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Food allergy in infants and children: clinical evaluation and management
1Allergy Unit, Kipper Institute of Immunology, Children's Medical Center of Israel, Petah Tikva.
Insights
Cow milk, egg white, soy, and peanut are common pediatric food allergies. Oral food challenges are the gold standard for diagnosis, while skin tests are unreliable predictors of reactions.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Immunology
Background:
- Food allergy is a significant concern in infants and children.
- Accurate diagnosis is crucial for effective management and prevention of adverse reactions.
Purpose of the Study:
- To evaluate common food allergens in pediatric patients.
- To assess the diagnostic accuracy of skin prick tests versus oral food challenges.
- To determine the safety of measles-mumps-rubella (MMR) vaccine in children with egg allergy.
Main Methods:
- Retrospective analysis of 122 pediatric patients referred for food allergy.
- Inclusion of patient history, physical examination, skin prick tests, and oral food challenges.
- Specific protocols for skin testing and oral challenges, including MMR vaccine testing in a subset of patients.
Main Results:
- Cow milk/formula, egg white, soybean, and peanut were identified as the primary allergens.
- Oral food challenges confirmed allergies in 13 children, predominantly to cow milk/formula.
- Negative skin tests showed high predictive value for negative oral challenges in children over 3 years old.
- Positive skin tests were poor predictors of clinical reactions.
- MMR vaccine was safely administered to infants with egg allergy post-skin testing.
Conclusions:
- Oral food challenge is the gold standard for diagnosing pediatric food allergies.
- Skin prick tests have limitations in predicting clinical reactivity.
- Cow milk and egg white are prevalent allergens in this pediatric cohort.
- MMR vaccination is safe for children with egg allergy following appropriate skin testing.
Abstract:
A total of 122 infants and children up to age 17 (69 males and 53 females) who were referred for food allergy to the Pediatric Allergy and Clinical Immunology Unit were evaluated by complete history, emphasizing the implicated foods, clinical presentation and involvement of various organ systems, physical examination, and prick skin tests to food allergens. Fourteen infants with a history of egg white allergy and positive skin tests to egg white also underwent skin tests (prick and intradermal in 1:100 dilution) to measles-mumps-rubella (MMR) vaccine; 35 children under 3 years old had 41 oral challenges with the suspected foods; and 9 children over 3 years old had 12 oral challenges with the suspected foods. We found that cow milk/humanized milk formula, egg white, soybean, and peanut are the main allergenic foods in the pediatric population. Thirteen children had 13 positive oral challenges: 12 to cow milk/humanized milk formula and one to egg white. Symptoms reproduced by oral challenges included urticarial and erythematous rash, conjunctival itching, angioedema, abdominal pain, vomiting, diarrhea, and rhinorrhea. No anaphylactic shock was reported. Negative skin test has an excellent predictive accuracy for negative oral challenge with the suspected food in children > 3 years old. The negative predictive accuracy of cow milk skin test in children < 3 years was 73%. Positive skin test is not a good predictor of a clinical reaction to food. Oral food challenge performed cautiously in a medical setting is the "gold standard" for diagnosis. MMR vaccine can be safely administered to infants with egg white allergy after skin tests with the vaccine are performed.