Hospital-Based Food Challenges for the Diagnosis of Food Allergy-A BSACI Clinical Practice Statement

Food challenges play an important role in the diagnosis and management of food hypersensitivity. Although the gold-standard is the double-blind, placebo-controlled food challenge, an open challenge, where the challenge food is known to both the patient and the allergy team, is a practical and effective tool for use in daily clinical practice. A food challenge can help determine the presence or absence of a food allergy if the history and allergy tests are discordant, or if resolution of the allergy is expected. The outcome of a food challenge can result in either confident introduction or re-introduction of foods or provide clarity on which foods or forms of the food need to be avoided. Challenges can be a positive or negative experience for individuals; to maximise the potential for positive impact, food challenges should be overseen by individuals with relevant knowledge, skills and experience, and take place in a suitable clinical area with appropriate access to emergency support and a pathway for admission to an inpatient facility. Challenge foods should be age-specific, in an appropriate form (uncooked, cooked, baked, composite food), and given in incrementally increasing amounts until an age-specific top or cumulative dose has been consumed. The decision to pause or stop a challenge should be based on international guidance and clinician judgement, but also consider an individual's symptom history and their preferences.