Safety of open food challenges in the office setting

Open food challenges are a practical alternative to double-blind, placebo-controlled food challenges in confirming clinical sensitivity or tolerance to a food, and the risks associated with open challenges are unknown.

To examine the safety of open food challenges administered in an office setting.

A retrospective medical record review of open food challenges, administered in a university-based pediatric allergy-immunology clinic during a 3-year period, was performed.

A total of 109 patients (69% male) underwent 150 open food challenges, most of which were to milk (n = 39), peanut (n = 37), and egg (n = 29). There were 40 positive challenges (27% of all challenges) in 33 patients. Reactions were mild to moderate in 92% of positive challenges. Cutaneous reactions occurred in 68% of positive challenges, followed by gastrointestinal tract reactions (45%) and upper respiratory tract reactions (38%), excluding laryngeal symptoms. No patient had cardiovascular involvement. Food specific IgE values did not correlate with reaction severity. Interventions included observation or antihistamine only in 92% of positive challenges. No patient received epinephrine or required hospitalization. For negative challenges to milk, peanut, and egg, median prechallenge food specific IgE approached previously published negative predictive values for these foods. Negative challenges in patients allowed the introduction of 19 different foods into the diet of 88 patients.

Open food challenges are a safe procedure in the office setting for patients selected based on history and food specific IgE approaching negative predictive values.