Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy - 01/08/14
, Alena Beder a, John Beschorner, MD a, Frank Ahrens, MD b, Armin Gruebl, MD c, Eckard Hamelmann, MD d, Gesine Hansen, MD e, Andrea Heinzmann, MD f, Katja Nemat, MD g, Bodo Niggemann, MD a, Ulrich Wahn, MD a, Kirsten Beyer, MD aAbstract |
Background |
Threshold levels for peanut allergy determined by using oral challenges are important for the food industry with regard to allergen labeling. Moreover, the utility of biological markers in predicting threshold levels is uncertain.
Objective |
We sought to use a modified oral food challenge regimen that might determine threshold levels for peanut allergy mimicking a more real-life exposure and to correlate the eliciting dose (ED) and severity of clinical reaction in children with peanut allergy with B-cell, T-cell, and effector cell markers.
Methods |
A modified food challenge procedure with doses scheduled 2 hours apart was used in 63 children with peanut allergy. All children received a maximum of 8 semi-log increasing titration steps of roasted peanuts ranging from 3 to 4500 mg of peanut protein until objective allergic reactions occurred. Severity of symptoms was graded from I to V. Biological markers were measured before challenge.
Results |
Forty-five of 63 patients showed objective symptoms after greater than 30 minutes, with a median latency of clinical reaction of 55 minutes. By using a log-normal dose-distribution model, the ED5 was calculated to be 1.95 mg of peanut protein. The ED was significantly and inversely correlated with peanut- and Ara h 2–specific IgE levels, skin prick test responses, basophil activation, and TH2 cytokine production by PBMCs. Symptom severity did not correlate with any of the markers or the ED.
Conclusion |
This modified food challenge procedure might better reflect threshold levels for peanut allergy than the standard procedure because most of the patients reacted at a time interval of greater than 30 minutes. By using this model, threshold levels, but not severity, could be correlated with biological markers.
Le texte complet de cet article est disponible en PDF.Key words : Basophil activation, Ara h 2, children, cytokines, peanut allergy, food challenge
Abbreviations used : BA, CDmax, CD-sens, DBPCFC, ED, fMLP, OIT, SPT
Plan
| Supported in part by a grant from Charité (Rahel Hirsch grant), the Foundation for the Treatment of Peanut Allergic Patients (bea Stiftung), and the Berlin Sparkassen Foundation for Medicine. |
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| Disclosure of potential conflict of interest: K. Blumchen has received grants from the Foundation for the Treatment of Peanut Allergic Patients (bea Stiftung), the Berlin Sparkassen Foundation for Medicine, and the Nutricia Research Foundation (2012-15); is employed by Charité, Department of Pediatric Immunology and Pneumology; has received payment for lectures from Novartis Pharma, GmbH, Meda Pharma, the Society to Promote Dermatologic Research and Education, and the Society for Education of Chronically Ill Patients. E. Hamelmann is a board member for the National Allergy Society Germany (DGAKI): General Secretary of DGAKI, chair of the Pediatric Section; has consultant arrangements with Boehringer Ingelheim, ALK-Abelló, Novartis, and Bencard; has provided expert testimony on behalf of GLG for respirator medicine and allergology; and has received payment for lectures from ALK-Abelló, and Novartis. G. Hansen has received research support from Deutsche Forschungsgemeinschaft (HA 2799/3-3) and Bundesministerium fur Bildung und Forschung (82DZL00201). K. Nemat has received payment for lectures from Thermo Fisher Scientific, Nutricia GmbH, Novartis Pharma AG, HAL Allergy Group, and Bencard Allergie GmbH. K. Beyer has received research support from the Foundation for the Treatment of Peanut Allergic Patients (bea Stiftung), the Berlin Sparkassen Foundation for Medicine, Charité, Deutsche Forschungsgemeinschaft, European Union, Danone, Thermo Fisher, DST Diagnostic Systems, Food Allergy and Anaphylaxis Network, and Pina e. V.; has received consultancy fees from Danone, Novartis, ALK-Abelló, Meda Pharma, and Unilever; and has received lecture fees from Danone, Infectopharma, CSL, Behring, Novartis, UCB, Meda Pharma, Med Update, Allergopharma, and Thermo Fisher. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 134 - N° 2
P. 390 - août 2014 Retour au numéro
Article précédent
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