Oral Food Challenge

An oral food challenge is the best and safest way to find out if your child has a food allergy. During the test, you’ll stay with your child the whole time. The allergy team will watch them closely and treat any reaction right away. Some children react to a small amount of food. Others only react after eating more.

This test helps us learn:

• Your child’s risk for a reaction.
• What a reaction looks like, if it happens, how fast it ends, and how to treat it. 
• If they no longer have the reaction to the food.
• If the food can be added back into their diet.

Before the Test

• Help your child feel ready. If your child is old enough, tell them:
  • They will be safe.
  • The health care team will watch them the whole time in case there’s a reaction.
  • You will stay with them.
  • They may be able to eat more foods after this test if they’re not allergic anymore.
• Your child must be healthy and not sick for at least 24 hours before the test. If not, the test will be rescheduled.

Medicines to Stop Before the Test

Some medicines can hide early signs of an allergic reaction. For accurate results, your child may need to stop certain medicines. 

• 5 days before, STOP:
  • Cetirizine (Zyrtec^®)
  • Hydroxyzine (Atarax^®, Vistaril^®)
  • Loratadine (Claritin^®, Alavert^®)
  • Levocetirizine (Xyzal^®)
  • Fexofenadine (Allegra^®)
  • Desloratadine (Clarinex^®)
  • Diphenhydramine (Benadryl^®)
  • Cyproheptadine (Periacton^®)
• Day of the test, STOP:
  
  • Over-the counter NSAIDs like ibuprofen (Motrin^®, Advil^®) or naproxen (Aleve^®). It is okay to take acetaminophen (Tylenol^®).
  • Albuterol (Proventil^®, Ventolin^®), levalbuterol (Xopenex^®), or rescue inhalers.

Keep giving prescribed medicines, including asthma medicines and inhalers, eczema creams, ointments, and moisturizers, unless the allergy team tells you to stop.

What to Bring

On the day of your child’s test, it’s important to bring the following:

• Their epinephrine auto-injector (EpiPen^® or AUVI-Q^®). We may cancel the test if you don’t bring it.
• A change of clothes in case they throw up (vomit).
• A food they like to help mix with the test food.
• A safe snack for after the test.
• A comfort item like books, toys, or games. This is optional.

Test Day

Plan to be here for 3 to 4 hours. This may be longer if your child has an allergic reaction. Give your child a light breakfast the morning of the test. They should only be a little hungry.

• Your child will not be hooked up to any kind of machine.
• Small amounts of the food are given every 10 to 15 minutes.
• More food is slowly added. The team checks for signs of a reaction after each dose.
• After the last dose, our team will watch them for 1 to 2 more hours. If there are no symptoms, your child is not allergic to the food given.

Possible Reactions

Mild Symptoms

Medicine may be given to treat common mild symptoms, like itching, rash, coughing, or vomiting.

Severe Reactions

Severe reactions are rare. If needed, we will give epinepherine right away to treat allergic reactions, like trouble breathing, trouble swallowing, repeated vomiting, or passing out.

After the Test

• Most children feel fine and can return to normal activities.
• Delayed symptoms may happen later that day. This is rare.
• If your child had NO reaction:
  • We will update their medical record.
  • They can start eating that food.
  • Tell other providers and caregivers.

When to Call

Call the allergy clinic for mild delayed symptoms after you go home.

Use epinephrine and call 911 for trouble breathing, trouble talking, repeated vomiting, a swollen tongue, or a throat that feels tight.

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