Actual food consumption after a negative oral food challenge in children: A challenge after the challenge?

Background: Unnecessary dietary eliminations may impair quality of life, affect children's growth, and negatively impact healthcare costs. Previous studies reported that around 11 % to 28 % of children continue a food-avoidance diet despite a negative oral food challenge (OFC).

Objectives: This study aimed to evaluate the actual consumption at home of the tested food after a negative OFC and the reasons reported by families in the case of persistent avoidance.

Methods and settings: A retrospective study was conducted in the Pediatric Gastro-Enterology and Pneumo-Allergology Departments of Robert Debré Hospital (Paris), involving patients who had a negative OFC. Data were collected from the patients' medical files and supplemented by a telephone survey.

Results: 101 families completed the telephone survey, corresponding to 129 OFCs with full data available. The tested foods were tree nuts for 29.5 % (38/129), milk for 28.7 % (37/129), and egg for 21 % (27/129). Persistent avoidance represented 17.1 % of the OFCs (22/129), and partial consumption 4.6 % (6/129). Consumption of the tested food was inversely correlated with child's age and length of avoidance period. Consumption was more frequent in the case of ubiquitous allergens (milk, egg). The main causes mentioned for non-consumption were family habits (72.7 %, 16/22) or the child's disgust for the tested food (54.5 %, 12/22).

Conclusion: A negative OFC does not always result in actual consumption of the tested food at home. These results underline the importance of performing an OFC as early as possible in the patient's life. Monitoring and supporting patients who have a negative OFC is key for successful consumption at home.