What To Expect When You’re Expecting…An Oral Food Challenge
Updated November 2022
If you or a loved one has a food allergy, chances are you’ve either experienced or discussed an oral food challenge (OFC) with your doctor. If you’re unfamiliar with this term, we’re here to fill you in!
To start, I have personal experience—my family has experienced a few of these with our food-allergic daughter. 💁♀️
Today, oral food challenges are considered the gold standard for food allergy diagnosis in children and adults. Skin prick and blood tests aid in the diagnosis, but they are prone to error—false positives are not uncommon (more on that here).
Typically, there are three reasons why you might do an OFC:
1. You or your child tested positive for a food allergy but have never actually eaten the food.
2. You or your child tested positive for a food allergy and have eaten the food before with no symptoms.
3. To see if you or your child has outgrown a known food allergy.
An oral food challenge is usually held at your allergist’s office over a few-hour period. The allergist administers tiny amounts of the potential allergen in gradually increasing doses over a set period of time (usually 3 to 6 hours). In my experience, the whole challenge from start to finish lasts around 4 hours. Once the full serving is administered, the doctor will typically observe the patient for a couple of hours to monitor for signs or symptoms of an allergic reaction. If symptoms occur at any point during an OFC, the challenge stops, and symptoms are treated immediately.
Importantly, not everyone is a good candidate for an OFC. According to allergist Dr. Jordan Scott, “When asthma is flaring or when patients are ill, we don’t challenge.”
OK, so let’s talk about what to expect.
First, block off the day, because even if the OFC is expected to last a few hours, the experience can be emotionally draining and stressful. Being prepared and understanding the purpose and procedure is incredibly important! Below you’ll find a list of things to prepare ahead of time, so you can tackle the challenge head-on.
1. ASK YOUR ALLERGIST WHAT THEY NEED YOU TO BRING
They may ask you to provide the food for the challenge, or their office may provide the food (we’ve done both). If you’re providing the food, double check you’ve done your homework to ensure it’s not processed in a shared facility or processed on a shared line with something else you’re allergic to. For example, when we challenged sesame a few years ago, we ensured the hummus we brought wasn’t processed in a shared facility with nuts, my daughter’s other allergen. We didn’t want cross-contact playing a factor.
2. ASK YOUR ALLERGIST WHAT YOU SHOULD STOP DOING
Ask your allergist what medicines you need to stop taking before the challenge. Our allergist requires we stop giving our daughter her daily antihistamines for seasonal allergies a few days before the challenge, because they can mask symptoms. Additionally, she cannot take any asthma medicine that day. However, if asthma symptoms start flaring, there’s a chance they’ll want to play it safe and reschedule your challenge anyway—clear communication with your allergist is key!
3. BRING LOTS OF ACTIVITIES FOR ENTERTAINMENT
If the trial is for a child, I’ve found new activities, games, and library books always help to hold their attention longer. Having a favorite stuffed friend or something the child associates with comfort is helpful too. If you’re an older child or an adult, a good book and your favorite digital gadgets will probably suffice!
4. PACK SAFE SNACKS
If the challenge goes well, you may be at the allergist’s office for several hours. However, the tiny doses of food your allergist administers aren’t likely to fill you up. We like to bring our daughter’s favorite tried and true snacks that we know are safe (another way to avoid bringing cross-contact into the equation!).
Since the challenge is at an allergist’s office, there will likely be patients in the near vicinity with food allergies. It’s an added bonus if you can bring foods that are free from the most common allergens: peanuts, tree nuts, fish, shellfish, wheat/gluten, egg, milk, soy, and sesame. I also bring disinfectant wipes in case the food spills so I can clean it up properly for the next allergic patient. Good food allergy etiquette is important!
5. BRING YOUR EMERGENCY MEDICATIONS
While this may seem unnecessary (hello, you’re at the allergist’s office! 😄), it’s important. There is always a small chance of a delayed reaction, and if that happens on the way home, you’ll want your epinephrine and antihistamines at the ready.
6. STAY CALM
If you’re a parent accompanying a child to an OFC, it helps to remain calm if your child experiences an allergic reaction. “If a reaction occurs, it is important for parents to remain calm because children can pick up on the anxiety and feed on that,” advises allergist Dr. John Lee. If your child experiences a reaction, Dr. Lee also suggests parents avoid calling it a “failed challenge” in front of their child, noting, “This can make a child feel as if they’ve somehow failed, or done something wrong.”
7. LEAVE THE SIBLINGS AT HOME
If the food challenge is for your child, it’s smart to leave siblings at home so you can stay focused—especially in the event of an allergic reaction. The best-case scenario is your child doesn’t have a reaction, and it ends up being quality time with your babe. If you’re an adult, you’ll still want to bring someone with you for support and to ensure you get home safely.
8. SET A COURSE OF ACTION/NEXT STEPS
Once the challenge is complete, talk to your allergist about the next steps. If the challenge went well, make sure you know how to proceed with exposure to the food moving forward. If it didn’t, they may recommend future testing and follow-up, and possibly strict avoidance of the food.
I hope you find these tips helpful! After experiencing my daughter’s first oral food challenge, I felt far better equipped to take on the next. 💪
— Meg and the Allergy Amulet Team