title: Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut.
abstract: BACKGROUND
  The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC.
  
  
  METHODS
  We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes.
  
  
  RESULTS
  In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7.
  
  
  CONCLUSIONS
  We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.
authors.affiliation: Allergy Department, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: González-Mancebo
authors.affiliation: Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Alonso Díaz de Durana
authors.affiliation: Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: García Estringana
authors.affiliation: Allergy Department, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Meléndez Baltanás
authors.affiliation: Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Alvarez
authors.affiliation: Allergy Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: de la Hoz Caballer
authors.affiliation: Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Del Prado
authors.affiliation: Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Rivas
mesh_terms: D000328:Adult; D003296:Cooking; D031211:Corylus / Q000009:adverse effects / Q000276:immunology; D004311:Double-Blind Method; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D004527:Egg Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D005260:Female; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D008894:Milk Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D021184:Nut Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D017060:Patient Satisfaction; D028321:Plant Preparations / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012677:Sensation; D013030:Spain
chemical_list: D004527:Egg Proteins; D008894:Milk Proteins; D028321:Plant Preparations
keywords: Double-blind placebo-controlled food challenge; Egg white; Food allergy; Hazelnut; Milk; Recipe; Sensory test; Triangle test; Validation