Legume and Sesame Oral Food Challenge Outcomes

Background: Legume and sesame are emerging food allergens. The utility of specific IgE testing (sIgE) to predict clinical reactivity to these allergens is not well described.Objective: To describe clinical outcomes and sIgE in sesame and legume OFCs. Methods: We performed a retrospective review of 74 legume and sesame oral food challenges (OFC) performed between 2007-2017 at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves (ROC) and logistic regression models predicting OFC outcome were generated. Results: Twenty-eight patients (median age 6.15 years) passed legume OFC (84.85%), and twenty-five patients (median age 5.91 years) passed sesame OFC (60.98%). The median sIgE to legume was 1.41 kUa/L, and 2.34 kUa/L, to sesame. For patients who failed legume OFC, 67% had cutaneous, 16.5% had gastrointestinal, and 16.5% had anaphylaxis. Of these reactions, 80% were controlled with Benadryl alone and 20% required epinephrine. For patients who failed sesame OFC, 53% had cutaneous, 12% had gastrointestinal, and 35% had anaphylaxis. Of these reactions, 6% required epinephrine, 31% were controlled with Benadryl alone, and 63% required additional epinephrine or steroids. Conclusion: Most OFC to legumes were passed and reactions to failed legume OFCs were more likely to be non-severe. Failing an OFC to sesame was almost twice as likely compared to failing a legume OFC, and reactions to failed sesame OFC were often more severe. Sesame sIgE did not correlate with OFC outcome.