Practical peanut challenges for the clinician

Background: There is an increasing incidence of peanut allergy in many Westernized countries. Unfortunately, current diagnostic tests that evaluate for sensitization can give false-positive results and may lead to overdiagnosis of peanut allergy. Due to this and to the fact that there are several therapies currently being investigated for the treatment of peanut allergy, it is imperative that practitioners who are caring for patients with food allergy be knowledgeable about and comfortable with performing oral challenges to peanut in nonresearch settings. Methods: Literature review and author experience. Results: This article focused on various aspects of a peanut challenge, including patient selection, contraindications, the location of the challenge, form of the peanut to be fed, the starting and goal doses for the challenge, and practical dosing schedules. It is meant to be a real-world overview for a practicing clinician. Conclusions: Clinicians should be able to perform open peanut challenges in properly selected patients.