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ABSTRACT: BACKGROUND: For most allergenic foods, insufficient threshold dose information within the population restricts the advice on levels of unintended allergenic foods which should trigger precautionary labeling on prepackaged foods. OBJECTIVE: We wanted to derive threshold dose distributions for major allergenic foods and to elaborate the protein doses at which a proportion of the allergic population is likely to respond. METHODS: For 7 allergenic foods double-blind, placebo-controlled food challenges (DBPCFCs) with a positive outcome for allergic reactions were selected from the clinical database of children routinely tested to diagnose food allergy at the University Medical Center Groningen. For each allergen 2 population threshold distributions were determined with the individual minimal eliciting dose and the preceding dose of each DBPCFC for objective symptoms and any symptom (either subjective or objective). RESULTS: Individual positive DBPCFCs were available for peanut (n = 135), cow's milk (n = 93), hen's egg (n = 53), hazelnut (n = 28), and cashew nut (n = 31). Fewer children were challenged with soy (n = 10) or walnut (n = 13). Threshold dose distributions showed a good statistical and visual fit. The protein dose at which 5% of the allergic population is likely to respond with objective reactions was 1.6 mg for peanut, 1.1 mg for cow's milk, 1.5 mg for hen's egg, 7.4 mg for cashew nut, and 0.29 mg for hazelnut. Thresholds for any symptom were on average 2 to 6 times lower than for objective symptoms. The 95% upper and lower confidence intervals of the threshold distributions were overlapping. The peanut threshold distribution on objective symptoms was similar to the distribution of another European center. CONCLUSIONS: Threshold distribution curves and eliciting doses are a powerful tool to compare different allergenic foods and for informing policy on precautionary labeling.
The Journal of allergy and clinical immunology 11/2012; · 9.17 Impact Factor
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ABSTRACT: BACKGROUND: Currently, the longitudinal validity (validity over time) and responsiveness (ability to measure change over time) of the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF), the Food Allergy Quality of Life Questionnaire-Teenager Form (FAQLQ-TF), and the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) are unknown. Additionally, the self-reported impact of a double-blind, placebo-controlled food challenge (DBPCFC) on health-related quality of life (HRQL) in adults (≥18 years of age), adolescents (13-17 years of age), and children (8-12 years of age) is unknown. OBJECTIVE: The aims of this study were to assess the longitudinal validity and responsiveness of the FAQLQ-AF, FAQLQ-TF, and FAQLQ-CF and to assess the impact of a DBPCFC on HRQL. METHODS: Two hundred twenty-one participants suspected of food allergy were included from Dutch allergy centers. Participants undergoing a DBPCFC (experimental group) completed the FAQLQ and Food Allergy Independent Measure (FAIM) 1 month before (baseline) and 6 months after (follow-up) a DBPCFC. Participants not undergoing a DBPCFC (control group) completed the questionnaire package twice with a 7-month interval. RESULTS: HRQL scores improved after a DBPCFC, with greater improvements in HRQL scores after a negative outcome (food allergy ruled out) than a positive outcome (food allergy confirmed), demonstrating responsiveness of the FAQLQs. Significant correlations were shown between the change (follow-up minus baseline) in FAQLQ and FAIM scores supporting longitudinal validity of these questionnaires: FAQLQ-AF (Pearson correlation coefficient = 0.71, P < .001), FAQLQ-TF (Pearson correlation coefficient = 0.35, P = .018), and FAQLQ-CF (Pearson correlation coefficient = 0.51, P < .001). CONCLUSIONS: Our findings demonstrate the longitudinal validity and responsiveness of the FAQLQs. Greater improvements in HRQL scores were shown after a negative outcome than after a positive outcome.
