The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleImpact of Allergic Reactions on Food-Specific IgE Concentrations and Skin Test Results
Section snippets
Subjects
Participant characteristics and study enrollment procedures were previously reported.8, 9 Briefly, this was an observational study of 512 infants in the Consortium for Food Allergy Research (CoFAR2) observational study enrolled with likely egg or milk allergy who were not yet diagnosed with a likely peanut allergy, recruited at ages 3 to 15 months, and enrolled at 5 US sites (New York, NY; Baltimore, Md; Little Rock, Ark; Denver, Colo; and Durham, NC). Infants fulfilled at least 1 of the
Demographic characteristics
Table E1 in this article's Online Repository at www.jaci-inpractice.org presents the demographic features of children who underwent OFCs or experienced FAEs included in these analyses, compared with the remainder of the observational study cohort. The median months on study was 84.6 months (interquartile range [IQR], 75.4-90.4 months) for those in the analyses included here compared with 70.0 months (IQR, 53.8-84.2 months) for those not in the analyses (P < .01). The median IgE levels at
Discussion
The difficulties of elimination diets in the management of food allergy are well established, with frequent accidental reactions occurring as a result. For example, we previously reported in the full CoFAR observational study cohort an annualized rate of 0.81 accidental reactions per year.4 However, the prognostic implications, if any, of such exposures is unknown. Similarly, children with food allergies are exposed to known food allergens during diagnostic OFCs, and the long-term impact of
Acknowledgments
Additional Site Investigators: C. Cho, A. Liu, A.M. Scurlock, and R.D. Pesek.
Coordinators and support: D. Brown, L. Talarico, S. Noone, K. Mudd, S. Knorr, P. Steele, J. Kamilaris, S. Carlisle, M. Mishoe, A. Grishin, M. Beksinska, H. Haczynska, J. Grabowska, A. Hiegel, L. Christie, M. Groetch, J. Ellingson, J. Stone, S. Leung, K. Morgan, K. Brown-Engelhardt, W. Hiemstra, R. Reames, D. Brown, K. Lee, K. Peyton, and S. Cushing.
We thank Dr Marshall Plaut, the medical officer, and J. Poyser for
References (22)
- et al.
Maximal rise in IgE antibody following ragweed pollination season
J Allergy Clin Immunol
(1975) - et al.
Risk of oral food challenges
J Allergy Clin Immunol
(2004) - et al.
The natural history of IgE-mediated cow's milk allergy
J Allergy Clin Immunol
(2007) - et al.
The natural history of egg allergy
J Allergy Clin Immunol
(2007) - et al.
The relationship of allergen-specific IgE levels and oral food challenge outcome
J Allergy Clin Immunol
(2004) - et al.
Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy
J Allergy Clin Immunol
(2002) - et al.
Predicting outcome of repeat milk, egg, or peanut oral food challenges
J Allergy Clin Immunol
(2009) - et al.
Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy
J Allergy Clin Immunol
(2004) - et al.
State of the art on food allergen immunotherapy: oral, sublingual, and epicutaneous
J Allergy Clin Immunol
(2014) - et al.
Food allergy: epidemiology, pathogenesis, diagnosis, and treatment
J Allergy Clin Immunol
(2014)
Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel
J Allergy Clin Immunol
Cited by (17)
Food Allergy
2023, Primary Care - Clinics in Office PracticeEarly epitope-specific IgE antibodies are predictive of childhood peanut allergy
2020, Journal of Allergy and Clinical ImmunologyMulticenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy
2019, Journal of Allergy and Clinical ImmunologyCitation Excerpt :The study was registered at clinicaltrials.gov (NCT01980992). SPTs were performed according to the standard protocol using commercial wheat extract (Greer Laboratories, Lenoir, NC), and results were read at 15 minutes.12 The SPT score was calculated by subtracting the value in millimeters of the saline wheal diameter from the wheat wheal diameter, and therefore it was possible to have a negative value.
