Mild Ocular and Nasal Symptoms Are Not Indicative of Reactions during Open Oral Food Challenges

Oral food challenges (OFC) are employed in clinical practice to confirm suspected IgE-mediated food allergy and are also important research metrics. There is a paucity of systematic data on the predictive value of specific symptoms or signs and which, if any, correlate with challenge failures for those with IgE-mediated food allergy. 100 open label OFCs, equally divided with respect to outcomes, were selected from the MGH Food Allergy Center Oral Food Challenge Database. Patients (n=71) were between 4 and 18 years (median 7 years) at the time of OFC. We used nursing score sheets to determine signs, symptoms, and their severity, organized by organ system. We compared these measures with the MD-confirmed challenge outcome, using chi-square analysis and Fisher’s exact test. OFC outcomes included 49 passes, 49 failures, and 2 indeterminates; foods challenged included tree nuts, peanut, egg, milk, sesame, soy, fish, wheat, and coconut. Eight OFCs required intramuscular epinephrine. Mild urticaria, mild sneezing, nasal or ocular pruritis, tearing, and conjunctival injection were not statistically associated with challenge failure. Tachycardia (p<0.001), severe sneezing (p<0.002), severe urticaria (p<0.001), nausea (p<0.001), abdominal pain (p<0.001), vomiting (p<0.02), perioral urticaria (p<0.03), oral pruritis (p<0.004), throat pruritis (p<0.002), mild pruritus (p<0.02), and lip edema (p<0.001) were associated with challenge failure. Mild eye symptoms (tearing, ocular pruritus, conjunctival injection), mild nasal symptoms (sneezing, nasal pruritus), and mild urticaria were not associated with open oral food challenge failure. These results suggest that OFCs for patients experiencing these specific mild symptoms should proceed to completion with close observation.