Methods: We examined OFC outcomes in children with SPTs ≥ 10 mm wheal size. The clinical characteristics of those who passed OFCs were compared with those who failed within this group.
Results: Out of 2304 children who underwent OFCs, 328 (14%) had SPTs ≥ 10 mm. Within this group, 66% failed OFCs, and 26% were treated with epinephrine. Failure rate varied for different food antigens with the majority of children undergoing OFCs for peanut, milk, egg, tree nuts failing (82%, 71%, 70%, 67%respectively), and the majority of children undergoing OFCs to meats, baked egg, baked milk and seeds passing (78%, 75%, 67%, 60% respectively). Higher rate of epinephrine use was observed in OFCs to tree nuts, peanuts and seeds (46%, 40% and 36% respectively), and lower in OFCs to baked egg, baked milk, milk, meat and egg (5%, 16%, 18%,22% and 23% respectively).
Conclusions: Large SPTs are associated with a high rate of failed OFCs with a significant portion of these children receiving epinephrine, especially for tree nuts and peanuts. However, several other food antigens have a high pass rate with low use of epinephrine despite a large SPT. Thus, performance of supervised OFCs can be considered in certain situations despite large SPTs to avoid unnecessary restrictive diets.