SEQUENTIAL INCREMENTAL DOSE CHALLENGE

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1 APPENDIX 2 SEQUENTIAL INCREMENTAL DOSE CHALLENGE INSTRUCTIONS Carefully follow the detailed instructions for sequential incremental dose challenge provided in Chapter 28. Eat each test food in column two in the quantities and frequency described in 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 instructions in that column. If you recorded a reaction, place a check mark by the Fail and follow the instructions in that column. Proceed exactly as instructed, and in the specified sequence, for each selected food category. You can test the food category (dairy products, grains, fruits) in any order you wish. If the specific food you wish to challenge is not listed, test as described for the same type of food and enter results under Other foods at the end of the appropriate food category in the table Do not test any food that is suspected to have caused a severe or anaphylactic reaction in the past by this method. Any foods that might cause a potentially severe reaction, especially in children, should be challenged only under medical supervision in a suitably equipped facility. 441

2 442 APPENDIX 2 MILK AND MILK PRODUCTS 1 White hard Pass Fail Casein cheese; e.g., Not sensitive to Sensitive to mozzarella, casein proteins casein proteins Parmesan Proceed to Proceed to Test 2 Test 8 2 ange/yellow Pass Fail Casein aged cheese, Not sensitive to Sensitive to Biogenic e.g., aged (old) annatto or biogenic amines amines cheddar biogenic or annatto a Annatto Proceed Proceed 3 Lactaid milk Pass Fail Casein or Lacteez milk Not sensitive Sensitive to whey whey (99% lactose- to whey or proteins, but not free) casein proteins to casein proteins Not sensitive to cow s milk proteins Proceed STOP HERE 4 Milk: Pass Fail Casein Homogenized, Not lactose- Lactose-intolerant Whey fat-reduced, intolerant Not sensitive to lactose 2%, 1%, or skim Not sensitive to cow s milk cow s milk proteins proteins Proceed Proceed 5 Yogurt (plain Pass Fail Modified only) Not sensitive Lactose milk proteins to milk intolerance Partially confirmed digested Proceed lactose STOP HERE 6 Cottage cheese Pass Fail Curdled Not sensitive to Sensitive to a milk with whole milk or component of minimum lactose cottage cheese fermentation Retest lactose Proceed Retest whole milk STOP HERE a When you have a reaction, test each component (annatto [p. 461], biogenic amines [p. 454], histamine, and/or tyramine) separately.

3 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 443 MILK AND MILK PRODUCTS 7 Ice cream Pass Fail Complete Not sensitive Suspect: milk in a to milk (1) Sucrose complex Not lactose- intolerance b manufactured intolerant (2) Sensitivity to product Not sensitive food additives c to food additives Not sucrose intolerant 8a Whey powder Pass Fail Whey (contains whey Not sensitive to Sensitive to whey (without but free from whey proteins proteins casein) casein and milk Lactose-free solids) Proceed STOP HERE Test only if Lactose-free or Test 1 for treated with casein lactase enzyme proteins is (Lactaid drops) positive (failed Test 1) 8b Complete whey Pass Fail Whey with powder Not lactose- Lactose-intolerant lactose intolerant Saccharomyces Debittered Pass Fail species brewer s yeast Not sensitive Sensitive to to yeast yeast WHEAT YEAST GRAINS 1 Cream of wheat Pass Fail Individual Puffed wheat Not sensitive Sensitive to wheat grain Wheat flakes to wheat (cooked) Proceed STOP HERE b Challenge sucrose as described under Sugars. c Challenge food additives as described under Food Additives.

4 444 APPENDIX 2 GRAINS (continued) WHEAT (continued) 2 Yeast-free soda Pass Fail Grain in a bread Not sensitive Sensitive to an yeast-free Yeast-free flat to wheat ingredient in the baked product bread Not sensitive to product other than Triscuit cracker other ingredients wheat in the product Test other ingredients listed on the label of a manufactured food Proceed STOP HERE 3a White bread Pass Fail White (wheat) made with Not sensitive to Sensitive to white flour without unbleached white (wheat) (wheat) flour bleaching agent white (wheat) flour Sensitive to yeast (contains yeast, flour if test for yeast but no Use (page 443) is benzoates) manufactured positive bread, or it can be made at Proceed to Proceed to home with Test 3b Wheat Test 4 unbleached white (wheat) flour 3b White bread or Pass Fail White (wheat) rolls made with Not sensitive to Sensitive to flour with a regular to white flour, benzoates bleaching agent bleached white yeast, or Confirm by testing (benzoate) wheat flour benzoates cinnamon, which contains a high level of benzoate (see page 4610) 4 100% whole- Pass Fail Whole grain wheat bread Not sensitive to Possibly sensitive in a baked wheat to proteins in product with Not sensitive to wheat bran yeast yeast Sensitive to yeast if test for yeast (page 443) is positive

5 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 445 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 sensitive baked product free) or Wasa to rye to an ingredient Light Not sensitive in the product to other Product label may ingredients in identify possible the product reactive ingredients Proceed STOP HERE OATS ***** ***** ***** ***** Single grain Oatmeal Pass Fail porridge made from natural oats (e.g., Traditional Quaker oatmeal) Grain in a Traditional Scottish Pass Fail baked product oat cake without wheat, made with oat flour BARLEY Single grain Barley flakes Pass Fail cooked as a porridge Pearl barley Pass Fail added to a meatbased stew Grain in a Barley bread with Pass Fail baked product only tolerated ingredients ***** From this point on, Pass means the food, or component part of food, being tested is tolerated; Fail means that it is NOT tolerated.

