Oral Food Challenge Test Research Articles

Fish allergy tolerance 16 months after diagnosis.

Fish allergy is generally thought to be persistent, and approximately 80% of patients with fish allergies do not develop tolerance even 10 years after diagnosis. There have been no reports of rapid tolerance development in patients with severe fish allergies. We report the development of tolerance 16 months after the diagnosis of fish allergies. A 13-month-old boy was diagnosed with rosefish allergy (Sebastes matsubarae) and Japanese jack mackerel allergy (Trachurus japonicus). To find out which species of fish he could consume safely, he underwent several oral food challenge (OFC) tests. It was determined that he could consume tuna, salmon, cod, sardine, chub mackerel (Scomber japonicus), and Japanese amberjack (Seriola quinqueradiata) without eliciting signs of allergy. He continued to eat the fish that did not produce allergic reactions three to four times a week. The titer of serum allergen-specific immunoglobulin E (IgE) to fish had decreased in a subsequent ImmunoCAP®-specific IgE blood test performed 16 months after the diagnosis of the rosefish allergy. Following this test result, he underwent OFCs with rosefish and Japanese jack mackerel, both of which turned out to be negative, and it was determined that he had developed tolerance to fish. In this case, the repeated OFCs were useful in identifying fish species that were safe for consumption. In addition, the decrease in allergen-specific IgE was useful in predicting the development of tolerance. We hypothesize that proactive consumption of available fish species may lead to this rapid induction of tolerance to fish allergens.

Points to consider when giving nutritional education after taking the Oral Food Challenge test through studies of the anaphylaxis cases

Points to consider when giving nutritional education after taking the Oral Food Challenge test through studies of the anaphylaxis cases

Effect of early childhood cow's milk elimination diet on eating behaviours, nutrition and growth status at age 2-6years.

The present study aimed to investigate the eating behaviour, nutritional status and growth of Caucasian children in ages 2-6years who had a diet because of cow's milk protein allergy (CMA) [immunoglobulin (Ig)E-mediated and/or non-IgE-mediated] in early childhood. In this cross-sectional, case-control study, the cow's milk elimination (CME) group comprised children aged 0-2years who were receiving a CME diet because of CMA, as confirmed by an oral food challenge test, and had reintroduced cow's milk for at least ≥3months. The control group never had a restricted diet. Eating behaviour and children's growth was assessed. A 3-day food record was taken to determine the macronutrient and micronutrient intake of the children. Data on the children's socio-demographic, infant nutrition and family allergy history were collected from their medical records and face-to-face interviews with mothers. In total, 62 children with a median age of 32months were recruited for the study. The total scores of food avoidance and satiety responsiveness in the CME group (n:31) were higher than in the controls (n=31) (p=0.036 and 0.006, respectively). Weight-for-age and height-for-age are statistically lower in the CME group than in the control group (p<0.001). A significant difference between groups in terms of dairy intake was recorded (p=0.011). In the CME group, the current frequency of adequate energy, vitamin B1, folic acid, vitamin C and calcium intake was significantly lower than in the control group (p<0.05). Dietary interventions because of CMA at age 0-2years can affect children's nutritional habits and parental-reported assessment of children's eating behaviours, resulting in growth restriction with insufficient micro/macronutrients and/or dairy products at the age of 2-6years.

EVALUATION OF THE RELATIONSHIP BETWEEN THE SEVERITY OF SOLID FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME AND POST-EMETIC SERUM THYMUS AND ACTIVATION-REGULATED CHEMOKINE LEVELS

We reported that post-emetic serum thymus and activation-regulated chemokine (TARC) levels may be a potential biomarker to diagnose solid food protein-induced enterocolitis syndrome (FPIES). However, there are no reports on the relationship between FPIES severity and serum TARC levels. The subjects were 13 cases of FPIES (hen's egg=10, Wheat=1, rice=1, short-neck clam=1) for a total of 22 events (7 emergency outpatient visits, 9 positive and 6 negative results of oral food challenge test). Serum TARC levels at 6 and 24 h after antigen ingestion were compared between the symptomatic and asymptomatic events and the mild-moderate and severe events. We also evaluated the correlation between vomiting duration and serum TARC levels. The median serum TARC (pg/ml) in the asymptomatic, mild-moderate, and severe events were 546, 1093, and 3127 at 6 h after ingestion, and 910, 2053, and 6496 at 24 h after ingestion, respectively. The serum TARC level was significantly higher in the symptomatic events than the asymptomatic events, and it was significantly higher in the severe events than the mild-moderate events (p < 0.01). There was a moderate correlation between serum TARC levels and vomiting duration. Post-emetic serum TARC correlates with the severity of FPIES. It is expected that this information will lead to an objective evaluation of the severity of FPIES.

