Small Bites: Disparities in Oral Food Challenges at AAAAI 2026, with Melissa Ptak, DO

Disparities in oral food challenge completion among pediatric patients at a major academic medical center highlight persistent racial and insurance-based gaps in access to definitive food allergy diagnosis.

At the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting, Melissa Ptak, DO, of Cleveland Clinic Children’s Hospital, presented research examining health care disparities in oral food challenge completion. Following this presentation, Ptak sat down with the host of Small Bites of Allergy and Immunology, Brian Schroer, MD, board-certified allergist/immunologist from Cleveland Clinic Children’s Hospital.

As Ptak explains in the interview, the study aimed to identify racial and socioeconomic factors influencing whether patients complete this gold-standard diagnostic test for food allergy.

Oral food challenges are essential in allergy care because they definitively determine whether a patient is truly allergic. A completed challenge can relieve families of dietary restrictions, label-reading anxiety, and unnecessary food costs. Given their importance, disparities in access or completion carry significant downstream implications.

Ptak and fellow investigators retrospectively reviewed 279 pediatric patients (aged 7 months to 19 years) who underwent oral food challenges at a pair of sites. Results indicated scheduling rates were similar between White and non-White patients (95% vs 96%). However, completion rates differed significantly, with 90% of White patients completing oral food challenges compared with 80% of non-White patients (P = .029). Completion rates varied among racial/ethnic subgroups, including 76% among Black patients and 79% among multiracial patients, despite comparable initial uptake.

Although the study did not determine causation, the discussion highlighted potential structural factors: geographic distance to the main campus, parking challenges, early morning scheduling, and 4-hour visit duration—all of which may disproportionately affect families with transportation, employment, or child care constraints.

By moving beyond identifying disparities to investigating completion outcomes, this work adds new insight to the food allergy field and lays the groundwork for targeted improvements in patient-centered care.

Disclosures for Schroer include Amgen, AstraZeneca Pharmaceuticals, BioCryst, GENZYME Corporation, GSK, LEO Pharma, Novartis Pharmaceuticals, and Regeneron Pharmaceuticals. Ptak has no relevant disclosures to report.

References

1. The current state of oral immunotherapy. The American Academy of Allergy, Asthma & Immunology. May 21, 2025. Accessed March 3, 2026. https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Allergies/The-Current-State-of-Oral-Immunotherapy

2. Ptak M, McDonnell J, McNamara K. Health care disparities in oral food challenges. Presented at: 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting; February 27-March 2, 2026; Philadelphia, PA.