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Maris I, Dölle‐Bierke S, Renaudin J, Lange L, Koehli A, Spindler T, Hourihane J, Scherer K, Nemat K, Kemen C, Neustädter I, Vogelberg C, Reese T, Yildiz I, Szepfalusi Z, Ott H, Straube H, Papadopoulos NG, Hämmerling S, Staden U, Polz M, Mustakov T, Cichocka‐Jarosz E, Cocco R, Fiocchi AG, Fernandez‐Rivas M, Worm M, Grünhagen J, Wittenberg M, Beyer K, Henschel A, Küper S, Möser A, Fuchs T, Ruëff F, Wedi B, Hansen G, Buck T, Büsselberg J, Drägerdt R, Pfeffer L, Dickel H, Körner‐Rettberg C, Merk H, Lehmann S, Bauer A, Nordwig A, Zeil S, Hannapp C, Wagner N, Rietschel E, Hunzelmann N, Huseynow I, Treudler R, Aurich S, Prenzel F, Klimek L, Pfaar O, Reider N, Aberer W, Varga E, Bogatu B, Schmid‐Grendelmeier P, Guggenheim R, Riffelmann F, Kreft B, Kinaciyan K, Hartl L, Ebner C, Horak F, Brehler R, Witte J, Buss M, Hompes S, Bieber T, Gernert S, Bücheler M, Rabe U, Brosi W, Nestoris S, Hawranek T, Lang R, Bruns R, Pföhler C, Eng P, Schweitzer‐Krantz S, Meller S, Rebmann H, Fischer J, Stichtenoth G, Thies S, Gerstlauer M, Utz P, Neustädter I, Klinge J, Volkmuth S, Plank‐Habibi S, Schilling B, Kleinheinz A, Brückner A, Schäkel K, Manolaraki I, Kowalski M, Solarewicz‐Madajek K, Tscheiller S, Seidenberg J, Cardona V, Garcia B, Bilo M, Cabañes Higuero N, Vega Castro A, Poziomkowska‐Gęsicka I, Büsing S, Virchow C, Christoff G, Jappe U, Müller S, Knöpfel F, Correard A, Rogala B, Montoro A, Brandes A, Muraro A, Zimmermann N, Hernandez D, Minale P, Niederwimmer J, Zahel B, Dahdah L, Arasi S, Reissig A, Eitelberger F, Asero R, Hermann F, Zeidler S, Pistauer S, Geißler M, Ensina L, Plaza Martin A, Meister J, Stieglitz S, Hamelmann E. Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry. Allergy 2021; 76:1517-1527. [PMID: 33274436 DOI: 10.1111/all.14683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. METHODS Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. RESULTS 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). CONCLUSIONS The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.
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Affiliation(s)
- Ioana Maris
- Bon Secours Hospital Cork/Paediatrics and Child HealthUniversity College Cork Cork Ireland
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Lars Lange
- Department of Paediatrics St. Marien‐Hospital Bonn Germany
| | - Alice Koehli
- Division of Allergology University Children’s Hospital Zurich Zürich Switzerland
| | - Thomas Spindler
- Department of Paediatrics Medical Campus Hochgebirgsklinik Davos Davos Switzerland
| | - Jonathan Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Children’s Health Ireland Dublin Ireland
| | | | - Katja Nemat
- Practice for paediatric pneumology and allergology Kinderzentrum Dresden‐Friedrichstadt Dresden Germany
| | - C. Kemen
- Department of Paediatrics Children’s Hospital WILHELMSTIFT Hamburg Germany
| | - Irena Neustädter
- Department of Paediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | - Christian Vogelberg
- Department of Paediatrics Universitätsklinikum Carl Gustav CarusTechnical University Dresden Germany
| | - Thomas Reese
- Department of Paediatrics Mathias‐Spital Rheine Rheine Germany
| | - Ismail Yildiz
- Department of Paediatrics Friedrich‐Ebert‐Krankenhaus Neumuenster Germany
| | - Zsolt Szepfalusi
- Division of Paediatric Pulmonology, Allergology and Endocrinology Department of Paediatrics and Adolescent Medicine Competence Center Paediatrics Medical University of Vienna Vienna Austria
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology Epidermolysis bullosa‐Centre HannoverChildren’s Hospital AUF DER BULT Hanover Germany
| | - Helen Straube
- Division of Allergology Darmstädter Kinderkliniken Prinzessin Margaret Darmstadt Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection Immunity& Respiratory Medicine University of Manchester Manchester UK
| | - Susanne Hämmerling
- Division of Paediatric Pulmonology and Allergology University Children`s Hospital Heidelberg Heidelberg Germany
| | - Ute Staden
- Paediatric Pneumology & Allergology Medical practice Klettke/Staden Berlin Germany
| | - Michael Polz
- Department of Paediatrics GPR Klinikum Rüsselsheim Germany
| | - Tihomir Mustakov
- Chair of Allergy University Hospital Alexandrovska Sofia Bulgaria
| | - Ewa Cichocka‐Jarosz
- Department of Paediatrics Jagiellonian University Medical College Krakow Poland
| | - Renata Cocco
- Division of Allergy Clinical Immunology and Rheumatology Department of Paediatrics Federal University of São Paulo São Paulo Brazil
| | | | | | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Blumchen K, Ulbricht H, Staden U, Dobberstein K, Beschorner J, de Oliveira LCL, Shreffler WG, Sampson HA, Niggemann B, Wahn U, Beyer K. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol 2010; 126:83-91.e1. [PMID: 20542324 DOI: 10.1016/j.jaci.2010.04.030] [Citation(s) in RCA: 277] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The only treatment option for peanut allergy is strict avoidance. OBJECTIVE To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy. METHODS Twenty-three children (age, 3.2-14.3 years) with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenge (DBPCFC) received OIT following a rush protocol with roasted peanut for 7 days. If a protective dose of at least 0.5 g peanut was not achieved, patients continued with a long-term buildup protocol using biweekly dose increases up to at least 0.5 g peanut. A maintenance phase for 8 weeks was followed by 2 weeks of peanut avoidance and a final DBPCFC. Immunologic parameters were determined. RESULTS After OIT using the rush protocol, patients tolerated a median dose of only 0.15 g peanut. Twenty-two of 23 patients continued with the long-term protocol. After a median of 7 months, 14 patients reached the protective dose. At the final DBPCFC, patients tolerated a median of 1 g (range, 0.25-4 g) in comparison with 0.19 g peanut at the DBPCFC before OIT (range, 0.02-1 g). In 2.6% of 6137 total daily doses, mild to moderate side effects were observed; in 1.3%, symptoms of pulmonary obstruction were detected. OIT was discontinued in 4 of 22 patients because of adverse events. There was a significant increase in peanut-specific serum IgG(4) and a decrease in peanut-specific IL-5, IL-4, and IL-2 production by PBMCs after OIT. CONCLUSION Long-term OIT appears to be safe and of some benefit in many patients with peanut allergy. With an increase in threshold levels and a reduction of peanut-specific T(H)2 cytokine production, the induction of tolerance may be feasible in some patients.
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Affiliation(s)
- Katharina Blumchen
- Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
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Blumchen K, Ulbricht H, Staden U, Dobberstein K, Niggemann B, Wahn U, Beyer K. Oral Immunotherapy In patients With Peanut Allergy And High Risk Of Anaphylactic Reactions. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Staden U, Blumchen K, Blankenstein N, Dannenberg N, Ulbricht H, Dobberstein K, Ziegert M, Niggemann B, Wahn U, Beyer K. Rush oral immunotherapy in children with persistent cow's milk allergy. J Allergy Clin Immunol 2008; 122:418-9. [PMID: 18602681 DOI: 10.1016/j.jaci.2008.06.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 05/31/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
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Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 2007; 62:1261-9. [PMID: 17919140 DOI: 10.1111/j.1398-9995.2007.01501.x] [Citation(s) in RCA: 292] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specific oral tolerance induction (SOTI) seems to be a promising treatment of food allergy. Specific oral tolerance induction and elimination diet were compared with respect to efficacy rate and patterns of clinical reaction. METHODS Children with challenge proven immunoglobulin E (IgE)-mediated cow's milk (CM) allergy or hen's egg (HE) allergy were randomly assigned to SOTI or elimination diet as a control group. Specific oral tolerance induction treatment was performed at home on a daily basis according to a study protocol with fresh CM or lyophilized HE protein. Re-evaluation of clinically relevant food allergy was performed by food challenge after a median of 21 months. Children in the SOTI group received a secondary elimination diet for 2 months prior to follow-up challenge to evaluate persistence of induced oral tolerance. RESULTS At follow-up challenge, nine of 25 children (36%) showed permanent tolerance in the SOTI group, three of 25 (12%) were tolerant with regular intake and four of 25 (16%) were partial responders. In the control group, seven of 20 children (35%) were tolerant. Allergen-specific immunoglobulin E decreased significantly both in children who developed natural tolerance during the elimination diet (P < 0.05) and in those with SOTI (P < 0.001). CONCLUSIONS Specific oral tolerance induction seems a valid treatment option for patients with persistent food allergy. Indications may be given if avoidance cannot be guaranteed or for those who are eager to eat the food in question. Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion of the allergen. However, careful monitoring during SOTI is mandatory.
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Affiliation(s)
- U Staden
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
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Mehl A, Rolinck-Werninghaus C, Staden U, Verstege A, Wahn U, Beyer K, Niggemann B. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol 2006; 118:923-9. [PMID: 17030247 DOI: 10.1016/j.jaci.2006.07.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 07/04/2006] [Accepted: 07/05/2006] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is an increasing need to develop test instruments that make oral food challenges superfluous. OBJECTIVE We sought to study the utility of atopy patch tests (APTs) in the diagnostic workup of food allergy. METHODS We investigated 437 children (median age, 13 months; 90% with atopic dermatitis) referred for evaluation of suspected food allergy. Specific serum IgE (sIgE) measurements, skin prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS We analyzed 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. Correctly bypassing an oral food challenge with combined testing, including APTs, only between 0.5% and 7% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSION Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14% of study patients. In addition, the APT is time consuming and demands a highly experienced test evaluator. CLINICAL IMPLICATIONS For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in our study population.
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Affiliation(s)
- Anne Mehl
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
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Abstract
Specific oral tolerance in food allergy can be induced by oral administration of the offending food, starting with very low dosages, gradually increasing the daily dosage up to an amount equivalent to a usually relevant dose for daily intake, followed up by a daily maintenance dose. Unfortunately, the body of scientific evidence concerning specific oral tolerance induction (SOTI) is still rather poor. Following a couple of case reports, only a few studies on a limited number of patients including different allergens are available. So far, no placebo-controlled, long-term study has been published. Concerning the underlying immunological mechanism, a limited number of studies have reported on changes in antibody production, and more recently on the role of different T-cell populations. The individual pattern of clinical reaction during SOTI seems to vary considerably between patients and from allergen to allergen. Arguments in favour of SOTI are the safety for an inadvertent intake of the offending food and the increased quality of life. Arguments against SOTI are the necessity for a regular intake and possible long-term compliance problems. Indications to consider SOTI in the future might be (i) importance of the incriminated food for the individual nutritional regimen, (ii) avoidance of the corresponding food cannot be assured and (iii) persistent severe food allergy. However, before SOTI can be recommended for the daily praxis, more studies are warranted to clarify whether certain patients may profit from SOTI and to understand the underlying mechanism.
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Affiliation(s)
- B Niggemann
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
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Heine RG, Verstege A, Mehl A, Staden U, Rolinck-Werninghaus C, Niggemann B. Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Immunol 2006; 17:213-7. [PMID: 16672009 DOI: 10.1111/j.1399-3038.2005.00368.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The interpretation of the atopy patch test (APT) to foods is not standardized. This study aimed to validate the reading of the APT in terms of the diagnostic accuracy of individual skin signs. Eighty-seven children (mean age 2.4 +/- 2.5 yr, range 0.5-13.5; 57 male) with atopic dermatitis (AD) and suspected food allergies underwent APT to cow's milk, hen's egg, wheat and soy. Twelve-millimetre Finn chambers were applied for 48 h, and results were read after 48 and 72 h. Skin changes were graded for erythema, induration, papule formation and 'crescendo' phenomenon (increase of skin sign severity from 48 to 72 h). Food allergy was assessed by double blind, placebo-controlled food challenges (DBPCFC). Sensitivity, specificity and predictive values were calculated for each skin signs in relation to challenge outcome. Of 165 DBPCFC children, 75 (45%) were positive. The combination of any skin induration plus papules (seven or more), or of moderate erythema plus any induration plus seven or more papules had a positive predictive value (PPV) and specificity for the challenge outcome of 100%; however, the sensitivity was low (8% and 15%). The best diagnostic accuracy for single signs was found for induration beyond the Finn chamber margin (PPV 88%, specificity 99%, sensitivity 9%) and presence of at least seven papules (PPV 80%, specificity 96% sensitivity 21%). Presence of both induration and of at least seven papules at 72 h were the APT skin signs with the greatest diagnostic accuracy for food allergy in children with AD.
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Affiliation(s)
- Ralf G Heine
- Department of Pediatric Pneumology and Immunology, Children's Hospital Charité, Humboldt University, Berlin, Germany
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Rolinck-Werninghaus C, Staden U, Mehl A, Hamelmann E, Beyer K, Niggemann B. Specific oral tolerance induction with food in children: transient or persistent effect on food allergy? Allergy 2005; 60:1320-2. [PMID: 16135001 DOI: 10.1111/j.1398-9995.2005.00882.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The standard treatment of food allergy is elimination of the incriminated food from the diet. Specific oral tolerance induction (SOTI) seems to be a promising approach for a causal treatment; however, it is unclear whether the tolerance achieved is transient or persistent. We report on a subset of three patients of a larger ongoing study who were treated successfully with SOTI treatment, but experienced a secondary loss of tolerance after a period of allergen avoidance. METHODS The patients suffered from IgE-mediated allergy either to cow's milk (CM) (patient A) or hen's egg (HE) (patients B and C), confirmed by double-blind, placebo-controlled food challenge (DBPCFC). SOTI treatment was performed at home on a daily basis until tolerance to a maximum of 250 ml CM or 4.5 g lyophilized HE protein was achieved. The daily maintenance dose was 100 ml CM or 2.5 g HE protein. RESULTS Patients A, B and C reached tolerance to the maximum dose after 37, 41 and 52 weeks, respectively. According to the protocol, patients A and B performed a strict secondary elimination diet for 2 months prior to a follow-up DBPCFC after a maintenance phase of 27 and 39 weeks, respectively. Patient C discontinued treatment for 2 days after 4 weeks on the maintenance dose. Despite previous tolerance, on re-exposure to the allergen all patients experienced moderate systemic allergic reactions. CONCLUSIONS We conclude that SOTI can induce transient tolerance in food allergy, but does not necessarily lead to its permanent abrogation. Regular allergen intake seems necessary to maintain the established tolerance.
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Affiliation(s)
- C Rolinck-Werninghaus
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
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Verstege A, Mehl A, Rolinck-Werninghaus C, Staden U, Nocon M, Beyer K, Niggemann B. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy 2005; 35:1220-6. [PMID: 16164451 DOI: 10.1111/j.1365-2222.2005.2324.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The skin prick test (SPT) is regarded as an important diagnostic measure in the diagnostic work-up of food allergy. Objective To evaluate the diagnostic capacity of the SPT in predicting the outcome of oral food challenges, and to determine decision points for the weal size and the skin index (SI) that could render double-blind, placebo-controlled food challenges unnecessary. METHODS In 385 children (median age 22 months), 735 controlled oral challenges were performed with cow's milk (CM), hen's egg (HE), wheat and soy. Three hundred and thirty-six of 385 (87%) children suffered from atopic dermatitis. SPT was performed in all children. Diagnostic capacity, receiver-operator characteristics (ROC) curves and predictive decision points were calculated for the mean weal size and the calculated SI. RESULTS Three hundred and twelve of 735 (43%) oral food challenges were assessed to be positive. Calculation of 95% and 99% predicted probabilities using logistic regression revealed predictive decision points of 13.0 and 17.8 mm for HE, and 12.5 and 17.3 mm for CM, respectively. However, using the SI, the corresponding cut-off levels were 2.6 and 3.7, respectively, for HE, and 2.7 and 3.7 for CM. For wheat, 95% and 99% decision points of 2.2 and 3.0 were found in children below 1 year of age. CONCLUSION Predictive decision points for a positive outcome of food challenges can be calculated for HE and CM using weal size and SI. They may help to avoid oral food challenges.
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Affiliation(s)
- A Verstege
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany
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Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, Niggemann B. Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy 2005; 60:1034-9. [PMID: 15969684 DOI: 10.1111/j.1398-9995.2005.00806.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Double-blind, placebo-controlled food challenges are time-consuming, expensive and not without risk to patients. Therefore, an in vitro test that could accurately diagnose food allergy would be of great value. OBJECTIVE To evaluate the utility of the ratio of specific immunoglobulin E (IgE)/total IgE compared with specific IgE (sIgE) alone in predicting symptomatic food allergy. METHODS We retrospectively analysed 992 controlled oral food challenges performed in 501 children (median age 13 months). The ratio of sIgE/total IgE was calculated and tested for correlation with the outcome of food challenges. Receiver operator characteristics (ROC)-curves were performed; predicted probabilities and predictive decision points were calculated. RESULTS A significant correlation was found between the ratio and the outcome of food challenges for cow's milk (CM), hen's egg (HE), and wheat, but not for soy. The ROC and predicted probability curves as well as sensitivity and specificity of the decision points of the ratio were similar to those of sIgE levels for CM, HE and wheat. CONCLUSION In view of the greater effort needed to determine the ratio, without benefit compared with the sIgE alone, the calculation of the ratio of sIgE/total IgE for diagnosing symptomatic food allergy offers no advantage for CM, HE, wheat or soy. For the majority of cases controlled oral food challenges still remain the method of choice.
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Affiliation(s)
- A Mehl
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
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Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, Niggemann B. Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy 2005. [PMID: 15969684 DOI: 10.1111/j.1398‐9995.2005.00806.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Double-blind, placebo-controlled food challenges are time-consuming, expensive and not without risk to patients. Therefore, an in vitro test that could accurately diagnose food allergy would be of great value. OBJECTIVE To evaluate the utility of the ratio of specific immunoglobulin E (IgE)/total IgE compared with specific IgE (sIgE) alone in predicting symptomatic food allergy. METHODS We retrospectively analysed 992 controlled oral food challenges performed in 501 children (median age 13 months). The ratio of sIgE/total IgE was calculated and tested for correlation with the outcome of food challenges. Receiver operator characteristics (ROC)-curves were performed; predicted probabilities and predictive decision points were calculated. RESULTS A significant correlation was found between the ratio and the outcome of food challenges for cow's milk (CM), hen's egg (HE), and wheat, but not for soy. The ROC and predicted probability curves as well as sensitivity and specificity of the decision points of the ratio were similar to those of sIgE levels for CM, HE and wheat. CONCLUSION In view of the greater effort needed to determine the ratio, without benefit compared with the sIgE alone, the calculation of the ratio of sIgE/total IgE for diagnosing symptomatic food allergy offers no advantage for CM, HE, wheat or soy. For the majority of cases controlled oral food challenges still remain the method of choice.
