A food challenge is the best test to see if your child has outgrown a food allergy. Only one food can be tested at a time. During the challenge, your child will be given small but increasing amounts of the food and monitored very closely for any reaction. By the end of the day, your child will need to ingest a serving size of the food in question.
Your child ideally should have at least a 50 percent chance of passing the challenge. This is the case for almost all children who have only had a positive skin test but no clinical history of having reacted to the food in the past. For other children, the risk is estimated based on allergy testing, previous severity of reaction, and the passage of time. You may want to discuss your child’s specific risk with your allergist prior to the food challenge appointment.
Please call and cancel the challenge. Allergic reactions can be more serious in a child who is already sick. We cannot perform a food challenge on a child if he is sick, recovering from a recent asthma flare (asthma symptoms within 1-2 weeks), or has a severe eczema flare/rash.
If your child arrives and is sick, a challenge will not be performed.
If you are unsure or have questions, please call us. If your child is sick on the day of the challenge, please call our office to reschedule. You should not bring your sick child to food challenges for examination; instead, we may be able to help schedule an office visit if necessary.
Prior to the date of the visit, our staff can provide you with the necessary procedure codes to share with your insurance company. Please contact your insurance company to discuss insurance coverage and the possibility of out-of-pocket expenses. If your insurance plan requires referrals from your primary doctor, please be sure to get one before your visit.
For more information about your financial responsibilities and a list of resources available to you for insurance- and billing-related questions, please see Financial Matters.
Your child should continue to take maintenance asthma medications (like Flovent, Advair and Singulair). If your child is on other medications for other conditions, please let us know. If there are specific questions, please call us.
Your child should stop taking all antihistamines prior to the challenge. Remember, many over-the-counter cough and cold preparations contain antihistamines, which need to be stopped three days before challenge.
Stop these medicines three days before the challenge: Allegra (fexofenadine), Zyrtec (cetirizine), Xyzal (levocetirizine), Benadryl (diphenhydramine), Atarax (hydroxyzine) and Periactin (cyproheptadine).
Stop Claritin (loratadine) seven days before the food challenge.
Asthma medications: Do not give Albuterol, Xopenex or other rescue inhalers on the morning of the challenge. If your child needs them, please call to cancel the appointment.
Your child may not have anything to eat after midnight the night before the test. During this time, you may give your child clear liquids only. If your child is still breastfeeding, she may continue prior to the food challenge.
Clear liquids include: water, apple juice, fruit juices with no pulp, iced tea, Gatorade, Jell-O, popsicles or water ice without fruit chunks. The following are not clear liquids: milk, formula, orange juice, soda and hot cocoa.
No. They may only have clear fluids from midnight onward the night prior to the challenge.
Due to limited space, we request that only 1-2 adults accompany your child. Please do not bring other children.
You and your child will be here for several hours. Favorite toys, DVDs, books, electronics, etc., will help to stay occupied.
Bring about 32 oz. of clear liquids for your child to drink during the challenge. Juice boxes, Jell-O and other clear liquids as listed above are some good choices.
Bring lunch for you and your child. She may be permitted to eat lunch/snacks approximately one hour after the last dose of challenge food is given.
For you and your child in case of vomiting.
A nurse will contact you before the challenge to discuss exactly what type of food to bring for the challenge and how it should be prepared. We kindly ask that you also bring in the packaging in which the food came. It is very important to not bring foods that contain your child’s other allergens, as these will not be allowed.
If given instructions on how to prepare food for the challenge (such as with baked egg/milk challenges), it is very important to follow instructions exactly. If there are any questions, please call our office during business hours before to your scheduled challenge.
Report to the 2nd floor of The Children's Hospital of Philadelphia's Seashore House (Musculoskeletal Center) to register by 7:30 a.m. An allergy nurse will meet you in the waiting room to bring you and your child to the Day Medicine Unit, where the food challenge is performed. You may park in the Wood Building which will cost approximately $3; please bring your ticket to the office to be stamped.
The total visit will last until after lunch (at times, a bit longer).
There are three possible outcomes following a food challenge:
Once at home, there is a rare chance that your child will have a delayed allergic reaction to the food challenge. Contact your allergist or the allergist on call (215-590-1000 and ask for allergy physician on call) immediately if this happens.
Rarely, allergy may recur after a child has passed a food challenge. We therefore recommend that your child keep the specific food in his diet about three times per week. Recurrence of allergy has infrequently been reported, and these episodes were associated with infrequent ingestion or avoidance of peanut.
For scheduling, questions or to talk to the allergy office/physician-on-call: 215-590-2549
Reviewed by: Allergy Clinical Team
Date: January 2014