title: Outcome of oral food challenges in children in relation to symptom-eliciting allergen dose and allergen-specific IgE.
abstract: BACKGROUND
  Oral food challenge (FC) protocols are discussed with reference to starting doses, dose increments, safety, and predictability of results. The aim of this study was to evaluate the relation of eliciting allergen doses, specific IgE levels and predictive factors to the outcome of FCs in children.
  
  
  METHODS
  In 869 children (median age 1.2 years), FCs were performed with cow's milk (n = 633), hen's egg (n = 456), wheat (n = 265) and/or soy (n = 317) starting at 3-5 mg of protein. Each of the seven doses was administered every 30 min using semi-log increases. Severity of symptoms was graded from I to V. IgE was determined prior to challenges.
  
  
  RESULTS
  Of the children allergic to egg or milk, 9% and 10%, respectively, experienced reactions already at the first dose. Of these, 14% (egg) and 4% (milk) experienced grade IV reactions. In contrast, few children reacted to the first doses of wheat or soy, and most reactions occurred after the maximum dose. For all allergens, grade V reactions did not occur. However, grade IV reactions were seen at all eliciting doses. Elevated specific IgE level, young age and a history of atopic dermatitis were associated with a positive challenge outcome for milk or egg, and also IgE levels were associated with lower eliciting allergen doses and more severe symptoms.
  
  
  CONCLUSIONS
  Oral FCs bear a risk of severe reactions at all dose levels. Doses of 3-5 mg protein induced symptoms in up to 10% of children allergic to milk or egg. However, food-specific IgE levels are of limited clinical value for the estimation of FC reactions.
authors.affiliation: Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Rolinck-Werninghaus
authors.forename: B
authors.initials: B
authors.lastname: Niggemann
authors.forename: L
authors.initials: L
authors.lastname: Grabenhenrich
authors.forename: U
authors.initials: U
authors.lastname: Wahn
authors.forename: K
authors.initials: K
authors.lastname: Beyer
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D000918:Antibody Specificity / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D007223:Infant; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D000485:Allergens; D007073:Immunoglobulin E