Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis

摘要: Background Eliciting doses (EDs) (eg, ED01 or ED05 values, which are the amounts of allergen expected to cause objective symptoms in 1% and 5% population with an allergy, respectively) increasingly being used inform labeling clinical management. These values generated from food challenge, but frequency anaphylaxis response these low levels exposure their reproducibility unknown. Objective Our aim was determine (1) rate low-level peanut (2) reaction thresholds (and anaphylaxis) at challenge. Methods We conducted a systematic review individual participant data meta-analysis studies that reported least 50 individuals allergy reacting double-blind, placebo-controlled challenge (DBPCFC) were published between January 2010 September 2020. Risk bias assessed by using National Institute for Clinical Excellence methodologic checklists. Results A total 19 included (covering 3151 participants, 534 whom subsequently underwent further challenge). At meta-analysis, 4.5% (95% CI, 1.9% 10.1%) reacted 5 mg less protein (moderate heterogeneity [I2 = 57%]). Intraindividual varied up 3 logs, although this variation limited half-log change 71.2% CI, 56.2% 82.6%) individuals. In all, 2.4% CI, 1.1% 5.0%) patients initially tolerated then dose subsequent (low 16%]); none developed anaphylaxis. Conclusion Around level might develop dose. This equates 1 6 events per 2500 exposed dose, respectively, broader allergy.