Allergies: A Leickly Story

Pediatric Allergist Frederick E. Leickly – Indianapolis, Indiana

• Home
• About
• Lectures
• Appointments
• Legal Disclaimer

Food Allergy Challenges

The Allergy Clinic at Riley Hospital for Children sees a significant number of children with food allergy. Our experience is mostly making the diagnosis. There is another part of food allergy that we do at Riley that is very exciting. The natural history is that some food allergies can be outgrown. We are doing food challenges to see if the food allergy has resolved.

We have an extensive experience in evaluating children who may have out grown their food allergy. I have always wondered about our track record with these food challenges. I have the opportunity to share our experience at Riley. We have opened many previously closed doors for a many children who have had food allergy.

 What follows is our experience over the past three years. Usually the child has had the diagnosis of a food allergy and has had at least a year of avoidance of that food. Prior to scheduling a food challenge, we perform skin testing and specific IgE blood tests. The results are used to help decide about scheduling a challenge.  With a specific IgE test at or below a critical cut-off level, we offer a food challenge in a controlled clinical environment. 

 

 

 

 

Not your typical food challenge- Stella enjoying Korean Bar-B-Que (May, 2009)

I selected recent data on food challenges. We have been doing these challenges at Riley since 1994. The following tables are our experience over these years. The table has the food of interest, the calendar year, the number of children who passed or failed, the total undergoing a specific food challenge for that year, and the percent of children who passed the challenge. The last table is a summary.

 

Peanut Challenges

Year	Passed	Failed	Total	% Pass
2006	3	3	6	50
2007	3	2	5	60
2008	7	3	10	70
 Summary	13	8	21	62

 Milk Challenges

Year	Passed	Failed	Total	% Pass
2006	6	2	8	75
2007	1	0	1	100
2008	6	1	7	86
 Summary	13	3	16	81

Egg Challenges

Year	Passed	Failed	Total	% Pass
2006	4	1	5	80
2007	5	7	12	42
2008	7	3	10	70
 Summary	16	11	27	59

 Wheat Challenges

Year	Passed	Failed	Total	% Pass
2006	1	0	1	100
2007	0	0	0	-
2008	1	0	1	100
 Summary	2	0	2	100

Soy Challenges

Year	Passed	Failed	Total	% Pass
2006	2	1	3	67
2007	5	0	5	100
2008	1	0	1	100
 Summary	8	1	9	89

  Food Challenge Summary 2006-2008

Year	Passed	Failed	Total	% Pass
2006	16	7	23	70
2007	14	9	23	61
2008	22	7	29	76
 Summary	52	23	75	69

Based on our experience 100% had a successful wheat challenge, 89% had a successful soy challenge, 81% passed the milk challenge, 62% had a successful peanut challenge, and 59% had a successful egg challenge. Surprisingly, egg tended to be less successful. Overall we have two out of three children (69%) passing their food challenge.

I worry about the unsuccessful food challenges and I am glad that we did this in the clinic. Our Riley clinic is attached to our hospital and since allergy is part of our Pediatric Pulmonary, Critical Care, and Allergy section, there is usually someone with intensive care experience on the next hallway if ever needed. To date we have not had a serious reaction.

During the challenge, small amounts of the food are given in a tolerated vehicle (juice/pudding). There is an observation period and if there is no reaction, the dose is doubled.

Our challenges are usually open food challenges. The children who underwent these challenges presented to our clinic with hives, atopic dermatitis, or anaphylactic shock.

Due to an increasing tendency for health care providers to order food allergy panels, we have seen a strikingly large number of children with results that just do not match what happens with everyday exposure to a food. I think there is a need to sort this out and to offer food challenges to see if the blood test result is ‘clinically relevant’.

We are also planning to perform food challenges with heated egg. Heated egg is the egg found in cakes, cookies, etc (all that good stuff). Cooked egg is egg scrambled, over easy etc (Just watch what the cook says when you order an egg ‘sunny side down and don’t turn it over’). Imagine a child with egg allergy who has avoided egg in all forms in hopes of outgrowing the egg allergy being challenged with heated egg and shown to tolerate those foods. In the study that served as the foundation for this proposal, 30% of children did react to the heated egg. I think it would be great to open the door for exposure to some of those tasty sweet things that we all like and contain egg. We are patiently waiting approval for this.

 

 

 

 

Eating and wearing cake at her first birthday party (Stella 1 year old on  April 2009)

So there is a significant amount of activity going on at Riley regarding food allergy (IgE) challenges.

Fred Leickly

May 13, 2009 · fleickly · 2 Comments
Posted in: Food Allergies

• « Previous post
• Next post »

• Frederick E. Leickly, MD, MPH

  

  About Me

• Recent Posts

  • Allergy-Problems from a global perspective
  • Making and Keeping Appointments
  • Antihistamines
  • Indy’s Child- Peanut Allergy Post
  • Egg Allergy and the Flu Vaccine