Should lip dosing be reconsidered when performing open food challenges?

Venter, Carina; Maslin, Kate; Grundy, Jane; Glasbey, Gillian; Dean, Tara

doi:10.1111/pai.12765

Cited by 2 publications

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings with respect to false-positive LDC are consistent with the observations of Hourihane et al 6 . Venter et al 14 also assessed the diagnostic utility of LDC, and found that all 9 of 13 patients with a positive LDC also had a positive OFC; however, 4 children did not proceed to formal food challenge. Both Rance and Dutau 4 and ourselves observed children who developed systemic symptoms following LDC; thus, the same safety measures should be in place for LDC as for routine OFC.…”

Section: Discussionsupporting

confidence: 91%

Lip Dose Challenges in Food Allergy: Current Practice and Diagnostic Utility in the United Kingdom

Vazquez‐Ortiz

Ludman

Aston

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

View full text Add to dashboard Cite

BackgroundLip dose challenges (LDCs) are often performed as an initial step before oral food challenges (OFCs). However, guidance on how to perform and interpret LDCs is unclear, and data are lacking regarding the diagnostic accuracy of LDCs.ObjectiveTo investigate current practice with respect to LDCs among UK allergy health care professionals, and to evaluate the diagnostic utility of LDCs in children undergoing OFCs for IgE-mediated food allergy.MethodsWe used an electronic survey to assess the use of LDCs by UK Allergy clinics. Separately, we prospectively recruited children undergoing “low-risk” OFCs for suspected IgE-mediated food allergy from 2 large specialist allergy units in London. LDC was performed 30 minutes before the OFC, by applying the food to the inner lip for 30 seconds. Objective symptoms were considered a positive outcome. All patients subsequently proceeded to OFC regardless of LDC outcome, and outcome assessed according to PRACTALL consensus.ResultsWe received 147 responses to the online survey, representing 67% of registered pediatric allergy clinics in the United Kingdom. Eighty percent of respondents (representing 81% of responding centers) included LDC as the first step of OFC in routine clinical practice. There was a wide variation in both how LDCs were performed and interpreted, with one-third not proceeding to OFC if LDC resulted in subjective symptoms. In the prospective study, 198 children (mean age, 7 years) with conclusive OFCs were included. Foods tested were tree nuts (30%), peanut (16.6%), egg (16%), fish (10.5%), milk (6%), shrimp (4%), and other (16.9%). There were 12 positive LDCs (1 of which triggered systemic symptoms: generalized urticaria) and 31 positive OFCs. Two children with positive LDCs went on to have a negative diagnostic OFC. Sensitivity of LDC was 32%, specificity 98%, with a false-negative rate of 68%.ConclusionsMost UK allergy clinics included LDC as an initial step during OFC, despite a wide variation in how LDCs are performed and interpreted, which raises major concerns about the reproducibility and the validity of the test. We found that LDC had poor sensitivity as an alternative or initial step to formal OFC.

show abstract

Section: Discussionsupporting

confidence: 91%

Lip Dose Challenges in Food Allergy: Current Practice and Diagnostic Utility in the United Kingdom

Vazquez‐Ortiz

Ludman

Aston

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

View full text Add to dashboard Cite

show abstract

AAAAI–EAACI PRACTALL: Standardizing oral food challenges—2024 Update

Sampson,

Arasi,

Bahnson

et al. 2024

Pediatric Allergy Immunology

View full text Add to dashboard Cite

This common statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) and The European Academy of Allergy and Clinical Immunology (EAACI) provides an update of the 2012 published guidelines on food challenges. The guidelines equally address food challenges in the research and the clinical settings. They first address the diagnostic tests which can guide the decision to conduct a challenge. Safety of food challenges is prime, and the various procedures and safety issues as well as medications potentially involved in challenges are extensively discussed. Challenges are suggested to be conducted with semi‐logarithmic incremental doses based on the protein content, typically for IgE‐mediated food allergy with intervals of 20–30 min between doses. Specific protocols for other types of reactions such atopic dermatitis or gastrointestinal food allergy are detailed separately. Proper stopping criteria are essential in order to reduce the risk of false‐positive diagnoses, but also severe reactions. The guidelines recommend criteria based on “go on,” “stop,” or “observation.” These revised guidelines will clearly provide much needed guidance for food challenges in the research and clinical settings. They will continue to evolve with new diagnostic tests or new needs in the field of food allergy.

show abstract

Should lip dosing be reconsidered when performing open food challenges?

Cited by 2 publications

References 13 publications

Lip Dose Challenges in Food Allergy: Current Practice and Diagnostic Utility in the United Kingdom

Lip Dose Challenges in Food Allergy: Current Practice and Diagnostic Utility in the United Kingdom

AAAAI–EAACI PRACTALL: Standardizing oral food challenges—2024 Update

Contact Info

Product

Resources

About