100607 - Eating Under Observation

For low risk drug allergy challenges, direct provocation testing is now commonplace. Food challenges are still mostly multi-step, requiring more time and staffing, leading to longer waiting lists. Our aim was to carry out one step or two step ‘supervised eating’ for low risk food challenges.

We risk stratified patients on the food challenge waiting list as “low risk” if they had 1) negative skin prick testing and specific IgEs and 2) clinical reactions that were not in keeping with anaphylaxis. These patients had a single or two step challenge and were monitored for an hour in the department afterwards.

Over a course of three months, 40% of our food challenges were triaged as ‘eating under observation’. This reduced the median time spent in the department for patients from a median of three hours to two hours.

An equivalent of single step drug provocation testing for food is helpful to reduce challenge waiting times for patients. This is particularly suited to low risk patients who have a lot of anxiety around home introduction of the foods.