TOPLINE:

A prior history of anaphylaxis to milk or egg affected the risk for oral food challenge failure in children. Among children without prior anaphylaxis, atopic dermatitis predicted oral food challenge failure, and casein-specific immunoglobulin E (IgE) showed the best accuracy in identifying those who did not pass milk challenges.

METHODOLOGY:

• Researchers analyzed oral food challenge outcomes according to prior anaphylaxis in children who underwent challenges involving cow’s milk or hen’s egg white protein from January 2014 to July 2025.
• They retrospectively reviewed charts of 192 children (median age, 4.75 years; 66.1% boys) who were classified as having a history of anaphylaxis to the challenge food (n = 110) or not (n = 82).
• Children were eligible for the oral food challenge if they had specific IgE concentrations greater than 0.35 kU/L.
• Food challenges involved incremental dosing every 30 minutes up to age-appropriate servings (200 mL milk or one egg). Baked milk challenges used 32 mL milk in muffins, and baked egg challenges used one third of an egg in muffins.

TAKEAWAY: 

• Overall, six oral food challenges were inconclusive, and oral food challenge failure occurred in 32.3% of challenges; 32 failures to cow’s milk protein and 30 failures to hen’s egg white protein were observed.
• Children with a history of anaphylaxis to hen’s egg white protein reacted to lower cumulative doses than children without such history (P = .03).
• Atopic dermatitis significantly predicted oral food challenge failure in children without prior anaphylaxis (P = .02), whereas asthma was a potential predictor in those with previous anaphylactic reactions (P = .05).
• Casein-specific IgE showed the highest diagnostic accuracy in patients without a history of anaphylaxis to milk protein (area under the curve, 0.81), and one patient with a history of anaphylaxis suffered anaphylactic shock during the procedure.

IN PRACTICE:

“A background of anaphylaxis remains an important consideration when selecting children for CMP [cow’s milk protein] and HEWP [hen’s egg white protein] challenges as it delineates distinct risk profiles and informs individualized risk assessment for OFC [oral food challenge] failure,” the authors wrote. “Incorporating these considerations into clinical practice may enhance OFC safety and improve diagnostic accuracy,” they added.

SOURCE:

Urszula Jedynak-Wąsowicz, MD, PhD, with Children’s University Hospital, Krakow, Poland, was the corresponding author of the study, which was published online on January 18, 2026, in Nutrients.

LIMITATIONS:

This study was limited by its retrospective design, reliance on open oral food challenges, small sample size, and absence of data on the systemic skin prick test. 

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.