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Oral Food Challenge Implementation: The First Mixed-Methods Study Exploring Barriers and Solutions

  • Elaine Hsu
    Correspondence
    Corresponding author: Elaine Hsu, MPH, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C11, Vancouver, BC V6H 3V4, Canada.
    Affiliations
    Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    BC Children's Hospital Research Institute, Vancouver, BC, Canada
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  • Lianne Soller
    Affiliations
    Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    BC Children's Hospital Research Institute, Vancouver, BC, Canada
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  • Elissa M. Abrams
    Affiliations
    Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Division of Pediatrics, Section of Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
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  • Jennifer L.P. Protudjer
    Affiliations
    Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada

    George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada

    The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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  • Christopher Mill
    Affiliations
    Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    BC Children's Hospital Research Institute, Vancouver, BC, Canada
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  • Edmond S. Chan
    Affiliations
    Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    BC Children's Hospital Research Institute, Vancouver, BC, Canada
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      Background

      Because of inaccuracies in commonly used tests for food allergy, oral food challenges (OFCs) are considered the criterion standard, but OFC implementation is suboptimal.

      Objective

      To use a mixed-methods approach to describe OFC barriers at multiple levels and investigate solutions.

      Methods

      Surveys of Canadian allergists, pediatricians, and parents investigated barriers to offering or participating in OFCs, and possible solutions. Parent focus groups were held to understand these barriers and solutions. Allergist offices in British Columbia were contacted via telephone to confirm their OFC practices.

      Results

      Of 62 responding allergists, 80.6% reported performing OFCs, 72.6% reported lack of resources as an influential barrier, and 72.6% reported that creation of standard guidelines for hospital versus community OFCs would influence them to perform more OFCs. Of 101 responding pediatricians, 51.5% reported having moderate-to-extensive OFC knowledge; these pediatricians were more likely to refer to allergists who performed them (odds ratio, 2.37; 95% CI, 1.06-5.30). Of 27 pediatricians who stated they refer more to allergists who do not perform OFCs, 40.7% reported long wait times as a deterrent. The most common parent barriers from surveys (N = 110) and focus groups (N = 27) were fear and anxiety about the procedure and about experiencing reactions during OFCs, suggesting the need for better information and psychosocial resources.

      Conclusions

      Multiple barriers prevent widespread use of OFCs. Efforts targeting OFC training for allergists, education for pediatricians, and standardized guidelines created with clinician and parent input (including consistent OFC information for families and guidance on which OFCs should be performed in-hospital versus the community) are likely to increase OFC acceptance.

      Key words

      Abbreviations used:

      BCCH (British Columbia Children's Hospital), FA (Food allergy), OFC (Oral food challenge), sIgE (Specific IgE), SPT (Skin prick test)
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