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  • Title: Clinical thresholds to egg, hazelnut, milk and peanut: results from a single-center study using standardized challenges.
    Author: Eller E, Hansen TK, Bindslev-Jensen C.
    Journal: Ann Allergy Asthma Immunol; 2012 May; 108(5):332-6. PubMed ID: 22541404.
    Abstract:
    BACKGROUND: Large studies of individual thresholds and risk profiles for foods are sparse. Previous reports indicate that thresholds adjusted for the protein content in foods would be comparable. OBJECTIVE: To establish and compare clinical threshold values for egg, hazelnut, milk and peanut, and correlating them to severity of symptoms. METHODS: Seven hundred eighty-one challenges were performed in 487 patients (age range, 0.5-73.5 years). Using interval censoring survival analysis, the dose distribution of thresholds was fitted to a log-normal function. Symptom score was correlated to thresholds. RESULTS: Based on the 405 challenges resulting in objective signs, similar distribution of thresholds for hazelnut, milk, and peanut challenges were found, whereas individuals with egg allergy were bimodally distributed with a high or a low threshold. Eliciting dose in 10% (95% confidence interval) was 42.9 (24-76.8) mg whole eggs, 133.8 (95.9-186.6) mg whole hazelnut, 106.5 (59.7-190.6) mg roasted peanut, and 2.9 (1.5-5.4) mL milk. Adults showed more severe symptoms and signs than children, and peanut caused more severe reactions than the 3 other foods. CONCLUSION: Thresholds for the different foods were not comparable, and eliciting dose for the 4 foods differed, even if adjusted for protein content. Increasing age but not a low threshold dose is associated with severe symptoms on challenge. Peanuts elicit more severe reactions than the other foods.
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