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Low-dose oral food challenges
Mari Takei1, Noriyuki Yanagida1, Sakura Sato1
1Department of Allergy, Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
Insights
Low-dose oral food challenges (LD-OFCs) are safe for infants under one year old with food allergies. This method allows safe introduction of small amounts of allergenic foods like egg, milk, and wheat.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Food Hypersensitivity Research
Background:
- Infants under one year with diagnosed food allergies typically require strict avoidance of causative foods.
- Low-dose oral food challenges (LD-OFCs) offer a potential strategy for safely reintroducing small quantities of allergenic foods.
- This study investigated the safety profile of LD-OFCs in infants under one year old with specific food allergies.
Purpose of the Study:
- To evaluate the safety and efficacy of LD-OFCs in infants aged less than one year.
- To determine the incidence and nature of adverse reactions during LD-OFCs for hen's egg, cow's milk, and wheat allergies.
- To assess the feasibility of using LD-OFCs as an initial approach for managing food allergies in this age group.
Main Methods:
- Retrospective analysis of clinical records for LD-OFCs conducted between April 2014 and October 2017.
- Inclusion criteria: infants under one year with confirmed allergies to hen's egg, cow's milk, or wheat.
- Challenge foods included specific low doses of heated hen's egg, heated cow's milk, and wheat noodles (udon).
Main Results:
- The study included 68 infants for LD-OFCs of hen's egg, 42 for cow's milk, and 13 for wheat.
- Positivity rates were 7% for egg, 24% for milk, and 0% for wheat.
- Adverse reactions were primarily mild skin symptoms, managed with oral antihistamines; no anaphylaxis or need for adrenaline was reported.
Conclusions:
- LD-OFCs are a safe method for introducing low doses of causative foods to infants under one year with food allergies.
- Complete food elimination may not always be necessary, and LD-OFCs represent a valuable strategy for initial food introduction in allergic infants.
- These findings support the use of LD-OFCs in pediatric allergy management for early reintroduction of foods.
Background:
Infants aged <1 year with confirmed food allergies generally need to avoid causative foods completely for a certain period. Low-dose oral food challenges (LD-OFCs) may be an effective strategy for safely introducing small amounts of causative foods to individuals with food allergies. This study clarified the safety of LD-OFCs in infants aged <1 year with food allergies.
Methods:
We retrospectively analyzed the clinical records of LD-OFCs performed in infants aged <1 year allergic to hen's egg, cow's milk, or wheat between April 2014 and October 2017. Approximately 1/25th-1/20th of the egg white from a heated whole hen's egg, 3 mL heated cow's milk, and 2 g wheat noodles (udon) were used as challenge foods. We examined the LD-OFC results, including the induced symptoms and treatment required for positive LD-OFC results.
Results:
The LD-Egg, LD-Milk, and LD-Wheat OFC groups comprised 68, 42, and 13 participants, respectively. The positivity rates for the LD-Egg, LD-Milk, and LD-Wheat OFC groups were 7%, 24%, and 0%, respectively. Patients predominantly exhibited skin symptoms, and most were treated with oral antihistamines alone. None of the patients experienced anaphylaxis or required adrenaline injections.
Conclusions:
Infants aged <1 year with food allergies can safely undergo LD-OFCs by consuming low doses of causative foods. Avoiding the complete elimination of causative foods is an important strategy for managing infants with food allergies when initially introducing causative foods.
