Stepwise oral food challenge test

PURPOSE OF REVIEW: The oral food challenge (OFC) remains the cornerstone procedure for diagnosing food allergies and guiding patient management. Recently, stepwise OFC, a new management strategy starting with very-low-dose (VLD) or low-dose OFC, has been reported. This review critically examines the clinical utility and safety profile of stepwise OFC approaches. RECENT FINDINGS: The stepwise OFC typically begins with a VLD or low-dose OFC, which is the most critical step in this approach. VLD and low-dose OFCs have been demonstrated to be useful strategies for avoiding complete elimination of causative foods and improving prognosis. Regarding safety considerations, a time interval of 30 min between doses may be insufficient, whereas an interval of at least 1 h is considered appropriate for stepwise OFC. SUMMARY: Stepwise OFCs starting with VLD or low-dose appear to be effective approaches. VLD and low-dose OFCs are well tolerated and effective for avoiding complete elimination of allergenic foods. VLD and low-dose OFCs, as part of stepwise OFC, represent useful strategies for improving the prognosis of children with food allergies.