Oral food challenges

  • Compliance and co-operation from the child is vital. It is worth discussing with the parents beforehand. The most difficult age is 4-6yrs.
  • Parents should bring the required food if the hospital cannot provide it, and they have no problem doing so.
  • 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: Straight cow’s milk

Setting: Hospital/Paediatric Day Unit
Amount:

  • For Children under 1 year use regular infant formula, starting with 1ml, 5ml, 10ml, 25,ml, 50ml.
  • For children over 1 year use full fat cow’s milk: disguise the taste using some of the child’s regular milk if needed.
  • For children over 5 yrs add an extra dose i.e 1ml, 5ml, 10ml, 25,ml, 50ml, 100ml.
  • Marvel a dried milk product is useful to use if the child cannot tolerate the taste of full fat milk. It is also used when conducting double blind placebo controlled challenges, the protein content is the same as regular cows milk.
  • The same principals apply for a soya milk challenge.

Method:

  • 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 cow’s milk must be introduced into the diet at least 2-3 times a week.

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

Food: Baked cow’s milk

Setting: home or hospital/paediatric day unit
Method

  • Choose a time and a day that suits the child and family.
  • Do not do on a day that the child is unwell or scheduled to take vigorous exercise later in the day.
  • Have oral antihistamines available.
  • 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.
  • Stop at the first sign of a reaction: e.g. swollen lip, itching, redness, nettle sting type rash, vomiting, wheezing. Give antihistamines. If not improving, seek medical attention.

Amount: 2 full buns (2.6 g of baked milk protein approx. per bun)

Parents should make the following at home in the absence of the child (and bring all with them if for a hospital challenge)

Parents should make the following at home in the absence of the child (and bring all with them if for a hospital challenge)
100 g (4 oz) butter (1g of protein), 100 g (4 oz) caster sugar, 2 eggs, beaten, 50 g (2 oz) self-raising flour
56g Marvel (dried skim milk powder 36.1g protein/100g powder)
Spread out 8 paper cases on baking sheets. Cream the butter and sugar together until pale and fluffy. Gradually beat in the egg, a little at a time, beating well after each addition. Fold in the flour & Marvel. Fill the paper cases half full. Bake at 175°C (350°F) mark 4 for 30 minutes.
Transfer to a wire rack to cool.

Amount : 4.6g baked milk protein per serving
Any brand of cheese pizza cooked at 425F/220C/Gas 7 for 13 minutes.

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

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