title: The range of minimum provoking doses in hazelnut-allergic patients as determined by double-blind, placebo-controlled food challenges.
abstract: BACKGROUND
  The risk for allergic reactions depends on the sensitivity of individuals and the quantities of offending food ingested. The sensitivity varies among allergic individuals, as does the threshold dose of a food allergen capable of inducing an allergic reaction.
  
  
  OBJECTIVE
  This study aimed at determining the distribution of minimum provoking doses of hazelnut in a hazelnut-allergic population.
  
  
  METHODS
  Thirty-one patients with a history of hazelnut-related allergic symptoms, a positive skin prick test to hazelnut and/or an elevated specific IgE level, were included. Double-blind, placebo-controlled food challenges (DBPCFC) were performed with seven increasing doses of dried hazelnut (1 mg to 1 g hazelnut protein) randomly interspersed with seven placebo doses.
  
  
  RESULTS
  Twenty-nine patients had a positive challenge. Itching of the oral cavity and/or lips was the first symptom in all cases. Additional gastrointestinal symptoms were reported in five patients and difficulty in swallowing in one patient. Lip swelling was observed in two patients, followed by generalized urticaria in one of these. Threshold doses for eliciting subjective reactions varied from a dose of 1 mg up to 100 mg hazelnut protein (equivalent to 6.4-640 mg hazelnut meal). Extrapolation of the dose-response curve showed that 50% of our hazelnut-allergic population will suffer from an allergic reaction after ingestion of 6 mg (95% CI, 2-11 mg) of hazelnut protein. Objective symptoms were observed in two patients after 1 and 1,000 mg, respectively.
  
  
  CONCLUSIONS
  DBPCFCs demonstrated threshold doses in half of the hazelnut-allergic patients similar to doses previously described to be hidden in consumer products. This stresses the need for careful labelling and strategies to prevent and detect contamination of food products with hazelnut residues.
authors.affiliation: Department of Dermatology/Allergology, University Medical Centre Utrecht, The Netherlands. m.wensing@azu.nl
authors.forename: M
authors.initials: M
authors.lastname: Wensing
authors.forename: A H
authors.initials: AH
authors.lastname: Penninks
authors.forename: S L
authors.initials: SL
authors.lastname: Hefle
authors.forename: J H
authors.initials: JH
authors.lastname: Akkerdaas
authors.forename: R
authors.initials: R
authors.lastname: van Ree
authors.forename: S J
authors.initials: SJ
authors.lastname: Koppelman
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: A C
authors.initials: AC
authors.lastname: Knulst
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D004306:Dose-Response Relationship, Immunologic; D004311:Double-Blind Method; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D021184:Nut Hypersensitivity / Q000209:etiology*; D009754:Nuts / Q000276:immunology*; D011537:Pruritus / Q000209:etiology; D014581:Urticaria / Q000209:etiology
chemical_list: D000485:Allergens