Am. J. Respir. Crit. Care Med., Vol 149, No. 1, 01 1994, 59-64.
Respiratory reactions provoked by double-blind food challenges in children
JM James, J Bernhisel-Broadbent and HA Sampson
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
A total of 320 children with atopic dermatitis undergoing double-blind,
placebo-controlled food challenges (DBPCFC) for the evaluation of food
hypersensitivity were monitored for respiratory reactions. The patients,
ages 6 months to 30 yr, were highly atopic (median IgE; 3,400 IU/ml) and
had multiple sensitivities to foods and aeroallergens. Fifty- five percent
of the patients had asthma; 45% presented with both asthma and allergic
rhinitis. Food hypersensitivity was confirmed by DBPCFC in 205 (64%) of the
320 patients evaluated, and 121 (59%) of these 205 patients experienced
respiratory reactions, including nasal, laryngeal, and/or pulmonary
symptoms in 34 (17%). To assess the degree of pulmonary dysfunction
developing during food hypersensitivity reactions, especially those
including lower respiratory symptoms, 88 of these patients were monitored
with spirometry during positive and negative DBPCFC. Of these patients, 13
(15%) developed lower respiratory symptoms, including wheezing, during
DBPCFC; however, only six patients had a > 20% decrease in FEV1. We
conclude that respiratory symptoms are commonly provoked in children with
atopic dermatitis during DBPCFC, but significant bronchopulmonary
obstruction is not frequently observed.
