Asia Pac Allergy.  2013 Jan;3(1):59-69. 10.5415/apallergy.2013.3.1.59.

Diagnosis of food allergies: the impact of oral food challenge testing

• Ito K

• KMID: 2397336
• DOI: http://doi.org/10.5415/apallergy.2013.3.1.59

Abstract

A diagnosis of food allergies should be made based on the observation of allergic symptoms following the intake of suspected foods and the presence of allergen-specific IgE antibodies. The oral food challenge (OFC) test is the most reliable clinical procedure for diagnosing food allergies. Specific IgE testing of allergen components as well as classical crude allergen extracts helps to make a more specific diagnosis of food allergies. The Japanese Society of Pediatric Allergy and Clinical Immunology issued the 'Japanese Pediatric Guideline for Food Allergy 2012' to provide information regarding the standardized diagnosis and management of food allergies. This review summarizes recent progress in the diagnosis of food allergies, focusing on the use of specific IgE tests and the OFC procedure in accordance with the Japanese guidelines.

Keyword

Food hypersensitivity; Immunoglobulin E; Oral food challenge

MeSH Terms

Allergy and Immunology
Antibodies
Asian Continental Ancestry Group
Diagnosis*
Food Hypersensitivity*
Humans
Hypersensitivity
Immunoglobulin E
Antibodies
Immunoglobulin E

Figure

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  Fig. 1 Probability curves of egg white- and milk-specific IgE antibodies. Age-related probability curves of allergen-specific IgE reactions to egg whites (A) and milk (B) for patients failing oral food challenge testing for heated eggs and milk, respectively. Adapted from reference [13].

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  Fig. 2 Probability curve for the initial diagnosis of egg allergies. Probability curves of allergen-specific IgE reactions to egg whites (n = 100, linear line) and ovomucoid (n = 80, dotted line) for patients failing boiled egg challenge testing based on testing performed in 1-year-old patients who had never eaten egg products. Adapted from reference [14].

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  Fig. 3 Receiver operating characteristic (ROC) curves showing the results of allergen-specific IgE (sIgE) tests for milk components in relation to the diagnosis of milk allergies. Milk-sensitized children were diagnosed with a cow's milk allergy (CMA, n = 61) or non-CMA (n = 22). ROC analyses were performed for the sIgE tests to milk, casein, α-lactalbumin, and β-lactoglobulin. Adapted from reference [15].

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  Fig. 4 Probability curves for wheat and ω-5 gliadin IgE. Probability curves of allergen-specific IgE reactions to wheat (A) and ω-5 gliadin (B) for the diagnosis of wheat allergies (n = 59) or clinically evaluated non-wheat allergies (n = 174). Adapted from reference [19].

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  Fig. 5 Provoked symptoms in positive food challenges. A total of 1,834 oral food challenge tests were performed at Aichi Children's Health and Medical Center between January 2006 and March 2009. The symptoms observed in the positive challenges (n = 717) are shown. In the respiratory symptoms, the blue bar indicates coughing, and the green bar indicates wheezing.

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  Fig. 6 Treatment plan for allergic symptoms. A flow chart of the treatment plan for patients with positive oral food challenge results is shown in the Japanese Pediatric Guideline for Food Allergy 2012.

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  Fig. 7 Selection of the introduction dose after oral food challenge testing. According to the final dose of the challenge food (boiled egg whites, udon noodles or milk) and the symptom grading (Table 3), the initial dose of intake at home is determined.

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