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

Abstract

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 (P < 0.01). 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.

Protective Effects of Oral Disodium Cromoglycate on the Asthmatic Responses Induced by Food Allergy

“…The patients were examined by means of routine diagnostic procedure, serving also as an exclusion-inclusion check i.e. confirmation of a patient 's eligibility for the study and the exclusion of contraindications [4,[6][7][8]10,11,19,20,[23][24][25]39,41,45,[47][48][49][51][52][53][54][55][56][57][58]60,61,63,64]. This procedure consisted of: (1) the general part: disease history, physical examination, basic laboratory tests, X-ray of chest and sinuses, lung function, determination of blood gases and bacteriological examination of the sputum; (2) the allergologic part: skin tests with inhalant and food allergens, bronchial histamine threshold [61,[75][76][77][78][79], and determination of the serum immunoglobulins; (3) 109 bronchial challenges with inhalant allergens (BPT) [75][76][77][78][79] and (4) 97 ingestion challenges with selected foods, suspected from the history and/or skin tests, in combination with recording of the lung function (FVC and FEV 1 ).…”

“…Nevertheless, later evidence has been found for the possible involvement of also other, so-called non-IgE-mediated, hypersensitivity mechanism types, such as late (immune-complex-mediated) and delayed (cell-mediated) types of hypersensitivity in food allergy [7][8][9][10][12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Food allergy can be involved in various disorders of the respiratory tract, such as bronchial asthma, allergic rhinitis, sinusopathy, etc [1][2][3][6][7][8][9][10][12][13][14][15][16][17][19][20][21][23][24]…”

“…Food allergy can be involved in various disorders of the respiratory tract, such as bronchial asthma, allergic rhinitis, sinusopathy, etc [1][2][3][6][7][8][9][10][12][13][14][15][16][17][19][20][21][23][24][25][38][39][40][41][42]. This involvement can occur either in a primary form, where the foods act as the sole causal factor in this disorder, or in a more frequently occurring secondary form, wherein addition to the already existing bronchial asthma to inhalant allergens, the foods play an additional role [6,7,19,[23][24][25]43]. The involvement of food allergy in patients with bronchial asthma leads to the development of various types of asthmatic response, such as immediate/early (IAR/ EAR), late (LAR), dual late (DLAR, a combination of an immediate and a late response),delayed (DYAR) and dual delayed (DDYAR, a combination of an immediate and a delayed) responses, described in our previous papers and reported also by other investigators [7,8,[12][13][14]16,17,[19][20][21][23]…”

“…This involvement can occur either in a primary form, where the foods act as the sole causal factor in this disorder, or in a more frequently occurring secondary form, wherein addition to the already existing bronchial asthma to inhalant allergens, the foods play an additional role [6,7,19,[23][24][25]43]. The involvement of food allergy in patients with bronchial asthma leads to the development of various types of asthmatic response, such as immediate/early (IAR/ EAR), late (LAR), dual late (DLAR, a combination of an immediate and a late response),delayed (DYAR) and dual delayed (DDYAR, a combination of an immediate and a delayed) responses, described in our previous papers and reported also by other investigators [7,8,[12][13][14]16,17,[19][20][21][23][24][25][27][28][29][30][31][32][33][34][35]37,38,[44][45][46]. The particular types of asthmatic response to food ingestion challenge differ each from other with respect to their clinical features, the association with other diagnostic parameters and the possibly underlying immunologic mechanisms [7,[9][10][11][12][13][14]…”

“…The provocation tests with foods should be considered to be definite confirmation of the involvement of the certain foods in the patient's complaints, e.g. bronchial asthma [1][2][3][4][5][6][7][8][9][10][11][12][14][15][16][19][20][21][23][24][25]30,31,[37][38][39][40]41,. Unfortunately the role of food allergy in patients with bronchial asthma is still underestimated by the clinicians because: (a) there is a the dearth of information concerning this problem; (b) the involvement of food allergy in patients with allergic disorders is complex, has various forms and modifications; (c) the diagnostic procedure(s) and confirmation of the in allergy in the patient's complaints is not an easy process, it requires specific conditions and precautions and is not performed in all clinics [1][2][3][4][5][6][7][8][9][10][11][12][14][15][16][19][20]…”