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Oral Food Challenge: Are There Better Means to Predict Outcomes?
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Elias Akl, MD, Donna W. Mitchell, RN MSN NP, Wei Zhao, MD PhD FAAAAI
Rationale: Current established food specific IgE values help predict patient with symptoms upon oral food challenge (OFC). However, there is a lack of cut off to predict that a patient may pass OFC. Our aim was to analyze the available OFC performed in our pediatric allergy clinic.

Methods: Retrospective chart review of all the OFC performed in our pediatric allergy clinic at VCU from January – June, 2015. Skin test data and food specific IgE were correlated with outcome of OFC.

Results: A total of 55 OFC completed on 44 children with questionable IgE-mediated reaction to food. The challenged foods were Egg (17), Tree nuts (17), Peanut (8), Milk (7), Wheat (2), Soy (2), Shellfish (1), Pea (1). 48 patients passed OFC while 7 failed (5 to egg, 1 to peanut and 1 to walnut). Among patients who failed, 2 of 4 who had a food specific skin prick test (SPT) done showed wheal size over histamine control and 5 of the 7 had specific IgE lower than 95% PPV value. 

Conclusions: Based on current objective measures, we observed a discrepancy between the published values for prediction and OFC outcome of individual patients. A multifactorial scoring system with history, food type, SPT (raw and normalized to positive control), and specific IgE may be needed to better predict the OFC outcome and meet patient/parents expectations.