Is it possible to predict the development of anaphylaxis before oral food challenge tests administered to evaluate tolerance in IgE-mediated food allergy in children?

Objective: Life-threatening anaphylaxis may occur in IgE-mediated food allergy. OralFood Challenge (OFC) is the gold standard in demonstrating tolerance and diagnosingfood allergy; however, these tests may cause anaphylaxis. Predicting the risk ofdeveloping anaphylaxis before performing OFC is valuable information in evaluatingtolerance as in diagnosis. The present study aims to evaluate the effectiveness of the testsused in clinical practice in predicting the risk of anaphylaxis during OFC in IgE-mediatedfood allergy. To our knowledge, this is the first study evaluating skin prick tests in theprediction of anaphylaxis.Material and Methods: In this descriptive cross-sectional study, the history,demographic, clinical and laboratory data of the patients, followed up with the diagnosisof IgE-mediated food allergy, on whom OFC was performed, were evaluatedretrospectively.Results: Of the 254 patients who underwent OFC, 133 were followed up with a diagnosisof IgE-mediated food allergy. The mean age was 21 months (12-120), and anaphylaxisoccurred in nine (6.7%) of them during OFC. According to the frequency, the foodresponsible for IgE-mediated food allergy was determined as milk, egg and egg-milkcombination. Age during the challenge and total IgE levels were higher in the group thatexperienced OFC-related anaphylaxis. The tests that could best determine the risk ofanaphylaxis before the challenge was the skin prick test (SPT) and prick to prick (PTP)test for milk. Milk SPT and PTP test at the time of initial diagnosis and determination ofmilk sIgE and egg white sIgE before challenge were found to predict the risk ofanaphylaxis. The negative predictive value was over 95% in tests that gave significantresults for milk. There was no statistically significant finding associated with otherallergenic foods.Conclusion: In evaluating tolerance development, performing sIgE, SPT and/or PTPtests for milk before OFC is useful in predicting anaphylaxis. Studies with larger numbersof cases are needed to assess the risk of anaphylaxis caused by other foods.