Oral food challenges: how can we increase their acceptance and availability?

Published online: July 10, 2019

Oral food challenges (OFC) are the gold standard in food allergy diagnostics due to inaccuracies in skin prick tests and specific Immunoglobulin E (blood) tests. OFCs are also useful to determine whether someone has outgrown the allergy, or the amount of food required to cause a reaction, but this procedure can be time consuming and there is risk of allergic reactions. OFC implementation is variable among allergists, with some patients reporting that their allergists do not perform OFCs at all, or only very rarely. Some referring physicians are not aware of the role of an OFC, and therefore do not refer their patients to an allergist who performs this test. Furthermore, some families are offered OFCs by their physicians but are afraid of proceeding.

In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Hsu and colleagues used a mixed-methods design to investigate OFC barriers and solutions among Canadian practitioners and patients. In total, 62 allergists, 101 pediatricians, and 110 parents of pediatric allergy patients completed surveys on barriers and solutions, and 27 parents attended focus groups to provide researchers with a deeper understanding of parental attitudes on OFCs.

The most commonly reported allergist barriers for conducting more OFCs were lack of resources (support staff, time, and space), and the most commonly mentioned solution was the creation of standard guidelines on which OFCs should be done in hospitals versus the community. Allergists with more OFC training were more likely to perform more than the median number (12) of OFCs per month, as well as conduct OFCs in infants under 12 months of age (71% vs 29%). Responding pediatricians reporting more OFC knowledge were more than twice as likely to refer patients to allergists who performed OFCs over pediatricians with less OFC knowledge. Pediatricians’ most commonly stated barrier to referring patients to allergists who perform OFCs was long wait times. Parents reported in the survey and during focus groups that fear and anxiety about the procedure and experiencing reactions during an OFC were the most important barriers to scheduling an OFC for their children. These results highlight the need for more allergist training on how to conduct OFCs, education among referring physicians on the importance of OFCs as a tool, the creation of standardized guidelines with parent input on which OFCs should be performed within a hospital versus community setting, and better information on OFCs for parents in addition to psychosocial support.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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