Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Food allergy (FA) is a condition with a growing incidence and is a constant concern for the medical world and healthcare providers. With potential symptoms including anaphylaxis, in the event of an allergic reaction the patient’s life may well be endangered. The diagnosis of FA is a continuous challenge because mild cases tend to be ignored or diagnosed late and young children with allergies are cared for by parents, who are not always able to accurately interpret symptoms. It is very important to be able to differentiate FAs from food intolerance and toxic reactions to food. An accurate diagnosis is required to provide personalized management of an FA. More sophisticated and accurate diagnostic tests, including component diagnosis and epitope reactivity, allow the provision of a directed diagnosis, a more accurate therapeutic approach, and a useful prognostic evaluation. Tests used in current practice include the specific search for serum IgE, elimination diets, oral food challenges, single, blind, and double-blind (DBPCFC) tests, as well as skin tests. The risk of anaphylaxis can be assessed by molecular diagnostics/component-resolved diagnosis (CRD) and by conducting a basophilic activation test (BAT). These tests allow a planned, personalized treatment based on molecular and clinical profiles. CRD can determine the individual profile of allergic molecular reactivity and enable the formulation of a prognostic judgment. Our article highlights the importance of knowing the immune mechanisms, diagnostics, and immunotherapies in FAs. Starting from observing exposure to food allergens, to identifying allergic reactions, analysing the severity of clinical manifestations, noting the possibilities of diagnosis, and illustrating adequate management strategies.

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Efficacy of birch-pollen immunotherapy on cross-reactive food allergy confirmed by skin tests and double-blind food challenges

Clinical & Experimental Allergy ◽

10.1111/j.1365-2222.2004.1939.x ◽

2004 ◽

Vol 34 (5) ◽

pp. 761-769 ◽

Cited By ~ 117

Author(s):

S. T. H. P. Bolhaar ◽

M. M. Tiemessen ◽

L. Zuidmeer ◽

A. van Leeuwen ◽

K. Hoffmann-Sommergruber ◽

...

Keyword(s):

Food Allergy ◽

Birch Pollen ◽

Skin Tests ◽

Double Blind ◽

Food Challenges

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Late Type of Bronchial Response to Milk Ingestion Challenge: A Comparison of Open and Double-Blind Challenge

Journal of Allergy ◽

10.1155/2012/515267 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11

Author(s):

Zdenek Pelikan

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Diagnostic Value ◽

Skin Tests ◽

Natural Food ◽

Double Blind ◽

Positive Skin ◽

Asthma Patients ◽

Natural Foods ◽

Milk Ingestion

Background. In some asthmatics the food allergy, for example, to milk, can participate in their bronchial complaints. The role of food allergy should be confirmed definitively by food ingestion challenge performed by an open challenge with natural foods (OFICH) or by a double-blind placebo-controlled food challenge (DBPCFC). Objectives. To investigate the diagnostic value of these techniques for confirmation of a suspected milk allergy in bronchial asthma patients. Methods. In 54 asthmatics with a positive history and/or positive skin tests for milk the 54 OFICH, and DBPCFC, were performed in combination with spirometry. Results. The 54 patients developed 39 positive late asthmatic responses (LAR) and 15 negative asthmatic responses to OFICH and 40 positive LARs and 14 negative responses to DBPCFC. The overall correlation between the OFICH and DBPCFC was statistically significant (). Conclusions. This study has confirmed the existence of LAR to milk ingestion performed by OFICH and DBPCFC in combination with spirometry. The results obtained by both the techniques did not differ significantly. The OFICH with natural food combined with monitoring of objective parameter(s), such as spirometry, seems to be a suitable method for detection of the food allergy in asthmatics. The DBPCFC can be performed as an additional check, if necessary.

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Changes in Blood Leukocyte Distribution during Double-Blind, Placebo-Controlled Food Challenges in Children with Atopic Dermatitis and Suspected Food Allergy

International Archives of Allergy and Immunology ◽

10.1159/000023933 ◽

1998 ◽

Vol 116 (2) ◽

pp. 110-115 ◽

Cited By ~ 15

Author(s):

Kirsten Beyer ◽

Harald Renz ◽

Ulrich Wahn ◽

Bodo Niggemann

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Double Blind ◽

Double Blind Placebo ◽

Food Challenges ◽

Blood Leukocyte

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Food Allergy-Related Quality of Life After Double-Blind, Placebo-Controlled Food Challenges in Adults, Adolescents, and Children

PEDIATRICS ◽

10.1542/peds.2013-2294jj ◽

2013 ◽

Vol 132 (Supplement) ◽

pp. S23-S23

Author(s):

M. R. Lester

Keyword(s):

Quality Of Life ◽

Food Allergy ◽

Double Blind ◽

Double Blind Placebo ◽

Related Quality ◽

Food Challenges

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Oral food challenges

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200008 ◽

2020 ◽

Vol 2 (1) ◽

pp. 31-34

Author(s):

