Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report

Bird, J. Andrew; Leonard, Stephanie A.; Groetch, Marion; Assa’ad, Amal; Cianferoni, Antonella; Clark, Allan; Crain, Maria; Fausnight, Tracy; Fleischer, David M.; Green, Todd; Greenhawt, Matthew; Herbert, Linda; Lanser, Bruce J.; Mikhail, Irene; Mustafa, S. Shahzad; Noone, Sally; Parrish, Christopher; Varshney, Pooja; Vlieg‐Boerstra, Berber; Young, Michael C.; Sicherer, Scott H.; Nowak‐Węgrzyn, Anna

doi:10.1016/j.jaip.2019.09.029

Cited by 146 publications

(127 citation statements)

References 124 publications

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“…DBPCFC should be performed to patients who define subjective and psychological symptoms in order to avoid false positive results and unnecessary food restriction [25]. In addition, OFCs for research settings should be performed with double-blinded procedure [45]. OFC with suspicion of IgE mediated allergy must be performed in an office or hospital setting where personnel and equipment are adequate to treat a severe allergic reaction [20].…”

Section: Oral Food Challengesmentioning

confidence: 99%

IgE-mediated food allergy throughout life

Çelebioğlu¹,

Akarsu²,

Şahiner³

2021

Turk J Med Sci

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Food allergy (FA) is an increasing problem throughout the world. In the last two decades, the frequency of FA has increased in both children and adults. The prevalence differs according to the research methodology, age and geographic regions, ranging between 2.0 to 10.0%. The most common form of FA is IgE mediated FA. In this form, patients may present with life-threatening condition as anaphylaxis or milder conditions like urticaria, angioedema, sneezing and nausea alone. The gold standard in the diagnosis of FA is oral provocation tests. Epidermal skin prick tests and specific IgE measurements as well as component resolved diagnostic techniques are helpful in the diagnosis and follow-up of patients. In this review, the epidemiology, diagnosis, follow-up and prognosis of Ig-E mediated FA in children and adults are discussed and some specific forms of FA such as pollen food allergy syndrome, alpha-gal allergy and food dependent exercise induced anaphylaxis are explained.

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Section: Oral Food Challengesmentioning

confidence: 99%

IgE-mediated food allergy throughout life

Çelebioğlu¹,

Akarsu²,

Şahiner³

2021

Turk J Med Sci

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“…wheat challenge and exclude conventional wheat allergy as this amount is 2.5-fold of portion sizes for adult. 38 Our proposed modified 3-day protocol aims not only to yield the diagnosis but also to differentiate between EIA, WA, and WDEIA within a single admission. The amount of wheat used in our protocol on day 3 (fixed at 4 slices of bread, equivalent to 4.8 g of gluten) was agreeably close to the median threshold of gluten dose (4.3 g) reported in Christensen's protocol of combined gluten, ASA (1000 mg), and exercise.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical Characteristics and Proposed Wheat-Cofactor Challenge Protocol with a High Diagnostic Yield in Adult-Onset IgE-Mediated Wheat Allergy</p>

Thongngarm¹,

Wongsa²,

Pacharn³

et al. 2020

JAA

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Background: IgE-mediated wheat allergy in adults can be childhood or adulthood onset. Adult-onset wheat allergy has been reported, but data on clinical characteristics and practical food challenge protocols are scarce. Objective: We aimed to describe the clinical characteristics of adult-onset wheat allergy, laboratory results, and outcomes of a modified 3-day challenge protocol using a combination of aspirin, wheat, and exercise. Patients and Methods: Patients with histories compatible with adult-onset wheat allergy were recruited from Siriraj Hospital, Thailand. Clinical history, skin prick tests (SPTs), and specific IgE (sIgE) levels were ascertained. Patients with no food challenge contraindications were asked to volunteer for wheat challenge. A modified 3-day protocol using 300 mg of acetylsalicylic acid, 60-75 g of wheat flour, and exercise was used for confirmatory diagnosis of conventional wheat allergy (WA) and wheat-dependent exercise-induced anaphylaxis (WDEIA). Results: Thirty-three patients were recruited. The mean age of onset was 29.7 years (SD 10.5). SPTs yielded positivity rates of 9.1%, 84.8%, and 81.8% in commercial wheat, inhouse gliadin, and in-house glutenin extracts, respectively. sIgE yielded a positivity rate of 61% and 88% in wheat and ω5-gliadin, respectively. Eighteen patients underwent oral wheat challenges. Of these, 17 patients (94.4%) had positive challenges leading to definite diagnoses of WA (35%), and WDEIA (65%). One WDEIA patient developed hypotensive anaphylaxis in the protocol. Conclusion: WDEIA was the most common phenotype. Our modified 3-day protocol could differentiate WA and WDEIA and yielded a high positivity rate (94.4%). It should be used cautiously as severe reactions can occur.

