Food challenges

Prior to the commencement of challenges participants were physically examined and the control of co-existent atopic conditions was assessed using the Asthma Control Test(13) and spirometry for asthma, the POEM score for eczema(14) and Total Nasal Symptom score for rhinitis. Challenges were postponed if these conditions were inadequately controlled or if the patient was unwell with an infective illness. The challenges were undertaken using a harmonised protocol in accordance with best practice where participants ingested increasing doses of the validated Europrevall dessert food matrix(12) either alone (placebo) or containing peanut allergen (active, 12.5% fat, light roast peanut flour from the Golden Peanut Company, Alphretta, GA, USA) until they developed an objective allergic reaction (definition below). An unblinded scientist with no interaction with the participant or the study team was responsible for the randomisation of subjects and preparation of the challenge material. During the active and intervention challenges participants consumed increasing doses of peanut protein in the form of partially defatted peanut flour in a challenge matrix. The dosing regimen was: 3μg, 30μg, 300μg, 3mg, 30mg, 100mg, 300mg and 1g peanut protein (1 gram peanut protein is equivalent to approximately 8 peanuts) (15).

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