Methods: We designed and implemented a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve ssIgE and skin prick test thresholds to determine when and where to conduct OFCs. Between June 2012 and May 2015, we tracked the ordering of 2366 food challenges for 1580 patients. Providers followed recommended ssIgE and skin prick test thresholds when ordering challenges although deviations were permitted.
Results: Allergists ordered 1388 OFCs in an outpatient clinic and 945 OFCs in a higher resource infusion center. In the clinic, patients presented for 579 challenges: 486 (84%) passed, 74 (13%) failed and 19 (3%) did not complete their challenge. In the infusion center, patients underwent 415 challenges: 306 (74%) passed, 89 (21%) failed, and 20 (5%) did not complete their challenge. 6 patients (8.1% challenge failures) in clinic required treatment with epinephrine compared to 22 patients (24.7% challenge failures) in the infusion center (p<0.01). Need for epinephrine was more common in patients with asthma (p<0.01). Recommended ssIgE and skin prick test thresholds were incrementally changed resulting in a decreasing percentage of challenges being ordered in the higher resource location.
Conclusions: By setting and continually refining ssIgE and skin prick test recommendations using the SCAMP method, allergists can better determine the risk of severe reactions and triage patients to the appropriate resource setting for an OFC.