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H A Sampson

Publications and source records attributed to H A Sampson.

At least 73 records · Page 4Linked to original sources
PubMed1999

Peanut-induced anaphylactic reactions.

Food allergies, particularly to peanuts, are a common cause of anaphylaxis. Approximately 125 people die each year in the USA secondary to food-induced anaphylaxis. Clinical anaphylaxis is a syndrome of diverse etiology and dramatic presentation of symptoms associated with the classic features of type I, IgE-mediated hypersensitivity [1]. Typically the term anaphylaxis connotes an immunologically-mediated event that occurs after exposure to certain foreign substances. This reaction results from the generation and release of a variety of potent biologically active mediators and their concerted effects on various target organs. Anaphylaxis is recognized by cutaneous, respiratory, cardiovascular, and gastrointestinal signs and symptoms occurring singly or in combination. This article focuses on allergic reactions to peanuts that manifest as signs and symptoms involving multiple target organs or the cardiovascular system alone.

Anaphylaxis↗
PubMed1999

Molecular cloning and epitope analysis of the peanut allergen Ara h 3.

Peanut allergy is a significant IgE-mediated health problem because of the increased prevalence, potential severity, and chronicity of the reaction. Following our characterization of the two peanut allergens Ara h 1 and Ara h 2, we have isolated a cDNA clone encoding a third peanut allergen, Ara h 3. The deduced amino acid sequence of Ara h 3 shows homology to 11S seed-storage proteins. The recombinant form of this protein was expressed in a bacterial system and was recognized by serum IgE from approximately 45% of our peanut-allergic patient population. Serum IgE from these patients and overlapping, synthetic peptides were used to map the linear, IgE-binding epitopes of Ara h 3. Four epitopes, between 10 and 15 amino acids in length, were found within the primary sequence, with no obvious sequence motif shared by the peptides. One epitope is recognized by all Ara h 3-allergic patients. Mutational analysis of the epitopes revealed that single amino acid changes within these peptides could lead to a reduction or loss of IgE binding. By determining which amino acids are critical for IgE binding, it might be possible to alter the Ara h 3 cDNA to encode a protein with a reduced IgE-binding capacity. These results will enable the design of improved diagnostic and therapeutic approaches for food-hypersensitivity reactions.

Allergens↗
PubMed1999

Electromotive drug administration of lidocaine as an alternative anesthesia for transurethral surgery.

PURPOSE: A multicenter study was undertaken to evaluate the safety, efficacy and cost of electromotive drug administration of intravesical lidocaine to produce bladder local anesthesia as an alternative to traditional methods of spinal or general anesthesia. MATERIALS AND METHODS: A total of 94 patients were enrolled in the study who had either a history of bladder tumor that required cold cup bladder biopsy with fulguration for possible recurrence as a comparison trial, a bladder tumor treated with transurethral resection/fulguration or benign prostatic hyperplasia/carcinoma treated with transurethral resection. Pain scores using a Verbal Rating Scale were recorded for each individual biopsy, fulguration and resection event. Data for direct and indirect costs were collected using a standardized form for each patient to capture the details of the procedure, including times, drugs and disposables for each patient. RESULTS: There was a significant reduction in pain for patients who received electromotive intravesical lidocaine compared to no anesthesia for biopsy (p<0.03). Similarly, electromotive intravesical lidocaine for bladder biopsy and transurethral bladder tumor resection/fulguration was associated with higher patient satisfaction compared to previous treatments (p<0.00002). In contrast, electromotive intravesical lidocaine was insufficient for 3 of 6 transurethral prostatic resections. The cost per patient was about $146 Cdn less with electromotive intravesical lidocaine than with conventional general/spinal anesthesia. CONCLUSIONS: Electromotive intravesical lidocaine may be a safe, effective and affordable form of anesthesia for the ambulatory care of patients requiring transurethral bladder biopsy, resection or fulguration with a potential for cost savings.

Aged↗
PubMed1998

Safe administration of influenza vaccine to patients with egg allergy.

OBJECTIVES: Specific recommendations for administering the influenza vaccine to patients with egg allergy are based on limited scientific data. The objectives of this investigation were to determine the safety of a 2-dose administration of an influenza vaccine to patients with egg allergy and to evaluate the usefulness of skin testing with the influenza vaccine before administration. STUDY DESIGN: In this multicenter clinical trial, clinical histories of egg allergy were confirmed by skin testing with egg and, if possible, by oral challenges with egg. Subjects with egg allergy received the vaccine in 2 doses, 30 minutes apart; the first dose was one tenth and the second dose nine tenths of the recommended dose as determined by age. Subjects without egg allergy were recruited as control subjects and received 1 age-determined dose of the vaccine. Skin prick tests with the influenza vaccine were performed on all subjects. RESULTS: From 1994 to 1997, 83 subjects with egg allergy and 124 control subjects were evaluated. The content of ovalbumin/ovomucoid was 0.1, 1.2, and 0.02 micrograms/mL, respectively in the 1994-95, 1995-96, and 1996-97 influenza vaccines. Results of vaccine skin prick tests were positive in 4 subjects with egg allergy and in 1 control subject. All patients with egg allergy tolerated the vaccination protocol without any significant allergic reactions. CONCLUSIONS: These results demonstrate that patients with egg allergy, even those with significant allergic reactions after egg ingestion, can safely receive an influenza vaccine in a 2-dose protocol when the vaccine preparation contains no more than 1.2 micrograms/mL egg protein.

Adolescent↗
PubMed1998

Clinical features of food protein-induced enterocolitis syndrome.

OBJECTIVE: To describe the clinical characteristics of food protein-induced enterocolitis syndrome (FPIES), a symptom complex of severe vomiting and diarrhea occurring several hours after the ingestion of particular food proteins in infants. STUDY DESIGN: Retrospective review of a referral population. RESULTS: Sixteen patients had typical FPIES; 11 reacted to milk, 11 to soy, and 7 to both. Mean age at diagnosis was 7 weeks for milk reactivity and 8 weeks for soy reactivity. Two patients also had rice- and pea-induced FPIES. Among 14 patients who were followed up for a median period of 25 months, loss of sensitivity to milk occurred in 6 of 10 patients and loss of sensitivity to soy occurred in 2 of 8. Six additional cases of FPIES were considered atypical: 1 patient had late-onset disease caused by poultry, and in 5 patients IgE antibody to milk or soy developed. During supervised food challenges with milk and soy, the peripheral blood neutrophil count rose over 3500 cells/mm3 in 9 of 10 positive challenges and did not rise above this value in the 7 negative challenges. Emergency treatment was required in 62% of challenges. CONCLUSIONS: Although most patients with FPIES are infants reactive to milk and/or soy, this diagnosis should be considered in older children and for other foods. Food-specific IgE sensitivity may develop in some patients. Standardized food challenges are helpful for diagnosis and follow-up.

Child↗
PubMed1998

Peanut allergens.

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Allergens↗
PubMed1998

Interpreting skin prick tests in the evaluation of food allergy in children.

BACKGROUND: Skin prick tests (SPTs) are utilized routinely in the evaluation of food allergy and several authors have discussed their utility. Efforts to standardize SPT reagents and procedures have been made, but the accuracies of different recording techniques have not been clearly defined. The aim of this study was to compare different SPT recording methods with the outcome of oral food challenge and determine whether they offer any advantage over the criteria proposed by Bock and May (1). PATIENTS AND METHODS: Children suspected of IgE-mediated symptoms to any of five common food allergens (egg, milk, peanut, soy and wheat) were skin tested by the prick technique utilizing commercial extracts. The wheal reactions were recorded by two different methods: first by measuring the largest diameter of the wheal and the diameter orthogonal to it (mean wheal diameter), and second by recording the surface area of the wheal with a hand-held scanner. Wheal sizes above the 95% confidence interval of tolerant individuals were considered positive. The results of double-blind, placebo-controlled food challenges were considered the "gold standard" for diagnosis. Cut-off values were compared for positive responses in our study population (mean diameter/surface area of wheal): 4 mm/16 mm2 for egg, 5 mm/29 mm2 for milk, 6 mm/40 mm2 for peanut, 3 mm/9 mm2 for soy, and 3 mm/7 mm2 for wheat. RESULTS: Significant differences in wheal sizes were seen between individuals who were allergic or tolerant to egg (P < 0.001), milk (P < 0.001), wheat (P < 0.005), and peanut (P < 0.05). Reactivity to soy could not be predicted based on SPT results (P = n.s.). The sensitivities and the specificities of the two recording methods were similar. The predictive values were not significantly different from that of the commonly utilized method of grading SPTs (i.e. positive = mean diameter 3 mm or greater than the negative control). CONCLUSIONS: Skin prick tests are a useful procedure for evaluating clinical reactivity to egg, milk, peanut and wheat, but not to soy. While the size of the SPT wheals may be interpreted utilizing mean diameter or surface area cut-offs, the predictive values of these measurement methods were no better than the commonly utilized grading method where a positive skin test was recorded as a mean wheal diameter 3 mm greater than the negative control.

