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Physician’s appraisal vs documented signs and symptoms in the interpretation of food challenge: the EuroPrevall birth cohort

Physician’s appraisal vs documented signs and symptoms in the interpretation of food challenge: the EuroPrevall birth cohort
Physician’s appraisal vs documented signs and symptoms in the interpretation of food challenge: the EuroPrevall birth cohort
Background. Blinded food challenges are considered the current gold standard for the diagnosis of food allergies. We used data from a pan-European multicentre project to assess differences between study centres, aiming to identify the impact of subjective aspects for the interpretation of oral food challenges.

Methods: Nine study centres of the EuroPrevall birth cohort study on food allergy recruited 12,049 newborns and followed them for up to 30 months in regular intervals. Intensive training was conducted and every centre visited to ensure similar handling of the protocols. Suspected food allergy was clinically evaluated by double-blind, placebocontrolled food challenges using a nine dose escalation protocol. The primary challenge outcomes based on physician’s appraisal were compared to documented signs and symptoms.

Results: Of 839 challenges conducted, study centres confirmed food allergy in 15.6% to 53.6% of locally conducted challenges. Centres reported 0 to 16 positive placebo challenges. Worsening of eczema was the most common sign when challenged with placebo. Agreement between documented objective signs and the challenge outcome assigned by the physician was heterogeneous, with Cohen’s kappa spanning from 0.42 to 0.84.

Conclusions: These differences suggest that the comparison of food challenge outcomes between centres is difficult despite common protocols and training. We recommend detailed symptom assessment and documentation as well as objective sign-based challenge outcome algorithms to assure
0905-6157
58–65
Grabenhenrich, Linus B.
c88f8903-2e8f-4a11-8b4d-04e7433c05ac
Reich, Andreas
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McBride, Doreen
aeb68668-81d7-44ba-ac14-586d6343ffef
Sprikkelman, Aline
4286bbae-0f70-4ece-8649-34dcbba608af
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Grimshaw, Kate E.C.
766b6cf0-347a-447d-aeab-f07366f8ce28
Fiocchi, Alessandro G.
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Saxoni-Papageorgiou, Photini
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Papadopoulos, Nikolaos G.
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Fiandor, Ana
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Quirce, Santiago
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Kowalski, Marek L
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Sigurdardottir, Sigurveig T
768a2385-c0c4-4281-84b3-1346fcd7217b
Dubakiene, Ruta
97130c6b-ba07-4eea-81e9-8dfab1370133
Hourihane, Jonathan O.B.
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Rosenfeld, Leonard
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Niggemann, Bodo
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Keil, Thomas
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Beyer, Kirsten
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Grabenhenrich, Linus B.
c88f8903-2e8f-4a11-8b4d-04e7433c05ac
Reich, Andreas
a97f6e41-9936-485f-9061-8ceac58f8cf6
McBride, Doreen
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Sprikkelman, Aline
4286bbae-0f70-4ece-8649-34dcbba608af
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Grimshaw, Kate E.C.
766b6cf0-347a-447d-aeab-f07366f8ce28
Fiocchi, Alessandro G.
937ae2ae-5803-4650-af47-4c1bc4123cdd
Saxoni-Papageorgiou, Photini
2e01ee31-7077-45aa-be88-fade2197177c
Papadopoulos, Nikolaos G.
3625cc6b-6810-4219-aa71-665409abc3fc
Fiandor, Ana
aeeed163-6f3f-4043-b908-bc987bbae063
Quirce, Santiago
b386d834-e622-4a76-a273-a8269d844c86
Kowalski, Marek L
add36f36-eb7d-4ee9-b050-7234f9e4da5d
Sigurdardottir, Sigurveig T
768a2385-c0c4-4281-84b3-1346fcd7217b
Dubakiene, Ruta
97130c6b-ba07-4eea-81e9-8dfab1370133
Hourihane, Jonathan O.B.
5fe33421-131b-4db8-9b6c-11f7e8ff6dbe
Rosenfeld, Leonard
f470d080-ed1e-4065-9aa9-6b72cb2551bc
Niggemann, Bodo
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Keil, Thomas
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Beyer, Kirsten
9020c231-b5ed-4c6c-be7e-797db0f2ab1d

Grabenhenrich, Linus B., Reich, Andreas, McBride, Doreen, Sprikkelman, Aline, Roberts, Graham, Grimshaw, Kate E.C., Fiocchi, Alessandro G., Saxoni-Papageorgiou, Photini, Papadopoulos, Nikolaos G., Fiandor, Ana, Quirce, Santiago, Kowalski, Marek L, Sigurdardottir, Sigurveig T, Dubakiene, Ruta, Hourihane, Jonathan O.B., Rosenfeld, Leonard, Niggemann, Bodo, Keil, Thomas and Beyer, Kirsten (2018) Physician’s appraisal vs documented signs and symptoms in the interpretation of food challenge: the EuroPrevall birth cohort. Pediatric Allergy and Immunology, 29 (1), 58–65. (doi:10.1111/pai.12811).

Record type: Article

Abstract

Background. Blinded food challenges are considered the current gold standard for the diagnosis of food allergies. We used data from a pan-European multicentre project to assess differences between study centres, aiming to identify the impact of subjective aspects for the interpretation of oral food challenges.

Methods: Nine study centres of the EuroPrevall birth cohort study on food allergy recruited 12,049 newborns and followed them for up to 30 months in regular intervals. Intensive training was conducted and every centre visited to ensure similar handling of the protocols. Suspected food allergy was clinically evaluated by double-blind, placebocontrolled food challenges using a nine dose escalation protocol. The primary challenge outcomes based on physician’s appraisal were compared to documented signs and symptoms.

Results: Of 839 challenges conducted, study centres confirmed food allergy in 15.6% to 53.6% of locally conducted challenges. Centres reported 0 to 16 positive placebo challenges. Worsening of eczema was the most common sign when challenged with placebo. Agreement between documented objective signs and the challenge outcome assigned by the physician was heterogeneous, with Cohen’s kappa spanning from 0.42 to 0.84.

Conclusions: These differences suggest that the comparison of food challenge outcomes between centres is difficult despite common protocols and training. We recommend detailed symptom assessment and documentation as well as objective sign-based challenge outcome algorithms to assure

Text Grabenhenrich_et_al_2017_Pediatric_Allergy_and_Immunology_Food_challenges - Accepted Manuscript
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Accepted/In Press date: 1 October 2017
e-pub ahead of print date: 2 November 2017
Published date: February 2018

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Local EPrints ID: 415088
URI: https://eprints.soton.ac.uk/id/eprint/415088
ISSN: 0905-6157
PURE UUID: 60ed5fe2-d1bc-47e1-a70a-a6b8f8aad351

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Date deposited: 25 Oct 2017 16:30
Last modified: 13 Jul 2018 16:31

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Contributors

Author: Linus B. Grabenhenrich
Author: Andreas Reich
Author: Doreen McBride
Author: Aline Sprikkelman
Author: Graham Roberts
Author: Alessandro G. Fiocchi
Author: Photini Saxoni-Papageorgiou
Author: Nikolaos G. Papadopoulos
Author: Ana Fiandor
Author: Santiago Quirce
Author: Marek L Kowalski
Author: Sigurveig T Sigurdardottir
Author: Ruta Dubakiene
Author: Jonathan O.B. Hourihane
Author: Leonard Rosenfeld
Author: Bodo Niggemann
Author: Thomas Keil
Author: Kirsten Beyer

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