Diagnosis Of Food Allergy Research Articles

WHY DO GENERALISTS ORDER FOOD ALLERGEN IGE PANELS? A QUALITY IMPROVEMENT NEEDS ASSESSMENT

<h3>Introduction</h3> Food allergy (FA) IgE panels are inappropriately ordered by generalists to evaluate eczema and other non-IgE-mediated conditions, resulting in inaccurate diagnosis of FA, increased costs, and potentially increased FA development due to delayed introduction of allergenic foods. We present a needs assessment utilized to plan a quality improvement (QI) project to reduce FA panel utilization funded by the ACAAI Allergists' Foundation Community Grant Program. <h3>Methods</h3> Reasons for ordering FA IgE panels and barriers to change were obtained from a literature review, listening sessions with generalists, and surveys. This study was reviewed and exempted from IRB approval. <h3>Results</h3> The top indications for ordering FA IgE panels were immediate reaction to a meal, eczema, idiopathic urticaria, screening prior to allergen introduction, caregiver request without medical indication, rhinitis and asthma, and difficulty eating. Over 90% of generalists have ordered a FA IgE test. However, generalists report a lack of self-efficacy in interpreting FA IgE testing, educating parents about the pathophysiology of eczema, and about early introduction of food allergens in infancy. Barriers to reducing FA IgE testing include caregiver pressure to test, misinformation caregivers receive about FA testing, lack of patient education materials, and lack of time for face-to-face education. <h3>Conclusion</h3> Eczema is the most common non-IgE-mediated indication for FA IgE testing. Improving generalist knowledge and self-efficacy about eczema diagnosis and management, including the protective benefits of early food allergen introduction, may reduce inappropriate FA IgE testing.

DIAGNOSIS AND MANAGEMENT OF FOOD ALLERGIC PATIENTS ACROSS SEVERITY AND ALLERGENS: A NATIONWIDE US SURVEY

<h3>Introduction</h3> Food allergies affect millions of Americans and may result in life-threatening outcomes. In this study we aimed to understand food allergy diagnosis and management patterns of US Allergists. <h3>Methods</h3> In November 2021, a nationwide survey was emailed to US-practicing allergists (N=2850) to determine their diagnosis and management patterns. Providers were screened to ensure management of at least 1 food-allergic patient per month, with >25% of patients representing a pediatric population. <h3>Results</h3> The survey was completed by 125 allergists; the majority of allergists (81%) were community practitioners who saw an average of 74 food-allergic patients per month, of which 58% were pediatric. Allergists' top priorities for managing patients included preventing serious allergic reactions and maximizing patients' quality of life. Only 40% of allergists rate the severity of food allergies in their patients: main factors to determine disease severity were the severity/type of symptoms, history of requiring intervention (epinephrine), and number of organ systems involved in the reaction following exposure. Less important factors were skin prick test wheal size, presence of comorbid allergic diseases, and impact on quality of life. <h3>Conclusion</h3> Among US-based allergists that manage food-allergic patients, preventing serious allergic reactions was a top priority. Less than half of allergists categorize food allergy severity, and reaction severity weighs predominantly in how the overall disease severity is characterized. Further research on the impact of how definitions of food allergy disease severity impact shared decision making is warranted.

Total serum IgE levels as predictor of the acquisition of tolerance in children with food allergy: Findings from a pilot study.

The gold standard to diagnose food allergy (FA) is a double-blind, placebo-controlled food challenge (OFC), even if it shows potential risk of severe allergic reactions for the patient and is time-consuming. Therefore, easier, and less invasive methods are needed to diagnose FA and predict the tolerance, changing the clinical practice. The main aim of this study was to assess whether the total IgE values at the diagnosis of FA were associated with the duration of the tolerance acquisition and thus of the food elimination diet. We retrospectively analyzed the medical records of 40 patients allergic to milk or egg who performed an OFC for the reintroduction of the causal food at the Pediatric Allergy and Respiratory Unit of the University of Chieti from January 2018 to December 2020. We found a positive association of total serum IgE with the elimination diet duration (β = 0.152; CI, 95% 0.04-0.27) after adjusting for age, sex, and type of allergy (milk or egg). We also showed a significant correlation (r = 0.41 and p-value = 0.007) between the total IgE values and the duration of the elimination diet and a significant correlation between the casein specific IgE values at diagnosis of FA and the severity of the clinical presentation (r = 0.66; p-value 0.009). Total serum IgE at baseline, along with the downward trend of food-specific IgE levels (to milk or egg), may be useful in the prognostication of natural tolerance acquisition.

