Graded Oral Food Challenge

A Graded Oral Food Challenge (GOFC) is the “gold standard” for confirming specific food allergies or the absence of following treatment. If your provider believes that you are a candidate based on your history, exam, testing, and previous treatment, a GOFC may be recommended.

The Graded Oral Food Challenge is a valuable tool to help answer questions about food allergy treatment progress, whether avoiding certain foods is necessary, or if a food can be safely reintroduced into the diet.

The Graded Oral Food Challenge will help your provider:

  • Determine how allergic you may be to a specific food
  • Evaluate the effectiveness of allergy drop treatment
  • Determine if you/your child has outgrown a food allergy

Graded Oral Food Challenge championThe challenge also provides diagnostic information allowing your medical team to further modify your treatment.

During a challenge, we test only one food at a time using a detailed protocol and designated food challenge suite that is closely monitored by a specially trained medical team. The specified food will be given in timed intervals at pre-calculated amounts.

Our challenge protocol integrates the best practices from leading food allergy centers that provide food challenges. Our team and facility are equipped with state-of-the art technology and training to address the many facets of food challenges in a safe, comfortable environment.

For details about the Graded Oral Food Challenge and whether you might be a candidate, please talk with your provider at your next scheduled visit.


Graded Oral Food Challenge (GOFC) Case Report, Summer 2020

Allergy Associates of La Crosse (AAOL) initiated its GOFC program in the spring of 2016 after completing a new building that included two Graded Oral Food Challenge suites and dedicated food prep kitchen. The suites were designed to comfortably and safely accommodate the lengthy challenge process for patients/families and staff with optimal observation and support for complications. The objective of challenges, which generally take three to four hours, is to consume a full serving of a food in graded increments, with detailed patient observations before, throughout, and for a period after completion of the challenge.

Over approximately four years (Spring 2016 to Spring 2020) the results from 541 challenges provides the data for this report prepared for our patients and colleagues. Since the program’s inception, the AAOL providers, GOFC team and our Registered Dietitian Nutritionist have meticulously developed 40 protocols for foods in the following categories:

  • Dairy, eggs & soy = 7 protocols
  • Fish & shellfish = 9 protocols
  • Fruits & vegetables = 6 protocols
  • Gains = 3 protocols
  • Protein/meat = 2 protocols
  • Tree nuts & seeds = 13 protocols

Patient selection is driven by detailed metrics of their conditions (comorbidities), history of testing and treatment including: Specific IgE, Total IgE, skin prick testing, treatment duration/level, history of severe reactions, several other measured criteria, and provider judgement.

Report Findings

A KEY finding of our program is the large number of patients with a history of food anaphylaxis (n=221 or 41% of all challenges). Of the 221 with anaphylaxis, 81 (36.7%) were challenged to the food causing anaphylaxis. 83.7% of the patients with any history of anaphylaxis passed their challenge, 6.8% partially passed and 9.5% failed. Of the patients challenged directly to their anaphylactic food, 76.5% passed their challenge, another 13.6% partially passed, and only 8.6% failed their challenge.

General results of the program challenges:

Basic demographics of challenge patients:

  • Age: Average patient age = 12 years. The youngest - 2 years; oldest 75 years.
  • Gender: 385 Males, 156 Females
  • Average Years of Sublingual Immunotherapy at time of challenge: 4 years

Top Ten - Most Common Foods Tested:

  1. Almond (n=90)
  2. Peanut (n=83)
  3. Cashew (n=63)
  4. Hazelnut (n=41)
  5. Baked egg (n=38)
  6. Cooked egg (n=34)
  7. Walnut (n=30)
  8. Pecan (n=28)
  9. Shrimp (n=20)
  10. Baked milk (n=17)

From a safety standpoint in all challenges: epinephrine use occurred four (4) times; no patients required or reported follow-up at an Emergency Center, and no patients were admitted to a hospital.

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