Tweeted by @AACMaven

"Who's afraid of the food challenge?"
http://asthmaallergieschildren.com/2015/07/26/whos-afraid-of-the-food-challenge/

QuoteIn summary, the study demonstrated the likely importance of a very deliberate and detailed discussion about the risks and benefits of the test, addressing biases such as considering whether food is important or not and issues about risk and fear of reactions. Patients should have lots of questions, and their doctors should be prepared to answer them.

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KFA webinar


"Oral Food Challenges: What to Expect"

Tue, Jul 28, 2015 1:00 PM - 2:00 PM EDT

https://attendee.gotowebinar.com/register/7210827419977609473?splash=false

QuoteJoin Dr. Irene J. Mikhail and Kids With Food Allergies for this free webinar

QuoteDr. Mikhail, an allergist and immunologist at Nationwide Children's in Columbus, Ohio

Tweeted by @allergydoc4kidz

QuoteOFC not intended to establish "severity" or threshold, simply confirm or refute clinical hypersensitivity #EAACI2015

I wonder if this type of thinking will eventually change regarding threshold.  Finding out that dd had a high sesame threshold had a huge impact on our quality of life. 


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Re: CSPI Sesame Petition filed!!!

Quote from: LinksEtc on May 27, 2015, 11:06:34 AM

1) My opinion is that allergists need to understand labeling rules & limitations in order to best advise allergy families on avoidance.  Especially for the non-top8, the risk of reaction should be balanced with quality of life & family mental health considerations (imo).  Unless medically necessary, pls don't set almost impossibly high avoidance standards.

Might help determine whether the Mount Sinai non-big8 common sense approach is ok to try.

Food Allergen Labeling: Using "common sense" when assessing safety

plus

cases where strict avoidance not always needed - ex baked egg

&

"Sesame oil allergy"
http://www.aaaai.org/ask-the-expert/sesame-oil.aspx

QuoteIn summary, I would suggest your patient continue to eat sesame seed but avoid hummus.

"What level of avoidance is medically necessary (ex - cross-contact, flavors, etc)" is a very important ? when strict avoidance is so difficult due to poor labeling.


There is a difference between OIT & keeping low level amts in diet if tolerated.


Reminder for patients - Always strictly avoid allergens unless your allergist advises otherwise.


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"5 Reasons Patients Shun Critical Food Allergy Testing"
http://allergicliving.com/2015/07/08/5-reasons-patients-shun-critical-food-allergy-testing/1/

QuoteWith the assistance of colleagues at the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, he decided to investigate why parents sometimes weren't taking up the offer for a food challenge – considered the most definitive test for food allergy.

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Re: Allergic Living

Tweeted by @AllergieVoeding

"The impact of oral food challenge tests on food allergy health-related quality of life."
http://www.ncbi.nlm.nih.gov/pubmed/24925125?dopt=Abstract&utm_source=dlvr.it&utm_medium=twitter

QuoteFood allergy health-related quality of life (FAQOL)

QuoteOf 54 children who had a food challenge between September 2012 and February 2013, 25 were positive (allergic) and 29 were negative (nonallergic). FAQOL improved significantly from 2 months prechallenge to 2 months postchallenge for both groups, but began to decrease at 6 months postchallenge in allergic patients.

"Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses"
http://www.nutritionj.com/content/12/1/22

What constitutes a "FAIL"?


"False-negative oral food challenge"
http://www.aaaai.org/ask-the-expert/false-negative-oral-food-challenge.aspx

Quotecertainly it has long been known that false-negative office-based food challenges occur. I have personally seen them. So knowledge of such false-negative reactions should be factored in when you assess the risk/benefit ratio of performing an oral food challenge.

"Evidence for False-Negative Open Food Challenges"

Quote
A total of 334 challenges on 276 patients were reviewed. The majority of challenges, 253 (76%), were negative. There were 4 cases (1.6%) in which patients developed symptoms consistent with an IgE-mediated allergic reaction at home to the challenged foods after appearing to pass an open-OFC: 2 were to soy, 1 to egg, and 1 to cashew. Time to symptom exacerbations following the negative challenges ranged from 6 hours to 5 months.

