Component-Driven Oral Food Challenges in the Community

Authors

  • Julie Wang, MD
  • Shouling Zhang, MD

DOI:

https://doi.org/10.58931/cait.2022.2127

Abstract

The diagnosis of immunoglobulin E (IgE) mediated food allergy is based on the clinical evaluation of a patient’s history, physical examination, and specific test results.These tests may include skin prick testing, serum IgE testing, and/or oral food challenge (OFC). Component-resolved diagnosis (CRD) targeting specific allergenic proteins in a food has the potential for improved diagnostic accuracy compared to serum IgE testing to whole allergens. An overview of the clinical considerations of how and when to proceed with an OFC will be outlined in this review, with special consideration given to the utility of component testing in making this determination.

Author Biographies

Julie Wang, MD

Dr. Julie Wang is Professor of Pediatrics in the Division of Allergy and Immunology at the Icahn School of Medicine at Mount Sinai. Her research focuses on clinical trials investigating novel food allergy therapies, food allergy management, and anaphylaxis in schools. She serves on the Joint Task Force on Practice Parameters, is Chair of the Executive Committee, Section on Allergy and Immunology of the AAP, and serves on the Editorial Board of the Journal of Allergy and Immunology and Journal of Allergy and Immunology: In Practice. She is co-program director for the Mount Sinai Allergy and Immunology Fellowship Training Program.

Shouling Zhang, MD

Dr. Shouling Zhang is currently a second year clinical fellow in allergy and immunology at Icahn School of Medicine at Mount Sinai. She graduated from University of Rochester with a dual degree in Biological Sciences: Microbiology and Psychology. She went on to receive her medical degree at Stony Brook University School of Medicine and completed her residency training in pediatrics at Cohen Children’s Medical Center in New York. Her interests include clinical research and practice, with a special interest in food allergy and childhood atopy.

References

Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol. 2014 Nov;134(5):1016-25.e43. doi:10.1016/j.jaci.2014.05.013

Valenta R, Lidholm J, Niederberger V, Hayek B, Kraft D, Grönlund H. The recombinant allergen-based concept of component-resolved diagnostics and immunotherapy (CRD and CRIT). Clin Exp Allergy. 1999 Jul;29(7):896-904. doi:10.1046/j.1365-2222.1999.00653.x

Burks AW, Tang M, Sicherer S, et al. ICON: food allergy. J Allergy Clin Immunol. 2012 Apr;129(4):906-20. doi:10.1016/j.jaci.2012.02.001

Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009 Jun;123(6 Suppl):S365-83. doi:10.1016/j.jaci.2009.03.042

Bird JA, Leonard S, Groetch M, et al. Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. J Allergy Clin Immunol Pract. 2020 Jan;8(1):75-90.e17. doi:10.1016/j.jaip.2019.09.029

Wang J. Component testing for pollen-related, plant-derived food allergies. In: Scott H. Sicherer ET, ed. UpToDate; 2021.

Wang J. Component testing for animal-derived food allergies. In: Scott H. Sicherer ET, ed. UpToDate; 2021.

Vieths S, Scheurer S, Ballmer-Weber B. Current understanding of cross-reactivity of food allergens and pollen. Annals of the New York Academy of Sciences. 2002 May;964:47-68. doi:10.1111/j.1749-6632.2002.tb04132.x

Rodriguez J, Crespo JF, Lopez-Rubio A, et al. Clinical cross-reactivity among foods of the Rosaceae family. J Allergy Clin Immunol. 2000 Jul;106(1 Pt 1):183-9. doi:10.1067/mai.2000.106927

Breiteneder H, Radauer C. A classification of plant food allergens. J Allergy Clin Immunol. 2004 May;113(5):821-30; quiz 831. doi:10.1016/j.jaci.2004.01.779

Pastorello EA, Robino AM. Clinical role of lipid transfer proteins in food allergy. Molecular nutrition & food research. 2004 Oct;48(5):356-62. doi:10.1002/mnfr.200400047

Greenhawt M, Shaker M, Wang J, et al. Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol. 2020 Dec;146(6):1302-1334. doi:10.1016/j.jaci.2020.07.031

Lieberman JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract. 2013 Jan;1(1):75-82. doi:10.1016/j.jaip.2012.11.002

Klemans RJ, Broekman HC, Knol EF, et al. Ara h 2 is the best predictor for peanut allergy in adults. J Allergy Clin Immunol Pract. 2013 Nov-Dec ;1(6):632-8.e1. doi:10.1016/j.jaip.2013.07.014

Dang TD, Tang M, Choo S, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara h 2. J Allergy Clin Immunol. 2012 Apr;129(4):1056-63. doi:10.1016/j.jaci.2012.01.056

Eller E, Bindslev-Jensen C. Clinical value of component-resolved diagnostics in peanut-allergic patients. Allergy. 2013 Feb;68(2):190-4. doi:10.1111/all.12075

Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010 Jan;125(1):191-7.e1-13. doi:10.1016/j.jaci.2009.10.008

