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- Title
Likelihood of Immediate Food Challenge Reactions Varies by Age, History, Allergens, and Levels of Sensitization.
- Authors
Kotaniemi-Syrjänen, Anne; Csonka, Péter; Pelkonen, Anna S.; Mäkelä, Mika J.
- Abstract
The diagnosis of food allergy is challenging due to different immunologic mechanisms and diversity of symptoms. An open or double-blinded oral food challenge (OFC) was performed on 391 children (aged 0.2-16.9 years) with suspected cow's milk ( n = 266) or wheat allergy ( n = 125) to characterize immediate, delayed, and transient symptoms, and to evaluate the role of earlier food-related symptoms and immunoglobulin E (IgE)-mediated sensitization for the OFC outcome. The OFC resulted in an immediate positive reaction in 38% ( n = 148) and a delayed positive reaction in 21% ( n = 81) of the 391 children. Transient reactions, the majority of which were localized skin reactions, were seen in almost third ( n = 50) of the patients with a negative OFC result ( n = 162/391). Immediate localized skin reactions were more common during the milk challenge ( p = 0.010), whereas immediate lower respiratory tract symptoms ( p = 0.001) were more common during the wheat challenge. Although 14% ( n = 21) of those with an immediate reaction received i.m. adrenalin as a treatment of the reaction, there were no life-threatening events. Multivariate analyses revealed that independent risk factors for the immediate OFC outcome were earlier moderate-to-severe immediate food-related reactions, marked IgE-mediated sensitization to the suspected food, and in case of wheat, age <12 months. The accuracy of OFCs can be enhanced without increasing the risk of serious allergic reactions by taking into account earlier food-related symptoms and the level of IgE-mediated sensitization, by refining our knowledge of transient non-specific reactions, and by applying standardized OFC protocols with over-one-day challenges.
- Subjects
ADRENALINE; DIAGNOSIS of food allergies; FOOD allergy; IMMUNOGLOBULINS; INTRAMUSCULAR injections; MULTIVARIATE analysis; RESPIRATORY diseases; SKIN diseases; BLIND experiment; DESCRIPTIVE statistics; DISEASE complications; SYMPTOMS; THERAPEUTICS
- Publication
Pediatric Allergy, Immunology & Pulmonology, 2017, Vol 30, Issue 1, p45
- ISSN
2151-321X
- Publication type
Article
- DOI
10.1089/ped.2016.0679