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

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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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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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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Work Group report: Oral food challenge testing

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2009.03.042 ◽

2009 ◽

Vol 123 (6) ◽

pp. S365-S383 ◽

Cited By ~ 336

Author(s):

Anna Nowak-Węgrzyn ◽

Amal H. Assa'ad ◽

Sami L. Bahna ◽

S. Allan Bock ◽

Scott H. Sicherer ◽

...

Keyword(s):

Work Group ◽

Food Challenge ◽

Oral Food Challenge ◽

Challenge Testing ◽

Group Report

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Dietary Normalization Following A Successful Oral Food Challenge In Children With Food Allergies

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2020.12.374 ◽

2021 ◽

Vol 147 (2) ◽

pp. AB100

Author(s):

Elizaveta Rakhmanova ◽

Kuang-Chih Hsiao

Keyword(s):

Food Challenge ◽

Oral Food Challenge ◽

Food Allergies

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Food Allergy Management Has Been Negatively Impacted During the COVID-19 Pandemic

Asthma Allergy Immunology ◽

10.21911/aai.628 ◽

2021 ◽

Author(s):

Elif Soyak Aytekin ◽

Sevda Tüten Dal ◽

Hilal Ünsal ◽

Ayşegül Akarsu ◽

Melike Ocak ◽

...

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Oral Food Challenge ◽

Food Allergies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dietary Compliance ◽

Trial Experience ◽

Related Risk ◽

Home Food

ABSTRACT Objective: The coronavirus disease 2019 (COVID-19) pandemic creates secondary problems for the health care system, and understanding specific issues can guide the management of the pandemic and its future consequences. We aimed to characterize the problems and related risk factors experienced with outpatient compliance and dietary compliance of children with food allergies during the COVID-19 pandemic. Materials and Methods: A cross-sectional survey was conducted on the mothers of children with ongoing food allergies, eight months after Turkey’s first confirmed case of COVID 19. Results: Of the 288 patients, 76.3% and 40.2% were non-adherent to their scheduled appointments and oral food challenge, respectively, during the pandemic. The group non-adherent to their scheduled visit was significantly older (p=0.005), had more frequent home food trials without the consent of their physicians (p<0.001), and had less usable epinephrine auto-injectors (EAI) available compared with the adherent group (p<0.001). Eighty-nine patients (30.9%) with home food trial experience had more essential food allergies (p<0.001) and experienced more allergic reactions (p=0.002), compared with patients who adhered to dietary elimination. Thirty parents (10.4%) eliminated some foods from their children’s diet because of the suspected reactions. Conclusion: The COVID-19 pandemic, significantly reduces adherence with scheduled appointments and OFC, and increases home food trials and food eliminations without physician approval. Keywords: The COVID-19 pandemic, food allergy, compliance, telemedicine, oral food challenge

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Oral Food Challenge

Medicina ◽

10.3390/medicina55100651 ◽

2019 ◽

Vol 55 (10) ◽

pp. 651

Author(s):

Calvani ◽

Bianchi ◽

Reginelli ◽

Peresso ◽

Testa

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Clinical History ◽

Specific Ige ◽

Oral Food Challenge ◽

Food Allergies ◽

Pediatric Allergy ◽

Expert Review ◽

Ige Mediated ◽

Food Specific Ige

: 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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