The severity of reaction after food challenges depends on the indication: A prospective multicenter study

Abstract

Background: There are expanding indications for oral food challenges (OFCs).Although several studies have examined the risk of OFCs, little has been reported on allergic reactions during OFCs depending on the indication. This study assessed the prevalence, severity, and treatment of allergic reactions depending on the indication for OFCs. Methods:We performed a prospective multicenter study between March 2012 and May 2013. Severity of symptoms elicited by OFCs was classified according to grading of anaphylaxis that ranges from grade 1 (most mild) to grade 5 (most severe). Results:A total of 5062 cases (median age, 3.8 years; males, 65.2%) were analyzed.Allergic reactions were elicited in 2258 (44.6%) OFCs, of which 991 (43.9%) were classified as grade 1, 736 (32.6%) were classified as grade 2, 340 (15.1%) were classified as grade 3, and 191 (8.5%) were classified as grade 4-5. Epinephrine was administered in 7.1% (n = 160) of positive OFCs. Among the top three most common food allergens (hen's egg, cow's milk, and wheat), severity differed significantly depending on the indication for OFC, and adjusted standardized residuals indicated that severity of allergic reactions was higher for the indication to assess threshold level for oral immunotherapy. In addition, the prevalence of epinephrine use was highest for the indication to determine safe intake quantity. Conclusions:Our study suggested that prevalence, severity, and treatment of allergic reactions differ depending on the indication for OFC. Further studies are needed to determine differences in risks depending on the indication for OFC. K E Y W O R D Sallergic reaction, children, epinephrine, food allergy, food challenge, indication, oral food challenge, severity

Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

“…However, OFC is the gold standard, particularly when it comes to eliminating the risk of unnecessary food avoidance. 12,16 Our OFC numbers are either slightly high 17,18 or slightly low 19,20 compared with previous studies. The numbers of OFCs are closely related to infrastructure and experience.…”

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

“…12 Egg followed the same trend, causing an adverse reaction in 19.8% OFCs (n = 49). The Japanese study conducted by Itazawa et al 4 actually found egg at the first place of challenged foods.…”

“…A similar condition was found in Perry et al's study 2 : severe reactions occurred in 28% of the OFCs, but epinephrine administration was administered in 11%. Moreover, a Japanese multicentric study 4 found 2258 positive OFCs, of which 991 (43.9%) were classified as grade 1, 736 (32.6%) were classified as grade 2, 340 (15.1%) were classified as grade 3, and 191 (8.5%) were classified as grade 4-5. Epinephrine was administered only in 7.1% (n = 160) of positive OFCs (44.5% of patients with grade 4-5 of anaphylaxis).…”

“…Similar data were found in a Japanese multicentric study: allergic reactions occurred in 44.6% cases, but epinephrine administration was necessary in 7.1%-positive OFCs. 4 In children with food protein-induced enterocolitis syndrome (FPIES), Wang et al 5 reported 18% of positive OFCs, of which 72.2% required intravenous (IV) drug administration; instead, Pena et al study 6 reported 39 positive OFCs, but severe reactions that required an IV treatment were fewer than 10%.…”

Oral food challenges

“…A recent prospective study of 5062 pediatric OFCs revealed that the prevalence, severity, and treatment of allergic reactions depended on the indication with the most severe reactions occurring when the indication was to discover the threshold to start oral immunotherapy. 12 In 74 patients with food allergy confirmed for a clinical trial, 39% were treated with epinephrine. 13 Therefore, the highest severity of OFC reactions tend to occur in the patients who are also at the highest probability of being allergic.…”