Amal H. Assa’ad

Keyword(s):

Food Allergy ◽

Peanut Allergy ◽

Food Challenge ◽

Oral Food Challenge ◽

Allergic Reactions ◽

Double Blind ◽

Trained Personnel ◽

Open Food Challenge ◽

Food Challenges ◽

Shed Light

Oral food challenge (OFC) is a procedure that is conducted most commonly by allergist/immunologists in their office or in food allergy centers to confirm a food allergy or to confirm tolerance to the food. The procedure as conducted in clinical practice is mostly open food challenge and, in research, a double-blind, placebo controlled food challenge. OFC has associated risks that can be minimized by having the challenges conducted by trained personnel who are prepared to treat allergic reactions and who have rescue medications available. However, OFCs have tremendous benefits to the patients and their families, including the potential to determine that a food is no longer an allergen and can be introduced into the diet. Even OFCs that result in clinical reactions have the benefit of confirming the food allergy and demonstrating the therapeutic effect of the rescue medications. The study of the outcomes of OFC has shed light on food allergy reactions and characteristics of the patients with food allergy as well as on the value of other diagnostic tests compared with OFC. OFCs have helped establish food allergy thresholds, confirm that subjects enrolled in research studies have the allergy, and demonstrate the response to the therapies tested in terms of ameliorating the allergic response or raising the reaction threshold. OFCs have also been used to promote the recent guidelines for the prevention of peanut allergy by identifying the infants at risk for peanut allergy but who are not allergic yet.

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Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis

Journal of Allergy and Clinical Immunology ◽

10.1016/0091-6749(84)90083-6 ◽

1984 ◽

Vol 74 (1) ◽

pp. 26-33 ◽

Cited By ~ 398

Author(s):

H SAMPSON ◽

R ALBERGO

Keyword(s):

Atopic Dermatitis ◽

Skin Tests ◽

Double Blind ◽

Double Blind Placebo ◽

Comparison Of Results ◽

Food Challenges

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Association of STAT6 gene variants with food allergy diagnosed by double‐blind placebo‐controlled food challenges

Allergy ◽

10.1111/all.13432 ◽

2018 ◽

Vol 73 (6) ◽

pp. 1337-1341 ◽

Cited By ~ 12

Author(s):

C. D. Ginkel ◽

M. E. Pettersson ◽

A. E. J. Dubois ◽

G. H. Koppelman

Keyword(s):

Food Allergy ◽

Gene Variants ◽

Double Blind ◽

Double Blind Placebo ◽

Food Challenges

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Analysis of a Large Standardized Food Challenge Data Set to Determine Predictors of Positive Outcome Across Multiple Allergens

Frontiers in Immunology ◽

10.3389/fimmu.2018.02689 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 9

Author(s):

Sayantani Sindher ◽

Andrew J. Long ◽

Natasha Purington ◽

Madeleine Chollet ◽

Sara Slatkin ◽

...

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Diagnostic Methods ◽

Population Characteristics ◽

Food Allergies ◽

Double Blind ◽

Data Set ◽

Prick Test ◽

Increased Risk ◽

Food Challenges

Background: Double-blind placebo-controlled food challenges (DBPCFCs) remain the gold standard for the diagnosis of food allergy; however, challenges require significant time and resources and place the patient at an increased risk for severe allergic adverse events. There have been continued efforts to identify alternative diagnostic methods to replace or minimize the need for oral food challenges (OFCs) in the diagnosis of food allergy.Methods: Data was extracted for all IRB-approved, Stanford-initiated clinical protocols involving standardized screening OFCs to a cumulative dose of 500 mg protein to any of 11 food allergens in participants with elevated skin prick test (SPT) and/or specific IgE (sIgE) values to the challenged food across 7 sites. Baseline population characteristics, biomarkers, and challenge outcomes were analyzed to develop diagnostic criteria predictive of positive OFCs across multiple allergens in our multi-allergic cohorts.Results: A total of 1247 OFCs completed by 427 participants were analyzed in this cohort. Eighty-five percent of all OFCs had positive challenges. A history of atopic dermatitis and multiple food allergies were significantly associated with a higher risk of positive OFCs. The majority of food-specific SPT, sIgE, and sIgE/total IgE (tIgE) thresholds calculated from cumulative tolerated dose (CTD)-dependent receiver operator curves (ROC) had high discrimination of OFC outcome (area under the curves > 0.75). Participants with values above the thresholds were more likely to have positive challenges.Conclusions: This is the first study, to our knowledge, to not only adjust for tolerated allergen dose in predicting OFC outcome, but to also use this method to establish biomarker thresholds. The presented findings suggest that readily obtainable biomarker values and patient demographics may be of use in the prediction of OFC outcome and food allergy. In the subset of patients with SPT or sIgE values above the thresholds, values appear highly predictive of a positive OFC and true food allergy. While these values are relatively high, they may serve as an appropriate substitute for food challenges in clinical and research settings.

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