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Innovation in Food Challenge Tests for Food Allergy

  • Immunologic/Diagnostic Tests in Allergy (P Matricardi, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review incorporates findings from studies of oral food challenges (OFC) over the last decade and highlights the latest innovations and understanding of the procedure.

Recent Findings

PRACTALL guidelines are widely used in OFC research, but there is still no international consensus on the OFC protocol in clinical practice. Guidelines for performing OFC in clinical practice have been updated to include oral food challenges for infants. There have been advances in predictive models for outcomes and severity of reaction during OFC that take into account multiple clinical data as well as newer laboratory modalities. Low-dose OFC and eliciting threshold dose determination are being examined for additional diagnostic and therapeutic use in the management of food allergy. Quality-of-life considerations have also been reviewed, as well as post-OFC assessment and care.

Summary

The OFC remains an important diagnostic tool in the management of food allergy and in clinical research. Advances in the field should improve safety and broaden the clinical applications of this essential procedure.

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Abbreviations

BAT:

Basophil activation test

DBPCFC:

Double-blind placebo-controlled food challenge

ED:

Eliciting threshold dose

FA:

Food allergy

OFC:

Oral food challenge

QoL:

Quality of life

ssIgE:

Serum-specific IgE

SPT:

Skin prick test

TN:

Tree nut

WD-EIA:

Wheat-dependent exercise-induced anaphylaxis

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134(5):1016–25e43.

    PubMed  Google Scholar 

  2. • Ballmer-Weber BK, Beyer K. Food challenges. J Allergy Clin Immunol. 2018;141(1):69–71.e2 An overview of food challenge methodology.

    PubMed  Google Scholar 

  3. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41–58.

    CAS  PubMed  Google Scholar 

  4. Niggemann B, Beyer K. Diagnosis of food allergy in children: toward a standardization of food challenge. J Pediatr Gastroenterol Nutr. 2007;45(4):399–404.

    CAS  PubMed  Google Scholar 

  5. Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, et al. Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012;130(6):1260–74.

    PubMed  Google Scholar 

  6. Yanagida N, Imai T, Sato S, Ebisawa M. Do longer intervals between challenges reduce the risk of adverse reactions in oral wheat challenges? PLoS One. 2015;10(12):e0143717.

    PubMed  PubMed Central  Google Scholar 

  7. Yanagida N, Sato S, Nagakura KI, Asaumi T, Ebisawa M. Oral food challenge using different target doses and time intervals between doses. Curr Opin Allergy Clin Immunol. 2018;18(3):222–7.

    CAS  PubMed  Google Scholar 

  8. Akuete K, Guffey D, Israelsen RB, Broyles JM, Higgins LJ, Green TD, et al. Multicenter prevalence of anaphylaxis in clinic-based oral food challenges. Ann Allergy Asthma Immunol. 2017;119(4):339–48.e1.

    PubMed  Google Scholar 

  9. Bird JA, Fleischer DM, Groetch M, Nowak-Wegrzyn A, Sicherer S, Young MC. Additional oral food challenge considerations. J Allergy Clin Immunol. 2018;141(6):2322.

    PubMed  Google Scholar 

  10. Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Work group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(6 Suppl):S365–S83.

    PubMed  Google Scholar 

  11. •• Bird JA, Groetch M, Allen KJ, Bock SA, Leonard S, Nowak-Wegrzyn AH, et al. Conducting an oral food challenge to peanut in an infant. J Allergy Clin Immunol Pract. 2017;5(2):301–11.e1 This is a very practical guide for performing food challenges in infants.

    PubMed  Google Scholar 

  12. Ebisawa M, Ito K, Fujisawa T. Committee for Japanese Pediatric Guideline for food allergy TJSoPA, clinical immunology TJSoA. Japanese guidelines for food allergy 2017. Allergol Int. 2017;66(2):248–64.

