Factors influencing reintroduction of peanut and tree nuts after negative oral food challenges in children

Abstract

Background: Compliance with reintroduction of foods after a negative oral food challenge (OFC) is variable. Ongoing avoidance of tolerated foods is associated with recurrence of allergy and a reduced quality of life.

Objective: To determine the proportion of children who reintroduced peanut or tree nuts after a negative OFC and to describe factors that influenced decisions regarding reintroduction or avoidance of nonallergic (negative) nuts.

Methods: Families of children that had undergone an OFC for peanut or tree nuts at Sydney Children's Hospital were invited to participate. Consenting families were sent an online questionnaire.

Results: The response rate to the questionnaire was 64%. More than 85% of respondents had introduced all or some of the negative nuts after the OFC and most had maintained at least some regular exposure in the child's diet at the time of the study. The age at diagnosis of the nut allergy and an awareness of the benefit of introducing foods after a negative OFC were significantly (P < .05) associated with introducing negative nuts. There was improved quality of life in those that introduced negative nuts.

Conclusion: Most families introduced or attempted to introduce negative nuts after a negative OFC. Educating families on the benefits of introducing foods after a negative OFC result is an important factor contributing to successful reintroduction.