Allergens↗
PubMed1998

Prevalence of IgE-mediated food allergy among children with atopic dermatitis.

OBJECTIVE: There is a growing body of clinical and laboratory evidence to support the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the incidence of IgE-mediated food allergy in children with AD is not well established. DESIGN: A prospective study to determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a university-based dermatologist for evaluation of AD. SETTING: University hospital pediatric dermatology clinic. PATIENTS: A total of 63 patients with AD were recruited (35 male; 32 white, 24 African-American, 7 Asian). METHODS: Patients were assigned an AD symptom score (SCORAD) and were screened for food-specific serum IgE antibodies to six foods (milk, egg, wheat, soy, peanut, fish) known to be the most allergenic in children. The levels of food-specific serum IgE were determined by the CAP System fluoroscein-enzyme immunoassay (CAP); patients with a value >/=0.7 kIUa/L were invited for an additional allergy evaluation. Those with CAP values below the cutoff were considered not food allergic. Patients were considered to be allergic if they met one of the following criteria for at least one food: 1) reaction on food challenge; 2) CAP value more than the 95% confidence interval predictive for a reaction; 3) convincing history of an acute significant (hives, respiratory symptoms) reaction after the isolated ingestion of a food to which there was a positive CAP or prick skin test. RESULTS: A total of 63 patients (median age, 2.8 years; median SCORAD, 41.1) were recruited; 22 had negative CAP values (without a significant difference in age or SCORAD score, compared with the 41 with positive specific IgE values). Further allergy evaluation was offered to the 41 remaining patients; 10 were lost to follow-up and 31 were evaluated further. Of these, 19 underwent a total of 50 food challenges (36 double-blind, placebo-controlled, and 14 open), with 11 patients experiencing 18 positive challenges (94% with skin reactions). Additionally, 6 patients had a convincing history with a predictive level of IgE; 5 had a convincing history with positive, indeterminate levels of IgE; and 1 had predictive levels of IgE (to egg and peanut) without a history of an acute reaction. Overall, 23/63 (37%; 95% confidence interval, 25% to 50%) had clinically significant IgE-mediated food hypersensitivity without a significant difference in age or symptom score between those with or without food allergy. CONCLUSIONS: Approximately one third of children with refractory, moderate-severe AD have IgE-mediated clinical reactivity to food proteins. The prevalence of food allergy in this population is significantly higher than that in the general population, and an evaluation for food allergy should be considered in these patients.

Adolescent↗
PubMed1998

Clinical features of acute allergic reactions to peanut and tree nuts in children.