    PubMed  Google Scholar 

  13. • Simberloff T, Parambi R, Bartnikas LM, Broyles AD, Hamel V, Timmons KG, et al. Implementation of a standardized clinical assessment and management plan (SCAMP) for food challenges. J Allergy Clin Immunol Pract. 2017;5(2):335–44.e3 This paper proposes specific diagnostic decision points for common foods.

    PubMed  Google Scholar 

  14. Yanagida N, Sato S, Takahashi K, Nagakura KI, Ogura K, Asaumi T, et al. Skin prick test is more useful than specific IgE for diagnosis of buckwheat allergy: a retrospective cross-sectional study. Allergol Int. 2018;67(1):67–71.

    PubMed  Google Scholar 

  15. Couch C, Franxman T, Greenhawt M. Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals. Ann Allergy Asthma Immunol. 2017;118(5):591–6.e3.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Horimukai K, Hayashi K, Tsumura Y, Nomura I, Narita M, Ohya Y, et al. Total serum IgE level influences oral food challenge tests for IgE-mediated food allergies. Allergy. 2015;70(3):334–7.

    CAS  PubMed  Google Scholar 

  17. Gupta RS, Lau CH, Hamilton RG, Donnell A, Newhall KK. Predicting outcomes of oral food challenges by using the allergen-specific IgE-total IgE ratio. J Allergy Clin Immunol Pract. 2014;2(3):300–5.

    PubMed  Google Scholar 

  18. Dang TD, Tang ML, Koplin JJ, Licciardi PV, Eckert JK, Tan T, et al. Characterization of plasma cytokines in an infant population cohort of challenge-proven food allergy. Allergy. 2013;68(10):1233–40.

    CAS  PubMed  Google Scholar 

  19. Martino D, Dang T, Sexton-Oates A, Prescott S, Tang ML, Dharmage S, et al. Blood DNA methylation biomarkers predict clinical reactivity in food-sensitized infants. J Allergy Clin Immunol. 2015;135(5):1319–28e1-12.

    CAS  PubMed  Google Scholar 

  20. Lindvik H, Lodrup Carlsen KC, Mowinckel P, Navaratnam J, Borres MP, Carlsen KH. Conjunctival provocation test in diagnosis of peanut allergy in children. Clin Exp Allergy. 2017;47(6):785–94.

    CAS  PubMed  Google Scholar 

  21. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user’s guide. Pediatr Allergy Immunol. 2016;27(Suppl 23):1–250.

    PubMed  Google Scholar 

  22. • Santos AF, Brough HA. Making the most of in vitro tests to diagnose food allergy. J Allergy Clin Immunol Pract. 2017;5(2):237–48 This review discusses the evidence based approach to diagnostic testing for food allergy.

    PubMed  PubMed Central  Google Scholar 

  23. Grabenhenrich LB, Reich A, Bellach J, Trendelenburg V, Sprikkelman AB, Roberts G, et al. A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research. Allergy. 2017;72(3):453–61.

    CAS  PubMed  Google Scholar 

  24. Ahrens B, Niggemann B, Wahn U, Beyer K. Positive reactions to placebo in children undergoing double-blind, placebo-controlled food challenge. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology. 2014;44(4):572–8.

    CAS  Google Scholar 

  25. Miura T, Yanagida N, Sato S, Ogura K, Ebisawa M. Follow-up of patients with uncertain symptoms during an oral food challenge is useful for diagnosis. Ann Allergy Asthma Immunol. 2018;29(1):66–71.

    Google Scholar 

  26. Twomey N, Temko A, Hourihane JO, Marnane WP. Automated detection of perturbed cardiac physiology during oral food allergen challenge in children. IEEE J Biomed Health Inf. 2014;18(3):1051–7.

    CAS  Google Scholar 

  27. Wainstein BK, Studdert J, Ziegler M, Ziegler JB. Prediction of anaphylaxis during peanut food challenge: usefulness of the peanut skin prick test (SPT) and specific IgE level. Pediatr Allergy Immunol. 2010;21(4 Pt 1):603–11.

