Alergia pokarmowa
Rokowania, prognozy i postęp choroby

Alergia pokarmowa (AP) dotyka 6-8% małych dzieci, osiągając szczyt około 1. roku życia, i jest definiowana jako niepożądana odpowiedź immunologiczna na białka pokarmowe, manifestująca się objawami ze strony układów: dermatologicznego, oddechowego, pokarmowego, sercowo-naczyniowego i/lub neurologicznego. Najcięższą formą jest anafilaksja, wymagająca natychmiastowego podania epinefryny. Przewidywanie przebiegu i ciężkości alergii jest trudne, choć monitorowanie poziomów swoistych IgE (sIgE) i wyników testów skórnych (SPT) z 95% dodatnią wartością predykcyjną (PPV) pomaga w ocenie ryzyka i kwalifikacji do immunoterapii doustnej (OIT). Naturalny przebieg alergii IgE-zależnej na mleko, jajko, soję i pszenicę często prowadzi do ustąpienia w dorosłości, natomiast alergia na orzeszki ziemne ustępuje u około 20-50% dzieci. Poziomy sIgE i wielkość bąbla w SPT korelują z ryzykiem reakcji, jednak ciężkość reakcji pozostaje w dużej mierze nieprzewidywalna.

  1. Wprowadzenie do rokowania w alergii pokarmowej
  2. Historia naturalna alergii pokarmowej
    1. Przewidywanie ustępowania alergii pokarmowej
  3. Predyktory wyniku alergii pokarmowej
    1. Specyficzne czynniki predykcyjne
    2. Nowe biomarkery
  4. Doustne próby prowokacyjne w rokowaniu
    1. Zastosowanie OFC w monitorowaniu
  5. Metody oceny ryzyka
    1. Metody probabilistyczne
  6. Ograniczenia w przewidywaniu ciężkości reakcji
  7. Implikacje dla zarządzania alergią pokarmową
    1. Potrzeby przyszłych badań
    2. Kolejne rozdziały

Wprowadzenie do rokowania w alergii pokarmowej

Alergia pokarmowa (AP) dotyka około 6-8% małych dzieci, osiągając szczyt występowania w wieku około jednego roku życia. Jest definiowana jako niepożądana odpowiedź immunologiczna na białka pokarmowe, która wywołuje typowe objawy kliniczne obejmujące układy: dermatologiczny, oddechowy, pokarmowy, sercowo-naczyniowy i/lub neurologiczny. 12

Przewidywanie ciężkości i przebiegu alergii pokarmowej stanowi kluczową kwestię dla personelu medycznego, pacjentów, decydentów i przemysłu spożywczego, umożliwiając precyzyjne ukierunkowanie leczenia oraz poprawę strategii zarządzania i prewencji. Obecnie istnieje znaczna niepewność dotycząca czynników predykcyjnych ciężkości diagnostycznych lub przypadkowych reakcji alergicznych na pokarmy oraz zakresu, w jakim można przewidzieć nasilenie takich reakcji. 3

Anafilaksja jest najcięższą formą klinicznej manifestacji alergii pokarmowej IgE-zależnej, a epinefryna w formie iniekcji jest leczeniem pierwszego rzutu. Potencjał wystąpienia tego poważnego powikłania oraz szeroki zasięg medialny tego zjawiska doprowadził do zwiększonej świadomości na temat alergii pokarmowych i strachu u osób dotkniętych tym schorzeniem. 4

Historia naturalna alergii pokarmowej

Alergia pokarmowa IgE-zależna jest stanem przejściowym dla niektórych dzieci, choć obecnie istnieje niewiele wskaźników pozwalających przewidzieć, kiedy i u kogo alergia pokarmowa ustąpi. Naturalny przebieg alergii IgE-zależnej na mleko krowie, jajko, soję i pszenicę charakteryzuje się tendencją do ustępowania od wieku dziecięcego do dorosłości. 56

Dane dotyczące częstości ustępowania alergii różnią się między badaniami. Około 20% alergii na orzeszki ziemne ustępuje w dzieciństwie, choć niektóre doniesienia sugerują, że nawet do 50% alergii na orzeszki ziemne ma charakter przejściowy. 7

Ustąpienie alergii pokarmowej związane jest ze zmniejszeniem poziomu swoistych IgE w surowicy, dlatego też seryjne oznaczanie tych poziomów może pomóc przewidzieć ustąpienie choroby. 8

Przewidywanie ustępowania alergii pokarmowej

Obecnie jedynym dostępnym narzędziem do monitorowania naturalnego przebiegu alergii są poziomy IgE, mierzone za pomocą testów skórnych (SPT) lub oznaczania swoistych IgE w surowicy (sIgE). Monitorowanie SPT i sIgE może pomóc zidentyfikować dzieci, u których mało prawdopodobne jest rozwinięcie tolerancji, i które mogłyby zostać zakwalifikowane do interwencji takich jak immunoterapia doustna (OIT). 9

