Reproducibility of food challenge to cow's milk

Reproducibility of food challenge to cow's milk: Systematic review with individual participant data meta-analysis

Turner, P.J.
Patel, N.
Campbell, D.E.
Sampson, H.A.
Maeda, M.
Katsunuma, T.
Westerhout, J.
Blom, W.M.
Baumert, J.L.
Houben, G.F.
Remington, B.C.

2022

Background: Cow's milk (CM) is an increasingly common cause of severe allergic reactions, but there is uncertainty with respect to severity of reactions at low-level CM exposure, as well as the reproducibility of reaction thresholds. Objective: We undertook an individual participant data (IPD) meta-analysis of studies reporting double-blind, placebo-controlled food challenges in CM to determine the rate of anaphylaxis to low-level exposures and the reproducibility of reaction thresholds. Methods: We performed a systematic review and IPD meta-analysis of studies reporting relevant data. Authors were contacted to provide additional data and/or clarification as needed. Risk of bias was assessed using the National Institute for Clinical Excellence methodologic checklists. Results: Thirty-four studies were included, representing data from over 1000 participants. The cumulative ED01 and ED05 (cumulative doses causing objective symptoms in 1% and 5% of the at-risk allergic population) were 0.3 (95% confidence interval [CI], 0.2-0.5) and 2.9 (95% CI, 1.6-5.4) mg, respectively. At meta-analysis, 4.8% (95% CI, 2.0-10.9) and 4.8% (95% CI, 0.7-27.1) of individuals reacting to ≤5 mg and ≤0.5 mg of CM protein had anaphylaxis (minimal heterogeneity, I2 = 0%). Then 110 individuals underwent repeat double-blind, placebo-controlled food challenges; the intraindividual variation in reaction threshold was limited to a ½-log change in 80% (95% CI, 65-89) of participants. Two individuals initially tolerated 5 mg CM protein but then reacted to this dose at a subsequent challenge, although neither had anaphylaxis. Conclusions: About 5% of CM-allergic individuals reacting to ED01 or ED05 exposure might have anaphylaxis to that dose. This equates to 5 and 24 anaphylaxis events per 10,000 patients exposed to an ED01 or ED05 dose, respectively, in the broader CM-allergic population. Most of these anaphylactic reactions would be mild and respond to a single dose of epinephrine. © 2022 The Authors

Allergy
Anaphylaxis
Cow's milk
Eliciting dose
Food challenge
Precautionary allergen labeling
Thresholds

http://resolver.tudelft.nl/uuid:dc79629f-2778-4aec-b06a-27299d2be10c

https://doi.org/10.1016/j.jaci.2022.04.035

972654

Journal of Allergy and Clinical Immunology, 150 (150), 1135-1143

article