Differences in Oral Food Challenge Reaction Severity Based on Increasing Age in a Pediatric Population


Allergy and Immunology

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Annals of Allergy, Asthma & Immunology


Background: Food allergy (FA) reactions range from mild to severe with differences in age appearing to be an important factor associated with reaction severity.

Objective: To define differences in oral food challenge (OFC) reaction severity in pediatric patients from infancy to adolescence using objective clinical outcomes and standardized reaction grading tools.

Methods: Retrospective review of all positive OFCs at two large institutions between September 2016 and February 2019. Reaction severity was defined by presence of cardiovascular, neurologic, lower respiratory or laryngeal symptoms (CV/N/LR/L), epinephrine requirement and grading using two established FA reaction scales.

Results: Infants and toddlers demonstrated fewer reactions involving CV/N/LR/L symptoms compared to older age groups. Epinephrine was also required less frequently during reactions in infants and toddlers, compared to older age groups. There was no difference in reaction severity in infants and toddlers based on clinical history of eczema. Increasing age was significantly correlated with increased epinephrine requirement (R 2 =0.12, p=0.002), elevated CoFAR score (R 2 =.012, p=.003), and approached significance for increased PRACTALL score (R 2 =.005, p=.057). History of asthma and sesame allergy were identified to be positively correlated with more severe reactions.

Conclusion: Infants and young toddlers demonstrate less severe reactions during OFCs compared to older age groups supporting early food introduction practices. In children under 12 months of age, severe reactions are most rare calling into question screening practices using specific allergy testing prior to food introduction. Standardized reaction grading tools may be valuable instruments to categorize reaction severity during OFCs.



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