W praktyce klinicznej często wykorzystuje się progi SPT i sIgE o 95% dodatniej wartości predykcyjnej (PPV) dla alergii pokarmowej, aby zmniejszyć potrzebę przeprowadzania doustnych prób prowokacyjnych (OFC). Gdyby opracowano starannie i systematycznie mierzone progi o 95% PPV, mogłyby one zostać wykorzystane do określenia optymalnego czasu ponownej oceny dzieci i konieczności powtórzenia OFC u dzieci z alergią pokarmową. 10

Predyktory wyniku alergii pokarmowej

W rokowaniu alergii pokarmowej uczestniczy wiele czynników determinujących: pochodzenie etniczne i płeć, rodzaj pokarmu, wrodzona odpowiedź immunologiczna, dawka wywołująca, status sensytyzacji i inne biomarkery, skład mikrobioty jelitowej oraz obecność chorób współistniejących. Po zidentyfikowaniu przetrwałej alergii pokarmowej można zastosować aktywne metody leczenia, takie jak immunoterapia doustna lub użycie leków biologicznych, zawsze biorąc pod uwagę ich eksperymentalny charakter. 11

Specyficzne czynniki predykcyjne

Wartość predykcyjna swoistych IgE różni się w zależności od badanej populacji i konkretnego alergenu. Można stwierdzić, że niewykrywalne poziomy sIgE wiążą się z niskim ryzykiem reakcji, podczas gdy wyższe poziomy zwiększają prawdopodobieństwo reakcji alergicznej. 12

Najbardziej przekonujące wyniki dotyczą danych o czułości i ujemnej wartości predykcyjnej (NPV) wielkości bąbla w testach SPT i poziomów IgE: w wielu badaniach niewykrywalne poziomy sIgE i negatywne wyniki SPT są związane z niskim ryzykiem reakcji podczas OFC. Ponadto w innych badaniach większy rozmiar bąbla SPT i wyższy poziom sIgE korelują z wyższym ryzykiem reakcji na małą ilość alergennego pokarmu. 13

Wyniki badań wskazują, że kombinacja wieku, całkowitego IgE i swoistego IgE dla alergenu pokarmowego koreluje ze zwiększonym prawdopodobieństwem pozytywnego wyniku OFC dla potwierdzenia tolerancji u dzieci z alergią na jajko lub mleko. 14

Nowe biomarkery

Jednym z głównych wyzwań w immunoterapii alergii pokarmowej jest brak specyficznych biomarkerów do diagnozy choroby, monitorowania jej przebiegu, oceny terapii i przewidywania rokowania. 15

Obiecujące zastosowanie metod bioinformatycznych do porównania cech mechanistycznych między różnymi alergiami pokarmowymi i identyfikacji biologicznego znaczenia biomarkerów immunoterapii alergii pokarmowej może być przydatne do generowania nowych hipotez wyjaśniających, dlaczego alergia na białko mleka krowiego (CMA) ma inny wzorzec choroby niż alergia na orzeszki ziemne (PNA) oraz do wyboru biomarkerów użytecznych w przyszłych badaniach klinicznych. 16

Doustne próby prowokacyjne w rokowaniu

Złotym standardem diagnostyki alergii pokarmowych jest doustna próba prowokacyjna (OFC). W literaturze dane są sprzeczne co do tego, czy zwiększone stężenie sIgE i wielkość bąbla w SPT korelują z wynikami OFC. Większość badań wykazała, że testy in vivo i in vitro mogą przewidywać wyniki OFC z różną wartością predykcyjną, ale dane nie są jednoznaczne; dlatego OFC pozostaje obecnie złotym standardem diagnozy alergii pokarmowej. 17

Chociaż OFC jest stosowany w codziennej praktyce klinicznej, jest on kłopotliwy, wymagający odpowiedniego otoczenia z wyspecjalizowanym zespołem, ponieważ może wywołać ciężką reakcję alergiczną, aż do anafilaksji. 18

Zastosowanie OFC w monitorowaniu

OFC są najczęściej wykonywane w celu potwierdzenia rozwoju tolerancji (liczba, %; 267, 61,8%). Wskaźnik pozytywnych wyników był najwyższy wśród OFC dla potwierdzenia diagnozy (n = 83, 72,8%), a następnie dla potwierdzenia tolerancji (n = 179, 67,0%). 19

Opracowano nomogram do przewidywania wyniku OFC w celu określenia nabycia tolerancji z wybranymi zmiennymi; niższe swoiste IgE dla alergenu pokarmowego, wyższe całkowite IgE i młodszy wiek wskazywały na wyższe prawdopodobieństwo przejścia próby. Surowicze całkowite IgE i swoiste IgE dla alergenu pokarmowego w połączeniu z wiekiem wykazywały tendencję do pozytywnego wyniku OFC dla potwierdzenia rozwoju tolerancji. 20

