May is Food Allergy Awareness Month. According to FARE, the Food Allergy Research & Education organization, food allergy is a severe medical condition affecting up to 15 million Americans, including 1 in 13 children.
My son is one of them. Two years ago, he was diagnosed with severe allergies to milk, eggs and peanuts – three of the FDA-defined top eight food allergens, which also include wheat, soy, fish, shellfish and tree nuts. We learned this when he was just four months old and I tried to supplement nursing with formula. Almost immediately, his skin swelled with hives, and he became very ill. Skin scratch tests and blood tests with the allergist confirmed these food allergies and the potential for an anaphylactic response.
Since then, we have been armed with an epinephrine auto-injector and completely eliminated these foods from his diet, meeting with a pediatric allergist who regularly orders bloodwork to check his progress. One of the first questions I asked the allergist was if my child is likely to outgrow his food allergies.
Will My Child Outgrow the Food Allergy?
Many children outgrow a food allergy. Research shows that 15 to 20 percent of children allergic to peanuts will outgrow their allergy, and 85 percent of children allergic to milk, soy or eggs will outgrow their food allergy within childhood or adolescence. Many factors seem to impact the likelihood of outgrowing a food allergy. For instance, FARE cites that children with a history of mild reactions, allergy to only one food, and eczema as the only symptom are more likely to outgrow a food allergy than children with more severe symptoms (i.e., trouble breathing, swelling and anaphylaxis) and multiple food allergies. Additionally, the earlier a child’s first reaction, the more likely that child is to outgrow the allergy.
Good news came when my son’s most recent blood tests indicated increased probability of tolerance for egg. His antibody titers reached a range acceptable to proceed with a medically supervised baked egg challenge, so our allergist ordered an oral food challenge to determine if he had outgrown his egg allergy.
What is an Oral Food Challenge?
According to FARE and University Hospitals Rainbow Babies & Children’s Hospital, an oral food challenge is a highly accurate diagnostic test for food allergy conducted by an allergist in a controlled and monitored clinical setting. During the food challenge, the allergist feeds the food in measured doses, starting with very small amounts. After each dose, there is an observation period for any signs of reaction. This typically takes place over several hours. Larger doses are gradually given if there are no symptoms. If any signs of a reaction are shown, the food challenge is stopped. A successful food challenge confirms the child has outgrown the food allergy and the food can be safely reintroduced into the regular diet.
Tips for a Smooth Food Challenge Experience
My family is still relatively new to this food allergy journey. It's been a lifestyle change and ongoing learning experience, but along the way I've discovered some methods that have helped manage my toddler’s needs and prepare for the road ahead.
The food challenge we completed recently went more smoothly than I could have imagined. Of course, each case is unique and protocols will vary, so you should consult with your child’s allergist or physician regarding food allergy testing. Here are some things we did before, during and afterwards to help make our food challenge experience less challenging.
1-3 Weeks Before
Practice. After I received the muffin recipe from the allergist, I bought all of the ingredients and did a trial run to make sure: A) I could make the muffins (I’m not a baker), and B) my picky toddler would eat muffins (he hadn’t in the past). The recipe was clear and easy to follow. Since I had to use egg replacer until the food challenge, I tried batches with flaxseed eggs and store bought egg replacers to see which I preferred.
If permitted, adjust the recipe to your taste preference. To make the muffins more appealing to my son, I altered the recipe a bit with permission, of course, from the allergy nurse (whom I was on a first name basis with following all of my inquiries to her office). Much to my excitement, my son enjoyed a few bites of the banana nondairy chocolate chip applesauce muffins, and my family ate the rest.
Plan ahead for any lab visits. The allergist requested my son have another blood test to confirm we could proceed with the challenge. Since the allergist’s office had applied a numbing agent to my son’s arm before blood draws conducted at their facility, and this time we would be going to a different lab, I requested a prescription for a topical analgesic and ultimately purchased and applied an over-the-counter version myself (held in place by plastic wrap and medical tape). I had my husband who is stronger than I am hold my son while the lab technicians worked, and I distracted him with books, stickers and a snack afterwards. He didn’t even wince.
