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SINGAPORE - In a clinic room filled with toys and a big television screen showing cartoons, three-year-old Jerrell Lim settled down to a four-hour food challenge.
Every 15 minutes, he was fed a small portion of egg under the close supervision of nurses and dietitians at KK Women's and Children's Hospital.
The medical staff - who suspected he had an allergy to eggs - paid close attention, watching for any bad reaction to the food, such as rashes, cough and stomach ache.
Putting children through such a test is the "best way" to diagnose an allergy when a child's history with a particular food is unclear, said Dr Rajeshwar Rao, a senior consultant in KKH's allergy service.
It also determines if the child has outgrown an allergy.
Results from skin and blood tests may not be conclusive, explained the paediatrician.
The service, which began five years ago, handles an average of 50 cases a year, up from 19 in 2008.
Most children are referred there by a doctor.
Dr Rao said the rise in cases may be due to an increase in awareness about food allergies and, possibly, an increase in incidence.
Most of the children are between two and five years old. The hospital also runs tests for drug allergies.
Testing the child in a controlled environment means doctors and nurses are on hand if a bad reaction occurs. Said Dr Rao: "We can treat the child if something happens, rather than parents doing it at home where there is no support."
Parents will also know how much of the food the child can tolerate, he added.
Principal dietitian Phuah Kar Yin said medication is ordered in advance for children who may react strongly during the test.
Vital signs are also recorded before, during and after the session, including blood pressure, temperature, heart rate and breathing.
Up until last year, more than 200 children had taken the food test, with around a fifth experiencing an allergic response.
The challenge ends once there is a bad reaction, said Ms Phuah.
If a child goes into shock, he will be treated immediately and sent to the high dependency unit.
However, this happens only once or twice a year and high-risk children will not be put through the challenge.
If a child passes the test, he is free to eat as much of the food as he likes. Parents are even encouraged to include it in the child's daily meals - otherwise, the allergy may return.
Ms Phuah said about one in 10 parents still remains fearful and continues to avoid giving the child the food.
Children are monitored at home for 24 hours after the test in case of any delayed allergic reaction.
Jerrell cleared this hurdle, having had no problems since taking the egg test two weeks ago.
His father John Lim, 40, who attended the session, said his son is due to take another food challenge for peanuts after laboratory tests showed he may also be allergic to them.
Mr Lim, who works for a medical devices manufacturer, said the test helps to clear up doubts once and for all.
Jerrell's case is not clear-cut, he explained. Several months ago he ate a peanut candy but was fine.
He also has eczema and a respiratory infection called bronchiolitis, but whether they have a link to the allergies remains unclear.
Although the food test may cause anxiety among parents who are watching, it reduces the risk of emergencies happening at home, said Mr Lim, who also has a five-year-old daughter.
"It is also good to find out early. Once they grow up, it gets harder to keep track of what they eat."
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