Division of Allergy and Clinical Immunology, The University of Michigan Medical School, Ann Arbor, Michigan.
Family Allergy and Asthma Center, Florence, Kentucky.
Ann Allergy Asthma Immunol. 2016 May;116(5):420-4. doi: 10.1016/j.anai.2016.02.016. Epub 2016 Mar 24.
Food specific IgE (sIgE) is a useful marker to assess predictability of oral food challenge (OFC) outcome. A threshold of less than 2 kUA/L for peanut, egg, and milk has been proposed as a 50% negative predictive value at which patients may pass an OFC.
To assess the economic effect and outcome of delaying OFCs.
A retrospective analysis was performed for peanut, egg, and milk OFCs conducted between 2001 and 2012 at a tertiary food allergy referral center. Delayed OFC was defined as greater than 12 months from the time the sIgE level became less than 2 kUA/L. Time to OFC was explored in association with skin prick test result (wheal size), OFC outcome, and the economic effect of delay.
Of 319 challenges, 173 OFCs were delayed (54.2%) by a mean time of 35.5 months (range, 13-123 months) vs a mean time of 4.2 months in the 146 challenges that were not delayed (P < .001). The overall OFC passage rate was 89.9%. There was no association between delayed OFC and history of anaphylaxis, type of allergen, age at OFC, or challenge outcome. Delay in OFC was associated with an estimated mean economic cost of $12,203 per patient ($4,184 per 12 months) and $1,951,487 total (total delay, 5,597 months) in this population.
Despite a 50% negative predictive value, more than 50% of OFCs were delayed in this population by a mean time of nearly 3 years. Delaying OFC is associated with increased costs, and quality improvement is needed to help decrease time to OFC and reduce the economic burden of food allergy on families and the health care system.
食物特异性 IgE（sIgE）是评估口服食物挑战（OFC）结果预测性的有用标志物。已提出花生、鸡蛋和牛奶的 sIgE 阈值小于 2 kUA/L，作为 50%阴性预测值，在此阈值下患者可能通过 OFC。
评估延迟 OFC 的经济效果和结果。
对 2001 年至 2012 年在一家三级食物过敏转诊中心进行的花生、鸡蛋和牛奶 OFC 进行了回顾性分析。延迟 OFC 定义为 sIgE 水平低于 2 kUA/L 后超过 12 个月进行 OFC。探讨了时间到 OFC 与皮肤点刺试验结果（风团大小）、OFC 结果和延迟的经济影响之间的关系。
在 319 次挑战中，173 次 OFC 延迟（54.2%），平均时间为 35.5 个月（范围 13-123 个月），而未延迟的 146 次挑战的平均时间为 4.2 个月（P <.001）。总的 OFC 通过率为 89.9%。延迟 OFC 与过敏反应史、过敏原类型、OFC 年龄或挑战结果之间无关联。OFC 延迟与估计每位患者平均经济成本增加 12,203 美元（每 12 个月 4,184 美元）和 1,951,487 美元（总延迟 5,597 个月）有关。
尽管有 50%的阴性预测值，但在该人群中，超过 50%的 OFC 延迟了近 3 年。延迟 OFC 与成本增加有关，需要进行质量改进，以帮助缩短 OFC 时间并减轻食物过敏对家庭和医疗保健系统的经济负担。