Nomogram dla OFC z jajkiem w celu potwierdzenia tolerancji pokazał, że młodszy wiek, wyższy poziom całkowitego IgE i niższy poziom swoistych IgE dla białka jaja zwiększały prawdopodobieństwo przejścia próby. Podobnie w nomogramie dla OFC z mlekiem, młodszy wiek, niższy poziom IgE dla mleka krowiego i wyższy poziom całkowitego IgE wskazywały na wyższe prawdopodobieństwo pozytywnego wyniku. 21

Metody oceny ryzyka

Międzynarodowe warsztaty pod auspicjami projektu Europrevall zgodziły się, że modelowanie probabilistyczne jest najbardziej obiecującym podejściem do oceny ryzyka alergenów na poziomie populacji. Konsekwencje zdrowotne niezamierzonej obecności alergenów w produktach spożywczych, tj. prawdopodobieństwo wywołania reakcji w podatnej populacji, mogą być wyrażone ilościowo, a informacje te mogą być wykorzystane do oceny możliwych środków łagodzenia ryzyka. 22

Metody probabilistyczne

Probabilistyczna metoda oceny ryzyka opisana przez Spanjersberg i wsp. ma na celu uwzględnienie zmienności i niepewności zmiennych wejściowych i może wyrazić ryzyko dla populacji alergicznych użytkowników. Z kolei metoda opisana przez Rimbaud i wsp. wykorzystuje kombinację symulacji Monte Carlo drugiego rzędu i wnioskowań bayesowskich do oszacowania ryzyka reakcji alergicznej. 23

Chociaż podejścia bayesowskie i częstościowe dawały podobne wyniki, lepsza znajomość modeli częstościowych wśród naukowców zajmujących się żywnością sugeruje preferencyjne wykorzystanie techniki symulacji częstościowej. 24

Ograniczenia w przewidywaniu ciężkości reakcji

Ciężkość reakcji alergicznych podczas diagnostycznych doustnych prób prowokacyjnych z podwójnie ślepą próbą kontrolowaną placebo (DBPCFC) oraz przypadkowych reakcji na pokarm jest determinowana przez liczne czynniki, z których większość obecnie wydaje się być nieznana. Dlatego ciężkość reakcji alergicznych na pokarmy pozostaje w dużej mierze nieprzewidywalna. 25

Nasilenie objawów nie jest przewidywane przez poziom swoistych IgE lub wielkość bąbla w teście skórnym, ale prawdopodobieństwo wystąpienia objawów jest bezpośrednio powiązane. 26

Dawka wywołująca (ED) nie przewiduje ciężkości przypadkowej reakcji. Sugeruje to, że ograniczenie dawki jako środek zdrowia publicznego prawdopodobnie nie zmniejszy ciężkich reakcji bardziej niż łagodniejszych. 27

Implikacje dla zarządzania alergią pokarmową

Klinicyści nie powinni używać dawki wywołującej uzyskanej z stopniowej próby prowokacyjnej pokarmem do podejmowania decyzji związanych z ryzykiem, takich jak potrzeba rygorystycznego unikania pokarmów alergizujących lub przepisanie auto-strzykawki z epinefryną. 28

Lepsze zrozumienie czynników prognostycznych i fenotypów alergii pokarmowej ma kluczowe znaczenie w podejmowaniu decyzji dotyczących zapobiegania i zarządzania alergią pokarmową. Dobra klasyfikacja pacjenta alergicznego pozwala określić stopień diet eliminacyjnych i czas ponownego wprowadzenia unikanych pokarmów, gdy jest to możliwe. W przypadkach przetrwałej i ciężkiej alergii pokarmowej pojawia się wiele obiecujących interwencji, które mogłyby poprawić rokowanie i jakość opieki. 29

Postępowanie w przypadku alergii pokarmowej IgE-zależnej obejmuje szybkie leczenie reakcji alergicznych, ścisłe unikanie pokarmów i stosowanie strategii prewencyjnych, takich jak wczesne wprowadzanie pokarmów. W przyszłości prawdopodobnie immunoterapia stanie się użyteczna w leczeniu alergii pokarmowej IgE-zależnej. 30

Potrzeby przyszłych badań

Istnieje potrzeba przeprowadzenia populacyjnych badań alergii pokarmowej, wykorzystujących OFC niezależnie od SPT i sIgE w celu potwierdzenia wszystkich przypadków alergii pokarmowej na początku i podczas kontroli, aby zbadać zdolność SPT i sIgE do przewidywania przebiegu alergii pokarmowej. 31

