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Oral Food Challenge Parent Guide: Confirming lack of food allergy

Your child is scheduled to have a food challenge. A serving of the food will be given to
your child over the course of an hour (approximately). We will be observing your child
for any changes related to eating the food both during the challenge and for about 1-4
hours after the challenge.

Please bring a full serving of the food with you on the day of the challenge appointment.
You may want to consider bring multiple options of the food in case your child refuses to
eat something.

We do not have the capacity to do any “cooking” in clinic, but we do have a safe
microwave available to reheat foods that are brought in from home.
Also bring safe snacks / drinks for your child to eat after the challenge, during the
observation period.

Examples of foods for challenges:
Milk challenge-consider cheese or yogurt in addition to liquid milk. Be sure to check the
labels for any other foods you may be avoiding. Bring bottles or “sippy” cups so your
child can drink from something familiar. Also consider powdered milk which can be
added to many foods.

Egg challenge- consider making French toast with an entire egg. If you soak the egg in
the bread overnight, it’s easier and soaks more evenly. Cook the French toast at home and
bring it in with you on the morning of the challenge. We can warm it in the microwave.
You may bring in syrup, jelly or any other safe condiment. Some kids will eat a
scrambled egg.

Soy challenge- consider soy yogurt in addition to soy milk. You may consider trying to
get creative with tofu.

Wheat challenge-consider 2 slices of bread (check for milk and or / egg ingredients if
you are avoiding those), a serving of whole wheat cereal such a Wheat Chex, Frosted
Mini Wheat (again, check the label for other ingredients that you may be avoiding), or
Cream of Wheat cereal

Peanut challenge-Reese’s peanut butter cups or Reese’s Pieces work well for kids who
can tolerate milk. You can also use peanut butter. The “dose” is 2 tablespoons of peanut
butter. Most of the major label peanut butter (examples: Jiff, Skippy) do not carry a “may
contain nuts” label. The peanut butter can be spread on safe bread, crackers, celery or any
other safe vehicle.

Nut challenges- You need a nut that is not contaminated with peanut or other nuts if you
child is avoiding peanut or other tree nuts. The best way to assure there is no
contamination is to purchase the nuts in the shell and crack them at home. Please be
aware that you cannot buy cashews in the shell. The serving size will vary with the nuts.
Please contact us for guidance. You can grind the nuts and put them into a safe homemade
cookie,muffin or brownie.

Nuts Can be sprinkled on top of Pudding or
Yogurt if either of those foods is safe for your child.
Note: manufacturer-guaranteed pure almond butter Barney Butter
(www.barneybutter.com); also www.justalmonds.com
Meat or fish Challenges- a serving of meat or fish is usually about the size of a deck of
cards. Make sure the meat/fish is not processed or packaged with foods such as soy or
milk if these foods are being avoided. Deli’s can contaminate foods if they share
equipment between cheese and meats. Fish can be cross-contaminated if it is packaged or
stored with other seafood. Don’t forget to bring condiments such as ketchup, mustard or
BBQ sauce if those are foods that are safe for your child.

In addition, consider a fruit-based “smoothie” as the vehicle. The icy texture can hide
the crunchiness of tree nuts or sesame seeds and the coldness decreases the taste
associated with soy or cow’s milk. To make home-made smoothies, use about a cup of
fresh or frozen berries, peaches, banana or any other fruit that is “safe’. Add crushed ice
and blend in a food processor or blender until smooth. Freeze the smoothie in a plastic
container with a tight fitting lid. Bring the smoothie and the challenge substance to the
visit.

If your child tolerates milk or soy, you can add milk-based or soy-based yogurt to
the smoothie to give it a better base.

If you are using the smoothie for a milk or egg challenge, consider using dried
milk powder or dried egg powder to keep the volume as small as possible.
If you mix the challenge substance in the smoothie when you are making it, be
careful of the total amount of smoothie that you make. We will need your child to
eat the entire smoothie if you mix the challenge substance in as you go.

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