The Journal of allergy and clinical immunology 07/2012; · 9.17 Impact Factor
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ABSTRACT: Background: Cow's milk (CM) hydrolysates are frequently used as milk substitutes for children with CM allergy. In hydrolysates, allergenic epitopes within CM proteins are diminished by enzymatic treatment. The aim of this study was to examine the allergenic and immunogenic properties of whey proteins during hydrolysis. Methods: During hydrolysis, samples were obtained at 0, 10, 15, 30, 45, 60, 75 and 90 min. Degradation was checked by HPLC and SDS-PAGE. Allergenic potential was analyzed by IgE crosslinking capacity of human Fcε receptor type 1-transduced rat basophilic leukemia cells sensitized with serum of CM-allergic patients. Whey-sensitized C3H/HeOuJ mice were ear challenged intracutaneously with the hydrolysates. Immunogenicity was tested using whey-specific human T-cell clones and T-cell lines at the level of proliferation and release of IL-4, IL-10, IL-13 and IFN-γ. Results: After 15 min of hydrolysis, the majority of the proteins were degraded. Hydrolysis for 15 min resulted in 92% inhibition of mast cell degranulation and in 82% reduction of ear swelling in the mouse model. In contrast, T-cell-stimulatory capacity was less affected by hydrolysis: reduction of human T-cell proliferation was only 9%. This was further reduced to 57 and 74% after 30 and 45 min of hydrolysis, respectively. Cytokine production followed the pattern of T-cell proliferation. Conclusion: Via differential analysis of allergenic versus immunogenic properties of the time kinetics of hydrolysis of whey proteins, we have demonstrated specific hydrolysis conditions with reduced IgE-crosslinking responses but retained T-cell activating properties. This approach might be useful in better defining CM hydrolysates.
International Archives of Allergy and Immunology 06/2012; 159(3):263-70. · 2.40 Impact Factor
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ABSTRACT: ObjectiveThe self-administered Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF), -Teenager Form (FAQLQ-TF) and -Adult
Form (FAQLQ-AF) were recently developed within EuroPrevall, a multi-centred study of food allergy in Europe. The primary aim
of this study was to evaluate the test-retest reliability of the FAQLQ-CF, -TF and -AF.
MethodsOne hundred and one Dutch patients (31 children, 34 adolescents and 36 adults) completed the FAQLQ twice with a 10–14day
interval. The intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC) and Bland-Altman plots
were used to assess test-retest reliability.
ResultsTest-retest reliability was excellent with ICCs and CCCs above 0.907, 0.975 and 0.951 for the FAQLQ-CF, -TF and -AF, respectively.
Bland-Altman plots showed that the mean differences of the test and re-test were all close to zero for the FAQLQs.
ConclusionsThe FAQLQs are reliable over a short time interval. The FAQLQs are not only excellent tools for group comparison studies,
but also for monitoring individual patients.
Quality of Life Research 04/2012; 18(2):245-251. · 2.30 Impact Factor
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ABSTRACT: While genetic factors are known to be important in the development of sensitization to foods, it is not known whether they also play a role in clinical allergic reactivity to foods.
We aimed to determine whether parental atopic diseases are associated with a higher risk of a reaction to common allergenic foods when tested in a double-blind, placebo-controlled food challenge (DBPCFC).
Parents of children suspected of being food allergic were interviewed about their own and their child's atopic history. Specific IgE and skin prick tests to food allergens and the outcome of food challenges in the child were recorded.
Data from 553 double-blind food challenges performed in 396 children were analyzed. The foods tested were milk (n = 185), egg (n = 110), peanut (n = 198) and hazelnut (n = 60). Only parental eczema was significantly associated with positive outcomes for food challenges with milk after correction for age, sex, atopic comorbidity in the child and milk-specific IgE test results (odds ratio 3.1, 95% confidence interval 1.5-6.3).
Children with a positive DBPCFC to milk more frequently have parents with eczema than children with a negative test. This effect of parental eczema was not seen in children challenged with egg, peanut or hazelnut. Clinical reactivity to milk may be caused by genetic factors which are shared with parental eczema to a greater extent than clinical reactivity to other foods.
