Drug Challenge Test

Drug Challenge Test

Paediatric Department
Drug Challenge Test
It has been recommended that your child has a drug challenge test. The terms, ‘medicine’, ‘drug’ and ‘medication’ are used interchangeably and are used to describe a substance that is prescribed by a medical professional to treat a disease or condition.

This leaflet explains some of the benefits, risks and alternatives to the procedure. We want you and your child to have an informed choice so you can make the right decision. Please ask your medical team about anything you do not fully understand or want to be explained in more detail.

We recommend that you read this leaflet carefully. You and your doctor (or other appropriate health professional) will also need to record that you agree for your child to have the procedure by signing a consent form, which your health professional will give you.

Benefits of the procedure
A drug challenge test is used to exclude an allergy to a medicine. It is used when we suspect that there is not an underlying allergy to a medication. It is beneficial to understand what medication your child is allergic to so that they can receive the most appropriate medication if they become ill in the future

Serious or frequent risks
There are few serious risks. We do not challenge patients who we believe will have an anaphylactic reaction. An anaphylactic reaction is a serious, life threatening allergic reaction which develops rapidly after ingestion or administration of a drug. Anaphylaxis has been reported in a small number of cases and is extremely rare.

Moderate allergic reactions include wheezing and stridor. Mild allergic reactions, which are the most common, include urticaria (‘hives’), angioedema, itching, nasal congestion and sneezing, swollen or watery eyes.

Children and young people with eczema may develop a flare of eczema a few days afterwards if the allergen stimulates it but most children with eczema don’t experience this.

Your child will be cared for by a skilled team of doctors, nurses and other healthcare professionals who are involved in this type procedure frequently. If an allergic reaction arises, we will be able to assess them and treat them appropriately.

Other procedures which are available
There are no other procedures available to challenge patients against the purported drug allergen. We make an assessment before the challenge based on clinical information and possibly skin prick testing. This test is to prove the absence of drug allergy in a controlled setting.

Your child’s admission to the ward
Your child will usually be admitted to a day case bed in the Children’s Clinic. We will check your child’s details and fasten an armband containing their hospital information to his or her wrist.

We will usually ask you to continue with your child’s normal medication so please bring it with you but we will have asked you to refrain from any antihistamines in the 72 hours prior to a challenge as this may result in a false negative result.

Preparation
Unless your child is too young to understand you should tell them:

• why they are in hospital;
• that they will be given some medicine
• that we will need to look at their skin and check their physical health by using some machines
• encourage your child to talk about the procedure and ask questions.

We have nurses who can explain things to your child and encourage them to talk through play and appropriate communication if required.

Unless your child has a serious reaction, requiring more observation, we do not expect that your child will need to stay the night in hospital.

Before the procedure
We will ask you some questions about your child’s health to make sure that they are well enough for the challenge. We will also do some observations and listen to your child’s chest. We might need to do a skin prick test before we give the drug. We will ask you to sign the consent form. The medical team looking after your child will check the emergency equipment and medication are appropriately prepared

During the procedure
Your child will be awake all the time. We will administer your child the drug in question in either one dose or spread over more, smaller doses.

We will record your child’s observations like blood pressure and pulse. We will also ask your child how s/he feels and if s/he has any itching, tingling or rash. If your child is very young we will ask the accompanying adult. If there are any signs of an allergic reaction we will treat them accordingly.

After the procedure
We will ask your child to stay on the ward for one to two hours after the drug challenge has been completed. They may have to stay longer if they have a reaction and require some treatment such as antihistamines. The nurses will continue to check your child’s observations. Your child will be allowed home if there are no signs of an allergic reaction or any reaction has stabilised. Very occasionally a reaction can occur between 1 hour and 24 hours after the challenge but this is exceptionally rare and we will explain to you what to do if this occurs.

Leaving hospital

Length of stay
How long your child will be in hospital varies from patient to patient and depends on how quickly we complete your child’s procedure. Most children having this type of procedure will be in hospital for half a day.

Medication when you leave hospital
In most cases, an additional course of treatment needs to be completed at home. This is to make sure your child can tolerate a full treatment course. If extra medication is required for your child to take when you are at home we will arrange a prescription and explain how to give this.

Convalescence
Most children have no problems on returning home. Very occasionally a reaction can occur between 1 hour and 24 hours after the challenge has finished but this is very rare.

Outpatient appointment
No follow-up is arranged after a negative challenge unless there are other allergies requiring management. This appointment will usually already be arranged.

Contact details
If you have any specific concerns that you feel have not been answered and need
explaining, please contact the following.

• Children’s Clinic Worcestershire Royal Hospital (phone 01905 760588)

Other information
The following internet websites contain information that you may find useful.
https://www.nhs.uk/conditions/allergies/

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.