6 446 APPENDIX 2 GRAINS (continued) CORN 1 Corn on the cob Pass Fail Single grain Corn niblets Pass Fail 2 Popcorn Pass Fail Processed whole grain 3 Cornmeal bread Pass Fail Cornmeal or muffins with tolerated ingredients 4 Used as a Pass Fail Cornstarch or thickener in a corn flour product with tolerated ingredients 5 Added to a Pass Fail Corn oil recipe with tolerated ingredients 6 Add to recipe Pass Fail Corn syrup with tolerated ingredients SOY 1 Extra-firm tofu, Pass Fail Tofu cooked 2 Boiled Pass Fail Soy beverage d Uncooked Pass Fail 3 Tamari sauce Pass Fail Fermented soy product without wheat d Most commercial soy beverages are uncooked. Many people react to raw soy beverages, but tolerate them cooked.

7 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 447 FRUIT e ORANGE ange juice, Pasteurized Pass Fail cooked orange juice Diluted frozen Pass Fail orange juice, boiled and cooled ange juice Fresh squeezed Pass Fail Reconstituted Pass Fail from frozen concentrate ange, Canned mandarin Pass Fail cooked orange Fresh orange, Pass Fail cooked in microwave or oven Raw orange Fresh mandarin Pass Fail GRAPEFRUIT Fresh navel Pass Fail Grapefruit Pasteurized Pass Fail juice, cooked grapefruit juice Fresh or frozen Pass Fail grapefruit juice, boiled and cooled Grapefruit Fresh squeezed Pass Fail juice Reconstituted Pass Fail from frozen concentrate e Canned fruit is cooked. Dried fruit is sold in the raw state.

8 448 APPENDIX 2 FRUIT e GRAPEFRUIT (continued) Grapefruit, Canned grapefruit Pass Fail cooked segments Grapefruit cooked Pass Fail in microwave or oven Raw grapefruit Fresh white Pass Fail grapefruit GRAPES AND RAISINS f Fresh pink Pass Fail grapefruit Fresh grapes Grapes, washed Pass Fail Not sensitive to Sensitive to grapes grapes and/or sulfite Not sensitive to Test sulfite sulfite separately Raisins Nonsulfited Pass Fail without sulfite raisins Not sensitive to Sensitive to raisins raisins and probably grapes Raisins with Regular Pass Fail sulfite (sulfited) raisins Not sensitive to If nonsulfited raisins raisins are Not sensitive to tolerated, sensitive sulfite to sulfite APPLE Apple juice, Pasteurized Pass Fail cooked apple juice Fresh or frozen Pass Fail apple juice, boiled and cooled f Do not challenge grapes if sulfite sensitivity is suspected, until sulfite is proven safe by challenge.

9 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 449 FRUIT e (continued) APPLE (continued) Apple juice Unpasteurized Pass Fail pure juice Reconstituted Pass Fail from frozen concentrate Apple, cooked Fresh apple, Pass Fail peeled, cored, and cooked Applesauce Pass Fail without added sugar Fresh apple Golden Delicious Pass Fail OTHER FRUITS MacIntosh Pass Fail Granny Smith Pass Fail Other varieties Pass Fail (specify type) Apricot Cooked Pass Fail Banana Cooked Pass Fail Kiwi Cooked Pass Fail Peach Cooked Pass Fail

10 450 APPENDIX 2 FRUIT e (continued) OTHER FRUITS (continued) Pear Cooked Pass Fail Pineapple Cooked Pass Fail Nectarine Cooked Pass Fail Other fruits (specify type)

11 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 451 VEGETABLES 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 Tomato Commercial Pass Fail ketchup brand If tomato is (catsup) tolerated, suspect vinegar. Confirm by testing vinegar separately (page 453) SPINACH Cooked Fresh or frozen Pass Fail spinach leaves, boiled Raw Fresh spinach Pass Fail leaves, eaten as a salad CARROT Carrot juice, Juice extracted Pass Fail cooked from raw carrots, boiled

12 452 APPENDIX 2 VEGETABLES (continued) 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 OTHER VEGETABLES Celery Cooked Pass Fail Cucumber Cooked Pass Fail Lettuce Cooked Pass Fail Radish Cooked Pass Fail Other Pass Fail vegetables

13 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 453 SPICES 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 VINEGAR 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 vegetables in vinegar Other pickles Pass Fail and relishes

