ABSTRACT

Clinical Questions .................................................................................................. 151 Introduction ............................................................................................................ 152 Who Should Perform Oral Food Challenges? ....................................................... 152 Types (Formats) of Oral Food Challenges ............................................................. 153

Open Challenge ............................................................................................ 153 Single-Blind Challenge ................................................................................. 154 Double-Blind, Placebo-Controlled Food Challenge (DBPCFC) .................. 154

Determining When to Challenge ............................................................................ 154 Patient and Family Preparation .............................................................................. 155

Education about the Challenge, What to Expect .......................................... 155 Time, Staff, and Office Preparation .............................................................. 157 Patient Assessment ........................................................................................ 157 Administration of the Challenge ................................................................... 158

Interpreting the Result and Managing Aftercare .................................................... 159 Stopping the Challenge; Objective versus Subjective Symptoms ................ 159 Treatment of Reactions ................................................................................. 159 Patient and Family Education Postchallenge ................................................ 160 Food Challenges in Specific Food Allergy-Associated Disorders ................ 161

Atopic Dermatitis .............................................................................. 161 Food Protein-Induced Enterocolitis Syndrome (FPIES) .................. 161

Conclusions ............................................................................................................ 161 Clinical Pearls ........................................................................................................ 162 References .............................................................................................................. 163

6. How are food challenges prepared, dosed, and monitored; and how are outcomes assessed?