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Eliciting and stop dose during oral food challenges for peanut and common tree nuts in different age groups
Wouter W de Weger1, Diede Jansen1, Lidy van Lente2
1Department of Paediatrics, Martini Hospital, Groningen, The Netherlands.
Insights
Oral food challenges (OFCs) can be inconclusive in young children. To avoid false negatives, the full cumulative dose should be consumed, especially in uneventful food allergy testing.
Area of Science:
- Allergy and Immunology
- Pediatric Gastroenterology
- Clinical Trials
Background:
- Oral food challenges (OFCs) are standard for diagnosing food allergies.
- Younger children may not consume sufficient doses, leading to inconclusive results.
- Inconclusive OFCs can cause diagnostic uncertainty and anxiety.
Purpose of the Study:
- To assess the eliciting dose for objective symptoms across age groups.
- To determine if the final dose is necessary in uneventful OFCs.
- To minimize false negative outcomes in food allergy diagnosis.
Main Methods:
- Retrospective analysis of 1327 OFCs for common allergens (2012-2019).
- Examined age as a predictor of the stop dose in inconclusive OFCs.
- Assessed the association of age with eliciting dose and potential false negatives.
Main Results:
- 224 (16.9%) OFCs were inconclusive; age predicted stop dose only for almond.
- Objective symptoms occurred after the final dose in 2%-13% of positive OFCs.
- Potential false negatives were identified in 27.6% of uneventful OFCs.
Conclusions:
- Children under 6 often consume all doses in negative OFCs.
- Eliciting dose for symptoms is not age-dependent.
- A cumulative dose of 4.4g is recommended in uneventful OFCs to prevent false negatives.
Background:
Oral food challenges (OFCs) are used to confirm or reject a diagnosis of food allergy. However, younger children may encounter difficulties in consuming all offered doses during an OFC in the absence of symptoms, resulting in inconclusive outcomes. Our aim is to assess the eliciting dose for objective symptoms among various age groups and determine the necessity of consuming the final dose step during an uneventful OFC to avoid false negative outcomes.
Methods:
OFCs for common food allergens performed between 2012 and 2019 were analyzed retrospectively. The primary outcome was the association of age with stop dose for OFCs with inconclusive outcome. Secondary outcome measures were the association of age with eliciting dose and the potential number of false negative outcomes.
Results:
A total of 1327 OFCs were performed in 707 patients. Of these, 514 (38.7%) were positive, 589 (44.4%) negative, and 224 (16.9%) inconclusive. In OFCs with inconclusive outcome, age appeared to be a significant predictor of the stop dose only for almond (p = .005). Objective symptoms occurred after the last dose step in 2%-13% of all OFCs with positive outcome. In our cohort, potential false negative outcomes may have been drawn in 27.6% of uneventful OFCs.
Conclusions:
Two third of children under 6 years of age successfully consumed all the provided doses during OFCs with a negative outcome. The eliciting dose for objective symptoms was not associated with age, and in a substantial number of OFCs with positive outcome, symptoms occurred after eating the final dose. These findings suggest that in case of an uneventful OFC, the outcome should be drawn only after a cumulative dose of 4.4 g has been consumed to avoid the risk of a potential false negative outcome.
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