Food Challenges

We have been able to offer food challenges to our patients over the years and we have many children who have done very well with the food challenge. We usually do food challenges to show, in a safe and controlled clinical environment, that the child may have outgrown their food allergy. We can also do a food challenge when there is a question about a food allergy- sometimes a test for a food allergy is done and the child may have been eating that food without any problems or they may have never had any exposure to the food in question. The food challenge may help clear-up the situation.

Parents who are scheduling a food challenge often have many questions. What follows are some of those FAQs (frequently asked questions).  Hopefully these FAQs will help those who are anticipating doing a food challenge.

When Your Child is scheduled to undergo an Office Food Challenge;

  1. Please stop antihistamines one week before the scheduled challenge. Antihistamines may include Benadryl (diphenhydramine), Claritan ( loratadine), Zyrtec (cetirizine), Allegra (fexofenadine), or Atarax  (hydroxyzine) – there are many more. If you have any questions about a medication, call the office.
  2. All challenges start at  8:00 am. Please arrive at 7:30, so we may begin promptly at 8:00am. Challenges usually take all morning to complete. If we cannot start on time, we may need to reschedule.
  3. You will be asked to bring two snack pack size servings of applesauce, pudding, soy milk, etc. This is something to use to mix the food into. Pick something that the child has had experience with and likes! We will discuss what your child usually eats to make the challenge more palatable.
  4. Your child may eat breakfast, but no other food or drink will be allowed during the challenge.
  5. We encourage you to bring age appropriate diversion activities such as books, toys, or games. We have a DVD player and movies available in the clinic.
  6. If the challenge is successful, we advise not eating the particular challenge food for the rest of the day. Any promises for special treats that have been avoided should be postponed for the next day.

What Happens During the Office Food Challenge?

  1. You will have a room in the clinic for the morning.
  2. The child will have a set of vital signs taken.
  3. The physician will talk with you before the procedure and have you sign the consent form. The physician will go over the history of the reaction. A limited physical examination will be performed as well.
  4. The nurse will give your child increasing amounts of the challenge food in a powder form mixed with the food or drink you provided. Every 15 minutes, we give a doubled dose of the challenge food until the child eats a full serving of the food. You will stay for 30 minutes to one hour for observation after the challenge is completed.
  5. At the first sign of any reaction, we will assess your child, treat the reaction if needed, and stop the challenge. We determine then how long you need to remain in the clinic.

As always, if there are questions- call. Riley- 317-274-7208 and IU Health North 317-688-5700.

16 Responses

  1. Mel - July 15, 2011

    I have been learning so much through your website! Could you tell me what would happen if NO reaction happens during the food challenge? Would the child be able to go on every day eating that food?
    My son (5 yrs) tested positive with a blood test for a peanut allergy. He was tested for some other things and this came up. We have not noticed any reaction in him from eating things that contain peanuts .. though he refuses to eat peanut butter and has only had a few things with peanuts as the main ingredient (recess pcs, peanut butter cups, nutter butters, etc).
    His test came back with 16 KU/L.

    What if only a small reaction occurs (runny nose – no hives)? Is that possible? Will it get worse over time?

    My fear? That he will not react today, but will react later .. whether it be tomorrow, 3 months, or 3 years from now and we will be blind sided. On the flip side, I don’t want to put him in a peanut free bubble for no reason.

    I have 2 allergists telling me opposite things. One says “he’s fine if he is not reacting.” He would not do a skin test because he says I have given him no history of a reaction to justify it.
    The other says “He should avoid all things peanut”. He would not do a skin test because his test level is over 14 KU/L and says he could have a severe reaction.

    I am LOST! You are the only one that seems to be making any sense .. and I don’t know what else to do.

    Any help you can provide is greatly appreciated.

  2. fleickly - July 17, 2011

    Thank you for your comments and your question. The site has been fun and I hope of service. What follows are a few general ideas and concepts. Peanut allergy is scary-the groups from Duke, Mt. Sinai, and Johns Hopkins have done some tremendous research in peanut allergy.
    You and many others including some very good and ‘state of the art’ allergists have the same concerns and feeling of being lost. What follows is my take on the situation and a resource you can use. I think that in the next few years we will have the tools to hopefully clear-up situations like this. Reactions getting worse over time depend on many factors- the amount ingested, the presence of asthma, concurrent diseases, and medications. Remember that allergy requires a story and a laboratory study to support it. A positive laboratory study and no history indicates sensitizaton- the making of antibody. Food allergy tests can have 50% false positive results. However, we need to respect the peanut. Food researchers have shown that more children who have an egg or a milk allergy may go on to develop a peanut allergy.
    When we do peanut challenges-
    If nothing happens during the food challenge and the remainder of that day is calm and without symptoms, then we truly have a child who has passed the challenge and their slate or Etch-a-Sketch that at one time said ‘PEANUT’ allergy has been wiped clean.
    Peanut products can be eaten with the child have a very low chance of having a reaction. Those who have published on their successes for the peanut challenge have seen about 25% become ‘allergic’ if peanut products are not eaten about 3 times per week. Time cleared the initial sensitivity, the challenge proved that peanut is tolerated, and now the child has to maintain tolerance by having some regular exposure to the peanut. The key word here is tolerance.
    Your story is a common one, we have about 50 children who for some reason had a positive test to peanut and no story to support it. The tests for foods are poor predictors and if they are done without a story to support an allergic reaction, then a family has to struggle with the consequences. Children can have positive tests to peanut, but tolerate peanuts without a problem. Many of the children who have a successful peanut challenge will continue to have evidence of peanut antibody, however they were instructed regarding continued exposure to peanut and that helped with the development of tolerance to the food.
    Your case is a bit tricky, the blood tests tell us that antibody to peanut is being made. They are also used in a predictive fashion. Even at a value of <0.35 there may be a 10% chance of a reaction. The severity of a reaction is not predicted by the level- this has been made very clear in the new food allergy guidelines. The level says there is a good chance of a reaction,not what and how severe that reaction may be. Peanut allergy can be contact urticaria (hives), total body urticaria, atopic dermatitis, or anaphylaxis.
    Sometimes when you ask two allergists for an opinion, you may get 3 or more answers.
    My understanding is-
    If the child is eating the peanut protein equivalent of 3 Reece's Peanut Butter cups per week- then there would be tolerance and the chance of a reaction would be very low.
    If now, due to the blood test the child no longer is exposed to any peanut products, any tolerance that was there would be gone and there is a risk of a reaction- not the severity, just the risk. Then reassessment may be done to monitor the specific IgE to peanut.
    Hopefully, Phadia will have a more specific assay for peanut respoinses. They have been looking at the individual antibody responses and reports have shown that the positivie test may be due to proteins not associated with the more severe reactions.
    Hopefully this gives you some insight,
    FEL

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