Coming to the hospital for a food Challenge

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What is this information about?

This information is about your child’s ‘food challenge’ appointment. It explains: 

• what a food challenge is 

• where to go for your child’s appointment 

• what to do to prepare for your child’s appointment 

• what happens during and after the food challenge 

• what to do if your child has a delayed allergic reaction or you have concerns about them 

• where you can get further information or support. 

Why have I been given this information?

You have been given this information because your child has been invited to come to the Children’s Assessment Unit for a food challenge. Reading this information and following the advice in it can help you: 

• understand why your child has been offered an appointment 

• know what to expect from the appointment 

• prepare for the appointment and know what to bring to it 

• understand the risks of a food challenge 

• know what might happen after your child’s food challenge and what you and your child should do. 

What is a food challenge?

A food challenge is a way of testing if your child has an allergy to certain foods, or if they have grown out of an allergy. During the food challenge we will ask your child to eat or drink increasing measured amounts of the challenge food at timed intervals. 

There are several reasons why your child may have been asked to come in for a food challenge.  Your doctor or dietitian will have talked with you about why your child needs a food challenge.  

Where will my child’s food challenge appointment be?

Your child has been invited to the Children’s Assessment Unit at St Richard’s, Chichester or The Children & Young people’s day unit at Worthing Hospital for their food challenge.  

• For St Richard’s appointments: 

The children’s assessment unit is on the Children’s Ward, 2nd floor of the Women & Children’s block (West Wing), St Richard’s hospital. 

• For Worthing appointments: 

The children & young people’s unit is on Bluefin Ward, 1^st Floor (East Wing), Worthing Hospital. 

When you arrive, press the buzzer on the door and wait for us to reply. Tell us who you are, and we will let you in. 

How will I know where and when my child’s food challenge appointment will be?

The nursing team on the unit will contact you by phone to arrange an appointment for the food challenge.  

• If you do not answer their call, the nurses can only leave a message for you if you have a personalised answerphone reply message. This is to protect your privacy.  

• They will try to contact you up to 3 times. 

How to prepare for the food challenge before you come to hospital:

Does my child need to stop taking their antihistamine before the food challenge?

Yes. Do stop any antihistamine treatment 5 days before the challenge. This is important as it means the results from the challenge will be reliable.

This should include medicines such as: 

Chlorphenamine (Piriton), Cetirizine (Zirtek, Benadryl), Loratidine (Clarityn), and Fexofenadine (Telfast).    

Eczema creams and asthma medicines are ok and should be continued.   
 

What do I do if my child is feeling unwell on the day of the food challenge?

We will only perform the challenge if your child is well enough on the day.   

We will not perform a challenge if: 

• they have a tummy bug 

• they have had a temperature in the last 24 hours 

• if they are wheezy 

• if they have bad hay fever. 

Do please contact the unit to let us know if your child is unwell. We will rearrange the appointment.

Do I need to bring any food to the food challenge?

Yes. Buy and prepare the food that you have been asked to bring by the paediatric nurse or dietitian for the food challenge.  Bring it to the appointment in an air-tight container. 

Do I need to bring my child’s emergency medication with me?

Yes. Make sure that you have packed your child’s auto injector (such as EpiPen or Jext), antihistamine, or inhalers if they have one.  

Your child may need them if they have: 

• an allergic (positive) reaction to any of the foods they have in the food challenge 

• a delayed reaction on the journey home after their appointment 

On the day of the food challenge:

Should my child eat breakfast before the food challenge?

Yes. Your child should have a light breakfast on the day of the challenge.  

 How long will the food challenge take?

A challenge usually takes around half a day, but you may need to be on the ward all day.  

Do I need to bring a packed lunch for my child?

Yes. Please bring a packed lunch for your child. They will be allowed to eat it once the challenge has finished. Parents are also welcome to bring a packed lunch with them. 

What happens once we arrive on the children’s assessment unit?

When you arrive: 

• you (and your child) will have a chance to ask any questions that you would like to 

• we will ask you to read and sign a consent form. Signing the consent form means that you understand what the food challenge involves and agree to your child having it. We try to involve your child as much as possible in this process. 

• before the challenge starts, we will examine your child and record their general state of health. 

What happens during the food challenge?

• We will ask your child to eat or drink measured amounts of the challenge foods. Portions of the challenge food will be very small to start with. 

• We will give them increasing amounts of the challenge food at timed intervals. 

• Your child must stay on the unit during the challenge and for at least 2 hours after it has finished. 

• There are lots of toys and books on the ward that your child can play with during the food challenge. 

Could having the food challenge cause any harm to my child?

When they are having the food challenge there is a chance your child may develop: 

• an allergic reaction. Food challenges can cause an allergic reaction This most often involves the eyes, nose, mouth, skin or gut.   

We will check how your child is throughout the challenge. If they have symptoms of an allergic reaction, we will monitor these and give your child treatment if they need it.   

• anaphylaxis is a more severe form of allergic reaction. It can involve the airway, breathing or circulation.  Anaphylaxis is unusual during a food challenge.  

If your child needs treatment for anaphylaxis we will treat it with an Epipen device. 

• The nursing team will help you to give the Epipen to a younger child.  

• They will also help an older child to do this for themselves.  

You will stay on the ward until your child has fully recovered. Rarely, a child will need to stay in hospital overnight after a food challenge. We would expect one parent to stay on the ward overnight with them. 

Care of your child after a food challenge

What is a ‘positive’ food challenge?

If your child has reacted to the food during the challenge, it is called a ’positive’ food challenge. They should continue to avoid the food that that caused the ‘positive’ reaction.  

What activities should my child avoid if they have a positive food challenge?

For the rest of the day, they should avoid: 

• strenuous play or sport. This could bring on a delayed reaction. 

• becoming over-excited. Try to avoid situations where this may happen   

Usual toddler activities are ok.  

For 2 days after a positive food challenge your child should avoid: 

• very hot baths 

• fizzy drinks 

• large meals. 

These may cause a return of allergy symptoms. 

Your child should be fit for school or nursery the day after they have had a positive food challenge.   

What should I do if any allergic symptoms return?

Do contact the Children’s Ward if your child has a return of allergic symptoms overnight or is not well enough to go to school or nursery the next day.  

What is a negative food challenge?

If your child has not reacted to any foods during the challenge, this is called a ‘negative’ food challenge. They should not eat the food for another two days in case of mild delayed symptoms such as tummy pain, diarrhoea (watery poos) or a flare of eczema.   

Please contact your dietitian or consultant if you think that your child has had a delayed reaction after the food challenge.   

If my child has a negative food challenge, will they be discharged from the allergy service?

A member of the children’s allergy team will call you a few weeks following the challenge to see how you are getting on introducing the food. The consultant will also write to your GP with the result of the food challenge. 

What should I do if I have concerns about my child after their food challenge?

• Your child has ‘open access’ to the ward for 72 hours (3 days) after they have been discharged from the Unit.  

• If you have any concerns after 72 hours, please contact the Children’s Allergy Team (between 9am and 5pm Monday to Friday), please see contact details below.

Who can I contact if I have any questions or concerns after I have read this information?