Oral Food Challenge Implementation: The First Mixed-Methods Study Exploring Barriers and Solutions

Elaine Hsu; Lianne Soller; Elissa M Abrams; Jennifer L P Protudjer; Christopher Mill; Edmond S Chan

doi:10.1016/j.jaip.2019.06.034

Oral Food Challenge Implementation: The First Mixed-Methods Study Exploring Barriers and Solutions

J Allergy Clin Immunol Pract. 2020 Jan;8(1):149-156.e1. doi: 10.1016/j.jaip.2019.06.034. Epub 2019 Jul 10.

Authors

Elaine Hsu¹, Lianne Soller², Elissa M Abrams³, Jennifer L P Protudjer⁴, Christopher Mill², Edmond S Chan²

Affiliations

¹ Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada. Electronic address: ehsu@bcchr.ca.
² Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
³ Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Pediatrics, Section of Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
⁴ Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

PMID: 31301377
DOI: 10.1016/j.jaip.2019.06.034

Abstract

Background: Because of inaccuracies in commonly used tests for food allergy, oral food challenges (OFCs) are considered the criterion standard, but OFC implementation is suboptimal.

Objective: To use a mixed-methods approach to describe OFC barriers at multiple levels and investigate solutions.

Methods: Surveys of Canadian allergists, pediatricians, and parents investigated barriers to offering or participating in OFCs, and possible solutions. Parent focus groups were held to understand these barriers and solutions. Allergist offices in British Columbia were contacted via telephone to confirm their OFC practices.

Results: Of 62 responding allergists, 80.6% reported performing OFCs, 72.6% reported lack of resources as an influential barrier, and 72.6% reported that creation of standard guidelines for hospital versus community OFCs would influence them to perform more OFCs. Of 101 responding pediatricians, 51.5% reported having moderate-to-extensive OFC knowledge; these pediatricians were more likely to refer to allergists who performed them (odds ratio, 2.37; 95% CI, 1.06-5.30). Of 27 pediatricians who stated they refer more to allergists who do not perform OFCs, 40.7% reported long wait times as a deterrent. The most common parent barriers from surveys (N = 110) and focus groups (N = 27) were fear and anxiety about the procedure and about experiencing reactions during OFCs, suggesting the need for better information and psychosocial resources.

Conclusions: Multiple barriers prevent widespread use of OFCs. Efforts targeting OFC training for allergists, education for pediatricians, and standardized guidelines created with clinician and parent input (including consistent OFC information for families and guidance on which OFCs should be performed in-hospital versus the community) are likely to increase OFC acceptance.

Keywords: Allergists; Barriers; Focus groups; Food allergy; Food allergy testing; Guidelines; Oral food challenge; Parents; Pediatricians; Solutions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Allergens*
Allergists
British Columbia
Food
Food Hypersensitivity*
Humans

Substances

Allergens