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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]

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]

Background: Failure of milk introduction after a negative food challenge test is reported in a substantial number of patients. For this reason, guidelines recommend that the total dose of milk protein for a food challenge test should be comparable to a normal serving., Objective: Our aim is to compare the success rate of milk introduction after a negative double-blind placebo-controlled challenge test performed with different doses of milk protein and different milk products., Methods: We conducted a retrospective chart review of 485 patients challenged with a low or high dose of milk protein. Pasteurized milk and milk protein powder were used for the low-dose challenge tests, and condensed milk for the high-dose challenge tests. Successful introduction was defined as regular milk consumption, and discontinuation of further introduction due to the reappearance of symptoms as unsuccessful introduction. We also evaluated the association between milk products and successful introduction., Results: The outcome of 288 (59.4%) double-blind placebo-controlled food challenge tests was negative. There were no significant differences between the low and high dose of milk protein in patient characteristics, percentage of patients lost to follow-up (15% vs 20%), in whom introduction had not yet been performed (4% vs 3.1%), reappearance of symptoms (18% vs 17%), and successful introduction (88.0% and 83.4%). Age, gender, specific immunoglobulin E for milk, dose of milk protein, and atopy were not associated with successful introduction. Children who experienced symptoms during the introduction were less likely to consume milk (P < .001). There was a nonsignificant trend toward higher successful introduction rate if pasteurized milk was used as test material compared to milk protein powder, and condensed milk., Conclusion and Clinical Relevance: Successful introduction of milk after a negative challenge test is independent of the total dose of milk protein, and milk product used during the challenge test., (© 2020 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)