Asthma and Multi-Food Allergy Are Risk Factors for Oral Food Challenge Failure-A Single-Center Experience

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Diagnostics
• Gastroenterology

Background:

• Diagnosing food allergy (FA) relies on clinical history, IgE testing, and oral food challenges (OFCs).
• OFCs are the gold standard for FA diagnosis, particularly for cow's milk and hen's egg allergies.
• This study reviews OFC experiences in pediatric patients.

Purpose of the Study:

• To present the experience of performing OFCs in pediatric patients.
• To focus on OFCs for cow's milk and hen's egg allergies.
• To identify factors associated with OFC outcomes and reaction severity.

Main Methods:

• Retrospective analysis of 205 OFCs in children.
• Evaluation of clinical data and logistic regression for outcome associations.
• ROC curve analysis to predict outcomes for baked milk and egg challenges.

Main Results:

• Overall OFC failure rate was 32.2%; 2.4% were inconclusive.
• Most failures involved mucocutaneous symptoms; severe reactions occurred in 2.0% requiring epinephrine.
• Asthma and multi-food allergy were associated with increased OFC failure risk.
• Specific IgE cutoffs were identified for baked milk (58.1 kU/L) and baked egg (11.3 kU/L).

Conclusions:

• OFCs are a safe and effective diagnostic method for pediatric FA.
• Risk of severe reactions during OFCs is low with appropriate patient selection.
• Comorbidities like asthma and multi-food allergy increase the likelihood of OFC failure.