FOOD CHALLENGES
FAQ
Why are food challenges performed?
Food challenges are performed to demonstrate that a person does not have a food allergy. This might be because they have “outgrown” their known food allergy or to prove they are not actually allergic to the food they are avoiding. Sometimes food challenges are performed so that a modified form of the food (e.g. egg or dairy in “baked goods” such as muffins) can be shown that it can be tolerated and included in the diet.
Can my child have a food challenge?
Challenges can only be arranged after an appointment with Dr Nickolls. If the likelihood of the person being allergic to the suspected food is low, then Dr Nickolls will suggest a challenge (or may recommend home introduction of the food). Factors to consider when deciding to go ahead with a challenge include whether your child will actually eat the food during the challenge, or if including the food in your child’s diet is going to make a significant difference to their life. There is no point having a food challenge if the food is not incorporated into the diet on a regular basis. This is due to the risk of re-developing a food allergy if the food is still avoided for a long period of time.
Will the food challenge determine if my child is “anaphylactic”?
No. Food challenges are performed to work out if a person has an allergy or not. Challenges are stopped as soon as a person shows signs of an allergic reaction. This may be after only a very small dose of the food, so they might only have a minor reaction. It is possible that if they ate more of the food they could have a more severe reaction or anaphylaxis.
A food challenge can have 3 outcomes:
1) Negative challenge, i.e. no allergic reaction. This means the person has “passed” the challenge, and can now safely include the food in the diet as they are not allergic.
2) Positive challenge, i.e. allergic reaction. This means the person has “failed” the challenge, and should continue to avoid the food because they are allergic to it.
3) Incomplete challenge, i.e. the person does not eat enough of the challenge food to be able to determine the outcome. In this case the food needs to be continued to be avoided, until another challenge can be arranged when appropriate.
What are the risks of a food challenge?
Challenges are performed in hospital because there is a risk of an allergic reaction occurring, which can vary from mild (e.g. rash, swelling, vomiting) to severe (anaphylaxis). The risk of any reaction occurring – particularly a severe reaction – is relatively low, because:
1) A challenge will only be arranged if the history and timing of previous reactions and the skin prick test indicates that the risk of allergy is low
2) On the day of the challenge, the person having the challenge will be assessed by a doctor and nurse to ensure the challenge can be commenced
3) Strict food challenge protocols are followed
FOOD CHALLENGE - 10 POINT CHECKLIST
1. Book challenge with Dr Claire Nickolls
2. Complete admission paperwork for North Shore Private Hospital at least 2 weeks prior
Complete the General Admission Form as soon as possible to ensure health fund checks or self-funded estimates (if you don’t have private health cover) are completed at least 2 weeks prior to the challenge date. This form is online (www.northshoreprivate.com.au) or phone (8425 3000) or email (nspbook@ramsayhealth.com.au) to receive a hardcopy.
3. Inform Dr Nickolls or North Shore Private Hospital if unwell in the two weeks before the challenge
Please inform Dr Nickolls or the hospital if your child has any illness (e.g. asthma, fever, viral infection) in the 1-2 weeks before the challenge or the day of the challenge, as it may need to be postponed. Please call Dr Nickolls on 8052 4199 or the hospital on 8425 0000 or 8425 3178 (after hours) to discuss.
4. No antihistamines for 48 hours prior to challenge
Regular medications (e.g. asthma preventer, nasal spray, eczema creams) can be taken as normal
5. Generally only one parent/carer can attend the challenge
6. Don’t eat too much breakfast
7. Arrive on time – 7.45am for 8am start
Food challenges take ~5 hours, so please arrive on time. Check in and receive paperwork at the Theatre Admissions Desk on level 1, then you will be directed to the Short Stay Unit where the challenge will occur.
8. Bring challenge food
You need to bring the food your child is being challenged with (see list below), as well as any other food/drinks they would like. Sometimes the challenge food needs to be hidden in other yummy foods if a child is not keen to eat it. Don’t mix the challenge food in with anything before the challenge, because the amount given for each dose needs to be measured before the challenge starts. If your child is having a milk or soy challenge bring their usual sippy cup or bottle. Don’t worry if your child can’t eat whole nuts, they can be crushed up during the challenge and mixed in with other food. Check the table below for what to bring, or discuss with Dr Nickolls if you are unsure.
9. Bring other food and activities to keep you and your child entertained
10. Bring referral letter, Medicare card, Health Fund card
Challenge food
What to bring
Egg
2x raw eggs
These will be “scrambled” in the microwave and one will be used for the challenge (the other is a spare)
Baked egg
2x home-cooked muffins
You will be provided with a recipe to make these muffins. Please follow the instructions and quantities exactly. One will be used for the challenge (the other is a spare)
Milk
Cow’s milk or cow’s milk formula (200mL)
Yoghurt (1 tub) can also be brought as a back-up
Baked milk
2x home-cooked muffins
You will be provided with a recipe to make these muffins. Please follow the instructions and quantities exactly. One will be used for the challenge (the other is a spare)
Soy
Soy milk or soy formula (200mL)
Peanut
Peanut butter (small jar) or whole peanuts (at least 20 nuts)
Walnut
10 whole nuts
Almond
20 whole nuts
Hazelnut
30 whole nuts
Brazil nut
10 whole nuts
Cashew
20 whole nuts
Pistachio
40 whole nuts
Pecan
30 whole nuts
Macadamia
20 whole nuts
Pine nut
200g
Sesame
Sesame snaps or humus or tahini
Sesame seeds on bread roll
Bread roll with sesame seeds on top, e.g. hamburger bun
Fish
~100g serving of cooked fish
Tinned tuna
95g tinned tuna
Prawn
6 cooked prawns
Wheat
1 cup of wheat flour and/or 2 slices of bread