Diagnosis of food allergy to fruits by modified prick-prick testing and oral-pharyngeal provocative test

Diagnosis of food allergy to fruits by modified prick-prick testing and oral-pharyngeal provocative test

IgE and IgG4 Epitope Mapping of Food Allergens with a Peptide Microarray Immunoassay.

Peptide microarrays are a powerful tool to identify linear epitopes of food allergens in a high-throughput manner. The main advantages of the microarray-based immunoassay are as follows: the possibility to assay thousands of targets simultaneously, the requirement of a low volume of serum, the more robust statistical analysis, and the possibility to test simultaneously several immunoglobulin subclasses. Among them, the last one has a special interest in the field of food allergy, because the development of tolerance to food allergens has been associated with a decrease in IgE and an increase in IgG4 levels against linear epitopes. However, the main limitation to the clinical use of microarray is the automated analysis of the data. Recent studies mapping the linear epitopes of food allergens with peptide microarray immunoassays have identified peptide biomarkers that can be used for early diagnosis of food allergies and to predict their severity or the self-development of tolerance. Using this approach, we have worked on epitope mapping of the two most important food allergens in the Spanish population, cow's milk, and chicken eggs. The final aim of these studies is to define subsets of peptides that could be used as biomarkers to improve the diagnosis and prognosis of food allergies. This chapter describes the protocol to produce microarrays using a library of overlapping peptides corresponding to the primary sequences of food allergens and data acquisition and analysis of IgE and IgG4 binding epitopes.

Gestational and Early Life Risk Factors for Childhood Food Allergies

Aim(s) The prevalence of food allergy among children has risen steadily over the past two decades, with 4 to 6% of children having at least one type of food allergy.[1,2] We investigated whether the occurrence of food allergies in childhood were related to factors known to influence the early microbiome and implicated in immune training (e.g., delivery mode, antibiotic use, proximity to a farm). We also assessed maternal consumption of foods during pregnancy for which children become allergic and maternal history of food allergies. Methods Participants, enrolled in the New Hampshire Birth Cohort Study, included 2,011 women with a singleton pregnancy and their offspring. We used Cox Proportional Hazards models to estimate the risk of a medical diagnosis of food allergies during the first five years of life in relation to maternal-infant characteristics, adjusted for potentially confounding factors. Results A greater risk of food allergies was associated with cesarean delivery (HR = 1.99; 95% CI: 1.06, 3.74) and prenatal antibiotic use (HR = 2.29; 95% CI: 1.15, 4.56). Daycare attendance (HR: 0.27; 95% CI: 0.15, 0.47) was inversely associated with risk. Children of mothers with a history of food allergies, consuming tree nuts or eggs during pregnancy and those living near a farm had a higher risk and those whose mothers ate peanuts prenatally had a lower risk, but these associations could have been due to chance. Conclusion(s) Prenatal factors related to the early acquisition of the microbiome, such as method of delivery, prenatal antibiotics, and day care correlated to risk of a food allergy diagnosis among children in the first 5 years of life. Developing a clearer understanding of allergy development and its risk factors is crucial to reducing the burden of food allergies. Key words Food allergy, daycare attendance, prenatal factors, early childhood, prenatal antibiotics

A qualitative study of food choice behaviors among college students with food allergies in the US

PurposeThis study explored how food allergies have affected food-related behaviors and quality of life of college students with food allergies and identified factors influencing food choice decisions among this group of individuals.Design/methodology/approachOne-on-one interviews were conducted with 26 college students with self-reported or clinically diagnosed food allergies, recruited from two universities located in the southern region of the United States. The participants were asked a series of questions based on a semi-structured discussion guide. Each interview lasted about 30 min; all interviews were audio-recorded and transcribed verbatim. The transcriptions were coded independently by three researchers, and themes were identified.FindingsFood allergies affected the participants' food-related behaviors, including eating, food preparation and shopping, as well as some aspects of their quality of life. Individual factors, such as mood, other diseases, cultural background and sensory properties, also influenced food choices. Friends and families were the two most important social influencers of food choices. Regarding physical environmental factors, cost, convenience, value and variety were considered important in selecting food. However, the participants' food choices were less influenced by food advertisements and social media. Additionally, experiences and complex cuisines were also key factors in making food choices.Research limitations/implicationsTheoretically, this qualitative study applied a food choice decision framework in the context of college students with food allergies. Practical recommendations are provided, particularly to campus dining facilities, to fulfill the needs of college students with food allergies.Originality/valueThis study advanced the understanding of the complexity of food choice decision-making among college students with food allergies. A path diagram specific to food choice among college students with food allergies was developed based on the results of this study. This study also highlighted that food allergy management would involve various behavioral changes and revealed that the food choices are influenced by a wide range of factors.

