Background: In order to determine tolerance development in hen’s egg (HE) allergic children, international guidelines recommend an oral food challenge after 6-24 months. This study aimed to assess whether parents follow this advice and factors that influence their decision. Methods: A follow-up of 158 challenge-proven HE allergic children was performed. Families who did not come to a rechallenge were contacted by phone and a standardized survey relating to the current allergy status was conducted. Logistic regression models were used to assess the effect of clinical and laboratory characteristics on the reevaluation of the allergy status. Results: 35% of the HE-allergic children conducted a rechallenge in a hospital, 27% continued avoiding HE without reevaluation and 11% performed a “home-testing” with HE. The odds ratio for patients to test for HE tolerance at home instead of in a hospital increased 7.94 times (CI:2.31-27.31) for every decrease in the severity score at the initial challenge, and 3.24 times (CI:1.26-8.33) for every decrease of the baseline specific IgE CAP-class. Tolerance of heated HE prior to reevaluation was most frequent in the home-tested (100%) and was more frequent in patients, who continued avoidance (68%) compared to those, who were rechallenged (44%). Conclusions: Our data suggest an association between reaction severity as well as specific IgE levels at initial food challenge and the choice of families whether and how to evaluate natural tolerance development in their HE-allergic child. Individualized management may be needed in order to achieve safe and effective medical care for these patients.

A document by Jana Eckert. Click on the document to view its contents.

Background: Allergic diseases are the most prevalent chronic childhood diseases resulting in a massive societal and economic burden for the community and a significant reduction of health-related quality of life (HRQoL) for affected families. The project CHAMP (CHildhood Allergy and tolerance: bioMarkers and Predictors) was funded in 2017 by the German Federal Ministry for Education and Research. Methods: CHAMP investigates the determinants of different allergic diseases from birth to adolescence to identify clinically relevant biomarkers predicting onset, progression, remission and severity. Data on HRQoL and patient’s needs and requirements were collected, supported by the German Asthma and Allergy Association (DAAB). Using validated questionnaires and outpatient visits, eight subprojects analysed allergic diseases in epidemiological or clinical cohorts (more than 2500 children/adolescents), sampling numerous biomaterials to assess omics on several levels. Murine models disentangled underlying mechanisms of early tolerance, translating findings from the cohorts to models and vice versa. Results: The DAAB survey, including 851 participants, showed that 83% were interested in prediction of the course of different current allergic diseases and future manifestation. 86% of participants considered doctor’s specialized training and their education as highly important, over 70% chose research for allergy understanding and prevention as critical. CHAMP addresses these needs. Common SOPs have been established and recruitment is ongoing. Conclusion: The DAAB patient survey confirmed the critical need for translational allergy research. CHAMP envisions to predict onset, tolerance and remission of allergic diseases and to identify disease sub-phenotypes for future development of preventive strategies and novel avenues for therapeutic options.