Stay well, but don’t use antihistamines. I did my best to keep my son well before the big day, giving him his usual vitamins and keeping him away from anyone sick (even more vigilantly than usual), since he had to be healthy to take part in the challenge. Although allergy season was getting into full swing, I did not administer any antihistamines a week beforehand, per the doctor’s instructions.
The Day Before
Prepare the food, and pack your bags.I made the official batch of six muffins the evening before the appointment and gathered mix-ins like applesauce and sunflower butter, in case we needed to get creative to encourage my son to eat them. I also packed our own utensils, plates and sippy cups to make the experience more familiar in a new environment. Since we had to wake up very early (these are typically scheduled first thing in the day), I laid out our clothes and packed our bags the night before. This included my son’s favorite travel-friendly toys, puzzles and an extra outfit (in case he got sick or messy), in addition to the usual diaper essentials, wipes and medications.
Keep your routine consistent, but get a good night’s rest.I gave my son an evening bath and bedtime snack as usual. We started the routine a little earlier than normal but didn’t want to throw off his typical schedule. Since he would be fasting the next morning, we wanted him well fed the night before.
Discuss plans for the next day. My son is too young to have a conversation about the experience, but some children, particularly older ones, may benefit from a discussion. My husband and I, however, mapped out the office location and talked about our plans.
The Day Of
Out of sight, out of mind. My son is a big breakfast eater and wants to eat when we do.Eat your breakfast where your child can’t see you, since he or she will be fasting. I put our food away before my son came into the kitchen. Even then, we quickly shuttled him past the fridge and into the car. I went so far as to use new travel cooler bags so he didn’t recognize them as his usual “snack packs.” During the car ride, we distracted him with toys and books to keep his mind off his hunger.
Keep things positive.I was nervous but tried to keep things light and fun. Since my son is only two, it was best to tell him we were “taking a fun car ride” and “going to go play with some new toys.”
Pack the challenge food and other food for afterwards. Don’t forget to bring the suspect food for the challenge as well as any coffee, water and snacks for yourself and a meal for your child for when the challenge is over.
Make things easy on yourself. Don’t try to do too much. We blocked the entire day for this event, not knowing exactly how long it would take or how my son would feel afterwards. My parents watched my four-year-old daughter, and we valet-parked the car at the medical facility, so we could easily walk in as a family.
Try to relax. You’re in a safe place. The challenge itself turned out to be harder on me (and my nerves) than on my son. I breathed a huge sigh of relief when he took that first bite. I closely watched his face and inspected his skin throughout the process. It was comforting to have the doctor stop in often to check on progress and advise on how much more to give him and when. The constant presence of the nurse also put me at ease.
It’s a marathon, not a sprint. We were at the allergist’s office a total of four hours, including initial waiting time before the challenge began. We were put in a special room dedicated to such testing that included toys, a television, comfy chairs, a sink and separate restroom. The doctor started by introducing a quarter of the muffin. My son took his first bites right away, but we had to be patient while he “grazed” throughout the morning, alternating between eating and playing. The sunflower butter-coated muffin and mashed muffin smoothie made for a winning combination.
After the Challenge
Have other food ready. Aftereating one and a half muffins, my son was pretty full. However, he munched on snacks during the final hour of observation after the last dose was eaten. By then he was tired of muffins and looking for something else.
If all goes well, celebrate. Our experience went so smoothly, and our son napped on the way home, so we treated ourselves to lunch. He was still full and disinterested in eating more, so he occupied himself with the crayons and other activities while my husband and I ate. I even gave my son a toy surprise when we got home, because he was so cooperative.
If the challenge is stopped, don’t get discouraged. Results vary.I hope your food challenge goes as well as our first one did, but if it doesn’t, don’t worry. If reactions are shown, most are mild. Severe reactions are uncommon. If the food allergy is confirmed, the doctor will discuss avoidance techniques and prescribe medications as appropriate. Ask questions and plan for any next steps.
Follow your doctor’s orders. We were advised by the allergistto continue feeding my son baked egg and hope to conduct a challenge for peanuts in the near future. Always consult with your child’s physician regarding food allergies and use your own judgement on food safety.
Additional information on oral food challenges and food allergy resources can be found at the following links:
University Hospitals Rainbow Babies & Children’s Hospital
FARE, Food Allergy Research & Education