What is a food challenge?

In short, a food challenge involves giving a child a food to eat in a controlled setting and in a safe child-friendly environment. The food may be given in incremental stages (incremental challenge) or as one amount (cumulative challenge). Your child will then be observed for a period of time to ensure no allergic reaction occurs.

How will I know if my child needs a food challenge?

Your child will have been seen by a Paediatric Allergy Consultant at The Portland Hospital or by another referring doctor. Your child may have skin prick tests, a blood test for specific Immunoglobulin E (Ige) and a full medical history taken before any decision was made regarding a food challenge.

When is a food challenge indicated?

There are many reasons why a food challenge may be performed, including:

1. If your child has previously had a positive allergy result to a food which is now low or negative, it may be that the allergy has been A food challenge will be able to clearly answer this question.

2. Likewise your child may have recently tolerated a very small amount of a food to which they were allergic, suggesting this has been outgrown.

3. It is not uncommon for a child and/or their family to be anxious when introduced to afood and may wish for

A food challenge is the only true way of knowing whether your child will have an allergic reaction to a food.

How safe is a food challenge?

A food challenge is only ever carried out in a safe setting by experienced, well trained staff. The Consultant and specialist nurse must be happy that all parameters are within safe limits prior to and on the day of the challenge. The challenge is carried out in a controlled environment in The Portland Hospital’s dedicated paediatric daycase unit providing specialist nursing care to ensure any allergic reaction is responded to quickly.

The food is given slowly to the child either through small increments or as measured doses. This slow introduction of the food to the body means that the specialist nurse will be able to spot any signs or symptoms of an allergic reaction in the early stages and administer the appropriate medications immediately.

What happens if my child does react to the food?

The specialist nurse who is looking after your child is highly experienced and skilled at recognising the signs and symptoms of an allergic reaction. If your child starts to experience any significant behavioural changes, new onset of wheeze or cough, hives, itching, red rash, or swelling then the challenge will be stopped and an anti- histamine, and/or Ventolin and/or epipen will be administered immediately. This will be recorded as a positive food challenge and your child is then still allergic to the food. Your child will need to remain under observation by the specialist nurse for up to 4 hours after symptoms settle. The specialist nurse will recommend continued avoidance of the food item and appropriate discharge advice and training will be given prior to your child’s discharge from the unit.

If your child complains of not feeling well, but does not have any observable physical reaction to the food the specialist nurse will discuss with you and your child the need to either repeat the dose they have just eaten or move onto the next increment. Any concerns during the process will be communicated to the covering Allergy Consultant.

What happens if my child does not react to the food?

In the likely event that your child does not react to the food being tested, the specialist nurse will be able to administer all the increments of the food (in no less than 20 minute intervals). Your child will be encouraged to play in between the increments and there is a dedicated playroom and play specialist in The Portland hospital Daycase unit where the challenge will be carried out. Once all the food has been eaten, your child will continue to be observed for up to 2 hours after the last piece of food has been eaten. The observation period is required as there can be a delayed reaction.

If the challenge is negative, ongoing consumption of the food at least 3 times a week will be encouraged. It is therefore important that the challenge is performed with a food that your family enjoy eating and that your child is likely to eat.

If after a safe observation period your child has not had an allergic reaction, the specialist nurse will record the challenge as a negative challenge and will give advice on how to reintroduce and maintain the food in your child’s diet. This is important in order to maintain tolerance of that food. You may be recommended to return to see the Consultant in clinic post challenge.

What are the risks of my child having an allergic reaction during a food challenge?

The specialist nurse will take your child’s consent as you are admitted to the unit. Here it will be explained what the risks of the challenge entail. The most frequent risks are that your child may experience a mild or moderate severity allergic reaction requiring the administration of anti-histamines and asthma medications (if needed).

Such a reaction may also involve itchy hives, itchy red rash, swelling of face or lips, behaviour change, new-onset of wheeze or cough or vomiting.

Anaphylaxis is the most serious type of an allergic reaction which can involve problems with your Child’s breathing and/or blood pressure. They may present with a wheeze, trouble with talking in sentences or become floppy or drowsy. If this was to happen, the specialist nurse will administer an adrenaline auto injector. If you, as the parent, felt happy to do so, you would be encouraged to give the adrenaline auto injector yourself under the supervision of the specialist nurse. After administration of the epipen the covering consultant and/or the support resuscitation staff will be called as back up.

The Portland Hospital has an onsite Paediatric Intensive Care Unit (PICU). In the unlikely event that the primary interventions do not settle the severe allergic reaction, the attending PICU doctor will assess your child.

What if my child refuses to eat the food?

This is not uncommon. You and your child will often have been avoiding a food for several months or years, so to suddenly be asked to eat a food that your child may not have tasted before or that your child has memories of having a reaction to may understandably be difficult.

The specialist nurse will ask you to bring with you any food that you know your child can tolerate and likes to eat. (This can be used as a vehicle to mix or ‘blind’ the food being tested).

The specialist nurse is used to encouraging children to eat unfamiliar foods. They will work closely with you and your child to ensure that enough of the food is eaten to ensure a clear diagnosis of a positive or negative food challenge.

