Identifying thresholds of reaction for different foods

Abstract

Current food allergy management universally treats all patients with food allergy as being at risk for anaphylaxis (with the exception perhaps of pollen food allergy syndrome). Thus, patients are told to avoid the allergenic food in all potentially allergic forms and amounts. However, research over the past 2 decades has shown that many patients will tolerate small amounts of the allergen without any allergic reaction. Thus, if one were able to identify the threshold of reactivity, this could change management. At the population level, establishing levels at which the vast majority of patients (e.g., 95%) do not react could have public health ramifications, such as altering labeling laws. At the individual patient level, personal threshold levels could determine avoidance strategies, affect quality of life, and alter treatment decisions, e.g., oral immunotherapy starting doses. In this review, threshold data for various allergens and their potential effect on the management of the patient with food allergy are examined.

Keywords: Peanut allergy; double-blind challenge; exposure challenge; food allergy; open challenge.

Figure 1.

Sample peanut oral immunotherapy up-dosing regimen. The full dosing regimen is a typical up-dosing regimen, starting with a low dose, such as 3 mg. However, ∼50% of patients with peanut allergy are reported to tolerate > 120 mg of peanut protein. Thus, if this threshold is known, then many patients can start their dose later in the build-up, such as entering at the darkened arrow.