| Preparation of the provocation meal |
The provocation meal should include, as realistically as possible, the usual edible form of the food that triggered the reaction. A common target amount is 3 – 5 g of the food protein. Processing of the food and incorporation into a matrix can significantly affect allergenicity, e.g., raw or baked egg. In provocations to confirm pollen-associated food allergy, fresh fruits and vegetables should be used if possible, as the triggering proteins are usually heat-labile. |
| Choice of matrix |
Clear care should be taken to ensure that no other allergens to which the patient reacts are included in the meal. As few ingredients as possible should be used. For placebo meals, the sensory characteristics should be as close as possible to those of the test food. |
| Dosage |
Number of doses |
In most cases, a titration in seven semi-logarithmic steps should be chosen. If negative provocation is expected and there are no safety concerns, a single dose may be appropriate. |
| Initial Dose |
In clinical practice, an initial dose of 3 mg of food protein is appropriate for most foods. Smaller doses should be selected for threshold dose provocations and high-risk patients. |
| Maximum dose |
According to an age-adjusted portion, 3 g of food protein is suitable for most foods. |
| Cumulative total dose |
A cumulative total dose should be administered the next day or another day, as some patients do not respond until repetitive administration. |
| Time interval between doses |
20 – 30 minutes, but should be adjusted according to history. |
