![]() The oral challenge was administered as half-log (base 10) incremental doses (starting at. This study met the criteria for a waiver of informed consent by the research ethics board at the University of Manitoba as it was an internal quality improvement study. Challenges were performed to confirm food allergy, or when there was a suspicion of oral tolerance after a period of avoidance in a food allergic child. Oral food challenges were performed based on the clinical decision of the attending physician, with consideration of clinical history, results of epicutaneous testing, and/or results of serum food-specific IgE. We performed a retrospective chart review to examine whether oral food challenge outcomes varied by characteristics such as food being challenged, patient characteristics (age, atopy), and results of skin prick testing or serum food-specific IgE.Ī retrospective chart review was performed on all open oral food challenges between Januand Decemat the University of Manitoba pediatric allergy clinic. However, there is a paucity of literature examining other predictors of food challenge outcomes. Previous studies have examined the feasibility and safety of oral food challenges, as well as diagnostic levels at which to consider food challenges based on results of serum food-specific IgE and/or epicutaneous testing. The open oral food challenge is often used instead, although it is subject to patient bias. 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. However, OFCs do carry the risk of a systemic allergic reaction. Oral food challenges (OFCs) assist in the diagnosis of food allergy, and are essential to determine whether an allergy has been outgrown. The diagnosis of food allergy is often based on results of a careful history, skin prick testing (SPT) and serum food-specific IgE. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.įood allergy affects 2–10% of the population, and is more common in children than adults. The risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. 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. Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P < .001). ![]() ![]() Among challenge failures, 19% met criteria for anaphylaxis. ![]() 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). 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). There were 104 (33%) oral challenge failures. Resultsģ13 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). MethodsĪ 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. Little data exist on predictors of oral challenge failure and reaction severity. Oral food challenges are the clinical standard for diagnosis of food allergy. ![]()
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