Food challenges: Patient selection, predictors, component testing, and decision points

Background: Oral food challenges are commonly used when there is uncertainty based on a clinical history as to whether a food allergy exists and to assess whether a food allergy has been outgrown. Methods: A narrative review was performed, synthesizing available evidence in the literature. Results: Because food challenges are generally multi-hour procedures that carry the risk for potentially severe allergic reactions, careful patient selection is important. Allergy tests can provide additional supportive information to guide decision-making but do not have sufficient diagnostic accuracy to replace food challenges in most circumstances. Conclusion: Clinical history provides important clues with regard to the likelihood that a reaction may occur and should be combined with patient and family preferences and allergy test results when making decisions about pursuing food challenges.