Increase in Food Protein consumed during Milk and Egg Open Food Challenges are not associated with increase in failures.

Oral food challenges (OFC) are an integral part of evaluating patients with suspected food allergy or to establish tolerance. Indications for food challenge are not standardized and the decision to proceed to OFC is based on likelihood of achieving tolerance. We compared the outcomes of OFC after increasing the amount of protein consumed. 63 who underwent milk and egg OFC (1-10 years, 60% male) between January 2006 and December 2007 were compared to 38 subjects (1.4-15 years, 68% male) who underwent OFC to milk and egg between January and July 2011. Total protein ingested was 0.54 g cow's milk and 6.1 g egg in the first group versus 6.8 g and 13.6 g respectively in the second group. Pass rate defined as lack of immediate or delayed symptoms following OFC was determined. Similar milk OFC failure rates occurred in both groups, 20% (n=6/30) vs. 18% (n=3/22). A reduction in egg OFC failure rates from 14% (n=6/33) to 0% (n=0/16) was seen despite increase in protein content. Reactions observed or reported were similar in both groups including pruritus (n=7), emesis (n=1), urticaria and angioedema (n=13), cough and wheeze (n=2). Failed OFC were treated successfully with cetirizine in all but one patient. One patient after milk OFC required epinephrine and prednisone for anaphylaxis without further sequelae. Increasing the amount of protein content in milk and egg OFC was safely tolerated.