Background The national prevalence and patterns of food allergy (FA) in the United States are not well understood. Objective We developed nationally representative estimates of the prevalence of and ...demographic risk factors for FA and investigated associations of FA with asthma, hay fever, and eczema. Methods A total of 8203 participants in the National Health and Nutrition Examination Survey 2005-2006 had food-specific serum IgE measured to peanut, cow's milk, egg white, and shrimp. Food-specific IgE and age-based criteria were used to define likely FA (LFA), possible FA, and unlikely FA and to develop estimates of clinical FA. Self-reported data were used to evaluate demographic risk factors and associations with asthma and related conditions. Results In the United States, the estimated prevalence of clinical FA was 2.5% (peanut, 1.3%; milk, 0.4%; egg, 0.2%; shrimp, 1.0%; not mutually exclusive). Risk of possible FA/LFA was increased in non-Hispanic blacks (odds ratio, 3.06; 95% CI, 2.14-4.36), males (1.87; 1.32-2.66), and children (2.04; 1.42-2.93). Study participants with doctor-diagnosed asthma (vs no asthma) exhibited increased risk of all measures of food sensitization. Moreover, in those with LFA, the adjusted odds ratio for current asthma (3.8; 1.5-10.7) and an emergency department visit for asthma in the past year (6.9; 2.4-19.7) were both notably increased. Conclusion Population-based serologic data on 4 foods indicate an estimated 2.5% of the US population has FA, and increased risk was found for black subjects, male subjects, and children. In addition, FA could be an under-recognized risk factor for problematic asthma.
Work Group report: Oral food challenge testing Nowak-Węgrzyn, Anna, MD; Assa'ad, Amal H., MD; Bahna, Sami L., MD, DrPH ...
Journal of allergy and clinical immunology,
06/2009, Letnik:
123, Številka:
6
Journal Article
Recenzirano
Odprti dostop
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 arragements 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.
The cases were accumulated in a registry kept by members of the American Academy of Allergy, Asthma & Immunology and The Food Allergy and Anaphylaxis Network.1 The registry, which does not represent ...a systematic or complete accounting of all fatal food-induced allergic reactions in this country, has been maintained continuously since the initial report. Age (y) M/F Date Culprit Asthma Previous history Food Location Timely epinephrine 1 32 M 3/11/2001 Nuts Yes Yes Nut bowl Restaurant No 2 16 M 5/9/2001 Walnut Yes Yes Chinese food School, cooking class Probably 3 9 M 5/18/2001 Peanut Yes Yes Cookie School outing No 4 24 F 11/26/2001 Peanut Yes Yes Chinese food Home No 5 25 F 10/30/2001 Nut meats Yes Yes Candy Home of friends No 6 16 M 11/5/2002 Milk Yes Yes Bread Home Unk 7 31 M 12/13/2002 Peanut Yes Yes Catered food Office party No 8 50 M 12/24/2002 Nut Yes Yes Cookie Home No 9 12 F 3/14/2003 Peanut Unk Unk Egg roll Unk Unk 10 18 M 6/21/2003 Peanut Unk Unk Wrap Unk Unk 11 32 M 3/15/2003 Shrimp Yes Yes Meal Restaurant No 12 29 M 6/13/2003 Peanut Yes Yes Meal Restaurant No 13 29 M 4/24/2000 Almond Yes Yes Candy Office Yes 14 17 F 12/26/1986 Nuts Yes Yes Cookie Home of friends No 15 21 F 10/9/2003 Peanut Yes Yes Brownie College No 16 18 M 1/20/2004 Shrimp roll Yes Unk Shrimp roll Restaurant No 17 27 M 2/1/2004 Peanut Unk Yes Baked clam Home No 18 17 M 2/8/2004 Hazelnut Yes Yes Candy Home of friends No 19 17 F 4/6/2004 Peanut Yes Yes Peanut butter Camp No 20 34 F 5/29/2004 Peanut Unk Yes Thai dish Home No 21 5 M 8/1/2004 Peanut Unk No Peanuts Home No 22 9 M 7/22/2004 Milk Unk Unk Milk Camp Yes 23 22 F 10/29/2004 Peanut Yes Yes Dessert Restaurant No 24 14 F 1/22/2005 Peanut Yes Yes Egg roll Restaurant No 25 36 M 3/21/2001 Peanut Yes Yes Brownie Work No 26 17 M 3/5/2005 Milk/whey Yes Yes Protein shake Home No 27 7 F 3/2/2005 Milk Yes Yes Chocolate mix Home Unk 28 11 F 5/31/2005 Peanut Unk Yes Candied apple Carnival Unk 29 40 M 2/8/2006 Tree nut Unk Yes Cookie Work Yes 30 13 F 4/13/2006 Peanut Yes Yes Wrap Fast food in mall No 31 16 M 8/1/2006 Peanut Yes Yes Cookie Home of friends No Table I Food fatalities 2001-2006 F, Female; M, male; Unk, unknown.
