TOPLINE:

Children with asthma, atopic dermatitis, or allergic rhinitis — and those with even moderately positive specific immunoglobulin E (IgE) concentrations or skin prick test results — were more likely to react during oral food challenges (OFCs). However, no clinical, epidemiologic, or laboratory measure reliably predicted the severity of these reactions.

METHODOLOGY:

• Researchers conducted a retrospective study of 148 children and adolescents with suspected food allergies (median age, 51 months; 31.8% girls) to investigate whether specific clinical, epidemiologic, or laboratory findings could predict outcomes of OFCs.
• OFCs involved incremental dosing every 30 minutes up to a minimum final dose of 100 mL milk, half an egg, 25 g wheat flour, 16 whole peanuts, or four to eight large tree nuts. Children were observed for at least 2 hours after completing the challenge.
• Reactions were classified using the Ring and Messmer grading scale, and reactions of grade 2 or higher were considered anaphylaxis.

TAKEAWAY:

• Forty-four (29.7%) children had a positive OFC, and more than half of them had experienced anaphylaxis.
• Children with atopic comorbidities had higher odds of having a positive OFC (odds ratio, 3.96; P < .01). Optimal cutoff thresholds for predicting a positive OFC were 0.73 IU/mL for specific IgE concentration and 3.5 mm for wheal diameter on a skin prick test.
• Ten children (6.0%), ie, all eight who developed grade III reactions and two of those who developed grade II reactions, received epinephrine.
• No significant associations were observed between reaction severity during an OFC and sex, comorbidities, polysensitization, the type of food allergen, or the magnitude of allergy test results.

IN PRACTICE:

“OFCs should preferably be performed in a hospital setting, especially in children with comorbidities such as asthma or atopic dermatitis and clearly positive allergy test results. Notably, and representing the key finding of this study, neither clinical characteristics, including the original reaction severity, nor laboratory parameters, including the magnitude of allergy test results, were able to predict the severity of reaction at OFC when it occurs,” the authors wrote.

SOURCE:

Vojko Berce, MD, PhD, with University Medical Centre Maribor, Maribor, Slovenia, was the corresponding author of the study, which was published online on January 20, 2026, in Children.

LIMITATIONS:

The study was limited by its retrospective design, small sample size, and reliance on parental history for classifying the severity of the original allergic reactions. Case selection may have been influenced by parental involvement in the decision to proceed with an OFC.

DISCLOSURES:

The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.