IgE‐sensitization predicts threshold but not anaphylaxis during oral food challenges to cow's milk

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

“…3 Many studies report a correlation between IgE-sensitization and anaphylaxis (Table 3); however, the overlap in SPT/IgE between those with and without anaphylaxis is so extensive that there is insufficient discrimination to predict risk. [14][15][16][17][18]20,27,28,35,39,40,49,51,57,58,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] This is clearly demonstrated in well-curated datasets such as the LEAP study cohort (Figure 2): even IgE to Ara h 2 was not predictive of anaphylaxis at challenge, a finding confirmed elsewhere. 77 Some authors have overestimated the predictive utility of these tests by including non-allergic individuals as 'non-severe' reactors in their analyses.…”

“…Thus, the absence of prior anaphylaxis (at least in peanut‐allergic children) may reflect insufficient allergen exposure rather than an inherently lower risk of anaphylaxis 5,8,9 . However, many patients with prior anaphylaxis to a food only experience milder symptoms subsequently, whether due to accidental allergen exposure 6,10–12 or at formal food challenges 13–20 …”

“…For any given individual patient, therefore, the absence of prior anaphylaxis may be due to insufficient allergen exposure causing previous reactions, (rather than the patient being at an inherently lower risk) 3,5,6,8,9,12 . Therefore, a history (or not) of anaphylaxis is a poor predictor of future anaphylaxis 6,10–20 . Reassuringly, there is no robust evidence that food‐allergic individuals who react to very low levels of allergen are at greater risk of anaphylaxis 3,115–118 …”

“…5,8,9 However, many patients with prior anaphylaxis to a food only experience milder symptoms subsequently, whether due to accidental allergen exposure 6,[10][11][12] or at formal food challenges. [13][14][15][16][17][18][19][20]…”

Reproducibility of food challenge to cow’s milk: Systematic review with individual participant data meta-analysis

“…Five interventional studies (clinical trials of food allergen desensitization) included participants allocated to placebo treatment and who underwent repeat FC to CM at 5 to 12 months after initial baseline challenge. 28,31,33,41,46 Data from these participants were included in the IPD meta-analysis. The dose distributions for baseline DBPCFC in these participants are shown in Fig 3, together with the proportion reacting at each dosing level with anaphylaxis (defined according to WAO 2020 criteria 24 ).…”