D2.288 - Real- World Safety of Supervised Feeds: Evidence from Outpatient Clinic and Dayward Settings

Supervised feeds (SF) are increasingly being used to assess tolerance to foods.  In our centre, we do SFs in both the dayward (DW) and the outpatient clinic (OPD) setting. SFs within the OPD requires fewer resources and is suitable for lower risk cases. An age-appropriate portion of food is consumed and the child is observed for 1 hour. The aim of this study was to review the outcome of all SFs in both the OPD and DW settings. 

This retrospective review included children who underwent SFs in the Allergy Department Children’s Health Ireland at Connolly, Dublin, Ireland. All SFs in the OPD and DW between June 2023 to November 2025 were reviewed. Data was collected from electronic health records and internal DW records. 

Over the 30-month study period, 204 children had a SF; 104 (53%) were male with median age of 1 year 10 months (range: 6 months–15 years 11 months). 108 (53%) participants had co-existing food allergy.  66 (32%) took place on the DW and 138 (68%) in OPD. Median age was slightly younger on the DW (1yr 7 months) compared to OPD (2yrs 2 months). The most frequent SF food was peanut (n=82, 40%), followed by cashew nut (n=34, 17%). Median SPT overall was 3mm (range 0mm – 8mm). Median SPT of DW SFs was higher (4mm) than OPD SFs (3mm), (P=0.05).

Most children (N=165, 81%) passed their SF, 32 (16%) reacted and 7 (3%) were inconclusive. There was no significant difference in the number of positive feeds on the DW (N=13, 41%) compared to OPD (N=19, 59%) (p = 0.55).

All reactions were mild/moderate with no cases of anaphylaxis. Half of reactors received antihistamine. 

Our aim in the allergy clinic is to safely reintroduce foods back into a child's diet. In appropriately selected patients, most children pass their SF. Among those who reacted, they had mild symptoms with no cases of anaphylaxis. This supports SFs as a safe and useful tool to assess food tolerance, in particular in an OPD clinic setting.