Original Article
Impact of Allergic Reactions on Food-Specific IgE Concentrations and Skin Test Results

https://doi.org/10.1016/j.jaip.2015.11.015Get rights and content

Background

Although there is concern that food allergy reactions may negatively affect the natural history of food allergy, the impact of reactions on food-specific IgE (sIgE) levels or skin prick test (SPT) wheal size is unknown.

Objective

To measure the effects of allergic reactions on SPT wheal size and sIgE concentrations to milk, egg, and peanut.

Methods

Participants included 512 infants with likely milk or egg allergy enrolled in a multicenter observational study. Changes in sIgE level and SPT wheal size to milk, egg, and peanut were measured before and after oral food challenge (OFC) or accidental exposure for 377 participants.

Results

The median age of the cohort at the time of analysis was 8.5 years (67% males). There were no statistically significant changes in sIgE level or SPT wheal size after positive OFC to milk, egg, or peanut (n = 20-27 for each food). Change in sIgE level and SPT wheal size was measured after 446 and 453 accidental exposure reactions, respectively. The median change in sIgE level was a decrease of 0.33 kUA/L (P < .01) after milk and 0.34 kUA/L (P < .01) after egg reactions, but no other statistically significant changes in sIgE level or SPT wheal size were observed for milk, egg, or peanut. When we limited the analysis to only those participants who had diagnostic testing done within 6 months of an accidental exposure reaction, we found that peanut SPT wheal size increased by 1.75 mm (P < .01), but a significant increase was not noted when all participants with testing done within 12 months were considered.

Conclusions

The results suggest that reactions from OFCs and accidental exposure are not associated with increases in sensitization among children allergic to milk, egg, or peanut.

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

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    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.

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