Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration.
BACKGROUND
Oral food challenge (OFC) is the diagnostic 'gold standard' of food allergies but it is laborious and time consuming. Attempts to predict a positive OFC through specific IgE assays or conventional skin tests so far gave suboptimal results.


OBJECTIVE
To test whether skin test with titration curves predict with enough confidence the outcome of an oral food challenge.


METHODS
Children (n=47; mean age 6.2 +/- 4.2 years) with suspected and diagnosed allergic reactions to hen's egg (HE) were examined through clinical history, physical examination, oral food challenge, conventional and end-point titrated skin tests with HE white extract and determination of serum specific IgE against HE white. Predictive decision points for a positive outcome of food challenges were calculated through receiver operating characteristic (ROC) analysis for HE white using IgE concentration, weal size and end-point titration (EPT).


RESULTS
OFC was positive (Sampson's score >or=3) in 20/47 children (42.5%). The area under the ROC curve obtained with the EPT method was significantly bigger than the one obtained by measuring IgE-specific antibodies (0.99 vs. 0.83, P<0.05) and weal size (0.99 vs. 0.88, P<0.05). The extract's dilution that successfully discriminated a positive from a negative OFC (sensitivity 95%, specificity 100%) was 1 : 256, corresponding to a concentration of 5.9 microg/mL of ovotransferrin, 22.2 microg/mL of ovalbumin, and 1.4 microg/mL of lysozyme.


CONCLUSIONS
EPT is a promising approach to optimize the use of skin prick tests and to predict the outcome of OFC with HE in children. Further studies are needed to test whether this encouraging finding can be extended to other populations and food allergens.
Tripodi
S
S
Paediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy. salvatore.tripodi@gmail.com
Businco
A Di Rienzo
AD
Alessandri
C
C
Panetta
V
V
Restani
P
P
Matricardi
P M
PM
D000284:Administration, Oral; D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage*; D000818:Animals; D002645:Chickens; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D004531:Eggs; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012882:Skin Tests; D013997:Time Factors
D000485:Allergens