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Oral Food Challenge Note Template (Pre-Challenge, Dose Log and Outcome)

2026-10-07 · 8 min read

By Pankaj Sabharwal · Co-founder, Medora

Oral Food Challenge Note Template (Pre-Challenge, Dose Log and Outcome)

The short answer: an oral food challenge (OFC) note has three parts. The

pre-challenge section records why you're challenging, that the patient is

well enough and off interfering medications, and that consent was given. The

dose log records every dose with its time, amount and what you saw. The

outcome section records the result, the doses tolerated, any reaction and

its treatment, how long the patient was observed, and what they were told to

do at home.

The template below follows the AAAAI Adverse Reactions to Foods Committee work

group report, *Conducting an Oral Food Challenge: An Update to the 2009

Adverse Reactions to Foods Committee Work Group Report* (Bird JA, et al. J

Allergy Clin Immunol Pract 2020;8:75-90). It recommends that "all patients

undergoing an OFC have documented verbal or a signed written consent," and

its tables cover reasons to delay a challenge, medications to stop

beforehand, dosing and stopping.

It's a documentation aid, not a protocol. AAAAI notes that its work group

reports are for reference and don't reflect current AAAAI policy five years

after publication. Your practice's own challenge protocol, signed off by your

allergists, comes first.

Template 1: before the first dose

```

ORAL FOOD CHALLENGE: PRE-CHALLENGE

Indication

Food challenged: [food, form (e.g. baked milk muffin, peanut butter), brand/recipe]
Reason: [test results don't match history / possible tolerance / expand restricted diet / cross-reactive food / food processing (PFAS) / other]
Relevant history: [last reaction, date, severity]
Relevant results: [SPT wheal (date), specific IgE / components (date)]

Challenge type

[open / single-blind / double-blind placebo-controlled]
Planned protocol: [4-dose / 6-dose / other], interval [15-30 min]
Target total serving: [amount, approx. protein content]

Readiness (reasons to reschedule)

Current illness, fever, wheeze or cough: [none / describe]
Short-acting beta-agonist in last 48 h: [Y/N]
Asthma, atopic dermatitis, rhinitis control: [controlled / not]
Pregnancy: [N/A / no / yes]
Beta-blocker, ACE inhibitor: [none / describe]
Antihistamines and other interfering medications stopped: [Y/N, last doses]
Fasting: [last meal time]

Baseline

Weight: [ ] Temp: [ ] RR: [ ] HR: [ ] BP: [ ] SpO2: [ ]
Peak flow / spirometry (if asthma): [ ]
Exam (skin, nose, eyes, oropharynx, heart, lungs): [ ]

Emergency preparedness

Epinephrine dose calculated by weight: [mg IM]
Other emergency medications calculated: [Y/N]
IV access: [not placed / placed, reason]

Consent

[verbal, documented / written, signed], discussed risks including anaphylaxis
Who consented: [patient / parent or guardian]

```

Three details worth writing down:

Why the challenge is worth doing. The report lists the situations

where an OFC helps, including test results that don't match the history,

and expanding the diet for people with multiple restrictions. A one-line

reason in the note explains the decision to anyone who reads it later.

The medication check. Table II gives recommended washout times for

antihistamines (for example, cetirizine 3 days, or 3 to 5 depending on the

source), and Table III covers beta-blockers, ACE inhibitors, NSAIDs and

others. Record what was stopped and when, not only "meds held".

The readiness check. Table I lists reasons to reschedule: concurrent

illness, a short-acting beta-agonist in the past 48 hours, poorly

controlled asthma, atopic dermatitis or rhinitis, unstable cardiovascular

disease, pregnancy, beta-blocker therapy, or interfering medications not

stopped. A note that shows each one was checked supports the decision to

go ahead.

Template 2: the dose log

```

ORAL FOOD CHALLENGE: DOSE LOG

1 | [ ] | [ ] | [ ] | [ ] | [none / describe]

2 | [ ] | [ ] | [ ] | [ ] | [ ]

3 | [ ] | [ ] | [ ] | [ ] | [ ]

4 | [ ] | [ ] | [ ] | [ ] | [ ]

(5-6 if 6-dose protocol)

Subjective symptoms (itchy mouth, throat, stomach pain, nausea):

[none / describe, time, whether the next dose was delayed or repeated]

Objective signs (by system):

Skin: [urticaria / angioedema / flushing / scratching / none]
Respiratory: [sneezing / rhinorrhea / cough / wheeze / stridor / dysphonia / none]
GI: [vomiting / abdominal cramping / diarrhea / none]
Cardiovascular: [pallor / hypotension / none]
Behavior (young children): [change in activity or behavior / none]

Challenge stopped: [no, completed / yes, after dose __, reason]

```

Why the dose log matters: the report says doses in an open OFC are

"typically given 15 to 30 minutes apart." Its Figure 1 sets out a 4-dose

protocol (1/12, 1/6, 1/4 and 1/2 of the serving) and a 6-dose protocol (1%,

4%, 10%, 20%, 30% and 35% of the total). It also says the challenge "should be

stopped for any objective signs of an allergic reaction," and that the

decision about subjective symptoms is the physician's. A log with times,

amounts and findings at each dose is what lets a reader see when the reaction

started and why the challenge stopped or continued.

