Medline ® Abstracts for References 1,28,33
of 'Oral food challenges for diagnosis and management of food allergies'
Work Group report: oral food challenge testing.
Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS, Adverse Reactions to Food Committee of American Academy of Allergy, Asthma&Immunology
J Allergy Clin Immunol. 2009;123(6 Suppl):S365.
Oral food challenges are procedures conducted by allergists/immunologists to make an accurate diagnosis of immediate, and occasionally delayed, adverse reactions to foods. The timing of the challenge is carefully chosen based on the individual patient history and the results of skin prick tests and food specific serum IgE values. The type of the challenge is determined by the history, the age of the patient, and the likelihood of encountering subjective reactions. The food challenge requires preparation of the patient for the procedure and preparation of the office for the organized conduct of the challenge, for a careful assessment of the symptoms and signs and the treatment of reactions. The starting dose, the escalation of the dosing, and the intervals between doses are determined based on experience and the patient's history. The interpretation of the results of the challenge and arrangements for follow-up after a challenge are important. A negative oral food challenge result allows introduction of the food into the diet, whereas a positive oral food challenge result provides a sound basis for continued avoidance of the food.
Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY, USA.
Risk of oral food challenges.
Perry TT, Matsui EC, Conover-Walker MK, Wood RA
J Allergy Clin Immunol. 2004;114(5):1164.
BACKGROUND: Oral food challenges are essential to the diagnosis of food allergy; however, little has been reported regarding the risks of performing food challenges in children with suspected food allergy.
OBJECTIVE: To examine the risk and reaction severity of failed oral food challenges.
METHODS: A retrospective chart review was performed on children who underwent food challenges to milk, egg, peanut, soy, and/or wheat in a university-based pediatric allergy clinic over a 7-year period.
RESULTS: Of the 584 challenges completed, 253 (43%) resulted in an allergic reaction. There were 90 milk, 56 egg, 71 peanut, 21 soy, and 15 wheat failed challenges. Of patients who failed, there were 197 (78%) cutaneous, 108 (43%) gastrointestinal, 66 (26%) oral, 67 (26%) lower respiratory, and 62 (25%) upper respiratory reactions. No patients had cardiovascular symptoms. There was no difference between foods in the severity of failed challenges or the type of treatment required to reverse symptoms.All reactions were reversible with short-acting antihistamines +/- epinephrine, beta-agonists, and/or corticosteroids. No children required hospitalization, and there were no deaths.
CONCLUSIONS: There are risks associated with food challenges, and the risks are similar for each of the foods studied. Given the benefits that result from a negative challenge, these risks are reasonable when challenges are performed under the guidance of an experienced practitioner in a properly equipped setting.
Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Impact of elimination diets on nutrition and growth in children with multiple food allergies.
Venter C, Mazzocchi A, Maslin K, Agostoni C
Curr Opin Allergy Clin Immunol. 2017;17(3):220.
PURPOSE OF REVIEW: Growth and nutritional intake of children with cows' milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of 'sub-inflammation', which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth.
RECENT FINDINGS: The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related tothe exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences.
SUMMARY: Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes.
aDivision of Allergy and Immunology, Cincinnati Center for Eosinophilic Disorders, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, USA bPediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Ca' Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy cMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.