The Consortium for Food Allergy Research (CoFAR): The first generation
2019, Journal of Allergy and Clinical ImmunologyCitation Excerpt :In evaluating 20 to 27 OFCs with reactions for each food and more than 446 accidental reactions, the data support the conclusion that these exposures were not associated with significant increases in sensitization to milk, egg, or peanut.17 Table I13,17,18 provides practical lessons from these studies that could be used for educating families about food allergy management. CoFAR also sought to gain insights into EoE by establishing a registry enrolling children and adult subjects with this disease.18
Advances in the approach to the patient with food allergy
2018, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Peanuts and tree nuts were the most common allergens (60%) that were not incorporated regularly into the diet despite a negative OFC result. The effect of allergic reactions on SPT wheal size and milk, egg, and peanut sIgE concentrations was investigated in 377 children before and after OFC or accidental exposure; the authors concluded that allergic reactions during OFC or accidental exposure were not associated with increased sensitization.43 After publication of the addendum guidelines for early peanut introduction, it is anticipated that allergists will see an increased demand for OFCs in infants, a unique population that requires special considerations.
The Role of Food Challenges in Clinical Practice
2018, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Patients with clear reactions are considered to have a positive food challenge and should continue to avoid the food and have self-injectable epinephrine available. Having a positive food challenge does not seem to affect the natural history of food allergy,68 and many patients with an initial positive food challenge can subsequently have a negative challenge to the same food at a later date. Occasionally patients will have a delayed reaction after completion of the challenge, often after leaving the office.
This study was supported by the National Institutes of Health (NIH)-National Institute of Allergy and Infectious Diseases (grant nos. U19AI066738 and U01AI066560). The project was also supported by National Jewish (grant no. UL1 TR-000154), Mount Sinai (grant no. UL1 TR-000067), Arkansas (grant no. UL1 TR-000039), University of North Carolina (grant no. UL1 TR-000083) and Johns Hopkins (grant no. UL1 TR-000424) from the National Center for Research Resources (NCRR), a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH.
Conflicts of interest: S. H. Sicherer has received research support from the National Institute of Allergy and Infectious Diseases (NIAID); has received research support from Food Allergy Research and Education; received royalties from UpToDate; and is an associate editor of the Journal of Allergy and Clinical Immunology: In Practice. R. A. Wood has received research support from the NIAID and DBV Technologies; has received consultancy fees from Stallergenes and Sanofi; is employed by Johns Hopkins University; and receives royalties from UpToDate. B. P. Vickery has received research support from the National Institutes of Health (NIH)-NIAID and is employed by and has stock/stock options in Aimmune Therapeutics. T. T. Perry has received research support from the NIH. S. M. Jones is on the Food Allergy Research Education (FARE) Research Advisory Board; has received consultancy fees from Stallergenes; has received research support from NIH-NIAID's Consortium of Food Allergy Research and Immune Tolerance Network (Protocol ITN050AD), FARE, Allergy Research Corporation, DBV Technologies, and National Peanut Board; has received lecture fees from Kansas City Allergy Society, Mercy Children's Hospital, Riley Children's Hospital, Southwestern Medical School-Children's Medical Center, European Academy of Allergy & Clinical Immunology, New York Allergy & Asthma Society, Iowa Society of Allergy, Asthma & Immunology, University of Iowa, and Paul Seebohm Lectureship in Allergy. B. Blackwell has received research support from the NIH. P. Dawson has received research support from the NIH (EMMES serves as the Statistical and Clinical Coordinating Center for the Consortium of Food Allergy Research and is funded by the NIAID). A. W. Burks was the American Academy of Allergy, Asthma & Immunology 2012 Board President and 2013 Board Past President; was the FARE Chairman of the Research Advisory Board from 2012 to 2015; is a board member for the NIH Allergy, Immunology, and Transplantation Research Committee, the NIH Hypersensitivity, Autoimmune, and Immune-mediated diseases Study Section, and the World Allergy Organization; is a member of the Stallergenes Board of Experts; has received consultancy fees from ActoGeniX, Adept Field Solutions, Genentech, GLG Research Inc, Merck, SRA International, and Valeant Pharmaceuticals North American LLC; is an unpaid consultant for Dow AgroSciences, ExploraMed Development LLC, Insys Therapeutics, Novartis Pharma AG, Nutricia North America, Regeneron Pharmaceuticals Inc, and Sanofi Aventic US Inc; is employed by the University of North Carolina School of Medicine; has provided expert testimony for Friday Eldrege & Clark; has received research support from the NIH and Wallace Research Foundation; has served as an unpaid lecturer for Mylan Specialty; has received royalties from the American Society for Microbiology; is a minority stockholder in Allertein; and is a minority stockholder and consultant for Mastcell Pharmaceuticals Inc. R. Lindblad has received research support from the NIH. H. A. Sampson has received research support from the NIAID and the NIH and has received travel support from EMMES. D. Y. M. Leung declares that he has no relevant conflicts of interest.