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Abbreviated Oral Food Challenge As a Safe and Effective Alternative For Diagnosing Food Allergy In a Pediatric Clinic
Abstracts AB209
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Oral Food Challenge Outcome Among Children With a Negative Skin Prick Test Result Dr. Wipa Jessadapakorn, MD1, Dr. Prapasri Kulalert, MD2, Dr. Araya Yuenyongviwat, MD3, Dr. Pasuree Sangsupawanich, MD4; 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand, 2Prince of Songkla University, Songkla, Thailand, 3Prince of Songkla University, Songkhla, Thailand, 4Prince Songkhlanagarind hospital, Hadyai, Thailand. RATIONALE: Oral food challenges (OFCs) are procedures to make an accurate diagnosis of food allergy and are usually performed in the hospital because of risks of systemic and life-threatening reactions. However, the disproportionate numbers of patients and allergists make the OFCs in the hospital impractical. Thus, we aimed to examine the outcome of OFCs among children with histories of non-severe food reactions. METHODS: A retrospective chart review of children with negative skin prick test (SPT) results who underwent OFCs at the Pediatric Allergy Clinic of Songklanagarind Hospital between July 2011 and August 2013 was performed. Children with histories of severe food reactions were excluded. SPTs were performed using commercial food extracts. RESULTS: We performed 88 OFCs in 69 children (30 males, 39 females). The mean age of children who participated in OFCs was 20 months (range, 2 months – 8 years). Most children (53.6%) presented with atopic dermatitis. Cow’s milk was the most commonly tested food (60%). Sixteen out of the 88 OFCs (18%) failed the challenges. Most reactions occurred after 24 hours and were self-limited. Only 1 out of 16 developed sneezing and rhinorrhea at 2 hours after the OFC and was treated with oral antihistamine. No systemic or severe reactions were observed. CONCLUSIONS: Although OFCs can cause severe allergic reactions and should be done in a hospital, our data found that most patients with negative SPTs who experienced only eczema or mild allergic reactions had a low risk for OFCs. In selected patients, OFCs can be done at home safely.
725
Abbreviated Oral Food Challenge As a Safe and Effective Alternative For Diagnosing Food Allergy In a Pediatric Clinic April L. Goolsby, BS1, Heather Minto, MD1,2, Amy Perkins, MS1,2, Kelly M. Maples, MD1,2; 1Eastern Virginia Medical School, Norfolk, VA, 2Children’s Hospital of The King’s Daughters, Norfolk, VA. RATIONALE: Along with the increasing prevalence of food allergy (FA), comes increased misdiagnosis and unnecessary food avoidance. Skin prick tests (SPT) and specific IgE testing have a high false positive rate and alone are insufficient for FA diagnosis. Traditional oral food challenges (OFC) are the gold standard for FA diagnosis but are also lengthy, costly, and impractical for many allergy clinics. A two-step abbreviated oral food challenge (AOFC) may be as reliable and safe in FA diagnosis in selected populations while improving cost, efficiency, and availability of food challenges. METHODS: A retrospective chart review of 2-18 year-olds who completed an OFC or AOFC at our children’s hospital between January 2010 and December 2012 was performed to assess the safety, efficacy, and reliability of AOFC compared to OFC. Demographics, history, and allergic sensitizations by SPT and IgE were collected. OFC and AOFC were compared by challenge pass rates, frequency of epinephrine usage, and time to completion of the food challenge. RESULTS: 203 AOFC and 232 OFC were completed. In each group, 10% of patients failed and 90% passed the challenge. 14% of patients given AOFC and 17% of patients given OFC required epinephrine after failure. Mean AOFC time to completion was 112.2 minutes, and mean OFC time was 246.2 minutes (P<0.001). CONCLUSIONS: In carefully selected patients, AOFC is a safe, effective alternative to OFC in FA diagnosis. AOFCs reduce the length of food challenges and unnecessary food avoidance while increasing availability of testing and office productivity.
