The “Challenge” of an Oral Challenge
It’s 8:30 in the morning and we’re sitting in a tiny, cramped doctor’s office. My husband is in the lobby. He cannot come back with us because of Covid restrictions. We brought a gigantic bag of movies and toys with us for our toddler to play with, knowing we will be stuck in this room for the next 4-5 hours. I listen to the doctor explain the appointment and procedures and I sign the waiver. Unfortunately, this is not new to us. We’ve done this…. 6 times now? And it’s never an easy day. We are at the allergist’s office for an oral challenge.
In an oral challenge, minuscule amounts of whatever allergen you are testing for (today is almond) is given in increasing amounts. The dose is increased every 15-20 minutes as long as the patient is tolerating it. This goes on for probably 2 hours. The nurse is just outside the door the entire time. She comes in to assess the skin for any rash or hives, and breathing and oxygen levels after every dose. She has emergency medications in her pocket, ready to go. After the last dose, we wait. And wait and wait and wait to see if my son will have a reaction.
An oral challenge is unfortunately the “gold standard” for food allergy testing. Consuming the food is the only way to know for sure if you are allergic. There is obviously risk associated with this and there are other tests that can be performed, but they are not always accurate. They could lead to unknowingly exposing yourself to an allergen in an unsafe setting, or unnecessarily avoiding a food. The point of doing an oral challenge is to introduce the food in the doctor’s office where there are trained medical personnel and emergency medications in case anything happens. And things do happen.
When we were brand new to this, I took my son to an oral challenge to test for a peanut allergy. He failed the test almost immediately and they kept us for a couple of hours after the initial reaction. In his case, it was vomiting, lots of vomiting. After a couple of hours, he had no other symptoms so they released us and I drove him home. Once I got home, I noticed him breaking out in hives, everywhere. He vomited again and I quickly realized he was having an anaphylactic reaction. I frantically called my husband to come home from work, administered my son’s epi-pens, and then we rushed him, my 6-month-old baby, to the emergency room where they administered more medications and kept us overnight for observation. I remember one specific doctor on the pediatric unit fist-bumping me, commending me for saving my son’s life that day. Talk about a reality check. That day began our journey with food allergies.
Since that day, my husband and I take my son to oral challenges together. After all, we have an hour drive home and the last thing I want is to be pulled off on the side of the interstate giving Epi and calling 911 by myself. That day was a very sobering day for us and taught us that we now needed to always be prepared to take action if necessary. Food allergies can become a life or death situation very quickly.
These tests are risky and hard. It’s hard to sit there for hours, and give your kid bites of a food they might be allergic to. And it’s hard to wait. It’s so incredibly hard to sit there and wait for your child to potentially break out in hives, vomit, or even stop breathing. But you know what is also hard? Avoiding foods. Not being able to eat something when everyone around you can eat it. It’s hard not to eat out, and it’s hard to travel when you have to deal with food allergies. It’s hard to find products that are safe. And it’s hard to educate others on the severity of food allergies. That’s why we do these oral challenges. Because every one that my son passes opens up a whole new food he can have. It brings us one step closer to a food allergy-free life. It brings just a little bit more normalcy to our lives. So even though these tests carry risks and are hard for us as parents to do, we do them to hopefully make an easier and safer life for our son in the future.
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So how did our oral challenge go? HE PASSED. And now we have almond butter toast almost every morning together, usually with sprinkles on top.
Happy Food Allergy Awareness Week, Luca. You continue to be a source of strength to me and I hope the challenges you face now, and in the future, show you that you can do hard things. Food allergies or not, I can’t wait to see the big things you do someday.
