Abstract
Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP).
Highlights
Food allergies have been increasing: A recent systematic review and meta-analysis report that lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0% [1].Diagnosis of a food allergy is not simple, and self-reported rates of food allergies are much higher than the true prevalence [2]
This review does not intend to analyze comprehensively all the issues related to the diagnosis of food allergy, but to summarize some practical information on the oral food challenge (OFC) procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP) [4]
Two different kinds of cut-off values were proposed in the literature, both for SPTs and for sIgEs: Those based on a high positive predictive value (95% PPV) and those based on a high specificity
Summary
Food allergies have been increasing: A recent systematic review and meta-analysis report that lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0% [1]. Diagnosis of a food allergy is not simple, and self-reported rates of food allergies are much higher than the true prevalence [2]. The oral food challenge (OFC) is the gold standard for diagnosis of a food allergy [3]. OFC comprises the oral administration of the suspected allergen in a controlled and standardized setting. It is a complex test, which requires large healthcare (physician, nurse, hospital facilities) and family (stress, fear) resources. Children with a history of recent anaphylaxis (within 12 months) and detectable levels of IgE specific to a suspected food should be excluded from being tested with the oral food challenge [5]. Patients should not be challenged if affected by atopic disease that might interfere with the assessment, diseases that might affect safety, or if they are taking drugs that might interfere with the assessment or affect safety [8]
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