    PubMed  Google Scholar 

  28. Chan JCK, Peters RL, Koplin JJ, Dharmage SC, Gurrin LC, Wake M, et al. Food challenge and community-reported reaction profiles in food-allergic children aged 1 and 4 years: a population-based study. J Allergy Clin Immunol Pract. 2017;5(2):398–409 e3.

    PubMed  Google Scholar 

  29. Nowak-Wegrzyn A, Lawson K, Masilamani M, Kattan J, Bahnson HT, Sampson HA. Increased tolerance to less extensively heat-denatured (baked) milk products in milk-allergic children. J Allergy Clin Immunol Pract. 2018;6(2):486–95.e5.

    PubMed  Google Scholar 

  30. Capucilli P, Cianferoni A, Fiedler J, Gober L, Pawlowski N, Ram G, et al. Differences in egg and milk food challenge outcomes based on tolerance to the baked form. Ann Allergy Asthma Immunol. 2018.

  31. Yanagida N, Sato S, Asaumi T, Ogura K, Ebisawa M. Risk factors for severe reactions during double-blind placebo-controlled food challenges. Int Arch Allergy Immunol. 2017;172(3):173–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Yanagida N, Sato S, Takahashi K, Nagakura KI, Asaumi T, Ogura K, et al. Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge. Pediatr Allergy Immunol. 2018;29(4):417–24.

    PubMed  Google Scholar 

  33. Yanagida N, Sato S, Takahashi K, Nagakura KI, Ogura K, Asaumi T, et al. Reactions of buckwheat-hypersensitive patients during oral food challenge are rare, but often anaphylactic. Int Arch Allergy Immunol. 2017;172(2):116–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. DunnGalvin A, Daly D, Cullinane C, Stenke E, Keeton D, Erlewyn-Lajeunesse M, et al. Highly accurate prediction of food challenge outcome using routinely available clinical data. J Allergy Clin Immunol. 2011;127(3):633–9.e1-3.

    PubMed  Google Scholar 

  35. DunnGalvin A, Segal LM, Clarke A, Alizadehfar R, Hourihane JO. Validation of the Cork-Southampton food challenge outcome calculator in a Canadian sample. J Allergy Clin Immunol. 2013;131(1):230–2.

    PubMed  Google Scholar 

  36. Sugiura S, Matsui T, Furuta T, Sasaki K, Kando N, Ito K. Development of a prediction model for severe wheat allergy. Pediatr Allergy Immunol. 2018;29(1):93–6.

    PubMed  Google Scholar 

  37. Sugiura S, Matsui T, Nakagawa T, Sasaki K, Nakata J, Kando N, et al. Development of a prediction model of severe reaction in boiled egg challenges. Allergol Int. 2016;65(3):293–9.

    CAS  PubMed  Google Scholar 

  38. Sugiura S, Sasaki K, Matsui T, Nakagawa T, Kando N, Ito K. Development of a prediction model for a severe reaction in cow’s milk challenges. Allergol Int. 2017;66(3):493–4.

    PubMed  Google Scholar 

  39. Yoneyama M, Nomura T, Kato T, Sobajima T, Tanida H, Morishita T, et al. Probability curves for predicting symptom severity during oral food challenge with milk. Ann Allergy Asthma Immunol. 2015;115(3):251–3.

    PubMed  Google Scholar 

  40. Kamioka N, Nomura T, Kato T, Yoneyama M, Sobajima T, Tanida H, et al. Probability curves for predicting symptom severity during an oral food challenge with wheat. Allergol Int. 2017;66(4):627–8.

    PubMed  Google Scholar 

  41. Song Y, Wang J, Leung N, Wang LX, Lisann L, Sicherer SH, et al. Correlations between basophil activation, allergen-specific IgE with outcome and severity of oral food challenges. Ann Allergy Asthma Immunol. 2015;114(4):319–26.

