Multicenter prevalence of anaphylaxis in clinic-based oral food challenges

Ann Allergy Asthma Immunol. 2017 Oct;119(4):339-348.e1. doi: 10.1016/j.anai.2017.07.028. Epub 2017 Sep 7.

Abstract

Background: Although previous single-center studies report the rate of anaphylaxis for oral food challenges (OFCs) as 9% to 11%, little is known regarding the epidemiology of clinical OFCs across multiple centers in the United States.

Objective: To examine the epidemiology, symptoms, and treatment of clinical low-risk OFCs in the nonresearch setting.

Methods: Data were obtained from 2008 to 2013 through a physician survey in 5 food allergy centers geographically distributed across the United States. Allergic reaction rates and the association of reaction rates with year, hospital, and demographics were determined using a linear mixed model. Meta-analysis was used to pool the proportion of reactions and anaphylaxis with inverse-variance weights using a random-effects model with exact confidence intervals (CIs).

Results: A total of 6,377 OFCs were performed, and the pooled estimate of anaphylaxis was 2% (95% CI, 1%-3%). The rate of allergic reactions was 14% (95% CI, 13%-16%) and was consistent during the study period (P = .40). Reaction rates ranged from 13% to 33%. Males reacted 16% more frequently than females (95% CI, 4%-37.5%; P = .04). Foods challenged in 2013 varied geographically, with peanut as the most challenged food in the Northeast, Midwest, and West and egg as the most challenged in the South.

Conclusion: As the largest national survey of allergic reactions of clinical open OFCs in a nonresearch setting in the United States, this study found that performing clinical nonresearch open low-risk OFCs results in few allergic reactions, with 86% of challenges resulting in no reactions and 98% without anaphylaxis.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Allergens / immunology*
  • Anaphylaxis / diagnosis
  • Anaphylaxis / epidemiology*
  • Anaphylaxis / physiopathology
  • Arachis / chemistry
  • Arachis / immunology
  • Child
  • Child, Preschool
  • Food Hypersensitivity / diagnosis
  • Food Hypersensitivity / epidemiology*
  • Food Hypersensitivity / physiopathology
  • Humans
  • Incidence
  • Infant
  • Linear Models
  • Prevalence
  • Risk
  • Sex Factors
  • Skin Tests
  • United States / epidemiology

Substances

  • Allergens