Long‐term prognosis after low‐dose peanut challenge for patients with a history of anaphylaxis

Akamatsu, Nobuko; Nagakura, Ken‐ichi; Sato, Sakura; Yanagida, Noriyuki; Ebisawa, Motohiro

doi:10.1111/pai.14031

Cited by 3 publications

(2 citation statements)

References 10 publications

(8 reference statements)

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“…In school children, low-dose reactivity is one of the factors representing persistent HE or peanut allergy. 27,28 Additionally, children with low-dose reactivity may have an extended period during which they are at risk of experiencing AAR compared with those with low-dose tolerance. Therefore, children with low-dose reactivity are likely to experience AAR, and evaluation of low-dose reactivity would be useful for managing food allergies.…”

Section: Discussionmentioning

confidence: 99%

Accidental Allergic Reactions to Immediate-Type Food Allergens in Japanese Children: A Single-Center Study

Yanagida,

Miura,

Nagakura

et al. 2023

Preprint

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Background: Accidental allergic reactions (AAR) in children are under-studied, especially with precise pediatrician-based exact diagnoses and follow-ups. This study aimed to assess the prevalence and risk factors for AAR in Japanese children with immediate-type food allergies. Methods: This single-center study included children with immediate-type hen’s egg (HE), cow’s milk (CM), wheat, or peanut allergy who had been followed-up regularly at a national center specialized for allergy in Japan. Low-dose reactivity was defined as allergic reactions to a low dose of ≤250, ≤102, ≤53, or ≤133 mg HE, CM, wheat, or peanut protein, respectively. From January to December 2020, pediatricians followed the AAR experience every 2–4 months. Risk factors for AAR were analyzed using multiple logistic regression. Results: Of the 1096 participants, 609, 457, 138, and 90 had HE, CM, wheat, and peanut allergies, respectively. In this cohort, the median age was 5.0 years, 39% had completely eliminated allergenic food, and 24% had low-dose reactivity. The annual AAR rate was 0.130 in all sub-cohorts. Moderate and severe symptoms occurred in 50% and 0.7%, respectively, of children who experienced AAR. Multiple logistic regression revealed that low-dose reactivity was a significant risk factor for AAR in the overall, HE, and CM cohorts, respectively ( p <0.001, p = 0.029 and 0.036). Conclusion: In Japanese children with immediate-type food allergies, the annualized rate of AAR was relatively low; however, half of the participants with AAR had moderate to severe symptoms. Children, especially those with low-dose reactivity, would require careful risk management of AAR.

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Section: Discussionmentioning

confidence: 99%

Accidental Allergic Reactions to Immediate-Type Food Allergens in Japanese Children: A Single-Center Study

Yanagida,

Miura,

Nagakura

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In school children, children with low-dose reactivity in HE or peanut allergy had difficulty acquiring tolerance. 19,28 Additionally, children with low-dose reactivity may have an extended period during which they are at risk of experiencing AAR compared with those with low-dose tolerance. Therefore, children with low-dose reactivity are likely to experience AAR, and evaluation of low-dose reactivity would be useful for managing food allergies in routine clinical practice.…”

Section: Notementioning

confidence: 99%

Accidental allergic reactions to immediate‐type food allergens in Japanese children: A single‐center study

Miura,

Nagakura,

Takahashi

et al. 2024

Pediatric Allergy Immunology

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BackgroundFew studies have assessed the nature of accidental allergic reactions (AAR). We assessed the prevalence and risk factors for AAR in Japanese children.MethodsThis study included children with immediate‐type hen's egg (HE), cow's milk (CM), wheat, or peanut allergy who developed allergic reactions within at least 2 years and were followed up regularly at a single national allergy center in Japan. From January to December 2020, low‐dose reactivity was defined as allergic reactions to ≤250, ≤102, ≤53, or ≤ 133 mg of HE, CM, wheat, or peanut protein, respectively. The annualized AAR rate showed the number of reactions per patient per year (95% confidence interval). AAR risk factors were analyzed using multiple logistic regression.ResultsOf the 1096 participants, 609, 457, 138, and 90 had HE, CM, wheat, and peanut allergies, respectively. The median (interquartile range) age was 5.0 (2.3–8.6) years, 39% had completely eliminated allergenic food, and 24% had low‐dose reactivity. The annualized AAR rate was 0.130 (0.109–0.153) in all sub‐cohorts. Moderate and severe symptoms occurred in 50% and 0.7%, respectively, of children who experienced AAR. Multiple logistic regression revealed that low‐dose reactivity was a significant risk factor for AAR in the overall and CM cohorts, respectively (p < .001 and p = .036).ConclusionIn this single‐center study in Japan, the annualized AAR rate was relatively low during the COVID‐19 pandemic; however, half of the participants with AAR had moderate to severe symptoms. Especially in the case of low‐dose reactivity, children would require careful AAR risk management.

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Management of food allergy based on oral food challenge

Ishibashi,

Yanagida,

Sato

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Food allergy is a growing health problem that affects both patients and society in multiple ways. Despite the emergence of novel diagnostic tools, such as component-resolved diagnostics (CRD) and basophil activation tests (BAT), oral food challenge (OFC) still plays an indispensable role in the management of food allergies. This review aimed to highlight the indications and safety concerns of conducting an OFC and to provide insights into post-OFC management based on recent findings. Recent findings Standardized OFC protocols have regional diversification, especially in Japan and Western countries. Recent studies suggested that the interval between doses should be at least more than an hour. Furthermore, applying a stepwise method tailored to the patient's specific immunoglobulin E level and history of anaphylaxis seems to mitigate these risks. Recent surveys have shown that, following a positive OFC, options other than strict avoidance are also selected. Summary OFC serves diverse purposes, yet the risks it carries warrant caution. The stepwise protocol appears promising for its safety. Subthreshold consumption following OFC shows potential; however, further research on its efficacy and safety is required. Management following OFC should be tailored and well discussed between clinicians and patients.

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Long‐term prognosis after low‐dose peanut challenge for patients with a history of anaphylaxis

Cited by 3 publications

References 10 publications

Accidental Allergic Reactions to Immediate-Type Food Allergens in Japanese Children: A Single-Center Study

Accidental Allergic Reactions to Immediate-Type Food Allergens in Japanese Children: A Single-Center Study

Accidental allergic reactions to immediate‐type food allergens in Japanese children: A single‐center study

Management of food allergy based on oral food challenge

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