Obecnie immunoterapia jest najbardziej obiecującą terapią dla pacjentów z alergią pokarmową, którzy teraz polegają na unikaniu i noszeniu auto-strzykawek z adrenaliną w przypadku przypadkowego narażenia. Niestety, obecne leczenie immunoterapeutyczne alergii pokarmowej zbyt często wiąże się z alergicznymi skutkami ubocznymi i nie wydaje się zapewniać długoterminowej ochrony. 32

Skonstruowany model może być wykorzystywany przez lekarzy jako praktyczny przewodnik minimalizowania ryzyka OFC i terminowego ponownego wprowadzania pokarmów dla dzieci z alergiami pokarmowymi. 33

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
    https://www.mdpi.com/2075-4418/14/18/2069
    Food allergy (FA) affects approximately 6–8% of young children, with a peak prevalence at approximately one year of age. […] The gold standard for the diagnosis of FAs is the oral food challenge (OFC). […] In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. […] Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis. […] The purpose of this narrative review is to investigate the current evidence about the predictive value (PV) of SPTs and sIgE for the outcome of OFC. […] The evaluation of an individual with a potential IgE-mediated food allergy (FA) includes a combination of some diagnostic tools, such as history and clinical examination, skin prick tests (SPTs), in vitro testing such as serum specific IgE (sIgE) tests and component-resolved diagnosis (CRD) and oral food challenge (OFC).
  • #2
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. […] The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. […] Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. […] The potential for this devastating outcome and the widespread media coverage of this epidemic has resulted in increased awareness of food allergies and fear for those affected. […] The natural history of cows milk, egg, soy, and wheat IgE-mediated allergy is resolution from childhood to adulthood.
  • #3 Prediction of the severity of allergic reactions to foods
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
    There is currently considerable uncertainty regarding what the predictors of the severity of diagnostic or accidental food allergic reactions are, and to what extent the severity of such reactions can be predicted. […] To identify predictors for the severity of diagnostic and accidental food allergic reactions and to quantify their impact. […] The severity of DBPCFCs and accidental reactions to food remains largely unpredictable. Clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions. […] Prediction of the severity of allergic reactions to food is a key issue for medical professionals, patients, policymakers, and the food industry to be able to accurately target treatment and improve management and prevention strategies.
  • #4
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. […] The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. […] Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. […] The potential for this devastating outcome and the widespread media coverage of this epidemic has resulted in increased awareness of food allergies and fear for those affected. […] The natural history of cows milk, egg, soy, and wheat IgE-mediated allergy is resolution from childhood to adulthood.
  • #5 The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
    https://www.mdpi.com/1660-4601/10/10/5039
    IgE-mediated food allergy is a transient condition for some children, however there are few indices to predict when and in whom food allergy will resolve. […] Food allergy is a transient condition for some children, although reports on the rate of resolution vary between studies. Around 20% of peanut allergy resolves in childhood, although some reports suggest that up to 50% of peanut allergy is transient. […] At this stage, there are few indices to predict when and in whom tolerance will develop. This presents the problem of determining the optimal time to subject the child to further OFC while considering their existing risk of reaction. […] Currently the only tool available for monitoring the natural history is IgE levels, either by SPT or sIgE. […] Monitoring SPT and sIgE may help identify children who are unlikely to develop tolerance, and could therefore be considered for interventions such as oral immunotherapy (OIT).
  • #6
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. […] The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. […] Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. […] The potential for this devastating outcome and the widespread media coverage of this epidemic has resulted in increased awareness of food allergies and fear for those affected. […] The natural history of cows milk, egg, soy, and wheat IgE-mediated allergy is resolution from childhood to adulthood.
  • #7 The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
    https://www.mdpi.com/1660-4601/10/10/5039
    IgE-mediated food allergy is a transient condition for some children, however there are few indices to predict when and in whom food allergy will resolve. […] Food allergy is a transient condition for some children, although reports on the rate of resolution vary between studies. Around 20% of peanut allergy resolves in childhood, although some reports suggest that up to 50% of peanut allergy is transient. […] At this stage, there are few indices to predict when and in whom tolerance will develop. This presents the problem of determining the optimal time to subject the child to further OFC while considering their existing risk of reaction. […] Currently the only tool available for monitoring the natural history is IgE levels, either by SPT or sIgE. […] Monitoring SPT and sIgE may help identify children who are unlikely to develop tolerance, and could therefore be considered for interventions such as oral immunotherapy (OIT).
  • #8
