“These numbers look good. That with the negative skin test is a good indicator. We’d like to bring your son in for a partially-baked milk challenge.”
I didn’t know whether to feel excited or terrified.
On the one hand, I was encouraged to hear the allergist say that his numbers looked good. On the other hand, I knew that this food challenge meant having him eat the very food we had been so careful to avoid over the last two years.
If you’re reading this and have an upcoming food challenge, we’re here to let you know more of what to expect and offer some tips to make it easier.
What Is a Food Challenge?
A food challenge is a medically supervised introduction or re-introduction of a food. At the challenge, the food would be administered to the patient (in this case your child) in small doses, increasing the dosage amount approximately every 30 minutes until a specific amount of the suspected allergen is eaten.
Once a certain amount of the allergen has been safely consumed, the allergist will determine if the child can now safely consume the food at home and if there are a specific requirements for consuming that food. This is what’s called a “pass.”
Here is an explanation of an Oral Food Challenge from the American Academy of Allergy, Asthma, & Immunology.
Medical supervision is necessary for a variety of reasons, including past reaction history or skin and/or blood testing results. Usually, the particular food the allergist wants to challenge has been determined to cause allergic reactions in the past.
That also means that there is the potential for anaphylaxis. Anaphylaxis is a life-threatening immune response to the ingestion of a food allergen.
Basically, you are having the child consume the food while under medical supervision to confirm that he/she can eat the food without experiencing an allergic reaction.
Your child eats the food and you and the medical staff monitor for signs of an allergic reaction.
Talk about an absolutely anxiety-producing experience. I wish there was a better way. However, this is the process we have until more medical advancements become available and are safely practiced.
Allergic Living has a great article written by an allergist that takes a more in-depth look at the specifics of food challenges. Check it out here.
Some Questions to Ask Beforehand
Here are some question to consider asking your allergist prior to your child’s food challenge.
- What criteria do you look for to consider a food challenge for a child and why?
- After the challenge, what is considered a “pass” for my child?
- What reactions do you look for to stop an active food challenge?
- Can my child eat before the challenge? If so, what can he/she eat?
- If we take daily antihistimines and/or other medications, can we take those in the days before the food challenge or on the day of the food challenge?
- What medical capabilities do you have here in the clinic in the event that my child experiences anaphylaxis?
- What is the emergency protocol should my child experience anaphylaxis?
- Do you have any advice for talking to my child about the food challenge?
- Is there anything specific I need to bring?
- Is there anything else I should know?
My son developed an allergy to dairy at 11 months old. He was, however, able to tolerate baked dairy. Heat breaks down the whey and casein proteins in baked dairy products. My son’s body accepted that. For some kiddos with a dairy allergy, the body still rejects the proteins even if broken down.
Note: Not all proteins will break down with heat. For example, the proteins that trigger my son’s peanut and tree nut allergies will not break down regardless of heat.
For almost two years, we had milk baked in muffins almost daily. Each year his allergists would order skin and blood testing to see how the dairy allergy was progressing.
At age 2, we got the results that his numbers looked great, the skin test was negative and that he qualified for a partially-baked milk challenge.
Partially baked is different than baked milk. To be considered baked, the milk has to be baked at 350 degrees for 30-35 minutes. Partially-baked is like a pancake or waffle where it is only in the heat for about 5 minutes. This breaks down the proteins a little, but not nearly as much as the baked milk.
The allergist gave me a waffle recipe that I had to make at home for my son’s food challenge.
A Word of Advice
Make sure you read the recipe long before the day of the appointment. I read the recipe the night before (face palm).
Read it earlier. Read it earlier so you can calmly call the allergist if you have questions.
My waffle recipe had a specific temperature that it wanted the waffle iron to be set to and I had no way to measure that on my waffle iron.
That resulted in me panicking at 8pm and racing to a store to try and solve the heat issue. Luckily, we worked it out, but if you can, spare yourself this added stress!
