title: Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges.
abstract: BACKGROUND
  Severe anaphylactic symptoms can occur during oral food challenges (OFCs). Thus, high-risk patients (e.g., patients with a history of anaphylaxis or high antigen-specific immunoglobulin E [IgE] levels) must carefully undergo OFCs in hospitals. We attempted to identify the risk factors for severe symptoms during OFC testing among high-risk patients.
  
  
  METHODS
  We retrospectively evaluated patients' characteristics and severe symptoms that were experienced during a double-blind placebo-controlled food challenge test performed before the patients underwent oral immunotherapy between June 2008 and June 2012. Patients were ≥5 years old and had an anaphylactic history or antigen-specific IgE (>30 kUA/L). Severe symptoms were defined using the grading of the Japanese Anaphylaxis Guidelines, which are modified from the European Academy of Allergology and Clinical Immunology Guidelines.
  
  
  RESULTS
  We evaluated 393 cases with positive test results, including 98 cases with severe symptoms. The most frequent severe symptoms were respiratory (77%), gastrointestinal (28%), cardiovascular (27%), and neurological (13%) symptoms. Multivariate analysis revealed that the significant factors for a severe reaction were a history of anaphylaxis to the causative food (adjusted odds ratio [OR]: 2.147, p = 0.003), older age (per 1 year increase, adjusted OR: 1.102, p = 0.044), and an egg OFC (adjusted OR: 0.433, p = 0.003).
  
  
  CONCLUSIONS
  The risk factors for a severe reaction to OFCs were a history of an anaphylactic reaction and older age. An egg OFC was associated with low risk of severe symptoms during OFC. Therefore, OFCs for patients with these risk factors should only be performed under specialist supervision with access to rapid treatment and full resuscitation equipment.
authors.affiliation: Department of Pediatrics, Sagamihara National Hospital, Sagamihara, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagida
authors.forename: Sakura
authors.initials: S
authors.lastname: Sato
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Asaumi
authors.forename: Kiyotake
authors.initials: K
authors.lastname: Ogura
authors.forename: Motohiro
authors.initials: M
authors.lastname: Ebisawa
mesh_terms: D000284:Administration, Oral; D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D000707:Anaphylaxis / Q000188:drug therapy / Q000209:etiology; D000818:Animals; D010367:Arachis / Q000009:adverse effects / Q000276:immunology; D002648:Child; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D004311:Double-Blind Method; D004531:Eggs / Q000009:adverse effects; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008892:Milk / Q000009:adverse effects / Q000276:immunology; D016017:Odds Ratio; D014908:Triticum / Q000009:adverse effects / Q000276:immunology
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D004837:Epinephrine
keywords: Anaphylaxis; Children; Food hypersensitivity; Oral food challenge; Pediatric patients