Tander Simberloff1, Ron Parambi2, Lisa M Bartnikas3, Ana Dioun Broyles3, Victoria Hamel4, Karol G Timmons4, D Marlowe Miller1, Dionne A Graham5, Lynda C Schneider3, Andrew J MacGinnitie6. 1. Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass. 2. Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass. 3. Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. 4. Division of Immunology, Boston Children's Hospital, Boston, Mass. 5. Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass; Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass. 6. Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: Andrew.macginnitie@childrens.harvard.edu.
Abstract
BACKGROUND: Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs. OBJECTIVE: The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients. METHODS: Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions. RESULTS: Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location. CONCLUSIONS: By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.
BACKGROUND: Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs. OBJECTIVE: The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients. METHODS: Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions. RESULTS: Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location. CONCLUSIONS: By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.
Authors: Wouter W de Weger; Aline B Sprikkelman; Catherina E M Herpertz; Gerbrich N van der Meulen; Judith M Vonk; Arvid W A Kamps; Gerard H Koppelman Journal: Pediatr Allergy Immunol Date: 2021-09-09 Impact factor: 5.464
Authors: Sayantani Sindher; Andrew J Long; Natasha Purington; Madeleine Chollet; Sara Slatkin; Sandra Andorf; Dana Tupa; Divya Kumar; Margaret A Woch; Katherine L O'Laughlin; Amal Assaad; Jacqueline Pongracic; Jonathan M Spergel; Jonathan Tam; Stephen Tilles; Julie Wang; Stephen J Galli; Kari C Nadeau; R Sharon Chinthrajah Journal: Front Immunol Date: 2018-11-27 Impact factor: 7.561
Authors: Natasha Purington; R Sharon Chinthrajah; Andrew Long; Sayantani Sindher; Sandra Andorf; Katherine O'Laughlin; Margaret A Woch; Alexandra Scheiber; Amal Assa'ad; Jacqueline Pongracic; Jonathan M Spergel; Jonathan Tam; Stephen Tilles; Julie Wang; Stephen J Galli; Manisha Desai; Kari C Nadeau Journal: Front Immunol Date: 2018-09-21 Impact factor: 7.561