title: Development of a prediction model of severe reaction in boiled egg challenges.
abstract: BACKGROUND
  We have proposed a new scoring system (Anaphylaxis SCoring Aichi: ASCA) for a quantitative evaluation of the anaphylactic reaction that is observed in an oral food challenge (OFC). Furthermore, the TS/Pro (Total Score of ASCA/cumulative protein dose) can be a marker to represent the overall severity of a food allergy. We aimed to develop a prediction model for a severe allergic reaction that is provoked in a boiled egg white challenge.
  
  
  METHODS
  We used two separate datasets to develop and validate the prediction model, respectively. The development dataset included 198 OFCs, that tested positive. The validation dataset prospectively included 140 consecutive OFCs, irrespective of the result. A 'severe reaction' was defined as a TS/Pro higher than 31 (the median score of the development dataset). A multivariate logistic regression analysis was performed to identify the factors associated with a severe reaction and develop the prediction model.
  
  
  RESULTS
  The following four factors were independently associated with a severe reaction: ovomucoid specific IgE class (OM-sIgE: 0-6), aged 5 years or over, a complete avoidance of egg, and a total IgE < 1000 IU/mL. Based on these factors, we made a simple scoring prediction model. The model showed good discrimination in a receiver operating characteristic analysis; area under the curve (AUC) = 0.84 in development dataset, AUC = 0.85 in validation dataset. The prediction model significantly improved the AUC in both datasets compared to OM-sIgE alone.
  
  
  CONCLUSIONS
  This simple scoring prediction model was useful for avoiding risky OFC.
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan; Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Sugiura
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Kemal
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Joon
authors.initials: J
authors.lastname: Nakata
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kando
authors.affiliation: Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan. Electronic address: komei@cd5.so-net.ne.jp.
authors.forename: Komei
authors.initials: K
authors.lastname: Ito
mesh_terms: D000284:Administration, Oral; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D004531:Eggs / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008962:Models, Theoretical; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Anaphylaxis; Food allergy; Hen's egg; Oral food challenge; Prediction model