Table 1.

Findings from the CoFAR Observational studies (CoFAR 2 and 5) with management pearls for the clinician

Clinical Finding/Observation	Implication/Clinical Pearl/Counseling point
Accidental or OFC exposure with reaction to egg, milk or peanut did not boost IgE sensitization (16)	Oral food challenges should not be deferred for concerns of increasing sensitization
Despite receiving standard instructions about avoidance and treatment, the rate of annualized reactions was 0.81 over a median follow up of 36 months from enrollment and rescue epinephrine was under-utilized (12)	Accidental (and purposeful) ingestion of food allergens is not uncommon and epinephrine rescue is under-utilized emphasizing the need for repeated education of patients and caregivers.
About 2 of 3 accidental ingestions resulting in reactions were due to lack of vigilance (12)	Educate families about supervision, reading labels, discussing allergy with restaurant staff, educating about cross contact and hidden ingredients
About half of reactions occurred when not under parental supervision (12)	Extend education to relatives, friends, caregivers
Purposeful trying of avoided foods accounted for 11% of reactions (12)	Ensure families are comfortable with the diagnosis and know not to attempt home trials
Epinephrine was not given for 30% of severe reactions (12)	Educate families regarding safety and utility of prompt administration of epinephrine
Delayed EoE diagnosis is common (17)	Maintain a high index of suspicion for EoE
Co-morbidity in EoE is common (17)	Consider possibility of co-incident eosinophilic gastritis, and immune and, and neurodevelopmental disorders.