Unveiling heterogeneity in individual thresholds validation using urinary prostaglandin D2 metabolite in food allergy reactions
Main Article Content
Keywords
food allergy, oral food challenge, threshold, tolerated dose, prostaglindin
Abstract
Background: The prevalence of food allergies among children is on the rise, presenting with a spectrum of severity from mild cases to those resulting in anaphylaxis. Ensuring the safe progression of home-based food ingestion is essential in managing food allergy. While the oral food challenge (OFC) test ideally confirms the threshold and tolerated dose, past findings indicated that about 30% of children who passed peanut OFCs experienced peanut-related allergic reactions when introducing peanuts at home.
Objective: It is presumed that the immune reactions occurring within individual patients vary in levels according to the situation. To date, no reports have objectively examined these conditions.
Material and Methods: We present the symptoms and validation of an objective biomarker in eight pediatric cases during home introduction of food allergens. The urinary Prostaglandin D metabolite (PGDM) was measured as a noninvasive biomarker.
Results: Some cases exhibited mild symptoms and elevated urinary PGDM levels during home introduction despite ingesting half the dose that confirmed as safe during OFC.
Conclusion: It underscores the importance of considering individual variability in determining food allergy thresholds.
References
1. ) Warren CM, Jiang J, Gupta RS.: Epidemiology and burden of food allergy. Current Allergy and Asthma Reports. 2020;, 20(2):6. https://doi.org/10.1007/s11882-020-0898-7
2. ) Yamamoto-Hanada K, Pak K, Saito-Abe M, Yang L, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka Ohya YK, et al.: Allergy and immunology in young children of Japan: The JECS cohort. World Allergy Organization Journal. 2020;, 13(11):xxx. https://doi.org/10.1016/j.waojou.2020.100479
3. ) Miyaji Y, Yamamoto-Hanada K, Yang L, Fukuie T, Narita M, Ohya Y.: Effectiveness and safety of low-dose oral immunotherapy protocols in paediatric milk Upon checking the journal, we confirmed that no page numbers are listed in the available bibliographic information. Accordingly, we have left the page number unspecified in the revised manuscript. and egg allergy. Clin Exp Allergy. 2023;, 53(12):1307-130–9. https://doi.org/10.1111/cea.14400
4. ) van Erp FC, Boot J, Knulst AC, Pasmans SG, van der Ent CK, Meijer Y.: Reintroduction failure after negative peanut challenges in children. Pediatr Allergy Immunol. 2014;, 25(6):580-58–5. https://doi.org/10.1111/pai.12266
5.) Inagaki S, Maeda S, Narita M, Nakamura T, Shimosawa T, Murata T, Ohya Y, et al.: Urinary PGDM, a prostaglandin D(2) metabolite, is a novel biomarker for objectively detecting allergic reactions of food allergy. J Allergy Clin Immunol. 2018;, 142(5):1634-163–6.e1610. https://doi.org/10.1016/j.jaci.2018.06.032
6.) Inagaki S, Nakamura T, Natsume O, Yamamoto-Hanada K, Fukuie T, Narita M, Shimosawa T, Murata T, Ohya Y, et al.: Urinary prostaglandin D(2) metabolite appears to be a useful biomarker for evaluating the status of egg oral immunotherapy in children. J Allergy Clin Immunol Pract. 2021;, 9(11):4164-416–6.e4162. https://doi.org/10.1016/j.jaip.2021.06.040
7.) Inuzuka Y, Yamamoto-Hanada K, Nakamura T, Shimosawa T, Murata T, Ohya Y.: Detection of allergic reactions during oral food challenge using noninvasive urinary prostaglandin D2 metabolites. Clin Exp Allergy. 2022;, 52(1):176-17–9. https://doi.org/10.1111/cea.14006
8.) Shimada M, Yamamoto-Hanada K, Inuzuka Y, Kabashima S, Nakamura T, Shimosawa T, Murata T, Ohya Y, et al.: Association of age, allergic rhinitis, and regular food intake with urinary tetranor-PGD metabolite levels. Journal of Laboratory and Precision Medicine Med. 2022;, 7:36-40. https://doi.org/10.21037/jlpm-22-46
9.) Ito N, Nakamura T, Sakamoto N, Hayashi A, Murata T.: Extraction and measurement of urinary tetranor-PGDM in disposable diapers. J Pharmacol Sci. 2021;, 147(2):208-2–10. https://doi.org/10.1016/j.jphs.2021.06.011
10.) Patel N, Adelman DC, Anagnostou K, Baumert JL, Blom WM, Campbell DE, Chinthrajah RS, Mills ENC, Javed B, Purington N, et al.: Using data from food challenges to inform management of consumers with food allergy: A systematic review with individual participant data meta-analysis. J Allergy Clin Immunol. 2021;, 147(6):2249-22–62.e2247. https://doi.org/10.1016/j.jaci.2021.01.025
11.) Turner PJ, Patel N, Campbell DE, Sampson HA, Maeda M, Katsunuma T, Westerhout J, Blom WM, Baumert JL, Houben GF et al.: Reproducibility of food challenge to cow's milk: Systematic review with individual participant data meta-analysis. J Allergy Clin Immunol. 2022;, 150(5):1135-11–43.e1138. https://doi.org/10.1016/j.jaci.2022.04.035
12.) World Health Organization (WHO). Risk assessment of food allergens. Part 2: Review and establish threshold levels in foods for the priority allergens:. meeting report. Food Safety and Quality Series 15. Geneva, Switzerland: WHO, 2023.