scholarly journals Immunoglobulin E‐mediated food allergy diagnosis and differential diagnosis

2020 ◽  
Vol 2 (1) ◽  
pp. 26-30
Author(s):  
Charles F. Schuler IV ◽  
Malika Gupta ◽  
Georgiana M. Sanders
Keyword(s):  
Differential Diagnosis ◽  
Immunoglobulin E ◽  
Food Challenge ◽  
Clinical History ◽  
Food Allergies ◽  
Duration Of Symptoms ◽  
Symptom Complex ◽  
Food Challenges ◽  
Food Allergy Diagnosis ◽  
Double Blinded

Food allergies consist of aberrant immunologic, typically immunoglobulin E mediated, reactions that involve food proteins. A clinical history with regard to the suspected food, temporal associations, the duration of symptoms, characteristic symptom complex, and reproducibility in some cases is the key to making an accurate diagnosis. The differential diagnosis includes, for example, other immunologic adverse food reactions, nonimmunologic adverse food reactions, and reactions that involve nonfood items. Skin and blood immunoglobulin E testing for the suspected food antigen can aid the diagnosis in the context of a supportive clinical history. Immunoglobulin E testing for food components may further enhance diagnostic accuracy. Novel testing modalities are under development but are not yet ready to replace the current paradigm. Thus, double-blinded placebo controlled oral food challenge is considered the criterion standard of testing, although unblinded oral food challenges are usually confirmatory.

scholarly journals Using oral food challenges to provide clarity and confidence when diagnosing food allergies

2021 ◽  
Vol 3 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Justin Greiwe
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Food Challenge ◽  
Clinical History ◽  
The United States ◽  
Oral Immunotherapy ◽  
Food Allergies ◽  
Ige Mediated ◽  
Challenge Education ◽  
Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

Oral food challenges in clinical practice: a missing element of food allergy diagnosis in Russia

2021 ◽  
Vol 17 (4) ◽  
pp. 19-29
Author(s):  
Daria M. Levina ◽  
Ilya A. Korsunskiy ◽  
Daniel B. Munblit
Keyword(s):  
Food Allergy ◽  
Russian Federation ◽  
Food Challenge ◽  
Clinical History ◽  
Allergy Diagnosis ◽  
Laboratory Test Results ◽  
The World ◽  
Life Threatening ◽  
Food Challenges ◽  
Food Allergy Diagnosis

Food allergy is one of the most prevalent allergic conditions, causing reduction in patient quality of life. It is linked with high levels of anxiety due to potential life-threatening reactions, and high economic burden for a healthcare system. Food allergy affects approximately 5 to 10% of children around the world. In Russian Federation the diagnosis of food allergy is primarily based on clinical history, laboratory test results, examination and elimination of suspected food. Meanwhile oral food challenge (OFC) is considered a gold standard of food allergy diagnosis by most of professional bodies nationally and internationally. OFC is a diagnostic procedure involving administration of a causative allergen in gradually increasing amount under a close medical supervision. The method is safe, highly specific and sensitive and is widely used around the world for more than 45 years. The main goals of OFC include food allergy diagnosis and presence of tolerance evaluation, which may result in diet expansion. OFC may also help establishing both, reaction severity and dose needed to elicit reaction, which may further assist with alleviation of patients anxiety. In this paper we discuss existing approaches to the diagnosis of food allergy in Russian Federation and review available recommendations on OFC outlined in international guidelines.

scholarly journals The Epidemiology of Food Allergy in the Global Context

2018 ◽  
Vol 15 (9) ◽  
pp. 2043 ◽  
Author(s):  
Wenyin Loh ◽  
Mimi Tang
Keyword(s):  
Developing Countries ◽  
Food Allergy ◽  
Immunoglobulin E ◽  
Clinical History ◽  
Food Allergies ◽  
Western Countries ◽  
Specific Immunoglobulin E ◽  
Food Challenges ◽  
Surrogate Measures ◽  
Allergy Prevalence

There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow’s milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country’s feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.

scholarly journals Prediction of Food Allergens Sensitization Based on History Taking Technique in Young Children

2021 ◽  
Vol 42 (5) ◽  
pp. 407-410
Author(s):  
Jeongmin Lee ◽  
Kyunguk Jeong ◽  
Eunjoo Lee ◽  
Sooyoung Lee
Keyword(s):  
Immunoglobulin E ◽  
Area Under The Curve ◽  
Food Challenge ◽  
Clinical History ◽  
Egg White ◽  
Food Allergies ◽  
Cow’S Milk ◽  
Serological Tests ◽  
Cow's Milk ◽  
Class 1

