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What is an oral food challenge?

  • An oral food challenge is a highly accurate tool to test for food allergy.  The food of concern is eaten slowly, in gradually increasing amounts, under an allergist’s supervision.

How do I prepare for an oral food challenge?

  • No antihistamines (Benadryl, Zyrtec, Claritin, Allegra, over the counter cough/cold medications) for 4-7 days prior to the challenge.
  • No Albuterol the morning of the challenge.
  • Must be in good health the day of the challenge.  If you have a fever, cold, upper respiratory symptoms, asthma exacerbation, rash or other symptoms, your challenge will need to be postponed.
  • Chronic allergic conditions (asthma, eczema, hay fever) have to be well controlled so they do not interfere with the doctor’s interpretation of any symptoms.
  • Avoid eating or eat lightly for 2 hour prior to the food challenge.

What should I bring to the oral food challenge?

  • You must bring the food to be challenged.
  • You must bring your usual medications and emergency/rescue medications (Epi-pen, Albuterol) so you have them for the trip to the doctor and back. 

What happens on the day of the oral food challenge?

  • A physical examination, vital signs, and a breathing test are done before starting.  Occasionally a skin prick test will need to be done depending on the individual patient’s case.
  • The challenge starts with a small serving of the food and after a period of time (usually 15-30 minutes), if no symptoms are present, a slightly larger amount is eaten.  This continues until a full serving portion is eaten.
  • After the final dose, you are monitored for at least 30 minutes or longer to make sure there are no symptoms.

What is the usual treatment in case of an allergic reaction during a food challenge?

  • For a mild reaction, Benadryl is given.  If the reaction is more severe, then epinephrine and other medications may need to be administered.

***The average time for a food challenge from start to finish is 3 hours but can be longer depending on the individual case.  Please plan accordingly***



  • Bring multiple food options to encourage cooperation by your child.
  • Consider bringing products to help mask the food (apple sauce, syrup, crackers, ketchup, etc.).
  • Entertainment
  • Favorite utensils, cups, etc. from home
  • Usual medications and emergency/rescue medications (Epi-pen, Albuterol)


A full serving of the challenge food without reaction needs to be tolerated to “pass” an oral food challenge.

MILK- plain milk, chocolate milk, yogurt (at least 8 oz. need to be consumed)

EGG- scrambled egg, hard-boiled egg, plain omelet, French toast, egg white protein powder (at least 1 egg needs to be consumed)

PEANUT- peanuts, peanut butter, peanut protein powder (PB2), bamba (at least 2 tablespoons need to be consumed)

TREE NUTS- whole nuts, tree nut butter (ex- almond butter), tree nut powder (can grind into a fine powder) (at least 1 ounce of select nut needs to be consumed)

FISH/SHELLFISH- boiled without seasoning or prepared plain (at least 3 oz. needs to be consumed)

SOY: soymilk (plain or chocolate), tofu, edamame, (at least 8 oz. of soy milk or 3 oz. of tofu/edamame needs to be consumed)

BAKED MILK/BAKED EGG- 1 muffin (see recipes on below)




Yield: 6 muffins (1/3 egg per muffin)

1 cup of flour
¼ tsp. salt
2 Tbsp. rice milk (or soy milk, cow’s milk, almond milk)
1 tsp. baking powder
¼ tsp. cinnamon
2 eggs
½ cup sugar
½ cup corn oil
½ tsp. vanilla
1 cup ripe banana or apple

Preheat oven 350 degrees F, combine dry ingredients and mix with wet ingredients. Pour muffin cups and back for 30 minutes.


Yield: 6 muffins (1.3 ounce milk per muffin)

1 cup of Milk
2 Tbsp. canola oil
1 tsp. vanilla extract
1 Egg or 1 ½ tsp. Egg replacer (Note: We use Ener-G brand egg replacer.)
1 ¼ cup of flour (or flour substitute)
½ cup sugar
¼ tsp. salt
2 tsp. baking powder

Preheat oven 350 degrees F, combine dry ingredients and mix with wet ingredients. Pour muffin cups and bake for 30-35 minutes.