International Archives of Allergy and Immunology 12/2011; 158(1):77-83. · 2.40 Impact Factor
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ABSTRACT: The aim of the study was to estimate the prevalence of probable food allergy in adolescents aged 11-20 and to examine the frequency of epinephrine autoinjector (EAI) ownership among high-risk individuals. Adolescents were screened followed by a more detailed telephone questionnaire inquiring about suspected food(s), symptoms, diagnosis, and use of an EAI. The participating adolescents were classified as probably or unlikely to be food-allergic. The need for an EAI was assessed. In total, 2284 adolescents completed the screening questionnaire, of which 396 indicated food to be a problem and 168 agreed to be interviewed. Forty-eight adolescents were classified as probably food-allergic, of which eight were not aware of their food allergy. Twenty-three adolescents were considered candidates for an EAI, whereas only two of them had been prescribed this medication. The calculated questionnaire-based prevalence of EAI need was 3.0% (minimal prevalence at least 1.0%), whereas the EAI ownership was 0.09%. In conclusion, we found an alarming under prescription of EAIs in school-going adolescents.
Pediatric Allergy and Immunology 06/2011; 22(4):374-7. · 2.46 Impact Factor
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ABSTRACT: Hypoallergenic infant formulas are commonly used for genetically predisposed children and infants diagnosed with cow's milk allergy. This study describes both in vitro and in vivo approaches to assess residual allergenicity of partially hydrolysed infant formulas. Electrophoretic patterns indicated that β-lactoglobulin and other whey proteins were largely degraded. For safety reasons, according to the European commission-guidelines, it is required that the sensitizing capacity of hypoallergenic formulas is tested in an animal model. In contrast to whey sensitization, no elevated levels of whey-specific IgE, anaphylactic reactions or drop in body temperature were observed in sensitized mice exposed to whey hydrolysates. This indicates that the whey hydrolysates lost their putative sensitizing capacity in a mouse model using oral sensitization, which is highly relevant in relation to the human situation. In combination with the lost capacity of hydrolysed infant formulas to cross-link human IgE antibodies on RBL-huFcɛRI in vitro, both the sensitization and the challenge phase of the allergic response were studied. This combination of assays is proposed as a strategy for the screening of new hypoallergenic formulas aimed at preventing sensitization in atopic children and avoiding clinical symptoms in infants suffering from cow's milk allergy.
Toxicology Letters 01/2011; 201(3):264-9. · 3.23 Impact Factor
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Charlotte B Madsen,
René Crevel,
Chun-Han Chan, Anthony E J Dubois,
Audrey DunnGalvin,
Bertine M J Flokstra-de Blok,
M Hazel Gowland,
Sue Hattersley,
Jonathan O'B Hourihane,
Pia Nørhede,
Sylvia Pfaff,
Gene Rowe,
Sabine Schnadt,
Berber J Vlieg-Boerstra
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ABSTRACT: We have reached a point where it is difficult to improve food allergy risk management without an agreement on levels of acceptable risk. This paper presents and discusses the perspectives of the different stakeholders (allergic consumers, health professionals, public authorities and the food industry) on acceptable risk in food allergy. Understanding where these perspectives diverge and even conflict may help develop an approach to define what is acceptable. Uncertainty about food allergy, its consequences and how to manage them is the common denominator of the stakeholders' views. In patients, uncertainty is caused by the unpredictability of reactions and the concern about whether avoidance strategies will be effective enough. Variability of symptoms and the lack of markers do not allow stratification of patients according to their reactivity, and force health professionals to give the same advice to all patients despite the fact that the risk to each is not identical. Regulators and the food industry struggle with the fact that the lack of management thresholds forces them to make case-by-case decisions in an area of uncertainty with penalties for under- or over-prediction. As zero risk is not a realistic possibility, consensus on acceptable risk will be needed.
Regulatory Toxicology and Pharmacology 03/2010; 57(2-3):256-65. · 2.43 Impact Factor
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ABSTRACT: Asthma and rhinitis may represent two manifestations of the same airway disease. Genetic research can increase our understanding of their common or distinct pathogenesis. IL13 and IL4R polymorphisms are associated with asthma and show gene-gene interaction in asthma. Their role in rhinitis has not been extensively studied.
