Safety of DBPCFC

The risk of generalised anaphylactic reactions should be considered when undertaking a challenge with a foodstuff. British practitioners tend to work from within a hospital setting, while Continental and American allergists often work from 'stand alone' offices or clinics. Whatever the context, there are good guidelines on the personnel and equipment necessary for those undertaking immunotherapy using allergy extracts.23 These standards are also applicable to food challenges. General principles of resuscitation apply, with the ready availability and if necessary administration of subcutaneous epinephrine/ adrenaline as the first-line drug in the case of a systemic reaction. Antihistamines are only useful adjuvants, their mode of action being too slow in this scenario. Two North American allergists, S. A. Bock and H. A. Sampson, who have performed many food challenges and written extensively on the subject, state that they have never had to use intravenous resuscitation, and have never had an episode of cardiopulmonary arrest.24 Prudence, however, dictates that a patient with a history of anaphylaxis should be challenged only in the hospital setting with very small incremental doses of food.

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