The Leeds Teaching Hospitals NHS Trust

Food and Medication Challenges

Food challenges are the gold standard of testing for a food allergy. As the phrase goes, the proof of the pudding is in the eating. The response your child has to their food challenge will provide a definite answer as to whether they are allergic to a food or not.

Who can have a food/medication challenge?

We do food and medication challenges on many of our patients, in order to rule out allergies. The criteria for food challenge referrals includes, but is not limited to:

  •  Most children with egg and milk allergies - we expect most children will outgrow these allergies, therefore if their skin and or blood tests indicate little or no reaction, a challenge can be arranged to these.
  •  Children with vague reaction histories, and negative skin test results. These children are highly likely to pass their challenge, and it is usually just done as a final formality.
  • Children with nut allergies. For example, children with allergies to one or two nuts, are not necessarily allergic to all nuts. If there is no history of a reaction, or even consumption of particular nuts, along with negative blood and or skin testing, nut biscuit challenges can be done. Note: we are currently only offering mixed nut biscuit challenges to children aged 11 years and over.

What happens during the challenge:

1. You and your child will arrive to the ward allocated for the challenge. On arrival you will be greeted by the allergy nurses running that day's challenges, and be allocated a bed.

2. The allergy nurse will go through some admission questions with you, regarding your child's current health. A set of observations will be taken, and the nurse will explain the procedure and the consent process.  You will receive a copy of the consent form for your own records.

3. Once we have ensured you understand the procedure, and answered any questions you may have, we will take the food you have prepared, and portion it out in our food preparation area. All of our nurses practice safe hygiene precautions prior to, and after handling any food. We also take care to keep each patient's food separate to avoid cross-contamination.

4. Your child will be given a portion of food to eat every 15-30 minutes, starting with a very small amount, and working up the equivalent of a full portion. We have worked out all of our protocols to ensure all of our patients have eaten an age appropriate amount of food that would allow us to safely say whether or not they are allergic to the food. With medications, we split one full single dose (calculated according to your child's age and/or weight) into a number of stages, and give these split doses in 15-20 minute intervals.

5. After your child has finished eating their food/taking their medication they will need to be observed for 1-2 hours, for any allergic reactions.

6. If your child has an allergic reaction at any point in the challenge, we will stop the challenge and treat them with the appropriate medication. If the reaction is severe, one of the allergy consultants will review them, and they will need to stay in hospital for at least a further 4-6 hours for observation.

7. Regardless of the outcome, we will provide you with written information on how to manage your child after their food challenge, and this information will be tailored to your child and the food they have been challenged to.

8. If your child has been challenged to antibiotic and has successfully completed all steps, we will send you home with further doses to give for 3 days following the challenge. It is important that you follow the instructions provided by your allergy nurse.

Frequently Asked Questions:

  • How long is the waiting list for a food challenge?: Our challenge waiting list currently sits at 6-8 months, although we are working hard to reduce this.
  • How long will my child's food challenge take?:For our standard challenges, we usually say to allow between 4-5 hours - this allows time for eating the food, and the two hour observational period. For children having a supervised feed, we expect 2-3 hours.
  • What is a supervised feed?: A supervised feed is a type of food challenge we do for lower-risk challenges. We give a portion of food over 3 steps (small, medium and large) and observe for one hour thereafter.
  • Can my child eat other food during the challenge?: We advise against our patients eating other foods during their challenge for two reasons. The main reason is that consumption of other food can result in the food they are being challenged to taking longer to digest, which can lead to a potential delay in allergic reaction. Although, if your child requires encouragement to eat their food, we can allow small amounts, such a s a sweet with each step, or some tomato sauce to mask the taste. Secondly, consumption of extra food could result in your child being too full to eat the food we are challenging them to, and become uncooperative with the challenge.
  • Will you provide the food?: We do not have the kitchen facilities to provide our patients with the food to be challenged to. Before your challenge you will be sent a letter with instructions on what food to bring with you. If the food needs preparing, for example a fairy cake or a biscuit, a recipe will be provided.
  • Who will provide the medication? We will provide the medication required for a challenge as this will need to be prescribed.
  • My child is unwell - what do I do?: We cannot do food challenges on children who are unwell, due the increased chance of an allergic reaction. If your child becomes unwell in the week before the planned challenge, give the allergy nurses a ring and they can advise.
  • Is there anything else I need to know? It is important that your child has not had any antihistamines 72 hours prior to their food challenge, as this could result in a false positive result. If your child needs their antihistamine, still give them a dose, and contact the allergy nurses to let them know, as we may need to reschedule your appointment.
  • I am unable to attend my appointment, what do I do?: If you are unable to attend an appointment you have already arranged, please do let us know no later than 24 hours prior to the appointment. If you fail to attend an appointment without informing someone beforehand, your child will be removed from the challenge waiting list until they have next been seen in clinic.  We endeavour to contact all of our food challenge patients at least 1-2 days prior to the challenge, to answer any questions you may have and provide any information you may need.
  • Is there a quicker way to be challenged? The only way to potentially speed up your challenge appointment date is by joining the short notice waiting list. We sometimes get cancellations 1-2 days before challenges, and at these times we will ring the patients who have requested to be on this waiting list. This will require you to be available at short notice and to provide us with a contact number on which you will be easily reachable. Please be aware that this does not completely guarantee that you will get an appointment any quicker than waiting on the normal waiting list, and for that reason you will also be put on the regular list.