However, there has recently been an expansion toward using the ladder approach to sequential food challenges in the home setting for some IgE-mediated food allergies in low-risk patients, although it is acknowledged that a robust safety framework (including for patient selection) is needed for this approach, and that it is arguably more akin to slow oral desensitization in its mechanism and often in its clinical intent than it is to an OFC.16 This evidence concerns the gene IGHE and food allergy.