Test de provocation orale : indications

The Oral Food Challenge Test (OFC) is a key test in the management of food allergies (FA). It has been the subject of recommendations, both French in 2006 and international (EAACI in 2014) [1,2]. Initially considered as the gold standard for a diagnosis of certainty or cure, new indications and modalities have emerged. These are notably linked to the emergence of new forms of allergy, to the evolution of therapeutic strategies, to the complexity of certain situations, particularly in the case of cross-allergy, and finally to the evolution of prevention.

The effect of food elimination and probiotic supplementation in asthmatic children with food allergy

Background: Both bronchial asthma and food allergy are comorbidities of increasing prevalence and growing concern worldwide. Objectives: We sought to detect the prevalence of food allergy in children with bronchial asthma, the effect of food elimination and probiotic supplementation on the clinical outcome of asthma and the quality of life (QOL). Methods: This randomized controlled trial included 226 children aged from 4 to 18, suffering from bronchial asthma, 88 of whom had associated food allergy. Patients who suffered food allergy as diagnosed by history, prick to prick test food elimination and oral food challenge test, were randomly divided into four groups, each comprised 22 children. Group (1): received pharmacological treatment only, group (2): received pharmacological treatment and probiotic supplementation, group (3): practiced food elimination and received pharmacotherapy, and Group (4): practiced food elimination and received probiotic supplementation and pharmacological therapy. For patients in all groups, grading of asthma severity, measurement of total IgE and Pediatric Asthma quality of life questionnaire (PAQLQ) were performed before and after 6 months at the end of the study. Results: There were significant statistical improvements in the severity of asthma, total serum IgE level and QOL for all groups before and after the intervention. The best outcome was achieved in children who practiced avoidance of food allergen(s) and took probiotic supplementation in addition to the pharmacological therapy (p <0.001). Conclusion: Diagnosis of food allergy in asthmatic children is mandatory and combining pharmacological therapy, avoidance of the offended food allergen and intake of probiotics are encouraged.

Patterns of sensitization to food allergens among allergic adults and children following-up in Zagazig university hospitals, Egypt

BackgroundBackground: Data regarding food sensitization and food allergy in developing countries are lacking. We sought to explore the frequency and pattern of sensitization to food allergens among a sample of Egyptian allergic patients. Methods: This cross-sectional study included 1373 allergic patients. They were subjected to thorough history taking, skin prick test and measurement of serum specific IgE (sIgE) level. Patients with evidence of sensitization to food were subjected to food elimination followed by an open oral food challenge (OFC) test. Results: Four hundred and nineteen patients (30.5%) (76 children and 343 adults) had evidence of sensitization to one or more food allergen. Among children, 41 (52.5%) had urticaria, 31 (39.7%) allergic rhinitis, 13 (16.6%) pollen food allergy syndrome, 16 (20.5%) bronchial asthma, 9 (11.5%) eczema and 7 (9%) had GIT symptoms. Among adults, 152 (44.5%) had allergic rhinitis, 149 (43.6%) urticaria and 57 (16.7%) had GIT symptoms. The most common allergens among children were peanut (31; 39.7%), fish (29; 37%), egg (18; 23%), and strawberry (17; 21.79%) while in adult, they were jalapeno pepper (123; 36%), egg (122; 35.7%), tomato (120; 35.1%), peanut (110; 32.2%), and fish (109; 31.9%). Significant associations were found between sensitization to different types of foods including associations between citrus fruits and mango, and between shrimps and crabs (p < 0.001). Out of the sensitized 419 patients, 118 (28.2%) had positive OFC test. Conclusion: A significant proportion of both adults and children with allergic disorders are sensitized to foods. Pepper, peanut, egg, fish, tomato, strawberry are the most common foods to which Egyptian patients are sensitized.

Evaluation of some predictive parameters for baked-milk tolerance in children with cow's milk allergy.

