Original Article
Food Challenge and Community-Reported Reaction Profiles in Food-Allergic Children Aged 1 and 4 Years: A Population-Based Study

https://doi.org/10.1016/j.jaip.2016.12.021Get rights and content

Background

Oral food challenge is the main tool for diagnosing food allergy, but there is little data on the reaction profiles of young children undergoing challenges, nor how these reactions compare to reactions on accidental ingestion in the community.

Objectives

To compare reaction profiles from food challenges and parent-reported reactions on accidental ingestion, and assess predictors of severe reactions.

Methods

HealthNuts is a longitudinal population-based cohort study of 5276 1-year-old infants. Infants underwent skin prick tests and those with identifiable wheals were offered food challenges. Food challenges were repeated at age 4 years in those with previous food allergy or reporting new food allergies. Community-reported reactions were ascertained from parent questionnaires.

Results

Food challenges were undertaken in 916 children at age 1 year and 357 children at age 4 years (a total of 2047 peanut, egg, or sesame challenges). Urticaria was the most common sign in positive challenges at both ages (age 1 year, 88.7%, and age 4 years, 71.2%) although angioedema was significantly more common at age 4 years (40.1%) than at age 1 year (12.9%). Anaphylaxis was equally uncommon at both ages (2.1% and 2.8% of positive challenges at ages 1 and 4 years, respectively) but more common for peanut than for egg (4.5% and 1.2% of positive challenges at ages 1 and 4 years, respectively). The patterns of presenting signs reported during community reactions were similar to those observed in formal food challenges. Serum food-specific IgE levels of 15 kU/L or more were associated with moderate to severe reactions but skin prick test was not.

Conclusions

There was a shift from the most common presenting reaction of urticaria during food challenges toward more angioedema in older children. Serum food-specific IgE levels were associated with reaction severity.

Section snippets

Recruitment

The HealthNuts study is a longitudinal population-based cohort study of childhood food allergy in Melbourne, Australia. The recruitment methods have been described in previous publications.15, 16 A total of 5276 (out of 7134 approached, 74% participation rate) 12-month-old infants were recruited at council-run immunization sessions, and had SPTs performed to 4 common food allergens, including peanut, egg, and sesame. All children with a detectable wheal size of greater than 1 mm were invited to

Participation and demographic characteristics of the sample

Participation in the HealthNuts study has been described in detail previously. Figure 1 describes participation in food challenges at age 1 year, and subsequent follow-up at age 4 years for food-allergic and nonallergic children. Among 5276 children from the full cohort, 1093 (20.7%) fulfilled the criteria for having a food challenge performed at age 1 year, of which 916 (83.8%) participated. Infants who participated in food challenges were more likely to have a higher socioeconomic status,

Discussion

This is the first study to investigate the reaction profiles of children undergoing food challenges in a longitudinal population-based cohort, and compare the reactions observed at different time points for the same cohort of children. Our findings have identified differences between the types of signs presented during food challenges between age 1 and 4 years. Although urticaria remained the most common type of reaction observed as the end point in food challenges, the proportion of children

Acknowledgments

We thank the children and parents who participated in the HealthNuts study as well as the staff of Melbourne's Local Government Areas for providing access to community immunization clinics. We thank ALK-Abello SA, Madrid, Spain, for supplying the skin prick testing reagents; and the HealthNuts Safety Committee comprising Associate Professor Noel Cranswick (Australian Paediatric Pharmacology Research Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia), Dr Jo Smart

References (33)

  • T.T. Perry et al.

    Risk of oral food challenges

    J Allergy Clin Immunol

    (2004)
  • J.M. Spergel et al.

    Correlation of initial food reactions to observed reactions on challenges

    Ann Allergy Asthma Immunol

    (2004)
  • J.W. Yu et al.

    Accidental ingestions in children with peanut allergy

    J Allergy Clin Immunol

    (2006)
  • M. Ben-Shoshan et al.

    Food allergy: temporal trends and determinants

    Curr Allergy Asthma Rep

    (2012)
  • J.A. Boyce et al.

    Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel

    J Allergy Clin Immunol

    (2010)
  • S.H. Sicherer et al.

    Allergy testing in childhood: using allergen-specific IgE tests

    Pediatrics

    (2012)
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    This work was supported by funding from the National Health & Medical Research Council (NHMRC) of Australia, Ilhan Food Allergy Foundation, AnaphylaxiStop, the Charles and Sylvia Viertel Medical Research Foundation, the Victorian Government's Operational Infrastructure Support Program, and the NHMRC Centre for Food and Allergy Research. J.C.K.C. is a recipient of the Hong Kong Innovation and Technology Scholarship.

    Conflicts of interest: M Wake has receives research support from the National Health & Medical Research Council (NHMRC Project Grant 491233); has received consultancy fees from the Australian Dept of Social Services; is employed by the National Health & Medical Research Council; and has received travel support from Sandoz. M Tang is a member of the Nestle Nutrition Institute medical advisory board Oceania; is a past member of the Danone Nutricia Global Scientific advisory board; has received consultancy fees from GLG Consulting and Deerfield; has received lecture fees from Danone Nutricia; has a patent owned by Murdoch Childrens Research Institute; receives royalties from Wiley; and has received payment for development of educational presentations from MD Linx. S Prescott is on the Danone and Nestle Nutrition Institute advisory boars; has received consultancy fees from Bayer Pharmaceuticals; has received lecture fees and travel support from ALK Abello; and receives royalties from UpToDate. K Allen has received speaker honorarium from Nestle, ThermoFisher, Aspencare, and Nutricia. The rest of the authors declare that they have no relevant conflicts of interest.

    Denotes co-first authors.

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