Oral Food Challenges

Oral food challenges when 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: Tree nuts
Setting: Hospital/Paediatric Day Unit
Amount: 8g of the Tree nut being challenged
Method:

  • Work the dose up every 15-20 minutes for example , ¼ tree nut, ½, 1, 2 , etc.
  • Tree nuts can be crushed and added to some yoghurt as it is easier to eat. A mortar and pestle can be used to crush the nuts.
  • Give the child incremental doses every 15-20 minutes
  • Children must be observed for 2 hrs after completion of the last dose.

Tips for mixed nut challenge:

  • Mix 8g of each tree nut (crushed) with some yoghurt as it is easier to eat, there is no need to do a lip rub in this case as it is not practical.
  • 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 the tree nut must be introduced into the diet at least 2-3 times a week.

Outcome 2: If the oral food challenge is positive to the mixed tree nut challenge the tree nuts must be strictly avoided, and individual challenges with the tree nuts will need to be performed.

Appropriate follow up should be arranged as per carepathway.