Allergy and Asthma Program

• One week before the challenge: Stop giving your child antihistamines, which can interfere with the challenge results.
• Three days before the challenge: Stop giving your child cold medication such as Benadryl.
• If you are unsure what medicines contain antihistamines or unable to stop a medication, please call 617-355-6117 and ask to speak with an allergy nurse.

Your child needs to stop eating two hours before the challenge (your child should not eat breakfast). It is helpful if your child is hungry for the challenge. Your child will be able to sip water during the challenge, but cannot eat other foods.

Talk to your child about why the challenge is needed and what will happen. You can tell your child that he or she will eat small amounts of a specific kind of food to see how the body responds to it.

All children can be fussy, and it is OK if your child does not want to eat the challenge food. We do not expect you to force your child eat the challenge food. If your child cannot eat the food in the challenge, we will work with you to reschedule.

Please note: We will not force your child to eat the challenge food.

The visit can take up to three hours, so you may want to have small toys, games, tablet/phone, or books for your child to use while you are waiting. Please be sure to bring 4 to 8 oz. (or a half to 1 cup) of the food to be challenged. Keep in mind:

• All foods should be pre-cut and measurable.
• The food should be cooked if needed (eggs, shellfish, fish, etc.).
• Remove shells from shellfish, peanuts, or tree nuts.
• Please make sure that the challenge food is not cross contaminated with other foods (like other kinds of nuts).
• You can bring condiments, like ketchup and mustard, if your child has had them before and is not allergic to them.
• For baked egg and baked milk challenges, you will need to follow the recipe on the Baked Egg Challenge instructions and Baked Milk Challenge instructions.

The allergy program staff will give you some ideas on what to bring. Do not bring food that may have other ingredients that your child is allergic to. If you forget to bring the food, your challenge will have to be rescheduled. Make sure to bring your child’s epinephrine auto-injector. If you forget your epinephrine auto-injector, your challenge will have to be rescheduled.

Please arrive on time. The challenge will most likely have to be rescheduled if you are late. When you get to the clinic, register with the front desk. Your child’s temperature, blood pressure, height, and weight are measured. An allergy nurse or physician meets with you and your child, asks some questions, listens to your child’s lungs, and looks at your child’s skin. Your child will be:

• Given the food without changing its taste or the way it looks
• Asked to eat the food in increasing amounts over a set amount of time
• Watched carefully for 60 to 90 minutes after the last amount of food is given

The whole process takes about three hours.

Your child will be watched closely during the challenge by the allergy nurse for any signs of a reaction. An allergist will be available at all times.

It is possible that your child will have an allergic reaction, like hives, a rash, throwing up, diarrhea, or low blood pressure. If your child has a reaction, the allergy nurse will stop the challenge and may give medication, such as the epinephrine auto-injector. Your child may need to be watched in the Emergency Department or be admitted to the hospital for observation.

If you’re on your way home or at home and your child has an allergic reaction, such as hives, a rash, vomiting (throwing up), diarrhea, or low blood pressure:

• Give your child the epinephrine auto-injector and call 911 right away
• Call the Boston Children’s page operator at 617-355-6363 and ask to speak to the allergist on call

If you have any questions, please call the Allergy and Immunology Program at 617-355-6117 and follow the appropriate prompt.