Association of IL13 and IL4R polymorphisms in relation to rhinitis, asthma, serum IgE and skin test response was studied in: (1) 188 trios ascertained through a proband with rhinitis who were clinically not affected by asthma; (2) 407 trios with an asthmatic proband, and (3) 118 asthma cases and 102 unrelated healthy controls using family-based association testing, logistic regression, and analysis of variance as appropriate. Gene-gene interaction was evaluated using logistic regression analysis.
IL13 C-1111T (rs1800925) was significantly associated with rhinitis and atopic phenotypes in rhinitis trios that were not affected by clinical asthma. IL13 Arg130Gln (rs20541) and G870A (rs1295685) were consistently associated with asthma and serum IgE in both asthma populations. IL4R Glu375Ala (rs1805011) and Ser411Leu (rs1805013) were associated with asthma in the asthma case-control population. Combining risk genotypes of IL13 Arg130Gln with IL4R Glu375Ala, and IL13 C-1111T with IL4R Ser478Pro yielded increased risks for asthma compared to their separate effects.
IL13 polymorphisms were associated with asthma and rhinitis without clinical asthma; thus, these polymorphisms may constitute a common etiologic pathway for their development. In addition, the study replicates a previously reported interaction of IL13 and IL4R polymorphisms in asthma.
International Archives of Allergy and Immunology 01/2010; 153(3):259-67. · 2.40 Impact Factor
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ABSTRACT: Little is known about specific psychological factors that affect parents' decisions to take part in clinical studies. We examined factors, related to health-related quality of life (HRQoL), that may influence parents' decision to allow their children to participate in research on clinical food allergy.
Parents of children with food allergies were offered investigational oral immunotherapy (OIT) in a regular outpatient clinic. Forty parents (group A) declined, and 25 parents (group B) agreed to take part. Both groups agreed to complete the Food Allergy Quality of Life-Parent Form and the Food Allergy Independent Measure.
Children were aged between 1 and 12 years (mean: 6.5 years). Groups A and B displayed a similar and typical distribution for gender, age, number of foods, severity and number of symptoms, and socioeconomic variables. Parents who chose to enroll their children in the OIT trial reported a similar impact of food allergy on the HRQoL of their children as parents of children who did not volunteer for the study. Participating parents perceived a significantly higher likelihood (odds ratio: 6.753) of their child having a severe reaction and dying if food is ingested. By using this model, the likelihood of taking part in immunotherapy could be predicted accurately in 90% of cases.
Parents who had higher anxiety about negative outcomes from accidental ingestion were more likely to consent to experimental therapy for their child. This finding has ethical implications for investigators and supports the need to create mechanisms to avoid unintended coercion in vulnerable groups.
PEDIATRICS 09/2009; 124(3):e503-9. · 4.47 Impact Factor
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ABSTRACT: Food allergy can affect health-related quality of life (HRQL). Currently, no validated, self-administered, disease-specific HRQL questionnaire for adolescents with food allergy exists.
We sought to develop and validate the Food Allergy Quality of Life Questionnaire-Teenager Form (FAQLQ-TF) in the Dutch language.
Ten adolescents (13-17 years) with food allergy were interviewed and generated 166 HRQL items. The most important items were identified by 51 adolescents with food allergy by using the clinical impact method, resulting in the FAQLQ-TF containing 28 items (score range: 1 "no impairment" to 7 "maximal impairment"). The FAQLQ-TF, the Food Allergy Independent Measure, and a generic HRQL questionnaire (CHQ-CF87) were sent to 98 adolescents with food allergy for cross-sectional validation of the FAQLQ-TF.
