J. Kukler

Placebo reactions in double‐blind, placebo‐controlled food challenges in children

Background:  A cardinal feature of the double‐blind, placebo‐controlled food challenge (DBPCFC) is that placebo administration is included as a control. To date, the occurrence and diagnostic significance of placebo events have not extensively been documented.

Validation of novel recipes for double‐blind, placebo‐controlled food challenges in children and adults

To cite this article: Vlieg‐Boerstra BJ, Herpertz I, Pasker L, van der Heide S, Kukler J, Jansink C, Vaessen W, Beusekamp BJ, Dubois AEJ. Validation of novel recipes for double‐blind, placebo‐controlled food challenges in children and adults. Allergy 2011; 66: 948–954.

Dietary assessment in children adhering to a food allergen avoidance diet for allergy prevention

Objective:The purpose of this investigation was to verify if avoidance of allergenic foods in children adhering to a food allergen avoidance diet from birth was complete and feasible, and whether dietary assessment can be used as a tool in predicting the outcome of double-blind, placebo-controlled food challenges (DBPCFCs).Design:Children adhering to an allergen avoidance diet from birth underwent DBPCFCs. The investigator-dietician verified whether the elimination was complete, using food frequency questionnaires for common allergenic foods.Setting:University Medical Centre Groningen, the Netherlands.Subjects:Thiry-eight children aged 1–13 years, who were consecutively referred to the University Medical Centre Groningen for DBPCFC between January 2002 and February 2004.Results:Among the 38 children undergoing DBPCFCs, there were 15 challenges with egg, 15 with peanut, five with hazelnut and three with soy. Fifteen food challenges (39%) were positive. Small quantities of allergenic foods were inadvertently present in the diets of 13 patients (34%), were possibly present in the diets of 14 patients (37%) and could not be identified in the diets of 11 patients (29%). Seven patients (54%) who had inadvertently ingested small quantities of allergenic foods without sequelae had a positive DBPCFC.Conclusion:Dietary avoidance was incomplete and not feasible in most cases. Tolerance of small amounts of allergenic foods does not preclude positive challenge reactions. Dietary assessment does not seem a useful tool in predicting the outcome of DBPCFC in children adhering to an elimination diet.Sponsorship:The Stichting Astma Bestrijding (Foundation for the Prevention of Asthma), The Netherlands.

Ready-to-use introduction schedules for first exposure to allergenic foods in children at home

Background:  The vast majority of children will undergo their first exposure to common allergenic foods at home. However, the first exposure may lead to clinical reactions. It has been proposed to introduce allergenic foods gradually into the diets of children at risk for food allergy, but no practical dietary advice has been devised.

Association of food allergy and atopic dermatitis exacerbations

BACKGROUND Atopic dermatitis (AD) and food allergy frequently coexist in children. OBJECTIVE To examine the association between food allergy and AD. METHODS Between 2001 and 2011, children referred to our tertiary care center underwent double-blind, placebo-controlled food challenges (DBPCFCs) for one or more suspected food allergies as part of regular care. Immediate reactions were observed and recorded by allergy nursing staff, whereas late reactions were ascertained by semistructured telephone interview 48 hours after challenge. To test to which degree specific IgE results were predictive in the outcome of DBPCFCs in children with and without (previous and current) AD, logistic regression analysis was performed. RESULTS A total of 1186 DBPCFCs were studied. Sensitization to foods occurred significantly more often in children with previous AD. The association between specific IgE results and the outcome of DBPCFCs was significant for children with and without (previous and current) AD but stronger for children without current AD. The positivity rate of DBPCFCs in children with mild, moderate, and severe AD was 53.3%, 51.7%, and 100%, respectively. Children with AD and a history of worsening AD as their only symptom reacted as often to placebo as to challenge food. CONCLUSION Children with current AD are more frequently asymptomatically sensitized to the foods in question than those without AD. In addition, children suspected of food allergy should be considered for testing, regardless of the severity of their AD. Our results suggest that children with exacerbation of AD in the absence of other allergic symptoms are unlikely to be food allergic.

No matrix effect in double-blind, placebo-controlled egg challenges in egg allergic children

Diagnostic and accidental food allergic reactions may be modified by the matrix containing the allergenic food. Previous studies of double‐blind, placebo‐controlled food challenges (DBPCFCs) with peanut found an effect of the fat content of the challenge matrix on the severity of the challenge reactions.

Is 30 minutes between doses long enough in oral food challenges

Arch Allergy Appl Immunol 1991: 96: 263– 70. 6. Focke M, Hemmer W, Valenta R, Gotz M, Jarisch R. Identification of oilseed rape (Brassica napus) pollen profilin as a crossreactive allergen. Int Arch Allergy Immunol 2003: 132: 116–23. 7. Puumalainen TJ, Poikonen S, Kotovuori A, et al. Napins, 2S albumins, are major allergens in oilseed rape and turnip rape. J Allergy Clin Immunol 2006: 117: 426–32. 8. Sirvent S, Palomares O, Cuesta-Herranz J, Villalba M, Rodriguez R. Analysis of the structural and immunological stability of 2S albumin, nonspecific lipid transfer protein, and profilin allergens from mustard seeds. J Agric Food Chem 2012: 60: 6011–18. 9. Poikonen S, Puumalainen TJ, Kautiainen H, Palosuo T, Reunala T, Turjanmaa K. Sensitization to turnip rape and oilseed rape in children with atopic dermatitis: a casecontrol study. Pediatr Allergy Immunol 2008: 19: 408–11. 10. Asero R, Pravettoni V. Anaphylaxis to plant-foods and pollen allergens in patients with lipid transfer protein syndrome. Curr Opin Allergy Clin Immunol 2013: 13: 379– 85.

PD18 - Filaggrin loss-of-function variants are associated with clinical reactivity to foods

The mechanism that determines the difference between asymptomatic sensitisation and clinical reactivity to food is as yet unknown. The aim of this study was to determine the effect of loss-of-function variants in the filaggrin gene on clinical reactivity, sensitisation and severity of food allergy.

Exacerbations of atopic dermatitis without other symptoms are rarely caused by food allergy

and fresh as well negative IgE