Template 3: outcome and discharge

```

ORAL FOOD CHALLENGE: OUTCOME

Result: [passed (tolerated) / failed (reacted) / indeterminate]

Highest dose tolerated: [ ] Cumulative dose tolerated: [ ]
Eliciting dose (if reacted): [ ] Cumulative dose at reaction: [ ]

Reaction (if any)

Onset after dose __ at [time]; signs: [ ]
Treatment: [epinephrine dose, route, time / antihistamine / albuterol / other]
Response: [ ]
Observation after resolution: [from __ to __]

Observation after final dose (if tolerated): [from __ to __]

Vitals and exam at discharge: [ ]

Plan

Tolerated: [introduce food at home, how often, form]
Reacted: [continue avoidance / emergency action plan reviewed]
Epinephrine auto-injector: [current / prescribed / reviewed]
Written post-challenge instructions given: [Y/N]
Delayed reactions: told to avoid the food for the rest of the day and to call with any concerns: [Y/N]
Follow-up: [ ]

```

Two details worth writing down:

The observation time. The report says patients who tolerated the

challenge are typically observed "for at least 1 to 2 hours for an

immediate-type reaction and up to 4 hours after an FPIES challenge," and

that after a reaction it's typical to observe for 2 to 4 hours after

symptoms resolve. Write the actual times.

The home instructions. After a negative challenge, the report advises

avoiding the food for the rest of that day and watching for reactions as

it's reintroduced, and recommends eating the food regularly afterwards. It

also recommends that every patient, whatever the result, has an emergency

treatment plan and medications at discharge. Note that these were given.

FPIES challenges are different. They use a single dose or 3 equal doses

of 0.06 to 0.6 g of food protein per kg (Table VI), a longer observation,

and different signs (repetitive vomiting with lethargy or pallor 1 to 4 hours

after ingestion). Use a separate template for them.

Where these notes usually go wrong

An OFC is long, and the note is often written after the patient has left.

The details that matter most come up in conversation along the way: the

antihistamine taken three days ago "just once," the parent saying the child

is quieter than usual after dose 3, the patient saying their mouth feels

itchy. Those are easy to lose by the end of the afternoon.

Medora was built with a working allergy practice to keep them:

Medora Copilot has visit templates built for drug and food challenges,

alongside templates for new patients, follow-ups, skin testing,

immunotherapy and asthma. It listens to the visit and drafts an

allergy-structured SOAP note with pertinent negatives, and recording can be

paused and resumed across a long visit.

Evidence Mapping links lines of the note back to the moment in the visit

conversation where they were said, so the clinician can check where a

detail came from before signing.

At the next visit, Patient Intelligence shows a snapshot of the prior

visit, and the allergen profile keeps the documented reaction, severity and

status for each allergen.

The clinician reviews, edits and signs every note. Whether to challenge,

when to stop, and every treatment decision stay with the clinician.

In a 60-day pilot at Allergy Affiliates, provider sign-off per skin-test visit went from 18 minutes to 4

(the case study).

Frequently asked questions

What should be documented for an oral food challenge?

The reason for the challenge, readiness checks (current illness, asthma and

skin control, interfering medications stopped), baseline vital signs and

exam, consent, each dose with its time and amount, any symptoms or signs, the

decision to continue or stop, the result, any treatment given, the

observation period, and the instructions given at discharge.

Does an oral food challenge need written consent?

The AAAAI work group report recommends that all patients undergoing an OFC

have documented verbal consent or signed written consent. Its online

repository includes a sample written consent. Follow your practice's own

consent policy.

How far apart are doses in an oral food challenge?

In an open OFC, doses are typically given 15 to 30 minutes apart, using a

4-dose or 6-dose protocol depending on the likelihood of a reaction and the

patient's risk factors, according to the AAAAI report.

How long should patients be observed after an oral food challenge?

The AAAAI report says patients who tolerate the challenge are typically

observed for at least 1 to 2 hours for an immediate-type reaction, and up to

4 hours after an FPIES challenge. After a reaction, it's typical to observe

for 2 to 4 hours after symptoms resolve.

Does Medora decide when to stop a food challenge?

No. Medora Copilot drafts the visit note for the clinician to review, edit

and sign. Whether to proceed, when to stop, and how to treat a reaction stay

with the clinician and your practice's protocols.

Try it on your own visits

*Source: Bird JA, Leonard S, Groetch M, et al. Conducting an Oral Food

Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work

Group Report. J Allergy Clin Immunol Pract. 2020;8(1):75-90

(doi:10.1016/j.jaip.2019.09.029; Tables I, II, III and VI, Figure 1, and the

sections on safety, emergency preparedness, stopping the OFC and guidance

after the OFC). Quotes are from the report. Check for later AAAAI updates and

follow your own protocols.*