Patient information for children, parents and guardians.

Important information

• One caregiver: with regard to safety. During the provocation test, only one caregiver can accompany your child; no siblings can accompany on this day.
• No antihistamine: 72 hrs prior to the test no antihistamine should be given to your child.
• Illness: In case of illness or allergic symptoms, the test might need to be postponed. Please cancel the appointment well in time or if in doubt contact us (see further explanation at the end of the letter).

Why a provocation test? The provocation test provides clarity about:

• Whether allergic symptoms occur in reaction to the tested food and how severe these reactions may be.
• At what level symptoms arise (relevant for dietary advice).
• Whether there is a need for an adrenaline auto-injector to treat a severe allergic reaction.

How does the provocation test proceed?

Double-blind provocation test

In a double-blind provocation test, you will receive an invitation for 2 visits: we know from research that if a person knows in advance that they are going to eat a suspect food item, this can affect the outcome of the study. To avoid this, we mask the food to be tested in, for example, a muffin, pancake, fruit snack or milk substitute. This way, you, your child, the nurse and the doctor do not know whether the food is hidden in the food on the first or second visit; that is why we call this a double-blind study. Only later will we disclose whether your child ate the food on the first or second visit. This is usually by telephone, a few days after the second provocation day.

Open provocation test

With an open provocation test, you will receive a 1-visit invitation: The food to be tested will then be given on one visit. The choice for an open provocation depends on several factors (including risk of reactions and the age of the patient). You can then be sure that your child gets the food to be tested that day. If the test goes well and your child can tolerate the food well, you will receive an explanation from the doctor and/or dietitian on how to introduce the food at home.

Explanation of open/double-blind provocation test

During the provocation test, your child is given an increasing amount of the food in a series of steps (four to eight), with 20 to 30 minutes between each step. We start with a (very) small amount of the food and slowly stepwise increase this amount. Before each new step, as well as in between, your child is closely monitored and it is assessed whether the next step can be given. Still, there is a chance that allergic symptoms may occur; therefore, the provocation test also takes place at the hospital in the pediatrician's office so that we can act immediately if symptoms occur.
After taking the last step, you should wait another hour. After an hour, the doctor will come to assess your child's ability to go home. In total, the examination for an 8-step provocation takes at least 5 hours (if no symptoms develop).
Between steps, your child can play and relax in the playroom or lounge room. There are plenty of play materials available for all ages. You and your child should stay near the allergy room so the nurse can observe your child.

If your child develops symptoms during the test, the doctor will assess whether your child can proceed to the next step, repeat a step, or stop the provocation test. The doctor will also assess whether your child needs medication to reduce the symptoms. Your child must then stay at least two hours longer until all symptoms are completely gone. In case of severe reactions or doubt or if medication has been given, this observation time is longer, sometimes up to 4 hours longer.

Preparation at home

• On the morning of the test, your child may have a normal breakfast. Infants may have a bottle or breast milk. Throughout the test afterwards, your child should not eat and should drink only water or tea without milk. So no bottle or breastfeeding either. Please bring your own bottle.
• If your child is taking an anti-histamine, tablet or suspension (such as Aerius, Xyzal or Zyrtec), you must stop taking it 72 hours before the test.
• However, your child should continue any medication he or she is taking for eczema or asthma. Ointments, asthma maintenance sprays and nasal sprays may be used as usual.
• Please bring something to eat/drink for your child that they are used to eating; often after the test, they are hungry for something.
• For infants/toddlers coming for an egg, peanut or nut provocation test, we ask that you bring a fruit or vegetable snack of at least 200 grams to mask egg, peanut or nut. Please bring a pushchair for possible naptime. You are with many parents and children in 1 room, there is no bed where your child can sleep. Also, remember e.g. your child's pacifier or cuddly toy.

Illness or allergic complaints: 015-2603570

If your child is ill (e.g. severe cold or diarrhea) or suffers from eczema, hay fever or asthma (with use of Salbutamol/Ventolin/Airomir), the provocation cannot take place. We cannot then adequately assess your child for the early signs of an allergic reaction; this increases the risk of more severe reactions. So when in doubt, we ask you to cancel the provocation well in time or call for advice. Sometimes it is necessary to have your child assessed by the doctor first in order to decide whether the provocation test can go ahead, and so you may still need to come to the hospital so that the doctor can assess whether or not the test can go ahead.

If you are unable to attend: 015-2603577

Should you be unable to attend your appointment for any reason, please inform us as soon as possible due to the time and preparation required for the examination and considering the long waiting list.

For other questions: allergology outpatient clinic, 070-3401243 or dac@rdgg.nl