Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia.
School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2023 Jun;59(6):822-826. doi: 10.1111/jpc.16398. Epub 2023 Apr 3.
Oral food challenges (OFC) are an important tool in the assessment of food allergy. We sought to identify factors available at initial assessment visit which were associated with successful outcome or challenge failure in Australian children.
We conducted a retrospective review of all paediatric patients who underwent OFC in our allergy service over a 5-year period. Clinical data comprising patient demographics, co-morbidities, skin prick test (SPT) results, nature of previous reactions, elapsed time since previous reactions and outcome at OFC were recorded.
Four hundred and fifty-six OFCs were conducted, with 56 cases (12.3%) resulting in a reaction. Likelihood of reaction at OFC was significantly increased for patients with atopic dermatitis (odds ratio 1.99). When stratified by food substance, atopic dermatitis had the strongest association with reaction within the peanut group (odds ratio 3.2), and no association was demonstrated for soy or prawn. Increasing SPT wheal size (P < 0.001) and previous history of anaphylaxis to the challenge food (P < 0.001) correlated with failure at OFC. A low-risk group was identified, of patients with no clear history of prior reaction to the challenge food, and SPT result <3 mm.
Factors identified at assessment visit which correlated with reaction at OFC are atopic dermatitis, prior history of anaphylaxis, and increasing SPT wheal size. Domiciliary OFC could be considered in a select low-risk group of patients undergoing food challenge. This study was performed at a single centre with limited sample size, further large-scale and multicentre study verification of our data will provide more accurate representation of the Australian demographic.
口服食物挑战（OFC）是评估食物过敏的重要工具。我们旨在确定初始评估时可获得的因素，这些因素与澳大利亚儿童的成功结果或挑战失败相关。
我们对过敏科进行 OFC 的所有儿科患者进行了回顾性研究，时间为 5 年。记录了临床数据，包括患者人口统计学、合并症、皮肤点刺试验（SPT）结果、既往反应的性质、既往反应后时间以及 OFC 的结果。
共进行了 456 次 OFC，其中 56 例（12.3%）出现反应。OFC 发生反应的可能性在特应性皮炎患者中显著增加（优势比 1.99）。按食物物质分层时，特应性皮炎与花生组反应之间的相关性最强（比值比 3.2），而与大豆或虾无相关性。SPT 风团大小增加（P<0.001）和对挑战食物有过敏反应的既往史（P<0.001）与 OFC 失败相关。确定了一个低风险组，即患者对挑战食物无明确既往反应史，且 SPT 结果<3mm。
评估时确定的与 OFC 反应相关的因素包括特应性皮炎、既往过敏反应史和 SPT 风团大小增加。可以考虑在进行食物挑战的选择低风险组患者中进行家庭 OFC。本研究在单中心进行，样本量有限，进一步的大规模多中心研究验证我们的数据将更准确地反映澳大利亚人群。
