Abstract
Legume and sesame are emerging food allergens. The utility of specific immunoglobulin E (sIgE) testing to predict clinical reactivity to these allergens is not well described. To describe clinical outcomes and sIgE in sesame and legume oral food challenges (OFC). We performed a retrospective review of 74 legume and sesame OFCs between 2007 and 2017 at the Ann and Robert H. Lurie Children's Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves and logistic regression models that predicted OFC outcome were generated. Twenty-eight patients (median age, 6.15 years) passed legume OFC (84.9%), and 25 patients (median age, 5.91 years) passed sesame OFC (61.0%). The median sIgE to legume was 1.41 kUA/L and, to sesame, was 2.34 kUA/L. In patients with failed legume OFC, 60.0% had cutaneous symptoms, 20.0% had gastrointestinal symptoms, and 20.0% had anaphylaxis. Of these reactions, 80.0% were controlled with antihistamine alone and 20.0% required epinephrine. In patients for whom sesame OFC failed, 50.0% had cutaneous symptoms, 12.5% had gastrointestinal symptoms, and 37.50% had anaphylaxis. Of these reactions, 6.3% required epinephrine, 31.3% were controlled with diphenhydramine alone, and 63.50% required additional epinephrine or prednisone. Most OFCs to legumes were passed and reactions to failed legume OFCs were more likely to be nonsevere. Sesame OFC that failed was almost twice as likely compared with legume OFC that failed, and reactions to sesame OFC that failed were often more severe. Sesame sIgE did not correlate with OFC outcome.
Highlights
Food allergy is the result of a specific immune response that occurs reproducibly on exposure to a given food[1]
Failing an oral food challenges (OFC) to sesame was almost twice as likely compared to failing a legume OFC, and reactions to failed sesame OFC were often more severe
While our study identified an 84.5% pass rate for legume OFCs, there was no significant difference between legume specific IgE testing (sIgE) levels in patients who passed versus failed a legume OFC
Summary
Food allergy is the result of a specific immune response that occurs reproducibly on exposure to a given food[1]. Over the past two decades, the prevalence of food allergy in children has been increasing[2,3,4]. There has been a threefold increase in food allergy presentations in an outpatient clinical setting[5]. For those affected, these allergies can be a cause of significant distress, including both physical symptoms if the trigger allergen is ingested, and an increase in anxiety[6]. In addition to the increase in prevalence of food allergy to well-known allergens, there are reports of newer, emerging food allergens that are being more commonly seen in clinical practice[7]. Legume and sesame are emerging food allergens. The utility of specific IgE testing (sIgE) to predict clinical reactivity to these allergens is not well described
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