Construct validity was assessed based on the correlation between the FAQLQ-TF and the Food Allergy Independent Measure (rho = 0.57, P < .001). The FAQLQ-TF had excellent internal consistency (Cronbach alpha = .92) and discriminated between adolescents who differed in number of food allergies (1 vs >2 food allergies: total FAQLQ-TF score, 4.3 vs 3.5; P = 0.037) but did not discriminate between those who did or did not have reported anaphylaxis. The FAQLQ-TF correlated weakly with 6 of the 11 CHQ-CF87 scales, demonstrating convergent/discriminant validity.
The FAQLQ-TF is the first self-administered, disease-specific HRQL questionnaire for adolescents with food allergy. It has good construct validity and excellent internal consistency and discriminates between adolescents who differ in the number of food allergies. The FAQLQ-TF is short and easy to use and might therefore be a useful tool in clinical research.
The Journal of allergy and clinical immunology 07/2008; 122(1):139-44, 144.e1-2. · 9.17 Impact Factor
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ABSTRACT: Approximately 2% of the Northern and Central European population is allergic to apples. Because of symptoms of oral allergy syndrome, many individuals avoid eating fresh apples. A strategy to allow apple allergic individuals to eat apples is the development of hypoallergenic apple varieties.
To investigate the allergenicity of a putatively hypoallergenic apple cultivar, the Santana apple, on apple allergic individuals using a method of challenge in which loss of allergenicity is minimized.
The study population consisted of 15 apple allergic individuals, who underwent an open oral challenge with 3 different apple cultivars: Santana, Golden Delicious, and Topaz. Food challenges were performed between February 1 and May 31, 2005, during the birch tree pollen season. Sensory perception during challenges was minimized by use of a blindfold and nose clip and randomization of challenge order. Subjective symptoms were scored by a visual analog scale.
After challenge with the Santana apple, 8 of 15 study participants (53%) developed no symptoms, which was a significantly greater proportion than after challenge with the Topaz apple (1 participant) and Golden Delicious apple (1 participant) (P = .002). The visual analog scale scores for the Santana apple (dose 1) were significantly lower than that for the Golden Delicious and Topaz apples. A total of 73% of the participants stated they would eat Santana apples in the future.
The Santana apple caused significantly fewer allergic symptoms in apple allergic individuals than the Golden Delicious and Topaz apples. The Santana apple may be a good choice for most apple allergic individuals who want to eat apples.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2008; 99(6):522-5. · 2.83 Impact Factor
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ABSTRACT: We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to 'high risk' families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted.
Pediatric Allergy and Immunology 10/2007; 18(6):475-9. · 2.46 Impact Factor
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ABSTRACT: Despite recent advances in our understanding of basophil biology and discovery of new markers for basophil activation, tests measuring basophil activation are not widely utilized in Hymenoptera allergy. Studies of the basophil-activation test in Hymenoptera allergy were examined and the clinical utility of this test was assessed.
It has been demonstrated that the results of basophil-activation tests correlate quite well with those of serum IgE testing or skin-prick tests. Many studies compare test outcomes with history in patients and nonallergic controls, so that specificity in sensitized but clinically nonreactive individuals remains unknown. Although one study showed that the basophil-activation test might predict immunotherapy side effects, this could not be confirmed in a second study, and no role has been established for the basophil-activation test in the monitoring of venom immunotherapy. The basophil-activation test has no extra value in assessing sting challenges, although experience is limited.
The measurement of basophil-activation markers may be useful in detecting IgE-mediated sensitization but the relevance for application of the basophil-activation test in prediction of clinical reactivity in Hymenoptera allergy is very limited. For this reason, this test currently has no established role in the diagnosis and management of patients with insect sting allergy.
Current Opinion in Allergy and Clinical Immunology 09/2007; 7(4):346-9. · 4.11 Impact Factor
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ABSTRACT: Venom immunotherapy (VIT) is a treatment with established efficacy for the prevention of repeated anaphylactic reactions in patients with Hymenoptera allergy, which also allows patients to discontinue carrying an EpiPen. Despite their merits, both treatments can have negative aspects potentially important to patients.
