A Mixed Tree Nut Challenge: Is that “Nuts”?


It’s almost been two months since Superman’s mixed tree nut challenge, but I’ve been wanting to share our experience.  Mainly, I want to share with you why we did a mixed tree nut challenge, versus doing one tree nut at a time.

I definitely got a a lot of frightened looks when I told fellow allergy parents and advocates that we were testing three nuts at one food challenge.  Even those without food allergies in their family would say, “If he reacts, how will you know which one he is still allergic to?”.

First off, this isn’t our first time around the food challenge block.  In fact, this was Superman’s 7th food challenge, so even though I’m still nervous every time, I’m fairly used to what to expect, even in the event of a failed food challenge.   Don’t get me wrong-I don’t want to put Superman through unnecessary anaphylaxis just because we’re in the comfort of a board certified pediatric allergist’s office.   I know that our allergist would definitely not recommend Superman do a food challenge unless he was positive he would pass.  When he failed the baked egg challenge, we were ALL surprised he didn’t pass.  This study outlines that egg allergic children typically can tolerate baked egg, and in turn accelerates the likelihood that they will outgrow their egg allergy.

Why a mixed tree nut challenge?  Because Superman has never tested positive for any tree nut allergy.  He was diagnosed with a peanut allergy by blood test at around age 2 1/2.  We had been strictly avoiding peanut and all tree nuts since he was diagnosed with an oat, soy, milk, and egg allergy at 9 months old.

Mixed Tree Nut Food Challenge-Mom Vs. Food Allergy

Nervous mom, happy kid…before the challenge.

We have been doing his allergy testing nearly every 6 months (this isn’t typical) since he was about 3, and every time has tested negative to tree nuts.  Because of his age and not wanting him to be confused between peanuts and tree nuts, we kept our rule of strictly avoiding all peanuts and tree nuts.  This past January, we did a food challenge for almond to start our trek into the tree nut world.  He passed!  We felt his understanding of the difference between peanuts and tree nuts is at a level where I feel comfortable letting him have tree nuts in his diet (only at home and peanut-free).

This summer we decided it was time to challenge more tree nuts, so that his diet could be more rich in protein and dense calories.  He’s short and thin for his age, and he could use the boost in nutrition.  Thanks to companies like Tierra Farms that have peanut-free facilities, it’s possible for us to have safe tree nuts.

Mixed Tree Nut Food Challenge-Mom Vs. Food Allergy

Peanut-free facility!


How does a mixed tree nut challenge work?  In our situation, they crushed walnuts, pecans, and cashews up and put each dose on top of his dairy-free ice cream.  This was his favorite food challenge since there was ice cream involved.  It was one of the most nerve-wracking for me, but I was still confident he would pass and he did.  To find out how a food challenge works and how to prepare for it, read this post.

Are we glad we did the mixed tree nut challenge?  Yes, there was really no reason why he would have failed the food challenge.  Although it’s not typically done, mixed tree nut challenges are for special situation like Superman’s where all tree nut tests (even individual nuts) were negative.

Do I recommend a mixed tree nut challenge?  Yes and no.  If your child’s situation is like Superman’s it may be appropriate, but must be discussed at length with your allergist.  If your child has ever had a positive tree nut challenge, then absolutely do not do a mixed tree nut challenge.  Never do a food challenge at home, and of course, consult with a board certified allergist before trying new foods.

Mixed Tree Nut Food Challenge-Mom Vs. Food Allergy

Typical 5-year-old silliness. He’s always so excited and calm at food challenges.

Mixed Tree Nut Food Challenge-Mom Vs. Food Allergy

So proud he passed his mixed tree nut challenge!

What about you….has your child passed a tree nut challenge?  I would love to hear other successful tree nut challenges that may encourage other readers.  


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