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Pediatric oral food challenges in the outpatient setting: A single-center experience.

Publication ,  Journal Article
Koutlas, N; Stallings, A; Hall, G; Zhou, C; Kim-Chang, J; Mousallem, T
Published in: J Allergy Clin Immunol Glob
February 2024

BACKGROUND: Oral food challenge (OFC) is the criterion standard for diagnosing food allergy (FA). It is important to have parameters to aid in selecting ideal OFC candidates. OBJECTIVE: We sought to characterize outcomes and predictors of OFCs for common food allergens. METHODS: We completed a retrospective chart review of all OFCs for IgE-mediated FA performed at Duke University pediatric allergy clinics from June 2017 through May 2022. Patients were deemed eligible for milk, egg, and nut OFC if testing revealed a specific IgE level not exceeding 2 kU/L and a skin prick test (SPT) resulting in a wheal size not exceeding 5 mm. Different parameters were followed for selecting candidates for baked challenge. RESULTS: A total of 663 OFCs were conducted on 510 patients (59% male). The most common foods challenged were peanut (26%), plain egg (23%), baked egg (8%), and milk (8%), with pass rates of 84%, 88%, 62%, and 84%, respectively. Of the patients who failed OFC, 84% had objective symptoms, 23% had multisystemic reactions, and 15% required epinephrine. Although the presence of a personal or family history of atopy or prior failed OFC was not associated with outcomes, a history of anaphylaxis (regardless of the trigger) was associated with increased risk of failure. CONCLUSION: Although there are no established consensus guidelines, our study provides a benchmark illustrating that cutoffs of a specific IgE level not exceeding 2 kU/L and SPT finding not exceeding 5 mm result in a failure rate of approximately 13% for nonbaked milk, nonbaked egg, and nuts. The high rate of failed baked egg OFCs is likely related to selection bias, but our results illustrate the low negative predictive value of ovomucoid.

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Published In

J Allergy Clin Immunol Glob

DOI

EISSN

2772-8293

Publication Date

February 2024

Volume

3

Issue

1

Start / End Page

100187

Location

United States
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Koutlas, N., Stallings, A., Hall, G., Zhou, C., Kim-Chang, J., & Mousallem, T. (2024). Pediatric oral food challenges in the outpatient setting: A single-center experience. J Allergy Clin Immunol Glob, 3(1), 100187. https://doi.org/10.1016/j.jacig.2023.100187
Koutlas, Nicole, Amy Stallings, Geoffrey Hall, Cynthia Zhou, Julie Kim-Chang, and Talal Mousallem. “Pediatric oral food challenges in the outpatient setting: A single-center experience.J Allergy Clin Immunol Glob 3, no. 1 (February 2024): 100187. https://doi.org/10.1016/j.jacig.2023.100187.
Koutlas N, Stallings A, Hall G, Zhou C, Kim-Chang J, Mousallem T. Pediatric oral food challenges in the outpatient setting: A single-center experience. J Allergy Clin Immunol Glob. 2024 Feb;3(1):100187.
Koutlas, Nicole, et al. “Pediatric oral food challenges in the outpatient setting: A single-center experience.J Allergy Clin Immunol Glob, vol. 3, no. 1, Feb. 2024, p. 100187. Pubmed, doi:10.1016/j.jacig.2023.100187.
Koutlas N, Stallings A, Hall G, Zhou C, Kim-Chang J, Mousallem T. Pediatric oral food challenges in the outpatient setting: A single-center experience. J Allergy Clin Immunol Glob. 2024 Feb;3(1):100187.

Published In

J Allergy Clin Immunol Glob

DOI

EISSN

2772-8293

Publication Date

February 2024

Volume

3

Issue

1

Start / End Page

100187

Location

United States