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Dan’s Food Challenge… Tree Nuts

Have you ever wondered what would happen during a food challenge from a clinical and emotional perspective?  This month’s blog post was written by a client who’s son recently underwent a food challenge for walnuts. The results will surprise you!

Walnut

Whole walnut kernel and shell by David

 

What is a food challenge?

If clinical testing suggests a food allergy is non remarkable, the patient will then eat the item in the Dr.’s office to find out the testing’s actual relevance.

History

Dan’s allergy to tree nuts was diagnosed when he was five years old. There were obvious incidents when he was younger than five, for example: vomiting after eating a banana nut muffin and swollen eyes after using a contaminated keyboard.

However, we finally had him tested when he threw up and developed hives everywhere on his body after eating just one bite of a granola bar. Luckily there were no apparent breathing issues, but this incident leads us to his diagnosis.

At 5 years of age, Dan’s blood work and scratch tests were somewhat inconsistent. Blood work showed he was allergic to walnuts, pecans, almonds and shrimp respectively. Scratch tests showed pecans and shrimp were the most severe allergens. Dan has always eaten peanut butter, a legume, so we were instructed to continue to give it to him.

When Dan was about 10 years old, we realized he was eating some things that contained almonds or almond milk. We felt comfortable having almond products around because he never had a bad reaction to them before we had him tested. While he does not eat a lot of almond products, we do try to have him drink almond milk periodically in smoothies, or other cooked items. Interestingly, Dan’s scratch test reaction to peanut butter was similar to his reaction to almonds, which is also why we felt comfortable giving it to him.

Dan is now 12 years old. A few months ago his allergist thought we should re-do his blood work, since it had been more than five years since he was tested. His blood tests came back “non-remarkable” for tree nut allergies, with the same slight elevations for walnuts, pecans, almonds, and shrimp that showed up when he was five years old.

Food Challenge

We decided to do a Food Challenge at the Allergist’s office to see if he would react.  We brought several types of nuts with us to the test. I was glad we talked about this part of the test beforehand; since it never occurred to me that we would have to bring our own food!

At the food challenge, they first performed a scratch test to gauge his reaction and to determine which foods to test first.  The Scratch test yielded similar results: worse for pecans than walnuts, despite opposite findings in his blood work. Based on the scratch test, we gave Dan 1/8 of a walnut, which is about the size of a pinky nail. He ate it and we waited.

Within just a minute or two, he said he felt like it was stuck in his throat. The Doctor checked his vitals, looked in his throat, felt for swelling and all seemed normal. She asked him to wait and to calm down. He continued to claim it was stuck in his throat and felt strange – and he started to panic. The Doctor never left the room and continued to monitor him, but his vitals were still normal. Based on his level of panic and complaints of the feeling in his throat, the Doctor gave him Benadryl and ended the test.

My take-away from this challenge: While I do and always have carried an Epi-Pen, I don’t always have Benadryl with me, and even if I do, it is in pill form.  My kids started swallowing pills at a young age, so I never thought to have the liquid form of Benadryl with me.  I’m not sure that Dan would have easily been able to swallow 2 pills during that “situation.”  I now keep liquid Benadryl on hand.

I must say we were more surprised than we were disappointed. This would have been a momentous milestone to be able to eat or at least not have to worry about accidentally eating walnuts in the real world.

Conclusion

Blood work and scratch tests aren’t always accurate or consistent. It takes a physical food challenge to find out how a patient will react when he actually eats the allergen in question. However, as his ability to eat almond products suggests, there is evidence that a mind / body component affects the ability of a patient to be able to eat allergens in the real world.  Dan’s blood work at the age of 5 and almost 12 years was “non-remarkable.” His mother wishes she “could find out if he could eat cashews or other nuts, but he really has no interest.”

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