The following is a summary of “Outcomes of oral food challenges in a real-world setting, with predictors of outcomes,” published in the November 2023 issue of Allergy & Immunology by Mustafa, et al.

The oral food challenge (OFC) is still the gold standard for diagnosing food allergies (FA). For a study, researchers talked about an observing experience that all OFCs had in a single center over the course of 3 years. All OFCs done in a private office were kept track of. The OFCs were done without clear rules about who could or could not participate. It was possible to record demographic information and the outcomes of medical tests and OFCs. There were 1,132 OFCs, and the average age was 4 years (interquartile range = 2.0–10.0). 

Out of the 1,132 OFCs, 862 (76.1%) were able to handle the food, 232 (20.5%) had a response, and 38 (3.4%) did not finish the OFC because they refused the food. The type of food that was tolerated the least was baked eggs (66.1%), while shrimp was accepted the most (91.1%). Of the 66 (5.8%) OFCs considered high-risk, 35 (53.0%) could handle the food. More than half of the responses happened on the first or second dose. Urticaria or angioedema were the most common clinical symptoms, and epinephrine was used to treat 29.2%. 

Several things, like the food challenge, the reason for not eating the food, being older at the time of the OFC, having fewer allergic skin prick tests, and having lower food-specific immunoglobulin E levels, all predicted the ability to handle an OFC. Some things can help you figure out if someone can handle an OFC, and even those thought to be high risk can be done safely in an outpatient setting. Most people can handle the food, and most responses won’t need epinephrine treatment.

Source: sciencedirect.com/science/article/abs/pii/S1081120623004969