Oral food challenge

A patient with serum food allergy-specific IgE in excess of the 95% predictive value may be considered reactive and an oral food challenge would not be warranted. A patient with a food allergen-specific IgE levels less than 95% predictive value may be reactive but would require a food challenge to confirm the diagnosis (Sampson and Ho, 1997 Sampson, 1999a, 2001 Bock, 2003) (Table 3.3.9). 

Prior to oral food challenges, patients should avoid the suspected food(s) for at least two weeks and discontinue antihistamines or long-term asthma medications (beta-agonists) according to their elimination half-life. They should be evaluated carefully, before the challenge, for the presence of any clinical symptoms (The Food Allergy and Anaphylaxis Network, 2005 Chapman et al 2006). 

Niggemann, Wahn, and Sampson have designed the following procedure for oral food challenges (Niggemann et al., 1994) ... 

Oral food challenges have to be performed in a control manner if used for clinical studies. 

In infants, oral food challenges may also be performed in an open manner while in older children, oral challenges should be done double-blind and placebo-controlled food challenge (DBPCFC)—especially in the case of atopic dermatitis. 

Niggemann, B., Rolinck-Werninghaus, C., Mehl, A. et al. 2005. Controlled oral food challenges in children—when indicated, when superfluous Allergy. 60 865-870. 

Niggemann, B., Wahn, U., and Sampson, H.A. 1994. Proposals for standardization of oral food challenges in infants and children. Diagnosis of cow s milk and food allergy. Pediatr Allergy Immunol 5 11-13. 

Reibel, S., Rohr, M., Ziegert, M. et al. 2000. What safety measures need be taken in oral food challenges in children Allergy 55 940-944. 

Sampson, H.A. 1999b. Food allergy When and how to perform oral food challenges. Pediatric Allergy Immunol 10 226-234. 

Verstege, A., A. Mehl, C. Rolinck-Weminghaus, U. Staden, M. Nocon, K. Beyer, and B. Niggemann. 2005. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy 35 (9) 1220-1226. 

Sicherer, S.H., Morrow, E.H., Sampson, H.A. 2000b. Dose-response in double-blind, placebo-controlled oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol 105 582-586. 

Perry TT, Matsui EC, Conover-Walker MK, Wood RA (2004). Risk of oral food challenges. J. Allergy Clin. Immunol, 114 1164—1168. 

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