Abstract
BackgroundOral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity.MethodsA retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010.Results313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge failures. Children were more likely to fail an oral challenge if they were older (P = .04), had asthma (P = .001) or had atopic dermatitis (P = .03). Risk of challenge failure was significantly different between food allergens, with more failures noted for peanut than for tree nuts, milk or egg (P = .001). Among challenge failures, 19% met criteria for anaphylaxis. Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P < .001). Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). The highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis.ConclusionThe risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.
Highlights
Oral food challenges are the clinical standard for diagnosis of food allergy
The diagnosis of food allergy is often based on results of a careful history, skin prick testing (SPT) and serum food-specific IgE [2]
Oral food challenges (OFCs) assist in the diagnosis of food allergy, and are essential to determine whether an allergy has been outgrown [3]
Summary
Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predic‐ tors of oral challenge failure and reaction severity. Food allergy affects 2–10% of the population, and is more common in children than adults [1]. Oral food challenges (OFCs) assist in the diagnosis of food allergy, and are essential to determine whether an allergy has been outgrown [3]. OFCs do carry the risk of a systemic allergic reaction [3]. While the double blind placebo controlled food challenge is the most accurate and a true ‘gold standard’ for diagnosis of food allergy, it is time consuming and costly [3]. The open oral food challenge is often used instead, it is subject to patient bias [3]
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