BACKGROUND: Peanut (PN) and tree nut (TN) allergies are potentially life-threatening, rarely outgrown, and appear to be increasing in prevalence. However, there is relatively little reported about the clinical features of acute reactions to these foods and their potential association. OBJECTIVE: To describe the clinical features of acute reactions during initial and subsequent accidental ingestions of PN and TN among children with a history of at least one acute allergic reaction to these foods. DESIGN: Questionnaire survey, examination, and serologic testing for specific IgE antibody of patients with convincing histories of acute reactions (at least one organ system involved within 60 minutes of ingestion) to PN or TN. RESULTS: A total of 122 patients (63% males; median age, 8 years at time of study) had acute reactions; 68 had reactions only to PN, 20 only to TN, and 34 to both PN and TN. Of those reacting to TN, 34 had reactions to one, 12 to two, and 8 to three or more different TN, the most common being walnut, almond, and pecan. Initial reactions usually occurred at home (median age, 24 months for PN and 62 months for TN) and were considered to result from a first exposure in 72% of cases. Eighty-nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea). Two organ systems were affected in 31% of initial reactions, and all three in 21% of reactions. Thirty-eight of 190 first reactions to PN or TN were treated with epinephrine. Accidental ingestions occurred in 55% of PN-allergic children (average of two accidents per patient with an accidental ingestion) and in 30% of TN-allergic children over a median period of 5.5 years. On average, symptoms after accidental exposure were generally similar to those at initial exposure. Accidents occurred commonly in school but also at home and in restaurants. Modes of accidental ingestion included sharing food, hidden ingredients, cross-contamination, and school craft projects using peanut butter. Eighty-three percent of the children were breastfed, with >90% of the mothers ingesting PN and at least one TN during lactation. Among patients reporting no history of exposure (>60% of patients for each TN), IgE antibodies were found to a particular TN in 50% to 82% of patients and to PN in 100% of patients. CONCLUSIONS: Acute allergic reactions to PN occur early in life. PN and TN allergic reactions coexist in one third of PN-allergic patients, frequently occur on first known exposure, and may be life-threatening, requiring emergency treatment. Accidental ingestions are common, occur frequently outside of the home, and often require emergency treatment. Consequently, early diagnosis followed by education on avoidance and treatment measures (including self-administered epinephrine) is imperative.

Arachis↗
PubMed1997

Food allergy.

The evaluation of adverse reactions to foods involving abnormal immune responses to food allergens remains an important part of the practice of allergy and immunology. Approximately 5% of children younger than 3 years and 1.5% of the general population experience food allergic disorders, indicating that about 4 million Americans suffer from food allergies. The evaluation of adverse reactions to foods depends on a careful clinical history, diagnostic studies including appropriate skin testing or in vitro testing with food extracts, and/or endoscopy and biopsy. The mainstay of therapy remains avoidance of incriminated foods and education to deal with inadvertent exposures. Experience over the past decade suggests that the ready availability and early introduction of highly allergenic foods (eg, peanuts and nuts) into the diet will only increase the number of individuals suffering from hypersensitivity reactions to foods. Research has focused on the identification and characterization of allergenic proteins and the development of new therapeutic strategies, eg, plasmid DNA vaccines, to treat these disorders.

Digestive System↗
PubMed1997

Dermal and airway responses to monoclonal antibodies specific for canine IgE.

In order to understand mechanisms underlying variability of IgE-mediated responses in vivo, we compared effects of different monoclonal antibodies of IgE on dermal and airway responses in a group of atopic dogs. Using intradermal testing, fourteen antibodies were screened in Basenji-Greyhound dogs. For further comparisons between dermal and airway responses, we selected the two antibodies that stimulated the greatest and least dermal responses, respectively. These antibodies bound to IgE with similar affinities (4.1 +/- 0.2 x 10(9) and 1.5 +/- 0.2 x 10(10) M-1). Dose-response curves to intradermal testing were constructed for these two antibodies. On a separate occasion, peripheral airway resistance (Rp) was determined before and after aerosol challenge with an antibody or saline in the same dogs. For one antibody (affinity 4.1 +/- 0.2 x 10(9) M-1), Rp reached a maximum (407 +/- 142% above baseline; mean +/- SE, n = 6) 10 to 15 min after challenge, while maximum responses to saline (62 +/- 16% above baseline, p < 0.01) occurred immediately after aerosol delivery. Responses to the other antibody were similar (p = 0.068) to responses to saline. The magnitude of skin responses did not predict the magnitude of airway responses. These findings suggest that differences in affinities, alone, do not predict magnitude of responsiveness to the anti-IgE antibody and that mechanisms underlying skin and airway responses may differ qualitatively and/or quantitatively.

Airway Resistance↗
PubMed1997

Allergenic properties of ovomucoid in man.

Ovomucoid, the dominant allergen in hen's egg, is a highly glycosylated protein comprising 186 amino acids arranged in three tandem domains (Gal d 1.1, 1.2, and 1.3). The purpose of this study was to evaluate the allergenic properties of ovomucoid. The three ovomucoid domains were isolated and evaluated with sera from egg allergic patients to determine B cell domain specificity, B cell epitopes, and the relative importance of linear and conformational structures and carbohydrate chains to B cell epitopes. Peripheral blood T cells from egg allergic patients were used to evaluate T-dominant domains and reactivity to reduced and oxidized ovomucoid. There was significantly more IgE activity to the second ovomucoid domain (median percentage of ovomucoid-specific IgE: Gal d 1.2, 40%; Gal d 1.1, 23%; Gal d 1.3, 26%). Quantities of patient IgG Ab were comparable for all three domains. Five IgE and seven IgG binding regions were identified. IgE Ab binding to reduced ovomucoid and IgG binding to oxidized ovomucoid were significantly reduced compared with that to native ovomucoid (28 and 69%, respectively). Peripheral blood T cells of 21 of 33 patients reacted to Gal d 1.3, 18 of 33 reacted to Gal d 1.2, and 18 of 33 reacted to Gal d 1.1. T cell proliferation in vitro in response to reduced and oxidized ovomucoid were significantly greater than that in response to the native protein. These results indicate a dichotomy between T and B cell domain dominance, and the presence of both unique and common IgE and IgG epitopes. Furthermore, the results suggest that conformational B cell epitopes play a more significant role in ovomucoid allergenicity than previously appreciated, and that carbohydrate moieties have a minor effect on allergenicity.

Allergens↗
PubMed1997

Clinical reactivity to beef in children allergic to cow's milk.

BACKGROUND: Cow's milk is one of the most common food allergens in children. Limited information is available on the prevalence of reactivity to a related food source, beef. The purposes of this study were to examine the prevalence of symptomatic sensitivity to beef in a selected pediatric population and to determine the frequency of concomitant reactivity to cow's milk and beef. METHODS: Children referred for assessment of atopic dermatitis and possible food hypersensitivity were evaluated for symptomatic reactivity to beef by double-blind placebo-controlled food challenges (DBPCFCs) and subsequent open feedings of beef. Sodium dodecyl-sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblot, and immunodot blot analyses were performed with patients' sera on preparations of beef extracts subjected to different cooking conditions: raw (no heating), medium, and well-cooked. RESULTS: Eleven of 335 children referred for evaluation of atopic dermatitis and possible food hypersensitivity were found to have symptomatic sensitivity to beef; eight were also sensitive to milk, as demonstrated in previous DBPCFCs. Eight patients reacted to beef during DBPCFC, and three tolerated beef in a DBPCFC and well-cooked beef in an open challenge but reacted to ingestion of less well-cooked beef. SDS-PAGE of raw beef revealed at least 24 protein fractions. Several protein bands in raw beef appeared to denature with heating. Bovine serum albumin and bovine gamma globulin were heat-labile in the beef extract, but six protein fractions persisted even after heating the beef extract for 2 hours at 85 degrees C. IgE from patients reacting to rare and well-cooked beef bound up to six of these heat-resistant fractions, but IgE from patients reacting only to rare beef failed to bind any of these fractions with one exception. In addition, patients reacting to rare and well-cooked beef had specific IgE to a 17.8 kd fraction, which was only weakly recognized by one patient reacting only to rare beef. CONCLUSIONS: Specific IgE antibodies to heat-labile beef proteins might explain why some patients can tolerate well-cooked beef but not medium-rare and rare beef. Patients reacting only to rare beef may not need to maintain a complete beef elimination diet.

Adolescent↗
PubMed1997

Evaluation of the usefulness of lymphocyte proliferation assays in the diagnosis of allergy to cow's milk.

