Background: The minimum dose of food protein to which subjects with food allergy have reacted in double-blind, placebo-controlled food challenges is between 50 and 100 mg. However, subjects with ...peanut allergy often report severe reactions after minimal contact with peanuts, even through intact skin.
Objective: We sought to determine whether adults previously proven by challenge to be allergic to peanut react to very low doses of peanut protein.
Methods: We used a randomized, double-blind, placebo-controlled food challenge of 14 subjects allergic to peanuts with doses of peanut ranging from 10 μg to 50 mg, administered in the form of a commercially available peanut flour.
Results: One subject had a systemic reaction to 5 mg of peanut protein, and two subjects had mild objective reactions to 2 mg and 50 mg of peanut protein, respectively. Five subjects had mild subjective reactions (1 to 5 mg and 4 to 50 mg). All subjects with convincing objective reactions had short-lived subjective reactions to preceding doses, as low as 100 μg in two cases. Five subjects did not react to any dose up to 50 mg.
Conclusion: Even in a group of well-characterized, highly sensitive subjects with peanut allergy, the threshold dose of peanut protein varies. As little as 100 μg of peanut protein provokes symptoms in some subjects with peanut allergy. (J Allergy Clin Immunol 1997;100:596-600.)
Full text
Available for:
IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Actinidia chinensis (gold kiwi) is a newly available fruit which has been shown to have in vitro immunoglobulin E (IgE) cross‐reactivity with green kiwi. This is the first study to investigate ...clinical reactivity of gold kiwi. Five patients clinically allergic to green kiwi were investigated by skin test and double‐blind placebo controlled food challenge (DBPCFC) with gold kiwi fruit. IgE‐binding patterns of individual sera from the five challenged patients and a pool of sera from a further nine patients with kiwi allergy were compared in the two fruits by Western blotting. Cross reactivity of proteins in the two fruits was assessed by inhibition of immunoblots and by IgE enzyme‐linked immunosorbent assay (ELISA) inhibition. Four of the five patients had a positive DBPCFC to gold kiwi. Western blotting showed marked differences in the allergen patterns of green and gold kiwi. However, inhibition of the immunoblots and ELISA assay reveals extensive inhibition of IgE binding to proteins in each fruit by the alternative species. Gold kiwi fruit is allergenic and patients allergic to green kiwi are at risk of reacting to the gold kiwi fruit. Despite having different protein profiles and IgE‐binding patterns, the two species have proteins that extensively cross‐inhibit the binding to IgE.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background Blinded food challenges are considered the current gold standard for the diagnosis of food allergies. We used data from a pan-European multicenter project to assess differences between ...study centers, aiming to identify the impact of subjective aspects for the interpretation of oral food challenges. Methods Nine study centers of the EuroPrevall birth cohort study about food allergy recruited 12 049 newborns and followed them for up to 30 months in regular intervals. Intensive training was conducted and every center visited to ensure similar handling of the protocols. Suspected food allergy was clinically evaluated by double-blind, placebo-controlled food challenges using a nine dose escalation protocol. The primary challenge outcomes based on physician's appraisal were compared to documented signs and symptoms. Results Of 839 challenges conducted, study centers confirmed food allergy in 15.6% to 53.6% of locally conducted challenges. Centers reported 0 to 16 positive placebo challenges. Worsening of eczema was the most common sign when challenged with placebo. Agreement between documented objective signs and the challenge outcome assigned by the physician was heterogeneous, with Cohen's kappa spanning from 0.42 to 0.84. Conclusions These differences suggest that the comparison of food challenge outcomes between centers is difficult despite common protocols and training. We recommend detailed symptom assessment and documentation as well as objective sign-based challenge outcome algorithms to assure accuracy and comparability of blinded food challenges. Training and supervision of staff conducting food challenges is a mandatory component of reliable outcome data.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Surviving the journey is a good prognostic indicator EDITOR,--Malcolm Fisher's article on acute anaphylaxis was prompted by an anecdote concerning a doctor's panic when his young daughter developed ...an acute allergic reaction. 1 The father ended up "ranting and raving" in the emergency department because his daughter had not received adrenaline immediately.
Full text
Available for:
BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
AR101 Oral Immunotherapy for Peanut Allergy Vickery, Brian P; Vereda, Andrea; Casale, Thomas B ...
New England journal of medicine/The New England journal of medicine,
11/2018, Volume:
379, Issue:
21
Journal Article
Peer reviewed
Open access
A peanut-derived protein product, AR101, used in an oral desensitization protocol in children and adolescents with severe peanut allergy increased the amount of oral peanut protein tolerated in ...approximately two thirds of participants who received AR101, as compared with 1 of 25 controls.
PDF
