Abstract
Background
Ascribing food allergy diagnosis to patients who are not allergic is well described, but its implications on oral immunotherapy (OIT) have not been studied. The aim was to study non-allergic patients referred for OIT.
Methods
All patients who began OIT at Shamir Medical Center between November 2015 and August 2020 were included. Medical records were reviewed, and skin prick tests (SPT) and/or specific IgE were measured. Patients were challenged to the index food. Allergic and non-allergic patients were compared.
Results
A total of 1073 patients were studied (milk, n = 327; egg, n = 41; peanut, n = 272; sesame, n = 130; and tree nuts, n = 303) and 87 (8.1%) were found non-allergic (milk, n = 21; egg, n = 6; sesame, n = 5; peanut, n = 29; tree nuts, n = 26). Predictors of being not allergic were no previous reaction to the index food (OR = 3.3, p = 0.001), not having asthma (OR = 2.4, p = 0.001), or HDM sensitization (OR = 2.0, p = 0.007), male sex (OR = 2.3, p = 0.004), and a smaller SPT wheal size (OR = 1.5, p < 0.001).
Conclusions
A substantial number of patients referred for OIT are mislabeled with food allergy, suffer from unjustly food limitations and impairments in quality of life, and “take up” OIT places of true allergic patients. Awareness of OIT centers to this phenomenon is important.
Impact
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A significant number (8.1%) of patients referred for OIT are found not allergic to the food they intended to treat.
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This study characterizes non-allergic patients referred for OIT (a lack of previous reaction to the index food, a smaller or negative SPT wheal size, and less atopic co-morbidities) and discusses the implications of such referrals.
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Increased awareness by OIT centers to potential non-allergic patients referred for OIT is required, including screening of patients before treatment initiation, to minimize unnecessary treatments of non-allergic patients.
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Data availability
Additional data regarding the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to thank Hasia Duani and Tehila Abargil for coordinating the patient clinical visits and to Keren Golobov, Mor Carmel, and Michal Noah Tal for assisting with OFC performance.
Funding
This study was self-supported. M.R.G. is funded by a Kamea grant from the Ministry of Health, Israel.
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All authors have met the Pediatric Research authorship requirements. Y.K.: conceptualization (equal); investigation (lead); writing original draft (equal); review and editing (equal). L.N.: investigation (supporting); review and editing (equal). M.R.G.: investigation (supporting); review and editing (equal). M.B.L.: investigation (supporting); review and editing (equal). N.E.-R.: investigation (supporting); review and editing (equal). A.E.: conceptualization (equal); investigation (supporting); formal analysis (lead); writing original draft (equal); review and editing (equal).
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Koren, Y., Nachshon, L., Goldberg, M.R. et al. Characteristics of patients diagnosed as non-allergic following food allergy oral immunotherapy referral. Pediatr Res 93, 643–648 (2023). https://doi.org/10.1038/s41390-022-02119-3
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DOI: https://doi.org/10.1038/s41390-022-02119-3
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