Clinical thresholds to egg, hazelnut, milk and peanut: results from a single-center study using standardized challenges

Ann Allergy Asthma Immunol. 2012 May;108(5):332-6. doi: 10.1016/j.anai.2012.03.010.

Abstract

Background: Large studies of individual thresholds and risk profiles for foods are sparse. Previous reports indicate that thresholds adjusted for the protein content in foods would be comparable.

Objective: To establish and compare clinical threshold values for egg, hazelnut, milk and peanut, and correlating them to severity of symptoms.

Methods: Seven hundred eighty-one challenges were performed in 487 patients (age range, 0.5-73.5 years). Using interval censoring survival analysis, the dose distribution of thresholds was fitted to a log-normal function. Symptom score was correlated to thresholds.

Results: Based on the 405 challenges resulting in objective signs, similar distribution of thresholds for hazelnut, milk, and peanut challenges were found, whereas individuals with egg allergy were bimodally distributed with a high or a low threshold. Eliciting dose in 10% (95% confidence interval) was 42.9 (24-76.8) mg whole eggs, 133.8 (95.9-186.6) mg whole hazelnut, 106.5 (59.7-190.6) mg roasted peanut, and 2.9 (1.5-5.4) mL milk. Adults showed more severe symptoms and signs than children, and peanut caused more severe reactions than the 3 other foods.

Conclusion: Thresholds for the different foods were not comparable, and eliciting dose for the 4 foods differed, even if adjusted for protein content. Increasing age but not a low threshold dose is associated with severe symptoms on challenge. Peanuts elicit more severe reactions than the other foods.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allergens / administration & dosage
  • Allergens / adverse effects
  • Allergens / immunology
  • Animals
  • Arachis / adverse effects*
  • Arachis / immunology
  • Child
  • Child, Preschool
  • Corylus / adverse effects*
  • Corylus / immunology
  • Dose-Response Relationship, Drug
  • Egg Hypersensitivity / diagnosis
  • Egg Hypersensitivity / immunology
  • Egg Hypersensitivity / physiopathology
  • Eggs / adverse effects*
  • Female
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / immunology
  • Food Hypersensitivity / physiopathology
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Milk / adverse effects*
  • Milk / immunology
  • Milk Hypersensitivity / diagnosis
  • Milk Hypersensitivity / immunology
  • Milk Hypersensitivity / physiopathology
  • Nut Hypersensitivity / diagnosis
  • Nut Hypersensitivity / immunology
  • Nut Hypersensitivity / physiopathology
  • Peanut Hypersensitivity / diagnosis
  • Peanut Hypersensitivity / immunology
  • Peanut Hypersensitivity / physiopathology
  • Reference Standards*
  • Severity of Illness Index*
  • Young Adult

Substances

  • Allergens