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What is a Food Challenge?

If blood and skin testing for a potential food allergy is negative your allergist may order an in office food challenge.

A food challenge is a type of food allergy test conducted by an allergist. It is considered the “gold standard” of food tests and a highly-effective way of examining what foods an individual is allergic to. This test is also commonly known as an oral food challenge (OFC) or feeding test. You can receive a food challenge test as a child or adult. During the food challenge, you can only be tested for one food at a time.

How Does a Food Challenge Work?

During a food challenge, a patient will be gradually introduced to a specific food in increasing larger amounts to test their tolerance. As the more and more of the food is introduced to your system, the allergist will monitor to see if a patient reacts. If symptoms of a reaction start, treatment will begin immediately and the food challenge will stop.

Since this test has the potential to cause a serious allergic reaction or life-threatening anaphylaxis, the test should only be done under medical supervision. During the test, the patient is closely monitored for any negative reaction to the food.

When Do I Need a Food Challenge?

Any individual, no matter their age, can benefit from a food challenge. However, a food challenge can be extremely useful for young children who have the symptoms of an allergy (such as hives or flushing) at a young age but don’t know the trigger. It can also be conducted on older children or adults who have lived most of their lives with an allergy but want to know if they’ve outgrown it.

Are There Any Side Effects?

Since a food challenge is conducted to test an allergy, a patient may experience flushing, itching or hives or other signs of an allergic reaction.  While most allergic reactions are mild, a severe reaction may occur.

What to Expect Before and After a Food Challenge?

Before you or your child are expected to go to the allergy clinic for a food challenge, speak with your allergist to see if there’s anything you can or cannot do before the appointment. On most occasions, your allergist will request that the patient does not take any antihistamines (allergy medications) for three to five days prior to the food challenge.

During the test, the patient must be in 100% good health. Since the test takes approximately three to six hours, it’s a good idea to bring something to do, like a coloring book or electric device. You can expect a high level of supervision during the exam in a friendly and safe environment. If you or your child do not experience symptoms, you can expect to be monitored for one hour.

If the patient has a reaction during the test, it will be treated promptly and in accordance with the severity. For example, a mild reaction may be treated with antihistamines, while a more severe reaction would require an epinephrine auto-injector and observance for multiple hours, or possibly a transfer to an emergency room.

How to prepare for a food challenge:

The patient must be feeling well on the day of the food challenge. A food challenge may need to be rescheduled if the patient is sick or if the patient is experiencing worsening asthma, eczema, or nasal allergies the week the food challenge is scheduled.

Eating before the food challenge:

Before a food challenge, you should not have anything to eat for at least 4 hours. Infants and younger children can have a light meal 2 hours before the challenge.

Medication guidelines:

  • Stop all antihistamines five days before the challenge.
  • Other medications may be discontinued per your doctor’s instructions.
  • Continue all asthma steroid preventative inhalers and nasal steroid sprays (fluticasone, budesonide, beclomethasone, flunisolide, mometasone, ciclesonide, triamcinolone).
  • If your asthma preventative inhaler has salmeterol or formoterol in it, do not use this inhaler eight hours before the challenge.
  • Do not use a rescue inhaler (albuterol, xopenex) preventively (eg, before exercise to prevent symptoms) eight hours before the challenge.
  • Please always use a rescue inhaler if needed for symptoms and then let the office know.
  • Never avoid treating allergy or asthma with rescue medications because a food challenge is approaching. If you/your child needs to use a rescue inhaler, an antihistamine, or even epinephrine, please use the medicine and then call the office to discuss the symptoms in case the challenge should be postponed. If you have a question about a specific medication, please contact the office.

What to bring to the food challenge:

  • Details will be provided by our oral food challenge team about the specific food to bring; however, it is recommended that you bring at least 2 different servings of the food to be challenged.
  • Bring your/your child’s epinephrine autoinjector twin pack to the visit. Bring something to entertain yourself/your child during the visit.

Special considerations for children:

  • Prepare your child for the food challenge by explaining the procedure to them without overwhelming them.
  • Tell your child that he or she will have an OFC to see whether he or she is allergic to the food.
  • Tell him or her that the food will be eaten at the doctor’s office and doctors and nurses will be at the challenge to keep them safe.
  • Emphasize that your child can bring games and fun activities to the challenge. For young children or picky eaters, it is helpful to bring several forms of the food (eg, cow’s milk and cow’s milk yogurt).
  • Bring anything that may make it easier for your child to eat a new food (favorite plates, cups, spoons, prizes, etc).

If you have any questions or concerns about the procedure, please call 704-372-7900. Because there is a substantial waiting list for food challenges, please take care in scheduling the food challenge appointment and inform the office as soon as possible if you need to reschedule.

Recipes:

Baked Egg Recipe

Baked Milk Recipe

 

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