Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology–European Academy of Allergy and.

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Presentation transcript:

Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology–European Academy of Allergy and Clinical Immunology PRACTALL consensus report Hugh A. Sampson, MD, Roy Gerth van Wijk, MD, Carsten Bindslev-Jensen, MD, PhD, Scott Sicherer, MD, Suzanne S. Teuber, MD, A. Wesley Burks, MD, Anthony E.J. Dubois, MD, Kirsten Beyer, MD, Philippe A. Eigenmann, MD, Jonathan M. Spergel, MD, PhD, Thomas Werfel, MD, Vernon M. Chinchilli, PhD Journal of Allergy and Clinical Immunology Volume 130, Issue 6, Pages 1260-1274 (December 2012) DOI: 10.1016/j.jaci.2012.10.017 Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Toward a standardization of food challenges. Reprinted with permission from Niggemann et al.12 Journal of Allergy and Clinical Immunology 2012 130, 1260-1274DOI: (10.1016/j.jaci.2012.10.017) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Incremental doses of various schedules used for DBPCFCs. Individual doses are expressed as micrograms of protein in the food administered during the active food challenge. Schedules shown are either generic or derived from those devised for challenges with cow’s milk. The numbers shown with symbols refer to the source publications in the reference list. Journal of Allergy and Clinical Immunology 2012 130, 1260-1274DOI: (10.1016/j.jaci.2012.10.017) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Scoring the challenge outcome (modified from Bock et al65 and Nowak-Wegrzyn et al14). The scoring system proposed here can be used for IgE-mediated reactions to determine the degree of response in various target organs and changes from baseline. Challenges should usually not commence if there are baseline symptoms exceeding descriptions in green (an exception might be AD that remains moderate despite maximal therapy). See the text for additional comments. (Please note that I,C,1 was made orange because it is similar to mild objective symptoms in other areas, is not a stopping indication, and, depending on clinical judgment, might or might not represent contact urticaria). Journal of Allergy and Clinical Immunology 2012 130, 1260-1274DOI: (10.1016/j.jaci.2012.10.017) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Diagnostic algorithm for the identification of food allergy in patients with AD. Journal of Allergy and Clinical Immunology 2012 130, 1260-1274DOI: (10.1016/j.jaci.2012.10.017) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions