Is it possible to predict the development of anaphylaxis before oral food challenge tests administered to evaluate tolerance in IgE-mediated food allergy in children?
Main Article Content
Objective: Life-threatening anaphylaxis may occur in IgE-mediated food allergy. Oral Food Challenge (OFC) is the gold standard in demonstrating tolerance and diagnosing food allergy; however, these tests may cause anaphylaxis. Predicting the risk of developing anaphylaxis before performing OFC is valuable information in evaluating tolerance as in diagnosis. The present study aims to evaluate the effectiveness of the tests used in clinical practice in predicting the risk of anaphylaxis during OFC in IgE-mediated food allergy. To our knowledge, this is the first study evaluating skin prick tests in the prediction of anaphylaxis.
Material and Methods: In this descriptive cross-sectional study, the history, demographic, clinical and laboratory data of the patients, followed up with the diagnosis of IgE-mediated food allergy, on whom OFC was performed, were evaluated retrospectively.
Results: Of the 254 patients who underwent OFC, 133 were followed up with a diagnosis of IgE-mediated food allergy. The mean age was 21 months (12-120), and anaphylaxis occurred in nine (6.7%) of them during OFC. According to the frequency, the food responsible for IgE-mediated food allergy was determined as milk, egg and egg-milk combination. Age during the challenge and total IgE levels were higher in the group that experienced OFC-related anaphylaxis. The tests that could best determine the risk of anaphylaxis before the challenge was the skin prick test (SPT) and prick to prick (PTP) test for milk. Milk SPT and PTP test at the time of initial diagnosis and determination of milk sIgE and egg white sIgE before challenge were found to predict the risk of anaphylaxis. The negative predictive value was over 95% in tests that gave significant results for milk. There was no statistically significant finding associated with other allergenic foods.
Conclusion: In evaluating tolerance development, performing sIgE, SPT and/or PTP tests for milk before OFC is useful in predicting anaphylaxis. Studies with larger numbers of cases are needed to assess the risk of anaphylaxis caused by other foods.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Boyce JA, Jones SM, Rock L, Sampson HA, Cooper SF, Boyce S, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol [Internet]. 2010 Dec [cited 2021 Sep 17];126(6):S1–58. Available from: /pmc/articles/PMC4241964/
Prescott SL, Pawankar R, Allen KJ, Campbell DE, Sinn JKH, Fiocchi A, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J. 2013;6(1):1–12.
Akçay A. Global Prevalence of Food Allergies. In: Güler N, editor. Türkiye Klinikleri PEDIATRIC IMMUNOLOGY AND ALLERGIC DISEASES - SPECIAL TOPICS FOOD ALLERGY IN CHILDREN. 1.Edition. Ankara: Türkiye Klinikleri; 2021. p. 29–34.
Muraro A, Roberts G. Food Allergy and Anaphylaxis Guidelines. Eur Acad Allergy Clin Immunol [Internet]. 2014;294. Available from: http://www.eaaci.org/foodallergyandanaphylaxisguidelines/Food Allergy - web version.pdf (Último acceso 23 noviembre 2018).
Longo G, Berti I, Burks AW, Krauss B, Barbi E. IgE-mediated food allergy in children. Lancet. 2013 Nov 16;382(9905):1656–64.
Pajno GB, Fernandez-Rivas M, Arasi S, Roberts G, Akdis CA, Alvaro-Lozano M, et al. EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy Eur J Allergy Clin Immunol. 2018;73(4):799–815.