Prevalence, clinical presentation, and associated atopic diseases of pediatric fruit and vegetable allergy: A population-based study.

In children, fruit and vegetable allergies are often overlooked compared with well-known allergies such as those to eggs, milk, and shellfish. Therefore, this study aimed to analyze fruit and vegetable allergies in children, including prevalence, types of food allergens, clinical presentation, management, and associated comorbid atopic diseases. In 2012, a nationwide, cross-sectional, random sampling questionnaire-based survey for common fruit and vegetable allergies was conducted in Taiwan. Information regarding these plant food allergies was collected. Physicians diagnosed food allergies according to the descriptions of convincing symptoms. Enrolled questionnaires were reviewed by expert pediatricians. A total of 9,982 valid questionnaires were analyzed. The overall prevalence of fruit and vegetable allergies was 5.6% (n=560) and 3.0% (n=304), respectively. The most common fruit allergen was mango, followed by kiwifruit, whereas taro and bamboo shoot were the most common vegetable allergens. Meanwhile, most allergic symptoms were of the mucocutaneous tissue, followed by the upper airway and gastrointestinal tract. Most only required avoidance of allergens and not medical treatment. Children with fruit or vegetable allergies had a higher percentage of comorbid atopic dermatitis, allergic rhinitis, and asthma than those without food allergies; additionally, the proportion of comorbid atopic diseases was similar between fruit and vegetable allergies and shellfish allergy. One child developed anaphylaxis due to a corn allergy. Fruits and vegetables are common food allergens in Taiwanese children who present with diverse and potentially severe symptoms. Children with plant food allergies had a percentage of comorbid atopic diseases similar to that of shellfish allergy, the most common allergen. These findings indicate the importance of considering fruit and vegetable allergies in children.

Passive tolerance and productive uncertainties in food allergy immunotherapy biomedical practices.

There has been little sociological research on food allergy in North America, despite the fact that it impacts a significant population in the US and Canada. Immunotherapy for food allergy is now a prominent area of investigation and experts argue it is one dimension of a 'paradigm shift' that encourages exposure to food allergens in contrast to avoidance of them. This article reports on an ethnographic investigation of immunotherapy for food allergy research and practice between the years 2015 and 2020. I report on analyses of N=31 in-depth interviews with spokespersons with different types of engagement in immunotherapy and over 100h of ethnographic observations at clinical and scientific conferences. My research revealed the entangled ontologies of food and drug in immunotherapy and related uncertainties in the diagnoses of food allergy, which catalysed further uncertainty about who is receiving and who should receive immunotherapy (IT). Relatedly, there are uncertainties about the goals and/or outcomes of IT. I elaborate on previous sociological work about how uncertainty is valued in medicine and science. I argue shared uncertainties and mutual scepticism in IT co-exist, representing a passive (productive) tolerance and reticently accepted form of tension in the domain, which have resulted in calls for intra-professional and inter-professional collaborations and the involvement of other stakeholders in knowledge making regarding food allergy immunotherapy.

IL-4 receptor alpha signaling alters oral food challenge and immunotherapy outcomes in mice

Food allergy diagnosis and management causes a number of social and emotional challenges for individuals with food allergies and their caregivers. This has led to increased interest in developing approaches to accurately predict food allergy diagnosis, severity of food allergic reactions, and treatment outcomes. However, the utility of these approaches is somewhat conflicting. We sought to develop and utilize a murine model that mimics the disease course of food allergy diagnosis and treatment in humans and to identify biomarkers that predict reactivity during food challenge (FC) and responsiveness during oral immunotherapy (OIT) and how these outcomes are modified by genetics. Skin-sensitized intestinal IL-9 transgenic (IL9Tg) and IL9Tg mice backcrossed onto the IL-4RαY709F background received a single intragastric exposure of egg antigen (ovalbumin), underwent oral FC and OIT; food allergy severity, mast cell activation, and ovalbumin-specific IgE levels were examined to determine the predictability of these outcomes in determining reactivity and treatment outcomes. Subcutaneous sensitization and a single intragastric allergen challenge of egg antigen to BALB/c IL9Tg mice and Il4raY709F IL9Tg induced a food allergic reaction. Enhanced IL-4Rα signaling altered the symptoms induced by the first oral exposure, decreased the cumulative antigen dose, increased the severity of reaction during oral FC, and altered the frequency of adverse events and OIT outcomes. Biomarkers after first oral exposure indicated that only the severity of the initial reaction significantly correlated with cumulative dose of oral FC. Collectively, these data indicate that single nucleotide polymorphisms in IL-4Rα can alter clinical symptoms of food allergic reactions, severity, and reactive dose during FC and OIT, and that severity of first reaction can predict the likelihood of reaction during FC in mice with IL-4Rα gain of function.

