Comparison of Double‐Blind and Open Food Challenges for the Diagnosis of Food Allergy in Childhood: The ALDORADO Study

IF 12.6 1区 医学 Q1 ALLERGY Allergy Pub Date : 2024-12-14 DOI:10.1111/all.16428
Wouter W. de Weger, Aline. B. Sprikkelman, Catherina. E. M. Herpertz, Gerbrich N. van der Meulen, Judith. M. Vonk, Gerard. H. Koppelman, Arvid. W. A. Kamps
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Abstract

BackgroundDouble‐blind placebo‐controlled food challenge (DBPCFC) is widely regarded as the “gold standard” to diagnose food allergy. Maximum efforts are made to reduce bias, yet DBPCFCs are costly, time‐, and resource‐intensive. Less demanding open food challenges are increasingly used in clinical practice. However, recommendations regarding the use of these challenges are based on low certainty of evidence, and no comparative studies have been performed using the most recent international food challenge guidelines. We hypothesised that the open food challenge is non‐inferior to DBPCFC in children suspected of allergy to cashew nuts, hazelnuts or peanuts.MethodsA total of 63 children, aged 4 years and older, were included if referred for suspected IgE‐mediated allergy to cashew nut, hazelnut, or peanut. All study participants underwent DBPCFC first, followed by an open food challenge for the same food. Challenge outcomes were assessed by predefined criteria into positive, negative, or inconclusive.ResultsDBPCFC and open food challenge outcomes were the same for 36/41 (87.8%) patients. Sensitivity and specificity of the open food challenge were 0.91 (95% CI 0.79, 1.03) and 0.83 (95% CI 0.63, 1.01), respectively, with an AUC value of 0.87. Eliciting and stop doses were not significantly different between both food challenges.ConclusionThe Diagnostic accuracy of open food challenge is non‐inferior to that of DBPCFC. This finding implies less demanding open food challenges can be implemented for children from the age of 4 years suspected to be cashew nut, hazelnut, or peanut allergic. Further research is necessary to validate our findings and to investigate the diagnostic accuracy for other major food allergens.
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背景双盲安慰剂对照食物挑战(DBPCFC)被广泛认为是诊断食物过敏的 "黄金标准"。为了减少偏差,我们尽了最大努力,但双盲安慰剂对照食物试验(DBPCFC)成本高昂、耗费时间和资源。在临床实践中,越来越多地使用要求较低的开放性食物挑战。然而,有关使用这些挑战的建议所依据的证据确定性较低,而且尚未使用最新的国际食物挑战指南进行比较研究。我们假设,在怀疑对腰果、榛子或花生过敏的儿童中,开放性食物挑战并不比 DBPCFC 差。方法共纳入了 63 名 4 岁及以上的儿童,他们都是因怀疑对腰果、榛子或花生 IgE 介导的过敏而转诊的。所有研究参与者首先接受 DBPCFC,然后接受相同食物的开放性食物挑战。挑战结果按照预先设定的标准评估为阳性、阴性或不确定。开放性食物挑战的敏感性和特异性分别为 0.91 (95% CI 0.79, 1.03) 和 0.83 (95% CI 0.63, 1.01),AUC 值为 0.87。结论 开放式食物挑战的诊断准确性不低于 DBPCFC。这一发现意味着,对于 4 岁以上怀疑对腰果、榛子或花生过敏的儿童,可以采用要求较低的开放式食物挑战法。有必要开展进一步研究,以验证我们的发现,并调查其他主要食物过敏原的诊断准确性。
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来源期刊
Allergy
Allergy 医学-过敏
CiteScore
26.10
自引率
9.70%
发文量
393
审稿时长
2 months
期刊介绍: Allergy is an international and multidisciplinary journal that aims to advance, impact, and communicate all aspects of the discipline of Allergy/Immunology. It publishes original articles, reviews, position papers, guidelines, editorials, news and commentaries, letters to the editors, and correspondences. The journal accepts articles based on their scientific merit and quality. Allergy seeks to maintain contact between basic and clinical Allergy/Immunology and encourages contributions from contributors and readers from all countries. In addition to its publication, Allergy also provides abstracting and indexing information. Some of the databases that include Allergy abstracts are Abstracts on Hygiene & Communicable Disease, Academic Search Alumni Edition, AgBiotech News & Information, AGRICOLA Database, Biological Abstracts, PubMed Dietary Supplement Subset, and Global Health, among others.
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