Oral Food Challenges in the Outpatient Office Setting: Assessment of Risk Factors to Predict Best Clinical Outcomes
Monday, March 5, 2018
South Hall A2 (Convention Center)
Margo Stevenson, DO, Justin C. Greiwe, MD, Umesh Singh, MD PhD, Jonathan A. Bernstein, MD FAAAAI
RATIONALE: Current skin and serologic tests for assessing food sensitization have poor positive predictive values and can be discordant. This makes it difficult to identify true IgE-mediated food allergy. Empiric food testing in infancy has resulted in many children unnecessarily avoiding a variety of foods. The diagnostic gold standard for food allergy remains the oral food challenge (OFC) which is underutilized due to anaphylaxis concerns. This study’s purpose is to provide a “real-world” risk assessment and outcomes related to in-office OFCs.

METHODS: A retrospective patient chart review of OFCs in a large clinical allergy practice in Midwest Ohio between January 2015 and January 2017 was performed. Data was extracted from medical records for information on food allergy history, skin and/or serologic testing, co-morbid disease(s) and other relevant demographic information. Data was entered into SAS and underwent univariate and multivariate analysis.

RESULTS: 71 OFCs were reviewed thus far. 8.45% failed OFC. Asthma, eczema, seasonal allergies and gender were not predictive of OFC outcomes. Univariate analysis revealed wheal (p<0.003) and flare (p<0.04) diameter, sIgE (p<0.0001) and sIgE/Total IgE ratio (p<0.0005) were highly predictive of OFC outcomes. Multivariate analysis revealed a high log (sIgE) was most predictive of OFC failure (p<0.001). No adverse outcomes were observed to date with OFC challenges.

CONCLUSIONS: OFCs are safe to perform in a controlled outpatient setting by experienced Allergists. Specific IgE testing appears to be the best marker for predicting a failed OFC. Data collection is ongoing to increase the number of OFCs and confirm the predictability of this risk factor.