A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?

S. L. Taylor, S. L. Hefle, C. Bindslev-Jensen, F. M. Atkins, C. Andre, C. Bruijnzeel-Koomen, A. W. Burks, R. K. Bush, M. Ebisawa, P. A. Eigenmann, A. Host, J. O. Hourihane, E. Isolauri, D. J. Hill, A. Knulst, G. Lack, H. A. Sampson, D. A. Moneret-Vautrin, F. Rance, P. A. VadasJ. W. Yunginger, R. S. Zeiger, J. W. Salminen, Charlotte Bernhard Madsen, P. Abbott

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low-dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. Objective A roundtable conference was convened to develop a consensus clinical protocol for low-dose challenge trials for the estimation of threshold doses for specific allergenic foods. Methods In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low-dose challenge trials. Results A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP-RAST scores can be enrolled in low-dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double-blind, placebo-controlled design should be used for low-dose challenge trials. Low-dose challenge trials would begin at doses of 10 mug of the allergenic food and would continue with doses of 100 mug and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30-min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low-dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95% certainty that 90% of allergic individuals will not react to that dose. Conclusion A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.
Original languageEnglish
JournalCLINICAL AND EXPERIMENTAL ALLERGY
Volume34
Issue number5
Pages (from-to)689-695
ISSN0954-7894
Publication statusPublished - 2004

Cite this

Taylor, S. L., Hefle, S. L., Bindslev-Jensen, C., Atkins, F. M., Andre, C., Bruijnzeel-Koomen, C., ... Abbott, P. (2004). A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much? CLINICAL AND EXPERIMENTAL ALLERGY, 34(5), 689-695.
Taylor, S. L. ; Hefle, S. L. ; Bindslev-Jensen, C. ; Atkins, F. M. ; Andre, C. ; Bruijnzeel-Koomen, C. ; Burks, A. W. ; Bush, R. K. ; Ebisawa, M. ; Eigenmann, P. A. ; Host, A. ; Hourihane, J. O. ; Isolauri, E. ; Hill, D. J. ; Knulst, A. ; Lack, G. ; Sampson, H. A. ; Moneret-Vautrin, D. A. ; Rance, F. ; Vadas, P. A. ; Yunginger, J. W. ; Zeiger, R. S. ; Salminen, J. W. ; Madsen, Charlotte Bernhard ; Abbott, P. / A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?. In: CLINICAL AND EXPERIMENTAL ALLERGY. 2004 ; Vol. 34, No. 5. pp. 689-695.
@article{19c1c95b3e7d44f1a1b841e818a598ee,
title = "A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?",
abstract = "Background While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low-dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. Objective A roundtable conference was convened to develop a consensus clinical protocol for low-dose challenge trials for the estimation of threshold doses for specific allergenic foods. Methods In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low-dose challenge trials. Results A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP-RAST scores can be enrolled in low-dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double-blind, placebo-controlled design should be used for low-dose challenge trials. Low-dose challenge trials would begin at doses of 10 mug of the allergenic food and would continue with doses of 100 mug and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30-min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low-dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95{\%} certainty that 90{\%} of allergic individuals will not react to that dose. Conclusion A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.",
author = "Taylor, {S. L.} and Hefle, {S. L.} and C. Bindslev-Jensen and Atkins, {F. M.} and C. Andre and C. Bruijnzeel-Koomen and Burks, {A. W.} and Bush, {R. K.} and M. Ebisawa and Eigenmann, {P. A.} and A. Host and Hourihane, {J. O.} and E. Isolauri and Hill, {D. J.} and A. Knulst and G. Lack and Sampson, {H. A.} and Moneret-Vautrin, {D. A.} and F. Rance and Vadas, {P. A.} and Yunginger, {J. W.} and Zeiger, {R. S.} and Salminen, {J. W.} and Madsen, {Charlotte Bernhard} and P. Abbott",
year = "2004",
language = "English",
volume = "34",
pages = "689--695",
journal = "Clinical and Experimental Allergy",
issn = "0954-7894",
publisher = "Wiley-Blackwell",
number = "5",

