Delayed symptoms and orthostatic intolerance following peanut challenge.

Abstract

BACKGROUND:

Clinical reactions to Oral Food Challenge (OFC) in peanut-allergic individuals have been well-characterised, but rates and phenotypes of symptom recurrence beyond the first hour after objective symptoms are less well-characterised.

OBJECTIVE:

To evaluate the rate of new-onset symptoms occurring at least 1 h after stopping OFC in peanut-allergic children and adults undergoing peanut-OFC.

METHODS:

We prospectively collected data relating to adverse events following positive reactions at double-blind, placebo-controlled food challenges (DBPCFC) to peanut in children and adults evaluated for eligibility to participate in two clinical trials (NCT02149719, NCT02665793). The trials included people aged 8 to 45 with primary, IgE-mediated peanut allergy at DBPCFC. The challenge protocol included consumption of a light meal 1 h after reaction.

RESULTS:

A total of 121 participants (64 children, 57 adults) had immediate, objective symptoms at DBPCFC, 25 (17 children, 8 adults) with anaphylaxis. Thirty-three (27%) had progression or recurrence of symptoms ≥ 1 h after objective clinical reaction, of whom 8 developed anaphylaxis. In 23 cases, the onset of new symptoms was associated with consumption of a light meal. In eight cases, symptoms were limited to a symptomatic postural fall in blood pressure noted in preparation for discharge, without any other new features of an allergic reaction.

CONCLUSIONS & CLINICAL RELEVANCE:

Progressive or new-onset symptoms ≥1 h following initial allergic reaction at OFC are common and can include orthostatic hypotension. Recurrent symptoms may be temporally associated with food consumption.

• Authors: Paul J Turner, Monica Ruiz-Garcia, Nandinee Patel, Gonçalo Abrantes, Sarah Burrell, Marta Vazquez-Ortiz, Isabel Skypala, Stephen R Durham, Robert J Boyle
• Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (Clin Exp Allergy) Vol. 51 Issue 5 Pg. 696-702 (05 2021) ISSN: 1365-2222 [Electronic] England
• PMID: 33715235 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

Chemical References

• Allergens

Topics

• Administration, Oral
• Adolescent
• Adult
• Allergens (administration & dosage)
• Anaphylaxis (etiology, physiopathology)
• Child
• Disease Progression
• Double-Blind Method
• Female
• Food Hypersensitivity
• Humans
• Male
• Orthostatic Intolerance (complications, etiology, physiopathology)
• Peanut Hypersensitivity (physiopathology)
• Recurrence
• Time Factors
• Young Adult