Background Previous studies report epinephrine use for positive oral food challenges (OFCs) to be 9-11% when generally performed to determine outgrowth of food allergies. (FAHF-2) (n=45) and Milk Oral Immunotherapy (MOIT) (n=29) conducted at the Icahn School of Medicine at Mount Sinai was performed. Results The most common initial symptom elicited was oral pruritus reported for 81% (n=60) of subjects. Overall subjective gastrointestinal symptoms (oral pruritus throat pruritus nausea abdominal pain) were most common (97.3% subjects) followed by cutaneous symptoms (48.7%). Of the Icariin 74 positive DBPCFCs 29 (39.2%) were treated with epinephrine; 2 of these subjects received 2 doses of epinephrine (6.9% of the reactions treated with epinephrine or 2.7% of all reactions). Biphasic reactions were infrequent occurring in 3 subjects (4%). Conclusions Screening OFCs to confirm food allergies can be performed safely but there was a higher rate of epinephrine use compared to OFCs used for assessing food allergy outgrowth. Therefore personnel skilled and experienced in the recognition of early signs and symptoms of anaphylaxis who can promptly initiate treatment are required. test for comparisons of means. The χ2 test and Fisher exact test were applied to determine differences in proportions. A value <.05 was considered statistically significant. Results Subjects There were a total of 74 positive DBPCFCs. The median age was 13 years (range 7-40 years) and 32.4% were females. This was a highly atopic group with 85% having multiple food allergies 78.4% had a history of asthma 35.1% had a history of anaphylaxis and 33.8% previously received epinephrine to treat an allergic reaction. The median allergen Rabbit Polyclonal to ZP1. specific IgE was 30 kUA/L (range 0.59 to >100) and median SPT wheal diameter was 8.5 mm (range 2-17.5) Symptoms The most common initial symptom at reaction was oral pruritus reported for 81% (n=60) of subjects. This symptom was not dose-limiting thus all of these subjects continued the food challenge and received subsequent doses. No challenge was stopped solely for oral pruritus. Throat pain and/or tightness were the first symptoms for 8.1% and abdominal pain for 4%. Overall subjective gastrointestinal symptoms (oral pruritus throat pruritus nausea abdominal pain) were the most common symptoms affecting 97.3% subjects. Other symptoms included cutaneous (48.7%) upper respiratory tract (sneezing rhinorrhea) (31.1%) lower respiratory tract (wheezing cough stridor) (56.8%) objective gastrointestinal (emesis diarrhea) (27.0%) cardiovascular (5.4%) and neurological (5.4%). Neurological symptoms were described as a feeling of weakness or of feeling faint. Treatments Epinephrine was used as treatment for symptoms in multiple body systems respiratory symptoms throat tightness and/or severe abdominal pain and cramping as outlined in each of the protocols. Of the 74 positive DBPCFCs 29 (39.2%) were treated with epinephrine. Two of these subjects were given 2 doses of epinephrine (6.9% of the reactions treated with epinephrine or 2.7% of all reactions). There were no significant Icariin differences in age gender food challenged having multiple food allergies or history of anaphylaxis between those who were treated with epinephrine and those not treated with epinephrine (Table 1). The group receiving epinephrine did not have a higher rate of asthma but did have a higher rate of previously receiving epinephrine to treat an allergic reaction. Both groups were comparable in Icariin terms of food-specific IgE levels SPTs as well as median quantity of food protein eliciting the reaction and cumulative dose at termination of food challenge. Table 1 Icariin Patient Characteristics The median time between onset of first symptoms and administration of epinephrine was 65 min (range 5-201 min) since the majority of subjects had subjective gastrointestinal symptoms as the initial complaint. Epinephrine was used to treat mild reactions where mild symptoms were observed in multiple body systems or complaints of throat symptoms beyond pruritus were described. For the 2 2 subjects who were given 2 doses of epinephrine the second dose was administered 15 and 29 min after the first dose of epinephrine. No subjects required more than 2 doses of epinephrine. Steroids and intravenous fluids (IVF) were administered more often for reactions treated with epinephrine than for those not treated with epinephrine (Table 2). All subjects were treated with H1.