Will Oral Food Challenges Still Be Part of Allergy Care in 10 Years' Time?

Overview

Journal J Allergy Clin Immunol Pract

Specialty Allergy & Immunology

Date 2023 Feb 23

PMID 36822320

Authors

Nandinee Patel

Wayne G Shreffler

Adnan Custovic

Alexandra F Santos

Affiliations

Soon will be listed here.

Abstract

Oral food challenges (OFCs) are currently the definitive diagnostic procedure in food allergy. Their design has evolved over the decades to maximize safety, optimize convenience, and address several specific clinical questions. However, they are a resource-intensive investigation that carry a risk for severe allergic reaction in which fatal outcomes, although rare, have been reported. In this review, we explore the many roles that OFC fulfil in the clinical and research settings. We also discuss progress that has been made in developing alternative diagnostic tools and how far these have reached in offering a viable replacement to OFC in clinical practice. Finally, we discuss the ongoing importance of research OFC to improve the future diagnostic capabilities of novel diagnostic tools.

Citing Articles

Genome-Wide Association Study Reveals a Causal Relationship Between Allergic Rhinitis and Hazelnut Allergy.

Sun Y, Vonk J, Kersten E, Qi C, Sprikkelman A, Koppelman G Allergy. 2024; 80(1):309-318.

PMID: 39673378 PMC: 11724235. DOI: 10.1111/all.16411.

The future of food allergy diagnosis.

Wong D, Santos A Front Allergy. 2024; 5:1456585.

PMID: 39575109 PMC: 11578968. DOI: 10.3389/falgy.2024.1456585.

Omalizumab Implementation in Practice: Lessons Learned From the OUtMATCH Study.

Vickery B, Bird J, Chinthrajah R, Jones S, Keet C, Kim E J Allergy Clin Immunol Pract. 2024; 12(11):2947-2954.

PMID: 39293782 PMC: 11560495. DOI: 10.1016/j.jaip.2024.08.056.

Understanding the heterogeneity of childhood allergic sensitization and its relationship with asthma.

Custovic A, Custovic D, Fontanella S Curr Opin Allergy Clin Immunol. 2024; 24(2):79-87.

PMID: 38359101 PMC: 10906203. DOI: 10.1097/ACI.0000000000000967.

References

Alvarez Garcia O, Bartra J, Ruiz-Garcia M, Skypala I, Durham S, Boyle R . No apparent impact of incremental dosing on eliciting dose at double-blind, placebo-controlled peanut challenge. Allergy. 2021; 77(2):667-670. DOI: 10.1111/all.15130. View

Yanagida N, Okada Y, Sato S, Ebisawa M . New approach for food allergy management using low-dose oral food challenges and low-dose oral immunotherapies. Allergol Int. 2016; 65(2):135-140. DOI: 10.1016/j.alit.2015.10.010. View

Remington B, Krone T, Kim E, Bird J, Green T, Lack G . Estimated risk reduction to packaged food reactions by epicutaneous immunotherapy (EPIT) for peanut allergy. Ann Allergy Asthma Immunol. 2019; 123(5):488-493.e2. DOI: 10.1016/j.anai.2019.08.007. View

Niggemann B, Lange L, Finger A, Ziegert M, Muller V, Beyer K . Accurate oral food challenge requires a cumulative dose on a subsequent day. J Allergy Clin Immunol. 2012; 130(1):261-3. DOI: 10.1016/j.jaci.2012.03.021. View

Turner P, Gowland M, Sharma V, Ierodiakonou D, Harper N, Garcez T . Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2014; 135(4):956-963.e1. PMC: 4382330. DOI: 10.1016/j.jaci.2014.10.021. View

Patel N, Adelman D, Anagnostou K, Baumert J, Blom W, Campbell D . Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis. J Allergy Clin Immunol. 2021; 147(6):2249-2262.e7. PMC: 8168954. DOI: 10.1016/j.jaci.2021.01.025. View

dArt Y, Forristal L, Byrne A, Fitzsimons J, van Ree R, DunnGalvin A . Single low-dose exposure to cow's milk at diagnosis accelerates cow's milk allergic infants' progress on a milk ladder programme. Allergy. 2022; 77(9):2760-2769. PMC: 9543429. DOI: 10.1111/all.15312. View