Inclusion of baked-milk products to the diet appears to markedly accelerate tolerance to unheated milk compared to a strict avoidance diet. : The present study aims to investigate the predictors of baked-milk tolerance in children with Immunoglobulin E (IgE)-mediated cow's milk (CM) allergy. The study included 80 patients diagnosed with IgE-mediated CM allergy upon oral food challenge (OFC) testing at our clinic. Patients who developed and did not develop reactions during OFC with baked milk were compared considering clinical and laboratory parameters. Eighty patients with CM allergy comprised 48 male and 32 female infants with an average age of 7.25 ± 2.45 (3-13) months. We found that 62.5% of them showed tolerance to baked milk in the OFC test performed with cakes containing 2.6-g milk protein. When the patients who tolerated and could not tolerate baked-milk products were compared for test results, we detected a statistically significant intergroup difference regarding diameter of wheal in skin prick test (SPT) performed with muffin slurry, levels of specific Immunoglobulin E (sIgE) in CM, sheep's milk (SM), goat's milk (GM), casein, and the amount of unheated milk consumed until a reaction developed in the OFC test performed with unheated milk (P < 0.05). We defined novel decision points based on CM, SM, GM, casein sIgE levels, wheal diameter in SPT with muffin slurry, and the amount of milk ingested during OFC performed with unheated milk that may be useful in predicting outcomes of baked-milk ingestion.

Pru p 3 Sublingual Immunotherapy in Patients with Lipid Transfer Protein Syndrome: Is It Worth?

Background: Lipid transfer proteins (LTPs) syndrome is an important cause of multiple plant food allergy in the Mediterranean area. The effectiveness of sublingual immunotherapy (SLIT) with the LTP Pru p 3 extract has been little investigated in the real-world setting. This study aimed to investigate the outcome of Pru p 3 SLIT in real-life patients with LTP syndrome with/without concurrent reactions to peanut and/or nuts. Methods: This was a prospective real-life study including all patients diagnosed with LTP allergy and treated with Pru p 3 SLIT between 2011 and 2018 in a tertiary hospital in Spain. Patients underwent open oral food challenge (OFC) tests for unpeeled peach and nuts/peanuts 1 year after the treatment started to assess food tolerance. A control group of patients diagnosed with LTP allergy who refused treatment with immunotherapy were included. Severity of symptoms and diet avoidance was recorded in both groups. Results: Twenty-nine patients with a median age of 24.7 years (range 5.5–43.1) were included: 100% were allergic to fruit; 72%, to peanut and/or nuts; 19 had a history of severe systemic reactions. Seven patients discontinued therapy; 3 (10%), due to adverse events. One year after SLIT start, 16 (73%) patients had negative OFC to peach; 95%, after 2 years; 69% had negative OFC to nuts/peanuts. The control group included 13 patients: 53.8% experienced reactions with new foods; severity of symptoms increased significantly (p < 0.001), and diet restrictions were maintained in this group. Conclusions: SLIT with Pru p 3 shows a good safety profile, and avoid dietary restrictions in patients with LTP syndrome treated in the real-life setting.

Over restrictive elimination of foods in children with food allergy.

Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians. We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey. Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and > 10 foods were 28%, 25% from the maternal and infant diet, respectively. Cow`s milk, cheese, butter, yoghurt, baked milk products and hen`s egg were the most commonly restricted items. Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations.

Threshold dose of cow's milk in sensitization to casein higher than those of casein and β-lactoglobulin in children with cow's milk allergy.

Recent treatment for food allergies involves the intake of allergy-causing foods at doses lower than the threshold dose determined by the oral food challenge (OFC). For a more successful treatment, it is necessary to identify a biomarker to establish safer doses of allergens in foods consumed at home. In this study, we aim to investigate whether the pattern of sensitization to cow's milk (CM) is related to the threshold dose of CM. Fifty patients with sensitization to casein (casein-specific IgE titer ≥ 0.7 UA/ml) and who have undergone the CM OFC test from July 2013 to July 2015 were enrolled. They were examined for the presence or absence of sensitization to β-lactoglobulin (BLG) (BLG-specific IgE ≥ 0.7 UA/ml). They were divided into two groups, namely, the only-casein-specific IgE-positive (C) group, and both casein- and BLG-specific IgE-positive (C + B) group. The C group had 26 patients and the C + B group had 24. Both the CM- and casein-specific IgE titers were higher in the C + B group than in the C group. The positivity rates determined from OFC test results were 53.8 and 87.5%, and the threshold doses of CM were 88.7 and 31.1 ml in the C and C + B groups, respectively. In patients with low casein-specific IgE titers (≤ 10 UA/ml), the C + B group showed a significantly lower threshold dose of CM than the C group. Our results suggest that children with CM allergy sensitized to casein alone have a higher threshold dose than those sensitized to both casein and BLG.

