85% of U.S. allergists report that they perform oral food challenges (OFCs). However, there is a large discrepancy in the number of OFCs being performed, with a very small proportion (5.6%) of allergists performing more than 10 OFCs per month.
Oral Food Challenges (click to enlarge the diagram).
The top 3 barriers to performing OFCs were:
- inadequate reimbursement
- risk of an adverse event
The duration of the procedure is 3 to 4 hours, with significant use of the allergist and additional office staff for and supervision (most insurances pay approximately $120 for the 3-4-hour procedure).
The lack of adequate reimbursement (77% of the responders in the survey) for the time-intense procedure may explain the low rate of use.
Fewer than 50% of the respondents had personally performed OFCs during allergy/immunology training.
The last statistic is truly frightening. If fewer than 50% of fellows-in-training have had personal experience with OFCs, they will be unlikely to be proactive in performing the test in the future. The JCAAI is currently reviewing the reimbursement code for OFCs and the allergists were invited to participate.
As a reminder, the only definitive test to rule out food allergy is an oral food challenge (OFC) performed by a board-certified allergist in a specialty clinic. The skin test and the blood test (sIgE) can point to the likelihood of a successful food challenge but they do not make the diagnosis.
8 foods cause 90% of food allergies (click to enlarge the image). The likelihood of a negative oral food challenge is shown in relation to the respective values of skin prick test (SPT) and serum IgE (sIgE):
Oral food challenge practices among allergists in the United States. The Journal of Allergy and Clinical Immunology, Volume 129, Issue 2 , Pages 564-566, February 2012.
Food Challenges for Diagnosis of Food Allergy