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Oral food challenges and chronic urticaria

Question:

4/18/2017
Do you have any practical advice for oral food challenge on patients with chronic urticaria? I have several children with chronic urticaria and I am afraid that I would mistake the chronic urticaria for a reaction during an OFC. Also, for the children dependent on antihistamines to control their hives, is there any way to safely perform an OFC?

Answer:

Performing oral food challenges can be tricky in patients with chronic urticaria. You might consider the following approach. If your patient is on a long-acting antihistamine, withhold it for 5-7 days to see the extent and severity to which urticaria may recur. If it the urticaria is generalized, then it may not be possible to conduct an OFC until such time that the hives go into remission. If the urticarial rash is focal and limited in terms of number of hives, then you could proceed with OFC. In such a situation, you might consider proceeding with the OFC until you see other, non-urticarial, manifestations of an allergic reaction to help you determine whether the patient is reacting to the food.

For a review of safety measures to employ during OFC, I recommend the Work Group Report on Oral Food Challenges published as a supplement in the June 2009 issue of J Allergy Clin Immunol by Anna Nowak-Wegrzyn et al

Dr. Jacqueline A. Pongracic, FAAAAI