TABLE 2

Conducting an Oral Food Challenge3

Before the challenge
    Suspected foods should be eliminated from the diet for 2 to 8 wk
        Length of time will depend on the type of food-induced allergic reaction being examined (eg, urticaria vs eosinophilic esophagitis)
        In infants, diet can be limited to a hypoallergenic formula
        For exclusively breastfed infants, the suspected food can be eliminated from the mother's diet
    Document any significant improvements as a result of dietary elimination
    If dietary elimination has led to significant improvement, the challenge test may be carried out while the patient is on minimal or no medication for treating allergy symptoms
    The test should be designed with supervision from medical personnel with experience in carrying out challenges
During the challenge
    The challenge should be carried out by medical personnel with experience in performing food challenges
    Oral food challenge begins with a low dose (intended to be lower than a dose that can induce a reaction)
    While monitoring for any allergic symptoms, the dose is gradually increased until a cumulative dose at least equivalent to a standard portion for age is consumed
    Treatment for reactions, including anaphylaxis, must be available for immediate administration