Abstract

BackgroundTolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development.MethodsThis was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels.ResultsIn 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy.ConclusionApproximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.

Highlights

  • Tolerance development rates differ between food allergies

  • Our aim was to analyze the association between the eliciting dose (ED) of the initial diagnostic DBPCFC with tolerance development and to identify confounding of this association by clinical parameters obtained during the initial DBPCFC

  • Logistic regression analyses were performed to estimate the association between clinical factors known at the time of the initial DBPCFC and tolerance development for each food group separately

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Summary

Introduction

Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. To the Editor, Children allergic to cow’s milk and hen’s egg show a high rate of tolerance development over time [1, 2]. The gold standard diagnostic method, the doubleblind, placebo-controlled food challenge (DBPCFC) has not been consistently used to investigate the association of parameters available at diagnosis with tolerance development over time, in peanut allergy.

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