Allergy Clinical Services

Food Challenge

What is a food challenge?

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.

What are the indications for doing a food challenge?

What factors should be considered prior to a food challenge?

What is my child’s risk of reaction?

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.

Does my child have to do this challenge?

What happens if my child has an allergic reaction to the food being tested?

What happens if my child gets sick before the challenge?

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.

Does insurance cover food challenges?

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

What medications can my child take?

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.

What medications should my child stop before a challenge?

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. 

How should you prepare your child the night before the challenge?

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.

Can my child eat breakfast prior to food challenge?

No. They may only have clear fluids from midnight onward the night prior to the challenge.

Who can come to the food challenge?

Due to limited space, we request that only 1-2 adults accompany your child. Please do not bring other children. 

What should I bring to the food challenge?

Toys/Distractions

You and your child will be here for several hours. Favorite toys, DVDs, books, electronics, etc., will help to stay occupied.

Snacks

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.

Lunch

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.

Change of clothing

For you and your child in case of vomiting.

Challenge food

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.

Where do I go on the day of the 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.  

What happens during a food challenge?

The total visit will last until after lunch (at times, a bit longer).

For IgE-mediated food challenge, the steps include:

For FPIES food challenge, the steps include:

What are possible outcomes of the food challenge?

There are three possible outcomes following a food challenge:

  1. Your child will have an allergic reaction. He will need to continue to avoid the food.
  2. Your child will tolerate the food. He will hold off on ingesting more of that food on the day of the challenge, but will then be instructed to keep the food in his diet. (For FPIES, you will be given a protocol outlining how to continue adding the food into your child's diet over the next several weeks.)
  3. Your child refuses to eat a sufficient amount of the food, making the challenge results inconclusive.

What can I expect after the 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.

Contact us

For scheduling, questions or to talk to the allergy office/physician-on-call: 215-590-2549


Reviewed by:
Allergy Clinical Team
Date: January 2014

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