Dose-time-response relationship in peanut allergy using a human model of passive cutaneous anaphylaxis

To the Editor: The extensive use of the double-blind, placebo-controlled oral food challenge in the diagnosis of food allergy and the growing uncertainties about the appropriate time interval between dose steps highlight the need to better understand which factors govern the reaction time in anaphyl...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology Vol. 139; no. 6; pp. 2015 - 2016.e4
Main Authors: Mose, Anja P., Mortz, Charlotte G., Eller, Esben, Sprogøe, Ulrik, Barington, Torben, Bindslev-Jensen, Carsten
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.06.2017
Elsevier Limited
Subjects:
Allergens
Allergy and Immunology
Anaphylaxis
Ara h 1 antigen
Ara h 2 antigen
Ara h 3 antigen
Clinical trials
Food allergies
Immunoglobulin E
Mimicry
Passive cutaneous anaphylaxis
Peanuts
Reaction time task
Skin
ISSN:0091-6749, 1097-6825, 1097-6825
Online Access:Get full text
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Summary:To the Editor: The extensive use of the double-blind, placebo-controlled oral food challenge in the diagnosis of food allergy and the growing uncertainties about the appropriate time interval between dose steps highlight the need to better understand which factors govern the reaction time in anaphylaxis, that is, the time it takes for an allergic reaction to develop after a patient has ingested the allergen.1 The purpose of this study was to determine whether the serum level of allergen specific IgE (sIgE) and/or the oral challenge dose affect the reaction time (Treact) and the size of the wheal (Swheal) in IgE-mediated, cutaneous reactions in vivo. In this technique, which Prausnitz and Küstner were the first to describe,2 human serum from 4 donors with severe peanut allergy was injected intradermally into nonallergic individuals (the recipients, 41 healthy adults). [...]the titrated oral peanut challenges with 1-hour dose intervals demonstrated large variations in threshold mimicking the real-life situation in patients (see Fig E2 in this article's Online Repository at www.jacionline.org). Donor serum Threshold (mg of peanut) Clinical symptoms to peanut sIgE (kIU/L) Case history DBPCFC Peanut Ara h 1 Ara h 2 Ara h 3 Ara h 8 Ara h 9 1 510 Globulus sensation OASNauseaAbdominal painVomiting 7.5 3.4 1.7 <0.35 <0.35 <0.35 2 Unknown OASRhinitisAsthmaUrticaria - 60.1 15.1 36.3 0.5 <0.35 <0.35 3 240 NauseaGenerally feeling unwell OASNauseaAbdominal painVomitingConjunctivitisUrticaria 61.8 31.7 45.0 8.8 1.1 <0.35 4 110 AngioedemaVomiting OASNauseaAbdominal painVomitingUrticaria 93.1 47.0 71.0 10.5 6.5 <0.35 1 K. Blumchen, A. Beder, J. Beschorner,...
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ISSN:0091-6749
1097-6825
1097-6825
DOI:10.1016/j.jaci.2016.11.034