Table II.

Advantages and disadvantages of different aspects of oral food challenges (OFCs)

Aspects of oral food challenges	Advantages	Disadvantages
Oral exposure to food in any setting	Transitions patient from reported knowledge of tolerance to a food to personal experience of tolerance, which is much more likely to result in future incorporation of food into the diet.	Carries risk for life-threatening anaphylaxis. (In the community setting, this can be minimized through careful patient selection and mitigated through patient preparation with comprehensive education on recognition and management of allergic reactions)
In health care setting	Supervision by experienced staff ensures that undue significance is not given to non-specific symptoms whereas highly indicative symptoms are dealt with promptly and not dismissed. Swift escalation of medical treatment is possible when required.	High health care resource use. Anxiety about attending hospital procedures affecting patient behaviors during food challenge.
Blinded to study protocol	Increases objectivity of assessment when pre-probability risk or patient anxiety may bias assessor’s assessment or patient’s experience of placebo symptoms.	Increases resource requirements, halving capacity. Requires significant preparation to mask OFC doses adequately.
Cumulative	Mimics real-world exposure patterns. Increases capacity in allergy centers for low-risk food reintroductions.	Requires careful patient selection to avoid severe reactions.
Incremental	Increases safety of OFC through dose-limitation between observation periods. Allows adaptation of exposure schedule according to reaction history (eg, dosing intervals may be adjusted).	Increases duration of assessment reducing capacity for high volume of visits.