What is an Oral Food Challenge?
Oral food challenges are a diagnostic tool that allergists use to test for food allergies. Very simply, the patient consumes some of a potential food allergen under the supervision of a Board Certified Allergist. This allows the allergist to test for food allergies reliably and safely.
Blood and skin tests can provide some valuable information about food allergies. However, oral food challenges are considered the gold-standard when it comes to determining whether or not someone is allergic to a particular food.
However, while oral food challenges are a powerful and reliable tool, they can be more anxiety- and panic-inducing than other tests. If the person being tested has had a reaction in the past, and they found the experience to be traumatic, they can be especially anxious about consuming a potential allergen.
What are the numbers?
The American College of Allergy, Asthma and Immunology conducted a study in which they looked at 6327 oral food challenges; the majority of which involved participants under the age of 18. Approximately 86% did not have any reaction at all, 14% had a mild reaction, and 2% had an anaphylaxis reaction. That is, 98% of the participants had no reaction or a mild reaction, and only 2% had an anaphylaxis reaction which was controlled in the allergist’s office. To put these statistics in perspective, in general 40% of kids with food allergies experience anaphylaxis at some point.
As the mother of a child with food allergies who has had experience with multiple anaphylactic reactions and over 2 handfuls of oral food challenges, even low numbers are nerve racking. Thankfully, allergists think very carefully before recommending an oral food challenge and prepare for, but do not expect, an anaphylaxis reaction to occur. Ruling out a food allergy can be empowering and save years of energy and strain put toward avoidance.
Oral Food Challenge and Anxiety: 5 ways to prepare yourself and your child:
1. Everyone involved should be on board for the oral food challenge
If you are preparing for an oral food challenge, you need to feel sure that you need to do it, that you want to do it, and that you’re ready to do it. If you are helping your child prepare, it is important that your child is on board with the whole process. It is crucial that your child is willing to go through the process and has had the opportunity to speak to the allergist (or yourself) to ask any questions they may have. They certainly should not feel that they are being forced to do something terrifying, especially if they do not understand why.
2. Make sure you (and your child) understand the process
This brings us to the second point, make sure your child understands why this is happening. They should know that you and their doctors are always prioritizing their health and wellbeing. Educate yourself on the process so that you can answer any questions that you or your child may have. Make sure you (and your child) are aware of the entire process: what they do, how they administer the small doses of allergens, and what will happen if there is a reaction. You (and your child) should have faith in the doctors and what they do.
3. Understand the difference between anxiety and an anaphylactic reaction
Anxiety activates your sympathetic nervous system, the system responsible for our “fight-or-flight” reaction. When this system is activated your heart rate is increased; you may feel butterflies in your stomach; your palms may get sweaty; and your mind may begin racing. Other signs that you or your child are having an episode of anxiety are muscle tension, tingling in fingers, and shortness of breath.
It’s helpful to know that anxiety can cause similar sensations to an allergic reaction. Because of this, it is important to keep anxiety under control both before and during the oral food challenge.
Indeed, your brain is constantly “spying” on your body and getting feedback from it. If your brain senses that your body is having a fight or flight reaction to something, it tries to figure out what you are reacting to. In the setting of an oral food challenge, your brain may assume that it is a food allergy reaction. Believing you are having an allergic reaction can in turn pump up your anxiety. This creates an anxiety feedback loop that can be hard to get out of in the moment.
Just knowing the sensations of anxiety, can help you and your doctor to determine if anxiety is at play or if a reaction is brewing. It can also help you to disengage from the feedback loop and not jump to conclusions about what is happening in your (or your child’s) body. Always keep your allergist in the know about all sensations so they can help you through the process.
4. Normalize the oral food challenge and anxiety
It is important to recognize that the anxiety that you’re feeling is normal. If you know that you might experience anxiety when in the presence of an allergen, you will be better prepared to deal with it. If your child is doing the challenge, let them know that they may feel worried or scared and that this is totally normal. Bravery is feeling the anxiety, but doing the scary thing anyway.
Before your appointment, visualize yourself having a positive experience at the allergist’s office. Visualize yourself completing the challenge, leaving the building, and getting home to your pet or comfortable couch. Help your child visualize themselves having a good experience as well. If you are using one of the tips from part 2, “combining tough things with fun things”, tell your child to visualize themself doing the fun thing during and after the appointment.
If you follow these simple steps, you and your child will be better prepared to recognize and cope with any anxiety that could arise during your oral food challenge. It may still be a scary experience, but you have now equipped yourself with coping mechanisms. Utilizing these suggestions that can make the entire experience better for you and your child. Stay tuned for our next blog on ways you can manage your anxiety during the oral food challenge.
Be sure to check out Dr. Fawn’s part two of this two-part blog on Oral Food Challenge and Anxiety.
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