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. 2019 Nov 6:9:58.
doi: 10.1186/s13601-019-0298-z. eCollection 2019.

Eliciting dose is associated with tolerance development in peanut and cow's milk allergic children

C Nitsche  1   2   3 , C D Westerlaken-van Ginkel  2   3 , B J Kollen  4 , A B Sprikkelman  2   3 , G H Koppelman  2   3 , A E J Dubois  2   3
Affiliations

Eliciting dose is associated with tolerance development in peanut and cow's milk allergic children

C Nitsche et al. Clin Transl Allergy. .

Abstract

Background: Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development.

Methods: This was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels.

Results: In 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy.

Conclusion: Approximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.

Keywords: Atopic dermatitis; Eliciting dose; Food allergy; Pediatrics; Prognosis.

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Conflict of interest statement

Competing interestsThe authors declare, that they have no relevant conflict of interest regarding this manuscript. The authors report to have received funding from the Nutricia Research Foundation, GSK, TEVA the Netherlands, UBBO EMMIUS Foundation, TETRI Foundation, Lung Foundation of the Netherlands, which had no relation to the submitted work.

Figures

Fig. 1
Fig. 1
Flowchart: selection procedure of children allergic to peanut, cow’s milk or hen’s egg
Fig. 2
Fig. 2
Kaplan-Meier survival curve in peanut, cow’s milk and hen’s egg allergic children
See this image and copyright information in PMC

References

    1. Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challenge-proven cow’s milk allergy in European children–EuroPrevall birth cohort. Allergy. 2015;70(8):963–972. doi: 10.1111/all.12630. - DOI - PubMed
    1. Peters RL, Dharmage SC, Gurrin LC, et al. The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol. 2014;133(2):485–491. doi: 10.1016/j.jaci.2013.11.032. - DOI - PubMed
    1. Hourihane JO, Roberts SA, Warner JO. Resolution of peanut allergy: case-control study. BMJ. 1998;316(7140):1271–1275. doi: 10.1136/bmj.316.7140.1271. - DOI - PMC - PubMed
    1. Blom WM, Vlieg-Boerstra BJ, Kruizinga AG, van der Heide S, Houben GF, Dubois AE. Threshold dose distributions for 5 major allergenic foods in children. J Allergy Clin Immunol. 2013;131(1):172–179. doi: 10.1016/j.jaci.2012.10.034. - DOI - PubMed
    1. Pettersson ME, Koppelman GH, Flokstra-de Blok BMJ, Kollen BJ, Dubois AEJ. Prediction of the severity of allergic reactions to foods. Allergy. 2018;73:1532–1540. doi: 10.1111/all.13423. - DOI - PMC - PubMed