What causes parents to delay an oral food challenge for their children?

An oral food challenge (OFC) is the only way to determine whether a food allergy exists. Sometimes both the child and the parent can be nervous about eating a food they have avoided for years. But, we know that passing the OFC can expand a child’s diet and even increase their quality of life. This is especially true if the child is allergic to multiple foods.

Researchers at the Jaffe Food Allergy Clinic at the Icahn School of Medicine at Mount Sinai in New York decided to take a look at this issue. They surveyed parents of children offered an OFC at least 6 months previously, but had not had one in the past 24 months. Out of the 102 surveys, most involved children who were allergic to more than one food. About half of the 102 parents who returned surveys said they had experience with a previous OFC.

Caregivers could choose from 27 possible survey choices. They were also able to write in their own answers. Reasons why families did not follow through with an OFC fell into these general categories:

• not interested/not important/impractical for diet
• fear/emotional impact
• doubted passing
• tried food at home
• scheduling
• other

Researchers analyzed the answers and found that OFCs are most often put off for scheduling problems, lack of interest in the food, or fear of reactions.

After excluding reasons related to scheduling, researchers said the more specific reasons for delaying an OFC were:

• Parents thought their child would not eat the food
• The food offered was a lower priority than another food they were going to try in a different OFC
• The child thought the food was not important to diet
• Fear of both physical and psychological effects
• Other various concerns, ranging from financial to thinking the child was too young.

Based on these findings, the authors advise that doctors discuss the child’s food preferences with the family before an OFC. They should also take into consideration how the food, if added, would fit into the family’s diet.

Interestingly, the survey also found that sometimes the food had already been tried at home. This can be dangerous due to the possibility of the child having anaphylaxis, a severe allergic reaction, while trying a suspect food. OFCs should always be done in a medical setting for that reason. In this survey, a little more than half of the people who tried the food first at home reported having a reaction. 

The authors also advise that doctors review the positive aspects of doing an OFC with the patient’s family. Positive aspects include the nutritional or social importance of gaining new foods, the survey said. They should also educate patients about the risks and benefits of doing an OFC.

The authors conclude that more research is needed to determine how allergists can address concerns about deferring OFCs. They also suggested that children’s feelings about OFCs be included in future results.

The results of the survey were published in a letter in the June 3 online edition of The Journal of Allergy and Clinical Immunology: In Practice.

Editors’ Notes:

Another point to note from another study regarding OFCs is that quality of life improves for those who undergo food challenges, regardless of outcome. The earlier study* found that even failed food challenges allow parents and children to better understand important factors. Those factors include: symptoms that develop, threshold doses that cause a reaction, and most importantly, how proper treatment can improve symptoms.

On July 28, Kids With Food Allergies will host a free webinar about Oral Food Challenges: What To Expect with Dr. Irene J. Mikhail of Nationwide Children’s Hospital in Columbus. To read more and register, click here.

Davis, N. Egan, M., Sicherer, S. Factors resulting in deferral of diagnostic oral food challenges. The Journal of Allergy and Clinical Immunology: In Practice. Published Online: June 03, 2015.

*Franxman, T., Howe, L., Teich, E., Greenhawt, MJ. Oral Food Challenge and Food Allergy Quality of Life in Caregivers of Children with Food Allergy. The Journal of Allergy and Clinical Immunology: In Practice , Volume 3 , Issue 1 , 50 – 56.