This study included almost 900 children (median age 1.2 years).
Of the children allergic to egg or milk , 9% and 10%, respectively, experienced reactions already at the first dose. Of these, 14% (egg) and 4% (milk) experienced grade IV reactions.
In contrast, few children reacted to the first doses of wheat or soy, and most reactions occurred after the maximum dose. Hence the importance to complete the challenge protocol until the very end, and administer the top dose.
Elevated specific IgE level, young age and a history of atopic dermatitis were associated with a positive challenge outcome for milk or egg. Higher IgE levels were associated with lower eliciting allergen doses and more severe symptoms.
Oral food challenges bear a risk of severe reactions at all dose levels. Doses of 3–5 mg protein induced symptoms in up to 10% of children allergic to milk or egg. Food-specific IgE levels are of limited clinical value for the estimation of the food challenge reactions.
8 foods cause 90% of food allergies (click to enlarge the image). The figure above shows the likelihood of a negative oral food challenge is shown in relation to the respective values of skin prick test (SPT) and serum IgE (sIgE).
Outcome of oral food challenges in children in relation to symptom-eliciting allergen dose and allergen-specific IgE. C. Rolinck-Werninghaus, B. Niggemann, L. Grabenhenrich, U. Wahn1, K. Beyer. Allergy, 05/2012.