We have personally done 4 Oral Food Challenges as of this writing and we think we are beginning to understand how they work. We have had 2 successful passes and 2 fails (one is a semi-fail). Just so you know, this is considered the gold standard as far as figuring out what your child is actually allergic too. The problem with the blood tests and the skin tests is that they really are only 40-60% effective. Or, according to this article (and Dr. P- Our Allergist Immunologist) there is a 50-60% chance of a false positive occuring. Which means that the test will say your allergic…when you really are not. The reality is that there is no better test than the child ingesting the food in question and watching for a reaction.
So, on the day of the challenge you will need to bring some version of the allergen that your child can eat. If you would like to know what we brought on various ones of these, you can reference the links below and get a good idea of what it entails. Anyways, you need to bring at least one serving of that allergen. It can be in something (e.g., bread, a cookie, a muffin, a paste, etc.), but it just needs to be 1 ADULT serving size, or greater. The Allergist/Immunologist will take it from there as they separate the different quantities for consumption by your little one.
Make sure when you schedule an oral food challenge that you plan to be at the doctors for a minimum of 4 hours, and most likely for the entire day. They never go as quick as you think they will, and they almost always have some surprises along the way.
So, once you are at the doctors you will need to provide the allergic food for your child to eat. Here’s what we’ve done so far as of this writing:
Baked Egg Challenge: Made muffins with egg in them according to this recipe.
Pistachio Challenge: We made this concoction of ground pistachios and organic dates.
Wheat Challenge: We bought Wheat Chex from the store.
At the doctors they will give you an exam room that you will be in, basically for the entire time. We walk laps with our kids around the center part of the office where we take it, or this is a great opportunity to actually let your kid watch a phone or an iPad (my wife is normally against this, but the stress makes it so that we save it for this time only).
They will look over your kids skin, ask if he/she has been sick lately, and then proceed to go and divide up one serving of the food you brought into doses that equal roughly the following proportions of an adult serving size.
1/64
1/32
1/16
1/8
1/4
1/2
The following is a crucial bit of information if you are going to do an oral food challenge:
Essentially, you want your child to be starving when you get to the test!
It is crucial that they are able to do that 1/2 portion when you get to it. For our son, the first time he took the baked egg challenge, he basically passed, but they couldn’t quite pass him because he didn’t finish enough to “Pass”.
…So, we learned our lesson and we are warning you.
Ok, moving on. They will have your child eat those various portions in succession starting with 1/64 and ending with 1/2. They space each feeding 20 min apart and check for any reaction for the entire time between these portions. This is where it gets a little stressful because as you sit there, your child gets anxious, might get itchy, they could even have something as serious as anaphylaxis occur. So, your job is to distract and play with them for those 20 min until they bring in the next round of edible goodies (potential allergens). If you are lucky, your wonderful doctor will provide a play-mat and sometimes a couple toys. PRO TIP: Bring toys for your child to play with!
If your child goes the distance and gets through all of the portions listed above, that is when the true waiting starts. You have to be there for observation for 2 hours after your allergy prone child finishes the last bite of the last serving (which is that 1/2 serving size).
If there is no reaction within 2 hours…YOU PASSED!!! You will then be instructed to continue feeding that allergen for up to 3 times a week following the challenge, and eventually your child will be considered not-allergic to that food! Congrats if you make it and pass…it is a wonderful feeling.
It may sound strange to you, but it is so much fun to sit outside and shell pistachios with our little one, or to give him muffins with baked egg. We are planning to continue these as long as we are able and excited to see what else he can pass in the near future.
We hope this was informative, please feel free to ask any questions in the comments. But first, a questions from us…
Are you planning on doing any Oral Food Challenges with your allergic child?
Comment below please!
