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Oral Food Challenge

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An oral food challenge, or OFC, is a medically supervised test in which a person eats a suspected allergenic food in controlled, gradually increasing amounts while being observed for signs of an allergic reaction. It is a reference standard for diagnosing food allergy because it directly tests whether eating the food produces clinical symptoms .1,2

During a typical challenge, small portions of the food are given at intervals, with the amount increasing if no reaction occurs. The procedure uses predefined criteria for continuing, observing, or stopping the challenge. Because exposure can provoke potentially severe allergic reactions, including anaphylaxis, oral food challenges are performed in settings with trained medical personnel and appropriate treatment available .1,3

A challenge is considered positive when the food produces symptoms that meet appropriate diagnostic stopping criteria and support a diagnosis of clinical food allergy. A negative challenge indicates that the tested amount was tolerated without the allergic reaction being investigated. Oral food challenges are particularly useful when the medical history and other allergy tests do not provide a clear diagnosis .1,2

An OFC differs from a skin-prick test or measurement of food-specific IgE in blood. Those tests detect allergic sensitization, which does not necessarily mean that eating the food will cause symptoms. An oral food challenge tests clinical reactivity itself. Many clinical challenges are open, meaning both the patient and clinician know what food is being given, while blinded, placebo-controlled challenges can be used when reducing bias is particularly important .1,2

References

  1. Sampson HA, Arasi S, Bahnson HT AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 Update. Pediatric Allergy and Immunology. 2024. About this source DOI
  2. Alexandra F. Santos, Carmen Riggioni, Ioana Agache, Cezmi A. Akdis, Mubeccel Akdis, Alberto Alvarez‐Perea, Montserrat Alvaro‐Lozano, Barbara Ballmer‐Weber, Simona Barni, Kirsten Beyer, Carsten Bindslev‐Jensen, Helen A. Brough, Betul Buyuktiryaki, Derek Chu, Stefano Del Giacco, Audrey Dunn‐Galvin, Bernadette Eberlein, Motohiro Ebisawa, Philippe Eigenmann, Thomas Eiwegger, Mary Feeney, Montserrat Fernandez‐Rivas, Helen R. Fisher, David M. Fleischer, Mattia Giovannini, Claudia Gray, Karin Hoffmann‐Sommergruber, Susanne Halken, Jonathan O’B. Hourihane, Christina J. Jones, Marek Jutel, Edward Knol, George N. Konstantinou, Gideon Lack, Susanne Lau, Andreina Marques Mejias, Mary Jane Marchisotto, Rosan Meyer, Charlotte G. Mortz, Beatriz Moya, Antonella Muraro, Caroline Nilsson, Lucila Camargo Lopes de Oliveira, Liam O’Mahony, Nikolaos G. Papadopoulos, Kirsten Perrett, Rachel L. Peters, Marcia Podesta, Lars K. Poulsen, Graham Roberts, Hugh A. Sampson, Jürgen Schwarze, Peter Smith, Elizabeth Huiwen Tham, Eva Untersmayr, Ronald Van Ree, Carina Venter, Brian P. Vickery, Berber Vlieg‐Boerstra, Thomas Werfel, Margitta Worm, George Du Toit, Isabel Skypala EAACI guidelines on the diagnosis of IgE ‐mediated food allergy. Allergy. 2023. About this source DOI
  3. Bird JA, Leonard S, Groetch M Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. Journal of Allergy and Clinical Immunology: In Practice. 2020. About this source DOI

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