What are food challenges?

If your child has food allergies, your doctor may recommend a food challenge.

Don’t worry; a food challenge isn’t an eating contest. Rather, during a food challenge, your child will eat a certain food in a supervised place like a doctor’s office. The results may confirm that your child is or isn’t allergic to the food.

Here’s what you need to know about food challenges.

What Is a Food Challenge?

A food challenge (also called an oral food challenge) is a medically controlled method of confirming food allergies, or to see if a child has outgrown a food allergy. Your child will start by eating a small amount of the food in question under medical supervision.

If they have no reaction, doctors will give them a larger amount of the suspected food in several doses. At all times, your child will be under the care of doctors and nurses in case of allergic reaction.

Any food can cause an allergy. But most childhood food allergies come from these categories.

  • Eggs
  • Fish
  • Milk
  • Peanuts
  • Shellfish
  • Soy
  • Tree nuts
  • Wheat

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Why Should My Child Have a Food Challenge?

A food challenge is the most accurate way of diagnosing food allergies, but most allergists use it as the safest way to see if a food allergy has been outgrown. Allergists refer to it as the “gold standard” of allergy testing.

To find out if your child is allergic to certain foods, doctors will start with skin and blood tests. But these tests for allergies don’t tell the whole story. They only show whether your body recognizes a food protein.

Your child may have a positive skin or blood test result but still be able to eat a certain food.

The most accurate way of telling whether your child is allergic to a certain food is through a food challenge.

Here are a few scenarios where a food challenge is appropriate:

  • Your child has tested positive for a food allergy (through a skin or blood test) but has never eaten the food.
  • The allergy tests and your child’s history don’t match up.
  • You think your child may have outgrown their food allergy.

What Happens Before, During, and After the Food Challenge?

You will need to plan ahead for the food challenge. You and your child should clear an entire day free from school, work, or other obligations.

Before the food challenge

Your child’s doctor will give you instructions on stopping certain medications (like antihistamines) a few days before the test. Some medicines may interfere with test results.

If your child is sick or getting over an illness, you will need to reschedule the test.

Most food challenges take three to six hours. You may need to be there longer if your child has an allergic reaction. You and your child should expect to spend most of the day in the doctor’s office or clinic.

During the food challenge

You may need to bring the foods for testing. Your doctor will give you instructions on how much to bring, and how to prepare it.

At the start of the test, a nurse will give your child a tiny portion of the suspect food. They will watch carefully for reactions.

If no symptoms develop in 15 to 30 minutes, they’ll give your child a larger portion. This process will continue until your child consumes a meal-sized portion of the food.

There are three types of food challenges:

  • Open challenge — the child knows they’re eating the challenge food. This is the most common type of food challenge.
  • Single-blind challenge — the child doesn’t know if they’re eating the challenge food or a placebo. Doctors may hide it by adding it to another food. Doctors use this method if a child has anxiety about eating the challenge food.
  • Double-blind challenge — neither the child nor the person giving the food know if it’s a challenge food or placebo. (A second health care professional keeps track of foods given.) This method is usually reserved for food allergy research purposes.

After the food challenge

You and your child will stay at the doctor’s office at least an hour for observation. If your child had an allergic reaction, you may need to stay for a few hours.

Are There Risks to Taking a Food Challenge?

It’s possible your child may have an allergic reaction to a food during the food challenge. Nurses and doctors will watch closely and administer emergency medication if that happens.

Food allergy symptoms include:

  • Hives.
  • Wheezing.
  • Swelling of the face.
  • Trouble swallowing.
  • Itching.
  • Runny nose.
  • Cramps.
  • Vomiting.
  • Diarrhea.
  • Anaphylaxis, a life-threatening allergic reaction.

Medications to control an allergic reaction include epinephrine, antihistamines, steroids, and albuterol. The medical team may have an IV line for fluids or medication ready if necessary.

In rare cases, the medical team may take your child to the emergency department or admit them to the hospital for observation.

Benefits of a Food Challenge

If your child has food allergies, life can be challenging. You need to be careful about anything your child eats, in and out of the home. Eating at school and other outings always carries an element of risk if your child should have an allergic reaction.

A food challenge is more accurate than blood or skin tests at diagnosing food allergies. No matter what the results of the food challenge, parents have greater peace of mind knowing what may trigger an allergic reaction.

If your child is not allergic to the food, you can add it safely to their diet. Or, if your child is allergic, you can avoid that food in the future. You’re no longer in doubt.

One caveat: You should never attempt a food challenge at home. It’s important to be in a medical setting with trained professionals and medical help available if need be.

American Academy of Allergy, Asthma, & Immunology, What Do Patients and Caregivers Need to Know about Oral Food Challenges? Link

Food Allergy Research and Education, Oral Food Challenge, Link

Asthma and Allergy Foundation of America, Oral Food Challenges for Diagnosing and Confirming Food Allergies, Link

National Library of Medicine, Oral Food Challenge, Link

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.