Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis

Clin Exp Allergy. 1999 Jan;29(1):91-6. doi: 10.1046/j.1365-2222.1999.00454.x.


Background and objective: Little is known about late phase clinical reactions during oral food challenges and the value of specific IgE in terms of sensitivity and specificity.

Methods: We therefore analysed retrospectively the clinical outcome of 387 oral provocations during double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis.

Results: Eighty-seven (81%) children showed a positive clinical reaction to at least one challenge. The vast majority of children (94%) showed clinical symptoms to one or two allergens. One hundred and thirty-one of 259 (51%) of verum challenges and 1/128 (0.8%) placebo challenge were assessed as positive. Oral provocations with hen's egg showed the highest percentage of positive reactions (70%). Sensitivity of specific IgE to the four allergens tested was 90%, specificity 30%. Sensitivity of the parental history as a predictive factor was 48%, specificity 72%. Ninety-two of 131 (70%) children with positive verum provocations showed early reactions, 33 (25%) late and six (5%) combined early and late reactions. In 84/131 (64%) positive provocations one organ system was involved, while in 44 (34%) provocations two and in three (2%) challenges three organ systems were involved. Skin reactions were the most frequent clinical manifestation leading to positive reactions followed by gastro-intestinal and respiratory symptoms. There was no correlation between titration dose and specific IgE. The subgroup of non-sensitized children did not differ in terms of sex, age or titration dose from the total study population.

Conclusion: Double-blind, placebo-controlled oral food challenges are helpful in distinguishing children with clinically manifested symptoms from those with food sensitization. Accurately identifying children with a clinical relevant food allergy may help to prescribe specific diets on a scientific basis, avoiding dietary limitations which may be unnecessary or even harmful.

MeSH terms

  • Administration, Oral
  • Animals
  • Chickens
  • Child
  • Dermatitis, Atopic / physiopathology*
  • Diarrhea / chemically induced
  • Double-Blind Method
  • Eczema / chemically induced
  • Eggs / adverse effects
  • Female
  • Food / adverse effects*
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / etiology
  • Humans
  • Immunoglobulin E / blood
  • Male
  • Milk / adverse effects
  • Placebos
  • Randomized Controlled Trials as Topic
  • Respiratory Tract Diseases / chemically induced
  • Retrospective Studies
  • Soybean Proteins / adverse effects
  • Treatment Outcome
  • Triticum / adverse effects
  • Vomiting / chemically induced


  • Placebos
  • Soybean Proteins
  • Immunoglobulin E