Allergy Asthma Immunol Res.  2015 Nov;7(6):547-556. 10.4168/aair.2015.7.6.547.

Prevalence and Clinical Impact of IgE-Mediated Food Allergy in School Children With Asthma: A Double-Blind Placebo-Controlled Food Challenge Study

• Krogulska
• Dynowski J
• Funkowicz
• Malachowska B
• Wasowska-Krolikowska K

• KMID: 2130261
• DOI: http://doi.org/10.4168/aair.2015.7.6.547

Abstract

PURPOSE
Recent studies indirectly suggest a possible link between food allergy (FA) and asthma. Most of them have evaluated the occurrence of FA in asthmatic children, especially in the first year of life, using questionnaire-based studies or specific IgE (sIgE) assay. The aim of this study was to evaluate the prevalence and clinical impact of IgE-mediated FA in school children with asthma using a double-blind placebo-controlled food challenge (DBPCFC).
METHODS
The study group consisted of school children with atopic asthma who were admitted to the Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, for the evaluation of food hypersensitivity. The diagnosis of FA was established using questionnaires, sIgE analysis, and the DBPCFC. Asthma severity and asthma control state were also assessed.
RESULTS
A relationship between consumed food and complaints was reported in 180 children (49.7%). Seventy children (19.3%) were sensitized to food allergens. IgE-mediated FA was confirmed in 24 children (6.6%), while 11 children (3%) demonstrated respiratory symptoms. Food-induced asthma exacerbations were observed in 9 patients (2.5%). Statistically significant differences in the prevalence of atopic dermatitis (P<0.002), urticaria (P<0.03), digestive symptoms (P<0.03), rhinitis (P<0.02), sIgE level (P<0.001), positive family history of atopy (P<0.001) and FA in history (P<0.001) were found between asthmatic children with FA and those without. Children with food-induced asthma exacerbations demonstrated significantly greater severity, poorer controls, and worse morbidity compared to those without.
CONCLUSIONS
Although food-induced respiratory reactions in children with asthma were rare, they were classified as severe and associated with worse morbidity, greater severity, and poorer control. As the most commonly observed symptoms were coughing and rhinitis, which can be easily misdiagnosed, a proper diagnosis is essential for improving the management of both clinical conditions.

Keyword

Food allergy; asthma; children; double-blind placebo-controlled food challenge

MeSH Terms

Allergens
Asthma*
Child*
Cough
Dermatitis, Atopic
Diagnosis
Food Hypersensitivity*
Gastroenterology
Humans
Immunoglobulin E
Prevalence*
Rhinitis
Urticaria
Allergens
Immunoglobulin E

Figure

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  Fig. 1 Study design. Flow chart depicting steps involved in patient selection and tests in this study.

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  Fig. 2 Degrees of asthma severity (A) and control (B) in association with the degree of food reactions after the OFC in children with asthma and food allergy.

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