Upton J, Bird J . Oral food challenges: Special considerations. Ann Allergy Asthma Immunol. 2020; 124(5):451-458. DOI: 10.1016/j.anai.2020.02.008. View

Venter C, Meyer R, Ebisawa M, Athanasopoulou P, Mack D . Food allergen ladders: A need for standardization. Pediatr Allergy Immunol. 2021; 33(1):e13714. DOI: 10.1111/pai.13714. View

10.

OB Hourihane J, Allen K, Shreffler W, DunnGalvin G, Nordlee J, Zurzolo G . Peanut Allergen Threshold Study (PATS): Novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy. J Allergy Clin Immunol. 2017; 139(5):1583-1590. DOI: 10.1016/j.jaci.2017.01.030. View

11.

Bird J, Leonard S, Groetch M, Assaad A, Cianferoni A, Clark A . Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. J Allergy Clin Immunol Pract. 2020; 8(1):75-90.e17. DOI: 10.1016/j.jaip.2019.09.029. View

12.

Suprun M, Kearney P, Hayward C, Butler H, Getts R, Sicherer S . Predicting probability of tolerating discrete amounts of peanut protein in allergic children using epitope-specific IgE antibody profiling. Allergy. 2022; 77(10):3061-3069. PMC: 10286745. DOI: 10.1111/all.15477. View

13.

Cao S, Borro M, Alonzi S, Sindher S, Nadeau K, Chinthrajah R . Improvement in Health-Related Quality of Life in Food-Allergic Patients: A Meta-Analysis. J Allergy Clin Immunol Pract. 2021; 9(10):3705-3714. PMC: 8511199. DOI: 10.1016/j.jaip.2021.05.020. View

14.

Hemmings O, Niazi U, Kwok M, James L, Lack G, Santos A . Peanut diversity and specific activity are the dominant IgE characteristics for effector cell activation in children. J Allergy Clin Immunol. 2021; 148(2):495-505.e14. PMC: 8340728. DOI: 10.1016/j.jaci.2021.02.029. View

15.

Warren C, Dyer A, Lombard L, Dunn-Galvin A, Gupta R . The Psychosocial Burden of Food Allergy Among Adults: A US Population-Based Study. J Allergy Clin Immunol Pract. 2021; 9(6):2452-2460.e3. PMC: 9190169. DOI: 10.1016/j.jaip.2021.02.039. View

16.

Burrell S, Patel N, Vazquez-Ortiz M, Campbell D, DunnGalvin A, Turner P . Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life. Arch Dis Child. 2020; 106(6):558-563. PMC: 8142442. DOI: 10.1136/archdischild-2020-319906. View

17.

Kemp A, Allen C, Campbell D . Parental perceptions in egg allergy: does egg challenge make a difference?. Pediatr Allergy Immunol. 2009; 20(7):648-53. DOI: 10.1111/j.1399-3038.2009.00859.x. View

18.

Zijlstra W, Flinterman A, Soeters L, Knulst A, Sinnema G, LHoir M . Parental anxiety before and after food challenges in children with suspected peanut and hazelnut allergy. Pediatr Allergy Immunol. 2009; 21(2 Pt 2):e439-45. DOI: 10.1111/j.1399-3038.2009.00929.x. View

19.

Saleh-Langenberg J, Flokstra-de Blok B, AlAgla N, Kollen B, Dubois A . Late reactions in food-allergic children and adolescents after double-blind, placebo-controlled food challenges. Allergy. 2016; 71(7):1069-73. DOI: 10.1111/all.12923. View

20.

Santos A, Kulis M, Sampson H . Bringing the Next Generation of Food Allergy Diagnostics Into the Clinic. J Allergy Clin Immunol Pract. 2021; 10(1):1-9. DOI: 10.1016/j.jaip.2021.09.009. View