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Pitfalls in double-blind, placebo-controlled oral food challenges.

机译：双盲，安慰剂控制的口服食品挑战中的陷阱。

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摘要

Although controlled oral food challenges are considered to be the gold-standard in the diagnosis of food related symptoms, especially if performed in a double-blind, placebo-controlled food challenges (DBPCFC) manner, there are still many unanswered questions and newer aspects, which may explain some pitfalls encountered during oral food challenges. For stopping an oral food challenge and declaring a challenge as positive or negative, symptoms should be objective and/or repetitive. The time interval between administering the food and observing the clinical reaction is an ambivalent factor. Possible reasons for false negative assessments include inadvertent drug use during oral challenges, and the fact that a short-term specific oral tolerance induction (SOTI) may be induced as increasing amounts of the offended food are administered during a titrated oral food challenge. Possible reasons for false positive assessments are the difficulty to maintain an appropriate strict diet throughout the oral challenge procedure, and that the elimination diet implemented before the oral food challenge in children with atopic eczema and suspected food related symptoms may itself be responsible for immediate type clinical symptoms, which had not been reported by the parents before. Finally augmentation factors are among the most plausible explanations for the inadequate reproducibility of an oral food challenge. Although a 100% standardization of the challenge procedure does not seem realistic, efforts should be made to improve the methodology used so far. On the contrary, the possible relation of DBPCFC and SOTI may offer potential advantages for future therapeutic approaches of food allergy.
机译：尽管受控的口服食物挑战被认为是诊断食物相关症状的金标准，尤其是如果以双盲，安慰剂控制的食物挑战（DBPCFC）方式进行，但仍然存在许多未解决的问题和较新的方面，这可以解释口服食物挑战时遇到的一些陷阱。为了停止口服食物刺激并将其宣布为阳性或阴性，症状应是客观的和/或重复的。服用食物与观察临床反应之间的时间间隔是一个矛盾的因素。假阴性评估的可能原因包括口服挑战期间无意使用药物，以及在滴定的口服食物挑战过程中，随着违规食物数量的增加，可能会诱导短期特异性口服耐受诱导（SOTI）。假阳性评估的可能原因是在整个口服挑战过程中难以维持适当的严格饮食，并且特应性湿疹和怀疑与食物有关的症状的儿童口服饮食之前实施消除饮食本身可能是直接型临床的原因症状，以前父母没有报告过。最后，对于口服食品挑战的可重复性不足，增加因子是最合理的解释之一。尽管挑战程序的100％标准化似乎并不现实，但应努力改善目前使用的方法。相反，DBPCFC和SOTI的可能关系可能为将来食物过敏的治疗方法提供潜在的优势。

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