Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications.
OBJECTIVE
The double-blind, placebo-controlled food challenge (DBPCFC) is widely considered as the 'gold standard' for the diagnosis of food allergy. However, in adult patients, this procedure is rather rarely performed outside the academic context. This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice.


RESULTS
There are many data showing that the DBPCFC poses a number of critical problems that are difficult to overcome in normal outpatient clinics and hospitals, and that are generally not addressed in most articles dealing with this issue.


CONCLUSIONS
Performing DBPCFC poses a number of practical problems and has several pitfalls, which make its routine use in normal clinical settings generally impossible. This review article shows that the need for this procedure in adult patients seems in effect very little and specifies new, more limited indications to its use in everyday practice. Further, it suggests a role for the open challenge, which lacks several of the disadvantages of DBPCFC.
Asero
Riccardo
R
Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21, 20037 Paderno Dugnano (MI), Italy. r.asero@libero.it
Fernandez-Rivas
Montserrat
M
Knulst
André C
AC
Bruijnzeel-Koomen
Carla Afm
CA
D000328:Adult; D000554:Ambulatory Care Facilities; D001985:Bronchial Provocation Tests / Q000379:methods; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D003951:Diagnostic Errors; D004311:Double-Blind Method; D005240:Feasibility Studies; D005247:Feeding Behavior; D005512:Food Hypersensitivity / Q000175:diagnosis*; D005612:Freeze Drying; D006801:Humans; D015990:Placebo Effect; D010919:Placebos / Q000737:chemistry / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity
D010919:Placebos