INSTRUCTIONS ◆ Carefully follow the detailed instructions for sequential incremental dose chal- lenge provided in Chapter 28. ◆ Eat each test food in column two in the quantities and frequency described in the challenge phase, Chapter 28. ◆ Record any reactions you experience in column three. ◆ If you didn’t have any reactions after the length of time specified on the Information Sheet, place a check mark by the “Pass” and follow the instruc- tions in that column. ◆ If you recorded a reaction, place a check mark by the “Fail” and follow the instructions in that column. ◆ Proceed exactly as instructed, and in the specified sequence, for each selected food category. ◆ You can test the food category (dairy products, grains, fruits) in any order you wish. ◆ If the specific food you wish to challenge is not listed, test as described for the same type of food and enter results under “Other foods” at the end of the appropriate food category in the table Do not test any food that is suspected to have caused a severe or ana- phylactic reaction in the past by this method. Any foods that might cause a potentially severe reaction, especially in children, should be challenged only under medical supervision in a suitably equipped facility. — APPENDIX 2 — SEQUENTIAL INCREMENTAL DOSE CHALLENGE 441
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SEQUENTIAL INCREMENTAL DOSE CHALLENGE · SEQUENTIAL INCREMENTAL DOSE CHALLENGE 441. ... ORANGE Orange juice, ... CARROT (continued) Carrot juice Juice from raw Pass___ Fail___
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INSTRUCTIONS
! Carefully follow the detailed instructions for sequential incremental dose chal-lenge provided in Chapter 28.
! Eat each test food in column two in the quantities and frequency describedin the challenge phase, Chapter 28.
! Record any reactions you experience in column three.! If you didn’t have any reactions after the length of time specified on the
Information Sheet, place a check mark by the “Pass” and follow the instruc-tions in that column.
! If you recorded a reaction, place a check mark by the “Fail” and follow theinstructions in that column.
! Proceed exactly as instructed, and in the specified sequence, for each selectedfood category.
! You can test the food category (dairy products, grains, fruits) in any order youwish.
! If the specific food you wish to challenge is not listed, test as described forthe same type of food and enter results under “Other foods” at the end ofthe appropriate food category in the table
Do not test any food that is suspected to have caused a severe or ana-phylactic reaction in the past by this method. Any foods that might causea potentially severe reaction, especially in children, should be challengedonly under medical supervision in a suitably equipped facility.
— APPENDIX 2 —
SEQUENTIAL INCREMENTALDOSE CHALLENGE
441
442 — APPENDIX 2 —
TEST 1 White hard Pass___ Fail___Casein cheese; e.g., Not sensitive to Sensitive to
TEST 2 Orange/yellow Pass___ Fail___Casein aged cheese, Not sensitive to Sensitive toBiogenic e.g., aged (old) annatto or biogenic aminesamines cheddar biogenic or annattoa
AnnattoProceed Proceed
TEST 3 Lactaid® milk Pass___ Fail___Casein or Lacteez® milk Not sensitive Sensitive to wheywhey (99% lactose- to whey or proteins, but not
free) casein proteins to casein proteinsNot sensitive tocow’s milkproteins
Proceed STOP HERE
TEST 4 Milk: Pass___ Fail___Casein Homogenized, Not lactose- Lactose-intolerantWhey fat-reduced, intolerant Not sensitive tolactose 2%, 1%, or skim Not sensitive to cow’s milk
cow’s milk proteinsproteins
Proceed Proceed
TEST 5 Yogurt (plain Pass___ Fail___Modified only) Not sensitive Lactosemilk proteins to milk intolerancePartially confirmeddigested Proceedlactose STOP HERE
TEST 6 Cottage cheese Pass___ Fail___Curdled Not sensitive to Sensitive to amilk with whole milk or component ofminimum lactose cottage cheesefermentation Retest lactose
Proceed Retest whole milk
STOP HERE
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
MILK AND MILK PRODUCTS
a When you have a reaction, test each component (annatto [p. 461], biogenic amines [p. 454], histamine, and/ortyramine) separately.
