Oral food challenges in children in Italy (original) (raw)

Diagnostic oral food challenges in the tertiary paediatric allergy clinic in the UK

The Central European Journal of Paediatrics, 2017

Objective – To assess outcomes of oral food challenges (OFC) and to investigate food reintroduction success among children who had negative OFC within single UK tertiary paediatric allergy centre. Methods – This study was a retrospective audit of OFC conducted over a 1 year period among children aged 0 to 18 years at Leeds’s Children’s Hospital who were referred for assessment of their food allergy. Data were collected on demographics, clinical history, challenge outcome and success of reintroduction Results – Out of 363 challenges conducted 282 (77.7%) had a negative outcome. Of 70 positive challenges, 2 were anaphylaxis due to cow’s milk. Positive challenge outcome was more common in children with a history of atopic eczema (23.4% vs 13.2%, p=0.03) and those who avoided multiple food allergens (p=0.007). The majority of nut challenges (93.9%) tended to be negative. Following negative challenge, data on reintroduction was available on 188/282 children. The majority of children (82....

The optimal diagnostic workup for children with suspected food allergy

Nutrition, 2011

Food allergy is defined as an abnormal immunologic reaction to food proteins that causes an adverse clinical reaction. In addition to well-known acute allergic reactions and anaphylaxis triggered by immunoglobulin E antibody-mediated immune responses to food proteins, there is an increasing recognition of cell-mediated disorders such as eosinophilic esophagitis and food protein-induced enterocolitis syndrome. More than 90% of food allergies in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish, and shellfish. The diagnostic workup for a child with suspected food allergy includes a detailed medical history, physical examination, food allergy screening tests, and responses to an elimination diet and an oral food challenge. None of the screening tests, alone or in combination, can definitely diagnose or exclude a food allergy. Novel diagnostic methods including those that focus on immune responses to specific food proteins or epitopes of specific proteins are under active study. Unconventional diagnostic methods are increasingly used, but they lack scientific rationale, standardization, and reproducibility. In selected cases, such as eosinophilic esophageal gastroenteropathies or food protein-induced gastroesophageal reflux disease, invasive procedures are mandatory for an accurate diagnosis. Properly done, an oral food challenge is still the gold standard in the diagnostic workup. An incorrect diagnosis is likely to result in unnecessary dietary restrictions, which, if prolonged, may adversely affect the child's nutritional status and growth.

The diagnosis of food allergy: protocol for a systematic review

Clinical and Translational Allergy, 2013

Background: The literature on diagnostic tests for food allergy currently lacks clear consensus regarding the accuracy and safety of different investigative approaches. The European Academy of Allergy and Clinical Immunology is in the process of developing its Guideline for Food Allergy and Anaphylaxis, and this systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management, and impact on quality of life, which will be used to inform the formulation of clinical recommendations. The aim of this systematic review will be to assess the diagnostic accuracy of tests aimed at supporting the clinical diagnosis of IgE-mediated food allergy. Methods: The following databases from inception to September 30, 2012 will be searched for studies of diagnostic tests: Cochrane Library (Wiley&Sons); MEDLINE (OVID); Embase (OVID); CINAHL (Ebscohost); ISI Web of Science (Thomson Web of Knowledge); TRIP Database (web www.tripdatabase.com); and Clinicaltrials.gov (NIH web). These database searches will be supplemented by contacting an international panel of experts. Studies evaluating APT, SPT, specific-IgE, and component specific-IgE in participants of any age with suspected food allergy will be included. The reference standard will be DBPCFC in at least 50% of the participants. Studies will be quality assessed by using the QUADAS-2 instrument. We will report summary statistics such as sensitivity, specificity, and/or likelihood ratios. We will use the hierarchical summary ROC (HSROC) model to summarize the accuracy of each test and to compare the accuracy of two or more tests. Discussion: Decisions on which tests to use need to be guided by availability of tests, populations being cared for, risks, financial considerations and test properties. This review will examine papers from around the world, covering children and adults with suspected food allergy in varying populations and concentrated on four type of tests: APT, SPT, specific-IgEs, and component specific-IgEs.

Doing the Food Allergy Diagnosis

Most people can eat a variety of foods without problems. However, in a small percentage of the population, certain foods can cause adverse reactions, from which the origin should be investigated: Perhaps food poisoning, a psychological aversion to a food, an intolerance to an ingredient in a meal or a true food allergy. Diagnosis of food allergy requires a combination of a detailed medical history, laboratory data and in many cases, an oral food challenge, which is confirmatory of either tolerance or an adverse food reaction (allergy or non-allergic). The cornerstone of food allergy management is the elimination of the allergen involved, however the allergen elimination process could predispose patients, especially children to inadequate diets and cause nutritional deficiencies thus eliminating diets should be done in the most specific way possible.

Guidelines for the use and interpretation of diagnostic methods in adult food allergy

Clinical and Molecular Allergy, 2015

Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed.

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Life

Food allergy (FA) is a condition with a growing incidence and is a constant concern for the medical world and healthcare providers. With potential symptoms including anaphylaxis, in the event of an allergic reaction the patient’s life may well be endangered. The diagnosis of FA is a continuous challenge because mild cases tend to be ignored or diagnosed late and young children with allergies are cared for by parents, who are not always able to accurately interpret symptoms. It is very important to be able to differentiate FAs from food intolerance and toxic reactions to food. An accurate diagnosis is required to provide personalized management of an FA. More sophisticated and accurate diagnostic tests, including component diagnosis and epitope reactivity, allow the provision of a directed diagnosis, a more accurate therapeutic approach, and a useful prognostic evaluation. Tests used in current practice include the specific search for serum IgE, elimination diets, oral food challenge...

Diagnosing and managing food allergy in children

Paediatrics and Child Health, 2008

Practice Points: 1. Children often present with apparently complicated food allergy stories. 2. The history should be aimed at diagnosing if a child has food allergy and, for each allergen, define the nature of what is being reported into one of 4 clear categories 3. Investigations such as skin prick testing and specific IgE are helpful only if an IgE mediated process is suspected. They must be carefully targeted and linked to history as their positive predictive value is only 50 to 65%. 4. The mainstay of management is avoidance. 5. There are currently no good tests for non-IgE mediated allergy and non allergic hypersensitivity.

The EuroPrevall outpatient clinic study on food allergy: background and methodology

Allergy, 2015

Abbreviations: SPT, skin prick test QOL, quality of life DBPCFC, double-blind placebo-controlled food challenge CRD, component resolved diagnosis NOAEL, no observed adverse effect level PEF, peak expiratory flow BP, blood pressure OFC, open food challenge SAE, severe adverse event SOP, standard operating procedures ABSTRACT Background: The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated