Published in issue: March-April, 2017
Oral food challenges are the main tool for diagnosing food allergy and they can result in severe allergic reactions. However, there are little published data reporting the reaction profiles of young children undergoing challenges or whether the reaction profiles in infants and young children are the same.
The HealthNuts study is a population-based longitudinal food allergy study in Melbourne, Australia which undertook over 2000 food challenges in 1 and 4 year old children, irrespective of skin prick test wheal size. Recently Chan and Peters et al reported the reaction profiles of children undergoing food challenges in The Journal of Allergy and Clinical Immunology: In Practice.
Urticaria was the most common presenting sign in positive egg and peanut challenges at both ages 1 and 4 years, however there was a shift towards more angioedema at age 4 years. Anaphylaxis during food challenges was rare was at both ages (2.1% and 2.8% of positive challenges at ages 1 and 4 years, respectively) but more common for peanut compared to egg challenges (4.5% and 1.2%, respectively). Serum food-specific IgE levels ≥ 15kU/L were associated with moderate-severe reactions but large skin prick tests responses were not. This study is important because it shows that food challenges in young children rarely result in severe reactions and anaphylaxis.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.