Motohiro Ebisawa, MD, PhD
Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
Food Allergy diagnosis is mostly made by the combination of history taking and proof of IgE. The presence of specific IgE antibodies can be confirmed through specific serum IgE antibody test, SPT, basophil activation test, etc. The presence of specific IgE antibodies indicates sensitization to the relevant food allergen, which is not always the actual food allergy. Therefore, oral food challenges (OFCs) are necessary for food allergy management. OFC should be conducted by physicians skilled in the treatment of food allergies and anaphylaxis. Control basic allergic diseases, such as bronchial asthma and atopic dermatitis is essential, since symptom induced by OFC may be difficult to judge and can be severe. The PRACTALL guidelines recommend a general challenge schedule consisting of 3, 10, 30, 100, 300, 1000, and 3000 mg of food protein at intervals of at least 20 minutes. This method provides information on patients’ reactions to the cumulative dose of food protein but does not examine the highest safe dose, as most symptoms develop after 20 minutes. The threshold dose in food allergy varies among patients. In Japanese Food Allergy Guideline 2016 recommends 3-level stepwise OFC. The 3-level stepwise OFC can determine whether patients with allergies to egg, milk, or wheat can safely consume these foods at low or medium doses. In high-risk cases where symptoms may be induced by a small dose or with a high antigen specific IgE value, a low total dose is recommended for an OFC test, while for negative cases, the OFC should be conducted subsequently with a medium or full dose. Administration of a higher dose OFC after a low-dose OFC can avoid complete elimination. The OFC using a stepwise approach is recommended to avoid complete elimination of causative foods, which can improve the quality of life of patients and guardians and prognosis of food allergy.
Allergy 过敏专场 下午
Allergy 过敏专场 下午