Abrams EM, et al. - This study focused on the oral food challenge outcomes in a pediatric tertiary care center. Findings demonstrated that different types of food carried different risk for challenge failure. The higher risk of challenge failure and anaphylaxis was reported for peanut and tree nut. Furthermore, cashew specifically carried a high risk. Clinicians must cautiously perform these types of oral challenges in children.

Methods

• Researchers conducted a retrospective chart review of all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010.

Results

• Data reported that 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29).
• 104 (33%) oral challenge failures were documented.
• Being older (P = .04), having asthma (P = .001) or atopic dermatitis (P = .03) were associated with a greater likelihood of failing an oral challenge in children.
• Researchers also observed that there was a significant difference between food allergens in terms of risk of challenge failure, with more failures noted for peanut than for tree nuts, milk or egg (P = .001).
• In addition, it was noted that among challenge failures, 19% met criteria for anaphylaxis.
• Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P < .001).
• Those who failed oral challenges (P < .001) had markedly elevated specific IgE level and skin test size.
• In addition, findings demonstrated that the highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis.