title: Implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) for Food Challenges.
abstract: BACKGROUND
  Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs.
  
  
  OBJECTIVE
  The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients.
  
  
  METHODS
  Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions.
  
  
  RESULTS
  Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location.
  
  
  CONCLUSIONS
  By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.
authors.affiliation: Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass.
authors.forename: Tander
authors.initials: T
authors.lastname: Simberloff
authors.affiliation: Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass.
authors.forename: Ron
authors.initials: R
authors.lastname: Parambi
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bartnikas
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Ana Dioun
authors.initials: AD
authors.lastname: Broyles
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hamel
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass.
authors.forename: Karol G
authors.initials: KG
authors.lastname: Timmons
authors.affiliation: Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass.
authors.forename: D Marlowe
authors.initials: DM
authors.lastname: Miller
authors.affiliation: Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Mass; Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, Mass.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Schneider
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: Andrew.macginnitie@childrens.harvard.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: MacGinnitie
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000485:Allergens / Q000276:immunology*; D001249:Asthma / Q000175:diagnosis* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005502:Food; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012015:Reference Standards; D012306:Risk; D012882:Skin Tests; D063189:Symptom Assessment; D014481:United States; D055815:Young Adult
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Allergy testing; Food allergy; Food challenges; Quality improvement