Thresholds of clinical reactivity to milk, egg, peanut and sesame in immunoglobulin E‐dependent allergies: evaluation by double‐blind or single‐blind placebo‐controlled oral challenges
- 5 August 2003
- journal article
- clinical trial
- Published by Wiley in Clinical and Experimental Allergy
- Vol. 33 (8) , 1046-1051
- https://doi.org/10.1046/j.1365-2222.2003.01734.x
Abstract
Summary: Background The prevalence of food anaphylaxis due to masked allergens has increased within the last 10 years. Contamination of manufactured products by food allergens is a key concern for food industries.Objective To determine quantities eliciting reactions in patients who have an IgE‐dependent food allergy, thanks to standardized oral provocation tests. To evaluate the subsequent levels of sensitivity required for the detection tests of allergens for egg, peanut, milk and sesame.Methods Prick‐in‐prick tests, Cap system RAST, and single or double‐blind placebo‐controlled food challenges (SBPCFC or DBPCFC) were performed. The doses of natural food were gradually increased from 5 to 5000 mg for solid food and from 1 to 30 mL for peanut oil, sunflower oil, soy oil and sesame oil.Results Data from 125 positive oral challenges to egg, 103 to peanut, 59 to milk and 12 to sesame seeds were analysed. Haemodynamic modifications were observed in 2%, 3%, 1.7%, and 8% of the oral challenges (OCs) to egg, peanut, milk and sesame, respectively. Respiratory symptoms were observed in 12%, 20%, 10% and 42% of egg, peanut milk and sesame allergies, respectively. A cumulative reactive dose inferior or equal to 65 mg of solid food or 0.8 mL of milk characterized 16%, 18%, 5% and 8% of egg, peanut, milk and sesame allergies, respectively. 0.8% of egg allergies, 3.9% of peanut allergies, and 1.7% of milk allergies reacted to 10 mg or less of solid food or to 0.1 mL for milk. The lowest reactive threshold has been observed at less than 2 mg of egg; 5 mg of peanut, 0.1 mL of milk and 30 mg of sesame seed. Ten out of 29 OC with peanut oil, two out of two OC with soy oil and three out of six OC with sunflower oil were positive. Five out six OC with sesame oil were positive: 1 and 5 mL induced an anaphylactic shock.Conclusion The risk of asthma and anaphylactic shock to sesame and peanut is confirmed. Minimal reactive quantities show that, in order to guarantee a 95% safety for patients who are allergic to egg, peanut and milk, and on the basis of consumption of 100 g of food, the detection tests should ensure a sensitivity of 10 p.p.m. for egg, 24 p.p.m. for peanut and 30 p.p.m. for milk proteins. Oil allergies being considered, the limit of sensitivity should fall to 5 p.p.m.Keywords
This publication has 35 references indexed in Scilit:
- Population study of food allergy in France☆Journal of Allergy and Clinical Immunology, 2001
- Long-term prospective observational study of patients with peanut and nut allergy after participation in a management planThe Lancet, 2001
- Fatalities due to anaphylactic reactions to foodsJournal of Allergy and Clinical Immunology, 2001
- Lessons for management of anaphylaxis from a study of fatal reactionsClinical and Experimental Allergy, 2000
- Food anaphylaxisBritish Medical Bulletin, 2000
- Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone surveyJournal of Allergy and Clinical Immunology, 1999
- Perceived prevalence of peanut allergy in Great Britain and its association with other atopic conditions and with peanut allergy in other household membersAllergy, 1999
- Food allergy to peanuts in France–evaluation of 142 observationsClinical and Experimental Allergy, 1998
- An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: A randomized, double-blind, placebo-controlled food challenge studyPublished by Elsevier ,1997
- Fatal and Near-Fatal Anaphylactic Reactions to Food in Children and AdolescentsNew England Journal of Medicine, 1992