726
Safety Of Ungraded Oral Food Challenges In Ruling Out Peanut Allergy In Children Dr. Darlene Kassab Mansoor, MD, MS1, Amit Singal, BS2, Shweta Bansil, BS2, Dr. Hemant P. Sharma, MD, MHS, FAAAAI1; 1Children’s National Medical Center, 2George Washington University School of Medicine. RATIONALE: Indiscriminate testing may misdiagnose peanut allergy (PA) due to false positive results. Oral food challenges (OFC) are the gold standard for ruling out PA, but are time-consuming and costly. A one-step, ungraded OFC versus traditional graded OFC may more efficiently rule out PA in select low-risk patients, but its safety is unknown. METHODS: A retrospective chart review was conducted of peanut OFC performed between 2011 and 2013 at a pediatric allergy referral center. Patients were offered ungraded OFC if they had: no prior peanut exposure or reaction history inconsistent with PA, peanut IgE <2kU/L, and peanut skin prick test (SPT) wheal diameter <8mm. Ungraded OFC delivered the goal peanut dose in one dose, while graded OFC used six gradually escalating doses. OFC outcome was compared between the two groups. RESULTS: 86 OFC were conducted, 11 of which were ungraded. Mean peanut-SPT was smaller in ungraded versus graded OFC (1.1mm and 5.6mm, p<0.01), but peanut-IgE did not significantly differ (0.8kU/L and 2.1kU/L respectively, p50.24). Mean age did not differ between ungraded and graded OFC (4.2 and 6.0 years respectively, p50.12), nor did prevalence of comorbid atopic disease. 11/11 ungraded OFC were passed, compared to 49/75 (65%) graded OFC (p50.02). 2/11 patients undergoing ungraded OFC developed mild self-limited symptoms (sneezing and perioral rash); 0/11 required treatment with antihistamine or epinephrine. 14/75 (18.7%) of graded OFC required epinephrine treatment. CONCLUSIONS: In carefully selected patients with a low pre-test probability of PA, ungraded OFC may be a safe and efficient way to rule out PA.
727
Safety Of Oral Food Challenges To Extensively Heated Egg In Children Dr. Cindy Nguyen, MD1, Shweta Bansil, BS2, Amit Singal, BS2, Dr. Hemant P. Sharma, MD, MHS, FAAAAI3; 1Children’s National Medical Center, Division of Allergy and Immunology, Washington, DC, 2 George Washington University School of Medicine, 3Children’s National Medical Center, Division of Allergy and Immunology, DC. RATIONALE: A majority of egg-allergic children tolerate extensively heated or baked egg products in their diet, and this is often initially determined through an oral food challenge (OFC) to baked egg. However, the characteristics of children who react to baked egg during OFC and the severity of their reactions are poorly defined. METHODS: A retrospective chart review was conducted of baked egg OFC performed at an allergy referral center between 2011 and 2013. Eggallergic subjects strictly avoided all egg prior to OFC. Challenges were performed following a standardized protocol with incremental dosages to a total amount of cake containing ¼ egg. Patient characteristics were compared between passed and failed OFC. RESULTS: Baked egg OFC was conducted in 34 children. Eighteen (53%) passed, 7 (21%) refused to eat the total goal dose, and 9 (26%) failed due to reactions requiring treatment. The most common reaction symptoms were skin and gastrointestinal complaints. Of those who reacted, 4 (44%) required treatment with epinephrine, but none required multiple doses. Comparing passed versus failed OFC, no significant differences were observed in mean age (5.8y and 3.7y respectively, p50.11), prevalence of comorbid atopic disease, or symptoms on prior accidental egg exposure. Egg skin prick test wheal size did not differ between passed and failed OFC (9mm and 9.7mm respectively), nor did egg white-specific IgE (8.9 and 31.1kU/L respectively, p50.27). CONCLUSIONS: While the majority of children tolerated baked egg OFC, 44% of those who reacted required epinephrine treatment. Baked egg OFC should take place in medically supervised settings.
