SEQUENTIAL INCREMENTAL DOSE CHALLENGE · SEQUENTIAL INCREMENTAL DOSE CHALLENGE 441. ... ORANGE...

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

mozzarella, casein proteins casein proteinsParmesan

Proceed to Proceed toTest 2 Test 8

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


MILK AND MILK PRODUCTS

YEAST

GRAINS

b Challenge sucrose as described under “Sugars.”c Challenge food additives as described under “Food Additives.”


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


GRAINS (continued)


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


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.


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


TEST 5 Added to a Pass___ Fail___Corn oil recipe with


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


GRAINS (continued)

d Most commercial soy beverages are uncooked. Many people react to raw soy beverages, but tolerate them cooked.


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

Orange, Canned mandarin Pass___ Fail___cooked orange

OrFresh orange, Pass___ Fail___cooked inmicrowave oroven

Raw orange Fresh mandarin Pass___ Fail___

Fresh navel Pass___ Fail___

GRAPEFRUIT

Grapefruit Pasteurized Pass___ Fail___juice, cooked grapefruit juice

OrFresh or frozen Pass___ Fail___grapefruit juice,boiled and cooled

Grapefruit Fresh squeezed Pass___ Fail___juice Or

Reconstituted Pass___ Fail___from frozenconcentrate


FRUITe

e Canned fruit is cooked. Dried fruit is sold in the raw state.


GRAPEFRUIT(continued)

Grapefruit, Canned grapefruit Pass___ Fail___cooked segments

OrGrapefruit cooked Pass___ Fail___in microwave oroven

Raw grapefruit Fresh white Pass___ Fail___grapefruit

Fresh pink Pass___ Fail___grapefruit

GRAPESAND RAISINSf

Fresh grapes Grapes, washed Pass___ Fail___Not sensitive to Sensitive to grapesgrapes and/or sulfiteNot sensitive to Test sulfitesulfite separately

Raisins Nonsulfited Pass___ Fail___without sulfite raisins Not sensitive to Sensitive to raisins

raisins and probablygrapes

Raisins with Regular Pass___ Fail___sulfite (sulfited) raisins Not sensitive to If nonsulfited

raisins raisins areNot sensitive to tolerated, sensitivesulfite to sulfite

APPLE

Apple juice, Pasteurized Pass___ Fail___cooked apple juice

OrFresh or frozen Pass___ Fail___apple juice,boiled andcooled


FRUITe

f Do not challenge grapes if sulfite sensitivity is suspected, until sulfite is proven safe by challenge.


APPLE(continued)

Apple juice Unpasteurized Pass___ Fail___pure juiceOrReconstituted Pass___ Fail___from frozenconcentrate

Apple, cooked Fresh apple, Pass___ Fail___peeled, cored,and cookedOrApplesauce Pass___ Fail___without addedsugar

Fresh apple Golden Delicious Pass___ Fail___

MacIntosh Pass___ Fail___

Granny Smith Pass___ Fail___

Other varieties Pass___ Fail___(specify type)

OTHERFRUITS

Apricot Cooked Pass___ Fail___

Raw Pass___ Fail___

Banana Cooked Pass___ Fail___

Raw Pass___ Fail___

Kiwi Cooked Pass___ Fail___

Raw Pass___ Fail___

Peach Cooked Pass___ Fail___

Raw Pass___ Fail___


FRUITe (continued)


OTHERFRUITS(continued)

Pear Cooked Pass___ Fail___

Raw Pass___ Fail___

Pineapple Cooked Pass___ Fail___

Raw Pass___ Fail___

Nectarine Cooked Pass___ Fail___

Raw Pass___ Fail___

Other fruits(specify type)


FRUITe (continued)


TOMATO

Tomato juice, Canned or Pass___ Fail___cooked boiled

Tomato juice, Commercial or Pass___ Fail___raw freshly made in

blender

Tomato, Canned or Pass___ Fail___cooked cooked slices

Tomato, Various varieties Pass___ Fail___raw (specify types)

Tomato Commercial Pass___ Fail___ketchup brand If tomato is(catsup) tolerated, suspect

vinegar. Confirmby testing vinegarseparately(page 453)

SPINACH

Cooked Fresh or frozen Pass___ Fail___spinach leaves,boiled

Raw Fresh spinach Pass___ Fail___leaves, eaten asa salad

CARROT

Carrot juice, Juice extracted Pass___ Fail___cooked from raw carrots,

boiled


VEGETABLES


CARROT(continued)

Carrot juice Juice from raw Pass___ Fail___carrots

Carrot, cooked Carrots, sliced Pass___ Fail___and boiled

Carrot, raw Carrot sticks, Pass___ Fail___fresh

OTHERVEGETABLES

Celery Cooked Pass___ Fail___

Raw Pass___ Fail___

Cucumber Cooked Pass___ Fail___

Raw Pass___ Fail___

Lettuce Cooked Pass___ Fail___

Raw Pass___ Fail___

Radish Cooked Pass___ Fail___

Raw Pass___ Fail___

Other Pass___ Fail___vegetables(specify types)


VEGETABLES (continued)


