Work Group report: Oral food challenge testing

Nowak‐Węgrzyn, Anna; Assa’ad, Amal; Bahna, Sami L.; Bock, S. Allan; Sicherer, Scott H.; Teuber, Suzanne S.

doi:10.1016/j.jaci.2009.03.042

Cited by 506 publications

(456 citation statements)

References 133 publications

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“…2 Oral food challenges (OFCs) are the recommended procedure to document the resolution of food allergy, 3,4 but they are time-consuming, difficult to perform, require resources, and expose the patient to the risk of a significant allergic reaction. Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs.…”

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confidence: 99%

“…11 In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%. 3 Previous research 11 has revealed that FSIgE of Յ2 kUa/L (or Յ5 kUa/L for peanuts without a history of previous reaction) are associated with an estimated Յ50% likelihood of reacting to eggs, milk, or peanuts during an OFC, and these FSIgE values have been incorporated into clinical guidelines. 11 Identifying additional clinical and laboratory factors associated with negative OFC within this group of patients would improve patient care by decreasing the number of unnecessary (i.e., predictably positive) OFCs.…”

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confidence: 99%

“…12,13 We extended this approach to the clinical scenario aimed at increasing the accuracy of identifying children who will experience negative OFCs. We aimed to investigate if there are food-specific combinations of clinical and laboratory characteristics that define subgroups of children, undergoing OFC based on the guideline-recommended FSIgE levels, 3 who are most likely to experience a negative OFC.…”

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confidence: 99%

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Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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Children 2 Oral food challenges (OFCs) are the recommended procedure to document the resolution of food allergy, 3,4 but they are time-consuming, difficult to perform, require resources, and expose the patient to the risk of a significant allergic reaction. Food-specific IgE (FSIgE) levels have been used to predict the outcome of OFC because FSIgE levels above certain cut points were found to be highly predictive of positive OFCs.5-10 However, FSIgE levels are less effective in identifying children who experience a negative OFC. 11In clinical practice, children with a known food allergy are considered appropriate candidates for OFCs to evaluate for resolution of food allergy when the likelihood of a positive OFC is Յ50%.3 Previous research 11 has revealed that FSIgE of Յ2 kUa/L (or Յ5 kUa/L for peanuts without a history of previous reaction) are associated with an estimated Յ50% likelihood of reacting to eggs, milk, or peanuts during an OFC, and these FSIgE values have been incorporated into clinical guidelines.11 Identifying additional clinical and laboratory factors associated with negative OFC within this group of patients would improve patient care by decreasing the number of unnecessary (i.e., predictably positive) OFCs.Recently, it was shown that the incorporation of clinical and laboratory data to supplement FSIgE levels effectively diagnosed food allergy and might eliminate the need for some OFCs to confirm the presence of food allergy. 12,13 We extended this approach to the clinical scenario aimed at increasing the accuracy of identifying children who will experience negative OFCs. We aimed to investigate if there are food-specific combinations of clinical and laboratory characteristics that define subgroups of children, undergoing OFC based on the guideline-recommended FSIgE levels, 3 who are most likely to experience a negative OFC.

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Clinical and laboratory factors associated with negative oral food challenges

Beigelman

Strunk²,

Garbutt³

et al. 2012

allergy asthma proc

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“…La prueba de reto oral controlado y una dieta con eliminación de la leche y sus derivados son los estándares de referencia y nos sirven para confirmar o descartar una reacción adversa por alimentos en un paciente con sospecha clínica; sin embargo, estas pruebas no permiten definir el mecanismo subyacente y por ello es necesario realizar otras pruebas, como la prueba intraepidérmica, la medición de IgE específica en sangre y la prueba de parche (21).…”

Section: Diagnósticounclassified

Alergia a la leche y al huevo: diagnóstico, manejo e implicaciones en América Latina

