Pearls and pitfalls of food challenges in infants.

An oral food challenge (OFC) is considered the diagnostic criterion standard procedure for evaluation of a suspected food allergy in patients of any age. This can be accomplished as either an open or a blinded challenge. In recent years, the open OFC has become an acceptable and practical office-based practice. With the advent of new early peanut introduction guidelines, there is a critical need to potentially perform OFC in very young infants between the ages of 4 and 12 months of life. Experience from multiple recent randomized controlled clinical trials indicates that such OFCs are both safe and feasible, although the extent to which providers in the clinical setting are comfortable and experienced with OFCs in this population is unclear. This review detailed the essential features of performing an OFC in an infant to help guide the practicing allergist in how to set up his or her office and best accomplish this very important procedure.