Diagnostic Performance of Source-Recorded Food-Specific Prick-by-Prick Testing Against Oral Food Challenge Outcomes: A Challenge-Selected Single-Center Retrospective Study

Oral food challenge (OFC) is the reference standard for diagnosing IgE-mediated food allergy, whereas the performance of prick-by-prick testing (PbP) with native foods in routine care is uncertain. We retrospectively screened all food-specific OFC records from 2 January 2024 to 6 December 2025 and included evaluations with a source-recorded same-food PbP result and an OFC classified by the attending allergist. Confidence intervals were estimated by patient-cluster bootstrap; a clustered logistic generalized estimating equation assessed the PbP–OFC association. Among 115 evaluations from 76 patients, 7 OFCs (6.1%) were positive. The matrix comprised 6 true positives, 17 false positives, 1 false negative, and 91 true negatives. Sensitivity was 85.7% (95% CI, 50.0–100.0), specificity 84.3% (73.6–93.4), positive predictive value 26.1% (8.3–52.9), and negative predictive value 98.9% (96.4–100.0). PbP positivity was associated with OFC positivity (odds ratio, 32.21; 95% CI, 3.48–297.97; p = 0.0022). Because only seven OFCs were positive, sensitivity and the GEE association estimate were imprecise. Negative PbP results were usually followed by negative OFCs in this challenge-selected, low-prevalence cohort; however, one of seven positive OFCs followed a negative PbP, and the open, non-blinded design permits diagnostic review bias. These hypothesis-generating findings do not support replacing OFC with PbP alone.