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Food Challenge Tests

Atopic eczema is a common, chronic, itchy skin rash that tends to affect people with other allergies like hay fever and asthma (see atopic eczema).

Wet wraps or wet dressing is used to treat severe atopic eczema or severe flares. They can also be used to prevent itching, especially at night and to avoid using steroids if applied early enough in a flare-up. Wet wraps can be easily applied at home after you have been taught how to use them.

  • Use aqueous cream, paraffin oil or an emollient as a soap substitute.
  • Use an emollient every day … as often as is possible, to keep the skin moist.
  • Steroid ointments must be used when there is a flare. During a flare the skin is being damaged by the eczema and the steroid ointment will prevent that damage.
  • Once a flare is under control a lower strength ointment should be used and then slowly reduced until it can be stopped and just the emollient continued.
  • Wet wraps can be done with steroid ointments and emollients during a flare and with the emollient alone when the skin is not flaring.
  • Wet wraps can be done with commercially available cotton clothes, or with home-made wraps made from stockinette bandage.
How long will the challenge take?

You and your child will need to be in hospital for at least a whole morning. Giving the doses of food takes up to 2 hours because we leave a 20 minute gap between each dose.

After the challenge, we will keep an eye on the child for at least 2 hours if there has been no reaction. This is to be safe that the child remains well and that there are no “late reactions.” If there has been a reaction, we will keep an eye on your child longer than 2 hours until we are happy that all is well. Sometimes, if children have a bad reaction, we may decide to keep them in hospital overnight. This is very rare.

Will a challenge hurt my child?

The food challenge itself is not painful in any way.

In a few children who are at higher risk of a reaction, especially those with asthma, we may consider putting a drip up before the challenge.

If children have a reaction during the challenge, the doctors and nurses will be right there to treat the child as quickly as possible. Most reactions are mild, such as rashes, and the child may need to take some antihistamine syrup. A few children will have more severe reactions, and these children may need an injection or even a drip. This is not common, because we start off with such small doses of food and watch the children so carefully.

What do you need to do before the challenge?

Your child will need to be off some of their regular medications for up to a week before the challenge. Your nurse will give you details of these.
If your child has been unwell in the 2 weeks before the challenge, please let the nurse know a few days before the challenge so that we can decide whether we need to postpone the challenge.

Before a challenge starts, we ask a few questions to make sure all is well, have a quick look at the child and take their observations such as temperature and pulse.
On the morning of the challenge, your child can have their regular milk and/or a light breakfast between After that they should not eat or drink anything(except a few sips of water) before the challenge.

We may ask you to bring along some of the child’s favourite food or regular milk so that we can mix the test food into it for the child to eat.
Please dress the child in comfortable clothes that are easy to lift up for examining the child, and a spare set of clothes.

Bring along any favourite toys/dummies/blankets. It is a long morning and we would like to make it as nice as possible for them!

Elimination - challenge testing

For delayed type allergies there are not currently any validated laboratory tests. The usual blood and skin tests are not reliable in excluding a delayed type reaction. In this case the proof of a specific food causing symptoms relies on stopping to eat that food item for a few weeks … if symptoms go away it is then critical to “re-challenge” the person with the food to prove that symptoms come back. (see Delayed Food Allergy pamphlet)

An “elimination-challenge” test is NOT the same as a food challenge test done for immediate type reactions. Because there is no risk of an immediate severe reaction, it can be just reintroduction of a normal portion of the food, and does not need to be done under special conditions.

A medical specialist with a special interest and skill in allergy might be able to help. See the list of health professionals with skills in allergy on the AFSA website.

Download our “Food Challenge Test” leaflet for free