Hospital challenge is Indicated when the likelihood of a reaction being elicited is relatively higher or where a home challenge is not acceptable.
Hospital challenge may be for diagnostic reasons if there is clinical uncertainty or to demonstrate resolution of pre existing allergies and for research purposes. Occasionally children who would be considered certain to react during challenge on the basis of existing tests but who have never actually reacted, or, who have forgotten how they reacted may need to have a challenge to educate them about the clinical signs they should recognize. This is most common in adolescents.
Hospital oral food challenges need to be performed as a day case procedure. Access to full resuscitation equipment is essential. Staff conducting and supervising the challenge should be competent in doing so. The ability to recognise and treat allergic reactions is essential.
- Compliance and co-operation from the child is vital. It is worth discussing with the parents before hand as otherwise it will end up a wasted trip for all involved. The most difficult age group is 4-6yrs.
- Parents will bring the required food if the hospital cannot provide it, and they have no problem doing so.
- A normal portion of food that is being challenged needs to be consumed over 5 or 6 doses in incremental 15-20 minute intervals. The last dose is always half the total dose so it’s as easy to work backwards if necessary.