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Pediatr Allergy Immunol. 2012 Jun;23(4):353-9. doi: 10.1111/j.1399-3038.2012.01266.x. Epub 2012 Feb 23.

A prediction rule for food challenge outcome in children.

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  • 1Department of Paediatric Pulmonology and Allergology, University Medical Centre, Utrecht, Utrecht, The Netherlands.



In children with food-related symptoms, a food challenge is considered as the gold standard to diagnose allergy. If food allergy could be predicted by patient history and/or diagnostic tests, the number of time-consuming and sometimes risky food challenges could be decreased. We aimed to determine questionnaire and test-based characteristics, to predict the food challenge outcome (FCO) in children referred to a tertiary centre for the evaluation of food-related symptoms.


Pre-challenge standardized questionnaires, skin prick tests (SPT), and specific IgE levels (sIgE) were obtained in patients that underwent a food challenge in our hospital in 2009. Characteristics of patients with positive and negative FCO were compared, and uni- and multivariate associations between predictors and FCO were calculated. Based on the multivariate model, a risk score was developed to predict the FCO.


One hundred and twenty-nine challenges were analyzed, 41.9% had a positive outcome. Median age of both groups was 4.9 yrs (range 2.8-8.3). Patients with a positive FCO reacted faster with symptoms after allergen ingestion and had higher sIgE levels compared to children with negative FCO. A clinical risk score was developed based on the index food, 'time between allergen ingestion and complaints' and sIgE levels (range 0-10). The prognostic capacity of this model (AUC) was excellent (0.90). The very high- and low-risk groups (24% of patients) are both predicted excellent without misclassification.


Positive FCO can be predicted by the index food, time between allergen ingestion and development of symptoms, and the sIgE level.

© 2012 John Wiley & Sons A/S.

[PubMed - indexed for MEDLINE]
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