MONDAY
724
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Oral Food Challenge Outcome Among Children With a Negative Skin Prick Test Result Dr. Wipa Jessadapakorn, MD1, Dr. Prapasri Kulalert, MD2, Dr. Araya Yuenyongviwat, MD3, Dr. Pasuree Sangsupawanich, MD4; 1Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand, 2Prince of Songkla University, Songkla, Thailand, 3Prince of Songkla University, Songkhla, Thailand, 4Prince Songkhlanagarind hospital, Hadyai, Thailand. RATIONALE: Oral food challenges (OFCs) are procedures to make an accurate diagnosis of food allergy and are usually performed in the hospital because of risks of systemic and life-threatening reactions. However, the disproportionate numbers of patients and allergists make the OFCs in the hospital impractical. Thus, we aimed to examine the outcome of OFCs among children with histories of non-severe food reactions. METHODS: A retrospective chart review of children with negative skin prick test (SPT) results who underwent OFCs at the Pediatric Allergy Clinic of Songklanagarind Hospital between July 2011 and August 2013 was performed. Children with histories of severe food reactions were excluded. SPTs were performed using commercial food extracts. RESULTS: We performed 88 OFCs in 69 children (30 males, 39 females). The mean age of children who participated in OFCs was 20 months (range, 2 months – 8 years). Most children (53.6%) presented with atopic dermatitis. Cow’s milk was the most commonly tested food (60%). Sixteen out of the 88 OFCs (18%) failed the challenges. Most reactions occurred after 24 hours and were self-limited. Only 1 out of 16 developed sneezing and rhinorrhea at 2 hours after the OFC and was treated with oral antihistamine. No systemic or severe reactions were observed. CONCLUSIONS: Although OFCs can cause severe allergic reactions and should be done in a hospital, our data found that most patients with negative SPTs who experienced only eczema or mild allergic reactions had a low risk for OFCs. In selected patients, OFCs can be done at home safely.
725
Abbreviated Oral Food Challenge As a Safe and Effective Alternative For Diagnosing Food Allergy In a Pediatric Clinic April L. Goolsby, BS1, Heather Minto, MD1,2, Amy Perkins, MS1,2, Kelly M. Maples, MD1,2; 1Eastern Virginia Medical School, Norfolk, VA, 2Children’s Hospital of The King’s Daughters, Norfolk, VA. RATIONALE: Along with the increasing prevalence of food allergy (FA), comes increased misdiagnosis and unnecessary food avoidance. Skin prick tests (SPT) and specific IgE testing have a high false positive rate and alone are insufficient for FA diagnosis. Traditional oral food challenges (OFC) are the gold standard for FA diagnosis but are also lengthy, costly, and impractical for many allergy clinics. A two-step abbreviated oral food challenge (AOFC) may be as reliable and safe in FA diagnosis in selected populations while improving cost, efficiency, and availability of food challenges. METHODS: A retrospective chart review of 2-18 year-olds who completed an OFC or AOFC at our children’s hospital between January 2010 and December 2012 was performed to assess the safety, efficacy, and reliability of AOFC compared to OFC. Demographics, history, and allergic sensitizations by SPT and IgE were collected. OFC and AOFC were compared by challenge pass rates, frequency of epinephrine usage, and time to completion of the food challenge. RESULTS: 203 AOFC and 232 OFC were completed. In each group, 10% of patients failed and 90% passed the challenge. 14% of patients given AOFC and 17% of patients given OFC required epinephrine after failure. Mean AOFC time to completion was 112.2 minutes, and mean OFC time was 246.2 minutes (P<0.001). CONCLUSIONS: In carefully selected patients, AOFC is a safe, effective alternative to OFC in FA diagnosis. AOFCs reduce the length of food challenges and unnecessary food avoidance while increasing availability of testing and office productivity.
