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190 7.1 Food Hypersensitivity – Food Allergies and Intolerances

Food Challenges Expert advice is needed from a dietitian to cut out
a suspected food completely as parents and
Food challenges are the most definitive part of children may not be aware of all the foods that can
diagnosis but are not always necessary if the contain traces of a suspected food.
clinical history is convincing. They will either:
Grading the severity of the symptoms to be
●● detect a specific food which causes symptoms recorded helps make the parent or carer recording
and needs to be excluded from the diet; or the symptoms more objective. For example,
diarrhoea can be graded as follows:
●● confirm that a specific food is not responsible
for symptoms and does not need to be restricted. Severity of symptoms Diarrhoea
0 Formed stool
They are also used to determine if and when a child 1 Slightly loose stool
has outgrown their food allergy. 2 Very loose stool
3 Liquid stool
The gold standard test is the placebo-controlled
double blind food challenge. In clinical practice, During the period of investigation the parent/carer
however, open challenges are usually performed. A records the timings of all the food and drinks
paediatric or allergy specialist dietitian needs to be consumed by the infant or child along with the time of
involved as the food suspected to be the cause of any symptoms and the grade of severity. For example:
symptoms must be consumed by the child and the
response monitored. Time Food and drinks Symptoms
7:30 consumed Diarrhoea – 2
Challenges must be carried out in appropriately
staffed and equipped settings because of the risk of 8:30 Small bowl Cheerios
a severe reaction. For children with any level of with full-fat milk +
specific IgE or any size SPT to the food or who have banana slices
developed symptoms to a food less than two hours
after eating it in the past, the food challenge should 1 cup milk
be done in hospital where the necessary medication
can be administered to reverse any severe 10:30 120 mL cup of apple
symptoms. 12:00 juice diluted 50% with
water
Food challenges can usually be carried out at 13:00
home in children with no specific IgE levels to a 1 digestive biscuit
food or negative SPT and a history of only slow 2 tbsp pasta
onset symptoms (Nice 2011).
1 tbsp meat sauce
A food challenge for non-severe, slower onset
symptoms of non-IgE-mediated food allergy and 3 carrot sticks
non-allergic food hypersensitivity usually involves:
2 cauliflower florets
1. recording the symptoms and foods eaten while
on a normal diet for one or two weeks 1 flavoured fromage
frais
2. recording the symptoms and foods eaten while
on a diet excluding the suspected food – usually 6 grapes
for one or two weeks
120 mL cup of water
3. recording the symptoms and foods eaten for a
further period of time with the suspected food Diarrhoea – 1
eaten to see if the symptoms reappear if they
have disappeared in step 2. The dietitian can then assess the diary and discuss
with the parents whether the suspect food is likely
to be causing the adverse reaction or not.