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Is Oral Food Challenge (OFC) test safe for preschool children?
Sait Karaman1, Semiha Erdem Bahçeci1, Hikmet Tekin Nacaroğlu1
1Department of Pediatric Allergy, Behcet Uz Children's Hospital, Izmir, Turkey.
Insights
Oral food challenges (OFCs) for diagnosing food allergies in young children typically result in mild reactions. These reactions are manageable, especially when allergy testing is below a certain threshold.
Area of Science:
- Pediatric Allergy
- Clinical Immunology
- Diagnostic Procedures
Background:
- Oral food challenges (OFCs) are crucial for diagnosing food allergies when patient history is inconclusive or to assess tolerance.
- Accurate diagnosis is essential for managing pediatric food allergies and preventing severe reactions.
Purpose of the Study:
- To determine the prevalence and severity of reactions during OFCs in preschool children.
- To evaluate the predictive value of allergy tests for OFC outcomes in young children.
Main Methods:
- Retrospective study of 122 children under 5 years old undergoing OFC for milk, egg white, or egg yolk.
- Data collected on symptoms during OFC, patient history, and allergy test results (serum-specific IgE, skin prick test).
- Symptoms were classified based on severity.
Main Results:
- 19% of OFCs resulted in mild allergic reactions, and 4.5% resulted in moderate reactions.
- Skin prick test wheal size and food-specific IgE levels below a 95% positive predictive value threshold did not reliably predict OFC reactions.
- A significant proportion of patients (50.8%) had a history of IgE-mediated food allergy, and 57.4% had co-existing allergies.
Conclusions:
- Allergic reactions during OFCs for milk and egg in preschool children are generally mild and manageable.
- Conducting OFCs when serum-specific IgE or SPT wheal size is below established cut-off points may lead to milder outcomes.
- OFCs remain a valuable diagnostic tool for pediatric food allergies.
Background:
Oral food challenges (OFCs) are performed for diagnosis of a food allergy in cases where the allergy is not supported by patient history, or when a newly developed tolerance level needs to be established.
Objective:
We aimed to investigate the prevalence and severity of reactions during OFCs in preschool children.
Methods:
A retrospective study was conducted on children younger than 5 years, for whom OFC had been performed with milk, egg white and egg yolk. All children had been admitted to the Department of Pediatric Allergy at Behçet Uz Children's Hospital between 1 January 2010 and 31 December 2014. Any symptoms developed during the OFC were classified and recorded.
Results:
A total of 122 patients who underwent an OFC were included in this study. The patients included 85 males (69.7%), and 50.8% of patients (n = 62) had a history of IgE-mediated food allergy. Co-existing allergies were found for 57.4% (n = 70) of patients. Of the OFCs performed, tests for milk, egg white and egg yolk made up 46.5, 30.5 and 23.0%, respectively. Of these, 19% (n = 33) were mild and 4.5% (n = 7) were moderate allergies in terms of symptom development. It was determined that the skin prick test (SPT) wheal size and the food-specific IgE levels did not effect in determining whether the allergic reaction would develop by OFC if the SPT wheal size and the food-specific IgE levels were below the cut-off point of a 95% positive predictive value (p > 0.05).
Conclusion:
The severity of egg and milk allergy symptoms resulting from the frequently used OFC in preschool children are generally mild and easy to manage, particularly if the OFC is only conducted if serum-specific IgE or SPT wheal size is below the cut-off point.
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