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Tips for Managing Oral Food Challenge Anxiety

Family sitting on couch talking to therapist

You've likely heard the term "oral food challenge" mentioned by your allergist or in online food allergy support groups. But if you haven't, here's a quick primer from the American Academy of Allergy, Asthma and Immunology on oral food challenges:


What is an oral food challenge?

An oral food challenge (OFC), or feeding test, is a medical procedure in which a food is eaten slowly, in gradually increasing amounts, under medical supervision, to accurately diagnose or rule out a true food allergy.


What are the reasons to perform an OFC?

OFCs are usually done when a careful medical history and allergy tests, such as skin and blood tests, are inconclusive. The OFC is a more definitive test because it will show whether the food ingested produces no symptoms or triggers a reaction.


Oral Food Challenge (OFC) Anxiety and Worry

Given that during oral food challenges, you are eating a food that you may potentially be allergic to or have previously been allergic to, it's no surprise that you may feel anxious and worried in anticipation of that appointment - many do. Our mind wants to keep us safe, so an oral food challenge can feel like a potential threat to our mind when we think about it. Therefore, it's normal and appropriate to experience anxiety about oral food challenges. However, it's important to remember that you don't need to interpret that anxiety to mean that the oral food challenge will result in the worst-case scenario. 


What Helps OFC Anxiety and Worry?

When you experience increased anticipatory anxiety - that is, anxiety about a future event, it can be helpful to prepare for the event in order to increase readiness and decrease fear.


Here is a brief list of ways to prepare ahead of time for your or your child's oral food challenge:

  • Purpose/Process: Do you understand the purpose and process of the oral food challenge? It's important to have a good understanding of these things before the actual appointment, so reach out to your allergist if you're unsure. 

  • Information: What other questions do you or your child have about the food challenge? Will you reach out to your allergist ahead of time to ask these questions? If not, what reputable sources can provide this information? 

  • Motivation: Connect with your motivation for doing the food challenge, whether it's for yourself or your child. Reconnecting with hope and thinking about what you may gain from doing the challenge can help when feeling nervous. 

  • Thoughts/Feelings: Notice what thoughts and feelings you're having about the food challenge. How do they make your body feel? If your child is doing the food challenge, help them notice and explore their thoughts and feelings, too. Develop a list of empowering replies to these thoughts such as "I can do hard things!" or "The allergist and nurses know what they're doing!"

  • Calming Strategies: Practice some calming strategies ahead of time so that you're familiar with them for the appointment. Here are a couple of simple calming strategies you can try: 

    • For teens or adults (Square or Box Breathing) - Exhale to a count of 4, then hold for a 4 count. Inhale to a count of 4, then hold air in your lungs for a count of 4. Exhale and repeat the pattern. 

    • For kids (Cupcake & Candle Breathing) - Inhale like you're smelling a yummy cupcake, and then exhale like you're blowing out the candle on it. Repeat as many times as necessary. 

    • 5-4-3-2-1 Activity: Notice 5 things you can see. Notice 4 things you can touch. Notice 3 things you can hear. Notice 2 things you can smell. Notice 1 thing you can taste. This helps stay present-focused rather than worrying about future things. 

  • Logistics Preparation: What do you need to bring with you to the oral food challenge appointment? Create a list of food items you may need (i.e. allergen, food to put allergen in for consumption) and fun or distracting games or activities. If the food challenge is for your child, have them help you brainstorm game or toy ideas for the appointment. Also, be sure to bring along any comforting items that may help decrease anxiety and increase calm.

Additional Resources and Tips to Help Manage Oral Food Challenge Anxiety


Podcast Episode:

Be sure to listen to Episode 14 of Exploring Food Allergy Families called, "Tips for Managing Oral Food Challenge Anxiety & Worry". In this episode, fellow allergy-informed therapist Fawn McNeil-Haber, PhD and I discuss helpful strategies for navigating oral food challenges. We offer preparation tips and guidance on navigating anxiety and mindsets prior to and during the food challenge. Here are specific topics we explore in this episode: 

  • Strategies to navigate nerves during the actual OFC appointment

  • The importance of having a mantra

  • Tips to help determine anxiety versus allergic reaction sensations

  • How far in advance to tell your child about an OFC 

  • Tips to encourage readiness and decrease anxiety for kids, teens, parents, adults

  • Answering: "How does the allergist know what's happening in my body?"

  • A fun idea parents can prepare for the actual appointment

You can listen via your favorite podcast app, including Apple Podcasts, Spotify, and iHeartRadio. Don't forget to subscribe so you don't miss future episodes!


Oral Food Challenge Preparation Worksheets:

Check out the Oral Food Challenge worksheets which help prepare before the appointment, offer helpful reminders for the day of, and prompts for processing after the food challenge. (There are separate worksheets for kids and teens/adults).


Also check out this post on a post-anaphylaxis tool known as T.R.A.C.E, which is a compass guiding you back to confidence after allergic reactions. You can find all of these worksheets in The FAC's Shop.


Hopefully reading this and checking out the podcast, worksheets and other resources offers you some reassurance that oral food challenge-related anxiety is normal and manageable. Don't hesitate to reach out and let me know if these tips have helped you or your patients, or to share tips of your own!


If you're looking for an allergy-informed therapist in your state (many of whom provide telehealth to residents of their state), visit the Food Allergy Counseling Directory. (May 2024 update: the directory is now located at www.FoodAllergyCounseling.org)

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