Allergy and immunology services at Sydney Children's Hospital, Randwick

The Immunology and Allergy Service at Sydney Children's Hospital, Randwick (SCH) provides a comprehensive service for the assessment, investigation, and management of autoimmune disease, immunodeficiency and allergic disorders.

Assessments include skin testing for allergy, clinical challenges and laboratory investigation.

Clinic appointments and referral information

The Immunology and Allergy Service runs clinics for assessment, investigation and management of autoimmune diseases immunodeficiency and allergic disorders.

Allergy and Immunology Services at SCH include:

• Food challenge clinics are held in Ward C1N, level 1, Sydney Children’s Hospital, Randwick.
• Immunology clinics 
• Infectious Disease clinics (including the Paediatric HIV Service, congenital infections and immunisation services)

To make an appointment to see an allergy and immunology specialist you will need a referral from your GP or Paediatrician.

Drug challenge information for parents

Drug challenges are similar to food challenges - a child is given a small dose of a medication which has previously caused an allergic reaction. Challenges are done to determine if the medication can be given to them in the future if needed.

Drug challenges are done under medical guidance with a doctor present.

• Download the Drug challenge information sheet

Food challenge information for parents

On the day of the challenge

• On arrival, please proceed to Ward C1N, Medical Day Unit, Level 1, Sydney Children’s Hospital, please see the clerical staff to complete admission paperwork before proceeding to the food challenge room.
• A food challenge takes approximately 5-6 hours in total. This includes 4-6 doses of the food given at 20-minute intervals, followed by a wait of 2 hours to observe for an allergic reaction.
• If your child has a reaction in food challenge you may need to stay longer to ensure the reaction has resolved. (Bring a change of clothes, in case of vomiting).
• Bring some fun activities for your child to do, as it is can be a long day and your child will not be able to leave the Ward. Free WIFI is available.
• Due to space constraints in the Ward, a maximum of one Parent or Legal Guardian may attend a food challenge with the child and if possible siblings should not attend.
• A Legal Guardian must accompany the child to the food challenge to give Medical Consent. A Grandparent (unless Legal Guardian) cannot attend in lieu of a parent.

The Food Challenge Ward is a busy environment with an average of 10-15 children eating a variety of different foods, sharing the space with your child and your child may witness another child having an allergic reaction during the food challenge.

If you feel this might be of concern to you or your child, please discuss it with the nurse a few days prior to your child's appointment.

Food to bring for the food challenge

• Please bring your child’s favourite food to mix with their challenge food.
• For nut challenges, fruit, yoghurt, custard or ice-cream can be mixed.
• For egg or seafood challenges, add savoury food like pasta, rice crackers or sandwiches.
• Please also bring a normal diet for morning/afternoon tea for yourself and your child.

Challenge foods

Peanuts, tree nuts, sesame, wheat, cow’s milk are supplied by the Hospital.

If your child is having a cow's milk challenge and is under 12 month's of age, please bring 300ml of their cow’s milk-based formula.

For Egg challenges

Please bring:

• 2 raw eggs (for egg challenge - the nurses will cook these on the day)

For Soy challenges

Please bring:

• 300ml soy milk
• 300ml soy milk-based formula (if child is under 12 months of age)

For Fish challenges

Please bring:

• 40g cooked fish + a tiny portion of raw fish for skin testing (No canned tuna or salmon)
• 40g fresh cooked shellfish (supply with shell removed)

An age-appropriate serving of fruit, vegetables, legumes can be cooked or raw as desired.

FPIES food challenge information for parents

On the day of the challenge

• On arrival, please proceed to Ward C1N, Medical Day Unit, Level 1, Sydney Children’s Hospital, please see the clerical staff to complete admission paperwork before proceeding to the food challenge room.
• An FPIES food challenge takes approximately 5-6 hours in total.  Prior to the challenge we usually place an intravenous(IVI) cannula to ensure we are able to treat profuse vomiting with IVI fluid if it occurs. The challenge involves eating a dose of the food followed by a 4-hour wait to observe for an FPIES reaction.
• If your child has a reaction in food challenge you may need to stay longer to ensure the reaction has resolved. (Bring a change of clothes, in case of vomiting).

