Infant/Toddler Oral Food Challenge Outcomes

The importance of infant/toddler oral food challenges (OFCs) and early introduction of foods has grown, though, data are still limited regarding optimal timing and dietary adherence. Infant/toddlers age 6-35 months participated in OFCs to various foods from October 2017 to August 2018 in a specialty hospital unit. Chart review at baseline included prior testing and reaction history. OFC failure rate and treatment were analyzed by age (infants 6-11 months versus toddlers 12-35 months). A follow-up survey was sent in September 2018 to assess dietary incorporation of challenge food. 125 OFCs were completed (44% peanut, 38% baked egg, 14% baked milk, 4% other food; 30% infants). Overall failure rate was 26% and was not significantly different by food. Failure rate for infants compared to toddlers was not significantly different by food. Epinephrine was administered in infants (n=3, 8% of infant OFCs); in toddlers (n=3, 3% of toddler OFCs), in 19% of all positive challenges, and 5% overall. Antihistamine/oral steroid was administered in 38% of failed OFCs. No child received a second dose of epinephrine, intravenous fluids, bronchodilators, oxygen, or transfer of care. Of infant peanut OFCs screened using national guidelines (n=18), 28% failed, with one dose of epinephrine administered. OFCs in these two age groups were safe. Rate of epinephrine administration was low with no advanced support required. No differences were observed in OFC failure rate by food or by age.