Oral Food Challenges OK for Diagnosing Allergies in Children

Open low-risk oral food challenges (OFCs) have been deemed safe for diagnosing food allergies in children, according to a recent study.

Previous single-center studies have reported that the rate of anaphylaxis associated with OFCs had been 9% to 11%. However, little is known about the epidemiology of clinical OFCs across multiple centers in the United States.
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For their study, the researchers assessed data on 6377 OFCs obtained via a physician survey in 5 food allergy centers across the United States from 2008 to 2013. A linear mixed model was used to calculate the rates of allergic reactions and the association of reaction rates with year, hospital, and demographics. Using a random-effects model with exact confidence intervals, the proportion of reactions and anaphylaxis were pooled with inverse-variance weights via meta-analysis.

Results indicated that the pooled estimate of anaphylaxis among the 6377 OFCs performed had been 2%. The rate of allergic reactions, which had been consistent throughout the study period, had been 14%. The researchers noted that the rates of reaction had ranged from 13% to 33%, and that boys had reacted 16% more frequently than girls. In 2013, peanuts were the most challenged food in the Northeast, Midwest, and West, and egg was the most challenged in the South.

“As the largest national survey of allergic reactions of clinical open OFCs in a nonresearch setting in the United States, this study found that performing clinical nonresearch open low-risk OFCs results in few allergic reactions, with 86% of challenges resulting in no reactions and 98% without anaphylaxis,” the researchers concluded.

—Christina Vogt

Reference:

Akuete K, Guffey D, Israelsen RB, et al. Multicenter prevalence of anaphylaxis in clinic-based oral food challenges [Published online September 7, 2017]. Ann Allergy Asthma Immunol.  http://dx.doi.org/10.1016/j.anai.2017.07.028.