Cinnamon Pass___ Fail___

Anise Pass___ Fail___

Nutmeg Pass___ Fail___

Cayenne Pass___ Fail___

Curry spice Pass___ Fail___mixture

Chili spice Pass___ Fail___mixture

Other spices Pass___ Fail___(specify types)

Distilled White vinegar Pass___ Fail___vinegar

Wine Wine vinegar Pass___ Fail___components

Fermented Rice vinegar Pass___ Fail___rice products

Additional Balsamic vinegar Pass___ Fail___ingredients

Raw Dill pickles Pass___ Fail___vegetablesin vinegar Other pickles Pass___ Fail___

and relishes(specify types)


SPICES

VINEGAR


Distilled Vodka Pass___ Fail___alcohol Or

Gin Pass___ Fail___OrTequila Pass___ Fail___OrWhite rum Pass___ Fail___

Histamine in White wine Pass___ Fail___wine

Tyramine in Red wine Pass___ Fail___wine

Fermented Beer Pass___ Fail___grain Orproducts Ale Pass___ Fail___

OrLager Pass___ Fail___

Fermented Apple cider Pass___ Fail___fruit products

Fermented De-alcoholized Pass___ Fail___beverage winewithoutalcohol(histamine)

Fermented De-alcoholized Pass___ Fail___beverage beer orwithout alcohol equivalent(grain products)

Herbal tea Pass___ Fail___

Green tea Pass___ Fail___

Decaffeinated Pass___ Fail___regular tea

Regular tea Pass___ Fail___


ALCOHOL

TEA


Decaffeinated Pass___ Fail___coffee

Regular coffee Pass___ Fail___

Flavored Pass___ Fail___coffees(specify types)

Maple sugar Pass___ Fail___or syrup

Cane sugar Pass___ Fail___

Beet sugar Pass___ Fail___

Corn syrup Pass___ Fail___

Date sugar Pass___ Fail___

Fructose Pass___ Fail___

Honey Pass___ Fail___

Cocoa butter Dark, bitter, Pass___ Fail___baker’s chocolatesweetened asdescribed inChapter 28(page 379)

Cocoa butter Dark baker’s Pass___ Fail___with milk chocolate with

milk andsweetener added

Complete Purchased Pass___ Fail___chocolate chocolateconfectionery


COFFEE

SUGARS

CHOCOLATE


Peanut Peanut, roasted Pass___ Fail___or boiled

Peanut, raw Pass___ Fail___

Whole beans, Green (French, Pass___ Fail___cooked (many string, runner)raw beans beanare toxic)

Yellow wax bean Pass___ Fail___

Broad bean (fava) Pass___ Fail___

Lima bean Pass___ Fail___

Dried beans Navy Pass___ Fail___

Pinto Pass___ Fail___

Kidney Pass___ Fail___

Black-eyed peas Pass___ Fail___

Lentils Pass___ Fail___

Split peas Pass___ Fail___

Others Pass___ Fail___(specify types)

Bean sprouts Mung bean Pass___ Fail___

Alfalfa Pass___ Fail___


Green peas Cooked Pass___ Fail___

Raw Pass___ Fail___


LEGUMES


Whole nuts Almond Pass___ Fail___

Brazil Pass___ Fail___

Cashew Pass___ Fail___

Chestnut Pass___ Fail___

Hazelnut (filbert) Pass___ Fail___

Macadamia Pass___ Fail___

Pine nut Pass___ Fail___

Pistachio Pass___ Fail___OrPecan Pass___ Fail___

Walnut Pass___ Fail___

Coconut Pass___ Fail___

Other nuts Pass___ Fail___(specify types)

Whole seeds, Sesame Pass___ Fail___roasted

Sunflower Pass___ Fail___

Flax Pass___ Fail___

Melon Pass___ Fail___

Poppy Pass___ Fail___

Pumpkin Pass___ Fail___

Other seeds Pass___ Fail___(specify types)


NUTS

SEEDS


Meat Beef Pass___ Fail___

Pork Pass___ Fail___

Lamb Pass___ Fail___

Other meats Pass___ Fail___(specify types)

Poultry Chicken Pass___ Fail___

Turkey Pass___ Fail___

Duck Pass___ Fail___

Other poultry Pass___ Fail___(specify types)

Processed Pepperoni Pass___ Fail___meats (“delimeats”) Salami Pass___ Fail___

Bologna Pass___ Fail___

Cured bacon Pass___ Fail___

Smoked bacon Pass___ Fail___

Cured ham Pass___ Fail___

Frankfurter Pass___ Fail___

Wiener Pass___ Fail___


MEAT AND POULTRY


Fresh or Cod Pass___ Fail___frozen, cooked

Sole Pass___ Fail___

Red snapper Pass___ Fail___

Salmon Pass___ Fail___

Halibut Pass___ Fail___

Perch Pass___ Fail___


Canned fish Tuna Pass___ Fail___

Salmon Pass___ Fail___

Sardines Pass___ Fail___


Cooked Lobster Pass___ Fail___

Prawn Pass___ Fail___

Shrimp Pass___ Fail___

Crab Pass___ Fail___


Raw For example, as Pass___ Fail___eaten in sushi(specify types)


FISH

SHELLFISH


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


FOOD ADDITIVES


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

Specify types: Pass___ Fail___


FOOD ADDITIVES (continued)

OTHER FOODS

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