14 454 APPENDIX 2 ALCOHOL Distilled Vodka Pass Fail alcohol Gin Pass Fail Tequila Pass Fail White rum Pass Fail Histamine in White wine Pass Fail wine Tyramine in Red wine Pass Fail wine Fermented Beer Pass Fail grain products Ale Pass Fail Lager Pass Fail Fermented Apple cider Pass Fail fruit products Fermented De-alcoholized Pass Fail beverage wine without alcohol (histamine) Fermented De-alcoholized Pass Fail beverage beer or without alcohol equivalent (grain products) TEA Herbal tea Pass Fail Green tea Pass Fail Decaffeinated Pass Fail regular tea Regular tea Pass Fail

15 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 455 COFFEE Decaffeinated Pass Fail coffee Regular coffee Pass Fail Flavored Pass Fail coffees SUGARS 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 CHOCOLATE Cocoa butter Dark, bitter, Pass Fail baker s chocolate sweetened as described in Chapter 28 (page 379) Cocoa butter Dark baker s Pass Fail with milk chocolate with milk and sweetener added Complete Purchased Pass Fail chocolate chocolate confectionery

16 456 APPENDIX 2 LEGUMES Peanut Peanut, roasted Pass Fail or boiled Peanut, raw Pass Fail Whole beans, Green (French, Pass Fail cooked (many string, runner) raw beans bean are 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 Bean sprouts Mung bean Pass Fail Alfalfa Pass Fail Others Pass Fail Green peas Cooked Pass Fail

17 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 457 NUTS 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 Pecan Pass Fail Walnut Pass Fail Coconut Pass Fail Other nuts Pass Fail SEEDS 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

18 458 APPENDIX 2 MEAT AND POULTRY Meat Beef Pass Fail Pork Pass Fail Lamb Pass Fail Other meats Pass Fail Poultry Chicken Pass Fail Turkey Pass Fail Duck Pass Fail Other poultry Pass Fail Processed Pepperoni Pass Fail meats ( deli meats ) Salami Pass Fail Bologna Pass Fail Cured bacon Pass Fail Smoked bacon Pass Fail Cured ham Pass Fail Frankfurter Pass Fail Wiener Pass Fail

19 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 459 FISH Fresh or Cod Pass Fail frozen, cooked Sole Pass Fail Red snapper Pass Fail Salmon Pass Fail Halibut Pass Fail Perch Pass Fail Others Pass Fail Canned fish Tuna Pass Fail Salmon Pass Fail Sardines Pass Fail Others Pass Fail SHELLFISH Cooked Lobster Pass Fail Prawn Pass Fail Shrimp Pass Fail Crab Pass Fail Others Pass Fail Raw For example, as Pass Fail eaten in sushi

20 460 APPENDIX 2 FOOD ADDITIVES Tartrazine 1 Pass Fail Cheese without Not sensitive to Sensitive to cow s tartrazine: cow s milk milk cheese natural orange/ cheese yellow cheddar Choose another cheese Proceed to similar food and Test 2 retest 2 Pass Fail Similar cheese Not sensitive Sensitive to containing to tartrazine tartrazine tartrazine: processed cheese food or processed cheese slides (label will read tartrazine or artificial food color) Sulfites 1 Pass Fail Dried fruit without Not sensitive to Sensitive to test natural color all test fruit fruit (apricot) fruits appear the (apricot) same beige/brown. Choose another Usually available Proceed to fruit and retest in health food Test 2 stores. Label will not have the word sulfite in the ingredient list. Example: dried apricots 2 Pass Fail The same dried Not sensitive to Sensitive to fruit treated with sulfites sulfites sulfites the fruit will retain its natural color. Sulfite will appear on the label. Purchase from a regular grocery store or supermarket. Example: dried apricots

21 SEQUENTIAL INCREMENTAL DOSE CHALLENGE 461 FOOD ADDITIVES (continued) MSG Available as a Pass Fail powder to be Not sensitive Sensitive to MSG added to a to MSG carrier food that is known to be tolerated Benzoates Cinnamon (see Pass Fail page 453) Not sensitive to Sensitive to benzoates benzoates Annatto 1 Pass Fail Cheese without Not sensitive to Sensitive to cow s annatto: white or cow s milk milk cheese natural (cream- cheese colored). Choose Choose another a cheese that is Proceed to similar food and available in both Test 2 retest an orange/yellow color and a natural/cream color, for example, cheddar. 2 Pass Fail The same type Not sensitive Sensitive to of cheese with to annatto annatto annatto added, such as orange/ yellow cheddar OTHER FOODS Specify types: Pass Fail

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Fruits. Dr. Dave, ND Kapha Balancing Foods. Enjoy fruits and fruit juices alone, 30 minutes before, and ideally at least 1 hour after.

Fruits. Dr. Dave, ND Kapha Balancing Foods. Enjoy fruits and fruit juices alone, 30 minutes before, and ideally at least 1 hour after. Dr. Dave, ND Fruits Enjoy fruits and fruit juices alone, 30 minutes before, and ideally at least 1 hour after. Apples Applesauce Apricots Berries Cherries Cranberries Figs (dry) Grapes (red, purple, black)