[Food-hypersensitive patients and labeling of food].
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Seventy-six children aged 5 months to 15 years who exhibited a net weal of 3.0 mm or greater to a puncture skin test with one or more of fourteen foods were subjected to double-blind food challenge. Confirmed reactions to double-blind food challenge were found to occur only with peanut, milk, egg and soybean. Puncture skin tests with 1:20 w/v concentration of food extracts identified all subjects who exhibited an adverse reaction during the double-blind food challenge. Performance of intradermal skin tests did not identify any additional subjects who reacted clinically to double-blind food challenge.
The terms milk allergy, milk sensitivity, and milk intolerance are used in the medical literature with different meanings. Milk allergy and lactase deficiency to which they are usually referring can be specifically differentiated and diagnosed. A modification of the Rinkel oral test meal can be used to separate these two entities for medical diagnostic accuracy and understanding.
The sera of 20 atopic patients, 10 with hypersensitivity symptoms upon ingestion of milk and 10 without such symptoms, were tested by a radioimmunoassay for the detection of IgE antibodies to whole bovine milk, betalactoglobulin (BL), enzymatic digests of BL and fractions thereof. While only 4/10 patients had IgE antibodies to undigested BL all 10 patients had IgE antibodies to BL digests. All controls gave negative results. These findings suggest that enzymatic digestion of BL may yield antigenic fractions which elicit IgE antibodies and that these antibodies would be missed if the undigested food protein were to be used solely in testing.
Foodstuff allergens may cause, either ingested, inhaled, locally or systemically, a varied pathology related particularily to the skin, the respiratory and the gastrointestinal tract. Due to the bewildering multitude of symptoms and the lack of reliable methodology for the detection of the allergens, no diagnosis is reached frequently. None of the available test methods (not even new in vitro tests such as RAST) can replace a thorough medical history. Between 1970 and 1975, we have ascertained 63 cases of foodstuff allergy in our clinic in Zürich. Many of them presented as bronchial asthma, allergic rhinitis, urticaria and Quinckeedema. Celery, potatoes, milk, egg-white, cheese and cereals were most frequently encountered as allergens. The only wholly effective therapeutic procedure consists in eliminating the allergenfrom food, a measure whose practical realization may prove to be quite difficult. Some results with oral hyposensibilisation are presented.
The ability of certain patients with an allergic diathesis to adapt to the ingestion of specific foods to which they are allergic accounts for the present confusion relative to the role food hypersensitivity plays in clinical medicine. An understanding of the concept of adaptation in ingestant allergy, with its stimulatory and withdrawal periods, aids both patient and physician in appreciating the problems involved in the recognition of food hypersensitivity. Specific adaptation undergoes a chronological development from the nonadapted stage through full adaptation to eventual maladaptation. Recognition of the stage of development present offers further diagnostic help in evaluation of the allergic patient. Reintroduction of a specific food into the diet after establishment of an induced nonadapted phase provides an accurate means of determining hypersensitivity to individual ingestants.
This study was undertaken to determine the proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Cutaneous reactions evoked by graded amounts of food extracts were compared with results of double-blind food challenge and in vitro release of histamine from leucocytes. A 3 mm or greater weal reaction in skin tests by puncture technique using food extracts of 1:20 w/v concentration was found to indicate the degree of hypersensitivity likely to be associated with clinically significant hypersensitivity reactions to food. Proper use of this simple technique will facilitate accurate diagnosis of food hypersensitivity in children by identifying the group among whom all positive reactions to food challenges will be found. Nevertheless, double-blind food challenge is essential to establish a diagnosis of symptomatic hypersensitivity to food.
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In vitro studies of antigenic release of histamine from peripheral leukocytes (basophils) have been done in more than 600 allergic children. Ordinarily only about 5% to 10% of the histamine content of leukocytes will leak out or be released "spontaneously" during incubation of suspensions in vitro, without the addition of antigen. A small percentage of children were found to have leukocytes that released 25% to 100% of the histamine content spontaneously during incubation. The significance of this was not apparent until recently, when studies were concentrated on children suspected of hypersensitivity reactions to foods, among whom a much greater prevalence of spontaneous histamine release from leukocytes was encountered. Of children proved by a double-blind food challenge to react with manifestations of immediate hypersensitivity, 100% had leukocytes that consistently released over 25% (usually between 50% and 100%) of the histamine content spontaneously without the addition of antigen. Such high spontaneous histamine release appears to be characteristic of persons with clinical evidence of hypersensitivity to food.
The syndrome of immediate type I food hypersensitivity, mediated by tissue-bound IgE antibody and mast cell histamine release, is well recorded in the medical literature. This case study represents a previously undescribed late food hypersensitivity, induced only by strenuous exercise. Identification of this new syndrome illustrates classical epidemiologic analysis, improves medical advice for the allergic and athletically inclined, and raises new questions in the areas of allergy and immunology.
In order to extend previous investigations of adverse reactions to foods performed at this institution, 68 children, aged 5 mo to 15 yr, were studied. All subjects reported a history of adverse reaction to ingestion of one or more of the 14 foods under study. Sixteen of 43 subjects, 3 yr of age or older, had 22 adverse reactions during 94 food challenges with one or more of the 14 foods. All reactions confirmed were to peanut or other nuts, milk, egg, and soy. Skin testing with 1:20 weight/volume concentrations of food extracts applied by the puncture technique produced a net wheal reaction 3 mm or greater in all subjects 3 yr of age or older in whom double-blind food challenges confirmed the history of adverse reaction. Thirteen of 25 children less than 3 yr of age manifested adverse reactions during 49 food challenges. Skin testing by puncture technique produced a net wheal 3 mm or greater in 9 children less than 3 yr of age in whom food challenge elicited a clinical response within 2 hr. One of 4 subjects less than 3 yr of age in whom the adverse reaction occurred more than 4 hr after food challenge exhibited a wheal to puncture skin test of 3 mm or greater. These studies suggest that at present double-blind food challenge is an indispensible tool for the unequivocal evaluation of adverse reactions to foods.