Risk of oral food challenges

Oral food challenges are essential to the diagnosis of food allergy; however, little has been reported regarding the risks of performing food challenges in children with suspected food allergy.

To examine the risk and reaction severity of failed oral food challenges.

A retrospective chart review was performed on children who underwent food challenges to milk, egg, peanut, soy, and/or wheat in a university-based pediatric allergy clinic over a 7-year period.

Of the 584 challenges completed, 253 (43%) resulted in an allergic reaction. There were 90 milk, 56 egg, 71 peanut, 21 soy, and 15 wheat failed challenges. Of patients who failed, there were 197 (78%) cutaneous, 108 (43%) gastrointestinal, 66 (26%) oral, 67 (26%) lower respiratory, and 62 (25%) upper respiratory reactions. No patients had cardiovascular symptoms. There was no difference between foods in the severity of failed challenges or the type of treatment required to reverse symptoms. All reactions were reversible with short-acting antihistamines +/- epinephrine, beta-agonists, and/or corticosteroids. No children required hospitalization, and there were no deaths.

There are risks associated with food challenges, and the risks are similar for each of the foods studied. Given the benefits that result from a negative challenge, these risks are reasonable when challenges are performed under the guidance of an experienced practitioner in a properly equipped setting.