— SEQUENTIAL INCREMENTAL DOSE CHALLENGE — 443
TEST 7 Ice cream Pass___ Fail___Complete Not sensitive Suspect:milk in a to milk (1) Sucrosecomplex Not lactose- intoleranceb
manufactured intolerant (2) Sensitivity toproduct Not sensitive food additivesc
to food additivesNot sucroseintolerant
TEST 8a Whey powder Pass___ Fail___Whey (contains whey Not sensitive to Sensitive to whey(without but free from whey proteins proteinscasein) casein and milkLactose-free solids) Proceed STOP HERETest only if Lactose-free orTest 1 for treated withcasein lactase enzymeproteins is (Lactaid™ drops)positive(failed Test 1)
TEST 8b Complete whey Pass___ Fail___Whey with powder Not lactose- Lactose-intolerantlactose intolerant
Saccharomyces Debittered Pass___ Fail___species brewer’s yeast Not sensitive Sensitive to
to yeast yeast
WHEAT
TEST 1 Cream of wheat Pass___ Fail___Individual Puffed wheat Not sensitive Sensitive to wheatgrain Wheat flakes to wheat
(cooked)Proceed STOP HERE
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
MILK AND MILK PRODUCTS
YEAST
GRAINS
b Challenge sucrose as described under “Sugars.”c Challenge food additives as described under “Food Additives.”
444 — APPENDIX 2 —
WHEAT(continued)
TEST 2 Yeast-free soda Pass___ Fail___Grain in a bread Not sensitive Sensitive to anyeast-free Yeast-free flat to wheat ingredient in thebaked product bread Not sensitive to product other than
Triscuit™ cracker other ingredients wheatin the product Test other
ingredients listedon the label of amanufactured food
Proceed STOP HERE
TEST 3a White bread Pass___ Fail___White (wheat) made with Not sensitive to Sensitive to whiteflour without unbleached white (wheat) (wheat) flourbleaching agent white (wheat) flour Sensitive to yeast(contains yeast, flour if test for yeastbut no Use (page 443) isbenzoates) manufactured positive
bread, or it canbe made at Proceed to Proceed tohome with Test 3b Wheat Test 4unbleachedwhite (wheat)flour
TEST 3b White bread or Pass___ Fail___White (wheat) rolls made with Not sensitive to Sensitive toflour with a “regular” to white flour, benzoatesbleaching agent bleached white yeast, or Confirm by testing(benzoate) wheat flour benzoates cinnamon, which
contains a highlevel of benzoate(see page 4610)
TEST 4 100% whole- Pass___ Fail___Whole grain wheat bread Not sensitive to Possibly sensitivein a baked wheat to proteins inproduct with Not sensitive to wheat branyeast yeast Sensitive to yeast
if test for yeast(page 443) ispositive
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
GRAINS (continued)
— SEQUENTIAL INCREMENTAL DOSE CHALLENGE — 445
RYE
Single grain Rye flakes Pass___ Fail___(cooked) Not sensitive Sensitive to rye
to rye
Proceed STOP HERE
Whole grain in 100% rye cracker: Pass___ Fail___a yeast-free Ryvita™ (wheat- Not sensitive Possibly sensitivebaked product free) or Wasa to rye to an ingredient
Light™ Not sensitive in the productto other Product label mayingredients in identify possiblethe product reactive ingredients
Proceed STOP HERE
OATS ***** ***** ***** *****
Single grain Oatmeal Pass___ Fail___porridge madefrom natural oats(e.g., TraditionalQuaker™ oatmeal)
Grain in a Traditional Scottish Pass___ Fail___baked product oat cake without
wheat, madewith oat flour
BARLEY
Single grain Barley flakes Pass___ Fail___cooked as aporridgeOrPearl barley Pass___ Fail___added to a meat-based stew
Grain in a Barley bread with Pass___ Fail___baked product only tolerated
ingredients
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
GRAINS (continued)
***** From this point on, “Pass” means the food, or component part of food, being tested is tolerated; “Fail” meansthat it is NOT tolerated.
