Patient and family perceptions on when it is appropriate to have an oral food challenge
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Monica T. Kraft, Rebecca Scherzer, MD FAAAAI, Elizabeth Erwin, MD, Irene Mikhail, MD

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.