Paul J Turner1, Yvonne M d'Art2, Bettina Duca1, Sophia A Chastell1, Guadalupe Marco-Martin3,4, Rosialzira N Vera-Berrios3,4, Olaya Alvarez4,5,6, Raphaëlle Bazire4,5,6, Pablo Rodríguez Del Río4,5,6, Marta Vazquez-Ortiz1, Joseph L Baumert7, Ronald van Ree8, Clare E N Mills9, Montserrat Fernandez-Rivas3,4, Jonathan O'B Hourihane2,10. 1. Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK. 2. Paediatrics and Child Health, University College Cork, Ireland. 3. Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain. 4. ARADyAL Research Network, Madrid, Spain. 5. Department of Allergy, Hospital Infantil Universitario Niño Jesus, Madrid, Spain. 6. Health Research Institute Princesa, Madrid, Spain. 7. Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA. 8. Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, The Netherlands. 9. Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK. 10. Paediatrics and Child Health, Royal College of Surgeons in Ireland, Children's Health Ireland, Dublin, Ireland.
Abstract
BACKGROUND: There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single-dose challenge study to validate a predicted ED05 for cow's milk of 0.5 mg protein. METHODS: Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity. RESULTS: 172 children (median age 6.0 (IQR 0.7-11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%-11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single-dose challenge using 0.5 mg cow's milk protein. CONCLUSIONS: These data support an estimated ED05 for cow's milk of 0.5 mg protein. Values for ED05 above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.
BACKGROUND: There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single-dose challenge study to validate a predicted ED05 for cow's milk of 0.5 mg protein. METHODS: Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity. RESULTS: 172 children (median age 6.0 (IQR 0.7-11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%-11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single-dose challenge using 0.5 mg cow's milk protein. CONCLUSIONS: These data support an estimated ED05 for cow's milk of 0.5 mg protein. Values for ED05 above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.
Authors: Paul J Turner; Nandinee Patel; Barbara K Ballmer-Weber; Joe L Baumert; W Marty Blom; Simon Brooke-Taylor; Helen Brough; Dianne E Campbell; Hongbing Chen; R Sharon Chinthrajah; René W R Crevel; Anthony E J Dubois; Motohiro Ebisawa; Arnon Elizur; Jennifer D Gerdts; M Hazel Gowland; Geert F Houben; Jonathan O B Hourihane; André C Knulst; Sébastien La Vieille; María Cristina López; E N Clare Mills; Gustavo A Polenta; Natasha Purington; Maria Said; Hugh A Sampson; Sabine Schnadt; Eva Södergren; Stephen L Taylor; Benjamin C Remington Journal: J Allergy Clin Immunol Pract Date: 2021-08-23
Authors: Yvonne M d'Art; Lisa Forristal; Aideen M Byrne; John Fitzsimons; Ronald van Ree; Audrey DunnGalvin; Jonathan O'Brien Hourihane Journal: Allergy Date: 2022-04-22 Impact factor: 14.710