Food Challenges - Allergy Physicians Calgary (403-ALLERGY)

ORAL FOOD CHALLENGES

If you were advised by us that you or your child is eligible for an oral food challenge, please read this section

What are Oral Food Challenges and when is it recommended?

If allergy test results and medical history do not show for certain whether or not you have a food allergy to a specific food, we recommend that you have an oral food challenge test. This is typically to determine if you still are allergic to a particular food.

The oral food challenge involves eating a serving of the allergic food in a slow, graded fashion under medical supervision. The food challenge procedure is the most accurate test to determine whether a food needs to be avoided or can be reintroduced into your diet.

The food challenge is undertaken when you are in good health and can discontinue antihistamines for 7 days before the test. Please note as mentioned below that YOU will need to bring the food to the appointment for which you are scheduled to be orally challenged.

What are the alternatives to an Oral Food Challenge?

If you choose not to have the oral food challenge, the safest thing to do is to completely restrict the food in question from your diet.

What will happen during the Oral Food Challenge?

During the food challenge, you will be given very small amounts of the specific food being tested. If tolerated, increasing amounts of the challenge food will be given with close observation at each stage.

You will be observed for symptoms such as itching, rash, abdominal pain, or difficulty breathing. If any symptoms develop, you will be treated immediately. In most cases, this will involve the use of and antihistamine or epinephrine to prevent any allergic reactions from getting worse. In studies of food challenges, many develop mild symptoms during a food challenge that require these treatments. Very rarely, other treatments are needed for more serious reactions.

In some cases, the food challenge is performed by masking the food to hide the taste, and using food that looks/tastes the same but does not contain the food being tested (placebo). These procedures reduce the possibility that we would misjudge a reaction to the food that could occur from fear or distaste of the new food.

What are the risks or discomforts of an Oral Food Challenge?

The discomforts associated with the food challenge are generally no more than those encountered when eating the food. Symptoms usually are short-lived (less than 2 hours). Symptoms may include an itchy skin rash, nausea, abdominal discomfort, vomiting, diarrhea, stuffy "runny" nose, sneezing, or wheezing.

The major risks involved include severe breathing difficulties and rarely a drop in blood pressure. While a severe outcome such as death is theoretically possible, this is exceptionally rare (has occurred one time in last 50 years in the United States)

The risk of a reaction is reduced by starting the challenge with very small amounts of food, administering the food over a prolonged time period and stopping the challenge at the first sign of a reaction, and by not giving any food suspected to cause a major reaction.

Medications, personnel and equipment will be immediately available to treat allergic reactions should they occur.

How to I prepare for an Oral Food Challenge?

It is important to be in good health the day of the oral food challenge. Sickness or stress to the body can cause you to react badly to oral food challenges.

Be prepared to stay for half the day in our clinic. The challenge takes two hours and you need remain an additional two hours for observation in our clinic. These are approximate times, so please plan accordingly.

Medication:
Epipen: Bring your epipen to the appointment. You will need to carry it with you the full day of the challenge. Delayed reactions can occur up to 24 hours later You are responsible to bring the foods that you wish to be challenged with to the clinic.

Allergy medication: Antihistamines should be discontinued 1 week before the challenge. The medication can mask a potential reaction the day of the challenge, making it difficult to recognize progressive anaphylaxis.

Health:
You much be in good health the day of the challenge. No fever, no cold symptoms, no rashes. If you have eczema, ensure that you are currently not having a flare. You can continue your eczema steroids.

If you have asthma, you should be well. If you needed to use ventolin (blue puffer) more than twice in the last 24 hours, please call us a few days before your scheduled oral challenge to discuss whether it is still safe to go ahead.

If you are on a beta blocker medication (such as propranolol), you must let us know immediately. Beta blockers can make anaphylaxis difficult to treat and it may not be safe to go ahead.

Meals
No alcohol 48 hours before the oral food challenge.
No food 4 hours before the challenge.
In infants, a small meal, such as milk can be given 2 hours before the challenge. You are welcome to bring your child's cutlery should you wish to make it less anxiety provoking to him or her.

Other:
Loose clothing should be worn, such as pyjamas or sweat pants so that medical evaluation and treatment can occur rapidly if required.

Food:
See the figure below for quantities and please bring double the highest dose listed (such as 2 slices of french toast or two scrambled eggs). This is to ensure that we have adequate amount of food available, should you our your child spit out some food or you/we drop it. Without the challenge amount, we will not be able to perform the challenge successfully.

When preparing the food, prepare the food as simple as possible. Scrambled eggs for instance: oil, eggs and salt if needed. No other ingredients. Our goal is to ensure that the challenge is to the food in question and not to other foods.

For peanut challenges, you can alternatively bring M&M chocolate covered peanuts (yellow bag), provided your child has had chocolate before and tolerated it well. This may be done in instances when children cannot tolerate the texture of peanut butter.

Why did the allergist suggest a BAKED egg or BAKED milk challenge?

The majority of patients who allergic to egg or milk are able to eat and tolerate baked products just fine.
Children with egg and milk allergies who eat baked egg or baked milk (such as cakes or muffins) regularly in their diet can outgrow their egg and milk allergies faster than if they strictly avoiding all milk or egg products including in baked form.

We therefore recommend most patients who have been found to be allergic to milk or egg have a baked challenge. There are exceptions of course (such as infants and patients with a sIgE > 30 kU/L) and do not embark on a challenge without our assessment and advice.

Do you have recipes for a BAKED egg or milk challenge?

Yes. Similar to any other oral food challenge, you would need to prepare the food and bring it to your appointment. You must have eaten and tolerated all those ingredients in the baked product previously, with the exception of egg or milk, depending on what you are being challenged to. While you can change, add or remove ingredients listed, the amount of egg (or milk for a milk challenge) should remain the same.

The baked egg recipe can be printed here
The baked milk recipe can also be printed here

Hours of Operation:
Monday 0800-1500
Tuesday 0800-1500
Wednesday 0800-1500
Thursday 0800-1500
Friday 0800-1200
Weekends and Holidays: closed

Address:
Allergy Physicians Calgary
5918 - 3rd St SW
Calgary T2H 0H8

Telephone:
403-ALLERGY (403-255-3749)
Facsimile:
1-833-816-5734
(Second fax line: 403-457-8237)

Drs. Hadi, Hinther and Almatrafi are medical sub-specialists and per Alberta Health regulations see patients via referral only. If you have an emergency, please call 9-1-1 or go to the nearest hospital. If you have an urgent or semi-urgent medical need, please see your primary care physician for evaluation or advice.