Most families reintroduce allergens into diets after negative oral food challenges
Key takeaways:
- Many parents and caregivers reintroduced foods because their health care providers said they should.
- Education and follow-up after oral food challenges encourage reintroduction.
SAN DIEGO — Nearly all children with a food allergy who passed an oral food challenge reintroduced the allergen into their diets within the next 4 weeks, according to an abstract presented here.
“Food allergy can reoccur after negative oral food challenges, and most of the time, those cases are associated with a limited allergen exposure,” Wan Shen, PhD, RN, assistant professor, Bowling Green State University, said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
The most common reasons why parents and caregivers do not reintroduce allergens into their child’s diet after a negative OFC include the child’s refusal to eat it, fear and lack of knowledge.
“As a dietitian, I cannot over-stress the importance of diet diversity for growing children,” Shen said, noting that the top nine allergens are rich in micronutrients and macronutrients.
The study comprised 25 children (mean age 4 years and 2 months) who passed an OFC, including egg (n = 15), cow’s milk (n = 3), peanut (n = 4), soy (n = 1), almond (n = 1) and hazelnut (n = 1). The researchers conducted four weekly follow-up surveys with 24-hour diet recalls after the OFC.
“We asked the parents and caregivers if the child has passed the oral food challenge on that day,” Shen said. “If the answer was yes, then we asked them for the reintroduction frequency.”
Using the Precaution Adoption Process Model, the researchers assessed if behavior was changing based on whether parents and caregivers were unaware, unengaged, deciding about action, deciding not to act, deciding to act, acting or maintaining.
The researchers also investigated the barriers that influenced parental and caregiver decisions not to reintroduce allergens into their child’s diet, along with apprehension on 1-5 scales of easy to hard, safe to unsafe, beneficial to harmful and not scary to very scary.
At week 1, 84% of parents and caregivers had begun introducing their children to their allergens, with 12% consuming their allergens daily, 72% consuming them weekly and 16% not consuming them yet.
Specifically, among children with egg allergy, 6.7% consumed egg daily, 86.7% consumed egg weekly and 6.7% had not tried it yet. Also, 50% of those with peanut allergy consumed peanut weekly and 50% had not tried it yet.
At week 2, 19% of children were consuming allergens daily, 66.7% of them were consuming them weekly, and 9.5% were consuming them rarely. The percentage of children who did not try them fell to 4.8%.
“That indicates that most parents and caregivers might be willing to follow this recommendation, but they probably need some proper education and a follow-up over the first week after they had the oral food challenge,” Shen said.
Week 3 totals included 25% consuming their allergens daily, 70% consuming them weekly and 5% who did not try them. At week 4, 15.8% had daily consumption, 78.9% had weekly consumption and 5.3% had no consumption.
Overall apprehensiveness scores peaked with an average of 8.3 at week 1, with averages of 5.9 at week 2, 5.3 at week 3 and 6.6 at week 4. Egg and peanut both followed this pattern of peaking in week 1.
Cow’s milk began with an average of 8.7 at week 1 before increasing to 11.5 in week 2 and then falling to 9 and 8.7 in weeks 3 and 4. Soy began at 12 in week 1 and registered 4 and 5 in weeks 2 and 3 before increasing to 12 again in week 4.
When asked why they reintroduced allergens to their child, 12 parents and caregivers said they did so because their health care provider told them to, and nine did so because they believed these foods would benefit their child.
“That indicates the critical role of medical professionals in guiding parents in this process,” Shen said.
Also, six said that they typically purchase these foods for their family, four said their child liked the taste and/or texture of these foods, and three said these foods were commonly prepared in their religion and/or culture.
“These families maybe need some dietary guidance, or maybe some help with a recipe to try to incorporate those foods into their daily diet practice,” Shen said. “There might be some financial support needed, but I think there needs to be more research on that.”
In free text, one parent said, “I want my child to be able to safely participate in social activities, and most involve snacks and food that contain allergens,” Shen noted.
Also, Shen said that patterns of reintroduction followed the stages of the precaution reduction process, as parents and caregivers moved from a lack of awareness and engagement through deciding to act and then maintaining behaviors.
Shen further noted the importance of following up with families within a week after their OFC to ensure they are reintroducing allergens into their children’s diets as well as the importance of collaboration between registered dietitians, social workers and nurses in these plans.
“We do think that it requires teamwork and that it definitely provides support and guidance and encouragement,” she said.
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