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Alphabirth adds new challenges The Binding of Isaac: Rebirth that each unlock specific items, trinkets, or pickups for Isaac on later runs.

Name Pack Description Items Unlocks
Empty Pack 2 Only active items spawn, use Void and Abyss to complete the challenge. Abyss + Void Fehu (Rune)
Exploding Head Syndrome! Pack 1 Isaac is blindfolded and only shoots transcendent ipecac tears in the direction he moves. Pseudobulbar Affect + Ipecac + Continuum Glitched Pickups
Faust Pack 1 Isaac starts with 12 heart containers; every floor he is automatically teleported to the boss room. He must use his 100% "Deal with the Devil" wisely as he has no access to treasure rooms or shops. Emperor's Crown + Goat Head Emperor's Crown
For The Hoard! Pack 2 Use your bums and damage upgrades from Hoarder to hoard every pickup throughout the run. Hoarder + Bum Friend + Key Bum Naudiz (Rune)
It Follows Pack 3 Avoid the Hush laser that slowly follows Isaac. ~ Apparition
Restless Leg Syndrome! Pack 2 Bombs spawn at Isaac's feet if he stands still for longer than 2 seconds. The damage boost from Hot Coals further encourages continual movement. Hot Coals Sowilo (Rune)
S#!7iest Day Ever! Pack 1 Isaac is blindfolded and must use Brown Eye poops as his main source of damage. Brown Eye + Brother Bobby + Nun's Habit + 9 Volt Brown Eye
The Collector Pack 2 Isaac must choose between using pickups traditionally, hoarding them as a way to get extra damage from Hoarder, or absorbing them with Cauldron to gain extra items. Cauldron + Hoarder Gebo (Rune)
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