Home-Based Up-Dosing in Build-Up Phase of Oral Immunotherapy of Egg Allergy Is Safe and Feasible in Real-World Practice.

Oral immunotherapy (OIT) has emerged to build sustained unresponsiveness or tolerance in patients with egg allergy. However, it is important to increase compliance and ensure safety because OIT requires an extended period of time and has a risk of side effects like anaphylaxis. We aimed to show the feasibility and safety of OIT during the build-up phase using a home-based, up-dosing method in children with egg allergy. Sixteen patients aged 4 to 12 years with egg allergy were enrolled. Patients increased the dose of boiled egg white (EW) by 5% per day at home and 25% per month at the hospital, with a target dose of 40 g of boiled EW (4.0 g of EW proteins). A historical control group (n = 16) was matched for age, sex, and clinical characteristics for comparisons with the OIT group. Oral food challenge (OFC) tests were performed after completing the build-up phase. In the OIT group, 93.8% (15/16) of patients achieved desensitization, with only 1 patient discontinuing OIT before the maintenance phase due to repeated allergic reactions. Mild allergic reactions and anaphylaxis occurred in 12 (75.0%) and 2 patients (12.5%), respectively. However, there were no significant adverse reactions such as serious anxiety or life-threatening events that required discontinuation of treatment. On the contrary, only 1 patient (6.3%) in the control group passed an OFC of 40 g of boiled EW during the same period (P < 0.001). Our results suggest that home-based up-dosing protocols using boiled eggs may be safe and feasible for the build-up phase of OIT in children with egg allergy.

Evaluation of red meat allergy patients and review of the literature.

It was reported that prevalence of red meat allergy in children was higher in our country than in western populations. However, the diagnosis of these patients is often delayed. The aim of the study was to present the clinical and laboratory characteristics of our red meat allergy patients. The data were collected retrospectively from the files of children with red meat allergy. Also, 6 adults with red meat allergies were recorded in the families of the children. Patients with symptoms associated with red meat allergy and sensitive to beef or mutton in prick-to-prick tests were recorded. The median age of the 43 patients was 12 years (2-37), and 51% were male. Most of the patients were children (n=37, 86%). The median age was 10 years in children (2-17), and 54% were male. All of the children had dermatologic manifestations, 51% had respiratory symptoms, and 64% had anaphylaxis upon exposure to red meat. The anaphylaxis history was not associated with demographic, clinical and laboratory data. A total of 63% children had additional allergic diseases, and 75% of them were sensitive to both mutton and beef in prickto- prick tests. The median total IgE level of the children was 327 (20-3550) IU/mL, median eosinophil count was 210/mm < sup > 3 < /sup > (40-990) and mean vitamin D was 13.1 ± 1.2 mcg/L (n=27). Anaphylaxis occurred in 3 of 9 patients who received the open oral food challenge (OFC) test. After OFC, 3 patients continued to eat red meat without issues, and 1 patient was recommended to eat alternatives to red meat. Clinical and laboratory findings were heterogeneous in children with red meat allergy. Anaphylaxis risk seems to be higher than other food allergies. OFC test is more helpful in both diagnosis and alternative red meat selection compared to laboratory findings.

Prevalence of confirmed immunoglobulin E-mediated food allergy among adult Egyptian patients

