The number of children with (suspected) food allergy is increasing. Therefore, it is important to provide certainty within the diagnostic process.
The first part of this thesis of Wouter de Weger focusses on oral food challenges (OFCs) within the hospital. During the double-blind placebo-controlled food challenge, the suspected food allergen is hidden in for example gingerbread. In random order the suspected food is eaten at one day, which is not the case at the other (placebo)day. During the open challenge, everyone knows the food will be administered. We found food challenges for peanut, cashew and hazelnut to be comparable. If confirmed by future research, open food challenges can be performed more often. As a result, healthcare will become more efficient, and less burdensome for children. OFC outcome depends on interpretation of symptoms, caused by mediators which are released during allergic reactions. We were able to measure tryptase en histamine in saliva, and this may be useful to objectify allergic reactions.
Food can be introduced gradually at home if the risk to be food allergic is estimated to be very low. In the second part of this thesis, an algorithm is introduced to select whether avoided foods can be introduced at home or clinically with OFC. Due to several reasons, parents are sometimes reluctant to perform the recommended introduction at home. We found a relationship with low quality of life, influenced by expected food allergy.
The insight of this thesis can be used to improve diagnostics for food allergic children. Future research might improve reliability, and efficiency even further.
