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What You Can Expect From an Oral Food Challenge

An oral food challenge (OFC) can provide many potential benefits such as safety from accidental exposure to an allergen and improvements in quality of life. Despite these benefits, parents and children may be nervous about participating in a food challenge due to the possibility of a severe allergic reaction.

An OFC may be recommended for a variety of reasons including gaining an accurate food allergy diagnosis, ruling out or identifying specific types of food allergic reactions, or even determining if a food allergy has been outgrown over time. Knowing what to expect and understanding how an oral food challenge is conducted may help ease any fears or anxieties surrounding the upcoming oral food challenge and allow the family to focus on the freedom that a negative OFC can provide.

What is an Oral Food Challenge (OFC)?

An oral food challenge (OFC) is a procedure in which a patient eats a food while being observed by their healthcare team in a medical setting.  The food is usually given in small but increasing amounts so the healthcare provider can identify possible adverse reactions as well as monitor and treat a reaction if needed.  OFCs can vary in length but most will last at least three hours depending on how long it takes for your child to eat the graduated doses.  In the event of an allergic reaction, your child will need to be observed and may be required to stay an extended period of time as determined by the healthcare team.

Why is an OFC Considered the “Gold Standard” for Reaching a Diagnosis?

While a child’s medical history and food allergy testing such as blood tests or skin prick tests are commonly used to reach a food allergy diagnosis, they have their pitfalls and do not always provide definitive answers. An OFC can provide “real world” answers and guidance on whether your child can safely eat the food as well as how much of the food may be tolerated.  It is important to do these under medical supervision of a healthcare team which provides a safe environment and proper interpretation of the OFC results.  Check out our blog on food allergy testing to learn more about the limitations of blood and skin prick tests.

Different Types of OFCs

Double-Blind, Placebo-Controlled Food Challenge

During this food challenge, the patient receives increasing doses of the suspected food allergen as well as a placebo. Both are usually mixed into the same vehicle – a food used to hide both substances – so the patient and healthcare team cannot tell which one is being given. The food allergen and placebo are given hours or days apart.   This type of OFC usually provides the most accurate results since the patient as well as the healthcare team are unaware of when the suspected allergen is administered. This method can prevent anxiety or preconceptions to change the outcome of the OFC.

Single-Blind Food Challenge

This challenge conceals the suspected allergen from the patient but allows the healthcare team to know when the allergen is given. It is conducted in the same way as the Double-Blind, Placebo-Controlled Food Challenge with the allergen and placebo being given at separate times in an identical vehicle to mask the allergen. 

Open Food Challenge

Open challenges are commonly used in the clinic setting because they are the simplest type of OFC. With this challenge, the patient and the healthcare team both know when the allergen is being given and no placebo is used.  They require less time than blinded challenges, allowing the challenge to be administered in one visit.  One of the biggest disadvantages of an open OFC is the patient may experience anxiety when eating a food

allergen making it difficult to differentiate these symptoms from those experienced during an allergic reaction.

Preparing for an Oral Food Challenge

A key step in preparing for an OFC will be to talk with your child.  Identifying any questions and emotions your child is feeling and making sure these are discussed ahead of time can help the entire family feel safe and empowered.  It is important to be honest and reassure your child when discussing a food challenge.  In addition, explaining the process will promote safety and confidence since your child will know what to expect during the challenge. For children with heightened anxiety, the support of a mental health professional may be helpful, and the OFC may need to be postponed until the child has time to become more comfortable with the OFC process.

It is important to follow the instructions of your healthcare team when preparing for an oral food challenge. Each facility will have different requirements, protocols and rules for OFCs, so it is important to discuss and be informed ahead of time.   Here are some things to consider when preparing for the OFC:

  • Illness – Your child should be free of illness the day of the challenge. If your child is sick, it is important to call ahead to discuss if your child can proceed with the challenge.  Many facilities will require that you reschedule for a time when your child is healthy and free of symptoms.
  • Medications – Your child may need to pause certain medications such as antihistamines. Make sure you talk to your child’s healthcare provider about all of his/her current medications and how long your child should be off of them prior to the OFC.
  • Challenge food for the OFC – Some medical facilities will require that you provide the food for the OFC while others will prepare it themselves and provide it when you arrive. Most facilities will have different recommendations for appropriate food products and amounts to bring for the allergen being challenged. Make sure to ask and prepare in case you need to bring food supplies with you.  Note that it may be helpful to discuss your child’s food preferences and decide on several food options for the day of the challenge. Having multiple options on hand can be helpful in case a food is refused during the challenge. It can be especially helpful for young children, picky eaters, or those with feeding difficulties.   This may also include bringing previously tolerated vehicles or condiments to provide further options during the challenge.
  • Recreate a normal environment – Bringing familiar items that make your child feel safe while eating may promote success during the OFC. This can include items such as plates, utensils, cups, highchairs, etc.  Comfort items such as security blankets or stuffed animals may also be helpful.
  • Bring entertainment – Due to the extended amount of time required to complete an OFC, children and parents may get restless and bored. Make sure to bring entertainment such as books, games, toys, or electronic devices.
  • Safe snacks or meals – Your child will not likely be able to eat items other than the food being challenged and it is important to follow the instructions of the healthcare providers who are conducting the OFC. However, it can be helpful to be prepared with safe foods, beverages and/or formulas for after the challenge or in the circumstance that the healthcare provider gives permission to provide other meals and snacks during your time at the facility.
  • Emergency medications – Just like every other time you leave home, bring your emergency medications including antihistamines and auto-injectable epinephrine for the car ride home.

When OFCs are completed without symptoms and the food is safely introduced, they can often lead to great nutritional, social and emotional benefits, often promoting better nutritional intake, improving quality of life, and reducing fears and anxiety.

Hypoallergenic Formula Options from Cambrooke

Whether an OFC confirms the need for continued allergen avoidance or allows expansion of the diet, meeting nutritional needs in children with food allergies, can be a challenge.  Cambrooke offers two amino acid-based formula options for children over the age of 1 year. Both offer complete nutrition and are appropriate for all types of food allergic disorders.  EquaCare Jr. provides comparable nutrition at 25% less cost than the competition.  Essential Care Jr. offers natural, value-added ingredients at a similar price to the competition. Learn more about these formulas for children with food allergies by visiting us online today or calling 1-833-377-2773.

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