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Resolution of food-allergic disease is accompanied by a decrease in serum food-specific IgE level so these levels can be serially followed to help predict disease resolution. […] The management of IgE-mediated food allergies includes prompt treatment of allergic reactions, strict food avoidance, and use of prevention strategies like early introduction of foods. […] In the future, it is likely immunotherapy will become useful in the management of IgE-mediated food allergy.
  • #9 The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
    https://www.mdpi.com/1660-4601/10/10/5039
    IgE-mediated food allergy is a transient condition for some children, however there are few indices to predict when and in whom food allergy will resolve. […] Food allergy is a transient condition for some children, although reports on the rate of resolution vary between studies. Around 20% of peanut allergy resolves in childhood, although some reports suggest that up to 50% of peanut allergy is transient. […] At this stage, there are few indices to predict when and in whom tolerance will develop. This presents the problem of determining the optimal time to subject the child to further OFC while considering their existing risk of reaction. […] Currently the only tool available for monitoring the natural history is IgE levels, either by SPT or sIgE. […] Monitoring SPT and sIgE may help identify children who are unlikely to develop tolerance, and could therefore be considered for interventions such as oral immunotherapy (OIT).
  • #10 The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
    https://www.mdpi.com/1660-4601/10/10/5039
    SPT and sIgE thresholds with 95% positive predictive value (PPV) for food allergy are frequently utilized in clinical practice to reduce the need for OFC. […] If carefully and systematically measured 95% PPV thresholds were developed, they could be used to determine the optimal time to review children and the necessity of repeat OFC in food allergic children. […] This review focuses on peanut, egg and milk allergy as they are responsible for the majority of allergic reactions in childhood. […] There is a need for population-based food allergy studies, using OFC irrespective of SPT and sIgE to confirm all cases of food allergy at baseline and follow-up, to examine the ability of SPT and sIgE to predict the course of food allergy.
  • #11 How to predict and improve prognosis of food allergy – PubMed
    https://pubmed.ncbi.nlm.nih.gov/29601351/
    Purpose of review: The prevalence of food allergy is increasing. More children are being diagnosed with food allergies, and it is taking longer to outgrow them, among those who develop tolerance. The aim of this review is to draw the profile of the persistent food allergic, so that prevention strategies can be developed and active treatment set up. […] Recent findings: Many determinants are involved in food allergy prognosis: ethnicity and sex, type of food, innate immune system, eliciting dose, sensitization status and other biomarkers determination, gut microbiome composition, and the presence of comorbidities. Once identified, a persistent food allergy could be conveyed to active treatments, such as oral immunotherapy or the use of biologics, always taking into account their experimental nature.
  • #12 Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
    https://www.mdpi.com/2075-4418/14/18/2069
    Although OFC is used in common clinical practice, it is troublesome, requiring an appropriate setting with a specialized team because it may cause a severe allergic reaction, up to anaphylaxis. […] The PV of sIgE varies based on the population studied and the specific allergen. […] It can be stated that undetectable sIgE levels are associated with a low risk of reaction, while higher levels increase the likelihood of an allergic reaction. […] The most convincing results concern data about the sensitivity and NPV of wheal size in SPTs and IgE levels: in many studies, undetectable sIgE levels and negative SPTs are associated with a low risk of reaction during OFC. […] Moreover, in other studies, a larger size of SPT wheal and a higher level of sIgE correlate with a higher risk of reacting to a small amount of the culprit food. […] Currently, the OFC remains the gold standard and the tool for FA diagnosis in the daily clinical practice of the pediatric allergist.
  • #13 Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
    https://www.mdpi.com/2075-4418/14/18/2069
    Although OFC is used in common clinical practice, it is troublesome, requiring an appropriate setting with a specialized team because it may cause a severe allergic reaction, up to anaphylaxis. […] The PV of sIgE varies based on the population studied and the specific allergen. […] It can be stated that undetectable sIgE levels are associated with a low risk of reaction, while higher levels increase the likelihood of an allergic reaction. […] The most convincing results concern data about the sensitivity and NPV of wheal size in SPTs and IgE levels: in many studies, undetectable sIgE levels and negative SPTs are associated with a low risk of reaction during OFC. […] Moreover, in other studies, a larger size of SPT wheal and a higher level of sIgE correlate with a higher risk of reacting to a small amount of the culprit food. […] Currently, the OFC remains the gold standard and the tool for FA diagnosis in the daily clinical practice of the pediatric allergist.
  • #14 AAIR :: Allergy, Asthma & Immunology Research
    https://e-aair.org/DOIx.php?id=10.4168/aair.2024.16.2.179
    The nomogram for egg OFCs to confirm tolerance showed that a younger age, higher total IgE level, and lower egg white-specific IgE level increased the likelihood of passing. […] Similarly, in the nomogram for milk OFCs, younger age, lower cows milk IgE level, and higher total IgE level indicated a higher probability of passing. […] The results of this study indicated that combined age, total IgE, and food-specific IgE correlated with an increased likelihood of passing OFCs for tolerance confirmation in children with egg or milk allergies.
