For questions concerning these recipes, please contact:
Dr. Imke Ehlers:
ImkeEhlers@web.de ,
or the
Secretary of the EAACI Interest group Food Allergy


MILK, SOY, EGG, WHEAT for small children

Food challenge in infants and small children
Products used as basis for blinding:
• extensively hydrolysed formulae (ehf): Alfare (Nestlé), Nutramigen (Mead Johnson), Pregestimil (Mead Johnson), Pregomin (Milupa)
• elemental diets, based on amino acids (ed): Pregomin AS (Milupa), Neocate (SHS)
Ingredients: How to be prepared:
placebo (total amount) for all following recipes 9 MS ehf or ed (see above) 270 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well
milk challenge, verum (total amount) 5 MS ehf or ed 135 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed 150 ml milk fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well finally add milk and mix well
soy challenge, verum (total amount) 5 MS ehf or ed 135 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed 150 ml soy drink (without sugar, salt, flavouring agents) fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well finally add soy drink and mix well
hen's egg challenge, verum (total amount) 7 MS ehf or ed 225 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed 1 fresh hen's egg, raw (cave: Samonellae) alternatively: fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well finally add milk and mix well
5 MS ehf or ed 135 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed 10 g dried egg powder (=50 g hen's egg) diluted in 150 ml cold water fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well finally add diluted egg powder and mix well. Do not bring to boil after adding the egg powder!
wheat challenge, verum (total amount) 5 MS ehf or ed 135 ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed 5 g wheat protein diluted in 150 ml cold water fill in bottle, cup or glass add water and mix well add flavouring agent and colouring agent and mix well finally add diluted wheat protein and mix well. Do not bring to boil after adding the egg powder!

*pseudoallergic reactions cannot be excluded
MS = measuring spoon
flavouring agent: orange flavour by SHS
colouring agent: beta-carotin

CEREALS, BIRCH POLLEN-RELATED; MUGWORT RELATED IN YOUNGSTERS AND ADULTS
The challenge dose is related to the average daily intake of the relevant age group. Whether the food challenge is performed as titrated challenge or with the total amount of food depends on the patient's history and the expected clinic reaction.

A cow's milk, soy or hen's egg challenge can be prepared according to the recipes for infants and small children.
Ingredients: How to be prepared:
cereal challenge in small children (older children, youngsters and adults) placebo (total amount) 20 (50) g rice wholemeal flakes 20g Sinlac 150 (140) ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed verum (total amount) 20 (50) g cereal wholemeal flakes (wheat, rye, oat) 20 g Sinlac 150 (160-180) ml water (boiled and cooled down) 1/2 MS flavouring agent* colouring agent*, if needed mix rice flakes and Sinlac, stirr in water add flavouring agent and colouring agent and mix well blending is possible mix cereal flakes and Sinlac, stirr in water add flavouring agent and colouring agent and mix well blending is possible
challenge with birch-associated foods (apple, carrot, celeriac, hazelnut) if an oral allergy syndrome is present, the relevant food item is eliminated both challenges (placebo and verum) have to be performed with sun glasses for better blinding
placebo (total amount) 210 ml water (boiled and cooled down) 40-60 g Sinlac 1/2 MS flavouring agent* colouring agent*, if needed 30 g rice wholemeal flakes verum (total amount) 120 ml water (boiled and cooled down) 30-40 g Sinlac 150 g birch-associated foods (50 g apple (Granny Smith), 50 g carrots, 50 g celeriac) 10 g hazelnuts 1/2 MS flavouring agent* colouring agent*, if needed (Granny Smith), 50 g carrots, 50 g celeriac) 10 g hazelnuts 1/2 MS flavouring agent* colouring agent*, if needed stir Sinlac in water add flavouring and colouring agent in order to imitate the verum's taste and colour place in the fridge add rice flakes shortly before food challenge stir Sinlac in water and place in the fridge, blend birch-associated foods and add to the pulp (this has to be done shortly before the pulp is served, otherwise the apple looses its allergenicity) add flavouring and colouring agent for blinding and serve immediately
challenge with mugwort-associated foods (celeriac, celery,carrot, tomato without kernels) if an oral allergy syndrome is present, the relevant food item is eliminated both challenges (placebo and verum) have to be performed with sun glasses for better blinding
placebo (total amount) 210 ml water (boiled and cooled down) 40-60 g Sinlac 1/2 MS flavouring agent* colouring agent*, if needed 30 g rice wholemeal flakes verum (total amount) 120 ml water (boiled and cooled down) 30-40 g Sinlac 160 g mugwort-associated foods (40 g celery, 40 g celeriac, 40 g carrots, 40 g tomato without kernels) 1/2 MS flavouring agent* colouring agent*, if needed stir Sinlac in water add flavouring and colouring agent in order to imitate the verum's taste and colour place in the fridge add rice flakes shortly before food challenge stir Sinlac in water and place in the fridge blend mugwort-associated foods and add to the pulp add flavouring and colouring agent for blinding and serve immediately

* pseudoallergic reactions cannot be excluded
MS = measuring spoon
flavouring agent: orange flavour by SHS
colouring agent: beta-carotin

Blinding of other foods:
yeast in pancake (for placebo use baking powder; blinding is easier, if the pancake has a vegetable filling)
meat use textured vegetable protein as placebo and serve in spicy sauce use tolerated meat and mince together with suspected meat, serve as hamburger
thuna / other fish serve in vegetable soup (liquidized) and use seaweed-vegetable soup as placebo
chocolade use carob as placebo and serve as flummery, cake or biscuit

Foods as basis for blinding, especially in children:
• flummery
• hamburger
• ice-cream
• rice-pudding
• apple-sauce
• milk shakes
• mashed potatoes

Foods with strong taste and colour, ideal for blinding:
• black currant juice
• beetroot juice
• cocoa
• peppermint oil

Placing the food in the fridge before serving it, helps better blinding.