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Oral Food Challenges: the Gold Standard for Food Allergy Diagnosis

 

Has your allergist suggested an oral food challenge? The thought of feeding your child a food they may be allergic to can be scary. But an oral food challenge is the best way to confirm a food allergy diagnosis. And it can have benefits – whether you get the results you are hoping for or not.

What Is an Oral Food Challenge?

Simply put, an oral food challenge is where your allergist feeds your child a food to see if they have an allergic reaction. Oral food challenges are the gold standard of food allergy diagnosis. It is a controlled process done in your allergist’s office. There the staff can monitor your child for reactions, such as anaphylaxis. The test usually takes about three to six hours.

Before your child has an oral food challenge, your child’s allergist may do a blood test and a skin prick test to tell if your child's body recognizes a food protein. While valuable parts of diagnosis, positive results from these tests do not totally diagnose a food allergy. So an oral food challenge is the most accurate test to confirm a diagnosis.

The infant daughter of Denzel Blount, Controller for the Asthma and Allergy Foundation of America (AAFA), had a positive skin prick test to both peanut and egg, so her allergist recommended an oral food challenge to confirm her food allergy diagnosis.

“My daughter was 7 months old when she had an allergic reaction to egg, so her pediatrician recommended seeing an allergist,” Denzel said. “Knowing that she had already experienced an allergic reaction, the allergist recommended a skin test for common allergies, including both egg and peanut. We confirmed the egg allergy, but the doctor also recommended doing the oral food challenge for peanut while we were in the office because this was the most certain way to test.”

Why and When Should Your Child Have an Oral Food Challenge?

Getting an accurate diagnosis is critical. Food allergies can greatly impact a family’s quality of life, including socially, emotionally, and financially. Restricting your child’s diet without an accurate diagnosis can create unnecessary stress for you and your child.

Your child’s allergist may recommend an oral food challenge if:

  • Your child tested positive to a food but has never had a reaction
  • Your child has not had a reaction in a while
  • The results of their blood tests and skin tests have gone down

Harriet Spitzer-Picker has two sons with food allergies. They have done several oral food challenges as recommended by their doctor.

“We have done multiple food challenges for many reasons,” Harriet recalled. “We started doing them when my son was 2. He is now 14. When he was a baby, he had a long list of IgE mediated food allergens. Our doctor started offering food challenges based on blood test and skin test results. Our doctor felt the risk/reward was worth doing challenges. My other son also took part in an oral food challenge when he was younger as part of a baked milk study. Finally, my son also did yearly food challenges as part of the Viaskin milk patch study.”

You should only do an oral food challenge under the supervision of a doctor. Never attempt to do your own food challenge at home unless you are under direct instruction from your child’s allergist.

How Should You Prepare for an Oral Food Challenge?

You and your child will want to prepare for an oral food challenge at least a week or two in advance. Plan on spending much of your day at the allergist’s office. Make plans for someone else to watch other children or handle your responsibilities that day.

Your allergist’s office will probably give you some instructions and tips regarding what to bring, especially in regard to the food they will be testing.

Here are some recommended items:

  • Full change of clothes for you and your child in case your child vomits or gets the allergen on their clothing
  • A lot of distracting activities
  • Two epinephrine auto-injectors
  • Bottles of water – one for you and two for your child (so they will have a safe bottle if the challenge doesn’t go as hoped)
  • Safe snacks to eat after the challenge (you and your child will likely be hungry)
  • A large supply of wipes to clean items contaminated with the trial food
  • Plastic bags to contain soiled clothes or any items that get contaminated with the trial food

Oral Food Challenge Tips

  • Talk with your child’s doctor and ask questions in advance.
  • Find out when or if your child should stop taking antihistamines.
  • Avoid “pass/fail” language with your child.
  • Try not to get too nervous.
  • Ask “What did we gain from this challenge?”
  • Plan something fun for after the challenge.

What Happens If Your Child Has a Reaction?

Of course, there is a chance your child could have a reaction. The clinical staff will be prepared to treat any reaction your child may have. The doctor will decide if they should stop the test based on how severe the reaction is. If it is a minor reaction, such as a couple of hives, they may observe your child and continue. If your child has a severe reaction, they will stop the challenge and observe your child another hour or more.

“I felt comfortable with the test in this environment,” Denzel mentioned. “I had some nervousness given that my daughter was so young. However, confirming a common allergy in office with the doctor and staff present gave me some comfort.”

What Are the Benefits of an Oral Food Challenge?

If your child eats the food without reaction, the benefits are obvious. Your child can start eating the food according to your doctor’s orders.

But what if your child reacts? Remember, there are no bad outcomes from a food challenge. It confirms your child's allergy and lets you know for certain to continue to avoid it.

If you have an older child who was too young to remember their last reaction, you both have the chance to experience a reaction and know what to expect. And if your doctor allows you and your child to be involved in treatment – like administering epinephrine – you’ll get practice in a controlled environment with guidance from the staff.

All of this can be empowering and help reduce some stress that can occur when managing food allergies. Harriet feels that oral food challenges were helpful for a couple of reasons.

“The main benefit was being able to add foods back into his diet,” said Harriet. “The other benefit was that if we did have a reaction, my child was able to learn what a reaction feels like and how to treat it under controlled circumstances.”

How Is Life Different After a Successful Food Challenge?

Adding a food back to your child’s diet that was once considered harmful can be an adjustment. It can especially be challenging if you have another child who is allergic to the food or if your child does not like the food after tasting it. Ask your allergist for recommendations on how to include the food in your child’s diet and if there are limits to how much they should have.

“We were able to add soy, wheat, peanut, baked egg, eggs, almond, and now we are doing low-dose baked dairy – all because of oral food challenges,” said Harriet. “Doing the yearly blind challenge for the milk patch also helped us see if any improvement was made and establish tolerance level.”

oral food challenges for food allergies handout

Are you preparing for an oral food challenge or want to learn more? Download our FREE complete reference guide. It includes detailed information on how to prepare, how to talk to your child, what to bring and what to expect during a challenge.

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Kids With Food Allergies
A Division of the Asthma and Allergy Foundation of America
1235 South Clark Street Suite 305, Arlington, VA 22202
Phone: 1-800-7-ASTHMA (1.800.727.8462)
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