Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report

Mount Sinai School of Medicine, New York, NY. Electronic address: .
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 12/2012; 130(6):1260-74. DOI: 10.1016/j.jaci.2012.10.017
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    • "In those papers where both immediate and delayed reactions were reported, only those reactions that were reported to occur within 2 hours of challenge or that caused the challenge to stop were considered (Fiocchi et al., 2003; Hill et al., 1984). This time frame was chosen so as to be consistent with the recommended protocols in Bindslev-Jensen et al. (2004), Taylor et al. (2004), and Sampson et al. (2012). "
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    ABSTRACT: Food allergy is a public health concern, affecting up to 6% of children and 2% of adults. The severity of allergic reactions can range from mild to potentially life-threatening. In addition, the minimum amount of protein needed to provoke an allergic reaction in an individual patient (the minimal eliciting dose, MED) ranges from a few micrograms to several grams. To determine whether a retrospective analysis of published data from oral food challenges could be used to assess the potential relationship between MEDs and reaction severities at the MEDs, a three class (mild, moderate, severe) reaction grading system was developed by integrating previously published reaction grading systems. MEDs and symptoms were collected from food challenge studies and each reaction was graded using the integrated grading system. Peanut allergic patients who experienced severe reactions had significantly higher MEDs and threshold distribution doses than those who experienced mild and moderate reactions. No significant differences in threshold distributions according to the severity grading were found for milk, egg and soy. The relationship between threshold dose distribution and reaction severity based on these grading criteria differed between peanut and other allergens, and severe reactions occurred in some patients at low MEDs for all of these food allergens. Copyright © 2015. Published by Elsevier Ltd.
    Food and Chemical Toxicology 03/2015; 80. DOI:10.1016/j.fct.2015.02.023 · 2.90 Impact Factor
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    • "None of the guidelines emphasize standardization of tests and challenges; perhaps because international consensus documents on standardization were only published in 2012 and 2013 [2-4,100,102]. "
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    ABSTRACT: ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.
    World Allergy Organization Journal 05/2014; 7(1):9. DOI:10.1186/1939-4551-7-9
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    • "The diagnosis routine of food allergy was performed based on the history and laboratory tests (specific IgE, skin prick test). Since there are no effective laboratory methods for the diagnosis of non-IgE-mediated FA, suspected in patients with symptoms suggestive of proctocolitis and enterocolitis, or in patients with diagnosis of eosinophilic esophagitis and atopic dermatitis moderate to severe, an elimination diet without a suspected allergenic protein and subsequent oral food challenge, which was open for children younger than 3 years and double-blind for children above 3 years, was used for diagnosis [5, 6]. "
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    ABSTRACT: Background and Aims. Food allergy (FA) is a common disease that is rapidly increasing in prevalence for reasons that remain unknown. Objective. The aim of this study was to analyze the clinical characteristics and anthropometric data of patients with food allergies followed in a tertiary centre of allergy and immunology. Methods. A retrospective study was performed that assessed the data records of patients with food allergy diagnosis, covering a period from February 2009 to February 2012. Results. 354 patients were evaluated in the period; 228 (69.1%) patients had a confirmed FA diagnosis. The z-scores for weight-for-age, height-for-age, and body mass indices-for-age showed lower significant values in the FA group compared with the non-FA group by Mann-Whitney test, with significance values of P = 0.0005, P = 0.0030, and P = 0.0066, respectively. There were no statistical differences in sex, gestational age, birth type, breastfeeding period, and age of introduction of complementary formulas based on cow milk protein between groups. Conclusion. FA patients had a lower growth rate in comparison with patients without FA. The early recognition of food allergies with the establishment of protein-implicated diet exclusion, in association with an adequate nutrient replenishment, is important to reduce the nutritional impact of food allergies.
    Journal of Allergy 05/2014; 2014(121):980735. DOI:10.1155/2014/980735
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