Oral challenges to foods or medications are performed in selected infants, children, and teenagers with a history of allergies. They are the most accurate method for confirming an allergy when reaction history or skin prick testing is unclear. Oral challenges also help guide treatment plans, determine allergy thresholds, assess suitability for immunotherapy programs, and identify whether an allergy has resolved naturally or following treatment.

To ensure safety and accuracy, antihistamines must be avoided for five days before the procedure. The patient must also be well on the day of the challenge, with no significant illness, asthma flare, acute hives, or severe eczema exacerbation.

Dr Willcocks supervises both food and drug oral challenges at her clinics:

Oral Food Challenges (OFC)

Dr Willcocks supervises all food and drug challenges at her clinics.

During an OFC, the patient receives gradually increasing amounts of the relevant food every 15–20 minutes under close medical and nursing supervision. The challenge begins with a very small dose and progresses stepwise to a full serve, provided no symptoms occur. After the final dose, the patient remains for 1–2 hours for observation.

Most children tolerate food challenges well. Families are encouraged to bring:

• Activities to keep the child occupied

• Preferred safe foods to mix with the allergen or for snacks between doses

• Water, formula, other drinks

• Spare clothing

• The child’s ASCIA Allergy/Anaphylaxis Action Plan and prescribed medications, including adrenaline devices

Although reactions can occur, challenges are conducted in a highly controlled environment with trained staff and emergency equipment available. If the challenge is passed, ongoing regular consumption of the food at home is recommended to maintain tolerance. If a reaction occurs, an updated management and follow‑up plan will be provided before discharge.

Oral Drug Challenges

Oral drug challenges involve administering a single or graded dose of the suspected medication under supervision to confirm or exclude an allergy. This is particularly useful for medications such as penicillins or non‑steroidal anti‑inflammatories, where skin or blood testing is difficult or unreliable.

Drug challenges help “de‑label” patients with suspected medication allergies, allowing safer and more appropriate prescribing in both community and hospital settings.

As with food challenges, these appointments may take several hours. Activities and snacks are recommended. Reactions can occur, but staff are well trained in early recognition and treatment, with emergency support readily available.