Validation of novel recipes for masking peanuts in double-blind, placebo-controlled food challenges

Abstract

Background

Double-blind, placebo-controlled oral food challenges are the gold standard in food allergy diagnosis. Nevertheless, proper masking of peanuts is particularly complex owing to their intense flavor and odor. Thus, it is important to use validated recipes to ensure their adequate masking during oral food challenges.

Objective

To design and validate recipes containing masked peanuts for double-blind, placebo-controlled oral food challenges.

Methods

Two types of products (cookies and a custard‑type dessert) containing the masked peanuts and other ingredients with low allergenic potential were designed and validated. For this purpose, of the 24 initial cookie recipes and 12 initial custard recipes developed, those that did not exhibit significant differences in their texture were selected for sensory validation.

Results

Similarity triangle tests were performed using a panel of 36 selected tasters, enabling the validation of 1 pair of cookie recipes and 1 pair of custard-type dessert recipe, both with low allergenic potential and suitable for those with celiac disease and for vegans.

Conclusion

The validated recipes are of clinical and research interest because they allow to confirm a peanut allergy and detect a wide range of tolerated threshold doses, which makes it possible to provide specific indications for each patient.

Introduction

The double-blind, placebo-controlled oral food challenge (DBPCFC) is the gold standard in food allergy diagnosis.¹ Food masking is not always easy, as the intense flavor, color, or odor of certain foods makes it difficult for them to be adequately masked within a food matrix. Thus, it is important to use validated recipes to ensure adequate food masking during oral food challenges. Although the use of different foods for oral challenges has already been validated in previous studies,^2,3 more validation recipes including some of the foods that are most often implicated in food allergies, such as peanuts, are required to conduct these tests in both young and adult patients.³

Data published in the literature^4,5 describe the increasing prevalence of food allergy in recent decades, with peanut allergy being perceived as a particularly important social concern in many countries with a high prevalence of this condition.⁶ After the diagnosis of a peanut allergy, complete avoidance of peanuts with a view to prevent severe reactions can be difficult owing to their ubiquity and adversely affects patients’ quality of life.^1,7 Because of these reasons, we believe that it is crucial to have the necessary tools to facilitate early and accurate diagnosis of this allergy to introduce peanuts into the diet of patients who tolerate this food. Hence, the aim of this study is to develop and validate masking recipes for placebo-controlled oral food challenges with peanuts.