Paediatric observed food challenges in new zealand: A case for diversifying care

Abstract

Paediatric food allergy practice requires access to an observed food challenge (OFC), the gold standard investigative tool. This process requires supervision by trained health professionals experienced in management of acute allergic reactions, including anaphylaxis. In New Zealand, OFCs are done in both a tertiary care paediatric center (Starship Children's Hospital - SCH) as well as numerous regional paediatric sites. We present the prospective data obtained from food challenges undertaken in an 18-month period from September 2015 to March 2017. Methods: Food challenges were conducted at 6 regional paediatric centers across the North and South Island and at SCH, Auckland. Decision for OFC was made by the treating physician and based on history and testing for food specific IgE (skin prick and/or serum specific IgE). Open label food challenge protocols were standardised to the ASCIA guidelines where possible and published 'stop' criteria were employed. Data was prospectively obtained, deidentified, compiled and analysed at the end of the study period. Results: During the 18-month study period 1104 children underwent OFC. Forty three percent of the challenges (473) were conducted at SCH. There was no significant difference between the rates of OFC clinical reaction at SCH (113/473 - 24%) compared to the regional sites, independently or combined, with an average reaction rate of 24% (range 13-31%). Anaphylaxis was seen at all but one site. This occurred in 14% of those that reacted at SCH (16/113) and at an average of 16% (24/154) in regional children (range 0-23%). Conclusion: Paediatricians and experienced allied health professionals are able to successfully and safely undertake OFC for children in regional areas with outcomes that replicate those in a tertiary centre. This reduces travel costs, public expenditure and tertiary waitlists while maintaining optimum allergy care provision.L6185630852017-10-10 <br />