If tolerance is suspected, I discuss with children and parents when to consider a food challenge. Such a protocol is probably best performed at a specialist’s office, particularly if a more comprehensive, double-blind, placebo-controlled challenge is warranted. Food challenges require significant time and resources, including advance preparations in case anaphylaxis occurs.
Also consider referral to a specialist when a food culprit is not easily identified; when there is disparity between diagnostic test findings and patient history; and when the patient and family require more comprehensive education.
This column, "Subspecialist Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Zacharisen is a professor of pediatrics and medicine specializing in the treatment of allergy, asthma, and clinical immunology at the Medical College of Wisconsin in Milwaukee. He also is on the faculty at the asthma and allergy center at the Children’s Hospital of Wisconsin, also in Milwaukee. Dr. Zacharisen said he had no relevant financial disclosures.