Allergy Mom’s Take: Oral Food Challenges Are Worth the Stress

in Food Allergy
Published: March 10, 2021

Among my four children, it’s the two brothers who have multiple food allergies. But fortunately, some of their allergies have been outgrown. We’ve discovered this by undergoing doctor-supervised oral food challenges. After six such challenges for my older son, starting when he was only a 1-year-old, to my youngest son getting to do his first three last fall, you might say we’re OFC veterans. 

Between the two, we’ve tested: soy, sesame, lentil, shrimp, oats, almond, hazelnut and the drug amoxicillin. We’ve been fortunate, all the challenges have been successful, and each new food makes our family’s lives that much easier.

As a food allergy blogger, I’ve chronicled the oral challenges live in my Instagram stories. Without fail, every time I’ll get a messages like: “We’ve been approved for an oral challenge too, and I just don’t know if I can handle it.”

I get it. Let me walk you through our experience, from a mother’s perspective, to help you weigh whether an OFC might be right for your family.

Qualifying for an Oral Food Challenge

How we determine if either of our boys are eligible for another oral food challenge is pretty simple. We get them re-tested every year to monitor how and if their food allergies are changing. We do this every fall, so that we have the up-to-date list to give to their schools, along with freshly signed 504 plans

When skin-prick testing to an allergen has decreased since the previous test, and there’s only a small wheal or hive reaction, one of my kids will be deemed worthy to challenge that food. Due to moving states, we’ve done oral food challenges with two different allergists, and their protocols were slightly different. So check with yours.

Test Day: What to Expect

Before the appointment, there’s a set time where children may need to be off certain allergy medications, so talk with your allergist about that. 

Depending on which food you’re trialing, you usually need to bring your own. And the instructions may be precise. For challenges to things like baked milk or baked egg, food such as muffins need to be prepared at home, following a very specific recipe. Or, for example, when challenging sesame, our allergist had us bring in tahini paste, instead of sesame seeds. 

Plan on being at the OFC appointment for three-to-four hours. That’s the hardest part for a little kid. Both of our allergists had a TV or movie to watch, and one even had a coloring table. Bring your own devices or distractions to help the time pass. Since the boys might not enjoy the foods they trial (raw shrimp or a spoonful of tahini paste), I prepare them to know they will be expected to eat their doses, even if it’s not a taste they like. The better news on that: we’ve been allowed to bring along treats or yummy drinks as a reward for swallowing. 

The process will start off with getting baseline vitals – oxygen and heart rate. The allergist and his staff will take the food you brought and measure it out.

They’ll bring in a very small amount to start with. Once that food is consumed, both the nurse and I are constantly watching to see whether a reaction is starting. (I try to act nonchalant, saying something like “we’re just checking out your skin,” so they don’t pick up on the fact that I’m nervously staring at them like a hawk.) The staff also checks their vital signs like clockwork to see if there is anything changing. If all is fine, they proceed to the second, higher dose. This goes on multiple times, until they’ve reached the desired serving size. 

Once dosing ends, we stay after for an hour or more, to ensure there are no delayed reactions. If there are none, then it’s a success and that food can now be a regular part of our diet with zero restrictions.

The Emotional Aspect

Now that you know the basics of it, the biggest question is the HOW. How in the world do you ask your child to eat the very thing you’ve avoided and feared for so long? 

My answer is this: I’d rather be worried for a few hours, than worry every minute of every day for the rest of my sons’ lives. Some will say, that even if their child may have outgrown an allergy, they’d rather just keep avoiding. For my kids, I don’t agree. I feel that if the chance is there, we want to try. I can’t keep them in a bubble, just because it makes me more comfortable. 

Do I feel worried? Absolutely. But broadening a diet, and opening up possible social situations, lets us have one less thing to worry about. This greatly outweighs the nervousness I feel. But being brave doesn’t mean never feeling fear.

However, I try not to pass on or model that fear for my sons. I see it as my job to set the tone. As we drive to the allergist’s office, I remind them what is going to happen in a calm and age-appropriate way. I let them know the doctor thinks their body may have outgrown a food allergy, and that the only way to be certain is to eat it. We feel it’s safest to try that with the doctor there to watch, just in case they get sick. 

Based on your child’s age and personality, you’ll know how much is too much. I don’t want them so freaked out that they won’t be willing to eat the food. I remind them to tell me if they start to feel funny, itchy or if their tummy starts to hurt.

I also remind myself that if they do have a reaction, there is no safer place than that office with multiple medical staff ready to jump in. Fortunately, and knock on wood, we have never had a “failed” oral challenge, though I know some who have. 

Feeling a Weight Lifted

Megan's 2 sons doing their hazelnut challenge.

It may sound trite to say passing an oral challenge is life-changing, but it’s the truth. My younger son has had a Nutella sandwich almost every day since he passed hazelnuts. He’d probably bath in the stuff, if I let him. Yet he really could care less for almonds, which are also now allowed. So, we’ve had it go both ways, where we’re wanting to make up for lost time enjoying a former allergen, or we’re sparingly incorporating it into our diet. 

But the psychological freedom a successful OFC brings is phenomenal. Just think of all of the mental real estate every food allergy takes up, plus the time and emotional weariness of reading labels, talking to teachers, speaking with waiters, and caregivers. Never worrying about the foods we’ve passed for the rest of my life feels like a weight lifted. It’s as though I’d been carrying around a backpack full of heavy rocks, and someone finally let me set it down. The relief is almost that palpable. 

Every year I honestly pray that we will get to do an oral challenge (my next one I’m really hoping for is beef). Based on our experiences with oral challenges I’m so grateful that we’ve gone through with them. I feel for those who have attempted a challenge without success, but still say good for them for being brave enough to try. With these challenges, by all means, to each their own. You have to weigh what your allergist recommends, as well as your own needs and desires. 

From the Mouths of Babes

Both of my boys are truly my heros, they handle food allergies so well and they are the ones who have to put the food down the hatch in a challenge. In closing, I thought it might be helpful to hear from my oldest son, as he’s done the most OFCs. 

His advice to another child who is nervous about doing an oral challenge is simply, “Do what the doctor says.” I asked if he’d ever felt nervous, and he said: “I’ve felt nervous, but then I would think of something happy.” Finally, he said, “It’s exciting to pass a food. Shrimp was my favorite one to pass.” Lastly, see the boys join me in the embedded video as we chat about oral food challenges.  

Allergy mom Megan Lavin is the creator of the Allergy Awesomeness blog, which features great Top-8 free recipes and articles. Follow her on Instagram and Facebook.

Related Reading:
Update on the Rewards, Risks with Baked Milk, Egg Challenges
Study Finds Few Severe Reactions with Oral Food Challenges