Work Group report: Oral food challenge testing - 13/08/11

Doi : 10.1016/j.jaci.2009.03.042

Anna Nowak-Węgrzyn, MD ^a, Amal H. Assa’ad, MD ^b,^⁎^{^{Authors listed alphabetically.}} , Sami L. Bahna, MD, DrPH ^c,^{^{Authors listed alphabetically.}}, S. Allan Bock, MD ^d,^{^{Authors listed alphabetically.}}, Scott H. Sicherer, MD ^a,^{^{Authors listed alphabetically.}}, Suzanne S. Teuber, MD ^e,^{^{Authors listed alphabetically.}}
Adverse Reactions to Food Committee of the American Academy of Allergy, Asthma & Immunology
^a Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY
^b Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
^c Louisiana State University Health Sciences Center, Shreveport, La
^d National Jewish Health and University of Colorado Health Sciences Center, Denver, Colo
^e University of California, Davis, School of Medicine, Davis, Calif

Reprint requests: Amal Assa’ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, and Past-Chair, Adverse Reactions to Foods Committee, 3333 Burnet Ave, Cincinnati, OH 45229.

Abstract

Oral food challenges are procedures conducted by allergists/immunologists to make an accurate diagnosis of immediate, and occasionally delayed, adverse reactions to foods. The timing of the challenge is carefully chosen based on the individual patient history and the results of skin prick tests and food specific serum IgE values. The type of the challenge is determined by the history, the age of the patient, and the likelihood of encountering subjective reactions. The food challenge requires preparation of the patient for the procedure and preparation of the office for the organized conduct of the challenge, for a careful assessment of the symptoms and signs and the treatment of reactions. The starting dose, the escalation of the dosing, and the intervals between doses are determined based on experience and the patient’s history. The interpretation of the results of the challenge and arragements for follow-up after a challenge are important. A negative oral food challenge result allows introduction of the food into the diet, whereas a positive oral food challenge result provides a sound basis for continued avoidance of the food.

Le texte complet de cet article est disponible en PDF.

Key words : Oral food challenge, food allergy, food allergens, anaphylaxis, food additives, single-blind, placebo-controlled oral food challenge, double-blind, placebo-controlled oral food challenge, skin prick test, IgE, food protein–induced enterocolitis syndrome, peanut, cow’s milk, milk, egg, wheat, tree nuts

Abbreviations used : DBPCFC, OFC, SPT

Plan

Supported by the Food Allergy Initiative. The Food Allergy Initiative is a nonprofit corporation dedicated to finding a cure for food allergies by funding food allergy research; it does not conduct scientific research or render medical advice. The opinion in the manuscript reflects that of the authors and not that of the Food Allergy Initiative, and Food Allergy Initiative is not responsible or liable for the information set forth in the manuscript or for any damages that may result from its use.

Disclosure of potential conflict of interest: A. Assa’ad has received research support from GlaxoSmithKline. A. Nowak-Węgrzyn has received research support from the National Institutes of Health. S. L. Bahna has received research support from Genentech/Novartis and CSL Behring. S. H. Sicherer has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases and is a consultant for the Food Allergy Initiative and a medical advisor for the Food Allergy and Anaphylaxis Network. The rest of the authors have declared that they have no conflict of interest.