Also, if you are making the food for the challenge yourself per your allergist, be mindful about cross-contact. For more on cross-contact, here’s our post, “What in the World is Food Cross-Contact.“
What Actually Happens At the Challenge
Without a doubt, my stomach was in knots the morning of the food challenge. I remember walking into the clinic, homemade waffles stashed in my purse, and my sweet son in my arms. My “brave mom face” was set in my jaw. I would not allow my fear to scare my son.
We checked in as you typically do at office visits and we were lead back to the scale to take my son’s height and weight. They also checked his oxygen levels and pulse.
Next, we were escorted to a private testing room, which was immediately located next to the medical staff room.
We were introduced to the medical staff member who would be conducting our food challenge. He was amazing with my son! After a quick overview, we brought out the waffles and he portioned the first dose onto a plate for my son.
Then, with my son in my lap, he ate the first dose.
The doctor continued to talk with my son, showed us different things in the room, etc. all while observing my son for the next 15 minutes or so. Eventually, he said we could get out our games and he stepped into the room next door.
Our protocol was that if I saw anything of note to simply open the door and he would be in to help us immediately.
Following the 30 minute mark, he returned for our second dose. This was about double what my son had eaten for the first dose. Again, my son ate and was observed by the doctor, but the time of observation was shortened.
Finally, it was just me and my son playing games again. I continued to monitor his behavior and watched for signs of an allergic reaction.
It’s A Long Appointment
We repeated this every 30 minutes for 3 hours.
We colored, we read books, we sang, and we watched Daniel Tiger. Understandably, my eyes were laser-focused on my child the entire time for even the faintest sign of redness or the slightest hint of a cough.
Each time the medical staff saw him, my worry would subside as they smiled and were encouraged by my son’s progress. I was comforted knowing they were right there should we need them.
After finishing the whole waffle, which was impressive for a two year old, we needed to stay for observation for one more hour.
My son passed! They reviewed what this would mean for next steps for him, and then sent us home.
What to Bring to the Food Challenge
Your Child’s Epinephrine
Without a doubt, you are probably already used to keeping the epinephrine with your child at all times. I know it seems obvious that you would bring it to the food challenge, but you will likely be nervous before the appointment.
Just a friendly reminder to not forget to bring this. Our allergist will not administer a challenge without it. And our family rule is wherever our kiddo goes, the epi goes. No exceptions.
The Food Challenge Food
Also, don’t forget the food challenge food! Especially if it’s refrigerated, because it would be so easy to forget it in the fridge. If it’s a shelf-stable food, I recommend putting it directly in the bag you will bring.
Doing that the night before the appointment will save you some time in the morning. Alternatively, you can even set it out on the counter where you will see it before you leave or stick a note up on the door so you don’t forget.
I’m not a screen time fan. Full disclosure, I’m that mom who limits screen time to less than an hour a day most days (my kiddos are under age 5).
However, I make an exception for stuff like this. This is a looooong appointment. My son was age 2 and we were there for 4 hours.
Pro-tip, download favorite movies, tv shows, or games to the tablet ahead of time so that you don’t have to rely on wifi at the clinic.
You know your kid. What will help them be entertained and comforted for almost 4 hours in a patient room?
Here are some ideas.
- Coloring Books and crayons
- Books to read
- Sticker Books
- Action Figures
- Water Wow Books
- Pop It activity
- Favorite stuffed animal
- Small Lego kit
- Fidget toys (this can help calm anxiety)
Another Pro Tip: Wrap several of these and have your kiddo open one every 30 minutes before or after a new dose. This is a fun way to pass the time and offers a new activity to change things up!
You don’t need to buy new stuff; they can be wrapped things from the house.
Change of Clothes
Just a reminder that vomiting can happen during an allergic reaction. In the event this could occur, a change of clothes for both of you can be very helpful. Bring a trash bag for the soiled clothes.
