title: Oral food challenge: safety, adherence to guidelines and predictive value of skin prick testing.
abstract: BACKGROUND
  The diagnostic gold standard of food allergy is the oral food challenge (OFC). Data on severe reactions and drug use during OFC are scarce. Our aims were (i) to investigate the prevalence and spectrum of reactions' severity during OFC and to assess drug use and epinephrine use in anaphylaxis due to OFC; (ii) to investigate the predictive value of the skin prick test wheal size for the outcome of OFCs.
  
  
  METHODS
  A retrospective charts review of children undergoing OFC at three Allergy Centres between January 2007 and December 2008 was performed.
  
  
  RESULTS
  A total of 544 OFCs were analysed. Most frequently involved foods were egg, milk and wheat. 254/526 (48.3%) were positive. 167 (65.7%) were defined mild reactions, 81 (31.9%) multiorgan reactions and 6 (2.4%) anaphylaxis. No patients had cardiovascular symptoms. Data on treatments were available in 98.8% OFCs. In half of them antihistamines were used vs. 10% cases in which steroids were preferred. Six children (2.4%) were treated with Epinephrine inhalation, 5 (2%) with beta-2 inhalation, 8 (3.1%) with steroid inhalation. One child was treated with IM Epinephrine + IV fluids. Skin prick tests predictive cut-off were 9 mm for albumen, 7 for yolk, 13 for fresh albumen, 10 for α-lactalbumin, seven for casein, eight for β-lactoglobulin, 20 for cow's milk and 10 for fresh cow's milk.
  
  
  CONCLUSIONS
  OFCs performed in controlled settings by expert Allergists are safe. Consideration needs to be given as to whether the Anaphylaxis' Guideline need to be modified when applied in treating patients undergoing OFC.
authors.affiliation: Department of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Calvani
authors.forename: Irene
authors.initials: I
authors.lastname: Berti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
authors.forename: Elena
authors.initials: E
authors.lastname: Galli
authors.forename: Valentina
authors.initials: V
authors.lastname: Giorgio
authors.forename: Alberto
authors.initials: A
authors.lastname: Martelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Miceli Sopo
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
mesh_terms: D000284:Administration, Oral; D000707:Anaphylaxis / Q000517:prevention & control*; D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D008894:Milk Proteins / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012882:Skin Tests
chemical_list: D008894:Milk Proteins; D004837:Epinephrine