IgE Threshold Testing for Food Allergy

Overseen By Fernanda D Young, M.D.

Age: < 65

Sex: Any

Trial Phase: Phase 2

Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)

Must not be taking: Beta-blockers, Omalizumab, Dupilumab

Disqualifiers: Pregnancy, Cardiac disease, Eosinophilic GI, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to improve the accuracy of food allergy tests for individuals with eczema (atopic dermatitis) who might be allergic to milk or peanuts. Participants will undergo oral food challenges, consuming small amounts of these foods to assess allergic reactions. This process helps determine true allergies. The trial seeks individuals aged 3-21 with eczema, high levels of allergy antibodies (IgE), and potential milk or peanut allergies. Participants must also be enrolled in another ongoing study and willing to try these foods under controlled conditions. As a Phase 2 trial, the research focuses on measuring the treatment's effectiveness in an initial, smaller group.

Will I have to stop taking my current medications?

You may need to stop taking certain medications like omalizumab or dupilumab at least 6 months before a food challenge, and you might need to stop antihistamines and oral steroids before the challenge as well. However, you can continue using topical steroids.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that about 75% of children with cow's milk allergy can safely consume baked milk without reactions. Studies also suggest that incorporating baked milk into their diets might help them outgrow milk allergies over time, indicating that baked milk is usually well-tolerated.

Regarding peanut flour, safety data from various studies indicate that reactions to peanut allergen powder are generally mild to moderate and tend to decrease over time. Guidelines for preventing peanut allergies support its safe introduction when done carefully.

In summary, studies have shown that both baked milk and peanut flour are generally safe for many people. However, it is important to closely monitor reactions, especially in a controlled setting like a clinical trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the IgE Threshold Testing for Food Allergy because it explores how specific foods like baked milk and peanuts might be safely reintroduced into the diets of people with food allergies. Unlike traditional avoidance strategies, this trial aims to determine safe thresholds for consuming these allergens, which could potentially reduce the burden of strict dietary restrictions. By using double-blind placebo-controlled food challenges, the trial seeks to provide more personalized and accurate information about individual allergy thresholds, potentially leading to more tailored and less restrictive dietary guidelines.

What evidence suggests that this trial's treatments could be effective for food allergies in people with atopic dermatitis?

Research has shown that baked milk, which participants in this trial may receive, can help children with cow's milk allergy. Studies have found that including baked milk in their diet can accelerate the process of outgrowing their milk allergy by gradually increasing their tolerance to milk.

For peanut flour, another treatment option in this trial, studies indicate that it can help individuals tolerate more peanut protein. After treatment, participants often exhibit lower levels of peanut-specific IgE (an allergy-related antibody) and higher levels of IgG4, which aids in building tolerance. This evidence suggests that peanut flour can help manage peanut allergies by reducing allergic reactions over time. ^{3 6 7 8 9}

Who Is on the Research Team?

Pamela A Guerrerio, M.D.

Principal Investigator

National Institute of Allergy and Infectious Diseases (NIAID)

Are You a Good Fit for This Trial?

This trial is for children and young adults aged 3-21 with atopic dermatitis (eczema) who may have milk or peanut allergies, a high total IgE level, and are part of another NIH study. They must be willing to stop certain allergy medications before food challenges.

Inclusion Criteria

You have been diagnosed with Alzheimer's disease by a doctor or you have reported having symptoms of Alzheimer's disease.

I am willing to have genetic tests done on my blood.

Willing to allow storage of blood samples for future use in medical research.

Exclusion Criteria

I have a known heart condition.

I am on long-term oral steroids for a chronic condition.

I am currently taking a beta-blocker medication.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Oral Food Challenge

Participants undergo open feedings and/or double-blind, placebo-controlled food challenges to assess food allergies

Up to 12 months

Multiple visits for each food challenge

Follow-up

Participants are monitored for safety and effectiveness after food challenges

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Baked milk and Rice milk (placebo for Baked milk)
• Dry Milk Powder and Corn Starch (placebo for Milk powder)
• Peanut flour and Oat flour (placebo for peanut flour)
• Peanut powder and Oat flour

Trial Overview The trial tests if participants with eczema are truly allergic to milk or peanuts by giving them increasing amounts of these foods or placebos in controlled settings. The goal is to improve food allergy testing methods.

How Is the Trial Designed?

Group I: Two-Step Open Feeding Experimental Treatment 4 Interventions

Participants who consume baked milk, straight milk, and/or peanut products less than once per week but at least once per month will do a two step open oral food challenge.

Group II: Peanut DBPCFC Experimental Treatment 2 Interventions

The DBPCFC for peanut allergy will be done with either peanut flour or a placebo (oat flour). The following participants will undergo this DBPCFC: - All participants who eat peanut less than once per month - Participants who never eat peanut On the first day of this challenge, participants will be randomized to either peanut or placebo, and then will be challenged with the other food on the next day.

Group III: One-Step Open Feeding Experimental Treatment 4 Interventions

Participants who are consuming baked milk, straight milk, and/or peanut products at least once per week will do a one-step oral food challenge.