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Affiliation(s)
- A Mehl
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
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Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, Niggemann B. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005; 35:268-73. [PMID: 15784102 DOI: 10.1111/j.1365-2222.2005.02150.x] [Citation(s) in RCA: 271] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Specific serum IgE is considered as one of the important diagnostic measures in the diagnostic work-up of food allergy. OBJECTIVE To evaluate the role of specific serum IgE in predicting the outcome of oral food challenges, and to determine threshold concentrations of specific serum IgE that could render double-blind, placebo-controlled food challenges unnecessary. METHODS In 501 children (median age 13 months), 992 controlled oral challenges were performed with cow's milk (CM), hen's egg (HE), wheat and soy. 440/501 (88%) children suffered from atopic dermatitis. For all children, specific IgE concentrations in serum were determined. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics-curves as well as predictive decision points were calculated. RESULTS Four hundred and forty-five out of 992 oral food challenges with allergens were assessed as positive. Sensitivity of specific serum IgE was 97% for HE, 83% for CM, 69% for soy, and 79% for wheat. Specificity was 51% for HE, 53% for CM, 50% for soy, and 38% for wheat. Calculating 90%, 95% and 99% predicted probabilities using logistic regression revealed predictive decision points of 6.3, 12.6, and 59.2 kU/L for HE, respectively. Subdividing our children in those of below or above 1 year of age resulted in a markedly different predicted probability for HE. For CM, only the 90% predicted probability (88.8 kU/L) could be calculated. No decision points could be determined for CM, wheat and soy. CONCLUSION In general, specific serum IgE levels showed a correlation with the outcome of positive oral food challenges for CM and HE. Meaningful predictive decision points can be calculated for HE, which may help to avoid oral food challenges in some cases. However, data need to be ascertained for each allergen separately. Furthermore, the age of the patient population under investigation must also be taken into account.
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Affiliation(s)
- S Celik-Bilgili
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, DE-13353 Berlin, Germany
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Heine R, Verstege A, Mehl A, Staden U, Rolinck-Werninghaus C, Niggemann B. Standardizing the interpretation of atopy patch testing to food in children. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- K Perackis
- Department of Pediatric Pneumology and Immunology, Children's Hospital Charité, Humboldt University, Augustenburger Platz 1 D 13353, Berlin, Germany
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Affiliation(s)
- Ute Staden
- Department of Pediatric Pneumology and Immunology, Charite Virchow Hospital, Humboldt University, Berlin, Germany.
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Perackis K, Celik-Bilgili S, Staden U, Mehl A, Niggemann B. Influence of age on the outcome of the atopy patch test with food in children with atopic dermatitis. J Allergy Clin Immunol 2003; 112:625-7. [PMID: 13679826 DOI: 10.1016/s0091-6749(03)01627-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Rolandic epilepsy is regarded as the classic example of benign focal epilepsy. However, neuropsychological deficits have been noted in affected children. As Rolandic discharges are mainly distributed over the centrotemporal region, specific interference with language function might be suspected. Therefore, we conducted a standardized neuropsychological assessment in children with Rolandic epilepsy which covered all important aspects of language processing. We measured intelligence Quotient, verbal memory, auditory discrimination, vocabulary, grammar and literacy in 20 children with an active Rolandic focus. Information about performance at school was obtained from teachers by means of a questionnaire. Patients with Rolandic epilepsy failed five of the twelve standardized language tests significantly more often than the normative population and consequently showed impairment of the following functions: reading, spelling, auditory verbal learning, auditory discrimination with background noise and expressive grammar. Thirteen of the 20 children showed language dysfunction with difficulties in two or more of the twelve standardized language tests. In eight of these 13 children the Full Scale Intelligence Quotient was within average range, indicating a specific language deficit. Language dysfunction was closely associated with learning difficulties at school. This study documents a consistent pattern of language dysfunction in children with Rolandic epilepsy which suggests interictal dysfunction of perisylvian language areas.
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Affiliation(s)
- U Staden
- Great Ormond Street Hospital for Children, London, UK
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