BackgroundClinicians use serum immunoglobulin E (IgE) and/or skin prick test (SPT) to help decide whether a child is suitable for a food challenge. Performing a food challenge (FC) or supervised feed (SF) is the gold standard for a definitive diagnosis of type 1 food allergy. Food challenges are labour intensive and our unit currently has long waiting lists for food challenges, exacerbated by the COVID 19 pandemic. This study aims to determine if the current thresholds for home introduction can be altered.ObjectivesTo evaluate the reaction rate, and the severity of reactions, of tuna and almond challenges performed in our hospital.To use results collected to examine whether the thresholds for home introduction of both tuna and almond should be reviewed.MethodsRetrospective data analysis of tuna and almond challenges performed in the Paediatric Allergy Service at St George’s Hospital. Electronic medical records were reviewed of all patients who underwent an oral food challenge between April 2018 to October 2020 at St George’s Hospital. Clinical history, results of SPT and specific IgE to tuna and almond and the outcome of the challenge were extracted from the hospital database.ResultsTuna14 children underwent a tuna food challenge. None were observed to have a positive result. One child had an inconclusive challenge as the final sample was refused;prior to this the child did not experience any signs of an allergy reaction. All these children had a known allergy to other fish.Almond77 children underwent an almond only challenge;8% (6) of these were supervised feeds, the other 92% (71) were food challenges. 8% (6) children were observed to have a positive almond challenge. One child had an inconclusive challenge as the final sample was refused;prior to this the child did not experience any signs of an allergy reaction.50% (3) of children with a positive challenge were managed with cetirizine alone, at the correct dosage for age. The other 3 children complained of mild symptoms which resolved with no treatment.ConclusionsNo children had a positive tuna challenge and the thresholds for home introduction of tune could be reviewed and relaxed.96% of children who had an SPT less than 2mm tolerated the almond challenge. For those that reacted, all reactions observed were mild to moderate. The threshold for home introduction of almond could also be reviewed and relaxed.
Review of paediatric food challenges: could more almond and tuna challenges be safely performed at home?