The shift towards lower-risk oral food challenges since the implementation of oral immunotherapy: a retrospective cohort study

Abstract We previously published data on the safety of oral food challenges (OFCs) at BC Children’s Hospital (BCCH), which demonstrated high rates of anaphylaxis requiring epinephrine (15.6%). However, since the 2019 paper, the introduction of oral immunotherapy (OIT) for treatment of food allergies has been widely adopted at our center, resulting in significant practice changes in terms of when and for which patients to offer an OFC. As a result, we sought to compare outcomes of OFCs between the pre-OIT (2014–2017) and post-OIT (2019–2021) eras. We conducted a retrospective chart review of all OFCs completed 2019–2021 at BCCH (post-OIT, n = 590) and compared this to previously published data from OFCs between 2014–2017 (pre-OIT, n = 353). Relative to the pre-OIT cohort, we found patients undergoing OFCs to have significantly lower odds of positive OFCs (26.3% vs 32.6%, OR = 0.738, p = 0.0444). Further, OFCs completed after a period of maintenance OIT were found to have reduced odds of requiring epinephrine (8.31% vs 15.0%, OR = 0.542, p = 0.0164). We also observed a low severity in those with positive OFCs, with only 3/49 (6.10%) Grade 4 (severe) reactions. While multifactorial in etiology, we found changes in clinical practice with the adoption of OIT to be associated with a significant improvement in safety of OFCs preformed at our institution.