Food allergy evaluation, OFC & prevention

Routes primary prevention (early introduction) vs evaluation of a reported reaction, drives targeted testing and oral food challenge, and covers the 2024 treatment landscape. Links the pollen-food cross-reactivity calculator.

Evidence tier: Guideline-derived.

Decision points

  • Prevention or reaction to evaluate?
  • What is the likely mechanism?
  • Diagnostic certainty after history + testing?
  • Challenge outcome?

Do-not-miss pitfalls

  • Do not order broad food panels or diagnose food allergy from IgG/IgG4 testing.
  • Do not equate a larger IgE level with a more severe future reaction.
  • Do not perform OFC in uncontrolled asthma or shortly after a severe reaction without careful risk assessment.
  • Do not present management as avoidance-only, omalizumab and OIT are now available.
  • Do not forget cofactors (exercise, NSAIDs, alcohol, infection, menses) that lower the reaction threshold.

Evidence & citations

  1. Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023;78(12):3057-3076. PMID 37815205
  2. Sampson HA, Arasi S, Bahnson HT, et al. AAAAI-EAACI PRACTALL: Standardizing oral food challenges, 2024 Update. Pediatr Allergy Immunol. 2024;35(11):e14276. PMID 39560049
  3. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States. J Allergy Clin Immunol. 2017;139(1):29-44. PMID 28065278
  4. Wood RA, Togias A, Sicherer SH, et al. Omalizumab for the Treatment of Multiple Food Allergies (OUtMATCH). N Engl J Med. 2024;390(10):889-899. PMID 38407394

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.