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The shift towards lower-risk oral food challenges since the implementation of oral immunotherapy: a retrospective

Adam P Sage1,2, Min Jung Kim3, Tiffany Wong4,5

  • 1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. adam.sage@phsa.ca.

Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology
|March 29, 2026
PubMed

Insights

The adoption of oral immunotherapy (OIT) has improved the safety of oral food challenges (OFCs). Post-OIT, OFCs showed fewer positive reactions and reduced need for epinephrine, indicating enhanced patient safety during allergy testing.

Area of Science:

  • Allergy and Immunology
  • Clinical Pediatrics
  • Food Allergy Research

Background:

  • Oral food challenges (OFCs) previously demonstrated high rates of anaphylaxis requiring epinephrine (15.6%) at BC Children's Hospital (BCCH).
  • The widespread adoption of oral immunotherapy (OIT) for food allergy treatment has led to significant changes in clinical practice regarding OFC indications and patient selection.

Purpose of the Study:

  • To compare the outcomes and safety of OFCs performed before and after the implementation of OIT at BCCH.
  • To evaluate the impact of OIT on the rate of positive OFCs and the severity of reactions.

Main Methods:

  • A retrospective chart review of OFCs conducted from 2019-2021 (post-OIT era) at BCCH.
  • Comparison of post-OIT data (n=590) with previously published pre-OIT data (2014-2017, n=353).

Main Results:

  • Patients undergoing OFCs in the post-OIT era had significantly lower odds of positive OFCs (26.3% vs 32.6%, OR=0.738, p=0.0444).
  • OFCs performed after maintenance OIT showed reduced odds of requiring epinephrine (8.31% vs 15.0%, OR=0.542, p=0.0164).
  • A low incidence of severe reactions was observed, with only 6.10% of positive OFCs resulting in Grade 4 reactions.

Conclusions:

  • Changes in clinical practice associated with OIT adoption have significantly improved the safety of OFCs.
  • OIT implementation has led to a decrease in positive OFC outcomes and a reduction in the need for emergency interventions during OFCs.

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