Sánchez¹,

Restrepo

Mopan

et al. 2013

biomedica

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La sensibilización a alimentos y el desarrollo de alergias alimentarias viene aumentando en todo el mundo, siendo la leche de vaca y el huevo de gallina los principales alimentos implicados. En la mayoría de los países latinoamericanos no existen guías de manejo y cuando se elaboren deberán adaptarse a las condiciones de la población de cada región. En el presente artículo presentamos una revisión del manejo de la alergia alimentaria a la leche y al huevo útil para el personal de salud de todos los niveles, así como algunas consideraciones de los factores presentes en los países latinoamericanos.Palabras clave: alergia e inmunología, hipersensibilidad al huevo, hipersensibilidad a la leche, alimentos, anafilaxia, dieta, desensibilización inmunológica, inmunoterapia, tolerancia. doi: http://dx.doi.org/10.7705/biomedica.v34i1.1677 Milk and egg allergy: Diagnosis, management and implications for Latin AmericaSensitization to food allergens, as well as the development of food allergies, is increasing worldwide, and cow's milk and hen's eggs are the main implicated foods. In most Latin American countries there are no management guidelines on the aforementioned topics; at their creation, such guidelines should be adapted to the conditions of the population in each region. This paper presents a review of the management of food allergy to milk and eggs useful for health personnel at all levels and some considerations of the factors found in Latin American developing countries.Keywords: Allergy and immunology, egg hypersensitivity, milk hypersensitivity, food, anaphylaxis, diet; desensitization, immunologic; immunotherapy, permissiveness. doi: http://dx.doi.org/10. 7705/biomedica.v34i1.1677 Las reacciones adversas a los alimentos se producen por una gran variedad de mecanismos que incluyen el sistema inmunitario, los procesos enzimáticos, las reacciones fisiológicas y los componentes psicológicos (1). Cuando se demuestra un mecanismo inmune, se le denomina alergia a alimentos, y si se encuentran niveles elevados de inmunoglobulina E (IgE) específica para alérgenos de alimentos con relevancia clínica, se habla de alergia alimentaria mediada por IgE (2). Igualmente, se pueden presentar reacciones alérgicas a alimentos mediadas por mecanismos celulares y alergias alimentarias mixtas, en las cuales participan los dos mecanismos anteriores.Los alimentos implicados y la frecuencia de las reacciones dependen de los hábitos y costumbres alimentarias en los distintos países, al igual que de los parámetros metodológicos utilizados en los diferentes estudios. Se estima que la prevalencia de reacciones adversas a alimentos es de entre 13 y 43 %, según informes de los padres de niños preescolares (3,4); sin embargo, solo una parte de las reacciones reportadas en dichos informes se deben realmente a un alimento; en un estudio en el que 28 % de los pacientes había

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“…Because the procedure carries a small risk of anaphylaxis, it should be conducted in a supervised medical setting where resuscitation equipment is available. Several papers have been published recently on this topic aiming at standardizing the procedure [33][34][35]. The main problems of OFC are related to the wide variety of symptoms possibly related to immunological mechanism of FA that lead to difficulties in the interpretation of results and to the optimal timing and dosage of this procedure.…”

Section: Oral Food Challengementioning

confidence: 99%

Diagnosing and Treating Food Allergy

et al. 2013

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Food allergy (FA) is defined as an abnormal immunological reaction to food proteins. Over 90 % of FAs in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish and shellfish. The diagnostic work up for a child with suspected FA includes detailed medical history, physical examination, FA screening tests and response to elimination diet and to oral food challenge. Sometimes additional diagnostic tools to explore intestinal damage and function could be adopted. Currently, the only treatment for FA relies on strict elimination diets supervised by the nutritionist. Main new therapeutic strategies for FA include allergen-specific (oral, sublingual, epicutaneous, subcutaneous immunotherapy and heat treatment of food) and nonallergen-specific therapies (humanized monoclonal antibodies, anti-IgE and anti-IL5, probiotics). An incorrect diagnosis is likely to result in unnecessary dietary restrictions, which, if prolonged, may adversely affect the child's nutritional status and growth.

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Work Group report: Oral food challenge testing

Cited by 506 publications

References 133 publications

Clinical and laboratory factors associated with negative oral food challenges

Clinical and laboratory factors associated with negative oral food challenges

Alergia a la leche y al huevo: diagnóstico, manejo e implicaciones en América Latina

Diagnosing and Treating Food Allergy

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