Oral Food Challenges

diagnosis

• Confirming food allergy when history is unclear
• Ruling out food allergy when testing suggests possible tolerance
• Evaluating resolution of food allergy (outgrowing allergy)

management

• Determining if strict avoidance is necessary
• Assessing tolerance to baked forms of allergens
• Evaluating cross-reactivity concerns

setting

• Must be performed in medical facility
• Emergency equipment and medications available
• Trained medical staff present
• Ability to treat anaphylaxis immediately

protocol

• Gradual, incremental dosing
• Observation periods between doses
• Stopping if any symptoms develop
• Emergency treatment plan in place

risks

• Allergic reaction possible
• Anaphylaxis risk (low but present)
• Requires medical supervision
• Cannot be done at home

medications

• Stop antihistamines 5-7 days before
• Continue controller medications (asthma, etc.)
• Discuss all medications with provider
• May need to adjust other medications

medical

• Well-controlled asthma (if applicable)
• No active illness
• Stable overall health
• Recent evaluation by allergist

day Of

• Fast for 2-4 hours before (clear liquids okay)
• Arrive well-rested
• Bring epinephrine auto-injectors
• Plan for several hours at clinic

during

• Continuous monitoring during challenge
• Assessment after each dose
• Vital signs monitored
• Observation for any symptoms

after

• Extended observation period after completion
• Monitoring for delayed reactions
• Clear instructions before discharge
• Emergency plan if reactions occur at home

duration

Typically 3-6 hours total, depending on protocol

pass

• No reaction to full serving
• Can safely include food in diet
• May need to continue regular consumption
• Follow-up instructions provided

fail

• Reaction occurs during challenge
• Confirms allergy - strict avoidance needed
• Treatment provided if reaction occurs
• Updated action plan provided