Preparation prior to the challenge:

Your child should not have any antihistamine for 3 days prior to the challenge. This includes cold medications and antihistamines such as Claratyne, Phenergan, Zyrtec and Telfast.

Food to bring to the challenge

• Please bring your child’s favourite food to mix with their challenge food.
• For egg or seafood challenges, add savoury food like pasta, rice crackers or sandwiches.
• Please also bring a normal diet for lunch, morning/afternoon tea for yourself and your child.

Challenge foods

• The hospital provides cow’s milk but all other foods required for challenge you will need to bring on the day.  

For egg challenge 

Please bring one cooked egg (boiled, fried, scrambled, omelette)

For rice challenge

Please bring a small serving of cooked rice (boiled, fried, steamed, rice cereal or rice cakes-unflavoured

For fish or chicken challenge

Please bring a small serving size of cooked fish or chicken (boiled, fried, steamed)

For fruit/vegetable challenge

Please bring a normal serving size of either cooked or raw fruit or vegetable.

Preparation for a food challenge

Your child should not have any antihistamine or oral steroids for 3 days prior to the food challenge.

This includes cold medications and antihistamines such as Claratyne, Phenergan, Zyrtec and Telfast, or oral steroids such as Redipred or Predmix.

If your child is taking asthma preventer medications such as Singular, Flixotide or Seretide they should continue taking this medication to ensure asthma is well controlled for food challenge.

Parent-led food challenges

We provide a medically-supervised environment so that parents can feel safe when introducing potentially allergic food. This is only available when recent tests have shown that your child is extremely unlikely to have an allergic reaction.

Please arrive at the clinic at 8:30 am for orientation and explanation about the food challenge.

Bring the food with you in an age-appropriate form (e.g. soft peanut butter for infant, or crushed nuts or nut paste for toddlers and preschoolers)

Introducing the food

• Perform introduction slowly over the course of 3-4 hours, by giving your child a small quantity of the food.
• Observe for symptoms of an allergic reaction (see ASCIA Green Allergy Plan or red Anaphylaxis Plan)
• If no reaction has occurred after half an hour give double the amount
• Double the dose ½ hourly to get to (depending on the food) 1 teaspoon, 100mls, ½ cup, 1 muffin or 1 slice of bread
• If at any time, you feel that your child is having a reaction, please speak to one of the nurses or doctors in the clinic rooms to get assistance.

Food quantities

• Nuts: 1/8 flat teaspoon
• Egg: 1/8 flat teaspoon. Ensure egg is fully cooked—Boil for 4 minutes; scramble with no transparent white left
• Milk: 1/2 teaspoon
• Baked food such as egg muffin or bread: 1/8 of a slice of bread equivalent

Continuing at home

• If there is no reaction in the clinic, and your child is approved for continued challenges at home, give the same amount at home for 3 days.
• If your child has no reaction to the food, then it is safe for them to include it in a normal diet.
• If your child tolerates a food, it is important to introduce that food regularly into their diet, as this may protect against the future development of allergy to that food.
• If they have a reaction, when symptoms settle, email the clinic or phone 93821003 to let us know.

Baked egg challenge recipe

This recipe is supplied by The Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body of clinical immunology and allergy specialists in Australia and New Zealand. 

• Visit www.allergy.org.au
• Download the recipe

Please bake the muffin as follows and bring to the clinic on the day of your child's challenge.

