Preparing for an Oral Food Challenge

What is an oral food challenge?

An oral food challenge (also called a food challenge) can help your allergy team figure out whether your child is allergic to a certain food. During the challenge, your child will eat small amounts of the food they are being tested for, while the care team monitors (regularly checks) for signs of an allergic reaction. If your child does not show signs of an allergic reaction, they will continue to eat slightly larger amounts of that food. Your child will then continue to be monitored by the care team until they are ready to go home.

How long is the food challenge?

Food challenges take about 4 hours to complete. This includes having your child eat the food being tested and having the care team observe your child. If your child has a reaction, you may need to stay longer than 4 hours. If you need to cancel for any reason, please let the care team know at least a week in advance. This will allow the care team to offer the food challenge appointment to another child.

Can I be with my child during the food challenge?

Yes. Two adults (including a parent or guardian) can stay with your child during the food challenge. No other family members, including siblings, are allowed.

If my child is hesitant to eat the food they are alleric to during the food challenge, what should I do?

It is normal for children to feel hesitant or nervous about eating the food they may be allergic to. This is especially true if they have completely avoided that food for a long time. The taste and texture may also be challenging for your child.

Usually, the care team can help your child cope with these feelings before or during the food challenge. If you feel unsure about your child’s feelings or hesitancy toward the food or food challenge, please let the care team know at least a week before the food challenge.

How do I prepare for the food challenge?

5 days before the food challenge

• Stop all antihistamines for 5 days before the oral food challenge. Common antihistamines to stop taking before the food challenge include:
• Cetirizine (Zyrtec®)
• Diphenhydramine (Benadryl®)
• Desloratadine (Clarinex®)
• Fexofenadine (Allegra®)
• Hydroxyzine (Atarax®, Vistaril®)
• Levocetirizine (Xyzal®)
• Loratadine (Claritin®)
• If your child takes an antihistamine or other medication (such as over-the-counter cough and cold medications) that is not on this list, ask the care team if your child should stop taking it.
• It is okay for your child to continue taking their other medications as needed, including their regular asthma medications.
• If your child is having any health problems the week before the food challenge, please call the Food Allergy Center at 617-643-6834 to ask if the challenge should be rescheduled. Reasons to reschedule a food challenge might include illness with or without a fever, asthma symptoms, eczema flare, rash or severe seasonal allergies.

Day of the food challenge

Morning of the food challenge

• Make sure your child does not have any signs of illness the day of the oral food challenge appointment. Please call the Food Allergy Center at 617-643-6834 to reschedule the appointment if your child is ill or has any of the following symptoms: fever, cough, wheezing, hives, vomiting or diarrhea.

Two hours before the food challenge

• Your child can have a small meal the day of the challenge. They should not eat for 1-2 hours before their challenge appointment time. This small meal should be something your child has eaten before with no allergic reaction.

When you arrive at the hospital

• Please arrive 15 minutes before your appointment time. The food challenge will take at least 4 hours. If your child has an allergic reaction, the appointment may take longer.

During the food challenge

• The care team asks that families not eat during the food challenge. Your child will only be able to eat the food to be challenged, although the medical provider may say it is okay for your child to have a snack during that last hour of the observation. You should not give your child any food during the challenge until you have spoken with the team. You can bring a snack you know your child can tolerate.

What to bring to the food challenge

Please bring the following items with you to the appointment:

• ___ Two unexpired epinephrine autoinjectors (such as EpiPen®, Auvi-Q® or Adrenaclicks®)
• ___ The food to be challenged. Follow any instructions from the care team for preparing the food.
• ___ Change of clothing for your child and yourself, especially for infants and your children.
• ___ Things for you and your child to do to help pass the time.
• ___ Snacks for your child to eat during the last 1-2 hours of the food challenge. Snacks should be foods your child has eaten before with no allergic reaction.

What to expect for the food challenge

1. You and your child will be greeted at the front desk.
2. A care team member will check your child’s height, weight, temperature, pulse and blood pressure. A doctor will also do a brief exam and ask you to sign a consent form.
3. If your child is part of a food challenge study, you will meet the study coordinator. The study coordinator will ask you to read and sign a research consent form and short survey and will train you on how to use an epinephrine auto-injector (Auvi-Q®) in case of an allergic reaction.
4. The food challenge will begin. Your child will be given a very small amount of the food to be challenged while the care team carefully observes for signs of an allergic reaction. The doctor or nurse practitioner helping with the food challenge may or may not be your child’s regular allergy care provider.
5. The care team will check your child’s mouth and throat, skin, heart, lungs and breathing. They will also ask you and your child about nausea and abdominal (stomach area) cramping or other changes you might notice during the food challenge. This can include fussiness, irritability, anxiety or dizziness. Let the care team know if there are symptoms you or your child notice or feel.
6. If your child does not have an allergic reaction, they will be given a larger portion of the food to be challenged. This will be repeated a few times with even larger portions. These portions are given about every 15 minutes for the first 1-2 hours of the challenge. Then, your child will be observed for about 2 hours.
7. If your child has symptoms during the challenge, the care team will decide if the challenge should be continued or stopped. The team will observe your child more closely and may give your child medications to treat their symptoms. They will also decide if more medical treatment is needed.
8. If your child has a severe allergic reaction, epinephrine may be given. In rare cases, the care team may arrange to have your child transported to an emergency room to receive further treatment.
9. After the food challenge, a member of your child’s care team will discuss the results and make recommendations for your child based on the results.

Contact the Food Allergy Center

If you have any questions, please call the Food Allergy Center before or after the food challenge, send a message through Patient Gateway or call 617-643-6834.

Rev. 7/2021. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.