Background: The diagnosis of food allergies needs to be confirmed through an oral food challenge (OFC). However, specific immunoglobulin E (sIgE) concentrations analyzed by serological tests are also helpful in determining OFC items and predicting the presence of allergic reactions. Unfortunately, there is a limit to the number of antigens that can be simultaneously evaluated at one time. The purpose of this study was to analyze the possibility of detecting sIgE antibodies against food using clues in self-reported food allergy symptoms. Methods: Medical records of 377 patients aged 3 years or younger were collected for egg white-, cow’s milk-, walnut- and soybean-sIgE sensitization, and related clinical history. Each clinical history was classified into class 1: direct- isolated intake resulting in anaphylaxis or hives with consistent clincical history; class 2a: class 1 with inconsistency; class 2b: indirect-mixed intake resulting in anaphylaxis or hives regardless of consistency; class 2c: direct/indirect- isolated/mixed intake resulting in itching without hives, vomiting, or diarrhea with consistent clincical history; or class 3: class 2c with inconsistency or asymptomatic to direct, isolated exposure. Results: The area under the curve (AUC) of class 1 for cow’s milk was 0.790, and the accuracy was 78.0%. The AUC of class 1 and 2 for egg white was better than that of class 1 (0.750), and the accuracy rate was 77.6%. The AUCs of class 1 for walnut and soybean were 0.775 and 0.662, respectively. Conclusion: In conclusion, sIgE sensitization to foods could be predicted by the combination of exposure and selfreported symptoms in children under 3 years of age.

scholarly journals Evaluation of early skin or laryngeal reaction at oral food challenge

2021 ◽  
Author(s):  
Toshinori Nakamura ◽  
Yuki Okada ◽  
Mayu Maeda ◽  
Taro Kamiya ◽  
Takanori Imai
Keyword(s):  
Prediction Models ◽  
Immunoglobulin E ◽  
Food Challenge ◽  
Serum Levels ◽  
Oral Food Challenge ◽  
Food Allergies ◽  
Specific Immunoglobulin E ◽  
Allergic Skin ◽  
Test Initiation ◽  
Skin Signs

Background: An oral food challenge (OFC) is required for diagnosing food allergies; however, uncertain reactions can impair the determination of when to stop the test. We aimed to determine the associations between immediately occurring mild allergic skin signs/laryngeal symptoms and positive OFC results. Methods: We retrospectively included children (aged 6 months to 15 years) who underwent open OFC for hen’s egg (HE), cow’s milk (CM), or wheat at a single centre between May 2012 and March 2020. Participants with mild skin signs or laryngeal symptoms at OFC initiation were classified as “skin” or “laryngeal” cases, respectively. Using logistic regression, the risk of positive OFC results, in a skin or laryngeal case, was assessed using univariate and multivariate analyses. Age, sex, total target dose, and serum levels of total and food-specific immunoglobulin E were used as covariates in prediction models. Results: In total, 2954, 1126, and 850 tests for HE, CM, and wheat, respectively, were included and comprised 115 (4%) and 25 (0.9%), 92 (9%) and 24 (2%), and 7 (1.3%) and 0 (0%) skin and laryngeal cases, respectively. Children with reactions to both HE and CM had a higher risk of a positive OFC than controls (odds ratio [95% confidence interval]: 4.6 [3.3–6.4], 2.9 [2.0–4.1] and 6.5 [3.0–10.9], 4.9 [2.2–10.9], respectively). Areas under the curves of prediction models ranged from 0.61 to 0.71. Conclusions: Uncertain reactions immediately after test initiation could not robustly predict OFC results, indicating the OFC could be continued under careful observation.

scholarly journals Skin Prick Tests and Patch Tests in Children with Food Allergies.

2020 ◽  
pp. 1-4
Keyword(s):  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Food Challenge ◽  
Diagnostic Methods ◽  
Food Allergies ◽  
Sufficient Evidence ◽  
Patch Tests ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
Skin Prick Tests

Abstract Diagnosing food allergies can be challenging for patients and health professionals. Standard diagnostic methods include skin prick testing, food-specific immunoglobulin E (IgE) and oral food challenge. There is no scientifically sufficient evidence for routine use of patch testing for food allergy evaluation in children.

scholarly journals White paper peanut allergy—part 2: Diagnosis of peanut allergy with special emphasis on molecular component diagnostics

2021 ◽  
Author(s):  
Lea Alexandra Blum ◽  
Birgit Ahrens ◽  
Ludger Klimek ◽  
Kirsten Beyer ◽  
Michael Gerstlauer ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Systemic Reaction ◽  
Food Challenge ◽  
Clinical History ◽  
Double Blind ◽  
Skin Reactions ◽  
Diagnostic Algorithms