}

Taylor, SL, Hefle, SL, Bindslev-Jensen, C, Atkins, FM, Andre, C, Bruijnzeel-Koomen, C, Burks, AW, Bush, RK, Ebisawa, M, Eigenmann, PA, Host, A, Hourihane, JO, Isolauri, E, Hill, DJ, Knulst, A, Lack, G, Sampson, HA, Moneret-Vautrin, DA, Rance, F, Vadas, PA, Yunginger, JW, Zeiger, RS, Salminen, JW, Madsen, CB & Abbott, P 2004, 'A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?', CLINICAL AND EXPERIMENTAL ALLERGY, vol. 34, no. 5, pp. 689-695.

A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much? / Taylor, S. L.; Hefle, S. L.; Bindslev-Jensen, C.; Atkins, F. M.; Andre, C.; Bruijnzeel-Koomen, C.; Burks, A. W.; Bush, R. K.; Ebisawa, M.; Eigenmann, P. A.; Host, A.; Hourihane, J. O.; Isolauri, E.; Hill, D. J.; Knulst, A.; Lack, G.; Sampson, H. A.; Moneret-Vautrin, D. A.; Rance, F.; Vadas, P. A.; Yunginger, J. W.; Zeiger, R. S.; Salminen, J. W.; Madsen, Charlotte Bernhard; Abbott, P.

In: CLINICAL AND EXPERIMENTAL ALLERGY, Vol. 34, No. 5, 2004, p. 689-695.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?

AU - Taylor, S. L.

AU - Hefle, S. L.

AU - Bindslev-Jensen, C.

AU - Atkins, F. M.

AU - Andre, C.

AU - Bruijnzeel-Koomen, C.

AU - Burks, A. W.

AU - Bush, R. K.

AU - Ebisawa, M.

AU - Eigenmann, P. A.

AU - Host, A.

AU - Hourihane, J. O.

AU - Isolauri, E.

AU - Hill, D. J.

AU - Knulst, A.

AU - Lack, G.

AU - Sampson, H. A.

AU - Moneret-Vautrin, D. A.

AU - Rance, F.

AU - Vadas, P. A.

AU - Yunginger, J. W.

AU - Zeiger, R. S.

AU - Salminen, J. W.

AU - Madsen, Charlotte Bernhard

AU - Abbott, P.

PY - 2004

Y1 - 2004

N2 - Background While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low-dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. Objective A roundtable conference was convened to develop a consensus clinical protocol for low-dose challenge trials for the estimation of threshold doses for specific allergenic foods. Methods In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low-dose challenge trials. Results A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP-RAST scores can be enrolled in low-dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double-blind, placebo-controlled design should be used for low-dose challenge trials. Low-dose challenge trials would begin at doses of 10 mug of the allergenic food and would continue with doses of 100 mug and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30-min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low-dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95% certainty that 90% of allergic individuals will not react to that dose. Conclusion A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.

AB - Background While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low-dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. Objective A roundtable conference was convened to develop a consensus clinical protocol for low-dose challenge trials for the estimation of threshold doses for specific allergenic foods. Methods In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low-dose challenge trials. Results A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP-RAST scores can be enrolled in low-dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double-blind, placebo-controlled design should be used for low-dose challenge trials. Low-dose challenge trials would begin at doses of 10 mug of the allergenic food and would continue with doses of 100 mug and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30-min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low-dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95% certainty that 90% of allergic individuals will not react to that dose. Conclusion A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.

M3 - Journal article

VL - 34

SP - 689

EP - 695

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

SN - 0954-7894

IS - 5

ER -

Taylor SL, Hefle SL, Bindslev-Jensen C, Atkins FM, Andre C, Bruijnzeel-Koomen C et al. A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much? CLINICAL AND EXPERIMENTAL ALLERGY. 2004;34(5):689-695.