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Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study
Food allergy (FA) negatively impacts the quality of life of millions of people and represents a substantial physical and economic burden for the patient, his family, and the state. The gold standard for food allergy diagnosis worldwide is the oral food challenge (OFC). However, data on the OFC thres...
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| Format: | Thesis |
| Language: | English English |
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Department of Paediatrics and Child Health
2026
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| _version_ | 1867613172768178176 |
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| access_status_str | Open Access |
| author | Levina, Daria |
| author2 | Levin, Michael |
| author_browse | Levin, Michael Levina, Daria |
| author_facet | Levin, Michael Levina, Daria |
| author_sort | Levina, Daria |
| collection | Thesis |
| description | Food allergy (FA) negatively impacts the quality of life of millions of people and represents a substantial physical and economic burden for the patient, his family, and the state. The gold standard for food allergy diagnosis worldwide is the oral food challenge (OFC). However, data on the OFC threshold and the efficiency of tests used for FA diagnosis in the South African population are lacking. Methods: A retrospective analysis of all the OFCs carried out at the Red Cross War Memorial Children's Hospital, University of Cape Town, from 2015 to 2023 was performed. Data on the type of food used, OFC outcome, the cumulative amount of protein taken, and data from the previous allergic assessment (skin prick test, specific IgE and components results) were collected. Results: Of the 223 oral food challenges conducted, 61% were negative, 36% were positive, and 2% were indeterminate. Diagnostic test performance varied by allergen, with internationally derived cut-offs often demonstrating suboptimal sensitivity. For cow's milk, the fresh skin prick test (SPT) (≥4 mm) showed high sensitivity (100%) and specificity (83.3%), whereas commercial SPT (≥8 mm) had poor sensitivity (0%). Ara h2-specific IgE (sIgE) outperformed peanut sIgE (AUC 0.785 vs. 0.635). ROC analysis identified lower optimal cut-offs for sIgE, improving diagnostic accuracy. Eliciting dose thresholds varied with age, with younger children exhibiting lower thresholds for cooked eggs and peanuts. Conclusion: These findings highlight the need for population-specific diagnostic thresholds and age- adjusted risk assessments. Lower diagnostic cut-offs improved test performance, and younger children exhibited lower eliciting dose thresholds for certain allergens. These findings emphasize the importance of refining allergy testing protocols to balance safety with minimizing unnecessary dietary restrictions. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42663 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:31:54.917Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42663 Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study Levina, Daria Levin, Michael Food allergy Children Food allergy (FA) negatively impacts the quality of life of millions of people and represents a substantial physical and economic burden for the patient, his family, and the state. The gold standard for food allergy diagnosis worldwide is the oral food challenge (OFC). However, data on the OFC threshold and the efficiency of tests used for FA diagnosis in the South African population are lacking. Methods: A retrospective analysis of all the OFCs carried out at the Red Cross War Memorial Children's Hospital, University of Cape Town, from 2015 to 2023 was performed. Data on the type of food used, OFC outcome, the cumulative amount of protein taken, and data from the previous allergic assessment (skin prick test, specific IgE and components results) were collected. Results: Of the 223 oral food challenges conducted, 61% were negative, 36% were positive, and 2% were indeterminate. Diagnostic test performance varied by allergen, with internationally derived cut-offs often demonstrating suboptimal sensitivity. For cow's milk, the fresh skin prick test (SPT) (≥4 mm) showed high sensitivity (100%) and specificity (83.3%), whereas commercial SPT (≥8 mm) had poor sensitivity (0%). Ara h2-specific IgE (sIgE) outperformed peanut sIgE (AUC 0.785 vs. 0.635). ROC analysis identified lower optimal cut-offs for sIgE, improving diagnostic accuracy. Eliciting dose thresholds varied with age, with younger children exhibiting lower thresholds for cooked eggs and peanuts. Conclusion: These findings highlight the need for population-specific diagnostic thresholds and age- adjusted risk assessments. Lower diagnostic cut-offs improved test performance, and younger children exhibited lower eliciting dose thresholds for certain allergens. These findings emphasize the importance of refining allergy testing protocols to balance safety with minimizing unnecessary dietary restrictions. 2026-01-23T10:53:41Z 2026-01-23T10:53:41Z 2025 2026-01-23T07:45:08Z Thesis / Dissertation Masters MSc http://hdl.handle.net/11427/42663 en eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Food allergy Children Levina, Daria Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| thesis_degree_str | Master's |
| title | Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| title_full | Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| title_fullStr | Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| title_full_unstemmed | Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| title_short | Cut-off values and thresholds of allergic reaction during oral food challenge: a retrospective study |
| title_sort | cut off values and thresholds of allergic reaction during oral food challenge a retrospective study |
| topic | Food allergy Children |
| url | http://hdl.handle.net/11427/42663 |
| work_keys_str_mv | AT levinadaria cutoffvaluesandthresholdsofallergicreactionduringoralfoodchallengearetrospectivestudy |