Specific IgE as the best predictor of the outcome of challenges to baked milk and baked egg

Boer, Rachel de; Cartledge, Natalia; Lazenby, Sophia; Tobías, Aurelio; Chan, Susan; Fox, Adam; Santos, Alexandra

doi:10.1016/j.jaip.2019.10.039

Cited by 12 publications

(9 citation statements)

References 10 publications

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“…36 Higher levels to Bos d 8 have been suggested as a predictor for baked milk reactivity as casein is more resistant to extensive heating. 19,37,38 A recent report of baked milk OFCs for patients with a history of CMA found no association of sIgE or casein IgE and OFC outcome. 39 Recommendations for the optimal cutoff for Bos d 8 and unheated or baked OFCs have varied.…”

Section: Specific Ige To Allergen Componentsmentioning

confidence: 99%

Improving Diagnostic Accuracy in Food Allergy

Foong

Dantzer

Wood

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Specific Ige To Allergen Componentsmentioning

confidence: 99%

Improving Diagnostic Accuracy in Food Allergy

Foong

Dantzer

Wood

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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“…Having studies with cut‐offs that help determine when a child may be successful in passing a challenge is useful although there are many factors that can influence this. De Boer et al 71 looked at optimum cut‐off points for determining 50% PPV for challenges and reported a sIgE cow’s milk of 3.06 kU A /L having a PPV of 92% for baked milk OFC and a sIgE egg white of 2.81 kU A /L having a PPV of 84% for baked egg OFC.…”

Section: The Resolution Of Food Allergymentioning

confidence: 99%

Biomarkers of diagnosis and resolution of food allergy

Foong

2020

Pediatric Allergy Immunology

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Food allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well‐being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50%‐60% of cow’s milk and egg‐allergic, 20% of peanut‐allergic and 9% of tree nut‐allergic children by school age. For that reason, food‐allergic status should be monitored over time to determine when to reintroduce the food back into the child’s diet. The gold‐standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves the risk of causing an acute‐allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision making in practice. We also evaluate predictive test cut‐offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children.

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“…In terms of sample size, we cannot exclude the presence of false‐negative results for the sample size adopted here may have limited our study. The study was powered to look at diagnosis and only a fraction of the population reacted during the challenges, although the proportion of positive baked egg challenges in the BAT2 study was higher (40%) than often observed in the routine clinical setting (20%) 31 . However, we showed that, with the current sample size, any possible issue due to lack of statistical power would arise only for AUC below the value of 0.7, which is not a value of clinical interest.…”

Section: Discussionmentioning

confidence: 99%

Basophil activation test as predictor of severity and threshold of allergic reactions to egg

Radulovic,

Foong,

Bartha

et al. 2023

Allergy

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BackgroundIdentifying patients at risk of severe allergic reactions and/or low threshold of reactivity is very important, particularly for staple foods like egg.MethodsOne hundred and fifty children underwent double‐blind placebo‐controlled food challenge (DBPCFC) to baked egg (BE), skin prick testing and blood collection for serology and basophil activation test (BAT). Patients who passed BE DBPCFC underwent loosely cooked egg (LCE) DBPCFC. Severity of allergic reactions was classified following Practall guidelines and threshold dose was determined during DBPCFC.ResultsSixty out of 150 (40%) children reacted to BE and 16 out of 77 (21%) to LCE on DBPCFC. Considering DBPCFC to BE, 23 children (38%) had severe reactions and 33 (55%) reacted to 0.13 g or less of egg protein (low threshold group). Two children (2 out of 16 = 12%) had severe reactions to LCE. Demographic, clinical and most immunological features were not significantly different between severe/non‐severe BE reactors or low/high threshold groups. Severe BE reactors had higher ovomucoid‐sIgE (p = .009) and higher BAT to BE (p = .001). Patients with lower threshold to BE had higher IgE‐specific activity (p = .027) and BAT to egg (p = .007) but lower severity score (p = .008). Optimal cut‐offs for ovomucoid‐sIgE had 100% sensitivity, 35% specificity and 60% accuracy and for BAT 76% sensitivity, 74% specificity and 75% accuracy to identify BE severe reactors. Optimal cut‐offs for specific activity had 70% sensitivity, 68% specificity and 69% accuracy and for BAT 70% sensitivity, 72% specificity and 71% accuracy to identify low threshold patients.ConclusionsBAT was the best biomarker to predict severity and threshold of allergic reactions to BE and can be useful when making decisions about management of egg allergy.

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Specific IgE as the best predictor of the outcome of challenges to baked milk and baked egg

Cited by 12 publications

References 10 publications

Improving Diagnostic Accuracy in Food Allergy

Improving Diagnostic Accuracy in Food Allergy

Biomarkers of diagnosis and resolution of food allergy

Basophil activation test as predictor of severity and threshold of allergic reactions to egg

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