Reply to I forgot my friend’s kid’s nut allergy

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]My young adult son is anaphylactic to peanuts, pistachios, hazelnuts and possibly pine nuts (never proven, I've never met an allergist who could do a skin test for that).

Some of our friends and relatives have, over the course of his childhood, forgotten his allergies, particularly because previously he couldn't eat ANY nuts, and also had reactions to almonds, pecans, walnuts, etc, so it became rather complicated to follow.

We would never excoriate them for their memory slips. It's hard to remember when you're not living with the child in question!

However, I did give my husband a very hard time for forgetting his own son's allergies when he was younger. We, the parents, are supposed to act as bulwarks! He forgot on two occasions, which lead to severe reactions both times: I was livid. My husband and son have ADHD, which makes remembering allergies harder... but still. I was hyper vigilant when DS was young and I would always remind hosts of parties that he was allergic to nuts, and hand them the Epipen. I only felt more relaxed when as a teen he started remembering his own allergies systematically. He still forgets his Epipen.

ADHD and anaphylaxia is a really bad mix.[/quote]

Why haven’t you just categorically ruled out tree nuts? [/quote]

Because as the child ages and becomes independent, the goal switches from protecting them at all costs by total avoidance, to living independently with the risk of anaphylaxis in the wider world (work place potlucks, friends or relatives who add allergenic ingredients, etc). This mean, for a large number of kids like my son, that they will be tested for IgEs, and if their level for that allergen is low enough, the allergist will decide to do a food challenge: have them eat a graduated and progressive larger amount of the allergen, in the office, under close supervision of doctors and nurses, Epipen at the ready. If the patient manages to eat all the mini cups of food, they are deemed "successful", and are allowed to ingest very small portions of that food outside of the doctor's office, to "maintain" their reduced sensitivity to it.

For my son this translates to the fact he can accidentally ingest a couple of peanuts and not drop dead immediately. His allergy to almonds has largely disappeared, and he can have a normal portion of dessert with almonds. He can have a couple of pecans, a few walnuts. He still has to be very careful with pistachios (he failed the food challenge and the nurse jabbed him with an Epipen) and hazelnuts, which is a shame, because chocolates with fillings often have pralines, which are made with hazelnuts. The point is for the adult patient to eat a bite, realize due to symptoms that it contains a deadly allergen, call 911, stick themselves with the Epipen... but that their lowered sensitivity will allow them to survive with a much greater probability than if they had not had that consistent exposure.

Some patients never reach that stage, because their allergies are too severe. And some should consistently expose themselves, but don't, because their anaphylactic reactions in the past have been so traumatizing that they can't bring themselves to eat tiny amounts of the allergen in question - which I can understand, of course. My own son isn't very good at eating the occasional half-peanut, or whatever. I would too, if I were him.

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