Does severity of low-dose, double-blind, placebo-controlled food challenges reflect severity of allergic reactions to peanut in the community

Background: The severity of allergic reactions to food appears to be affected by many interacting factors. It is uncertain whether challenge-based reactions reflect the severity of past reactions or can predict future risk.Objective: To explore the relationship of a subject's clinical history of past reactions to the severity of reaction elicited by a low-dose, double-blind, placebo-controlled food challenge (DBPCFC) with peanut.Method: Cross-sectional questionnaire assessment of community-based allergic reactions and low-dose DBPCFC in self-selected peanut-allergic subjects. Reaction severity was assessed using a novel scoring system, taking account of the dose of allergen ingested.Results: Forty subjects (15 males, 23 children, 23 asthmatics by history) were studied. Only the most recent community reaction predicted the severity of reaction in the DBPCFC, but even this association was weak (r=0.37, P=0.03). Peanut-specific IgE (PsIgE) and skin prick test (SPT) weal size were not associated with community score but PsIgE level correlated well with the challenge score (r=0.6, P=0.001). Asthma did not affect the eliciting dose or challenge score directly but the association of PsIgE and challenge score was stronger in those without asthma (r=0.72, P=0.001) than in those with asthma (r=0.48, P=0.02).Conclusions: The scoring system developed appears to improve the sensitivity of assessment of reactions induced by DBPCFC. This is the first prospective study showing an association between PsIgE levels and clinical reactivity in DBPCFC, an effect that is more pronounced in non-asthmatics. This finding has important implications for the clinical care of subjects with food allergy. There is a poor correlation between the severity of reported reactions in the community and the severity of reaction elicited during low-dose DBPCFC with peanut

Timing and depositional environments of a Middle Pleistocene glaciation of northeast England: New evidence from Warren House Gill, County Durham

At various times during the Quaternary, north-eastern England was a zone of confluence between dynamic ice lobes sourced from the Pennines, northern Scotland, the Cheviots, and Scandinavia. The region thus has some of the most complex exposures of Middle to Late Pleistocene sediments in Britain, with both interglacial and glacial sediments deposited in terrestrial and marine settings. We investigated sedimentary sequences exposed on the coastline of County Durham at Warren House Gill, and present a new model of British and Fennoscandian Ice Sheet interaction in the North Sea Basin during the Middle Pleistocene. The stratigraphy at Warren House Gill consists of a lower diamicton and upper estuarine sediments, both part of the Warren House Formation. They are separated from the overlying Weichselian Blackhall and Horden tills by a substantial unconformity. The lower diamicton of the Warren House Formation is re-interpreted here as an MIS 8 to 12 glaciomarine deposit containing ice-rafted lithics from north-eastern Scotland and the northeast North Sea, and is renamed the ‘Ash Gill Member’. It is dated by lithological comparison to the Easington Raised Beach, Middle Pleistocene Amino Acid Racemisation values, and indirectly by optically stimulated luminescence. The overlying shallow subaqueous sediments were deposited in an estuarine environment by suspension settling and bottom current activity. They are named the ‘Whitesides Member’, and form the uppermost member of the Warren House Formation. During glaciation, ice-rafted material was deposited in a marine embayment. There is no evidence of a grounded, onshore Scandinavian ice sheet in County Durham during MIS 6, which has long been held as the accepted stratigraphy. This has major implications for the currently accepted British Quaternary Stratigraphy. Combined with recent work on the Middle Pleistocene North Sea Drift from Norfolk, which is now suggested to have been deposited by a Scottish ice sheet, the presence of a Scandinavian ice sheet in eastern England at any time during the Quaternary is becoming increasingly doubtful