Trends in oral food challenges in Japan: A six-year prospective study

The number of patients with food allergies is increasing on a global level. The estimated prevalence in Japan is 5–10% among infants and 1–2% among schoolchildren.  The use of oral food challenges (OFCs) is the gold standard for the diagnosis of food allergies. As of 2015, Japan is currently the only country in the world in which OFC testing is covered by health insurance.We performed a questionnaire survey to all specialist training facilities belonging to the Japan Pediatric Society one time per year, excluding the 2013 fiscal year prospectively. Of the total 2,579 facilities that received the questionnaire during the six-year period, 1,993 responses (77.2%) were returned. The total OFC testing rates, including outpatient and inpatient OFC, in the 2008-2011 and 2013 fiscal years were 71.4%, 71.9%, 73.7%, 74.6%, and 85.7%, respectively. The percentage of nonspecialists performing inpatient OFC testing in the 2013 fiscal year (66.7%) was significantly higher in comparison with all other years (fiscal year 2008 [51.5%, p=0.014], fiscal year 2009 [47.8%, p<0.001)], fiscal year 2010 [53.0%, p=0.032], fiscal year 2011 [49.8%, p=0.004]).The total estimated OFC testing fill-rate in Japan for each year was 6.4%, 8.8%, 9.3%, 10.0%, and 17.1%, respectively. These results indicate that the increased percentage of non-allergists performing inpatient OFC testing lead to increase of total estimated OFC testing fill-rate in Japan.