Combination of magnetic beads extraction and ultraperformance liquid chromatography tandem mass spectrometry detection for the clinical diagnosis of allergies

The total amount of immunoglobulin E (IgE) in human serum is an important parameter in diagnosing allergies. To reduce the false diagnosis of allergies and better assist in therapy, clinical studies can be performed to obtain accurate and reliable measurements of IgE. A magnetic beads (MBs)-based ultraperformance liquid chromatography tandem mass spectrometry (UPLC–MS/MS) method for total IgE measurement and the diagnosis of food allergies in serum was developed in this study. First, IgE was extracted by MBs coupled with anti-IgE antibody from serum. The extracted IgE was quantified by a specific signal peptide after digestion. A spiked linear IgE concentration ranging from 400 to 5000 ng mL−1 was used for quantification. The limits of detection and quantification were 400 ng mL−1 and 800 ng mL−1, respectively, for the developed method. Additionally, the combined capacity of the extracted IgE with different allergic proteins was evaluated by a binding experiment in vitro. The combining capacity of IgE with different allergens was used to speculate the kind of allergens that induce allergies in patients. Overall, a new method was developed that could be used to quantify the amount of IgE and simultaneously diagnose which allergen causes an allergic reaction, and this method may provide a powerful new tool in the clinical detection of allergies. Moreover, the developed method was applied to analyze IgE in four samples of patient serum and four serum samples from healthy individuals.

Food allergy, mechanisms, diagnosis and treatment: Innovation through a multi-targeted approach.

The incidence of food allergy (FA) has continued to rise over the last several decades, posing significant burdens on health and quality of life. Significant strides into the advancement of FA diagnosis, prevention, and treatment have been made in recent years. In an effort to lower reliance on resource-intensive food challenges, the field has continued work toward the development of highly sensitive and specific assays capable of high-throughput analysis to assist in the diagnosis FA. In looking toward early infancy as a critical period in the development of allergy or acquisition of tolerance, evidence has increasingly suggested that early intervention via the early introduction of food allergens and maintenance of skin barrier function may decrease the risk of FA. As such, large-scale investigations are underway evaluating infant feeding and the impact of emollient and steroid use in infants with dry skin for the prevention of allergy. On the other end of the spectrum, the past few years have been witness to an explosive increase in clinical trials of novel and innovative therapeutic strategies aimed at the treatment of FA in those whom the disease has already manifested. A milestone in the field, 2020 marked the approval of the first drug, oral peanut allergen, for the indication of peanut allergy. With a foundation of promising data supporting the safety and efficacy of single- and multi-allergen oral immunotherapy, current efforts have turned toward the use of probiotics, biologic agents, and modified allergens to optimize and improve upon existing paradigms. Through these advancements, the field hopes to gain footing in the ongoing battle against FA.

Clinical characteristics and influencing factors of children with parent-reported food allergy