Group IV: Milk DBPCFC Experimental Treatment 2 Interventions

There are two double blind placebo controlled food challenges. The first challenge is to baked milk. The following participants will undergo this DBPCFC: - All participants who eat baked milk less than once per month. - Participants who never eat baked milk or straight milk. On the first day of this challenge, participants will be randomized to either milk Baked milk or rice milk. Dry milk powder or corn starch. or placebo, and then will be challenged with the other food on the next day.

Who Is Running the Clinical Trial?

National Institute of Allergy and Infectious Diseases (NIAID)

Lead Sponsor

Trials

3,361

Recruited

5,516,000+

National Institutes of Health Clinical Center (CC)

Collaborator

Trials

391

Recruited

30,880,000+

Published Research Related to This Trial

In a study of 16 patients, only 6 showed true corn allergy symptoms confirmed by a double-blind, placebo-controlled food challenge (DBPCFC), highlighting the need for this rigorous testing to confirm corn allergies.

A 50 kDa protein from the corn Reduced Soluble Protein (RSP) fraction was identified as a potential allergen, as it was recognized by IgE in all DBPCFC-positive patients and remained stable during cooking and digestion, suggesting it could trigger allergic reactions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

IgE-mediated allergy to corn: a 50 kDa protein, belonging to the Reduced Soluble Proteins, is a major allergen. Pasini, G., Simonato, B., Curioni, A., et al.[2019]

In a study involving 20 pediatric patients with asthma and/or eczema, specific IgE binding was found to be strongest with wheat, rye, and barley proteins, particularly the globulins and glutenins from wheat, indicating their significant role in allergic reactions.

Partial digestion of flour proteins significantly reduced their ability to bind IgE, suggesting that the structure of these proteins is crucial for their allergenic potential.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immunoglobulin E antibodies to ingested cereal flour components: studies with sera from subjects with asthma and eczema. Sutton, R., Hill, DJ., Baldo, BA., et al.[2019]

In a 6-month phase 3 trial involving 506 children with peanut allergies, PTAH (peanut allergen powder-dnfp) demonstrated a safety profile similar to that observed in previous trials that required double-blind, placebo-controlled food challenges (DBPCFCs).

The most common treatment-emergent adverse events (AEs) were mild to moderate gastrointestinal issues, with 55% of PTAH participants experiencing at least one AE compared to 33.9% for placebo, indicating that while AEs were common, they were generally not severe.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Participant characteristics and safety outcomes of peanut oral immunotherapy in the RAMSES and ARC011 trials. Ciaccio, C., Goldsobel, AB., Anagnostou, A., et al.[2022]

Grain-induced asthma is primarily caused by an IgE-mediated allergic response to proteins in cereal flours, particularly from wheat, rye, and barley, affecting workers in various grain-related professions.

Effective management of grain-induced asthma relies on avoiding exposure to allergens, and advancements in allergen characterization and immunomodulatory treatments, such as allergen immunotherapy, are promising for improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diagnosis and management of grain-induced asthma. Quirce, S., Diaz-Perales, A.[2021]

In a study involving 25 cow's milk allergic children aged 3 to 36 months, 72% tolerated a new standardized heated cow's milk protein (HP) product, suggesting it may help in developing tolerance to cow's milk.

Risk factors for intolerance included higher skin prick test results and specific IgE levels against certain milk proteins, indicating that these tests could help predict which children might have adverse reactions to the HP product.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Introduction of Heated Cow's Milk Protein in Challenge-Proven Cow's Milk Allergic Children: The iAGE Study. de Jong, NW., van Splunter, ME., Emons, JAM., et al.[2022]

Three patients developed asthma due to exposure to cereal flours in animal formula feeds, confirmed by positive skin prick tests and specific IgE antibodies to wheat, rye, and barley.

Bronchial provocation tests demonstrated immediate asthma responses to wheat and barley flours, indicating that these cereal flours can cause IgE-mediated hypersensitivity and highlighting their role as a potential occupational asthma trigger for farm workers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Farm animal feeders: another group affected by cereal flour asthma. Valdivieso, R., Pola, J., Zapata, C., et al.[2019]

The manufacturing process of peanut allergen powder (PTAH) for oral immunotherapy is critical for ensuring drug safety and efficacy, as variability in peanut flour sourcing and processing can affect allergen potency and contamination levels.

Despite challenges such as seasonal variability and aflatoxin contamination, stringent manufacturing controls are in place to maintain consistent allergenic potency and quality, ensuring that PTAH is safe and effective for treating peanut allergies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Manufacturing processes of peanut (Arachis hypogaea) allergen powder-dnfp. Leonard, SA., Ogawa, Y., Jedrzejewski, PT., et al.[2022]

Skin prick testing (SPT) with a baked milk (muffin) slurry can effectively predict which milk-allergic children can safely consume baked milk, showing a sensitivity of 100% for those with negative tests.