Beyer K, Grabenhenrich L, Härtl M, et al. Predictive values of component-specific IgE for the outcome of peanut and hazelnut food challenges in children. Allergy. 2015 Jan;70(1):90-8. doi:10.1111/all.12530

Hemmings O, Niazi U, Kwok M, et al. Combining Allergen Components Improves the Accuracy of Peanut Allergy Diagnosis. J Allergy Clin Immunol Pract. 2022 Jan;10(1):189-199. doi:10.1016/j.jaip.2021.08.029

Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012 Aug;130(2):468-72. doi:10.1016/j.jaci.2012.05.019

Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. J Allergy Clin Immunol Pract. 2013 Jan;1(1):1-13; quiz 14. doi:10.1016/j.jaip.2012.10.004

Keet CA, Johnson K, Savage JH, Hamilton RG, Wood RA. Evaluation of Ara h2 IgE thresholds in the diagnosis of peanut allergy in a clinical population. J Allergy Clin Immunol Pract. 2013 Jan;1(1):101-3. doi:10.1016/j.jaip.2012.08.007

van der Valk JP, Gerth van Wijk R, Vergouwe Y, et al. sIgE Ana o 1, 2 and 3 accurately distinguish tolerant from allergic children sensitized to cashew nuts. Clin Exp Allergy. 2017 Jan;47(1):113-120. doi:10.1111/cea.12794

Lange L, Lasota L, Finger A, et al. Ana o 3-specific IgE is a good predictor for clinically relevant cashew allergy in children. Allergy. 2017 Apr;72(4):598-603. doi:10.1111/all.13050

Savvatianos S, Konstantinopoulos AP, Borgå Å, et al. Sensitization to cashew nut 2S albumin, Ana o 3, is highly predictive of cashew and pistachio allergy in Greek children. J Allergy Clin Immunol. 2015 Jul;136(1):192-4. doi:10.1016/j.jaci.2015.03.037

Sato S, Movérare R, Ohya Y, et al. Ana o 3-specific IgE is a predictive marker for cashew oral food challenge failure. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2909-2911.e4. doi:10.1016/j.jaip.2019.04.049

Beyer K, Grishina G, Bardina L, Grishin A, Sampson HA. Identification of an 11S globulin as a major hazelnut food allergen in hazelnut-induced systemic reactions. J Allergy Clin Immunol. 2002 Sep;110(3):517-23. doi:10.1067/mai.2002.127434

Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol. 2013 Aug;132(2):393-9. doi:10.1016/j.jaci.2013.02.024

De Knop KJ, Verweij MM, Grimmelikhuijsen M, et al. Age-related sensitization profiles for hazelnut (Corylus avellana) in a birch-endemic region. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. 2011 Feb;22(1 Pt 2):e139-49. doi:10.1111/j.1399-3038.2011.01112.x

Ballmer-Weber BK, Lidholm J, Lange L, et al. Allergen Recognition Patterns in Walnut Allergy Are Age Dependent and Correlate with the Severity of Allergic Reactions. J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1560-1567.e6. doi:10.1016/j.jaip.2019.01.029

Elizur A, Appel MY, Nachshon L, et al. Clinical and Molecular Characterization of Walnut and Pecan Allergy (NUT CRACKER Study). J Allergy Clin Immunol Pract. 2020 Jan;8(1):157-165.e2. doi:10.1016/j.jaip.2019.08.038

Blankestijn MA, Blom WM, Otten HG, et al. Specific IgE to Jug r 1 has no additional value compared with extract-based testing in diagnosing walnut allergy in adults. J Allergy Clin Immunol. 2017 Feb;139(2):688-690.e4. doi:10.1016/j.jaci.2016.07.026

Rayes H, Raza AA, Williams A, Matthews S, Arshad SH. Specific IgE to recombinant protein (Ber e 1) for the diagnosis of Brazil nut allergy. Clin Exp Allergy. 2016 Apr;46(4):654-6. doi:10.1111/cea.12693

Baar A, Pahr S, Constantin C, et al. Specific IgE reactivity to Tri a 36 in children with wheat food allergy. J Allergy Clin Immunol. 2014 Feb;133(2):585-7. doi:10.1016/j.jaci.2013.10.044

Daengsuwan T, Palosuo K, Phankingthongkum S, et al. IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis. Allergy. 2005 Apr;60(4):506-9. doi:10.1111/j.1398-9995.2004.00656.x

Palosuo K, Varjonen E, Kekki OM, et al. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol. Oct 2001;108(4):634-8. doi:10.1067/mai.2001.118602

Shibata R, Nishima S, Tanaka A, Borres MP, Morita E. Usefulness of specific IgE antibodies to ω-5 gliadin in the diagnosis and follow-up of Japanese children with wheat allergy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. Oct 2011;107(4):337-43. doi:10.1016/j.anai.2011.07.013

Kattan JD, Sampson HA. Clinical reactivity to soy is best identified by component testing to Gly m 8. J Allergy Clin Immunol Pract. Nov-Dec 2015;3(6):970-2.e1. doi:10.1016/j.jaip.2015.06.002

Bernhisel-Broadbent J, Sampson HA. Cross-allergenicity in the legume botanical family in children with food hypersensitivity. J Allergy Clin Immunol. Feb 1989;83(2 Pt 1):435-40. doi:10.1016/0091-6749(89)90130-9

