Suspected food allergy in adults: mapping 208 open food challenges with allergy tests and risk stratification.
2020
It is estimated that food allergy affects 5% of adult population.1 We reported that food-induced anaphylaxis accounts for 21% of all anaphylaxis in British adults in a community setting.2 Food allergens are important confounders in the diagnostic evaluation of spontaneous anaphylaxis and chronic spontaneous urticaria (CSU) in adults. Best practice guidelines recommend careful interpretation of skin prick tests (SPTs) and serum-specific IgE (SSIgE) in conjunction with clinical history in patients with suspected food allergy.3 The ‘gold standard’ for diagnosis of food allergy is double-blind placebo-controlled food challenge but this procedure is onerous, resource dependent and not feasible for most allergy services in the UK due to unmet demand.3 4 Therefore, adult allergy services in the UK employ a supervised open food challenge (SOFC) to confirm or refute the diagnosis of food allergy when allergy tests (SPTs and/or SSIgE) are inconclusive or discordant with clinical history. However, SOFCs are time consuming and require resources and may not be a preferred option due to safety concerns imposed by COVID-19.
Most published data on food challenges involve paediatric population and there is paucity of information regarding safety and outcomes of SOFC in adults, particularly in a ‘real-world’ clinical practice. We conducted a retrospective chart review of sequential cases of SOFC at the adult allergy service, University Hospitals Birmingham (UHB) NHS Foundation Trust, one of the largest regional services in the UK. This project (06 August 2006 to 13 July 2018) was registered with …
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