What Is Different about Kids Who Fail Oral Food Challenge to Egg?

Abstract

Although specific IgE (sIgE) level has been associated with oral food challenge (OFC) outcome, other clinical predictors have not been established. We sought to determine clinical and laboratory differences between children who passed or failed OFC to egg. A retrospective chart review of 502 OFC to egg and baked egg was performed. Demographic data, personal and family history of atopy, details of previous reactions, sIgE levels, skin prick test (SPT) were compared. There were no differences in children who passed OFC (N=415) or failed OFC (N=87) with regards to age, gender, personal history of atopy, family history of atopy, history of breastfeeding, age at diagnosis, SPT size at diagnosis, sIgE at diagnosis, and sIgE at challenge. In addition, severity of first reaction and most recent reaction prior to OFC were not different between children who passed and failed OFC (p=0.343; p=0.314). However, time between first ever reaction and OFC was longer among children who passed OFC (3.54 vs. 2.47 years; p=0.008). Similarly, time between last reaction prior to OFC and OFC was significantly longer among the group of individuals who passed OFC (3.15 vs. 2.23 years, p=0.014). Once the sIgE level reaches a threshold where OFC is considered, there are few clinical and laboratory parameters that distinguish children who pass or fail OFC, including severity of previous reactions. However, timing between OFC and both first and most recent reaction may aid in predicting those individuals who are more likely to pass an OFC.