Hospital food challenges: information for children and their parents

What is a food challenge?

A food challenge is when your child is asked to come into hospital to eat a food that they have been allergic to, under supervision. This might be done where we think there is a strong chance that your child has outgrown their food allergy, but they have had a severe reaction to the food in the past. Or we might use a food challenge to assess whether your child has a specific food allergy where this is not clear from the testing that has been done already.

What happens before my child comes to hospital for a food challenge?

The food challenge will have been discussed with you in the clinic first. The team then meets to agree that a food challenge is appropriate and a suitable time and date will be booked for your child. You will receive a letter in the post, and a text reminder from our clinic closer to the date.

You will be telephoned approximately a week before the food challenge by one of the allergy team. They will be able to answer any questions you have and talk to you about the food you will need to bring in for the food challenge. You will also be informed whether you need to buy or cook any food specifically.

Please be aware that if your child is unwell (cough, cold, diarrhoea, sickness or with worsening asthma) we will not be able to go ahead with the food challenge. Please let the allergy team know as soon as possible if your child is unwell in the days before a booked food challenge so we can reschedule your appointment.

What will happen on the day of the food challenge?

Please follow the directions in your appointment letter to clinic 2A. Feel free to bring toys, books or games for your child. Older children could bring schoolwork or an iPad if preferred. Music might also be a helpful distraction. Don’t forget to bring yourself something to read!

Firstly, your child will be weighed and their observations (such as height, weight and blood pressure) will be taken. Your child will then start the food challenge. Once they have finished the food challenge, they will be observed for two hours to make sure they remain well. Please expect to be at the clinic for around four to five hours. Your child will not be able to attend school on the day of the challenge.

How will we give the food being challenged?

You will be asked to prepare a cake or some biscuits at home (for baked milk or egg challenges, and some nut challenges), or bring in the ‘pure’ food product (e.g. peanut, peas, beans). We will start by giving a very tiny piece of the food, and increase the amount given every 15-30 minutes providing your child is not showing any signs of an allergic reaction. This will continue until either your child shows signs of an allergic reaction, or they complete the portion of food with no signs of allergic reaction. If your child does have an allergic reaction, we will stop the challenge and give your child any treatment they need.

Can my child have anything else to eat during the challenge?

Ideally, only the food we are challenging on the day should be eaten while you are in hospital. However we recognise this isn’t practical for some children. Children should have their usual breakfast on the day of the challenge and if needed can have a light snack up to an hour beforehand. No other food can be eaten while we are increasing the amount of challenged food. After this, a low fat light snack (brought from home) may be eaten during the two hour observation period. All foods and drinks given should be items that have been consumed before without an adverse reaction.

What should I do if my child isn’t well on the day of the challenge?

Please contact us as soon as possible if your child isn’t well. Your child must not have a food challenge if they are unwell. If on arrival your child is showing signs of being unwell, with a cough or cold, or their asthma is not well controlled, they will not be able to proceed with the food challenge and will be asked to go home. We will then reschedule the appointment for a future date. Please contact us on 01223 348112.

Does my child need to stop their allergy medication?

Your child must stop taking antihistamines during the five days before a food challenge. These include:

• piriton (chlorphenamine)
• loratidine
• cetirizine
• fenofexadine

Some cold remedies and other medications also contain antihistamines and you should avoid these too.

If your child needs inhalers for their asthma they should continue to use these as normal. They can also continue to use any creams or topical steroids on their skin for eczema, and any other regular medication such as eye drops.

My child won’t eat the food they are being challenged to eat!

Many children find it difficult to eat the food they have previously been told to avoid. They may not like the taste, or they may remember that they had an allergic reaction to that food. If you think your child may have difficulty eating the challenge food please get in touch with the allergy team and we can discuss different ways in which we can give your child the food.

My child is feeling anxious about having a food challenge

We understand that this can be a daunting experience for some children. Please discuss any concerns you might have with the allergy team. They may be able to suggest some resources and strategies to help you and your child feel less anxious about the experience.

Please note that your child will be asked to continue eating the food at home regularly after the food challenge if they have no allergic reaction. If you feel they will be unable to do this, then please contact us as soon as possible to discuss whether a food challenge is still appropriate.

What happens after the food challenge?

If your child eats the full portion of food given with no allergic reaction, then they must continue including this food in their diet at least three to four times per week. They may then be able to increase this with time, with support from the allergy team.

If your child does not manage the full portion of food during the challenge, but has had no allergic reaction, then the team will decide on the day if they can continue eating this smaller amount at home.

In all cases, you will be provided with written information and contact details for the team, and your GP will be informed of the outcome of your food challenge. Your child will also be referred to the paediatric allergy dietitian for follow up six weeks after the food challenge for individual dietary advice.

Contact us

Paediatric allergy nurses: 01223 348112