Box 6: Recommendations for the safe provision of OIT	Ethical imperative, data or other considerations in support of the recommendation Level of evidence (applicable when recommendations are based on outcomes data from clinical studies)
OIT providers and patients should be prepared to recognize and treat allergic reactions, including anaphylaxis, during OIT. Food escalation should only be performed in a clinic with appropriate equipment and infrastructure* available to treat anaphylaxis A personalized action plan should be provided to patients to guide management of reactions occurring at home Providers should only offer OIT in age groups in which they have training or experience in treating anaphylaxis (*see Additional file 1: Appendix 5 for guidance on equipment and infrastructure requirements)	This recommendation is based on the principle of nonmaleficence It is supported by a large amount of consistent clinical evidence indicating that there is a risk of anaphylactic reactions during OIT [22–24]. A proportion of these reactions occur outside the healthcare setting [29, 32, 36, 38–40]. This is coherent with data from consultations. Level of evidence: HIGH
Patients should be observed in clinic for 1 h following dose escalation. The observation period can be decreased as appropriate to a minimum of 30 min, based on various factors that include patients who are reliable, confident and comfortable with the management of allergic reactions	This recommendation is based on the principle of nonmaleficence It is supported by data from consultations with stakeholders
Surveillance for the emergence of EoE or EGID should be based on monitoring for the emergence of clinical symptoms (e.g. dysphagia, oesophageal spasms, vomiting, diarrhea). Endoscopy and biopsy should be used to confirm the diagnosis in suspected cases not responding to dose adjustments or medication	This recommendation is based on the principle of nonmaleficence It is supported by data from consultations with stakeholders