Title
Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis
Author
Patel, N.
Adelman, D.C.
Anagnostou, K.
Baumert, J.L.
Blom, W.M.
Campbell, D.E.
Chinthrajah, R.S.
Mills, E.N.C.
Javed, B.
Purington, N.
Remington, B.C.
Sampson, H.A.
Smith, A.D.
Yarham, R.A.R.
Turner, P.J.
Publication year
2021
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.
Subject
Eliciting dose
oral food challenge
peanut allergy
precautionary allergen labeling
thresholds
peanut extract
placebo
allergen
abdominal pain
adolescent
adult
anaphylaxis
angioneurotic edema
checklist
child
cohort analysis
consumer
desensitization
diarrhea
enteropathy
female
frequency
hoarseness
human
hypotension
larynx edema
male
meta analysis
mouth disease
nausea
peanut
peanut allergy
phase 2 clinical trial (topic)
phase 3 clinical trial (topic)
priority journal
pruritus
randomized controlled trial (topic)
reproducibility
respiratory tract disease
rhinitis
systematic review
throat tightness
unspecified side effect
urticaria
vomiting
wheezing
adverse event
anaphylaxis
animal
Arachis
desensitization
food
food allergy
immunology
oral drug administration
peanut allergy
recurrent disease
Administration, Oral
Allergens
Anaphylaxis
Animals
Arachis
Desensitization, Immunologic
Food
Food Hypersensitivity
Humans
Peanut Hypersensitivity
Recurrence
Reproducibility of Results
To reference this document use:
http://resolver.tudelft.nl/uuid:dba96a47-ef8a-4924-9ff5-65319587c1de
DOI
https://doi.org/10.1016/j.jaci.2021.01.025
TNO identifier
967890
ISSN
0091-6749
Source
Journal of Allergy and Clinical Immunology, 147 (147), 2249-2262e7
Document type
article