Oral Food Challenges: What Parents Need to Know



Allergen-Collage2The heartbreaking news that a 3-year-old Alabama boy died during an oral food challenge test last July has shaken the food allergy community. The boy, Alastair Watson, suffered a severe allergic reaction – anaphylaxis – after undergoing the test at a children’s hospital in Birmingham.

It’s the first reported fatality associated with an oral food challenge, although the tests have been administered for decades.

Details of how the fatal reaction occurred have not been released. Meantime, many parents of food-allergic children are asking questions about the procedure. Here are some answers, via the American College of Allergy, Asthma & Immunology (ACAAI), American Academy of Allergy, Asthma & Immunology (AAAAI) and the Canadian Society of Allergy and Clinical Immunology:

What is an oral food challenge?

It’s a medical test in which a food is eaten slowly, in gradually increasing amounts, under medical supervision, to determine if it triggers an allergic reaction.

Why undergo it?

Sometimes skin prick or blood tests – combined with a patient’s medical history – are inconclusive in determining if the patient is allergic to a food. If this happens, allergists may turn to the oral food challenge, which is more definitive in showing whether an ingested food triggers a reaction.

Oral food challenges are also given to determine if someone with a previously diagnosed food allergy has developed tolerance and is no longer allergic.

What happens during the challenge?

An oral food challenge starts with having the patient eat a small amount of the suspected food allergen. If there is no reaction, the amount of food is increased over several steps.

The test is regarded as safe and reliable, but because it involves exposing a patient to a potential food allergen, there is risk of life-threatening anaphylaxis.

What safety precautions should be in place?

The oral food challenge should be conducted by an allergist who is well trained and experienced with food allergy and anaphylaxis. The test should be done at a medical facility with supplies of epinephrine, oxygen, IV fluids, resuscitation equipment and other emergency treatments for anaphylaxis.

Procedures should be in place for preparing and administering the food item, as well as for immediate treatment of any resulting reaction. A dedicated healthcare provider and nurse should be monitoring the patient during and after the challenge.

And there should also be a follow-up plan based on the test results.

If the patient has asthma and is experiencing symptoms, or has recently had an illness, that can increase the risk of an allergic reaction. In this case, it may be best to delay the oral food challenge.


Reviewed by William Berger, MD, Stanley Fineman, MD and Andrea Holka, AIRE Nebraska executive director