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“…In a survey of parents in New York, 17% reported trial of allergenic food at home as a reason for deferring OFCs (18). The American Academy of Allergy, Asthma and Immunology (AAAAI) recommends that OFCs be conducted in healthcare settings (13,15,16). The British Society for Allergy and Clinical Immunology (BSACI) permits home challenges or reintroductions without challenges for children with milk and egg allergies under certain circumstances and provides instructions for parents on how to do so (26,27).…”

Section: Discussionmentioning

confidence: 99%

“…Our study participants felt that OFCs are bene cial regardless of outcome and suggested a need for anxiety management solutions. The January 2020 update on conducting OFCs by the AAAAI includes a section on psychosocial considerations, calling for involvement of mental health professionals and implementation of anxiety management strategies (15). Other solutions for addressing fear and anxiety reported by parents in our study included offering DBPCFC, sharing of success stories by children and parents who have undergone OFCs, and emergency preparedness.…”

Section: Discussionmentioning

confidence: 99%

“…No previous studies have examined whether parental anxiety differs between open versus blinded OFCs. DBPCFCs are time and resource intensive, and costly compared to open challenges but can help with distinguishing true allergy symptoms from those caused by anxiety (15), especially with use of delayed unblinding protocols (34). Future studies could look at whether blinded challenges reduce anxiety, and whether it would be cost effective to implement increased use of DBPCFC.…”

Section: Discussionmentioning

confidence: 99%

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Challenges in Diagnosis of Food Allergies via Oral Food Challenges: A Qualitative Analysis of the Caregiver Perspective

Correa

Protudjer

Hsu

et al. 2020

Preprint

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Background: Food allergy disproportionately affects children and contributes to poor quality of life for families. As a result, accurate diagnosis of food allergy is important. Oral food challenges (OFC) are the gold standard test for diagnosis of food allergy. Yet, many children do not undergo OFCs. The purpose of this study was to understand the barriers to OFCs faced by parents of children with food allergies in Ontario, as well as solutions to increase their utilization.Methods: Three focus group discussions were carried out with a total of 24 parents of children with food allergies in Kitchener-Waterloo, Ontario. Focus group data were analyzed using constant comparative analysis.Results: Parents misperceived OFCs as management of food allergies. They were also unsure about whether OFCs take place in hospitals, clinics or in the home. Parents reported several barriers to OFCs including not being referred by their primary care physicians, wait times, and fear and anxiety. Additionally, parents with older children, children with multiple allergies and children who could only tolerate allergens in its baked form felt that OFCs would not improve their quality of life. Solutions offered by parents to increase uptake of OFCs included education of the public, physicians and policy makers to improve knowledge and training, and ensure timely access to OFCs. Parents also suggested a need for improved counselling about the risk of OFCs, psychological support, and sharing of patient success stories. Long-term follow-up after an OFC as well as support and guidance around food reintroduction was also suggested to ensure OFCs resulted in an improvement in quality of life.Conclusion: Interventions aimed at addressing barriers to OFCs identified by parents have the potential to increase utilization of OFCs, and thereby reduce the burden of food allergies in children and improve quality of life.

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Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report

Cited by 146 publications

References 124 publications

IgE-mediated food allergy throughout life

IgE-mediated food allergy throughout life

<p>Clinical Characteristics and Proposed Wheat-Cofactor Challenge Protocol with a High Diagnostic Yield in Adult-Onset IgE-Mediated Wheat Allergy</p>

Challenges in Diagnosis of Food Allergies via Oral Food Challenges: A Qualitative Analysis of the Caregiver Perspective

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