    CAS  PubMed  Google Scholar 

  42. Santos AF, Du Toit G, Douiri A, Radulovic S, Stephens A, Turcanu V, et al. Distinct parameters of the basophil activation test reflect the severity and threshold of allergic reactions to peanut. J Allergy Clin Immunol. 2015;135(1):179–86.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Brandstrom J, Nopp A, Johansson SG, Lilja G, Sundqvist AC, Borres MP, et al. Basophil allergen threshold sensitivity and component-resolved diagnostics improve hazelnut allergy diagnosis. Clin Exp Allergy. 2015;45(9):1412–8.

    CAS  PubMed  Google Scholar 

  44. Glaumann S, Nopp A, Johansson SG, Borres MP, Nilsson C. Oral peanut challenge identifies an allergy but the peanut allergen threshold sensitivity is not reproducible. PLoS One. 2013;8(1):e53465.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Nilsson N, Nilsson C, Hedlin G, Johansson SG, Borres MP, Nopp A. Combining analyses of basophil allergen threshold sensitivity, CD-sens, and IgE antibodies to hydrolyzed wheat, omega-5 gliadin and timothy grass enhances the prediction of wheat challenge outcome. Int Arch Allergy Immunol. 2013;162(1):50–7.

    CAS  PubMed  Google Scholar 

  46. Chinthrajah RS, Purington N, Andorf S, Rosa JS, Mukai K, Hamilton R, et al. Development of a tool predicting severity of allergic reaction during peanut challenge. Ann Allergy Asthma Immunol. 2018;121(1):69–76.e2.

    CAS  PubMed  Google Scholar 

  47. Dua S, Dowey J, Foley L, Islam S, King Y, Ewan P, et al. Diagnostic value of tryptase in food allergic reactions: a prospective study of 160 adult peanut challenges. J Allergy Clin Immunol Pract. 2018;6:1692–1698.e1.

    PubMed  Google Scholar 

  48. Smith G. Alabama boy, 3, dies of severe reaction during baked milk challenge test. 2017. Available from: https://www.allergicliving.com/2017/08/02/alabama-boy-3-dies-of-severe-reaction-during-baked-milk-challenge-test.

  49. Niggemann B, Yurek S, Beyer K. Severe anaphylaxis requiring intensive care during oral food challenge—it is not always peanuts. Pediatr Allergy Immunol. 2017;28(2):201–3.

    PubMed  Google Scholar 

  50. Rolinck-Werninghaus C, Niggemann B, Grabenhenrich L, Wahn U, Beyer K. Outcome of oral food challenges in children in relation to symptom-eliciting allergen dose and allergen-specific IgE. Allergy. 2012;67(7):951–7.

    CAS  PubMed  Google Scholar 

  51. Thalayasingam M, Loo EX, Tan MM, Bever HV, Shek LP. A review of oral food challenges in children presenting to a single tertiary Centre with perceived or true food allergies. Singap Med J. 2015;56(11):622–5.

    Google Scholar 

  52. Calvani M, Berti I, Fiocchi A, Galli E, Giorgio V, Martelli A, et al. Oral food challenge: safety, adherence to guidelines and predictive value of skin prick testing. Pediatr Allergy Immunol. 2012;23(8):755–61.

    PubMed  Google Scholar 

  53. Noone S, Ross J, Sampson HA, Wang J. Epinephrine use in positive oral food challenges performed as a screening test for food allergy therapy trials. J Allergy Clin Immunol Pract. 2015;3(3):424–8.

    PubMed  PubMed Central  Google Scholar 

  54. Turner PJ, Mehr S, Joshi P, Tan J, Wong M, Kakakios A, et al. Safety of food challenges to extensively heated egg in egg-allergic children: a prospective cohort study. Pediatr Allergy Immunol. 2013;24(5):450–5.

    PubMed  Google Scholar 

  55. Alqurashi W, Stiell I, Chan K, Neto G, Alsadoon A, Wells G. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis. Ann Allergy Asthma Immunol. 2015;115(3):217–23.e2.

