Medline ® Abstracts for References 1,28,33
of 'Oral food challenges for diagnosis and management of food allergies'
Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual.
Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S, Sachs M, Bush RK, Metcalfe DD
J Allergy Clin Immunol. 1988;82(6):986.
There is now enough experience with the use of double-blind, placebo-controlled, food challenge (DBPCFC) to recommend its use as an office procedure for most patients complaining of adverse reactions to foods. This manual discusses the practical methods required for the allergist to undertake DBPCFC in the office. Thorough histories supplemented by food allergen skin testing are used to design a DBPCFC that carefully attempts to reproduce the history of food-induced symptoms described by the patient. Precautions that must be taken are delineated before challenge, as is treatment that may be required if a reaction occurs. For those foods to which challenges are positive, longitudinal evaluation with repeated challenge at appropriate intervals help to determine whether or not the problem will resolve over a period of time.
National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo. 80206.
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.
Parental anxiety before and after food challenges in children with suspected peanut and hazelnut allergy.
Zijlstra WT, Flinterman AE, Soeters L, Knulst AC, Sinnema G, L'Hoir MP, Pasmans SG
Pediatr Allergy Immunol. 2010;21(2 Pt 2):e439.
As ingestion of peanut and hazelnut by allergic children is potentially life threatening, parents of these children need to be vigilant about their child's dietary intake. This may cause high levels of anxiety. To assess parental anxiety about food-allergic reaction in their child (state anxiety) and their personal disposition to anxiety (trait anxiety). Parental anxiety was investigated again after food challenges. Fifty-seven children (3-16 yr, mean age 7.2) with suspected peanut or hazelnut allergy (mean specific IgE 20.9) were evaluated by double-blind, placebo-controlled food challenge (DBPCFC). Thirty-two children (56%) developed an allergic reaction. All parents completed the Spielberger State-Trait Anxiety Inventory (STAI) prior to DBPCFC and 2 wk, 3 months and 1 yr thereafter. The mean anxiety scores on these moments were compared with each other and with general Dutch norms. The STAI was also investigated in a group that refused DBPCFC. Prior to DBPCFC, parents had high levels of state anxiety in contrast to a lower trait anxiety compared to the norm group. After DBPCFC, the state anxiety was significantly lower, regardless of a positive or negative outcome (p<or=0.05). The state anxiety was still significant lower after 1 yr (p<or=0.03). The trait anxiety remained unchanged in mothers and slightly decreased in fathers. The state anxiety in the group that refused DBPCFC was comparable to the challenge group, but the trait anxiety was significantly higher (p=0.038). Parents of children with suspected peanut or hazelnut allergy show high levels of anxiety about a food-allergic reaction. After DBPCFC, the anxiety was significantly lower, even in the group with a positive outcome.
Department of Pediatric Psychology, University Medical Center Utrecht, Utrecht, The Netherlands. email@example.com