Somnolence upon Allergen Provocation in a Child with Hen's Egg Allergy

Abstract

Recent epidemiological data reveal that food allergies highly affect the pediatric population and are an increasing cause for hospitalization. Typical food allergic symptoms range from mild, local symptoms, such as itching, swelling, nausea, vomiting and diarrhea, to systemic anaphylactic symptoms, like airway swelling, hypotension and arrhythmias (Boden SR et al., Immunol Rev 2011; 242: 247–257, Kirchlechner V et al., Klin Padiatr 2007; 219: 201–205). Although the appearance of these symptoms may facilitate the diagnosis of food allergy, diagnostics of food adverse reactions in the pediatric population is particularly difficult, as the patient or patient’s parents can often not communicate allergic symptoms appropriately. Therefore, objective screening tests including measurements of total and allergen specific IgE, skin prick testing (SPT) and the golden standard of food allergy diagnosis, the double blind placebo controlled food challenge (DBPCFC), are conducted especially in the young age groups. DBPCFC is not only of importance for diagnostic purpose, but is substantial for determination of threshold levels, which enable physicians to adequately advise patients or parents. Oral allergen provocations are carried out under hospital settings, due to possible adverse reactions, such as anaphylaxis, following international guidelines of NIAID (National Institute of Allergy and infectious Disease) (Boyce JA et al., J Allergy Clin Immunol 2010; 126: S1–58) and EAACI (European Academy of Allergy and Clinical Immunology). Increasing doses of the challenging food are given at 30 min intervals until the top dose has been reached, or the patient reports an objective symptom, which ensures the correct diagnosis of food allergy and which is the basis for dietary recommendations or therapeutic measures.