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Oral food challenge: safety, adherence to guidelines and predictive value of skin prick testing
Author(s) -
Calvani Mauro,
Berti Irene,
Fiocchi Alessandro,
Galli Elena,
Giorgio Valentina,
Martelli Alberto,
Miceli Sopo Stefano,
Panetta Valentina
Publication year - 2012
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12016
Subject(s) - medicine , anaphylaxis , oral food challenge , food allergy , epinephrine , inhalation , predictive value , gold standard (test) , allergy , anesthesia , immunology
Abstract Background The diagnostic gold standard of food allergy is the oral food challenge ( OFC ). Data on severe reactions and drug use during OFC are scarce. Our aims were (i) to investigate the prevalence and spectrum of reactions' severity during OFC and to assess drug use and epinephrine use in anaphylaxis due to OFC ; (ii) to investigate the predictive value of the skin prick test wheal size for the outcome of OFC s. Methods A retrospective charts review of children undergoing OFC at three A llergy C entres between J anuary 2007 and D ecember 2008 was performed. Results A total of 544 OFC s were analysed. Most frequently involved foods were egg, milk and wheat. 254/526 (48.3%) were positive. 167 (65.7%) were defined mild reactions, 81 (31.9%) multiorgan reactions and 6 (2.4%) anaphylaxis. No patients had cardiovascular symptoms. Data on treatments were available in 98.8% OFC s. In half of them antihistamines were used vs. 10% cases in which steroids were preferred. Six children (2.4%) were treated with Epinephrine inhalation, 5 (2%) with beta‐2 inhalation, 8 (3.1%) with steroid inhalation. One child was treated with IM Epinephrine + IV fluids. Skin prick tests predictive cut‐off were 9 mm for albumen, 7 for yolk, 13 for fresh albumen, 10 for α‐lactalbumin, seven for casein, eight for β‐lactoglobulin, 20 for cow's milk and 10 for fresh cow's milk. Conclusion OFCs performed in controlled settings by expert A llergists are safe. Consideration needs to be given as to whether the A naphylaxis' G uideline need to be modified when applied in treating patients undergoing OFC .