Summary Background Peanut allergy is an immunoglobulin E (IgE)-mediated immune response that usually manifests in childhood and can range from mild skin reactions to anaphylaxis. Since quality of life maybe greatly reduced by the diagnosis of peanut allergy, an accurate diagnosis should always be made. Methods A selective literature search was performed in PubMed and consensus diagnostic algorithms are presented. Results Important diagnostic elements include a detailed clinical history, detection of peanut-specific sensitization by skin prick testing and/or in vitro measurement of peanut (extract)-specific IgE and/or molecular components, and double-blind, placebo-controlled food challenge as the gold standard. Using these tools, including published cut-off values, diagnostic algorithms were established for the following constellations: 1) Suspicion of primary peanut allergy with a history of immediate systemic reaction, 2) Suspicion of primary peanut allergy with questionable symptoms, 3) Incidental findings on sensitization testing and peanut ingestion so far or 4) Suspicion of pollen-associated peanut allergy with solely oropharyngeal symptoms. Conclusion The most important diagnostic measures in determining the diagnosis of peanut allergy are clinical history and detection of sensitizations, also via component-based diagnostics. However, in case of unclear results, the gold standard—an oral food challenge—should always be used.

scholarly journals Legume and sesame oral food challenge outcomes

2021 ◽  
Vol 3 (2) ◽  
pp. 42-49 ◽  
Author(s):  
Jacob J. Pozin ◽  
Ashley L. Devonshire ◽  
Kevin Tom ◽  
Melanie Makhija ◽  
Anne Marie Singh
Keyword(s):  
Regression Models ◽  
Operating Characteristic ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Food Challenge ◽  
Logistic Regression Models ◽  
Receiver Operating Characteristic Curves ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
Food Challenges

Background: Legume and sesame are emerging food allergens. The utility of specific immunoglobulin E (sIgE) testing to predict clinical reactivity to these allergens is not well described. Objective: To describe clinical outcomes and sIgE in sesame and legume oral food challenges (OFC). Methods: We performed a retrospective review of 74 legume and sesame OFCs between 2007 and 2017 at the Ann and Robert H. Lurie Children’s Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves and logistic regression models that predicted OFC outcome were generated. Results: Twenty-eight patients (median age, 6.15 years) passed legume OFC (84.9%), and 25 patients (median age, 5.91 years) passed sesame OFC (61.0%). The median sIgE to legume was 1.41 kUA/L and, to sesame, was 2.34 kUA/L. In patients with failed legume OFC, 60.0% had cutaneous symptoms, 20.0% had gastrointestinal symptoms, and 20.0% had anaphylaxis. Of these reactions, 80.0% were controlled with antihistamine alone and 20.0% required epinephrine. In patients for whom sesame OFC failed, 50.0% had cutaneous symptoms, 12.5% had gastrointestinal symptoms, and 37.50% had anaphylaxis. Of these reactions, 6.3% required epinephrine, 31.3% were controlled with diphenhydramine alone, and 63.50% required additional epinephrine or prednisone. Conclusion: Most OFCs to legumes were passed and reactions to failed legume OFCs were more likely to be nonsevere. Sesame OFC that failed was almost twice as likely compared with legume OFC that failed, and reactions to sesame OFC that failed were often more severe. Sesame sIgE did not correlate with OFC outcome.

scholarly journals Estimating Cost-Effectiveness of Confirmatory Oral Food Challenges in the Diagnosis of Children With Food Allergy

2019 ◽  
Vol 6 ◽  
pp. 2333794X1989129
Author(s):  
Abdullah Alsaggaf ◽  
James Murphy ◽  
Sydney Leibel
Keyword(s):  
Food Allergy ◽  
Cost Effectiveness ◽  
Immunoglobulin E ◽  
Pediatric Population ◽  
The United States ◽  
Food Allergies ◽  
Prick Test ◽  
Life Years ◽  
Food Challenges ◽  
The Cost

Introduction. Food allergies affect 8% of the pediatric population in the United States with an estimated annual cost of US$25 billion. The low specificity of some of the main food allergy tests used in diagnosis may generate false positives incurring unnecessary costs. We examined the cost-effectiveness of oral food challenges (OFC) as confirmatory tests in the diagnosis of food allergy. Methods. We constructed a decision tree with a Markov model comparing the long-term (15 years) cost and effectiveness—in the form of quality-adjusted life years (QALY)—of confirmatory OFCs compared with immediate allergenic food elimination (FE) after a skin prick test or blood immunoglobulin E (IgE) level in children with suspected food allergy. For costs, we included the costs of OFCs and the reported annual costs of having a food allergy, including direct medical costs and costs borne by families. Results. The cost of OFC strategy was $8671 compared with $18 012 for the FE strategy for the length of the model. Also, the OFC strategy had a total QALY of 21.942 compared with 21.740 for the FE strategy. In the OFC strategy, the total cost was $9341 less than FE and the increase in QALY after OFCs led to a 0.202 higher effectiveness in the OFC strategy. Conclusion. In conclusion, our study shows that the confirmatory OFC strategy dominated the FE strategy and that a confirmatory OFC for children, within a year of diagnosis, is a cost-effective strategy that decreases costs and appears to improve quality of life.

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