Objective To assess the outcome of oral food challenges in patients placed on elimination diets based primarily on positive serum immunoglobulin E (IgE) immunoassay results. Study design This is a ...retrospective chart review of 125 children aged 1-19 years (median age, 4 years) evaluated between January 2007 and August 2008 for IgE-mediated food allergy at National Jewish Health and who underwent an oral food challenge. Clinical history, prick skin test results, and serum allergen-specific IgE test results were obtained. Results The data were summarized for food avoidance and oral food challenge results. Depending on the reason for avoidance, 84%-93% of the foods being avoided were returned to the diet after an oral food challenge, indicating that the vast majority of foods that had been restricted could be tolerated at discharge. Conclusions In the absence of anaphylaxis, the primary reliance on serum food-specific IgE testing to determine the need for a food elimination diet is not sufficient, especially in children with atopic dermatitis. In those circumstances, oral food challenges may be indicated to confirm food allergy status.
The misinterpretation of IgE-mediated specific antibody tests could lead to serious reactions when an undetectable antibody level is interpreted as negative and the patient is told to consume the ...food, and then clinical symptoms occur, emphasizing the point that an undetectable result is not necessarily a negative result.
To the Editor: The recently published National Institute of Allergy and Infectious Diseases-sponsored "Guidelines for the diagnosis and management of food allergy in the United States"1 and the "Work ...group report"2 both state that oral food challenge (OFC) is a critical procedure for the evaluation of food allergy. Allergist 77.4 Registered nurse 55.2 Medical assistant 26.1 Nurse practitioner 10.9 Physician's assistant 4.6 Other 9.1 Average duration of OFC procedure visit <1 h 1.3 1-2 h 27.0 3-4 h 63.6 5-6 h 7.4 >6 h 0.7 Table I Effort and personnel involved in OFCs Barrier Response rate (%) Response count Lack of time 55 292 Reimbursement 53.7 285 Risk of adverse event 51.8 275 Lack of staff 44.3 235 Lack of office space 27.1 144 Lack of experience 11.5 61 No nearby hospital 7.9 42 Lack of need 2.6 14 Other 9.2 49 Total
Conducting an Oral Food Challenge to Peanut in an Infant Bird, J Andrew; Groetch, Marion; Allen, Katrina J ...
The journal of allergy and clinical immunology in practice (Cambridge, MA),
03/2017, Letnik:
5, Številka:
2
Journal Article
Recenzirano
Results from the Learning Early About Peanut trial and its follow-up study suggest that early peanut introduction in the diets of high-risk infants may prevent the development of peanut allergy. ...Allergy organizations around the world released a unified statement, the Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High Risk Infants, in response to results from the Learning Early About Peanut trial, which recommends early introduction of peanut into the diet of those children at greatest risk of development of peanut allergy. As a result, it is expected that practicing allergists will experience an increased demand to perform an oral food challenge (OFC) in infants. Allergists often perform OFCs; however, conducting an OFC in an infant creates unique circumstances that have not been considered in previously published OFC guideline documents. The purpose of this workgroup report is to provide guidance to practitioners regarding the proper approach for conducting a peanut challenge in an infant.
PDF