    PubMed  Google Scholar 

  56. Katz Y, Nowak-Wegrzyn A, Spergel JM. Prevalence of biphasic response in anaphylaxis due to purposeful administration of allergenic food. Ann Allergy Asthma Immunol. 2015;115(6):526–7.

    PubMed  Google Scholar 

  57. Lee J, Garrett JP, Brown-Whitehorn T, Spergel JM. Biphasic reactions in children undergoing oral food challenges. Allergy Asthma Proc. 2013;34(3):220–6.

    PubMed  Google Scholar 

  58. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803–13.

    PubMed  PubMed Central  Google Scholar 

  59. Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016;374:1733–43.

    CAS  PubMed  Google Scholar 

  60. Fleischer DM, Sicherer S, Greenhawt M, Campbell D, Chan E, Muraro A, et al. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. J Allergy Clin Immunol. 2015;136(2):258–61.

    PubMed  Google Scholar 

  61. Niggemann B, Beyer K. Factors augmenting allergic reactions. Allergy. 2014;69(12):1582–7.

    CAS  PubMed  Google Scholar 

  62. Versluis A, van Os-Medendorp H, Kruizinga AG, Blom WM, Houben GF, Knulst AC. Cofactors in allergic reactions to food: physical exercise and alcohol are the most important. Immun Inflammation Dis. 2016;4(4):392–400.

    CAS  Google Scholar 

  63. Brockow K, Kneissl D, Valentini L, Zelger O, Grosber M, Kugler C, et al. Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol. 2015;135(4):977–84.e4.

    CAS  PubMed  Google Scholar 

  64. Yanagida N, Okada Y, Sato S, Ebisawa M. New approach for food allergy management using low-dose oral food challenges and low-dose oral immunotherapies. Allergol Int. 2016;65(2):135–40.

    CAS  PubMed  Google Scholar 

  65. Okada Y, Yanagida N, Sato S, Ebisawa M. Better management of wheat allergy using a very low-dose food challenge: a retrospective study. Allergol Int. 2016;65(1):82–7.

    CAS  PubMed  Google Scholar 

  66. Okada Y, Yanagida N, Sato S, Ebisawa M. Better management of cow's milk allergy using a very low dose food challenge test: a retrospective study. Allergol Int. 2015;64(3):272–6.

    CAS  PubMed  Google Scholar 

  67. Blom WM, Vlieg-Boerstra BJ, Kruizinga AG, van der Heide S, Houben GF, Dubois AE. Threshold dose distributions for 5 major allergenic foods in children. J Allergy Clin Immunol. 2013;131(1):172–9.

    CAS  PubMed  Google Scholar 

  68. Eller E, Hansen TK, Bindslev-Jensen C. Clinical thresholds to egg, hazelnut, milk and peanut: results from a single-center study using standardized challenges. Ann Allergy Asthma Immunol. 2012;108(5):332–6.

    PubMed  Google Scholar 

  69. Allen KJ, Remington BC, Baumert JL, Crevel RW, Houben GF, Brooke-Taylor S, et al. Allergen reference doses for precautionary labeling (VITAL 2.0): clinical implications. J Allergy Clin Immunol. 2014;133(1):156–64.

    CAS  PubMed  Google Scholar 

  70. Zurzolo GA, Allen KJ, Taylor SL, Shreffler WG, Baumert JL, Tang ML, et al. Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol. Allergy Asthma Clin Immunol. 2013;9(1):35.

    PubMed  PubMed Central  Google Scholar 

  71. • Hourihane JO, Allen KJ, Shreffler WG, Dunngalvin G, Nordlee JA, Zurzolo GA, et al. Peanut Allergen Threshold Study (PATS): novel single-dose oral food challenge study to validate eliciting doses in children with peanut allergy. J Allergy Clin Immunol. 2017;139(5):1583–90 A novel approach to evaluating eliciting doses of peanut.