"When is an oral food challenge positive?"
http://www.ncbi.nlm.nih.gov/pubmed/19796198

QuoteThere are a number of causes for false positive and false negative challenge results

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Lala's DS-- passing a peanut challenge and REDEVELOPING the allergy

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"Continuing food-avoidance diets after negative food challenges."
http://www.ncbi.nlm.nih.gov/pubmed/17121588

QuoteAmong other reasons listed, fears of persistence of allergies, with recurrent pruritus or non-specific skin rashes after eating the food, were reported in 12.7% of the total number of questionnaires.

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http://www.livingwithout.com/issues/4_7/pediactric_allergies_qa-1928-1.html

QuoteThere are circumstances when a child can become re-sensitized to the allergen even after passing the initial challenge. In addition, a few studies suggest that up to 6 percent of children who pass an oral food challenge may experience a return of their symptoms up to six months or a year after the challenge. To be on the safe side, many allergists advise parents to continue to closely monitor their child's food intake and to take precautions regarding reintroducing problem foods for about six months after the challenge.

---------------------------------

"OUTGROWN" A PEANUT ALLERGY? EAT MORE PEANUTS!"
http://www.hopkinsmedicine.org/press_releases/2004/11_09a_04.html

QuoteWood also recommends that those children who do eat concentrated peanut products frequently carry epinephrine injections for at least one year after passing an oral food challenge

Can SPT and Serum-Specific IgE Predict the Resolution of FA?

Is there a positive predictive value for sesame?

Who will outgrow egg allergy?  New info on how to tell

"Diagnosis of food allergy: Are skin prick tests (SPT) better than specific-IgE (sIgE) tests?"
http://allergynotes.blogspot.com/2014/03/diagnosis-of-food-allergy-are-skin.html

QuoteIn my academic clinical practice, SPTs have more clinical relevance than sIgE. It is not uncommon for patients with a negative sIgE (lower than 0.35) and a positive SPT (larger than 3 mm) to have a clinical reaction during food challenges. It is very unusual for a patient with with a negative SPT to have a reaction during a food challenge.

"Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy"
http://www.annallergy.org/article/PIIS1081120613000513/abstract?buffer_share=a2285&rss=yes&utm_source=buffer


"Predicting Outcomes of Oral Food Challenges by Using the Allergen-specific IgE–Total IgE Ratio"
http://www.jaci-inpractice.org/article/S2213-2198(13)00510-2/abstract

QuoteTo examine the accuracy of the ratio of sIgE to total IgE ("Ratio") in predicting the outcome of challenges performed to confirm the development of tolerance.

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Tweeted by @Aller_MD

"When to do an oral food challenge when skin tests and in vitro tests give divergent results"
http://www.aaaai.org/ask-the-expert/oral-food-challenge-skin-test.aspx?utm_content=bufferd04ac&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

QuoteThere are clearly circumstances in which the skin test and serum IgE level do not "agree" with one another, and in these instances, one must make a clinical judgement on the risk of challenge in conjunction with the patient's/parents' wishes.

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"Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology–European Academy of Allergy and Clinical Immunology PRACTALL consensus report"

http://www.jacionline.org/article/S0091-6749(12)01663-6/fulltext

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"Food Allergy: Practical Diagnosis and Management"
Edited by Scott H. Sicherer, MD

Chapter 8:  The Oral Food Challenge Procedure

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"Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel"

http://www.jacionline.org/article/S0091-6749(10)01566-6/fulltext#sec5.2.2.8

4.2.2.8. Oral food challenges

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"What to Expect at an Oral Food Challenge:
A Food Allergy Specialty Nurse Shares Insights"
By Anne F. Russell BSN, RN, AE-C

http://www.foodallergy.org/document.doc?id=235

QuoteWe use the term "pass," but not the word "fail" to describe results. Years ago I learned how negative the word fail can be from a teen who felt she "did not fail, but earned a C-."

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"Demystifying Oral Food Challenges"

http://www.kidswithfoodallergies.org/docs/Demystifying-Food-Challenges-for-Food-Allergy.pdf?pdf=Oral-Food-Challenges