Food allergy (FA) represents an increasing social and economic health problem. Prevalence of food allergy differs from one country to another depending on genetic and environmental as well as feeding habits of each country. Estimate the prevalence of confirmed immunoglobulin E-mediated food allergy (FA) among adult Egyptian patients and identify its possible risk factors. A total of 2081 adult subjects were randomly selected from the Allergy outpatient clinic at Ain Shams university hospitals. Patients who disclosed food adverse complaints (probable food allergy group) were further subjected to a detailed questionnaire, complete blood cell count, total immunoglobulin E level, skin prick test and /or specific immunoglobulin E test for common food allergens, and oral food challenge with the culprit food. Patients were classified into confirmed food allergy and no food allergy groups depending on the results of oral food challenge test. Out of the 2081 adults, 100 subjects had self-reported food adverse complaints, and of them, 45 (45%) had confirmed diagnosis of FA. Thirty four (75.6%) confirmed FA patients were females with mean age ± SD of (38.02 ± 13.08) years, five patients (11.1%) had persistent childhood FA, 11 (24.4 %) had family history of atopy, five (11.1%) had associated atopic diseases and 24 (53.3%) were polysensitized. Female gender, young age and exercise were found to be risk factors for confirmed FA (OR: 1.766, 1.4, and 1.9 respectively). Cutaneous manifestations were the most common presentation of confirmed FA patients in the form of urticaria 40/45 (88.9%) and angioedema 18/45 (40%). The most common food allergen was milk, banana, fish, tomato, strawberry and eggs. In conclusion, IgE mediated food allergy is a noticeable health problem among adult Egyptians, particularly adult females and young age groups.

Personalized algorithm for conducting oral food challenge tests with milk in children of the first year of life

Personalized algorithm for conducting oral food challenge tests with milk in children of the first year of life

A SURVEY ON ACCIDENTAL INGESTION OF PACKAGED PROCESSED FOODS, EATING OUT AND OVER-THE-COUNTER SALES BY INDIVIDUALS WITH FOOD ALLERGIES

To determine the frequency and effects of accidental ingestion of packaged processed foods, eating out, and over-the-counter sales in individuals with food allergies. The participants were guardians of children hospitalized for an oral food challenge test during January and February 2016 at the Department of Pediatrics, Sagamihara National Hospital. We conducted a questionnaire survey on food allergies, accidental ingestion via packaged processed foods, eating out, and over-the-counter sales in the past 1 year, and the degree of understanding of the display of allergen-related information. A total of 442 participants were given questionnaires, and 226 provided valid responses. Among these respondents, 31% had experienced accidental ingestion (packaged processed food: 24%, food service: 12%), and approximately one quarter of the subjects with allergic symptoms had repeated accidental ingestion. About 70% of the causes were due to overlooking or misunderstanding of allergen information. Of the participants, 85% were aware that processed foods must display allergen information, and 39% were aware that there was no requirement to label food sold in food service and over-the-counter sales. Patients with food allergies are familiar with and repeatedly experience accidental ingestion of packaged processed foods, eating out, and over-the-counter sales. In order to prevent accidental ingestion, it is important to thoroughly check allergy labeling and to instruct patients on precautions to take when eating out or over-the-counter sales.

Effect of oral immunotherapy in children with milk allergy: The ORIMA study

BackgroundThis study was aimed at evaluating the efficacy and safety of oral immunotherapy (OIT) in children with severe cow's milk allergy. MethodsThe subjects comprised 28 children (aged 3–12 years) with allergic symptoms that were induced by ≤ 10 mL of cow's milk in an oral food challenge test (OFC). The subjects were randomly allocated to the treatment group (n = 14) and control group (n = 14); the former received rush immunotherapy for 2 weeks, followed by a gradual increase of cow's milk volume to 100 mL for 1 year, and the latter completely eliminated cow's milk for 1 year. Both groups underwent an OFC with 100 mL of cow's milk after 1 year. ResultsThe treatment group had significantly higher rates of a negative OFC [7/14 (50%) vs. 0/14 (0%), p < 0.01] compared with the control group. The cow's milk-specific IgE level significantly decreased in the treatment group (p < 0.01) but not in the control group (p = 0.63). During the study period, adrenaline was required in 6/14 patients (43%) of the treatment group and in 0/14 patients (0%) of the control group. Long follow-up data were available at the 2-year point after the study for 8 in the treatment group and 7 (87.5%) of these continued to ingest milk (>100 mL). ConclusionsThe effect of immunotherapy was 50%, but the incidence of adverse events was not low. Further studies focusing on safety is necessary to standardize OIT for cow's milk allergy.