Objective: To analyze the clinical characteristics and influencing factors of children with parent-reported food allergy (FA), thus providing empirical evidence for facilitating the effective utilization of medical history information and promoting better health education for parents. Methods: A cross-sectional study was conducted, recruiting all 596 children under 3 years of age who underwent physical examinations from July to August 2019 at the Department of Child Health Care, Children's Hospital of Chongqing Medical University. Children were carried out with questionnaires, skin prick test, and diagnosed with FA through oral food challenge (OFC) by pediatricians. The parent-reported incidence rate, symptoms of FA, and the possible influencing factors, including demographic characteristics, family history of allergy, in-utero exposure to smoke and antibiotic use, feeding methods after birth, and residential environment were collected by questionnaire. The differences of clinical characteristics between parent-reported FA and medically diagnosed FA were analyzed by chi-square test. Logistic regression was used to analyze the factors associated with parent-reported FA. Results: A total of 596 children (316 boys and 280 girls) were recruited for this study. The incidence rate of FA by parent-report (22.0%, 131/596) was higher than that by medical diagnosis (9.9%, 59/596) (χ²=32.46, P<0.001). There were 36.6% (48/131) of children with parent-reported FA and 2.4% (11/465) of children without parent-reported FA receiving medical diagnosis of FA. Among children with parent-reported allergic symptoms, 37.5% (24/64) of those with gastrointestinal symptoms and 31.5% (23/73) of those with skin symptoms received medical diagnosis of FA, respectively. Six out of 7 children with co-presenting cutaneous and gastrointestinal symptoms were diagnosed with FA. Univariate Logistic regression analysis showed that family history of allergy (OR=1.83 (95%CI 1.22-2.73), P=0.003) and damp living environments (OR=2.33 (95%CI 1.13-4.79), P=0.022) were associated with higher likelihood of parent-reported FA. Conclusions: The incidence rate of parent-reported FA is higher than medically diagnosed FA. Clinicians should be highly suspicious of the possibility of FA in children with both cutaneous and gastrointestinal symptoms. Family history of allergy and damp living environments may increase the possibility of parent-reported FA.

Experiences and attitudes of parents of children with cow's milk and other food-allergy.

The attitude and behaviors of parents are important in the management of children with food allergy (FA). The aim of this study is to evaluate the experiences and attitudes of parents of children with allergy to cow's milk and other FA. The parents of children with FA were asked to complete an 18-item questionnaire to evaluate the FA history and experiences during diagnosis, treatment, and follow up. The data from 558 (91.2%) survey questionnaire that were filled completely were analyzed. The mean age of the parents was 33.4+4.9. It was found that most common food allergen was cow's milk (85.3%). The mean time to diagnosis from the onset of symptoms was 10.9±18.4 months. Around 229 parents (41.6%) admitted to at least four different physicians and 68 (12.3%) parents admitted to at least five different physicians before diagnosis. The median time to diagnosis from the onset of symptoms was five (1-108) months in the patients admitted to four or more physicians, but it was one (1-48) month in the patients that admitted to less physicians (p˂0.001). The most common symptoms were dermatitis and mucus-bloody stool, the least common ones were cardiovascular symptoms. Only 21.1% of the patients were able to use hypoallergenic formulas (HAF) in accordance with the recommendation of the physician. Delayed diagnosis of FA is a major concern, and during this period the patients admit many physicians. A majority of the patients with CMPA experience difficulties while using HAFs, and only one-fifth of them is able to use formula regularly.

Nasal mucosal reactivity assessment via a double-blind placebo-controlled food challenge with cow’s milk allergens

BackgroundAllergies, including food allergies, are a considerable clinical and public-health problem. The introduced preventive measures and differential diagnostics, including oral food challenges, are the gold standard for determining further treatment planning.Case presentationWe present a case of an 18-year-old girl with a cow’s milk allergy who underwent an oral food challenge (double blind oral food challenge). Such a challenge may be confounded by inducing a response from other systems and organs, which provides theoretical grounds for the use of other methods of assessing the body’s response to food allergens (response demonstrated by the upper respiratory tract). Based on this idea, in order to assess the degree of mucosal response, we used optical rhinometry as an objective method for nasal patency evaluation, as well as identification of tryptase level in nasal lavage fluid and exfoliative cytology of nasal mucosa. The results of these tests confirmed positive reaction of the nasal mucosa in the course of the oral allergen challenge.ConclusionsThe observed increase in the nasal mucosal reactivity that accompanies oral food challenges may suggest a potential for using food allergens in nasal allergen provocation testing in order to diagnose food allergies.

Filaggrin loss-of-function mutations are associated with persistence of egg and milk allergy

A genetic defect in the epidermal barrier protein filaggrin (FLG) plays a major role in the etiology of eczema and associated allergic airways diseases. However, it is still controversial to what extend loss-of-function (LOF) mutations in FLG contribute to the development and persistence of food allergies. This study tested association of FLG LOF mutations with allergic reactions to diverse foods and investigated their potential effect on the persistence of early food allergies. This study recruited 890 children with challenge-proven food allergy for the German Genetics of Food Allergy Study (GOFA). Longitudinal data were available for 684 children. All children were clinically characterized, including their allergic responses to specific foods, and genotyped for the 4 most common LOF mutations in FLG; R501X, 2282del4, R2447X, and S3247X. Associations between FLG mutations and food allergies were analyzed by logistic regression using the German Multicenter Allergy Study cohort as the control population. FLG mutations were associated with allergies to diverse foods including hen's egg (HE), cow's milk (CM), peanut, hazelnut, fish, soy, cashew, walnut, and sesame with similar risk estimates. Effects remained significant after adjusting for the eczema status. Interestingly, FLG mutations increased the risk of a persistent course of HE and CM allergy. Using the gold standard for food allergy diagnosis, this study demonstrates that FLG LOF mutations confer a risk of any food allergy independent of eczema. These mutations predispose to the persistence of HE and CM allergy and should be considered in the assessment of tolerance development.

