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Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests.
Clin Exp Allergy 2001; 31(7):1031-5CE

Abstract

BACKGROUND

Double-blind placebo-controlled food challenges (DBPCFC), the gold standard for the diagnosis of food hypersensitivity, are time-consuming and not without risk. We have recently reported skin prick test (SPT) weal diameters to cow's milk, egg and peanut above which infants and young children referred for investigation of suspected food allergy showed an adverse reaction on food challenge. We have termed these the "100% diagnostic SPT levels". In this study, we compare in vivo with in vitro measurement of IgE antibody levels to three common food allergens--cow's milk, egg and peanut--in infants and young children with suspected food allergy, in order to reduce the need for food challenges.

METHODS

SPT and Enzyme Allergo-sorbent Test (EAST) (from 1992 to 1998) and CAP values (from 1999 to 2000) were performed in 820 children < 2 years of age with suspected allergy to cow's milk and/or egg and/or peanut. SPT levels previously shown to be diagnostic of challenge-proven allergy to cow's milk, egg and peanut were used as the "100% diagnostic SPT levels" and compared with EAST and CAP values associated with IgE food allergy according to the manufacturer's definition.

RESULTS

McNemar's test showed a significant difference between the "100% diagnostic SPT levels" and positive EAST in identifying patients who did not require food challenge for cow's milk (P = 0.01), egg (P < 10-6) and peanut (P < 10-6), and a significant difference between the "100% diagnostic SPT levels" and positive CAP (P < 10-6) for egg and peanut but not cow's milk. Twenty-three per cent of food challenges which, based on the results of EAST and CAP, would have been necessary to confirm the diagnosis of food allergy were avoided by the use of the "100% diagnostic SPT levels" .

CONCLUSION

The use of the "100% diagnostic SPT levels" compared with in vitro measurement of IgE antibody to cow's milk, egg and peanut reduces the need for food challenge in young children with suspected food allergy.

Authors+Show Affiliations

Department of Allergy, Royal Children's Hospital, Flemington Road, Melbourne, Victoria 3052, Australia. allergy@cryptic.rch.unimelb.edu.au

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11467993

Citation

Hill, D J., et al. "Reducing the Need for Food Allergen Challenges in Young Children: a Comparison of in Vitro With in Vivo Tests." Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 31, no. 7, 2001, pp. 1031-5.
Hill DJ, Hosking CS, Reyes-Benito LV. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy. 2001;31(7):1031-5.
Hill, D. J., Hosking, C. S., & Reyes-Benito, L. V. (2001). Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 31(7), pp. 1031-5.
Hill DJ, Hosking CS, Reyes-Benito LV. Reducing the Need for Food Allergen Challenges in Young Children: a Comparison of in Vitro With in Vivo Tests. Clin Exp Allergy. 2001;31(7):1031-5. PubMed PMID: 11467993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. AU - Hill,D J, AU - Hosking,C S, AU - Reyes-Benito,L V, PY - 2001/7/27/pubmed PY - 2001/9/21/medline PY - 2001/7/27/entrez SP - 1031 EP - 5 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 31 IS - 7 N2 - BACKGROUND: Double-blind placebo-controlled food challenges (DBPCFC), the gold standard for the diagnosis of food hypersensitivity, are time-consuming and not without risk. We have recently reported skin prick test (SPT) weal diameters to cow's milk, egg and peanut above which infants and young children referred for investigation of suspected food allergy showed an adverse reaction on food challenge. We have termed these the "100% diagnostic SPT levels". In this study, we compare in vivo with in vitro measurement of IgE antibody levels to three common food allergens--cow's milk, egg and peanut--in infants and young children with suspected food allergy, in order to reduce the need for food challenges. METHODS: SPT and Enzyme Allergo-sorbent Test (EAST) (from 1992 to 1998) and CAP values (from 1999 to 2000) were performed in 820 children < 2 years of age with suspected allergy to cow's milk and/or egg and/or peanut. SPT levels previously shown to be diagnostic of challenge-proven allergy to cow's milk, egg and peanut were used as the "100% diagnostic SPT levels" and compared with EAST and CAP values associated with IgE food allergy according to the manufacturer's definition. RESULTS: McNemar's test showed a significant difference between the "100% diagnostic SPT levels" and positive EAST in identifying patients who did not require food challenge for cow's milk (P = 0.01), egg (P < 10-6) and peanut (P < 10-6), and a significant difference between the "100% diagnostic SPT levels" and positive CAP (P < 10-6) for egg and peanut but not cow's milk. Twenty-three per cent of food challenges which, based on the results of EAST and CAP, would have been necessary to confirm the diagnosis of food allergy were avoided by the use of the "100% diagnostic SPT levels" . CONCLUSION: The use of the "100% diagnostic SPT levels" compared with in vitro measurement of IgE antibody to cow's milk, egg and peanut reduces the need for food challenge in young children with suspected food allergy. SN - 0954-7894 UR - https://www.unboundmedicine.com/medline/citation/11467993/Reducing_the_need_for_food_allergen_challenges_in_young_children:_a_comparison_of_in_vitro_with_in_vivo_tests_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0954-7894&amp;date=2001&amp;volume=31&amp;issue=7&amp;spage=1031 DB - PRIME DP - Unbound Medicine ER -