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There are many tools that can help suggest the presence of food allergies, but, in the end, the most reliable procedure to confirm or exclude a diagnosis of food allergy remains the oral challenge.  But how should allergists perform them?  In this month’s issue of JACI, Drs. Ballmer-Weber and Beyer provide their insights on how to effectively conduct a food challenge ( J Allergy Clin Immunol 2018; 141(1): 69-71 ).   The majority of children with food allergies require such challenges to diagnose their condition, especially younger children with eczema who have skin prick or blood tests suggesting that allergic sensitization may be a trigger for eczema flares, or in whom a food allergy may no longer be present.  However, not all patients should have challenges.  The risks of a severe, life-threatening anaphylactic reaction have to be balanced with the benefits of more definitively establishing a diagnosis.  In addition, the risks of an oral challenge ma...

The rate of food allergies in the United States keeps on rising, but nobody really knows the exact reasons why.  In this month’s issue of the Journal of Allergy and Clinical Immunology, Du Toit and colleagues review the literature and focus on the ‘dual allergen’ hypothesis ( J Allergy Clin Immunol 2018; 141(1): 30-40 ).  Briefly, they explain that allergic sensitization may occur when there is low-level skin exposure to food allergens, while tolerance is more likely to develop in children to have early exposures to food proteins.  The data are mounting from both animal and human observational studies as well as randomized control studies.  The most notable has been the LEAP study, which showed that infants aged 4 to 11 months who consumed peanut products at least three times per week until age 60 months were far less likely to develop peanut allergies than infants who had complete avoidance.  Only 3.2% in the peanut-eating group developed peanut allergy, compar...