Reaction severity to oral food challenge to milk is unpredictable: a caveat for clinical practice

Reaction severity to oral food challenge to milk is unpredictable: a caveat for clinical practice

Authors

  • Maria Angela Tosca
  • Matteo Naso
  • Chiara Trincianti
  • Irene Schiavetti
  • Giorgio Ciprandi

Keywords:

cow’s milk allergy, oral food challenge, clinical reaction, anaphylaxis.

Abstract

Background Cow’s milk allergic (CMA) is common in infancy and early childhood; its work-up also is demanding. Oral food challenge (OFC) represents the gold-standard for diagnosis, but it may be dangerous. The present study aimed to identify possible risk factors predictive of severe reactions in clinical practice. Methods The study retrospectively evaluated data concerning children with positive OFC. The study evaluated detailed clinical history, including comorbidity, reactions’ characteristics, specific IgE to milk and its molecular components, and cumulative allergen dose. Results This study included 30 children (9 females and 21 males, mean age 89 months); 22 developed mild clinical reactions, four moderate, and four severe. There was no risk factor predictive of severe reaction. Conclusions This study emphasized the unpredictability of anaphylaxis during the OFC procedure, as no predictive and reasonable risk factors could rule out a severe reaction with absolute certainty. Consequently, OFC should be performed only at third-level pediatric allergy centers.

 

 

References

Perry TT, Matsui EC, Conover-Walker MK, Wood RA. Risk of oral food challenges. J Allergy Clin Immunol 2004;114:1164-8. doi: 10.1016/j.jaci.2004.07.063.

Cianferoni A, Garrett JP, Naimi DR, Khullar K, Spergel JM. Predictive Values for Food Challenge-Induced Severe Reactions: Development of a Simple Food Challenge Score. Isr Med Assoc J 2012;14(1):24-8. PMID: 22624438.

Sugiura S, Sasaki K, Matsui T, Nakagawa T, Kando N, Ito K. Development of a prediction model for a severe reaction in cow's milk challenges. Allergol Int 2017;66:493-494. doi: 10.1016/j.alit.2016.11.005.

Kawahara T, Tezuka J, Ninomiya T, et al. Risk prediction of severe reaction to oral challenge test of cow’s milk. Eur J Pediatr 2019;178(2):181-188. doi: 10.1007/s00431-018-3274-z.

Petterson ME, Koppelman GH, Flokstra-de Blok BMJ, Kollen BJ, Dubois AEJ. Prediction of the severity of allergic reactions to foods. Allergy 2018;73:1532-1540. doi: 10.1111/all.13423.

Turner PJ, Duca B, Chastell SA, et al. IgE-sensitization predicts threshold but not anaphylaxis during oral food challenges to cow's milk. Allergy 2022;77(4):1291-1293. doi: 10.1111/all.15195.

Nieminen O, Palosuo K, Kukkonen K, et al. Molecular allergy diagnostics in predicting oral cow’s milk challenge outcome in Finnish children. Allergy Asthma Proc 2023;44:71-77. doi: 10.2500/aap.2023.44.220079.

Fernández-Rivas M, Gómez García I, Gonzalo-Fernández A, et al. Development and validation of the food allergy severity score. Allergy. 2022;77(5):1545-1558. doi: 10.1111/all.15165.

Tosca MA, Pistorio A, Rossi GA, Ciprandi G. Cow's Milk Allergy: the Relevance of IgE. Allergy Asthma Immunol Res 2016;8(1):86-7. doi: 10.4168/aair.2016.8.1.86.

Yanagida N, Sato S, Takahashi K, et al. Increasing specific immunoglobulin E levels correlate with risk of anaphylaxis during oral food challenge. Pediatr Allergy Immunol 2018;29(4):417-424. doi: 10.1111/pai.12896.

Ciprandi G, Tosca MA. LTP Allergy: a pragmatic and reasonable approach in clinical practice. Eur Ann Allergy Clin Immunol. 2019;51(2):84-85. doi: 10.23822/EurAnnACI.1764-1489.75.

Turner PJ, Baumert JL, Beyer K, et al. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy 2016;71:1241-1255. doi: 10.1111/all.12924.

Tosca MA, Schiavetti I, Olcese R, Trincianti C, Ciprandi G. Molecular Allergy Diagnostics in Children with Cow's Milk Allergy: Prediction of Oral Food Challenge Response in Clinical Practice. J Immunol Res 2023:2023:1129449. doi: 10.1155/2023/1129449.

Niggemann B, Beyer K. Time for a new grading system for allergic reactions? Allergy 2016;71:135-136. doi: 10.1111/all.12765.

Tosca MA, Pistorio A, Accogli A, Rossi GA, Ciprandi G. Food anaphylaxis in children: Peculiarity of characteristics. Allergol Immunopathol (Madr). 2015;43(4):421-3. doi: 10.1016/j.aller.2014.04.007.

Downloads

Published

28-02-2024

Issue

Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Tosca MA, Naso M, Schiavetti I, Ciprandi G. Reaction severity to oral food challenge to milk is unpredictable: a caveat for clinical practice. Acta Biomed [Internet]. 2024 Feb. 28 [cited 2024 Jul. 18];95(1):e2024018. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/15273