We examined possible negative aspects of the EpiPen in comparison with VIT as perceived by patients.
Positive and negative aspects of both treatments were measured by using a burden of treatment questionnaire together with statements about the EpiPen.
One hundred ninety-three patients were included, of whom 94 consented to randomization: 47 received VIT, and 47 received the EpiPen. Of the remaining 99, 75 chose VIT, and 26 chose the EpiPen. Of the patients receiving VIT, 91.5% were (extremely) positive about their treatment, and 85% would choose VIT again. Of the patients receiving the EpiPen, only 48% were positive about their treatment, and even of these patients, 68% preferred to be treated with VIT after 1 year of carrying the EpiPen. Although most patients indicated that it is reassuring to carry an EpiPen and makes them feel safe, many patients also indicated that it is inconvenient and troublesome. Especially patients who were negative about the EpiPen indicated that they would not dare use the EpiPen if necessary and were afraid at possible side effects.
In contrast to VIT, the EpiPen is perceived as burdensome by most patients with venom allergy. For most patients, an EpiPen is an unsuitable definitive treatment.
As VIT enables patients with venom allergy to get rid of the EpiPen, patients should be offered VIT.
Journal of Allergy and Clinical Immunology 10/2006; 118(3):699-704. · 11.00 Impact Factor
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Anthony E J Dubois
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ABSTRACT: Mastocytosis is a rare disease with associations with anaphylactic reactions to Hymenoptera stings. The purpose of this review is to examine these associations with regard to prevalence, diagnosis, treatment and prognosis in the insect-venom-allergic population.
Systemic mastocytosis is overrepresented in the Hymenoptera-allergic population and is associated with an increased risk of more-severe reactions following field stings or sting challenges, lack of sensitization to venoms by skin test or radioallergosorbent test, increased side effects to venom immunotherapy, reduced efficacy of venom immunotherapy and treatment failures. Serum tryptase determinations are a simple and reliable screening procedure for systemic mastocytosis. Patients with elevated values should be referred to specialized centers for confirmatory diagnosis including bone marrow histology.
The diagnosis of systemic mastocytosis should be considered in Hymenoptera-allergic patients showing any of the management problems associated with this disease. Patients with mastocytosis and Hymenoptera allergy require special attention, mainly because of reduced safety and efficacy of venom immunotherapy. Whether or not venom immunotherapy is given, such patients should continue to carry an Epipen indefinitely.
Current Opinion in Allergy and Clinical Immunology 09/2004; 4(4):291-5. · 4.11 Impact Factor
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ABSTRACT: The use of double-blind, placebo-controlled food challenges (DBPCFCs) is considered the gold standard for the diagnosis of food allergy. Despite this, materials and methods used in DBPCFCs have not been standardized.
The purpose of this study was to develop and validate recipes for use in DBPCFCs in children by using allergenic foods, preferably in their usual edible form.
Recipes containing milk, soy, cooked egg, raw whole egg, peanut, hazelnut, and wheat were developed. For each food, placebo and active test food recipes were developed that met the requirements of acceptable taste, allowance of a challenge dose high enough to elicit reactions in an acceptable volume, optimal matrix ingredients, and good matching of sensory properties of placebo and active test food recipes. Validation was conducted on the basis of sensory tests for difference by using the triangle test and the paired comparison test. Recipes were first tested by volunteers from the hospital staff and subsequently by a professional panel of food tasters in a food laboratory designed for sensory testing. Recipes were considered to be validated if no statistically significant differences were found.
Twenty-seven recipes were developed and found to be valid by the volunteer panel. Of these 27 recipes, 17 could be validated by the professional panel.
Sensory testing with appropriate statistical analysis allows for objective validation of challenge materials. We recommend the use of professional tasters in the setting of a food laboratory for best results.
Journal of Allergy and Clinical Immunology 03/2004; 113(2):341-6. · 11.00 Impact Factor
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ABSTRACT: To evaluate the scientific evidence for purported intolerance to dietary biogenic amines.
