FOOD CHALLENGE PROTOCOLS

COW’S MILK CHALLENGE

CHALLENGE SUBSTANCE
1. Less than 12 months old – cow’s milk based infant formula
2. More than 12 months old - full cream cow’s milk

CHALLENGE PROTOCOL

Day 1

TIME mL milk
0 Drop inside lip (not to touch outside lip)
20 min 1 mL
40 min 5 mL
60 min 15 mL
80 min 40 mL
100 min 100 mL
Daily total ~160 mL

OBSERVATION POST-CHALLENGE
Generally for 2 hours

HOME CONTINUATION

Day 2
160 mL

Days 3-14
Increase amount as tolerated until all bottles in an infant (< 12 months of age) are cow’s milk based
formula or daily amount is 200-300 mL (> 12 months of age).

Note: Completely or partly hydrolysed (HA) formula should NOT be used for milk challenges.

© ASCIA 2011 The Australasian Society of Clinical Immunology (ASCIA) is the peak professional body of clinical immunology and
allergy specialists in Australia and New Zealand. Website: www.allergy.org.au Email: education@allergy.org.au

Disclaimer: Food challenges are used to confirm if an allergic reaction to a food exists or if it has resolved. They can result in
potentially life threatening anaphylaxis and should therefore only be carried out by medical practitioners in carefully selected
patients, under strict medical supervision and in consultation with a clinical immunology /allergy specialist. ASCIA Food
Challenge Protocols were developed by ASCIA to standardise the protocols for food challenges used by clinical
immunology/allergy specialists in Australia and New Zealand. They have been peer reviewed by ASCIA members and are based
on expert opinion and available published literature at the time of review.
Development of these protocols is not funded by any commercial sources and is not influenced by commercial organisations.
 Action plan for
www.allergy.org.au An ap h y l axis
Name:
For use with EpiPen® adrenaline autoinjectors
Date of birth: m i l d t o m o d e r at e A l l e r g i c r ea c t i o n
• Swelling of lips, face, eyes
• Hives or welts
• Tingling mouth
• Abdominal pain, vomiting (these are signs of a severe allergic
Photo
reaction to insects)
A CTION
• For insect allergy, flick out sting if visible. Do not remove ticks.
• Stay with person and call for help
• Locate EpiPen® or EpiPen® Jr
• Give other medications (if prescribed) ....................................
Confirmed allergens:
Dose: ..........................................................................................
• Phone family/emergency contact

Mild to moderate allergic reactions may

or may not precede anaphylaxis
Family/emergency contact name(s):
Watch for any one of the following signs of Anaphylaxis

Work Ph:
a n aph y l a x i s ( s e v e r e A l l e r g i c r ea c t i o n )
Home Ph: • Difficult/noisy breathing
Mobile Ph: • Swelling of tongue
Plan prepared by: • Swelling/tightness in throat
Dr: • Difficulty talking and/or hoarse voice
Signed: • Wheeze or persistent cough
Date: • Persistent dizziness or collapse
• Pale and floppy (young children)
How to give EpiPen®
1 2 A CTION
1 Lay person flat. Do not allow them to stand or walk.
If breathing is difficult allow them to sit.
Form fist around Place ORANGE 2 Give EpiPen® or EpiPen® Jr
EpiPen® and
pull off BLUE
end against outer
mid-thigh (with or
3 Phone ambulance*- 000 (AU), 111 (NZ), 112 (mobile)
SAFETY RELEASE. without clothing). 4 Phone family/emergency contact
5F  urther adrenaline doses may be given if no response after
3 4
5 minutes (if another adrenaline autoinjector is available)
© ASCIA 2013. This plan was developed by ASCIA

If in doubt, give adrenaline autoinjector

After giving adrenaline:
Push down Remove EpiPen®. • Commence CPR if there are no signs of life
hard until a click Massage • Give asthma medication if unsure whether it is asthma or anaphylaxis
is heard or felt injection site for
EpiPen® is generally prescribed for adults and children over 5 years.
and hold in place 10 seconds.
for 10 seconds. EpiPen® Jr is generally prescribed for children aged 1-5 years.
*Medical observation in hospital for at least 4 hours is recommended after anaphylaxis.

Instructions are also on the device label Additional information

and at www.allergy.org.au/health-
professionals/anaphylaxis-resources Note: This is a medical document that can only be completed and signed by the patient's
treating medical doctor and cannot be altered without their permission.