The two most important parts of managing food allergies confidently are prevention and being prepared for emergencies. Learn more from Michael Pistiner, MD.
What is a food challenge?
A food challenge is the most definitive procedure for testing whether someone can tolerate a specific food. A challenge involves giving increasing amounts of food every 10-20 minutes followed by an observation period.
The total procedure takes place over about 4 hours. During this time, we observe your child closely for any reaction. If reaction symptoms are suspected, your child will be assessed by a doctor before the challenge may continue. If a reaction is confirmed, your child will be treated and observed further for any persistent or recurrent symptoms. Parents should stay with their child and children must not leave the room during the challenge. During the challenge, no other food should be given to your child.
When should my child have a food challenge?
The decision to undergo a challenge is complex and should be made together with your allergist. Important considerations are the history, test results, the potential benefit to your child, your child’s readiness and the expected natural history of a particular food allergy.
What do I need to do to prepare my child for a food challenge?
- One to six months before challenge- Meet with your allergist to review what will happen on the day of the challenge and make sure your questions have been addressed. You will need to sign a consent form indicating that you understand the risks and benefits in order for the challenge to take place. You will also need to pick out a preferable food (that will be prepared by our nutritionists) to give for the challenge. For example, if your child is allergic to milk, your allergist may have you pick whole milk, yogurt, or cheese slices to be given during the challenge.
- You should also have a follow-up appointment with your allergist scheduled for 1-2 weeks after his/her challenge.
- One week before challenge—Stop any oral antihistamine medications. This includes Zyrtec (cetirizine), Benadryl (diphenhydramine), Claritin (loratidine), and Atarax (hydroxyzine), but there are many others, as well, so read all medication labels carefully, especially over-the-counter allergy/sinus/cold medications. If you have any questions, or if the child is given any of these medications accidently within one week of the challenge, please contact us.
- You should continue to give your child's daily inhaled medications (e.g., Flovent, Singulair, etc.) and/or nasal sprays (e.g., Rhinocort, Nasonex, etc.)
- Evening before challenge—Your child may not have solid foods after midnight the night before their food challenge.
- If he/she is 6 years or younger: He/she can have a light meal 6 hours before the challenge. If he/she is breastfed, you may breastfeed up to 2 hours before the challenge. He/she can only have clear liquids (e.g., water, fruit juices that have no pulp, sports drinks, popsicles) from 2-6 hours prior to the challenge.
What if my child is sick during the days before his/her food challenge?
If your child has a fever or any infection within 48 hours of the appointment, please contact us to discuss whether the challenge should be rescheduled.
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