Prevalence of food allergy diagnosis in pediatric patients with atopic dermatitis referred to allergy and/or dermatology subspecialty clinics

Atopic dermatitis (AD) is a common chronic inflammatory pediatric skin disorder, affecting up to 25% of children.1 Children with AD are at higher risk for food allergy (FA); approximately 30% to 50% of children with AD have a history of FA.2-5 Further, the prevalence of AD and FA has increased over time.6 Prior studies examining FA prevalence in children with AD often conflated multiple types of FA, including immediate immunoglobulin E (IgE)–mediated symptoms and food-triggered atopic dermatitis (FTAD), and did not clearly distinguish the two entities.

Predictor of buckwheat allergy in children based on challenge test results: a retrospective observational study in Japan.

Background. Buckwheat (BW) is a major food allergen and one of the leading causes of food-induced anaphylaxis in Japan. The standard method of diagnosing food allergy is the oral food challenge (OFC). The BW-specific IgE (BW-sIgE) value is used to assess BW allergy but its utility is limited. Aim. The aim of the present study was to identify factors with predictive value for the diagnosis of BW allergy using the OFC. Methods. We evaluated 37 patients who were classified into the positive or negative group according to their OFC results. Results. Ten patients (27.0%) showed objective or persistent, moderate, subjective symptoms during the OFC. The positive group had a significantly higher BW-sIgE/total IgE ratio than the negative group (p less than 0.001), but the total IgE (p = 0.139) and BW-sIgE (p = 0.130) did not differ significantly. Receiver operator characteristic (ROC) analysis showed that the BW-sIgE/total IgE ratio had a larger area under the curve (AUC, 0.885) than BW-sIgE (AUC, 0.667). The statistically optimal cut-off was 0.0058 for the BW-sIgE/total IgE ratio, which corresponded to a clinical sensitivity and specificity of 90.0% and 81.5%, respectively. Conclusions. BW-sIgE/total IgE ratio may be more useful predictor of BW OFC results than BWs-IgE.

Editorial introductions.

Editorial introductions.

Characteristics of patients diagnosed as non-allergic following food allergy oral immunotherapy referral.

Ascribing food allergy diagnosis to patients who are not allergic is well described, but its implications on oral immunotherapy (OIT) have not been studied. The aim was to study non-allergic patients referred for OIT. All patients who began OIT at Shamir Medical Center between November 2015 and August 2020 were included. Medical records were reviewed, and skin prick tests (SPT) and/or specific IgE were measured. Patients were challenged to the index food. Allergic and non-allergic patients were compared. A total of 1073 patients were studied (milk, n = 327; egg, n = 41; peanut, n = 272; sesame, n = 130; and tree nuts, n = 303) and 87 (8.1%) were found non-allergic (milk, n = 21; egg, n = 6; sesame, n = 5; peanut, n = 29; tree nuts, n = 26). Predictors of being not allergic were no previous reaction to the index food (OR = 3.3, p = 0.001), not having asthma (OR = 2.4, p = 0.001), or HDM sensitization (OR = 2.0, p = 0.007), male sex (OR = 2.3, p = 0.004), and a smaller SPT wheal size (OR = 1.5, p < 0.001). A substantial number of patients referred for OIT are mislabeled with food allergy, suffer from unjustly food limitations and impairments in quality of life, and "take up" OIT places of true allergic patients. Awareness of OIT centers to this phenomenon is important. A significant number (8.1%) of patients referred for OIT are found not allergic to the food they intended to treat. This study characterizes non-allergic patients referred for OIT (a lack of previous reaction to the index food, a smaller or negative SPT wheal size, and less atopic co-morbidities) and discusses the implications of such referrals. Increased awareness by OIT centers to potential non-allergic patients referred for OIT is required, including screening of patients before treatment initiation, to minimize unnecessary treatments of non-allergic patients.