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Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community?
Clin Exp Allergy. 2005 Sep; 35(9):1227-33.CE

Abstract

BACKGROUND

The severity of allergic reactions to food appears to be affected by many interacting factors. It is uncertain whether challenge-based reactions reflect the severity of past reactions or can predict future risk.

OBJECTIVE

To explore the relationship of a subject's clinical history of past reactions to the severity of reaction elicited by a low-dose, double-blind, placebo-controlled food challenge (DBPCFC) with peanut.

METHOD

Cross-sectional questionnaire assessment of community-based allergic reactions and low-dose DBPCFC in self-selected peanut-allergic subjects. Reaction severity was assessed using a novel scoring system, taking account of the dose of allergen ingested.

RESULTS

Forty subjects (15 males, 23 children, 23 asthmatics by history) were studied. Only the most recent community reaction predicted the severity of reaction in the DBPCFC, but even this association was weak (r=0.37, P=0.03). Peanut-specific IgE (PsIgE) and skin prick test (SPT) weal size were not associated with community score but PsIgE level correlated well with the challenge score (r=0.6, P=0.001). Asthma did not affect the eliciting dose or challenge score directly but the association of PsIgE and challenge score was stronger in those without asthma (r=0.72, P=0.001) than in those with asthma (r=0.48, P=0.02).

CONCLUSIONS

The scoring system developed appears to improve the sensitivity of assessment of reactions induced by DBPCFC. This is the first prospective study showing an association between PsIgE levels and clinical reactivity in DBPCFC, an effect that is more pronounced in non-asthmatics. This finding has important implications for the clinical care of subjects with food allergy. There is a poor correlation between the severity of reported reactions in the community and the severity of reaction elicited during low-dose DBPCFC with peanut.

Authors+Show Affiliations

Allergy & Inflammation Research (Child Health), University of Southampton, Southampton, UK. J.Hourihane@ucc.ieNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16164452

Citation

Hourihane, J O'B, et al. "Does Severity of Low-dose, Double-blind, Placebo-controlled Food Challenges Reflect Severity of Allergic Reactions to Peanut in the Community?" Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 35, no. 9, 2005, pp. 1227-33.
Hourihane JO, Grimshaw KE, Lewis SA, et al. Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community? Clin Exp Allergy. 2005;35(9):1227-33.
Hourihane, J. O., Grimshaw, K. E., Lewis, S. A., Briggs, R. A., Trewin, J. B., King, R. M., Kilburn, S. A., & Warner, J. O. (2005). Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community? Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 35(9), 1227-33.
Hourihane JO, et al. Does Severity of Low-dose, Double-blind, Placebo-controlled Food Challenges Reflect Severity of Allergic Reactions to Peanut in the Community. Clin Exp Allergy. 2005;35(9):1227-33. PubMed PMID: 16164452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community? AU - Hourihane,J O'B, AU - Grimshaw,K E C, AU - Lewis,S A, AU - Briggs,R A, AU - Trewin,J B, AU - King,R M, AU - Kilburn,S A, AU - Warner,J O, PY - 2005/9/17/pubmed PY - 2006/1/18/medline PY - 2005/9/17/entrez SP - 1227 EP - 33 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 35 IS - 9 N2 - BACKGROUND: The severity of allergic reactions to food appears to be affected by many interacting factors. It is uncertain whether challenge-based reactions reflect the severity of past reactions or can predict future risk. OBJECTIVE: To explore the relationship of a subject's clinical history of past reactions to the severity of reaction elicited by a low-dose, double-blind, placebo-controlled food challenge (DBPCFC) with peanut. METHOD: Cross-sectional questionnaire assessment of community-based allergic reactions and low-dose DBPCFC in self-selected peanut-allergic subjects. Reaction severity was assessed using a novel scoring system, taking account of the dose of allergen ingested. RESULTS: Forty subjects (15 males, 23 children, 23 asthmatics by history) were studied. Only the most recent community reaction predicted the severity of reaction in the DBPCFC, but even this association was weak (r=0.37, P=0.03). Peanut-specific IgE (PsIgE) and skin prick test (SPT) weal size were not associated with community score but PsIgE level correlated well with the challenge score (r=0.6, P=0.001). Asthma did not affect the eliciting dose or challenge score directly but the association of PsIgE and challenge score was stronger in those without asthma (r=0.72, P=0.001) than in those with asthma (r=0.48, P=0.02). CONCLUSIONS: The scoring system developed appears to improve the sensitivity of assessment of reactions induced by DBPCFC. This is the first prospective study showing an association between PsIgE levels and clinical reactivity in DBPCFC, an effect that is more pronounced in non-asthmatics. This finding has important implications for the clinical care of subjects with food allergy. There is a poor correlation between the severity of reported reactions in the community and the severity of reaction elicited during low-dose DBPCFC with peanut. SN - 0954-7894 UR - https://www.unboundmedicine.com/medline/citation/16164452/Does_severity_of_low_dose_double_blind_placebo_controlled_food_challenges_reflect_severity_of_allergic_reactions_to_peanut_in_the_community L2 - https://doi.org/10.1111/j.1365-2222.2005.02312.x DB - PRIME DP - Unbound Medicine ER -