Oral Food Challenge

Oral food challenges that need to be done as a day case procedure require access to full resuscitation equipment.  Staff conducting and supervising oral food challenges should be competent in doing so.  The ability to recognize and treat allergic reactions is essential to patient safety.

Food: Baked Egg

Setting: Hospital/Paediatric Day Unit
Amount:

  • Give the following recipe to the parents (to be made the day before the food challenge when the child is not in the vicinity).

    2 oz flour, 2oz sugar, 2 oz margarine, 2 eggs.
    Cream the margarine and sugar until light and pale. Gradually add the beaten egg. Gently fold in the flour.
    Divide the mixture to make 4 fairy cakes.
    Bake at 175°C (350°F) mark 4 for 30 minutes.
    Transfer to a wire rack to cool
    Bring all 4 cakes to the challenge.
    If the child has an allergy to any of the other ingredients i.e. milk or wheat, use their alternatives in the recipe.

  • 2 cakes which is equivalent to one egg needs to be eaten.
  • If younger children can’t manage the volume, completion at half the dose is acceptable

Method:

  • Divide the cakes into 5 doses the last dose being half the amount, work the doses out, backwards if it’s easier.
  • Give the child incremental doses every 15-20 minutes.
  • Children must be observed for 2 hrs after completion of the last dose.

Outcome 1: If the oral food challenge is negative baked egg must be introduced into the diet at least 2-3 times a week.

Outcome 2: If the oral food challenge is positive baked egg must be strictly avoided, and arrange appropriate follow up as per the care pathway.

Food: Straight Egg

Setting: Hospital/Paediatric Day Unit
Amount:

  • 1 whole scrambled egg or
  • Pasteurised whole egg powder can be used (available from www.myprotein.co.uk). 30g is equal to one egg.
  • The parents should bring yogurt or fruit puree that the child usually eats to mix it in with.

Method:

  • Divide the egg or egg powder into 5 doses the last dose being half the amount, work the doses out, backwards if it’s easier.
  • Give the child incremental doses every 15-20 minutes.
  • Children must be observed for 2 hrs after completion of the last dose.

Outcome 1: If the oral food challenge is negative straight egg must be introduced into the diet at least 2-3 times a week.

Outcome 2: If the oral food challenge is positive straight egg must be strictly avoided, and arrange appropriate follow up as per the care pathway.