In the rare event that epinephrine would be needed, your child will need to be observed in the hospital for at least a few hours before you are released to go home.
Some helpful things to have on hand in addition to the list above are:
- Cell phone charger
- Comfortable clothes
- Health Insurance Card
- Water bottle
I’m Terrified My Child Will React
I know you are, momma. I really, truly, know.
Here’s the reality. No tests are perfect. I wish the blood and skin tests were foolproof, but we know they are not. There is a risk of an allergic reaction. There just is. We can’t get around it.
However, remember a few key points.
1. Your Allergist Is Recommending This Food Challenge
Firstly, this food challenge is not happening because you up and decided your child was ready on a whim. Your allergist does not want your child to have a reaction either.
My allergist was very clear that they will not bring a child in for a food challenge unless they are very confident the child will pass.
A good allergist knows your child’s medical history, they have done the blood and skin testing, and they are using the medical profile of your child to make this recommendation.
Nothing is guaranteed, and yes, reactions do happen, but this is why it can be very helpful to ask the allergist what their criteria is for bringing a child in for a food challenge.
The allergist is trained in evaluating the risk to your child, and they have assessed that your child is ready for this food challenge. This is a good indicator.
2. You Will Have Help
During the challenge, every tool of importance will be available to keep your child safe. There are medically trained staff that will be monitoring your little one closely.
Furthermore, you will have the epinephrine. You will have help if something should happen. Remind yourself that you are not alone in managing it.
3. This Could Change Your Child’s Life for the Better
All of my fear around my son’s partially-baked milk challenge distracted me from the hope that my son could actually tolerate dairy.
What if your child could actually tolerate this allergen? What would that mean for him or her? How could this change your sweet child’s life?
Remember, They Just Might Pass
My son passed the partially-baked milk challenge and then went on to be able to tolerate cheese and raw milk. Outgrowing the dairy allergy has completely changed his life. In particular, it has opened up so many more food options for him.
It has given us hope. First and foremost, we have hope that he will outgrow other allergens, though we know he likely will not outgrow most of the tree nut or peanut allergies.
Unfortunately, the only way we could know for sure about whether or not he outgrew the dairy allergy was to go through the food challenge.
The only way to truly know momma, is the food challenge. The pathway to food freedom from this allergen is through the food challenge.
Another thing to keep in mind is that a food challenge is medically supervised. It is SO much safer than accidental exposure.
You have an opportunity for a medically supervised setting for your child to see if their body will now tolerate this allergen.
It’s so scary, but you will have an answer. Moreover, after the challenge is complete, you will know more about how to best care for your sweet child.
A Word About Passing and Failing
In the food allergy world, you will see a lot of “he passed the food challenge!” Or “we failed the food challenge today.”
Because I think it’s so important, I want to say this to you.
Your child does not “pass” or “fail” this food challenge. This is not the same as passing or failing a test. I have failed tests in school because I didn’t study. I have passed tests in school because I studied well. Both of those scenarios required my effort.
Differing from an actual test, it is completely outside of your child’s control whether or not their body will tolerate this allergen. It is outside of your control. They never asked for their bodies to react this way in the first place.
I know you know this.
However, I think we have to be careful with what they hear. If they hear, “you passed,” what message are they really hearing even if that’s not our intention?
I actually celebrate with my kids for just doing the food challenge. We have a deal that our kids get to choose a reward for simply completing the food challenge, regardless of the outcome.
Now, if we get to find out that the allergen is now not an allergen anymore, that’s really awesome! And we can definitely be excited about that.
Above all, we celebrate being brave and going through the food challenge.
Thinking of You
I know your stomach is in knots thinking about this appointment. I hope you feel more prepared and equipped with a few new ideas.
This stuff is tough. We really do get it.
Thinking of you as you head into this appointment. I am absolutely hoping for the best result for you and your sweet kiddo.
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