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Correspondence
Suspected food allergy in adults: mapping 208 open food challenges with allergy tests and risk stratification
  1. Kavitha Sooriyakumar1,
  2. Omar Mohamed1,
  3. Toni Osborne1,
  4. Sarah C Beck1,
  5. Cathryn Melchior1,
  6. Jane Heslegrave1,
  7. Silvy Mathew1,
  8. Richard L Baretto1,
  9. Anjali Ekbote1,
  10. Aarnoud P Huissoon1,
  11. Mamidipudi Thirumala Krishna1,2
  1. 1 Department of Allergy & Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Institute of Immunology & Immunotherapy and Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Mamidipudi Thirumala Krishna, Department of Allergy Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B95SS, UK; mtkrishna{at}yahoo.com

https://doi.org/10.1136/jclinpath-2020-206994

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    It is estimated that food allergy affects 5% of adult population.1 We reported that food-induced anaphylaxis accounts for 21% of all anaphylaxis in British adults in a community setting.2 Food allergens are important confounders in the diagnostic evaluation of spontaneous anaphylaxis and chronic spontaneous urticaria (CSU) in adults. Best practice guidelines recommend careful interpretation of skin prick tests (SPTs) and serum-specific IgE (SSIgE) in conjunction with clinical history in patients with suspected food allergy.3 The ‘gold standard’ for diagnosis of food allergy is double-blind placebo-controlled food challenge but this procedure is onerous, resource dependent and not feasible for most allergy services in the UK due to unmet demand.3 4 Therefore, adult allergy services in the UK employ a supervised open food challenge (SOFC) to confirm or refute the diagnosis of food allergy when allergy tests (SPTs and/or SSIgE) are inconclusive or discordant with clinical history. However, SOFCs are time consuming and require resources and may not be a preferred option due to safety concerns imposed by COVID-19.

    Most published data on food challenges involve paediatric population and there is paucity of information regarding safety and outcomes of SOFC in adults, particularly in a ‘real-world’ clinical practice. We conducted a retrospective chart review of sequential cases of SOFC at the adult allergy service, University Hospitals Birmingham (UHB) NHS Foundation Trust, one of the largest regional services in the UK. This project (06 August 2006 to 13 July 2018) was registered with …

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    Footnotes

    • Handling editor Stephen R A Jolles.

    • Contributors MTK, KS and OM planned the project. KS collated and analysed data and maintained quality assurance. MTK and KS drafted manuscript and all co-authors critically reviewed and approved final version. All authors were involved in clinical management.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The department received funds from ALK Abello, Thermo Fisher, MEDA, Allergopharma and other pharmaceutical companies for annual PracticAllergy course. MTK received funds from ALK Abello to attend an international conference. MTK has received research grants from MRC CiC, NIHR, FSA and GCRF; none related to this study. CM reports grants from ALK Abello, grants from Allergy Therapeutics, from null, outside the submitted work. APH reports personal fees from ALK Abello, outside the submitted work.

    • Patient consent for publication Not required.

    • Ethics approval Registered as an audit with Governance Unit, University Hospitals Birmingham National Health Service (NHS) Foundation Trust.

    • Provenance and peer review Not commissioned; externally peer reviewed.