726
Safety Of Ungraded Oral Food Challenges In Ruling Out Peanut Allergy In Children Dr. Darlene Kassab Mansoor, MD, MS1, Amit Singal, BS2, Shweta Bansil, BS2, Dr. Hemant P. Sharma, MD, MHS, FAAAAI1; 1Children’s National Medical Center, 2George Washington University School of Medicine. RATIONALE: Indiscriminate testing may misdiagnose peanut allergy (PA) due to false positive results. Oral food challenges (OFC) are the gold standard for ruling out PA, but are time-consuming and costly. A one-step, ungraded OFC versus traditional graded OFC may more efficiently rule out PA in select low-risk patients, but its safety is unknown. METHODS: A retrospective chart review was conducted of peanut OFC performed between 2011 and 2013 at a pediatric allergy referral center. Patients were offered ungraded OFC if they had: no prior peanut exposure or reaction history inconsistent with PA, peanut IgE <2kU/L, and peanut skin prick test (SPT) wheal diameter <8mm. Ungraded OFC delivered the goal peanut dose in one dose, while graded OFC used six gradually escalating doses. OFC outcome was compared between the two groups. RESULTS: 86 OFC were conducted, 11 of which were ungraded. Mean peanut-SPT was smaller in ungraded versus graded OFC (1.1mm and 5.6mm, p<0.01), but peanut-IgE did not significantly differ (0.8kU/L and 2.1kU/L respectively, p50.24). Mean age did not differ between ungraded and graded OFC (4.2 and 6.0 years respectively, p50.12), nor did prevalence of comorbid atopic disease. 11/11 ungraded OFC were passed, compared to 49/75 (65%) graded OFC (p50.02). 2/11 patients undergoing ungraded OFC developed mild self-limited symptoms (sneezing and perioral rash); 0/11 required treatment with antihistamine or epinephrine. 14/75 (18.7%) of graded OFC required epinephrine treatment. CONCLUSIONS: In carefully selected patients with a low pre-test probability of PA, ungraded OFC may be a safe and efficient way to rule out PA.
727
Safety Of Oral Food Challenges To Extensively Heated Egg In Children Dr. Cindy Nguyen, MD1, Shweta Bansil, BS2, Amit Singal, BS2, Dr. Hemant P. Sharma, MD, MHS, FAAAAI3; 1Children’s National Medical Center, Division of Allergy and Immunology, Washington, DC, 2 George Washington University School of Medicine, 3Children’s National Medical Center, Division of Allergy and Immunology, DC. RATIONALE: A majority of egg-allergic children tolerate extensively heated or baked egg products in their diet, and this is often initially determined through an oral food challenge (OFC) to baked egg. However, the characteristics of children who react to baked egg during OFC and the severity of their reactions are poorly defined. METHODS: A retrospective chart review was conducted of baked egg OFC performed at an allergy referral center between 2011 and 2013. Eggallergic subjects strictly avoided all egg prior to OFC. Challenges were performed following a standardized protocol with incremental dosages to a total amount of cake containing ¼ egg. Patient characteristics were compared between passed and failed OFC. RESULTS: Baked egg OFC was conducted in 34 children. Eighteen (53%) passed, 7 (21%) refused to eat the total goal dose, and 9 (26%) failed due to reactions requiring treatment. The most common reaction symptoms were skin and gastrointestinal complaints. Of those who reacted, 4 (44%) required treatment with epinephrine, but none required multiple doses. Comparing passed versus failed OFC, no significant differences were observed in mean age (5.8y and 3.7y respectively, p50.11), prevalence of comorbid atopic disease, or symptoms on prior accidental egg exposure. Egg skin prick test wheal size did not differ between passed and failed OFC (9mm and 9.7mm respectively), nor did egg white-specific IgE (8.9 and 31.1kU/L respectively, p50.27). CONCLUSIONS: While the majority of children tolerated baked egg OFC, 44% of those who reacted required epinephrine treatment. Baked egg OFC should take place in medically supervised settings.
MONDAY
724