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ABSTRACT Background Methods Results Conclusion Double‐blind placebo‐controlled food challenge (DBPCFC) is widely regarded as the “gold standard” to diagnose food allergy. Maximum efforts are made to reduce bias, yet DBPCFCs are costly, time‐, and resource‐intensive. Less demanding open food challenges are increasingly used in clinical practice. However, recommendations regarding the use of these challenges are based on low certainty of evidence, and no comparative studies have been performed using the most recent international food challenge guidelines. We hypothesised that the open food challenge is non‐inferior to DBPCFC in children suspected of allergy to cashew nuts, hazelnuts or peanuts.A total of 63 children, aged 4 years and older, were included if referred for suspected IgE‐mediated allergy to cashew nut, hazelnut, or peanut. All study participants underwent DBPCFC first, followed by an open food challenge for the same food. Challenge outcomes were assessed by predefined criteria into positive, negative, or inconclusive.DBPCFC and open food challenge outcomes were the same for 36/41 (87.8%) patients. Sensitivity and specificity of the open food challenge were 0.91 (95% CI 0.79, 1.03) and 0.83 (95% CI 0.63, 1.01), respectively, with an AUC value of 0.87. Eliciting and stop doses were not significantly different between both food challenges.The Diagnostic accuracy of open food challenge is non‐inferior to that of DBPCFC. This finding implies less demanding open food challenges can be implemented for children from the age of 4 years suspected to be cashew nut, hazelnut, or peanut allergic. Further research is necessary to validate our findings and to investigate the diagnostic accuracy for other major food allergens. [ABSTRACT FROM AUTHOR]

Background: Oral food challenge (OFC) is commonly used to diagnose food allergy. This test is time and resource intensive, and conclusions are not always unequivocal as this relies on the interpretation of symptoms. Therefore, an objective marker would improve the accuracy of the diagnostic workup of food allergy. Objectives: The aim of this study was to investigate whether tryptase can be detected in saliva of children following OFC. Method: Children from 3 to 18 years of age were eligible for inclusion if an OFC for peanut or tree nut had been recommended. Saliva samples were collected prior to the first dose and 5, 10, and 15 min following the last administered dose during OFC. Assay precision, spike-and-recovery, and assessment of lower limit of detection of the tryptase immunoassay were examined before analysis of tryptase in saliva was performed. Results: A total of 30 children were included (median age 8 years, 63.3% male, 53.3% positive OFC outcome). Tryptase was detected in saliva samples. The mean of the change in baseline tryptase value to each saliva collecting time point was significantly different in patients with a positive OFC outcome compared to a negative outcome (p < 0.01). Conclusions: This study showed that tryptase can be detected in saliva of children following OFC. Increased levels of tryptase compared to baseline were found if the OFC outcome was positive, suggesting that measuring tryptase in saliva may be useful in the diagnosis of food allergy. Further research is needed to evaluate the potential association between tryptase levels and symptoms. [ABSTRACT FROM AUTHOR]

Background: It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double‐blind placebo‐controlled food challenge (DBPCFC) has been regarded as the 'gold standard' for decades. However, DBPCFCs are costly, and time‐ and resource‐intensive procedures. Structural implementation of less demanding open food challenges will only find support if research demonstrates that their outcome is comparable to DBPCFC, yet this has been proven difficult to investigate. Methods: We performed a literature review to investigate the diagnostic accuracy of oral food challenges and interviewed 19 parents of children with proven or suspected food allergy about the design of a trial to study this. Results: An overview of the dilemma of diagnosing food allergy using oral food challenges, and the methodological issues and parents' opinions to study this. No comparative studies have been performed using the latest guidelines on oral food challenges. Conclusions: There is an urgent need to investigate the diagnostic accuracy of different oral food challenge protocols. We present the rationale and design of the ALDORADO trial (ALlergy Diagnosed by Open oR DOuble‐blind food challenge) that has been set up to investigate whether the outcome of the open food challenge is comparable to DBPCFC. [ABSTRACT FROM AUTHOR]

Low health-related quality of life is associated with declining home introduction of suspected food allergens The number of food allergens advised to introduce at home, was not found to be a confounder of the association between HRQL and parental decision. Further research is needed to determine whether HRQL measurements could contribute to a higher success rate of the introduction of potential food allergens at home. Keywords: children; diagnostic; food allergy; introduction; quality of life EN children diagnostic food allergy introduction quality of life 201 204 4 01/05/22 20220101 NES 220101 Key Messages One-third of parents did not follow advice to introduce food allergens to their child at home Low quality of life scores were associated with not following advice to introduce food allergens Multivariate analysis did not confirm this; other factors such as food relevance may be important I To the Editor, i Food allergy should be adequately diagnosed or excluded to avoid anxiety and unnecessary elimination of foods.1,2 Mothers who suspect their child to be food allergic appeared to be more anxious and eliminated (multiple) foods unnecessarily.3 Furthermore, peanut-allergic children avoided tree nuts even when this food was proven to be safe or had been eaten before without symptoms.4 We recommend to gradually introduce the food at home following a standardized schedule for children who are referred due to suspected food allergy but deemed tolerant (i.e. very low probability of food allergy based on medical and dietary history) for a specific food. [Extracted from the article]

Abstract In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21st century. The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients’ organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels. Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein.