Food challenge procedures: standardization of oral challenge and pulmonary measurements

The lung is one of many target organs that can be affected in an adverse reaction to a food or food additive. The question of pulmonary involve ment is often in the context of patients who have underlying asthma, a disease of the airways characterized by reversible airways narrowing. A number of unique problems must be addressed when attempting to measure pulmonary responses during adverse reactions. Prior to the study, it is necessary to determine if the subject has asthma and if so, to quantitate the severity of asthma. This can be accomplished by assessing pulmonary function, measuring airways reactivity, documenting medication requirements, recording duration of disease, and detailing complications. Procedures that may result in pulmonary reactions should be performed only where severe reactions can be optimally treated such as in the hospital or an office near a hospital. Medical personnel must have proper training in, and equipment for, resuscitation. Medications should be withheld when possible that may effect the ability to measure pulmonary responses. Specific endpoint criteria of a positive response should be set in advance of testing. Double‐blind placebo controlled food challenge is the experimental protocol of choice. Responses to specific foods or additives can be assessed both by measuring changes in pulmonary function and by repeated methacholine challenge to assess airways reactivity. With proper definition of the question, use of appropriate experimental design, exercise of caution, application of appropriate analytic methods, and the presentation of a clear and thorough report, adverse reactions to foods and additives involving pulmonary responses may be assessed with safety and scientific accuracy.