The Joy and Sorrow of Attempting an Oral Food Challenge

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When the list of foods my girls are allergic to was very long, I’d rattle each one in order, ticking them off with my fingers as if crossing them off a list until I was done. At that point, there were ten of them. Ten foods scrawled on a piece of paper on my fridge, serving as a warning sign to relatives and caretakers alike.

I longed for the day that list would whittle down. We were hopeful that the girls would outgrow most of them, but as fifth birthdays came and went (a line of demarcation, once upon a time), I grew less hopeful.

“I think her numbers are low enough to do a food challenge,” an allergist said, peering at a piece of paper. An oral food challenge — also called an OFC — is a diagnostic test for a food allergy. Blood work isn’t 100% accurate, and neither are skin tests, so often, if results seem ambiguous, a doctor will attempt an OFC. If you want to, of course.

I wanted to, but did my daughters want to?

For us on a food challenge day, we wake up extra early and drive an hour to the clinic where our allergist administers OFCs. There’s a skin test (ouch) and if all looks ok, the doctor and nurse will move forward with an OFC. In our cases, we’ve started out with a teeny tiny amount of the specific allergen, moving up incrementally in size over the span of hours. Patients are monitored and if a reaction happens, there’s no safer place they can be for it. Very straightforward.

Try explaining that to someone under four feet tall.

But we do, of course. We say that their kind allergist thinks they might no longer be allergic to XYZ, and we’re going to do a very careful test to see if they are. There is a risk, of course, that they’ll react and need epinephrine, but Mom’s going to be right there and there are all sorts of caring doctors and nurses around, too.

I’m essentially asking them if they’re ok with getting several pokes in the arm, sitting in a room for hours, and maybe needing an injection. (I probably don’t have to tell you how much my kid hates an Epi-Pen in the thigh.)  But they’re all in anyway. Because they want to see that list drop in number just like I do. 

So we wake up early and drive far and queue up some movies on the iPad (I generally stick to a “no screen time during the week” rule, but when they’re sitting in a 7×7 room for hours on end, I let them watch as much Moana as they want) and hope for the best.

First OFC was wheat. A success! I went home and baked bread the next day. Second OFC was coconut. Another success! We celebrated and paid an exorbitant amount of money for coconut yogurt. Third OFC was soy. Yet another successful doctor encounter. I bought a bottle of Kikkoman soy sauce and made a glaze for salmon. There was much rejoicing in the land.

Fourth OFC was for baked egg, and just for my middle daughter. Her numbers suggested she’d fly through this. I rubbed my hands together, thinking about baking with egg instead of flaxseed. We baked the special muffins using the recipe the doctor’s office gave us in anticipation of the OFC.

Skin test, all good.

1/16th of a muffin, cool.

1/8th of a muffin, grand.

1/4th of a muffin, great.

At this point, I ask the nurse if reactions even happen this late in the game. Surely if a child is allergic to something, they find out right away. Anaphylaxis would happen and all bets would be off.

But no, she said, that wasn’t the case. Sometimes you get through hours of an OFC and a reaction happens at the end. “Usually it’s a GI reaction,” she says. I nod and watch as my daughter chomps on one-half of a muffin while watching Netflix.

And like a light switch, everything is different. She’s doubled over in pain and crying and the OFC immediately stops. Symptoms lessen after a shot of epinephrine in the arm, but she also ends up with a dose of Zantac, a dose of steroids, and a dose of Benadryl.

Two hours later she’s asleep on my chest as her allergist and I go over options. Maybe she could have tolerated less. We could try desensitization.

At that point I beg to do a food challenge for the less common allergies.

“I know poppy isn’t a big deal, but for us, I think there would be even a psychological benefit of knocking another one off the list.”

Could we do poppy? Mustard, even? Numbers are too high for my girls to do anything else (peanuts and milk? not this year, sister), but maybe we could scratch that list down to five this year? Maybe?

She’s fine now (God bless kids, man, they’re so resilient), but I’m still feeling a little bruised. I’ll keep being hopeful, because I know what a shorter list means for them. Here’s to successful OFCs down the line for them (and your kids, too).

Roo Ciambriello

If Scratch or Sniff founder/editor Roo Ciambriello could list all of her favorite things, they’d include her sweet little family, food trucks, and every AMA Snoop Dogg has done on Reddit. Roo is a copywriter out of New Haven, Connecticut, and loves writing fun stories on the backs of potato chip bags and cereal boxes in Whole Foods, Target, Nordstrom, Kroger, y mucho mas. Roo creates voices for brands, ghostwrites for celebrities, writes a personal website, and is (much to the chagrin of those around her) pretty active on Twitter. You can also find her providing commentary on advertising/branding at Adweek and eating fajitas on deadline days.

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