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Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut

González-Mancebo E1, Alonso Díaz de Durana MD2, García Estringana Y2, Meléndez Baltanás A1, Rodriguez-Alvarez M3, de la Hoz Caballer B4, del Prado N5, Fernández-Rivas M3

1Allergy Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
2Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
3Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
4Allergy Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
5Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain

J Investig Allergol Clin Immunol 2017; Vol 27(1) : 40-45
doi: 10.18176/jiaci.0084

Background: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC.
Methods: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes.
Results: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7.
Conclusions: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.

Key words: Double-blind placebo-controlled food challenge, Egg white, Food allergy, Hazelnut, Milk, Recipe, Sensory test, Triangle test, Validation