Background It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double‐blind placebo‐controlled food challenge (DBPCFC) has been regarded as the ‘gold standard’ for decades. However, DBPCFCs are costly, and time‐ and resource‐intensive procedures. Structural implementation of less demanding open food challenges will only find support if research demonstrates that their outcome is comparable to DBPCFC, yet this has been proven difficult to investigate. Methods We performed a literature review to investigate the diagnostic accuracy of oral food challenges and interviewed 19 parents of children with proven or suspected food allergy about the design of a trial to study this. Results An overview of the dilemma of diagnosing food allergy using oral food challenges, and the methodological issues and parents’ opinions to study this. No comparative studies have been performed using the latest guidelines on oral food challenges. Conclusions There is an urgent need to investigate the diagnostic accuracy of different oral food challenge protocols. We present the rationale and design of the ALDORADO trial (ALlergy Diagnosed by Open oR DOuble‐blind food challenge) that has been set up to investigate whether the outcome of the open food challenge is comparable to DBPCFC.

To the Editor, Food allergy should be adequately diagnosed or excluded to avoid anxiety and unnecessary elimination of foods. 1,2 Mothers who suspect their child to be food allergic appeared to be more anxious and eliminated (multiple) foods unnecessarily. 3 Furthermore, peanutallergic children avoided tree nuts even when this food was proven to be safe or had been eaten before without symptoms. 4 We recommend to gradually introduce the food at home following a standardized schedule for children who are referred due to suspected food allergy but deemed tolerant (i.e. very low probability of food allergy based on medical and dietary history) for a specific food. However, this advice is declined for numerous reasons by many parents. Next to this, parents, who accepted the advice at first, did not introduce the food as recommended. To avoid unnecessary elimination and improve personalized medicine, it is therefore worthwhile to address potential hesitation during the visit and preferably in a standardized way. Health-related quality of life (HRQL) questionnaires might be valuable during this diagnostic process in order to screen for possible factors that influence the willingness to introduce the food at home.