Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis
Nandinee Patel, Daniel C. Adelman, Katherine Anagnostou, Joseph L. Baumert, W. Marty Blom, Dianne E. Campbell, R. Sharon Chinthrajah, E. N. Clare Mills, Bushra Javed, Natasha Purington, Benjamin C. Remington, Hugh A. Sampson, Alexander D. Smith, Ross A.R. Yarham, Paul Turner
Abstract
BACKGROUND: values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% of the population with an allergy, respectively) are increasingly being used to inform allergen labeling and clinical management. These values are generated from food challenge, but the frequency of anaphylaxis in response to these low levels of allergen exposure and their reproducibility are unknown. OBJECTIVE: Our aim was to determine (1) the rate of anaphylaxis in response to low-level peanut exposure and (2) the reproducibility of reaction thresholds (and anaphylaxis) at food challenge. METHODS: We conducted a systematic review and individual participant data meta-analysis of studies that reported at least 50 individuals with peanut allergy reacting to peanut at double-blind, placebo-controlled food challenge (DBPCFC) and were published between January 2010 and September 2020. Risk of bias was assessed by using National Institute for Clinical Excellence methodologic checklists. RESULTS: = 16%]); none developed anaphylaxis. CONCLUSION: dose, respectively, in the broader population of individuals with peanut allergy.