The range of minimum provoking doses in hazelnut-allergic patients as determined by double-blind, placebo-controlled food challenges
Article first published online: 11 DEC 2002
Clinical & Experimental Allergy
Volume 32, Issue 12, pages 1757–1762, December 2002
How to Cite
Wensing, M., Penninks, A. H., Hefle, S. L., Akkerdaas, J. H., Van Ree, R., Koppelman, S. J., Bruijnzeel-Koomen, C. A. F. M. and Knulst, A. C. (2002), The range of minimum provoking doses in hazelnut-allergic patients as determined by double-blind, placebo-controlled food challenges. Clinical & Experimental Allergy, 32: 1757–1762. doi: 10.1046/j.1365-2222.2002.01555.x
- Issue published online: 11 DEC 2002
- Article first published online: 11 DEC 2002
- Submitted 20 February 2002; revised 14 April 2002; accepted 14 July 2002
- double-blind placebo-controlled food challenge;
- food allergy;
- hazelnut allergy;
- minimum provoking dose;
- threshold dose
Background The risk for allergic reactions depends on the sensitivity of individuals and the quantities of offending food ingested. The sensitivity varies among allergic individuals, as does the threshold dose of a food allergen capable of inducing an allergic reaction.
Objective This study aimed at determining the distribution of minimum provoking doses of hazelnut in a hazelnut-allergic population.
Methods Thirty-one patients with a history of hazelnut-related allergic symptoms, a positive skin prick test to hazelnut and/or an elevated specific IgE level, were included. Double-blind, placebo-controlled food challenges (DBPCFC) were performed with seven increasing doses of dried hazelnut (1 mg to 1 g hazelnut protein) randomly interspersed with seven placebo doses.
Results Twenty-nine patients had a positive challenge. Itching of the oral cavity and/or lips was the first symptom in all cases. Additional gastrointestinal symptoms were reported in five patients and difficulty in swallowing in one patient. Lip swelling was observed in two patients, followed by generalized urticaria in one of these. Threshold doses for eliciting subjective reactions varied from a dose of 1 mg up to 100 mg hazelnut protein (equivalent to 6.4–640 mg hazelnut meal). Extrapolation of the dose–response curve showed that 50% of our hazelnut-allergic population will suffer from an allergic reaction after ingestion of 6 mg (95% CI, 2–11 mg) of hazelnut protein. Objective symptoms were observed in two patients after 1 and 1000 mg, respectively.
Conclusion DBPCFCs demonstrated threshold doses in half of the hazelnut-allergic patients similar to doses previously described to be hidden in consumer products. This stresses the need for careful labelling and strategies to prevent and detect contamination of food products with hazelnut residues.