Following the tragic death of a 3-year-old boy undergoing a baked milk food challenge, allergist groups have issued a comprehensive reminder of the protocols for health-care providers who perform this type of tests.
The American Academy of Allergy, Asthma & Immunology (AAAAI), The American College of Allergy, Asthma & Immunology (ACAAI) and the Canadian Society of Allergy and Clinical Immunology (CSACI) jointly distributed a statement on Aug. 4, 2017.
It notes that the Alabama boy’s passing is a rare situation; this is the first reported death during such a food challenge. The allergist associations then offer important protocol reminders for allergists and their health staff who conduct this procedure.
Oral food challenges have been concerned the “gold standard” of food allergy testing, due to the shortcomings of other available tests (blood and skin prick).
Until now, they have been conducted with a good safety record by allergists, which makes the Alabama boy’s death especially shocking to the food allergy community. The details of what went wrong in that situation are still not publicly known.
The associations’ joint statement stresses that oral food challenges should only be conducted when measures have been taken to minimize any patient safety risk. Following are the steps the statement lists for health-care providers to follow:
- First, the statement notes the need for food challenges to be “conducted by a provider who is well-trained and experienced with food allergy and anaphylaxis management, has experience in performing an oral food challenge, and there is an established procedure for conducting the challenge.”
- Second, that the test has to be carried out in “a proper office or hospital-based set-up, which includes a procedure for preparing and administering the food item by well-trained and experienced staff; layered supervision for the patient, including dedicated nursing and a supervising medical provider close by; a plan for treatment of any resulting reaction; and a post-feeding patient observation period. Resuscitation equipment must be available in case it is needed.”
- A third point relates to parental or patient consent, noting that “documentation of informed consent prior to the challenge should detail that the risks and benefits of the procedure were explained to the patient or caregiver, and that these risks were understood.”
- The allergist groups make two final points:
– That health-care providers need “a plan for advising the patient after the procedure based on the outcome.”
– The importance of aspects of a person’s food allergy management history that must be considered either in terms of whether to consider a challenge or whether to proceed with one in a person who is considered a candidate.”Challenges can be cancelled if the patient is having poor asthma control, has had a recent asthma flare, or has had a recent or concurrent illness,” the statement notes. “These, as well as multiple other factors, can increase the risk of a reaction occurring and potentially influence how severe a reaction is.”
Of the child’s tragedy, the allergist organizations’ statement says: “This event should serve as a valuable reminder for everyone involved in oral food challenges to review internal procedures and ensure the proper set-up, staffing, supervision, and protocols are in place to continue offering one of the safest procedures in allergy/immunology.”
If you have further questions about food challenge tests, Allergic Living recommends that you speak to your family’s allergist.