Sirin Kose S, Asilsoy S, Uzuner N, Karaman O, Anal O. Outcomes of Baked Milk and Egg Challenge in Cow’s Milk and Hen’s Egg Allergy: Can Tolerance Be Predicted with Allergen-Specific IgE and Prick-to-Prick Test? Int Arch Allergy Immunol [Internet]. 2019 Nov 1 [cited 2021 Sep 6];180(4):264–73. Available from: https://www.karger.com/Article/FullText/502957
Akarsu A, Ocak M, Köken G, Şahiner ÜM, Soyer Ö, Şekerel BE. Ige mediated food allergy in turkey: different spectrum, similar outcome. Turk J Pediatr [Internet]. 2021;63(4):554. Available from: http://www.turkishjournalpediatrics.org/doi.php?doi=10.24953/turkjped.2021.04.002
Cianferoni A, Muraro A. Food-Induced Anaphylaxis. Immunol Allergy Clin North Am [Internet]. 2012 Feb [cited 2021 Sep 19];32(1):165–95. Available from: /pmc/articles/PMC3440177/
Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol [Internet]. 2001 Jan;107(1):191–3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S009167490114683X
Foong R-X, Dantzer JA, Wood RA, Santos AF. Improving Diagnostic Accuracy in Food Allergy. J Allergy Clin Immunol Pract [Internet]. 2021 Jan;9(1):71–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213219820310862
Yanagida N, Minoura T, Kitaoka S, Ebisawa M. A three-level stepwise oral food challenge for egg, milk, and wheat allergy. J Allergy Clin Immunol Pract [Internet]. 2018;6(2):658-660.e10. Available from: https://doi.org/10.1016/j.jaip.2017.06.029
Sampson HA, Wijk RG van, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, et al. Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology–European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol [Internet]. 2012 Dec 1 [cited 2021 Sep 19];130(6):1260–74. Available from: http://www.jacionline.org/article/S0091674912016636/fulltext
Tang R, Wang Z-X, Ji C-M, Leung PSC, Woo E, Chang C, et al. Regional Differences in Food Allergies. 2016; Available from: https://doi.org/10.1007/s12016-018-8725-9
Kahveci M, Koken G, Şahiner ÜM, Soyer Ö, Şekerel BE. Immunoglobulin E-Mediated Food Allergies Differ in East Mediterranean Children Aged 0–2 Years. Int Arch Allergy Immunol [Internet]. 2020 May 1 [cited 2021 Jan 21];181(5):365–74. Available from: https://www.karger.com/Article/FullText/505996
Lyons SA, Clausen M, Knulst AC, Ballmer-Weber BK, Fernandez-Rivas M, Barreales L, et al. Prevalence of Food Sensitization and Food Allergy in Children Across Europe. J Allergy Clin Immunol Pract. 2020 Sep 1;8(8):2736-2746.e9.
Kahveci M, Akarsu A, Koken G, Sahiner UM, Soyer O, Sekerel BE. Food-induced anaphylaxis in infants, as compared to toddlers and preschool children in Turkey. Pediatr Allergy Immunol. 2020;31(8):954–61.
Pyrhönen K, Hiltunen L, Kaila M, Näyhä S, Läärä E. Heredity of food allergies in an unselected child population: An epidemiological survey from Finland. Pediatr Allergy Immunol [Internet]. 2011 Feb 1 [cited 2021 Sep 21];22(1pt2):e124–32. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-3038.2010.01095.x
Sampson HA, Sicherer SH; Concomitant Allergic Diseases in Persons with Peanut and Tree Nut Allergy in a Population Based Survey. In: Journal of Allergy and Clinical Immunology. 2011. p. AB187.
Koplin JJ, Allen KJ, Gurrin LC, Peters RL, Lowe AJ, Tang MLK, et al. The Impact of Family History of Allergy on Risk of Food Allergy: A Population-Based Study of Infants. Int J Environ Res Public Health [Internet]. 2013 Oct 25 [cited 2021 Sep 22];10(11):5364. Available from: /pmc/articles/PMC3863850/
Yuenyongviwat A, Koosakulchai V, Treepaiboon Y, Jessadapakorn W, Sangsupawanich P. Risk factors of food sensitization in young children with atopic dermatitis. Asian Pacific J Allergy Immunol [Internet]. 2021 [cited 2021 Sep 22]; Available from: https://apjai-journal.org/wp-content/uploads/2021/01/AP-250820-0946.pdf
Eigenmann A, Sicherer S, Borkowski T, Cohen B, Sampson H. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics [Internet]. 1998 [cited 2021 Sep 22];101(3). Available from: https://pubmed.ncbi.nlm.nih.gov/9481027/
Cox AL, Nowak-Wegrzyn A. Innovation in Food Challenge Tests for Food Allergy. Curr Allergy Asthma Rep [Internet]. 2018 Dec 30 [cited 2021 Sep 22];18(12):74. Available from: https://link.springer.com/article/10.1007/s11882-018-0825-3
Lemon-Mulé H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol [Internet]. 2008 Nov;122(5):977-983.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0091674908016680
Leonard SA, Caubet J-C, Kim JS, Groetch M, Nowak-Węgrzyn A. Baked Milk- and Egg-Containing Diet in the Management of Milk and Egg Allergy. J Allergy Clin Immunol Pract [Internet]. 2015 Jan;3(1):13–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213219814004188
Nowak-Węgrzyn A, Burks AW, Sampson HA. Reactions to Foods. In: Middleton’s Allergy [Internet]. Elsevier; 2014. p. 1310–39. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780323085939000826
Yanagida N, Sato S, Takahashi K, Nagakura K, Asaumi T, Ogura K, et al. Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge. Pediatr Allergy Immunol [Internet]. 2018 Jun 1 [cited 2021 Sep 27];29(4):417–24. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/pai.12896
Kwan A, Asper M, Lavi S, Lavine E, Hummel D, Upton JE. Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children. Allergy, Asthma Clin Immunol [Internet]. 2016 Dec 24 [cited 2021 Sep 27];12(1):54. Available from: /pmc/articles/PMC5078900/