{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:38:27Z","timestamp":1792471107018,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. Methods: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. Results: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters\u2014including prior reaction severity and the magnitude of allergy test results\u2014were associated with the severity of reactions during OFC. Comorbidities\u2014specifically asthma, atopic dermatitis, and allergic rhinitis\u2014were significantly associated with a positive OFC (p &lt; 0.01), as were elevated sIgE levels and larger SPT wheal diameters (p &lt; 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU\/mL for sIgE and 3.5 mm for SPT. Conclusions: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities.<\/jats:p>","DOI":"10.3390\/children13010146","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:02:07Z","timestamp":1768914127000},"page":"146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcome Predictors of Oral Food Challenge in Children"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0577-8925","authenticated-orcid":false,"given":"Vojko","family":"Berce","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja Pintari\u010d","family":"Lonzari\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3282-8326","authenticated-orcid":false,"given":"Elena","family":"Pelivanova","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Jagodic","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, General Hospital Ptuj, Potr\u010deva Cesta 23, 2250 Ptuj, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.1111\/all.15902","article-title":"EAACI guidelines on the diagnosis of IgE-mediated food allergy","volume":"78","author":"Santos","year":"2023","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jaci.2017.11.003","article-title":"Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management","volume":"141","author":"Sicherer","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1016\/j.jaip.2020.04.020","article-title":"Prevalence of food sensitization and food allergy in children across Europe","volume":"8","author":"Lyons","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2500\/jfa.2020.2.200022","article-title":"Classification of adverse food reactions","volume":"2","author":"Cox","year":"2020","journal-title":"J. Food Allergy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/j.jaci.2021.03.048","article-title":"Global patterns in anaphylaxis due to specific foods: A systematic review","volume":"148","author":"Patel","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/j.jaci.2015.11.015","article-title":"Anaphylaxis in children and adolescents: The European Anaphylaxis Registry","volume":"137","author":"Grabenhenrich","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1016\/j.jaip.2020.02.010","article-title":"Food allergy from infancy through adulthood","volume":"8","author":"Sicherer","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.jaci.2022.12.827","article-title":"Cross-reactive epitopes and their role in food allergy","volume":"151","author":"Kamath","year":"2023","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/cea.14439","article-title":"IgE to cross-reactive carbohydrate determinants in childhood: Prevalence, risk factors, putative origins","volume":"54","author":"Potapova","year":"2024","journal-title":"Clin. Exp. Allergy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/all.15939","article-title":"Accuracy of diagnostic tests for IgE-mediated food allergy: Systematic review and meta-analyses","volume":"79","author":"Riggioni","year":"2024","journal-title":"Allergy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/jdv.18919","article-title":"Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: A systematic review and meta-analysis","volume":"37","author":"Christensen","year":"2023","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/ACI.0000000000000977","article-title":"Precision allergy molecular diagnosis in food allergy","volume":"24","author":"Sato","year":"2024","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e14276","DOI":"10.1111\/pai.14276","article-title":"AAAAI\u2013EAACI PRACTALL: Standardizing oral food challenges\u20142024 update","volume":"35","author":"Sampson","year":"2024","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1111\/all.14290","article-title":"Frequency of food allergy in school-aged children in eight European countries: The EuroPrevall-iFAAM birth cohort","volume":"75","author":"Grabenhenrich","year":"2020","journal-title":"Allergy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S365","DOI":"10.1016\/j.jaci.2009.03.042","article-title":"Work Group report: Oral food challenge testing","volume":"123","author":"Bahna","year":"2009","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/S0140-6736(77)91953-5","article-title":"Incidence and severity of anaphylactoid reactions to colloid volume substitutes","volume":"309","author":"Ring","year":"1977","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/jpc.16398","article-title":"Oral food challenge outcomes in children and adolescents: A 5-year experience","volume":"59","author":"Jacob","year":"2023","journal-title":"J. Paediatr. Child Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jaip.2016.12.021","article-title":"Food challenge and community-reported reaction profiles in food-allergic children aged 1 and 4 years: A population-based study","volume":"5","author":"Chan","year":"2017","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.anai.2023.07.005","article-title":"Outcomes of oral food challenges in a real-world setting","volume":"131","author":"Mustafa","year":"2023","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Klim, L., Michalik, M., Cichocka-Jarosz, E., and Jedynak-W\u0105sowicz, U. (2025). Asthma and multi-food allergy as risk factors for oral food challenge failure. Nutrients, 17.","DOI":"10.3390\/nu17172769"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/j.1399-3038.2010.00993.x","article-title":"Sensitization patterns to food and inhalant allergens in childhood","volume":"22","author":"Dikkeschei","year":"2011","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e14204","DOI":"10.1111\/pai.14204","article-title":"Tolerance of peanuts and tree nuts in children sensitized exclusively to lipid transfer proteins","volume":"35","author":"Pedrosa","year":"2024","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.jaci.2022.04.008","article-title":"The Natural history of peanut and egg allergy in children up to age 6 years","volume":"150","author":"Peters","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1159\/000503749","article-title":"Natural course of immediate-type cow\u2019s milk and egg allergies in children","volume":"181","author":"Kim","year":"2020","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.anai.2021.05.013","article-title":"Reaction severity during OFC increases with age in children","volume":"127","author":"Kennedy","year":"2021","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.anai.2013.09.027","article-title":"Food-specific serum IgE in children presenting with food allergy","volume":"112","author":"Amin","year":"2014","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jaci.2004.04.009","article-title":"Relationship of allergen-specific IgE levels and oral food challenge outcome","volume":"114","author":"Perry","year":"2004","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1111\/j.1365-2222.2012.04046.x","article-title":"Skin prick test and specific serum IgE in suspected cow\u2019s milk and hen\u2019s egg allergy","volume":"42","author":"Mehl","year":"2012","journal-title":"Clin. Exp. Allergy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/pai.13140","article-title":"Reaction severity after food challenges depends on indication","volume":"31","author":"Itazawa","year":"2020","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100876","DOI":"10.1016\/j.waojou.2024.100876","article-title":"Updated grading system for systemic allergic reactions: WAO Joint Statement","volume":"17","author":"Turner","year":"2024","journal-title":"World Allergy Organ. J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:25:39Z","timestamp":1768915539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,20]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010146"],"URL":"https:\/\/doi.org\/10.3390\/children13010146","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,20]]}}}