PURPOSE OF THE STUDY.
To identify risk factors for reactions to peanuts (PN) and tree nuts (TN) on first known ingestion among sensitized children.
Children ages 3 to 16 years who were sensitized to PN and/or TN undergoing an oral food challenge to PN and/or TN.
Investigators conducted a retrospective case study of sensitized children undergoing PN and/or TN challenge without a history of consumption of the challenge food. Factors relating to food challenge outcome were analyzed.
Ninety-eight food challenges (47 PN and 51 TN) were performed. The challenge outcomes were 29 positive, 67 negative, and 2 equivocal. A positive maternal history of atopy (odds ratio: 3.73 [95% confidence interval: 1.31–10.59]) and specific immunoglobulin E (IgE) >5 kU/L (odds ratio: 3.35 [95% confidence interval: 1.23–9.11]) were associated with increased risk of positive food challenge. Atopic history in other immediate family members was not predictive of challenge outcome. In addition, there was no association between type of TN, other food allergies, other atopic conditions, severity of previous food reactions to other foods, or history of positive food challenges to other foods.
The authors concluded that the presence of maternal atopic history and specific IgE >5 kU/L were significantly predictive of oral food challenge outcome among children with no history of consumption of the challenge food.
This study addresses an important clinical scenario presenting to primary and subspecialty health care providers. Children with suspected or known food allergy to other foods often present with positive results on testing (skin or serum IgE) to PN and TN without a history of ingestion, and the clinician must advise patients regarding the risks of introducing these food allergens. Although further prospective studies in larger and more diverse patient populations are needed to better refine risk factors in this patient population, the current study identifies 2 important factors that may aid the clinician’s decision to conduct oral food challenges to PN and/or TN among sensitized children.
- Copyright © 2013 by the American Academy of Pediatrics