  • #15 A network-based approach for identifying suitable biomarkers for oral immunotherapy of food allergy | BMC Bioinformatics | Full Text
    https://bmcbioinformatics.biomedcentral.com/articles/10.1186/s12859-019-2802-9
    Oral immunotherapy (OIT) is a promising therapeutic approach to treat food allergic patients. However, concerns with regards to safety and long-term efficacy of OIT remain. There is a need to identify biomarkers that predict, monitor and/or evaluate the effects of OIT. […] One of the major challenges in immunotherapy of food allergy is the lack of food allergy-specific biomarkers for disease diagnosis, illness monitoring, therapy evaluation, and prognosis prediction. […] The aim of this study was i) to compare the key drivers of the mechanisms of scFOS/lcFOS diet-supported OIT in peanut allergy and cows milk allergy and ii) to identify the biological relevance of biomarker (panels) of immunotherapy of food allergy thereby enabling the prioritization of candidate biomarkers. […] Immunotherapy is currently the most promising therapy for patients with food allergy, who now rely on avoidance and carrying adrenaline auto injectors in case of accidental exposure. Unfortunately, current immunotherapy treatments of food allergy are too often accompanied by allergic side effects and do not appear to give long-term protection.
  • #16 A network-based approach for identifying suitable biomarkers for oral immunotherapy of food allergy | BMC Bioinformatics | Full Text
    https://bmcbioinformatics.biomedcentral.com/articles/10.1186/s12859-019-2802-9
    Here we provide a promising application of bioinformatics method to compare mechanistic features between different food allergies and to identify the biological relevance of biomarker (panels) of immunotherapy of food allergy. We have shown that the key drivers that influence PNA and CMA are similar but that these phenotypically similar diseases show mechanistic differences in their subnetworks. The application of this method may be useful to generate new hypotheses to explain why CMA has a different disease pattern than PNA and to select biomarkers that are useful in for future clinical studies.
  • #17 Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
    https://www.mdpi.com/2075-4418/14/18/2069
    Food allergy (FA) affects approximately 6–8% of young children, with a peak prevalence at approximately one year of age. […] The gold standard for the diagnosis of FAs is the oral food challenge (OFC). […] In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. […] Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis. […] The purpose of this narrative review is to investigate the current evidence about the predictive value (PV) of SPTs and sIgE for the outcome of OFC. […] The evaluation of an individual with a potential IgE-mediated food allergy (FA) includes a combination of some diagnostic tools, such as history and clinical examination, skin prick tests (SPTs), in vitro testing such as serum specific IgE (sIgE) tests and component-resolved diagnosis (CRD) and oral food challenge (OFC).
  • #18 Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests
    https://www.mdpi.com/2075-4418/14/18/2069
    Although OFC is used in common clinical practice, it is troublesome, requiring an appropriate setting with a specialized team because it may cause a severe allergic reaction, up to anaphylaxis. […] The PV of sIgE varies based on the population studied and the specific allergen. […] It can be stated that undetectable sIgE levels are associated with a low risk of reaction, while higher levels increase the likelihood of an allergic reaction. […] The most convincing results concern data about the sensitivity and NPV of wheal size in SPTs and IgE levels: in many studies, undetectable sIgE levels and negative SPTs are associated with a low risk of reaction during OFC. […] Moreover, in other studies, a larger size of SPT wheal and a higher level of sIgE correlate with a higher risk of reacting to a small amount of the culprit food. […] Currently, the OFC remains the gold standard and the tool for FA diagnosis in the daily clinical practice of the pediatric allergist.
  • #19 AAIR :: Allergy, Asthma & Immunology Research
    https://e-aair.org/DOIx.php?id=10.4168/aair.2024.16.2.179
    OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). […] We developed a nomogram to predict the outcome of OFCs to determine the tolerance acquisition with the selected variables; lower food-specific IgE, higher total IgE, and younger age indicated a higher probability of passage. […] Serum total IgE and food-specific IgE combined with age showed trends toward passing OFCs for confirming tolerance development. […] The constructed model may be used by clinicians as a practical guide for minimizing the risks of OFCs and a timely reintroduction for children with food allergies. […] The pass rate was highest among OFCs for diagnosis confirmation (n = 83, 72.8%), followed by those for tolerance confirmation (n = 179, 67.0%). […] The pass group from OFCs had lower food-specific IgE levels and higher food-specific IgG4/IgE ratios than the non-pass group for both food allergens.
  • #20 AAIR :: Allergy, Asthma & Immunology Research
    https://e-aair.org/DOIx.php?id=10.4168/aair.2024.16.2.179
    OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). […] We developed a nomogram to predict the outcome of OFCs to determine the tolerance acquisition with the selected variables; lower food-specific IgE, higher total IgE, and younger age indicated a higher probability of passage. […] Serum total IgE and food-specific IgE combined with age showed trends toward passing OFCs for confirming tolerance development. […] The constructed model may be used by clinicians as a practical guide for minimizing the risks of OFCs and a timely reintroduction for children with food allergies. […] The pass rate was highest among OFCs for diagnosis confirmation (n = 83, 72.8%), followed by those for tolerance confirmation (n = 179, 67.0%). […] The pass group from OFCs had lower food-specific IgE levels and higher food-specific IgG4/IgE ratios than the non-pass group for both food allergens.
  • #21 AAIR :: Allergy, Asthma & Immunology Research
    https://e-aair.org/DOIx.php?id=10.4168/aair.2024.16.2.179
    The nomogram for egg OFCs to confirm tolerance showed that a younger age, higher total IgE level, and lower egg white-specific IgE level increased the likelihood of passing. […] Similarly, in the nomogram for milk OFCs, younger age, lower cows milk IgE level, and higher total IgE level indicated a higher probability of passing. […] The results of this study indicated that combined age, total IgE, and food-specific IgE correlated with an increased likelihood of passing OFCs for tolerance confirmation in children with egg or milk allergies.
  • #22 Frequentist and Bayesian approaches for food allergen risk assessment: risk outcome and uncertainty comparisons | Scientific Reports
    https://www.nature.com/articles/s41598-019-54844-1
    Peer-reviewed probabilistic methods already predict the probability of an allergic reaction resulting from an accidental exposure to food allergens, however, the methods calculate it in different ways. […] This study aims to compare estimation of the risk of allergic reaction and associated uncertainty using different methods and suggest improvements. […] An international workshop under the auspices of the Europrevall project agreed that probabilistic modelling was the most promising approach for assessing the risk from allergens at the population level. […] The health consequences of unintended presence of allergens in food products i.e the probability of provoking a reaction in the susceptible population can be expressed quantitatively and this information can be used to evaluate possible risk mitigation measures, for example PAL or different forms of expressing it.
  • #23 Frequentist and Bayesian approaches for food allergen risk assessment: risk outcome and uncertainty comparisons | Scientific Reports
    https://www.nature.com/articles/s41598-019-54844-1
    The probabilistic risk assessment method described in Spanjersberg et al. aims to take into consideration the variability and the uncertainty from input variables and can express the risk for the allergic user population. […] The probabilistic risk assessment described in Rimbaud et al. uses a combination of second order Monte-Carlo simulations and Bayesian inferences to estimate the risk of allergic reaction. […] The four cases are formulated to estimate the risk of an unexpected allergic reaction. […] The probability of allergic reaction per eating occasion after consuming a contaminated cereal bar ranges from 9.79% to 14.69% in mean, depending on the way the risk of allergic reaction is estimated. […] While the Bayesian and frequentist cases produced similar results, the better familiarity of food scientists with frequentist models suggests preferential use of the frequentist simulation technique. […] In conclusion we have compared the four different cases that could be used in food allergen probabilistic risk assessment and found that although different mathematical formulations have been used, the overall results obtained are very similar.
  • #24 Frequentist and Bayesian approaches for food allergen risk assessment: risk outcome and uncertainty comparisons | Scientific Reports
    https://www.nature.com/articles/s41598-019-54844-1
    The probabilistic risk assessment method described in Spanjersberg et al. aims to take into consideration the variability and the uncertainty from input variables and can express the risk for the allergic user population. […] The probabilistic risk assessment described in Rimbaud et al. uses a combination of second order Monte-Carlo simulations and Bayesian inferences to estimate the risk of allergic reaction. […] The four cases are formulated to estimate the risk of an unexpected allergic reaction. […] The probability of allergic reaction per eating occasion after consuming a contaminated cereal bar ranges from 9.79% to 14.69% in mean, depending on the way the risk of allergic reaction is estimated. […] While the Bayesian and frequentist cases produced similar results, the better familiarity of food scientists with frequentist models suggests preferential use of the frequentist simulation technique. […] In conclusion we have compared the four different cases that could be used in food allergen probabilistic risk assessment and found that although different mathematical formulations have been used, the overall results obtained are very similar.
  • #25 Prediction of the severity of allergic reactions to foods
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
    The severity of reactions during DBPCFCs and accidental reactions to foods is determined by numerous factors, most of which currently seem to be unknown. Thus, the severity of food allergic reactions remains largely unpredictable. […] The ED did not predict the severity of the accidental reaction. This suggests that dose limitation as a public health measure is unlikely to reduce severe reactions more than milder ones. […] Finally, clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions such as the need for stringent avoidance of allergenic foods or the prescription of self-injectable epinephrine.
  • #26
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. […] The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. […] Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. […] The potential for this devastating outcome and the widespread media coverage of this epidemic has resulted in increased awareness of food allergies and fear for those affected. […] The natural history of cows milk, egg, soy, and wheat IgE-mediated allergy is resolution from childhood to adulthood.
  • #27 Prediction of the severity of allergic reactions to foods