Do I need to provide the food being challenged?

It is usually the case that the specialist nurse will ask you to bring in the food that is being challenged. Various forms of the food may be required. However, this will be discussed in detail with you prior to your appointment.

I have been told my child needs a food challenge. How do I arrange this?

After your consultation with your Consultant a referral will be made to The Portland Hospital (see details below) who will contact you to discuss the challenge.

If you are paying for the challenge yourself the specialist nurse will immediately be able to book a suitable date with you. If you are claiming through an insurance company, you will need to speak to your insurance company to obtain a pre-authorisation number for the food challenge test. Once the insurance is secured the specialist nurse will be able to arrange a suitable date with you. It is important that your insurer understands that a food challenge is the gold standard diagnostic test for food allergy and we are able to provide you with supporting documentation to assist with insurer pre-authorisation.

24 hours before the challenge, the specialist nurse will telephone or email you to complete a pre-challenge assessment. If your child is unwell in any way or has asthma and needs to use their blue inhaler frequently then it may be necessary to reschedule the appointment.

Likewise, severe hay fever symptoms may confuse the challenge outcome and would require antihistamines.

My child takes regular medications. Do I need to stop these?

If your child takes regular long acting anti- histamine such as Cetirizine they will need to have stopped this for ideally 7 days prior to the food challenge appointment.

If your child takes regular short-acting anti- histamine such as Piriton they will need to have stopped this medication for 2 days prior to the food challenge appointment. This is also true for GI medications e.g. chromoglycate.

If your child is requiring their Salbutamol Inhaler regularly due to his/her asthma, it may be necessary to reschedule the food challenge appointment.

If your child takes Montelukast, a nasal spray (such as Nasonex or Avamys) or a preventer inhaler (Clenil, Beclomethasone, Flixotide, Symbicort) their medications may continue to be taken as usual.

Please make the specialist nurse aware of any other medications your child may be taking during the pre-challenge telephone call as some medications do contain small amounts of anti- histamine and these may also need to be stopped before the food challenge.

My child has had a food challenge – now what?

If your child carries adrenaline auto injectors the specialist nurse will educate you and your child on the emergency management plan for an allergic reaction and will also discuss the administration of the adrenaline auto injector.

The specialist nurse will contact you the day after the food challenge to see how your child is doing and to check if you have any further questions. If during this time, or over a weekend, you have any concerns or queries please contact the nurse by email or call The Portland Hospital’s main switchboard on 020 7580 4400 and ask to speak to the Paediatric Bleep Holder.

If you are worried that your child is having an allergic reaction please contact your GP, or in an emergency please dial 999 and seek urgent medical attention.

General Information/ Frequently Asked Questions

COVID-19

-Patients are due to have two negative COVID 19 swab before admission.

-Covid 19 swab tests needs to be done at 7-9 days and 3 days before admission at The Portland Hospital.

-Please limit contact with groups of people outside of household bubble and maintain social distancing prior to admission.

-Only one parent/guardian is allowed on admission for the challenges.

-Patient and parent/ guardian wear a face-covering or mask on admission.

1. Q. How long does the cumulative or an incremental allergy challenge take?
2. A. On average a cumulative challenge will last between 2-4 An incremental challenge will last between 4-6 hours.

1. How can we reduce anxiety in our child prior to admission?
2. A. Before admission have a look at our website, bring in toys and familiar items your child likes having with them, and even some rewards for your child to be given during the A play area and play specialist will be available to speak to you and your child.

1. Can we introduce more than one food during the challenge?
2. A. Please discuss with your consultant and the specialist Generally we prefer to introduce a single food as this gives a clear indication of which food your child has or has not reacted to.

1. Q. Should I give my child breakfast before the challenge?
2. A. Please only give a moderate portion of what your child would normally The hungrier your child is at the start of the challenge, the more likely they are to give the new food a try.

1. Q. If my child reacts during the challenge what other food can they then eat?

1. A. Bring some food with you that you know your child is not allergic to and enjoys, then if they need to snack on something after the challenge they can do so.

1. Q. Do I need to bring my child’s emergency medications?

1. Please bring all your regular allergy medications with you, this will also cover you for your journey home post the challenge.

1. Q. Where is the hospital?
2. The challenge service is based in the Daycase Unit at The Portland Hospital, Ground Floor, 205 – 209 Great Portland Street, London, W1W 5AH. Please arrive 15 minutes before your appointment.

1. Q. What is the cost of the allergy test and how do I arrange payment?
2. The cost of the incremental challenge is £1,639. If you are covered by insurance then you will need to come to your challenge with your pre- authorisation number. If you do not have your pre- authorisation number you will need to pay on the day and claim back from your insurance company retrospectively.

1. Where can I park?
2. A. Visitors have the option of two car parks close by to the hospital; the NCP in Carburton Street or Union Carparks in Devonshire Row There is also meter parking in the surrounding streets. The forecourt of the hospital is available for arrival and collection of patients only.

Clinic contacts:

Allergy Consultants:

Dr Du Toit

Professor Lack

Dr Brough

Dr Cox

Dr Boyle

Allergy Clinical Nurse Specialist:

Melanie Davies

Louise Cameron