Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis - 03/06/21
Abstract |
Background |
Eliciting doses (EDs) (eg, ED01 or ED05 values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown.
Objective |
Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge.
Methods |
We conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between January 2010 and September 2020. Risk of bias was assessed by using National Institute for Clinical Excellence methodologic checklists.
Results |
A total of 19 studies were included (covering a total of 3151 participants, 534 of whom subsequently underwent further peanut challenge). At individual participant data meta-analysis, 4.5% (95% CI, 1.9% to 10.1%) of individuals reacted to 5 mg or less of peanut protein with anaphylaxis (moderate heterogeneity [I2 = 57%]). Intraindividual thresholds varied by up to 3 logs, although this variation was limited to a half-log change in 71.2% (95% CI, 56.2% to 82.6%) of individuals. In all, 2.4% (95% CI, 1.1% to 5.0%) of patients initially tolerated 5 mg of peanut protein but then reacted to this dose at subsequent challenge (low heterogeneity [I2 = 16%]); none developed anaphylaxis.
Conclusion |
Around 5% of individuals reacting to an ED01 or ED05 level of exposure to peanut might develop anaphylaxis in response to that dose. This equates to 1 and 6 anaphylaxis events per 2500 patients exposed to an ED01 or ED05 dose, respectively, in the broader population of individuals with peanut allergy.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Eliciting dose, peanut allergy, thresholds, oral food challenge, precautionary allergen labeling
Abbreviations used : AIT, DBPCFC, ED, ED01, ED05, FC, IPD, LOAEL, PRACTALL, WAO
Plan
| Funded in part by a UK Medical Research Council Clinician Scientist award to P.J.T. (reference MR/K010468/1). N.P. and P.J.T. are supported through the National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare National Health Service Trust and Imperial College London. The views expressed in this article are those of the authors and do not necessarily reflect those of the National Health Service, National Institute for Health Research, the Department of Health, or the Food Standards Agency. |
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| Disclosure of potential conflict of interest: K. Anagnostou reports personal fees from regional and national allergy societies (American College of Allergy, Asthma and Immunology, Eastern Allergy Conference, the Colorado Allergy and Asthma Society, and The Animal Awareness Society) and grants from Aimmune Therapeutics outside the submitted work. D. C. Adelman and A. D. Smith are employees of Aimmune Therapeutics, a Nestlé Health Science Company. J. L. Baument reports personal fees from DBV Technologies and Neogen Corporation outside the submitted work. W. M. Blom reports funding from the Dutch Ministry of Economic Affairs. D. E. Campbell is a part-time employee of DBV Technologies and reports receiving grant support from the National Health and Medical Research Council of Australia and personal fees from Allergenis, Westmead Fertility Centre, and Financial Markets Foundation for Children. R. S. Chinthrajah receives grants from the National Institute of Allergy and Infectious Disease, Consortium for Food Allergy Research, Aimmune Therapeutics, DBV Technologies, Astellas, and Regeneron and is an advisory member for Alladapt, Genentech, Novartis, and Sanofi. B. Javed is a part-time employee of the UK Food Standards Agency but has contributed to this work in her role at the University of Manchester. H. A. Sampson is a part-time employee of DBV Technologies and reports receiving consultancy fees from N-Fold Therapeutics, grant funding from the National Institutes of Health/National Institute of Allergy and Infectious Disease and royalties from Elsevier. E. N. C. Mills reports grants from the UK Biological and Biotechnological Sciences Research Council, DBV Technologies, Reacta Biotech, the Medical Research Council, the European Union, and the UK Food Standards Agency and has patents pending to Reacta Biotech Ltd (PCT/GB2016/051637 and PCT/GB2016/053829). B. C. Remington reports grants and personal fees from DBV Technologies and travel support from International Life Sciences Institute Europe. P. J. Turner reports grants from the UK Medical Research Council, National Institute for Health Research/Imperial Biomedical Researh Centre, and JM Charitable Foundation during the conduct of the study, as well as personal fees from UK Food Standards Agency, Aimmune Therapeutics, Allergenis, and the International Life Sciences Institute Europe outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 6
P. 2249 - juin 2021 Retour au numéro
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