Food and medication challenge information

Your consultant has requested for an appointment to be made for your child to have an oral food or medication challenge. We hope this information will answer any questions you may have about your food or medication challenge and will help to prepare you and your child for the admission.

Why do we carry out oral challenges?

Oral challenges are considered the gold standard test for diagnosing a food or medication allergy. Most of the challenges we perform in hospital are done to see whether a child has grown out of their allergy. Occasionally they are done to prove a child is not allergic to a specific food or medicine and sometimes they assist in the diagnosis of food or medication allergies.

You and your child will have already been seen in our outpatient department by the allergy team and may have had skin prick tests, blood tests (specific IgE) or both tests. The results of these tests along with information given to the doctor or nurse in clinic suggest that it is worthwhile performing a food or medication challenge in hospital under controlled conditions.

What are the benefits to having a challenge?

• If the challenge is successful your child will be able to reintroduce that food into the diet or have the medication as prescribed by a health professional.
• If there are any adverse reactions, you will know for certain that the food or medication should be avoided.
• The challenge is carried out in a controlled, child-friendly environment with full resuscitation support available if needed.

Are there any risks associated with food or medication challenges?

• Food and medication challenges are safe as long as they are done in the right place by the right people.
• There is a risk that your child may have a reaction, but children are carefully selected for challenges so the risk is low. If the risk is higher, this will already have been discussed with you.
• Oral challenges are carried out in a safe environment with access to medical equipment under the supervision of an experienced allergy nurse who has the knowledge and skills to recognise and respond to the signs of an allergic reaction.

Preparing for the food or medication challenge

Asthma, eczema and hay fever symptoms should be well controlled.

All antihistamines must be stopped before the challenge.

• Piriton (chlorphenamine), Phenergan and Vallergan – At least 48 hours before
• Cetirizine, loratidine or desloratidine, fexofenadine – One week before

However if your child has an allergic reaction you should follow your emergency treatment plan and give medication as required. Please let us know and we will rearrange the appointment for you.

What happens on the day of the challenge?

On the day of the challenge your child should have a light breakfast or lunch before coming to Medical Day Care.

1. You will be seen by the specialist nurse.
2. We will complete some paperwork, check your child’s weight and basic observations and explain the procedure.
3. The doctor or nurse will check your child is fit and healthy and take a brief medical history.
4. Rescue mediations will be prescribed in case of an allergic reaction.
5. Some children have a cannula put in before the challenge begins. A cannula is a thin plastic tube inserted under the skin, usually on the back of the hand. Putting a cannula in is very rare and will have been discussed with you before you come for the challenge. If needed the nurse will explain this in detail and will use local anaesthetic cream or spray to reduce any discomfort.
6. We will ask you to sign a consent form for the challenge to go ahead. If you have any questions, please ask the doctor or nurse before signing the consent form.
7. Your child must not leave the ward once the challenge has started.
8. The nurse will observe your child closely, making sure that any reaction is recognised quickly. If there is a definite reaction the challenge will be stopped and your child will be treated appropriately.
9. Once the challenge is completed you will need to remain on the Medical Day Care ward for 1 to 2 hours before being able to go home. If there is no reaction the food should be reintroduced into the diet and you will receive advice about this.
10. Some challenges require a longer period of observation and your child will need to stay on the ward for several hours. This will have been discussed with you prior to the appointment.

How long does an oral challenge take?

The amount of time you will be on the ward depends on the type of challenge your child needs. The allergy nurses perform graded oral food challenges, supervised feeds, medication challenges and occasionally all day challenges. We will discuss the type of challenge your child will be having before your admission.

What should I bring on the day?

• Some of the food your child needs for the challenge, the amount needed will be on your appointment letter.
• Any familiar or favourite foods that may be used to disguise or mix the challenge food with to persuade your child to eat the challenge food if they are reluctant. This could include yoghurts, banana, formula milk, fruit or vegetable puree, crisps, fruit juice.
• For a younger child, their usual cup or bottle.
• Bring a packed lunch of familiar foods for after the challenge.
• Favourite toy, comforter or other distraction.
• A change of clothes.
• Change for parking.
• Your child’s anti-histamine and adrenaline auto injectors if they have them.
• Food and drink for yourself as you are required to stay with your child throughout the challenge.

 Final checklist