Oral Food Challenge: Worth the Risk?

It’s a tragic time in the food allergic community as we mourn the loss of another child to food allergies.  On July 30th, Alistair, aged 3 of Alabama, passed away after participating in a baked milk challenge at the Children’s Hospital of Alabama in Birmingham.  What makes Alistair’s death even more alarming is that this is reportedly the first food allergy challenge death recorded.  At this time, the circumstances surrounding Alistair’s death have not been shared to allow the family privacy in their grief.

In a July, the medical journal Pediatrics, posted a report indicating that food allergy diagnoses from skin and blood tests alone were poor indicators of a true food allergy and suggesting that food allergies are being over diagnosed.  The report, from many well-known food allergy experts, indicates that the gold standard for a food allergy diagnosis is the Oral Food Challenge (OFC).  You can read the published report in more detail here:  http://pediatrics.aappublications.org/content/early/2017/07/19/peds.2017-0194

So reaction has been swift, especially from those food allergic people and parents who are facing upcoming OFCs.  It brings up many questions questioning the safety of Oral Food Challenges and, if they are advisable, under what conditions are OFC’s safe?

It’s important to understand why an allergist might suggest an Oral Food Challenge.  Most often, they’re recommended by a physician either when it appears that a previously diagnosed food allergy has been outgrown or when a suspected food allergen is negative on skin prick and blood tests.

Not all people will need to undergo an OFC.  For example, a patient coming to an allergist after a history of known allergic reactions (ie hives) after eating a specific food who then tests positive for that food on skin and/or blood tests may not be a candidate for an Oral Food Challenge.

In response to Alistair’s death, and the worry that it has created for so many food allergic people and parents, Web MD Health News published an article yesterday noting that while the worry is definitely legitimate, there are still very good reasons to move forward with an OFC.  However, a joint statement by the ACAA (American Academy of Allergy, Asthma & Immunology) and the Canadian Society of Allergy and Clinical Immunology Allergy says that the following guidelines must be followed for a challenge:

  • A well-trained provider of food allergy and anaphylaxis management, who has performed oral food challenges, does them.
  • There is an established procedure for doing the challenge.
  • It’s done in an office or hospital that includes well-trained and experienced staff, plenty of supervision for the patient, a plan for treatment of any reaction, and an observation period afterward.
  • Life-saving equipment is on hand.
  • There is documentation that the patient or family members were told beforehand of the risks and benefits of the test.
  • There is a plan to explain the results after the procedure.

You can read the entire WebMD article here:  http://www.webmd.com/allergies/news/20170807/alabama-boys-death-worries-food-allergy-parents 

Oral Food Challenges require an educated approach to determine whether they’re even needed and under what conditions an OFC might be helpful and safe for the patient.  Only you can make that decision with your doctor.

And advice for the many food allergy parents who have posted on social media that their doctor advised them to try an OFC at home?  Find a new doctor.