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
    The severity of reactions during DBPCFCs and accidental reactions to foods is determined by numerous factors, most of which currently seem to be unknown. Thus, the severity of food allergic reactions remains largely unpredictable. […] The ED did not predict the severity of the accidental reaction. This suggests that dose limitation as a public health measure is unlikely to reduce severe reactions more than milder ones. […] Finally, clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions such as the need for stringent avoidance of allergenic foods or the prescription of self-injectable epinephrine.
  • #28 Prediction of the severity of allergic reactions to foods
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6033096/
    The severity of reactions during DBPCFCs and accidental reactions to foods is determined by numerous factors, most of which currently seem to be unknown. Thus, the severity of food allergic reactions remains largely unpredictable. […] The ED did not predict the severity of the accidental reaction. This suggests that dose limitation as a public health measure is unlikely to reduce severe reactions more than milder ones. […] Finally, clinicians should not use the eliciting dose obtained from a graded food challenge for the purposes of making risk-related management decisions such as the need for stringent avoidance of allergenic foods or the prescription of self-injectable epinephrine.
  • #29 How to predict and improve prognosis of food allergy – PubMed
    https://pubmed.ncbi.nlm.nih.gov/29601351/
    Summary: A better understanding of prognostic factors and phenotypes of food allergy is crucial in decision-making when it comes to food allergy prevention and management. A good classification of the allergic patient allows to determine the degree of exclusion diets and the timing of the reintroduction of avoided food when possible. In the cases of persistent and severe food allergy, many promising interventions are emerging which could improve prognosis and quality of care.
  • #30
    https://link.springer.com/article/10.1007/s12016-018-8710-3
    Resolution of food-allergic disease is accompanied by a decrease in serum food-specific IgE level so these levels can be serially followed to help predict disease resolution. […] The management of IgE-mediated food allergies includes prompt treatment of allergic reactions, strict food avoidance, and use of prevention strategies like early introduction of foods. […] In the future, it is likely immunotherapy will become useful in the management of IgE-mediated food allergy.
  • #31 The Natural History of IgE-Mediated Food Allergy: Can Skin Prick Tests and Serum-Specific IgE Predict the Resolution of Food Allergy?
    https://www.mdpi.com/1660-4601/10/10/5039
    SPT and sIgE thresholds with 95% positive predictive value (PPV) for food allergy are frequently utilized in clinical practice to reduce the need for OFC. […] If carefully and systematically measured 95% PPV thresholds were developed, they could be used to determine the optimal time to review children and the necessity of repeat OFC in food allergic children. […] This review focuses on peanut, egg and milk allergy as they are responsible for the majority of allergic reactions in childhood. […] There is a need for population-based food allergy studies, using OFC irrespective of SPT and sIgE to confirm all cases of food allergy at baseline and follow-up, to examine the ability of SPT and sIgE to predict the course of food allergy.
  • #32 A network-based approach for identifying suitable biomarkers for oral immunotherapy of food allergy | BMC Bioinformatics | Full Text
    https://bmcbioinformatics.biomedcentral.com/articles/10.1186/s12859-019-2802-9
    Oral immunotherapy (OIT) is a promising therapeutic approach to treat food allergic patients. However, concerns with regards to safety and long-term efficacy of OIT remain. There is a need to identify biomarkers that predict, monitor and/or evaluate the effects of OIT. […] One of the major challenges in immunotherapy of food allergy is the lack of food allergy-specific biomarkers for disease diagnosis, illness monitoring, therapy evaluation, and prognosis prediction. […] The aim of this study was i) to compare the key drivers of the mechanisms of scFOS/lcFOS diet-supported OIT in peanut allergy and cows milk allergy and ii) to identify the biological relevance of biomarker (panels) of immunotherapy of food allergy thereby enabling the prioritization of candidate biomarkers. […] Immunotherapy is currently the most promising therapy for patients with food allergy, who now rely on avoidance and carrying adrenaline auto injectors in case of accidental exposure. Unfortunately, current immunotherapy treatments of food allergy are too often accompanied by allergic side effects and do not appear to give long-term protection.
  • #33 AAIR :: Allergy, Asthma & Immunology Research
    https://e-aair.org/DOIx.php?id=10.4168/aair.2024.16.2.179
    OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). […] We developed a nomogram to predict the outcome of OFCs to determine the tolerance acquisition with the selected variables; lower food-specific IgE, higher total IgE, and younger age indicated a higher probability of passage. […] Serum total IgE and food-specific IgE combined with age showed trends toward passing OFCs for confirming tolerance development. […] The constructed model may be used by clinicians as a practical guide for minimizing the risks of OFCs and a timely reintroduction for children with food allergies. […] The pass rate was highest among OFCs for diagnosis confirmation (n = 83, 72.8%), followed by those for tolerance confirmation (n = 179, 67.0%). […] The pass group from OFCs had lower food-specific IgE levels and higher food-specific IgG4/IgE ratios than the non-pass group for both food allergens.

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