Low-dose oral food challenges.

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.