Oral food challenges (OFC) remain the gold standard to confirm food allergy (FA). Current standards suggest offering an OFC when there is a 50% chance of passing but little is understood about patient/family perspectives regarding challenges.
We distributed anonymous surveys to English-speaking patients undergoing an OFC at a tertiary care medical center allergy clinic from March-August 2017. Questions included demographics, allergy history and a decisional conflict scale regarding the decision to undergo the OFC. Respondents were categorized as aggressive challengers (those who thought challenges should be offered when the chance of reacting is >50%) or conservative challengers (those who would recommend OFC at ≤50% chance of reaction).
Sixty-three surveys were returned. Patients were 67% male; 72% were <5 years old, 35% had never been exposed to the food and 34% failed their OFC. The most common food challenged was peanut. 53% were “aggressive challengers”, compared to 47% “conservative”. There was no significant change in responses on the pre-questionnaire compared to post, regardless of challenge outcome. Aggressive challengers were more likely to be undergoing an OFC to peanut or tree nut (OR 3.4, p < 0.05) and were less likely to have experienced a prior allergic reaction (OR 0.35, p 0.07). The groups did not differ in other ways including level of anxiety about the OFC or FA, years with FA, or history of prior OFC (p > 0.1).
It is unclear why over 50% of respondents preferred a more aggressive approach to offering OFC, but this topic should be explored.