Two Different Composite Markers Predict Severity and Threshold Dose in Peanut Allergy

Safe and cost-effective biological surrogate markers to evaluate the severity and threshold dose of peanut allergy (PA) reactions during an oral food challenge (OFC) are lacking. To evaluate biological markers associated with the severity and threshold dose of an allergic reaction during an OFC in a population of children with PA. Demographic and biological parameters of children with peanut OFC and basophil activation test (BAT) results were collected. Patients were stratified into 2 severity groups (mild-to-moderate and severe) and 2 cumulative threshold dose groups: low (LCTG) ≤100 mg crushed peanut and high >100 mg. Among the 68 children included, there was a 96% concordance between the OFC and BAT result for the diagnosis of PA. Of the 56 children with a positive OFC and BAT to peanut (median age: 8.8 years), the severity of an allergic reaction and the cumulative threshold dose were not correlated (P= .24). Higher Ara h 2-specific IgE and FcεRI-positive control values were both associated with severe reactions to peanut. Combining these 2 markers led to a 92% sensitivity (84%-97%) and an 82% specificity (71%-89%) for severe reactions in all subjects. For children in the LCTG, a 4-variable composite marker, including age, normalized basophil sensitivity (EC50), and FcεRI- and fMLP-positive control values, resulted in a 97% sensitivity (89%-99%) and 61% specificity (49%-71%). Distinct composite markers including BAT allergen-specific and non-allergen-specific parameters appear to be associated with severity and cumulative threshold dose in children with PA.

FPIES in exclusively breastfed infants: two case reports and review of the literature

BackgroundFood Protein-Induced Enterocolitis Syndrome (FPIES) is a non IgE-mediated food allergy that generally affects children in the first year of life. Usually symptoms break out when formula milk or solid foods are introduced for the first time but they might also appear in exclusively breastfed infants, since the trigger elements, especially cow’s milk proteins, can be conveyed by maternal milk as well. FPIES in exclusively breastfed babies is a very rare clinical condition and only few cases have been reported in the medical literature.Case presentationWe describe two cases of FPIES in exclusively breastfed babies. The first one is a two-month-old infant with a brief history of vomit and diarrhea that presented to the Emergency Department in septic-like conditions. The main laboratory finding was a significant increase in methemoglobin (13%). Clinically, we noted that, when breastfeeding was suspended, diarrhea drastically improved, and vice versa when maternal milk was reintroduced. An amino acid-based formula allowed a complete normalization of the symptoms. The second one is a three-month-old infant admitted for a 3 days history of persistent vomit and diarrhea. Blood tests showed a raised level of methemoglobin (7%). An esophagogastroduodenoscopy was performed and biopsies showed an eosinophilic infiltration of the duodenal mucosa. A maternal exclusion diet and an amino acid-based formula allowed a rapid regularization of the bowel function.ConclusionsWe searched all the cases of FPIES in exclusively breastfed babies reported in the medical literature, identifying eight patients, with an average age of 3 months (range 15 days – 6 months). The majority of the cases were initially diagnosed as gastroenteritis or sepsis, five cases were characterized by an acute on chronic scenario and cow’s milk was the most frequently involved food. Methemoglobin was never tested. An oral food challenge test was performed in two patients.FPIES in exclusively breastfed infants is a rare condition that, in the presence of compatible history and symptoms, should be considered also in exclusively breastfed babies. The evaluation of methemoglobin can simplify the diagnostic process.

Efficacy, safety, and parental anxiety in a randomized trial of two dietary instruction methods for children with suspected hen's egg allergy

BackgroundLittle has been reported on how to introduce hen's egg into the diet of children with suspected egg allergy. We compared the efficacy, safety, and parental anxiety of two different dietary instruction methods to introduce egg. MethodsEligible participants were children aged 1–4 years who were positive for egg white IgE, and ovomucoid IgE <3.5 kUA/L. Participants were either naïve in egg consumption or had a history of an immediate, but non-anaphylactic, allergic reaction to egg. After a negative result of baseline 2 g boiled egg white oral food challenge (OFC), participants were randomly assigned to the step-up OFC testing (SOFT) or home incrementing group. The primary outcome was the proportion of participants who were able to ingest 20 g of boiled egg white 6 months after initiation. This study is registered with the University Hospital Medical Information Network clinical trial registry (UMIN000024192). ResultsBetween September 2016 and August 2018, we randomly allocated 55 participants to the SOFT (n = 33 [60%]) and home incrementing (n = 22 [40%]) groups and analyzed 51 patients. Four patients were excluded because they were lost to follow-up. Thirty-one (96.9%) of 32 participants in the SOFT and 12 (63.2%) of 19 in the home incrementing group achieved the primary outcome (p = 0.003). No serious adverse reactions were observed in either group. Parental anxiety significantly improved during treatment in both groups. ConclusionsThe SOFT method was more effective than home incrementing as dietary instruction to introduce egg in children with suspected egg allergy.