Background

Food allergy reactions range from mild to severe with differences in age appearing to be an important factor associated with reaction severity.

Objective

To define differences in oral food challenge (OFC) reaction severity in pediatric patients from infancy to adolescence using objective clinical outcomes and standardized reaction grading tools.

Methods

Retrospective review of all positive OFC results at 2 large institutions between September 2016 and February 2019. Reaction severity was defined by presence of cardiovascular, neurologic, lower respiratory, or laryngeal symptoms, epinephrine requirement, and grading using 2 established food allergy reaction scales.

Results

Infants and toddlers had fewer reactions involving cardiovascular, neurologic, lower respiratory, or laryngeal symptoms compared with older age groups. Epinephrine was also required less frequently during reactions in infants and toddlers, compared with older age groups. There was no difference in reaction severity in infants and toddlers based on clinical history of eczema. Increasing age was significantly correlated with increased epinephrine requirement (R² = 0.12, P = .002), elevated Consortium of Food Allergy Research score (R² = .012, P = .003), and approached significance for increased Practical Allergy score (R² = .005, P = .05). History of asthma and sesame allergy were identified to be positively correlated with more severe reactions.

Conclusion

Infants and young toddlers have less severe reactions during OFCs compared with older age groups supporting early food introduction practices. In children under 12 months of age, severe reactions are most rare calling into question screening practices using specific allergy testing before food introduction. Standardized reaction grading tools may be valuable instruments to categorize reaction severity during OFCs.

中文翻译：

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基于儿童年龄增长的口服食物激发反应严重程度的差异

背景

食物过敏反应从轻微到严重不等，年龄差异似乎是与反应严重程度相关的重要因素。

客观的

使用客观的临床结果和标准化的反应分级工具来定义从婴儿期到青春期的儿科患者口服食物激发 (OFC) 反应严重程度的差异。

方法

对 2016 年 9 月至 2019 年 2 月期间 2 家大型机构的所有阳性 OFC 结果进行回顾性审查。反应严重程度定义为心血管、神经系统、下呼吸道或喉部症状的存在、肾上腺素需求，并使用 2 个既定的食物过敏反应量表进行分级。

结果

与年龄较大的年龄组相比，婴儿和幼儿在心血管、神经系统、下呼吸道或喉部症状方面的反应较少。与较大年龄组相比，婴儿和幼儿在反应期间需要肾上腺素的频率也较低。根据湿疹的临床病史，婴儿和幼儿的反应严重程度没有差异。年龄增加与肾上腺素需求增加（R ²  = 0.12，P  = .002）、食物过敏研究联盟评分升高（R ²  = .012，P  = .003）显着相关，并且接近实际过敏评分增加的显着性（ R ²  = .005，P = .05）。哮喘病史和芝麻过敏史被确定为与更严重的反应呈正相关。

结论

与支持早期食物引入实践的年龄较大的群体相比，婴儿和幼儿在 OFC 期间的反应不太严重。在 12 个月以下的儿童中，最罕见的严重反应是在引入食物之前使用特定的过敏测试对筛查实践提出质疑。标准化的反应分级工具可能是对 OFC 期间反应严重程度进行分类的有价值的工具。