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.
Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets.
Flinterman AE, Knulst AC, Meijer Y, Bruijnzeel-Koomen CA, Pasmans SG
BACKGROUND: Food allergy is not always correctly diagnosed in children with atopic eczema dermatitis syndrome (AEDS) and treatment with an avoidance diet is not without danger.
METHODS: After admission to our clinic, 11 children with a prolonged cow's milk (CM) elimination diet because of AEDS and sensitization underwent double-blind placebo-controlled food challenge (DBPCFC). Retrospectively, the exposure to CM, sensitization and reactions to accidental ingestion were carefully documented. The DBPCFC was used to evaluate the childrens' current status.
RESULTS: Before the elimination period (median 2.3 years; started before the admission) all 11 children with AEDS were sensitized and had ingested CM (four bottle-fed; seven breast-fed without CM diet of the mother) without the development of acute reactions. The diagnosis of CM allergy was not confirmed by DBPCFC previously. After elimination the AEDS had not improved, but nevertheless the diet was continued. During the elimination period, eight of 11 children developed severe acute allergic reactions to CM after accidental ingestion. In evaluation, in our clinic all 11 children experienced acute allergic reactions to CM during DBPCFC.
CONCLUSION: There is a considerable chance of developing acute allergic reactions to CM after elimination in children with AEDS without previous problems after CM intake.
Department of Dermatology/Allergology, University Medical Centre, Utrecht, Utrecht, the Netherlands.
False-negative food challenges in children with suspected food allergy.
Caffarelli C, Petroccione T
Food allergy can be diagnosed from an immediate-onset reaction after oral food challenge. We administered 370 challenges in 242 children; five (3%) of the 193 children tolerating foods on challenges developed immediate symptoms when the same preparation of foods was ingested openly at home the next day. We confirmed the food allergy by subsequent double-blind challenges. All children had positive skin-prick test reactions and all, but one, specific IgE antibodies to the offending foods. Our findings suggest that open feedings under observation, the day after negative challenges, are useful to eliminate false-negative challenge results.
Paediatric Department, University of Parma, 43100, Parma, Italy. Carlo.Caffarelli@unipr.it