    CAS  PubMed  Google Scholar 

  72. Blankestijn MA, Remington BC, Houben GF, Baumert JL, Knulst AC, Blom WM, et al. Threshold dose distribution in walnut allergy. J Allergy Clin Immunol Pract. 2017;5(2):376–80.

    PubMed  Google Scholar 

  73. Ballmer-Weber BK, Fernandez-Rivas M, Beyer K, Defernez M, Sperrin M, Mackie AR, et al. How much is too much?. Threshold dose distributions for 5 food allergens. J Allergy Clin Immunol. 2015;135(4):964–71.

    CAS  PubMed  Google Scholar 

  74. Blumchen K, Beder A, Beschorner J, Ahrens F, Gruebl A, Hamelmann E, et al. Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy. J Allergy Clin Immunol. 2014;134(2):390–8.

    CAS  PubMed  Google Scholar 

  75. Leonard SA, Caubet JC, Kim JS, Groetch M, Nowak-Wegrzyn A. Baked milk- and egg-containing diet in the management of milk and egg allergy. J Allergy Clin Immunol Pract. 2015;3(1):13–23 quiz 4.

    PubMed  Google Scholar 

  76. Ford LS, Bloom KA, Nowak-Wegrzyn AH, Shreffler WG, Masilamani M, Sampson HA. Basophil reactivity, wheal size, and immunoglobulin levels distinguish degrees of cow’s milk tolerance. J Allergy Clin Immunol. 2013;131(1):180–6e1-3.

    CAS  PubMed  Google Scholar 

  77. Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011;128(1):125–31 e2.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Lambert R, Grimshaw KEC, Ellis B, Jaitly J, Roberts G. Evidence that eating baked egg or milk influences egg or milk allergy resolution: a systematic review. Clin Exp Allergy. 2017;47(6):829–37.

    CAS  PubMed  Google Scholar 

  79. Yanagida N, Sato S, Asaumi T, Ogura K, Borres MP, Ebisawa M. Safety and feasibility of heated egg yolk challenge for children with egg allergies. Pediatr Allergy Immunol. 2017;28(4):348–54.

    PubMed  Google Scholar 

  80. Commins SP, James HR, Stevens W, Pochan SL, Land MH, King C, et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2014;134(1):108–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Nowak-Wegrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-workgroup report of the adverse reactions to foods committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111–26 e4.

    PubMed  Google Scholar 

  82. Miceli Sopo S, Bersani G, Monaco S, Cerchiara G, Lee E, Campbell D, et al. Ondansetron in acute food protein-induced enterocolitis syndrome, a retrospective case-control study. Allergy. 2017;72(4):545–51.

    CAS  PubMed  Google Scholar 

  83. Kansen HM, Le TM, Meijer Y, Flokstra-de Blok BMJ, Welsing PMJ, van der Ent CK, et al. The impact of oral food challenges for food allergy on quality of life: a systematic review. Pediatr Allergy Immunol. 2018;29:527–37.

    PubMed  Google Scholar 

  84. Knibb RC, Ibrahim NF, Stiefel G, Petley R, Cummings AJ, King RM. The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy. Clin Exp Allergy. 2012;42(3):451–9.

    CAS  PubMed  Google Scholar 

  85. Franxman TJ, Howe L, Teich E, Greenhawt MJ. Oral food challenge and food allergy quality of life in caregivers of children with food allergy. J Allergy Clin Immunol Pract. 2015;3(1):50–6.

    PubMed  Google Scholar 

  86. Gupta R, Holdford D, Bilaver L, Dyer A, Holl JL, Meltzer D. The economic impact of childhood food allergy in the United States. JAMA Pediatr. 2013;167(11):1026–31.

    PubMed  Google Scholar 

  87. Couch C, Franxman T, Greenhawt M. The economic effect and outcome of delaying oral food challenges. Ann Allergy Asthma Immunol. 2016;116(5):420–4.

    PubMed  Google Scholar 

  88. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS, et al. Work group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(6 Suppl):S365–83.

    PubMed  Google Scholar 

  89. Eigenmann PA, Caubet JC, Zamora SA. Continuing food-avoidance diets after negative food challenges. Pediatr Allergy Immunol. 2006;17(8):601–5.

    PubMed  Google Scholar 

  90. Gau J, Wang J. Rate of food introduction after a negative oral food challenge in the pediatric population. J Allergy Clin Immunol Pract. 2017;5(2):475–6.

    PubMed  Google Scholar 

  91. Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. Peanut allergy: recurrence and its management. J Allergy Clin Immunol. 2004;114(5):1195–201.

    CAS  PubMed  Google Scholar 

  92. van Erp FC, Boot J, Knulst AC, Pasmans SG, van der Ent CK, Meijer Y. Reintroduction failure after negative peanut challenges in children. Pediatr Allergy Immunol. 2014;25(6):580–5.

    PubMed  Google Scholar 

  93. Flammarion S, Santos C, Romero D, Thumerelle C, Deschildre A. Changes in diet and life of children with food allergies after a negative food challenge. Allergy. 2010;65(6):797–8.

    CAS  PubMed  Google Scholar 

  94. Miceli Sopo S, Monaco S, Greco M, Onesimo R. Prevalence of adverse reactions following a passed oral food challenge and factors affecting successful re-introduction of foods. A retrospective study of a cohort of 199 children. Allergol Immunopathol. 2016;44(1):54–8.

    CAS  Google Scholar 

  95. Inoue T, Ogura K, Takahashi K, Nishino M, Asaumi T, Yanagida N, et al. Risk factors and clinical features in cashew nut oral food challenges. Int Arch Allergy Immunol. 2018;175(1–2):99–106.

    CAS  PubMed  Google Scholar 

  96. van der Valk JP, Gerth van Wijk R, Dubois AE, de Groot H, de Jong NW. Failure of introduction of cashew nut after a negative oral food challenge test in children. Pediatr Allergy Immunol. 2016;27(6):654–8.

    PubMed  Google Scholar 

  97. van der Valk JP, Gerth van Wijk R, Flokstra-de Blok BM, van der Velde JL, de Groot H, Wichers HJ, et al. No difference in health-related quality of life, after a food challenge with cashew nut in children participating in a clinical trial. Pediatr Allergy Immunol. 2016;27(8):812–7.

    PubMed  Google Scholar 

  98. van der Valk JP, Gerth van Wijk R, Dubois AE, de Groot H, Reitsma M, Vlieg-Boerstra B, et al. Multicentre double-blind placebo-controlled food challenge study in children sensitised to cashew nut. PLoS One. 2016;11(3):e0151055.

    PubMed  PubMed Central  Google Scholar 

  99. Polloni L, Ferruzza E, Ronconi L, Toniolo A, Lazzarotto F, Bonaguro R, et al. Assessment of children’s nutritional attitudes before oral food challenges to identify patients at risk of food reintroduction failure: a prospective study. Allergy. 2017;72(5):731–6.

    CAS  PubMed  Google Scholar 

  100. van der Valk JP, Gerth van Wijk R, Vergouwe Y, de Jong NW. Failure of introduction of food allergens after negative oral food challenge tests in children. Eur J Pediatr. 2015;174(8):1093–9.

    PubMed  PubMed Central  Google Scholar 

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  1. Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1198, New York, NY, 10029, USA

    Amanda L. Cox & Anna Nowak-Wegrzyn

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  1. Amanda L. Cox
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  2. Anna Nowak-Wegrzyn
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Correspondence to Amanda L. Cox.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Immunologic/Diagnostic Tests in Allergy

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Cox, A.L., Nowak-Wegrzyn, A. Innovation in Food Challenge Tests for Food Allergy. Curr Allergy Asthma Rep 18, 74 (2018). https://doi.org/10.1007/s11882-018-0825-3

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  • DOI: https://doi.org/10.1007/s11882-018-0825-3

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