Guidelines for the Oral Food Challenges in Children

Tae Won Song; Kyung Won Kim; Woo Kyung Kim; Jeong Hee Kim; Hyun Hee Kim; Yong-Mean Park; Kangmo Ahn; Hyeon Jong Yang; Hye Yung Yum; Soo Young Lee; Yoo Hoon Jeon; Bok Yang Pyun

doi:10.7581/pard.2012.22.1.4

Journal List > Pediatr Allergy Respir Dis > v.22(1) > 1033201

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Song, Kim, Kim, Kim, Kim, Park, Ahn, Yang, Yum, Lee, Jeon, Pyun, and Atopic Dermatitis Study Group, The Korean Academy of Pediatric Allergy and Respiratory Diseases: Guidelines for the Oral Food Challenges in Children

Abstract

Pediatr Allergy Respir Dis 2012;22(1):4-20.

Published online: 20 January 2012

DOI: https://doi.org/10.7581/pard.2012.22.1.4

Guidelines for the Oral Food Challenges in Children

Tae Won Song, MD¹, Kyung Won Kim, MD², Woo Kyung Kim, MD³, Jeong Hee Kim, MD⁴, Hyun Hee Kim, MD⁵, Yong-Mean Park, MD⁶, Kangmo Ahn, MD⁷, Hyeon Jong Yang, MD⁸, Hye Yung Yum, MD⁹, Soo Young Lee, MD¹⁰, Yoo Hoon Jeon, MD⁸, Bok Yang Pyun, MD^8,; Atopic Dermatitis Study Group, The Korean Academy of Pediatric Allergy and Respiratory Diseases

¹Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

²Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea

³Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

⁴Deparment of Pediatrics, Inha University School of Medicine, Incheon, Korea

⁵Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea

⁶Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea

⁷Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁸Department of Pediatrics, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

⁹Atopy Clinic, Seoul Medical Center, Seoul, Korea

¹⁰Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea

책임저자: 편복양, 서울시 용산구 대사관로 59순천향대학교 서울병원 소아청소년과 Tel: 02)709-9339, Fax: 02)794-5471 E-mail: bypyun@schmc.ac.kr

Received 12 March 2012 Accepted 14 March 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Oral food challenge is a definitive diagnostic test for immediate and occasionally delayed adverse reaction to foods. The gold standard for diagnosing food allergy is still the double-blind, placebo-controlled food challenge, but it is time-consuming, expensive and troublesome for physician and patients. Open oral food challenge controlled by trained personnel is useful and sufficient methods when concern of bias is low. We aimed to provide a practical guideline for oral food challenge in children for the diagnosis of suspected food allergy or the evaluation of food tolerance. We considered reasons, types, indications, contraindications, risks, benefits, detailed methods, practical performance, interpretations of test results, and treatments for the adverse reactions of oral food challenge.

Keywords: Oral food challenge, Food allergy

References

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Fig. 1.

Flow sheet for the diagnostic work-up of children with suspected food-related clinical symptoms. IgE, immunoglobulin E; SPT, skin prick test. ∗In cases with milk, egg, peanut, and white fish. (Immunocap, Phadia AB, Uppsala, Sweden)

Fig. 2.

Decision tree for various situations during oral food challenge procedures.

Table 1.

Guidelines for Discontinuation of Medications before Oral Food Challenge (OFC)

Medication	Last dose before OFC
Oral antihistamines	3–10 days
Cetirizine	5–7 days
Diphenhydramine	3 days
Fexofenadine	3 days
Hydroxyzine	7–10 days
Loratadine	7 days
Antihistamine nose spray	12 hours
Oral H2 receptor antagonist	12 hours
Antidepressants	3 days-3 weeks, drug-dependent and dose-dependent
Oral/intramuscular/intravenous steroids	3 days-2 weeks
Leukotriene antagonist	24 hours
Short-acting bronchodilator
Albuterol, metaproterenol	8 hours
Turbutaline, isoproterenol	24 hours
Long-acting bronchodilator
Salmeterol, formoterol	48 hours
Inhaled cromolyn sodium	48 hours
Theophylline (liquid)	24 hours
Theophylline long-acting	48 hours
Ipratropium bromide (inhaled/intranasal)	4–12 hours depending on formulation and dosing
Oral intranasal α-adrenergic agents	Interval
Oral β-agonist	12 hours
Oral long-acting β2-agonist	24 hours
Drug that may be continued(
Antihistamine eye drops
Inhaled/intranasal corticosteroids
Topical steroids
Topical immunosuppressive preparations:pimecrolimus, tacrolimus

Table 2.

Case Examples of Challenge Doses for Oral Food Challenges

Example 1) Egg^∗, boiled, medium-sized (total dose 55 g): preparation with cutting.
Time (min)	Dose^†
0	Lip provocation^†
15	1/48^†
30	1/24^†
45	1/8^†
60	1/4^†
75	Rest^†
135	(observation)

^∗ Clinician may use egg white and/or egg yolk according to patients.

^† Amount of doses may be adjusted on the basis of a patient's history.

Example 2.

Egg^∗, boiled, medium-sized (total dose 55 g): preparation with scales

Time (min)	Dose (g)^†
0	Lip provocation^†
15	1^†
30	2^†
45	6^†
60	18^†
75	Rest^†
135	(observation)

^∗ Clinician may use egg white and/or egg yolk according to patients.

^† Amount of doses may be adjusted on the basis of a patient's history.

Example 3

Milk 200 mL (except for low-fat or fortified milk)

Time (min)	Dose (mL)^∗
0	Lip provocation^∗
15	1^∗
30	2^∗
45	6^∗
60	18^∗
75	54^∗
90	Rest^∗
135	(observation)

^∗ Amount of doses may be adjusted on the basis of a patient's history.

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