BACKGROUND: The significance of cell-mediated mechanisms in IgE-mediated milk allergy (IgE-MA) and in milk-induced enterocolitis syndrome (ME) is controversial. Some investigators have claimed that lymphocyte proliferation assays are useful in the diagnosis of food hypersensitivity, despite the great variability in study designs and results reported. This study was undertaken to address many of these variables and to determine whether lymphocyte proliferation assays correlate with clinical diagnoses. METHODS: Lymphocyte proliferative responses to milk antigen were evaluated in two groups of children, 27 with IgE-MA, and nine with ME and in 21 pediatric control subjects. IgE-mediated food allergy was documented by positive double-blind, placebo-controlled food challenges and positive skin prick test results. ME was diagnosed by oral challenge or by a history of repeated episodes of delayed vomiting (>2 hours) after ingestion of milk and by negative skin prick test responses. Peripheral blood mononuclear cells were isolated and cultured. Cultures stimulated with milk (the food antigen of interest), soy antigen (a nonrelevant food antigen), or tetanus antigen (a positive control antigen) and unstimulated controls were performed in quadruplicate. On days 5, 7, and 9, cells were pulsed with tritium-labeled thymidine and incubated for 4 hours. Results were compared as counts per minute (cpm) and as stimulation indices (SIs). RESULTS: Maximal proliferation was generally seen on day 7. The median cpm (20,941) and the median SI (19.2) in response to milk antigen in the 27 children with IgE-MA were significantly greater than those in the control patients (6969 cpm; SI = 14.2; p = 0.001 and p < 0.05, respectively). However, the ranges were large and overlapped extensively (IgE-MA, 5616 to 52,053 cpm; controls, 469 to 39,260 cpm). The non-soy-allergic patients with IgE-MA also had a significantly greater response to soy antigen than did the control subjects when cpm were compared (0.01 < p < 0.05). There were no differences in background or in response to tetanus antigen. The median response to milk in the patients with ME (11,975 cpm) was significantly greater than that in control subjects (6969 cpm; 0.01 < p < 0.05), when cpm were compared but not when SIs were compared. There were no significant differences between the patients with IgE-MA and those with ME. CONCLUSION: Overall, these results indicate that lymphocyte proliferation assays are neither diagnostic nor predictive of clinical reactivity in individual patients with milk allergy. Lymphocytes of many control patients are highly responsive to milk antigens, and lymphocytes of many patients with milk allergy are not. Statistically significant differences are only evident when the patients are compared as groups.

Animals↗
PubMed1997

Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents.

BACKGROUND: The double-blind, placebo-controlled food challenge (DBPCFC) is the "gold standard" for diagnosis of food hypersensitivity. Skin prick tests and RASTs are sensitive indicators of food-specific IgE antibodies but poor predictors of clinical reactivity. Previous studies suggested that high concentrations of food-specific IgE antibody were predictive of food-induced clinical symptoms. Because the CAP System FEIA (Pharmacia Diagnostics, Uppsala, Sweden) provides a quantitative assessment of allergen-specific IgE antibody, this study was undertaken to determine the potential utility of the CAP System FEIA in diagnosis of IgE-mediated food hypersensitivity. METHODS: Sera from 196 patients with food allergy were analyzed for specific IgE antibodies to egg, milk, peanut, soy, wheat, and fish by CAP System FEIA. Sera were randomly selected from 300 stored samples of children and adolescents who had been evaluated by history, skin prick tests, and DBPCFCs. The study population was highly atopic; all patients had atopic dermatitis, and approximately 50% had asthma and allergic rhinitis at the time of initial evaluation. The performance characteristics of the CAP System FEIA were compared with those of skin prick tests and the outcome of DBPCFCs or "convincing" histories of anaphylactic reactions. RESULTS: The prevalence of specific food allergies in the study population varied from 22% for wheat to 73% for egg. Allergy to egg, milk, peanut, and soy accounted for 87% of confirmed reactions. The performance characteristics of skin prick tests and CAP System FEIA (egg, milk, peanut, fish) were comparable, with excellent sensitivity and negative predictive accuracy but poor specificity and positive predictive accuracy. The performance characteristics of the CAP System FEIA for soy and wheat were poor. For egg, milk, peanut, and fish allergy, diagnostic levels of IgE, which could predict clinical reactivity in this population with greater than 95% certainty, were identified: egg, 6 kilounits of allergen-specific IgE per liter (kU[A]/L); milk, 32 kU(A)/L; peanut, 15 kU(A)/L; and fish, 20 kU(A)/L. CONCLUSIONS: When compared with the outcome of DBPCFCs, results of CAP System FEIA are generally comparable to those of skin prick tests in predicting symptomatic food hypersensitivity. Furthermore, by measuring the concentrations of food-specific IgE antibodies with the CAP System FEIA, it is possible to identify a subset of patients who are highly likely (>95%) to experience clinical reactions to egg, milk, peanut, or fish. This could eliminate the need to perform DBPCFCs in a significant number of patients suspected of having IgE-mediated food allergy.

Adolescent↗