446 — APPENDIX 2 —
CORN
TEST 1 Corn on the cob Pass___ Fail___Single grain Or
Corn niblets Pass___ Fail___
TEST 2 Popcorn Pass___ Fail___Processedwhole grain
TEST 3 Cornmeal bread Pass___ Fail___Cornmeal or muffins with
toleratedingredients
TEST 4 Used as a Pass___ Fail___Cornstarch or thickener in acorn flour product with
toleratedingredients
TEST 5 Added to a Pass___ Fail___Corn oil recipe with
toleratedingredients
TEST 6 Add to recipe Pass___ Fail___Corn syrup with tolerated
ingredients
SOY
TEST 1 Extra-firm tofu, Pass___ Fail___Tofu cooked
TEST 2 Boiled Pass___ Fail___Soy beveraged
Uncooked Pass___ Fail___
TEST 3 Tamari sauce Pass___ Fail___Fermented soyproduct withoutwheat
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
GRAINS (continued)
d Most commercial soy beverages are uncooked. Many people react to raw soy beverages, but tolerate them cooked.
— SEQUENTIAL INCREMENTAL DOSE CHALLENGE — 447
ORANGE
Orange juice, Pasteurized Pass___ Fail___cooked orange juice
OrDiluted frozen Pass___ Fail___orange juice,boiled and cooled
Orange juice Fresh squeezed Pass___ Fail___OrReconstituted Pass___ Fail___from frozenconcentrate
Raw For example, as Pass___ Fail___eaten in sushi(specify types)
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
FISH
SHELLFISH
460 — APPENDIX 2 —
Tartrazine TEST 1 Pass___ Fail___Cheese without Not sensitive to Sensitive to cow’startrazine: cow’s milk milk cheesenatural orange/ cheeseyellow cheddar Choose anothercheese Proceed to similar food and
Test 2 retest
TEST 2 Pass___ Fail___Similar cheese Not sensitive Sensitive tocontaining to tartrazine tartrazinetartrazine:processed cheesefood or processedcheese slides(label will read“tartrazine” or“artificial food color)
Sulfites TEST 1 Pass___ Fail___Dried fruit without Not sensitive to Sensitive to testnatural color—all test fruit fruit (apricot)fruits appear the (apricot)same beige/brown. Choose anotherUsually available Proceed to fruit and retestin health food Test 2stores. Label willnot have the word“sulfite” in theingredient list.Example: driedapricots
TEST 2 Pass___ Fail___The same dried Not sensitive to Sensitive tofruit treated with sulfites sulfitessulfites—the fruitwill retain itsnatural color.“Sulfite” willappear on thelabel. Purchasefrom a regulargrocery store orsupermarket.Example: driedapricots
TEST TESTCOMPONENT FOOD REACTION PASS FAIL
FOOD ADDITIVES
— SEQUENTIAL INCREMENTAL DOSE CHALLENGE — 461
MSG Available as a Pass___ Fail___powder to be Not sensitive Sensitive to MSGadded to a to MSGcarrier food thatis known to betolerated
Benzoates Cinnamon (see Pass___ Fail___page 453) Not sensitive to Sensitive to
benzoates benzoates
Annatto TEST 1 Pass___ Fail___Cheese without Not sensitive to Sensitive to cow’sannatto: white or cow’s milk milk cheesenatural (cream- cheesecolored). Choose Choose anothera cheese that is Proceed to similar food andavailable in both Test 2 retestan orange/yellowcolor and anatural/creamcolor, for example,cheddar.
TEST 2 Pass___ Fail___The same type Not sensitive Sensitive toof cheese with to annatto annattoannatto added,such as orange/yellow cheddar