In a study of 30 children aged 2-16 years, those with a muffin SPT result of less than 3 mm were likely to tolerate baked milk, while the optimal decision point for the test was determined to be 4 mm, indicating its potential utility in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective evaluation of testing with baked milk to predict safe ingestion of baked milk in unheated milk-allergic children. Kwan, A., Asper, M., Lavi, S., et al.[2020]

Aflatoxin B1 was found in hypoallergenic milk substitutes made from ingredients like soya protein isolate and corn syrup, but most levels were below 1 ng/ml, which is considered low risk.

Manufacturers' reserve samples of soya protein isolate were uncontaminated, suggesting that while contamination is possible, it may not be widespread; however, caution is advised due to the vulnerability of infants relying on these formulas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occurrence of Aflatoxin in Hypoallergenic Milk Substitutes. Hayes, AW., Unger, PD., Stoloff, L., et al.[2023]

Approximately 70% of children who are allergic to unheated milk or egg can tolerate extensively heated versions of these foods, suggesting that including baked forms in their diet may help them develop tolerance more quickly than strict avoidance.

Oral food challenges (OFC) and oral immunotherapies (OIT) using low doses of allergenic foods could be a promising strategy to improve tolerance and quality of life for patients with food allergies, especially since current OIT methods often lead to unsatisfactory results and require long-term commitment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New approach for food allergy management using low-dose oral food challenges and low-dose oral immunotherapies. Yanagida, N., Okada, Y., Sato, S., et al.[2022]

A patient with baker's asthma was found to have a rice allergy, indicating a potential cross-reactivity between wheat proteins and similar proteins in rice.

Specific IgE reactivity to wheat alpha-amylase/trypsin inhibitor and lipid transfer protein suggests that the rice allergy may be triggered by homologous molecules present in rice seeds.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A case of rice allergy in a patient with baker's asthma. Villalta, D., Longo, G., Mistrello, G., et al.[2015]

In a study of 64 children with severe cow's milk allergy, 67.2% tolerated a low-dose baked milk oral food challenge, indicating that baked milk oral immunotherapy (OIT) can be effective for many children.

Desensitization to fresh milk was achieved in 42.2% of the children, particularly those with lower cow's milk-specific IgE levels, although there remains a risk of anaphylactic reactions during the OIT process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of baked milk oral immunotherapy in French children with cow's milk allergy. Gruzelle, V., Juchet, A., Martin-Blondel, A., et al.[2021]

In a study of 48 children with IgE-mediated cow's milk allergy, 81% tolerated baked cow's milk when it was incorporated into a wheat matrix (ciambellone), indicating that the wheat matrix significantly aids in tolerance.

The study found that a negative prick-by-prick test (PbP) had a 100% negative predictive value, suggesting that if the test is negative, children can safely consume processed cow's milk without needing an oral food challenge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Matrix effect on baked milk tolerance in children with IgE cow milk allergy. Miceli Sopo, S., Greco, M., Monaco, S., et al.[2017]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39782691/

Clinical and immunological outcomes after randomized ... The aim of this study was to determine whether baked milk OIT (BMOIT) could reduce adverse reactions while still inducing desensitization.

2. annallergy.org annallergy.org/article/S1081-1206(23)01509-0/fulltext

Baked milk and egg diets revisited A randomized controlled trial provided clear evidence that baked diets can hasten the resolution of IgE-mediated milk allergy. Moreover, BM/BE ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S2213219825005914

Baked-Milk Modulates Cow's Milk Allergy in Children Limited evidence indicates that baked milk (BM) intake accelerates cow's milk allergy (CMA) resolution or modulates immunity in baked milk-tolerant (BMT) and ...

4. aaaai.org aaaai.org/Allergist-Resources/Ask-the-Expert/Answers/2025/milk

Baked milk OIT Background: Cow's milk and egg allergy affect approximately 1.9% and 0.9% of children, respectively. · Objective: To perform systematic review ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3151608/

Dietary baked-milk accelerates resolution of cow's milk ... The addition of baked-milk to the diet of children tolerating such foods appears to accelerate development of unheated-milk tolerance compared to strict ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11714411/

The baked side: Cow's milk and egg protein threshold dose ... Children allergic to milk and egg, but tolerant to baked products, display higher reactivity thresholds than the general population of ...

7. jacionline.org jacionline.org/article/S0091-6749(20)30480-2/fulltext

Standard testing fails to identify patients who tolerate ... However, recent studies have shown that about 75% of children with CMA can tolerate baked milk (BM). There is limited knowledge about the ...

8. insight.jci.org insight.jci.org/articles/view/184301

Clinical and immunological outcomes after randomized ... The aim of this study was to determine whether baked milk OIT (BMOIT) could reduce adverse reactions while still inducing desensitization.

9. sciencedirect.com sciencedirect.com/science/article/pii/S1939455124001443

The baked side: Cow's milk and egg protein threshold dose ... Milk thresholds are similar to those already observed in baked allergic versus baked tolerant children, while EDs for egg are at least 1.6 times higher than ...