Food challenges are part of allergy living, and like most things in allergy life, it is stressful, nuanced, and rewarding all at the same time! A food challenge is considered “the gold standard” test to determine if a person is allergic or not to a specific food.
3 years ago this month, Shaun (at 19mo old) had his first food challenge (Soy) that ended in success! We left the allergy office that day with the OKAY to add soy products to his diet. (If you live with strict avoidance of soy, you know how huge this win was for us! Soy is in a tremendous amount of food.)
Shaun has gone through 4 food challenges with a 75% success rate.
We have challenged:
Baked Cows Milk: Failed (a post all its own)
Each time Shaun passes a food challenge, our menu opens up, and we feel a little lighter!
So what is a food challenge?
A food challenge is when an allergic person under the supervision of their allergist, in a highly controlled environment, eats food they have previously been diagnosed as allergic to and are strictly avoiding.
Our allergist looks at IEG blood work results along with results from skin tests to determine if a food MIGHT be successfully added to a person’s diet if it is challenged. The recommendations an allergist make varies depending on patient history, age, ability to communicate, etc.
The entire food challenge process is very structured and highly monitored because although there is a chance that the outcome can be successful … there is also a chance that the challenge can end in hives, anaphylaxis, or anything in between.
For me, this was the part that elicited stress and strong emotions. How can I possibly bring Shaun into the doctor to feed him something that could send him into anaphylaxis? I had to rely on the controlled process and allow the reward of opening up his diet to outweigh the feelings of fear and the counter-intuitive nature of the food challenge.
Here is what we have learned to expect with a food challenge:
They take a long time to schedule.
If your allergist recommends that you schedule one of these tests sometimes, it can take 6 months or more (we have waited 8 months) before there is an available appointment. Because these challenges take a minimum of 5 hours, there is a limited number of available appointments per day. Be ready to take what you can get and rearrange other plans.
You can’t be sick.
Because food allergies are auto-immune based, it is essential that your immune system is not already taxed at the time of your food challenge. This means a cold, virus, or infection just before or at the time of your scheduled test will require you to reschedule.
3 of our 4 food challenges have needed to be rescheduled. Yes, it is beyond frustrating but also an important reality. First, because an already burdened immune system will increase the risk of a reaction occurring, and secondly because if you were to carry out the challenge in this state, you could fail the test only because your immune system is already working so hard; leaving you with inaccurate results.
Pass or fail it will be a long day in the office.
Because the doctors monitor you for any symptoms (from hives to anaphylaxis), you’ll be in the office for several hours. Plan to be out of work or school all day.
You will want to pack a few things to keep yourself busy!
With Shaun at such a young age, both John and I have always attended the food challenges together. This allows us to take turns distracting him in the small exam room and step out without leaving him alone if we need to use the bathroom or take a break.
We have read books, built puzzles, written postcards, played dinosaurs, colored, raced matchbox cars, and in really desperate moments watched movies. I try to pack one bag with varied activities that we can spend the day exploring. It is hard to be cooped up in a small room, but these activities help so much!
Also, it can be frigid in doctors offices, dressing in layers is crucial so you can add or remove layers as needed.
You most likely had a blood test, skin test or both to determine that you are in a position to schedule a food challenge, but the day you go in for the test they will repeat the skin test to verify that there have not been any changes that would increase the risk.
Skin test are, no doubt, unpleasant (we always have tears). Going through this just before the food challenge is another way the process is set up to lower the risk of anaphylaxis.
Signing the release form.
As with any medical procedure, the food challenge includes a release form explaining all the things that could go wrong as a result of ingesting the food you are about to test. It is always a scary moment acknowledging the risk involved. However, it’s important to remember that THIS is the safest way to carry out a food challenge to increase dietary options!
Do not try to do this at home, without proper medical supervision and emergency personnel ready to assist!
Dosing & Waiting
When you get the all clear to start the challenge, you will be given a precise dose of the food you are testing. Then you wait … 20 minutes … if you have no symptoms, a second dose (larger than the first) will be delivered.
This cycle will continue until you pass the test or have symptoms that end it.
Pass or fail; there is hope in this process! Hope that you may be able to open up your diet.
Work closely with your allergist, push through the fear. Food challenges have been life-changing for us, and they might be for you too!
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