Development of a clinical predictive score for allergic reactions during oral food challenges in pediatric patients

Background: The oral food challenge (OFC) is the gold standard for diagnosing food allergies; but, it carries risks ranging from mild to life-threatening reactions, including anaphylaxis. Understanding and predicting these reactions is critical for safe clinical practice. Objectives: This study aimed to develop and validate a clinically predictive score for allergic reactions during OFCs in pediatric patients. Methods: Using a retrospective database of pediatric patients undergoing OFCs at a pediatric outpatient clinic in Southern Thailand from January 2014 to December 2022, a multivariable predictive model was developed. Data on the reaction rates, demographics, and treatments were collected. Logistic regression analysis with predictor selection using a backward stepwise approach, was employed. The model’s performance was assessed using the area under the receiver operating characteristic curve (ROC), calibration, and classification measures. Results: This study included 179 patients with an allergic reaction incidence of 12.3%. Predictors encompassed female, anaphylaxis and positive skin prick testing. The developed model achieved an ROC of 0.71. The patients were categorized into the low-risk (score 0–1) and high-risk (score 2–3) groups. Reaction rates during the OFCs were 6.7% in the low-risk group and 29.5% in the high-risk group. Conclusions: Our scoring model demonstrated predictive ability for OFC reactions in pediatric patients, offering valuable insights for clinical risk assessment.