Wal JM. Bovine milk allergenicity. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. Nov 2004;93(5 Suppl 3):S2-11. doi:10.1016/s1081-1206(10)61726-7

Cingolani A, Di Pillo S, Cerasa M, et al. Usefulness of nBos d 4, 5 and nBos d 8 Specific IgE Antibodies in Cow’s Milk Allergic Children. Allergy, asthma & immunology research. Mar 2014;6(2):121-5. doi:10.4168/aair.2014.6.2.121

Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol. Aug 2008;122(2):342-7, 347.e1-2. doi:10.1016/j.jaci.2008.05.043

Caubet JC, Nowak-Węgrzyn A, Moshier E, Godbold J, Wang J, Sampson HA. Utility of casein-specific IgE levels in predicting reactivity to baked milk. J Allergy Clin Immunol. Jan 2013;131(1):222-4.e1-4. doi:10.1016/j.jaci.2012.06.049

Bartnikas LM, Sheehan WJ, Hoffman EB, et al. Predicting food challenge outcomes for baked milk: role of specific IgE and skin prick testing. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. Nov 2012;109(5):309-313.e1. doi:10.1016/j.anai.2012.07.026

De Boer R, Cartledge N, Lazenby S, et al. Specific IgE as the best predictor of the outcome of challenges to baked milk and baked egg. J Allergy Clin Immunol Pract. Apr 2020;8(4):1459-1461.e5. doi:10.1016/j.jaip.2019.10.039

Agyemang A, Saf S, Sifers T, et al. Utilizing boiled milk sIgE as a predictor of baked milk tolerance in cow’s milk allergic children. J Allergy Clin Immunol Pract. Jul-Aug 2019;7(6):2049-2051. doi:10.1016/j.jaip.2019.01.034

Dantzer JA, Dunlop JH, Wood RA. Standard testing fails to identify patients who tolerate baked milk. J Allergy Clin Immunol. Dec 2020;146(6):1434-1437.e2. doi:10.1016/j.jaci.2020.03.030

Esty B, Maciag MC, Bartnikas LM, et al. Predicting outcomes of baked egg and baked milk oral food challenges by using a ratio of food-specific IgE to total IgE. J Allergy Clin Immunol Pract. Apr 2021;9(4):1750-1752.e1. doi:10.1016/j.jaip.2020.11.004

Alessandri C, Zennaro D, Scala E, et al. Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen’s egg and an increased risk to progress to multiple environmental allergen sensitisation. Clin Exp Allergy. Mar 2012;42(3):441-50. doi:10.1111/j.1365-2222.2011.03915.x

Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. Sep 2008;122(3):583-8. doi:10.1016/j.jaci.2008.06.016

Lemon-Mulé H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. Nov 2008;122(5):977-983.e1. doi:10.1016/j.jaci.2008.09.007

Caubet JC, Bencharitiwong R, Moshier E, Godbold JH, Sampson HA, Nowak-Węgrzyn A. Significance of ovomucoid- and ovalbumin-specific IgE/IgG(4) ratios in egg allergy. J Allergy Clin Immunol. Mar 2012;129(3):739-47. doi:10.1016/j.jaci.2011.11.053

Bartnikas LM, Sheehan WJ, Larabee KS, Petty C, Schneider LC, Phipatanakul W. Ovomucoid is not superior to egg white testing in predicting tolerance to baked egg. J Allergy Clin Immunol Pract. Jul-Aug 2013;1(4):354-60. doi:10.1016/j.jaip.2013.04.002

Saifi M, Swamy N, Crain M, Brown LS, Bird JA. Tolerance of a high-protein baked-egg product in egg-allergic children. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. May 2016;116(5):415-9. doi:10.1016/j.anai.2015.12.012

Wang J, Calatroni A, Visness CM, Sampson HA. Correlation of specific IgE to shrimp with cockroach and dust mite exposure and sensitization in an inner-city population. J Allergy Clin Immunol. Oct 2011;128(4):834-7. doi:10.1016/j.jaci.2011.07.045

Pascal M, Grishina G, Yang AC, et al. Molecular Diagnosis of Shrimp Allergy: Efficiency of Several Allergens to Predict Clinical Reactivity. J Allergy Clin Immunol Pract. Jul-Aug 2015;3(4):521-9.e10. doi:10.1016/j.jaip.2015.02.001

Theler B, Brockow K, Ballmer-Weber BK. Clinical presentation and diagnosis of meat allergy in Switzerland and Southern Germany. Swiss medical weekly. May 2 2009;139(17-18):264-70.

Component Driven Oral Food Challenges in the Community

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Published

2022-04-01

How to Cite

1.
Wang J, Zhang S. Component-Driven Oral Food Challenges in the Community. Can Allergy Immunol Today [Internet]. 2022 Apr. 1 [cited 2024 Oct. 22];2(1):9–14. Available from: https://canadianallergyandimmunologytoday.com/article/view/2-1-wang-zhang

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Volume 2, Issue 1, April 2022

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Articles