Objective clinical and laboratory studies of immediate hypersensitivity reactions to foods in asthmatic children

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Abstract

Clinical and laboratory observations were made with 38 children afflicted with chronic severe asthma (reversible obstructive airway disease) in which hypersensitivity to food was incriminated in the histories. Symptoms were evoked in double-blind food challenges in only 1138 children and 1470 challenges, and were characteristic of immediate-type hypersensitivity and were chiefly gastrointestinal, even though asthma was the common presenting complaint. There were no delayed reactions. Peanut was responsible for 8 reactions, egg for 5, and cow's milk for 1. The feature that most successfully identified those having positive reactions in challenges was a significant wheal reaction in a skin test by puncture technique using a verified, extract of 1:20 WV concentration. No subject with clinically significant, symptomatic hypersensitivity to food had a negative puncture test, and puncture tests were positive in only 1056 instances of negative reactions in food challenges. Laboratory observations included release of histamine and enzymes from leukocytes and the levels of neutrophil enzymes in serum before and after food provocation tests. While these determinations were of interest with respect to the immunochemical basis of reactions to foods, they did not prove useful for practical clinical diagnosis. The outstanding laboratory finding was the occurrence of “spontaneous” release of 25% to 100% of the histamine from leukocytes in all cases proved clinically hypersensitive by food challenges, which suggests that this may be an indicator of immediate-type hypersensitivity to food. From the findings in the study, a general approach to food hypersensitivity was developed in which the immunologic components coupled with quantitative concentration-response relationships serve to render comprehensible the distinction between asymptomatic (immunologic) hypersensitivity and symptomatic (clinical) hypersensitivity.

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    Citation Excerpt :

    In such circumstances, it may be prudent to extend the observation period before proceeding with a next dose, repeating the same dose, or discontinuing the OFC per the physician's judgment.1 In 1976, May39 published recommendations for conducting double-blind, placebo-controlled food challenges (DBPCFCs), which led to the general adoption of DBPCFCs as the criterion standard for the diagnosis of food allergy by the allergy community. The DBPCFCs were conducted using dried food in capsules, and he reported that most patients reacted between 100 mg and 4000 mg of dry food by weight.

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Supported by Grant AI 11623 from the National Institute of Allergy and Infectious Diseases, United States Public Health Service.

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