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Oral food challenges in children in Italy
A Martelli1, G R Bouygue, P Isoardi
1Melloni Paediatria, Milan, Italy.
Insights
A nationwide survey of Italian pediatric allergy centers found significant variation in oral food challenge procedures and facilities. Standardization is needed before widespread implementation of these diagnostic tests for food allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Epidemiology
Background:
- An estimated 900,000 children in Italy may self-report food allergies.
- The double-blind, placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing food allergies.
- Nationwide data on the application of DBPCFC in pediatric centers were lacking.
Purpose of the Study:
- To assess the current practices and logistical aspects of oral food challenges in Italian pediatric allergy centers.
- To identify variations in diagnostic criteria, facilities, and procedures used for food allergy testing.
Main Methods:
- A nationwide questionnaire survey of hospital-based pediatric allergy centers was conducted from January 1 to June 30, 2003.
- The survey collected data on medical facilities, personnel, patient selection, foods tested, blinding, placebo use, evaluation criteria, and outcome rates for 2002.
- A 27-point questionnaire was distributed to all registered centers.
Main Results:
- Out of 456 centers, 202 (44.3%) responded, with one center serving approximately 37,400 children.
- A total of 11,728 food challenges were performed in 2002, with an average of 58 per center (range: 1-500).
- Cow's milk (100%) and egg (77.2%) were the most frequently tested foods. Only 18 centers used double-blinded challenges, and 28.6% of procedures were positive.
Conclusions:
- Significant heterogeneity exists in the criteria, facilities, and procedures for oral food challenges across Italian pediatric allergy centers.
- Many centers perform a low volume of procedures, suggesting a need for resource rationalization.
- Standardization of diagnostic procedures is recommended before widespread implementation in food allergy workup.
Background:
Epidemiological surveys identify a 900,000-strong potential paediatric population who may self-report with food allergy in Italy. As the reference test is the double-blind, placebo-controlled food challenge for diagnosis, we carried out a nation-wide questionnaire survey of hospital-based paediatric allergy centres between 1 January and 30 June 2003.
Methods:
All registered centres received a 27-point questionnaire polling logistics and protocols of oral food challenge. Items polled included medical facilities and personnel, selection of patients, foods tested, blinding, placebo use, evaluation criteria, number of tests and positive outcome rates in 2002.
Results:
Two hundred and two of 456 responders (44.3%) carried out food challenges (a ratio of one centre to 37,400 children in the general population). 11,728 challenges were performed in 2002 (an average of 58 procedures per centre; range: 1-500) and 3350 procedures were claimed positive (28.6%). Cow's milk was tested by all centres, egg by 77.2%, beef by 19.8% and cereals, peanuts, fish or fruit collectively by 37.6%. Twenty-nine of 202 centres performed blinded tests, 18 of which under double-blinded conditions. In cow's milk challenges, placebos included lyophilized cow's milk capsules, soy formula, extensive whey hydrolysate or extensive casein hydrolysate.
Conclusion:
Our survey reveals great differences in challenge test criteria, facilities and procedures and that many centres perform relatively few procedures. This argues in favour of greater rationalization in the allocation of tertiary-level resources before procedure standardization can be contemplated in the diagnostic workup of food allergy.