MEDLINE was searched for articles in the English language published between January 1966 and August 2001. The keyword biogenic amin* was combined with hypersens*, allerg*, intoler*, and adverse. Additionally, the keywords histamine, tyramine, and phenylethylamine were combined with headache, migraine, urticaria, oral challenge, and oral provocation. Articles were also selected from references in relevant literature.
Only oral challenge studies in susceptible patients were considered. Studies with positive results (ie, studies in which an effect was reported) were only eligible when a randomized, double-blind, placebo-controlled design was used. Eligible positive result studies were further evaluated according to a number of scientific criteria. Studies with negative results (ie, studies in which no effect was reported) were examined for factors in their design or methods that could be responsible for a false-negative outcome. Results of methodologically weak or flawed studies were considered inconclusive.
A total of 13 oral challenge studies (5 with positive results and 8 with negative results) were found. Three of them (all with positive results) were considered ineligible. By further evaluation of the 10 eligible studies, 6 were considered inconclusive. The 4 conclusive studies all reported negative results. One conclusive study showed no relation between biogenic amines in red wine and wine intolerance. Two conclusive studies found no effect of tyramine on migraine. One conclusive study demonstrated no relation between the amount of phenylethylamine in chocolate and headache attacks in individuals with headache.
The current scientific literature shows no relation between the oral ingestion of biogenic amines and food intolerance reactions. There is therefore no scientific basis for dietary recommendations concerning biogenic amines in such patients.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2003; 91(3):233-40; quiz 241-2, 296. · 2.83 Impact Factor
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Anthony E J Dubois
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ABSTRACT: The sting challenge has been an important tool in advancing our knowledge about allergy to stings from insects in the order Hymenoptera. While some European centers have advocated its use in the past as a routine diagnostic procedure to select patients requiring venom immunotherapy, this practice has been abandoned because of the poor reproducibility of the test. In this review, the possible use of the sting challenge in clinical practice is discussed in the light of current knowledge of the limitations of the test. Its use in recent studies is also discussed, with an emphasis on the implications of the test's variability.
Several studies have attempted to quantify the risk of recurrence of anaphylactic reactions to hymenoptera stings under various clinical circumstances on the basis of the outcome of a single sting challenge. Many of these studies were carried out with small patient numbers, and consequently must be interpreted with caution.
While the sting challenge with a living insect is still the best available test for ascertaining clinical reactivity to insect venoms, the reproducibility of this procedure is modest. The outcome of single sting challenges in individual patients should therefore be interpreted with caution, in both the research setting and clinical practice.
Current Opinion in Allergy and Clinical Immunology 09/2003; 3(4):283-5. · 4.11 Impact Factor
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ABSTRACT: As re-sting rates and mortality in Hymenoptera allergy are generally low, health related quality of life is an important therapeutic target in the treatment of allergic patients. This review focuses on the impact of anaphylactic reactions and the effect of interventions in health related quality of life for Hymenoptera allergic patients.
Anaphylactic reactions following insect stings can have a great impact on the quality of life of insect sting allergic patients. Venom immunotherapy, with information about the risks and benefits of the treatment, was shown to improve health related quality of life. There were no patients whose health related quality of life was so severely impaired that they did not improve with venom immunotherapy. Treatment with an Epipen (ALK-Abello, Nieuwegein, The Netherlands) resulted in a deterioration in health related quality of life.
These findings suggest that patient education of these risks and benefits is as important as the treatment itself in order to achieve all the important therapeutic goals of venom immunotherapy. For most patients the Epipen is insufficient as definitive treatment from a quality of life point of view. Although the low mortality, morbidity and re-sting frequency in Hymenoptera allergic patients has led some authorities to conclude that many patients are treated unnecessarily, this conclusion is refuted by the fact that venom immunotherapy improves health related quality of life in the vast majority of patients receiving this treatment, even if they are not re-stung.
Current Opinion in Allergy and Clinical Immunology 09/2003; 3(4):287-93. · 4.11 Impact Factor
