INCREASED SEVERITY UPON REPEAT ORAL FOOD CHALLENGES IN MULTI-FOOD ALLERGIC INDIVIDUALS

Introduction Oral food challenges (OFCs) are considered the gold standard of diagnosing food allergy. Repeat food challenges are necessary to assess if food allergies are persistent or outgrown. Methods A retrospective chart review was conducted on all clinical protocols initiated at our institution involving standardized screening OFCs. Analysis was performed among participants who were challenged to the same food twice at variable time points. Repeat challenges were available for 8 food allergens. Allergic reactions were assessed by modified Bocku0027s criteria and ranked in order of severity. Results Twenty-eight participants repeated challenges to the same allergen once or twice for a total of 65 challenges. Forty-two positive challenges corresponding to 18 participants were analyzed. Peanut had the largest number of repeat challenges (n=19 participants), followed by almond (n=4), milk, walnut and egg (n=2), cashew, hazelnut, and sesame (n=1). Among the positive challenges, sixteen repeat challenges were conducted to peanut, two to egg, and one each to almond, milk, and walnut. In participants with a repeat positive food challenge, the eliciting dose (ED) did not change (p=0.66), but reactions were more severe (p=0.02). Change in either ED or severity rank was not associated with time between repeat challenges (p=0.94 and p = 0.56, respectively). Additionally, our analysis showed that symptoms varied widely during subsequent challenges. Conclusions Our findings show increased severity with variable allergic reactions between OFCs, regardless of the duration of time between challenges. Larger cohorts are needed to validate these preliminary findings.