An oral food challenge is considered the ‘gold standard‘ of allergy testing. Skin-prick testing (SPT) and blood tests have their utility but can result in both over and under diagnosis. Bubba has a number of foods on her allergen list that only have a mild SPT reaction and/or a low blood IgE score. Over time, we would like to challenge these foods to know whether they can safely be incorporated into her diet. I’m in no rush for oysters, but other foods can have a big impact on her diet. So today we challenged pineapple.
We prepared Bubba for her appointment by explaining what would happen and also why this test was so exciting. We told her all the new foods she would be able to eat. We discussed what her allergic reactions have been like in the past, how her mouth felt, and how she would need to tell us if something felt funny or spicy in her mouth. We also told her there would be treats after the test. Oral food challenges are LONG appointments and (God willing) boring. Bubba believed that she “didn’t like pineapple” so we told her she would need to try it anyway and would be rewarded for that. We also emphasized our past success – Bubba outgrew her soy allergy and we confirmed this with an oral food challenge. She now eats (and loves!) edamame and chocolate soy milk.
The appointment went great. Before the challenge began Bubba’s temp, blood pressure, and blood-oxygen levels were taken. Her full body was examined and all her eczema spots were circled so they wouldn’t be confused with a reaction. We started with a bite of canned pineapple (thought less likely to elicit and allergic reaction). Her whole body contorted and her face screwed up like she’d eaten a lemon. She did NOT like it. But she ate it anyway. Because she’s a trooper. We waited 15 minutes – no reaction. Another bite.
This time one of her cheeks turned red so we waited a full 45 minutes before up-dosing. Nothing else happened so the cheek was just a fluke. We switched to fresh pineapple. Bubba did not seem overly impressed with the taste but agreed it tasted ‘better’ and ‘sweet’. Fifteen minutes later, last bite. After the last dose we had to wait another 45 minutes to be sure of no delayed reaction. She passed!
So why is pineapple so exciting? Well, I’m sure you can imagine with a food allergy list of nearly 30 foods, there are not a lot of places Bubba can eat or convenience foods we can buy. She has never been able to eat fruit salad because it almost always has pineapple. Also, pineapple concentrate is added to many of the otherwise safe sorbets at frozen yogurt shops. Many kids’ juice boxes have pineapple juice as do several chicken apple sausage brands. My favorite BBQ sauce is now an option for Bubba too. Lastly, it adds one more frozen waffle brand to our options. Exciting stuff in our little world. If you and your allergist think an oral food challenge is appropriate, I recommend reading a great publication put together by Kids with Food Allergies to help you and your child prepare for the appointment.