My little lady has had a lot of food challenges in hospital in the past four years, and only one of them lead to a reaction (baked egg two years ago). So far, we’ve crossed a few allergens off our list thanks to those allergen challenges.
Before Jumpy’s first food challenge, all I knew was that we’d spend a few hours in hospital and I had to bring soya milk. So what’s a food challenge? Are there other types of allergy testing? How do you prepare for a food challenge? Are there any ways to make it go smoothly?
Before I delve into the topic of food allergy tests, it’s important to understand that the severity of future reactions can’t possibly be predicted. In between appointments, keep a diary of all reactions as your allergist will need that information (symptoms, suspected triggers, when? how long? medication taken). It’s also a good idea to take a photo of the labels of all processed food you had prior to the reaction.
There are three types of food allergy tests. After talking to a fair few doctors, paediatricians and allergists, I would stay away from ‘check whether you have an allergy’ by post kind of ‘test,’ as well as tests done on hair (??) or anything else of that nature. You could end up with two dozen ‘foods to avoid’ when there is no real grounding behind the tests. Exclusion diets are not to be taken lightly, and should be supported by medical evidence and help from a dietician.
A skin prick test is the quickest and most common way to detect an allergy. Your skin gets pricked (well, pierced with a tiny needle, really) and a drop or a rub of the allergen is put on top of the prick. The bumps that form are then measured. You can read more about SPTs in an article Nath at ‘The Intolerant Gourmand’ wrote here.
Blood tests are more costly and generally done after SPTs to detect anaphylactic (IgE) allergies.
An open food challenge carried out in hospital is the most reliable way to determine whether you have an allergy.
You are given the food you might be allergic to incrementally, every 15 minutes. Symptoms are written down.
The reason Jumpy was offered food challenges this year is because most of her her last skin prick tests were negative and the bumps were significantly smaller than they’d ever been. Her RAST results were confirming that too.
How to Prepare for a Food Challenge?
– Reassure your child by chatting about the challenge beforehand, so your little one knows exactly what to expect. Make it clear that they will be trying something they are or used to be allergic to. Explain that because the prick tests did not trigger a big bump on their arm, and the blood tests show a lower risk of allergy, it is a good idea to try the allergen and see whether they’ve outgrown that food allergy.
– Prepare them for the fact a reaction could happen, but also explain that if it does, they will be in the best place possible for it to be dealt with. The last thing you want is for your child to develop a phobia of hospitals and get anxious before their next visit to their allergist, allergy clinic or ward.
– Pack with them to build up excitement about trying new foods.
Food Challenge Essentials:
- allergy kit (epinephrine auto-injectors, antihistamines, action plan, nebuliser if using)
- the allergen
- anything that could make it more palatable during the challenge
- safe treats & snacks
There will probably be a TV, puzzles, books and games on the ward, but I always find it’s best to overpack so that surprises can come out of the bag when they’re least expected.
Other things to consider packing:
- drinks both for you and your child
- a warm jumper (it can get cold when you’re not moving much)
- food for yourself
- your child’s comforter
- A colouring book and colouring pencils
- an activity book with stickers
- a notebook and pen
- a card game like Uno or Top Trumps
- a new magazine or book
- A tablet with a film & headphones
How can you make it easier?
Your child might be reluctant to try something they associate with a past reaction and feeling poorly.
You can make it easier for them by combining it with something safe they like in each stage of the challenge.
For example, to disguise the taste of the soya drink or the cow’s milk, why not bring cacao powder and a bit of honey? Straws also make drinks more appealing to little ones.
Nut challenges can be tricky, as children are rarely keen to have whole nuts.
There are several options when it comes to nuts:
- whole nuts (over 5s only) are usually quicker and easier to ingest than nut butter or ground nuts
- ground nuts can easily be ‘hidden’ in granola or porridge
- crushed nuts could be disguised in bits of cereal bar or in a chocolate truffle
- nut butter can be spread on bread. It can also be mixed with allergy-safe chocolate spread, mashed banana or jam.
Make sure you have plenty of water on hand to help your child swallow the food.
At the hospital
If your child is showing signs of anxiety, ask one of the nurses on the ward whether a play specialist is available. Play specialists are amazing at distracting the children’s attention away from the challenge and getting rid of any of the tension that might have accumulated.
When Jumpy had her wheat challenge last week, one of the other patients was really struggling with her challenge, and our lovely nurse asked for Helen, the play specialist, for help. Since the children were not allowed to leave the ward during their allergy testing. Helen brought tables, chairs and all sorts of bits and bobs for crafts (paper, glue scissors, sequins, paint, pipe cleaners, tissue paper…).
She gave the children a mission: to make the ward look more autumnal. Giving the children a ‘job’ really took the focus away from the challenges and that’s just what the children needed at that moment in time. Our nurses Emma and Olivia and one of the mums even joined in. It felt more like Art Club than an allergy food challenge.
A Negative Food Challenge: What Does that Mean?
Once you’ve completed the food challenge and period of observation with no signs of a reaction and after 48 hours with no delayed reaction, you can start introducing the challenged food item into their diet.
Over the past three weeks, my little lady has had negative food challenges to baked egg, wheat and almonds. I couldn’t be happier and she’s overexcited to be trying foods she’s never had!
If you want to read more about food challenges and allergies in general, I would highly recommend Food allergies by Tanya Wright. It’s a fascinating read.
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