Muffin ingredients

• 100 g of room temperature butter or Nuttelex margarine (or other milk-free margarine if cow’s milk allergic)
• 160 g of sugar 220 g of sifted self-raising flour (if allergic to wheat, use appropriate flour – e.g. soy, rice)
• 125 ml of milk child is tolerant to (e.g. cow’s, soy, rice, etc)
• 2 large (50 g) sized eggs (room temperatures)
• Muffin tray (12 muffins) and muffin cups

Preparation instructions

• Pre-heat conventional oven to 180oC (fan-forced 165)
• Mix butter and sugar until creamy
• Add the two eggs and mix
• Add flour and milk and combine on low speed
• Place muffin cups into the tray
• Distribute batter evenly into each muffin cup
• Bake for 20 minutes or until slightly golden brown and firm to touch
• Please bring two muffins along on the day of the challenge.
• The challenge will consist of a maximum of one whole muffin.

Baked milk challenge recipe

This recipe is supplied by The Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak professional body of clinical immunology and allergy specialists in Australia and New Zealand. 

• Visit www.allergy.org.au
• Download the recipe

Please bake the muffin as follows and bring to the clinic on the day of your child's challenge.

Muffin ingredients

• 125 g of butter at room temp
• 160 g of sugar
• 200 g of sifted self-raising flour (if allergic to wheat, use appropriate flour – e.g. soy, rice and baking powder - approx. 1tsp if required)
• 250 ml of milk
• 2 eggs or egg substitute (room temp)
• Muffin tray (12 muffins) and use only 10 large muffin cups

Preparation instructions

• Pre-heat conventional oven to 180oC (165 fan forced)
• Add softened butter and sugar and mix on low speed until creamy
• Add the two eggs and mix on low speed until combined
• Add alternative equal amounts of sifted flour and milk whilst mixing on low speed until all flour and milk has been added
• Combine ingredients on medium speed until smooth
• Add optional 1 teaspoon vanilla essence
• Place muffin cups into the tray and distribute batter evenly into each of 10 muffin cups
• Bake for 20-25 minutes or until slightly golden brown and just firm to touch (or test with skewer)
• Please bring two muffins along on the day of challenge.
• The challenge will consist of a maximum of one whole muffin.

Baked egg meatball recipe

Please bake the meatballs as follows and bring to the clinic on the day of your child's challenge.

Ingredients

• 500gm veal &/or pork mince (or a mince of your own choice of meat)
• 2 large 50gm eggs
• 3 slices stale bread grated
• Tbsp tomato & BBQ sauce each
• Mix together well with hands in a bowl

Preparation instructions

• Preheat oven 180 degrees
• Line muffin tray (12 cup) with paper muffin cups
• Divide meat mixture evenly into the muffin cups
• Bake 30 min
• Rest in tin 5 min before removing
• Sauce can be added when eating on the day.
• Please bring 2-3 meatballs with you for the challenge.
• Your child will eat 1-2 meatballs on the day.

FAQs 

What if my child is unwell prior to or on the day of food challenge?

The Food Challenge may need to be postponed if your child is unwell.
If your child is unwell or has required asthma reliever such as Ventolin the day before or on the day of Food Challenge please contact Allergy CNC on pager 47207 via switchboard 9382 1111

What if my child is a fussy eater?

Food Challenge staff will support you feeding your child in Food Challenge. If you think that it is very unlikely for your child to eat the Challenge Food, please contact the nurses beforehand to discuss whether Food Challenge is appropriate for your child at this stage.

Please note: It is common for a Food Challenge to be postponed because the child refuses to eat. We are unable to predict if this will happen, and we do not force feed children in Food Challenge.

What if I don't want my child to eat the food they are allergic to?

In general, it is only appropriate to perform a Food Challenge if you intend to introduce the food to the child’s diet if it is safe to do so. 
If you are not intending to introduce this Food at home for any reason, please contact the nurses prior to attending to determine whether Food Challenge is appropriate for your child at this stage.

What if my child has had anaphylaxis in the last 4 weeks prior to the food challenge date?

We can’t proceed with your child’s challenge within 4 weeks of an episode of anaphylaxis. Your child’s body is still in ‘high alert’ and it is not always safe to perform challenges at this time. Please let us know via email and we will push your challenge back so that it has been more than 4 weeks . We will not put you to the end of the waitlist.