GENERAL INFORMATION:
ORAL FOOD CHALLENGES
ORAL FOOD CHALLENGE PATIENT INFORMATION:
At the Allergy Clinic we believe knowledge is power! This information sheet will address questions you might have for your food challenge. We hope to equip you with the information required for you to feel comfortable and at ease during the upcoming food/ medication challenge.
Food challenges give us clarity.
Many people mistakenly believe that food allergies are strictly diagnosed based on skin and/or blood tests alone. While they are a very useful part of the diagnostic process, a positive result on one or both tests is not always definitive as diagnostic for food allergy.
The more important question is can you or your child eat the food safely. If the food can be eaten or taken without the development of any adverse symptoms, then it is unlikely that there is a food allergy.
The Allergy Clinic staff will email this document 2 weeks before your challenge is scheduled. In the correspondence we will include an explanation of the foods required for the challenge as well as the amounts. If foods are to be made or baked, the recipes will be provided. Our team will be available at any stage should you have queries, questions or concerns and we will answer them for you before the challenge.
Please email Dr McDonald: marinda@allergydoc.co.za
What are the Steps?
HOW TO PREPARE YOUR YOUNGER CHILD FOR THE FOOD CHALLENGE:
For younger children (ages 6 and under) you might find it helpful to do some role playing. You can then act-out the protocol of the challenge using an allergen-free food. Answer any questions your child may have in clear, simple terms and ensure your child understands that you will spend the full morning at the clinic.
The Allergy Clinic staff will email this document 2 weeks before your challenge is scheduled. In the correspondence we will include an explanation of the foods required for the challenge as well as the amounts. If foods are to be made or baked, the recipes will be provided. Our team will be available at any stage should you have queries, questions or concerns and we will answer them for you before the challenge. Please email Dr McDonald: marinda@allergydoc.co.za
- WHAT TO DO BEFORE THE CHALLENGE:
1-2 weeks before the challenge:
The Oral Food Challenge is scheduled from 8:00-14:00. However, if you or your child has a severe reaction (especially if this reaction happens during the final dose of the test), you may be at the clinic for even longer. Because of this, you must plan for you and your child to be at the clinic for the FULL DAY.
3-5 days before the challenge:
Based on the instructions from your allergist, do not take any antihistamine for three to five days before the test.
Day before the challenge:
- Confirm any arrangements that you have made for your other children.
- Review the email correspondence of how much and what food/medication items to bring and ensure that items are purchased or prepared.
- Buy snacks that can be used to hide allergenic foods, favourite foods, snacks, and drinks as well as lunch.
- Pack a bag with change of clothes.
Day of the challenge:
Eat a small meal of safe foods prior to coming into the clinic. The food challenge can be a lengthy process without additional foods being eaten if your child has eaten too much they might refuse to eat at the challenge.
- WHAT TO BRING TO THE CHALLENGE:
Things for you or your child to do:
Food challenges typically take three to six hours; sometimes they may take longer.
Cupcakes, flapjacks and egg challenges take about 2 hours.
Bring work to complete; an iPad or a book to read and bring things to entertain your child, such as books, toys, paper and crayons, electronic devices, and other non-edible items. If your child is young, bring a favourite comfort blanky or special toy.
Change of clothes for your child: In case your child has a reaction and vomits or gets the allergen on his or her clothes before failing the test, you’ll want to have some clean clothes on hand. (or if they play in the garden)
Foods to be challenged: You will be instructed as to exactly what to bring.
Cupcakes- link to recipe
Flapjack- link to recipe
Egg- 2 hard boiled eggs
Fish – 60g of cooked fish
Nuts- we provide peanut and tree nuts.
Sesame we provide
Shellfish- 60g of cooked shellfish
Safe food for after the challenge: You and your child are likely to be hungry by the time the test is over. During the final waiting time you might want a safe snack to share. Water is a beverage that can typically be consumed during the challenge.
- WHAT HAPPENS ON THE DAY OF THE CHALLENGE:
- A physical examination and vital signs are done before starting and periodically during the challenge. The Challenge starts with a small amount of the food and after a period of time, usually 15minutes, if no symptoms are present, a slightly larger amount is given.
- Before each subsequent dose, careful evaluation is performed to look for any symptoms. If symptoms occur, and the health professionals judge that a reaction is happening, the challenge is stopped, and medications are given as needed. Otherwise, the challenge continues until, typically, a meal sized portion is eaten, or one full medication dose is given.
- WHAT TO EXPECT DURING THE CHALLENGE:
- A High Level of Supervision – The challenge will be conducted under the supervision our team of doctors and nurses who have been specifically trained to manage oral food/medication challenges. The health professionals will be supervising a few food challenges at once. This will be based on a risk assessment before scheduling.
- A Safe Environment – In addition to close supervision from a trained healthcare professional will always be nearby and available. Emergency medications (including adrenaline, antihistamine and other emergency medications) will all be on hand and ready to be used. The Use of Measured, increasing (Graded) Doses.
- At the start of the challenge your or your child will be fed a very small, measured amount of the suspected allergen and observed closely. The test does not start with a full serving! If no symptoms develop after 10 to 20 minutes, then another, slightly larger amount of the food/medication will be given. If no adverse symptoms are observed, this process will be repeated over the course of approximately 2-3 hours. The goal is to work up to a full, normal serving size of the food.
- All oral food challenges are done in a developmentally appropriate way. The child is not bribed or tricked. The food being tested may be mixed with another food that is known to be safe to make it more palatable.
- WHAT HAPPENS IF I HAVE OR MY CHILD HAS A REACTION?
- The clinic staff is prepared and will provide appropriate treatment for any type of reaction that may occur. Depending on the severity of the reaction (i.e. two hives versus anaphylaxis), treatment can mean anything from stopping the test and simply observing the patient to giving antihistamines and/or asthma medication, to giving an injection of adrenaline. If adverse symptoms have been observed, the healthcare provider will discuss the proposed plan going forward and will give important information documents to ensure the allergen is avoided in the diet.
- Once the test is complete you or your child will be observed for an additional one to two hours. If all goes well you or your child might be cleared to eat full portions of the previous allergenic food. We will give you specific instructions how to add this food into you or your child’s diet, to optimize the nutritional status.
- REFERENCES:
- Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol 2010;126:1105-18.
- Sampson HA, Aceves S, Bock SA, et al. Food allergy: A practice parameter update-2014. J Allergy Clin Immunol 2014.
- Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, et al. Work Group report: oral food challenge testing. J Allergy Clin Immunol 2009;123:S365-83.
- Successful oral tolerance induction in severe peanut allergy. Allergy 2009: 64 1218-1220
The Allergy Clinic
- 65 Conrad Drive, Blairgowrie, Randburg, 2194
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+27 (0) 11 726 4214/5 (Office Line 1)
+27 (0) 10 822 8630 (Office Line 2)
- enquiries@allergydoc.co.za
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