When a food challenge makes sense

Performing food challenges in patients with suspected Food Allergies is often anxiety producing for patients and their families. Indeed, asking someone to eat a food that might make him or her ill seems contrary to that basic premise of medicine (and parenthood), "First, do no harm." However, there are a number of situations in which food challenges make sense.

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First, some food challenges are performed to prove that a food is not the cause of symptoms. An example is a patient who has had a reaction to a food and has been labeled allergic despite unconvincing skin test or blood test results. Many people who think they are allergic to a common food try to prevent exposure to that food by markedly restricting their diet. Finding out through a food challenge that they are not, in fact, allergic to the food can be very liberating.

Another common reason for performing food challenges is to see if the food allergy has been outgrown. In the majority of young children, allergies to milk, eggs, soy, or wheat are outgrown over the first several years of life. Thus, performing food challenges may be considered in children who have had accidental exposures without a reaction or whose skin test or blood test reactions have diminished to the point that having outgrown the allergy is deemed to be a reasonable possibility.

Sometimes a food challenge is used to pinpoint which of several foods ingested before a reaction is the cause of the reaction. For example, an adult who has a reaction after eating a large meal in a restaurant might have a positive skin test to more than one food or ingredient included in that meal. Even after appropriate skin testing and testing for IgE antibodies in the blood, it may not be clear which, if any, of the foods was the culprit. Determining which food actually caused the reaction is vital to preventing future reactions and avoiding eliminating safe foods from the diet.

Documenting the degree of sensitivity to an allergen is another reason for performing food challenges. For instance, some patients become concerned that exposure to even minuscule amounts of a food will cause a severe reaction.Carefully performed food challenges can be done to obtain a more accurate measure of a person's level of sensitivity to a tiny amount of the food.