Earlier this year, L’s allergist let me decide whether or not have L do a tree nut challenge. The blood work he had done came back negative for tree nuts (such as almonds, cashews, and hazelnuts). The scratch test L had done at his very first visit was also negative for almonds. This gave the doctor some confidence L wasn’t allergic to these nuts, but he said he would feel more comfortable giving us the green light to let L eat them and foods containing them if a food challenge was done first.
The allergist said that holding off on introducing those nuts could mean L was at a higher risk of developing an allergy to them, so introducing them to him now would be ideal. The only drawback he saw to the nut challenge was L’s age. At two-and-a-half he’s still too young to be able to tell us if something hurts were we can’t see it.
But age didn’t keep me from hesitating to move forward with the tree nut challenge. If L could have these nuts it might widen the variety of foods he could eat. And the evidence is there that waiting to introduce higher allergen foods can do more harm than good. So hell yeah, I was more than ready to bring on the tree nuts!
I was told to bring a nut butter and L’s epi pen with us. The food challenge is usually around two hours, but because L can’t communicate as effectively as older kids, I was advised the visit would probably be about three hours long.
L’s peanut allergy is apparently bad enough that we need to avoid foods that might potentially be cross contaminated with them. This makes shopping for food and going out to eat a challenge. But I wasn’t expecting that finding a nut butter that carried zero warning labels about peanuts to be a challenge. Rookie mistake. I really wanted a cashew butter because I was confident that L wasn’t allergic to almonds. I ate them while pregnant and nursing and he’d had two tests come back negative for them. I preferred to test a nut L hadn’t had much exposure to, but finding a nut butter that didn’t say “may contain” or “has been processes in a facility/on the same machinery as” peanuts was tough. The only peanut-free nut butter I found was an almond butter at Target, so I brought it along with some crackers.
Because the appointment was early in the morning, I made arrangements for G to spend the night at my in-laws so I wouldn’t need to bring him along. I knew keeping one child occupied in a doctor’s office for three hours would be tough. I didn’t want to have two with me if I could help it. For the first time ever I brought along the boys’ LeapFrog tablet so L would have something to occupy himself with, as well as a notepad for him to scribble on and the Little Blue Truck book he’s developed a fondness for. I brought along my mandala coloring book and some pens for myself. The allergist also had a binder of DVDs to choose from, so when all my options began failing around the 2 hour mark our nurse popped in a Thomas the Tank Engine DVD for us.
The Tree Nut Challenge
We began by smearing a bit of almond butter on L’s lips and let him lick it off. Thankfully he seemed to like the taste. Then the doctor set a timer for 20 minutes. He came in about five minutes later with a set of measuring spoons. The idea was that we’d feed L a certain amount of almond butter every twenty minutes or so, increasing the amount each time, until he got the full serving.
After 20 minutes the doctor asked how L was going and checked his lips, mouth and throat. Then 1/8 of a teaspoon was measured out onto a spoon which I fed to L. The timer was set for another 20 minutes.
After that 20 minutes, the doctor checked L’s belly and back for hives and his mouth again. Then I fed him 1/4 teaspoon, which he tried refusing. Clearly he was on to us. We waited another 20 minutes.
This time, our nurse came in after the timer went off. L refused to open his mouth for her, though he gladly lifted up his shirt so she could check for hives. The doctor had already measured out 1/2 teaspoon, but L refused it until I handed him a cracker. This time we had a 30 minute wait.
At the end of the half hour, L still wasn’t showing signs of an allergic reaction. The doctor gave us the green light to go home. He said 1/2 a teaspoon is typically enough to cause a reaction of some sort in people who are allergic to the food. I was instructed to avoid giving L anymore almond butter for the rest of the day and to continue to monitor him. The allergist said that if L seemed fine after today, we could start introducing other tree nuts. His confidence that tree nuts wouldn’t be an issue seemed high, though he knocked on wood just in case 😉
Introducing new nuts is just like introducing a new food to a baby: one at a time, wait a bit between new nuts, and make sure it’s a day L’s not going to be in the care of someone else. We have Zyrtec and Epi pens on stand by, which takes away a little bit of the stress of introducing something new. During my last trip to the grocery store it became apparent that L might not be able to eat nuts in whole form. MANY bags of nuts carry peanut warnings. The only one I came across that didn’t was Blue Diamond Almonds.
BUT! His world will be a little more open with chocolate and some snack foods, and that’s something.
Before we left, we got a prescription for new Epi pens and a Severe Allergy/Anaphylaxis Action Plan to take to school.
School! My baby is starting school next month. His food allergies make sending him to school scary for me. But that’s a post for another time.
Have you or your child done a food allergy challenge? What was your experience like?