Oral Food and Drug Challenge

Some questions to answer before your child is ready for their food challenge

If you answer “yes” to any of the questions below please call the children’s allergy nurse on 01429 522717.

The challenge may be re-arranged for another date.

• Does your child have an acute illness such as cold, sore throat, temperature, rash or infection?
• Is your child’s eczema or asthma worse than usual?
• Does your child have any symptoms of hayfever at the moment?
• Has your child taken any antihistamine or cough syrup in the 5 days before their challenge?
• Has your child taken their blue inhaler (salbutamol) in the 3 days before the challenge?
• Has your child reacted to the food in the last 6 months?
• Has your child eaten the food being challenged without reacting since they last came to clinic?
• Do you think your child is likely to refuse the food being offered during the challenge?
• Will it be difficult to introduce the food into your child’s diet 2 to 3 times per week after the challenge?

What is oral food/ drug challenge?

A challenge is always performed in hospital, as it is the safest way of finding out if your child reacts to a food/drug or not.

How is the challenge performed?

You and your child will be admitted to the Paediatric Day Unit.

• If your child is having a Food Challenge, the food will be given in increasing doses every twenty minutes, until the top dose is successfully eaten. Your child will be checked for signs of an allergic reaction prior to each dose of food being
  administered.

• If your child is having a Drug Challenge, the medication will be given and your child will be checked for signs of an allergic reaction prior to discharge. They may be discharged with further doses to take at home.

• If your child is having a Supervised Feed, they will be given a normal portion of the food to eat within 30 minutes and then monitored.

Once the Challenge is completed, you will need to stay on the ward for a minimum of 1 to 2 hours to ensure there is no delayed reaction.

We will contact you in advance and ask you to bring the food being challenged. If you think your child may have difficulties with eating the food being tested, you can contact our allergy nurse specialist in advance to discuss ideas.

It is a good idea to bring other food your child likes which could be used to disguise the food being challenged should they find it difficult to eat this. Bribery and treats can be useful if we are having difficulties.

It is a long day, so please come prepared. You may wish to bring toys/activities to keep your child (and yourself!) entertained.

Meal for your child

Unfortunately, due to the vast range of multiple allergies we encounter we are unable to provide your child with a meal. Therefore, we ask that you bring a packed lunch or snacks for your child. There is a microwave on the unit. Please ensure that your child has eaten this food before and it does not contain any of the food being challenged or which they are allergic to.

Foods commonly used in challenges

• Cow’s Milk – Full Fat Milk (provided by us)
• Baked Milk – Malted milk biscuits
• Egg – Scrambled Egg
• Baked Egg – Cake
• Soya – Soya Milk
• Peanut / Tree Nuts – Nut Butter or Whole Nuts
• Wheat – Weetabix
• Fish – Steamed / Grilled Fish
• Sesame – Tahini paste
• Shellfish – Prawns
• Oat – Oat Biscuits or Oatmeal

Allergic reactions

Challenges can cause allergic reactions, which may involve the eyes, nose, mouth, skin and gut.  Anaphylaxis is a more severe form of these symptoms and can involve the airway, breathing and/or circulation.

Your child will constantly be assessed throughout the challenge and any symptoms will be monitored and treated as necessary.  Anaphylaxis is very unusual during a Challenge, but should this occur our team is experienced in coping with such situations.

After the challenge

If your child has reacted to the food during the challenge, they remain allergic and should continue to avoid the food in their diet. They should not engage in strenuous play, activities or exercise for the rest of the day as this could trigger a delayed reaction. A delayed reaction can happen up to 72 hours later.

If your child has not reacted to the food during the challenge, they should not eat the food for the rest of the day to ensure they do not have a delayed reaction. If they remain symptom free, then they are no longer allergic to the food and you must introduce the food into your child’s diet 2 to 3 times per week to ensure they maintain tolerance.

Short notice waiting list

There may be a long wait for challenges, however we do get cancellations and an earlier appointment may become available. If you wish to be added to the short notice waiting list, please let us know and we will contact you by telephone if an earlier appointment becomes available.

Contact numbers

If you have any worries or concerns outside of these hours, you should contact your GP during normal surgery hours.  Outside surgery hours, you should contact your GP’s surgery for the Out of Hours Service number, or you can contact NHS 111.

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