  
Food Allergies ◽  
Sufficient Evidence ◽  
Patch Tests ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
Skin Prick Tests

Abstract Diagnosing food allergies can be challenging for patients and health professionals. Standard diagnostic methods include skin prick testing, food-specific immunoglobulin E (IgE) and oral food challenge. There is no scientifically sufficient evidence for routine use of patch testing for food allergy evaluation in children.

scholarly journals Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge

2018 ◽  
Vol 29 (4) ◽  
pp. 417-424 ◽  
Author(s):  
Noriyuki Yanagida ◽  
Sakura Sato ◽  
Kyohei Takahashi ◽  
Ken-ichi Nagakura ◽  
Tomoyuki Asaumi ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Food Challenge ◽  
Oral Food Challenge ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin

scholarly journals Component-Resolved Diagnosis in Food Allergies

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 498 ◽  
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.

In vitro testing for immunoglobulin E-mediated food allergies

1996 ◽  
Vol 115 (4) ◽  
pp. 312-318 ◽  
Author(s):  
Jacquelynne P. Corey ◽  
Anil Gungor
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Diagnostic Methods ◽  
Food Allergies ◽  
Vitro Assay ◽  
Positive Screen ◽  
Specific Immunoglobulin E ◽  
Radioallergosorbent Test ◽  
Specific Immunoglobulin

The role of immunoglobulin E-mediated food allergy in subjects with allergic disorders, especially in patients with rhinitis and sinusitis, is underestimated by clinicians because of the initial attribution of these disorders to immediate-type hypersensitivity reactions. The difficulties of diagnosing food-related reactions have caused further delay in their recognition and incorporation into the daily practice of diagnosing food allergy. Two of the diagnostic methods for food allergy are the in vitro assay of total immunoglobulin E and the measurement of food-specific immunoglobulin E levels in serum with the radioallergosorbent test. Measurement of specific immunoglobulin E level is the most commonly used but also one of the most controversial techniques. We examined 123 patients with rhinitis who were referred to our otolaryngology/allergy clinic between January and April 1995. All patients received an initial radioallergosorbent test screen, which included milk. We determined the positive predictive value of this positive screen and, in particular, of a positive test for milk in the diagnosis of immunoglobulin E-mediated food allergies in these patients. Conclusions were based on comparison with the result of an additional radioallergosorbent test food panel consisting of eight common and two investigational food allergens. (Otolaryngol Head Neck Surg 1996;115:312-8.)

Increased serum levels of food antigen-specific immunoglobulin E in patients with chronic pancreatitis (CP)

2000 ◽  
Vol 118 (4) ◽  
pp. A423
Author(s):  
Martin Raithel ◽  
Harald Dormann ◽  
Dieter Schwab ◽  
Sandra Winterkamp ◽  
Michael Weidenhiller ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Immunoglobulin E ◽  
Serum Levels ◽  
Food Antigen ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin

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

2021 ◽  
Vol 3 (1) ◽  
pp. 3-7 ◽  
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.

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

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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