When a Food Challenge is Unsuccessful

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Superman has had 8 food challenges, and 6 of them have been SUCCESSFUL.  He’s passed, soy, oat, cherry, strawberry, almond, and mixed tree nut.  The two that have been UNsuccessful have been baked egg.  You can read HERE about his first baked egg challenge when he had an anaphylactic reaction. Ironically, this time around it was almost an exact replay of his first baked egg challenge.  The one exception, is that it happened so much faster this time.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

 

At 9:20 I took a picture of Superman and I after his first “dose”, 1/4 of a cookie.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

Right after his first bite of baked egg cookie.

At 9:52 I took a picture of him right after he had his shot of epinephrine.

What happened in just 30 minutes, was something I want you to learn from, so you can see the progression of an anaphylactic reaction.

Superman first ate 1/4 of the chocolate chip cookie.

About 5 minutes later he got really sleepy.  I didn’t think much of it at first (except a flashback to his first baked egg challenge), because he had trouble falling asleep the night before due to being excited and a bit nervous.

He started rubbing his eyes here and there.

He complained that his stomach was hurting, and thought he might have to go to the bathroom.  My husband took him to the bathroom, since he hadn’t had a bowel movement in a couple of days (sorry, TMI….but part of this equation), but he didn’t have a bowel movement.

It was time for his  vitals check (every 15 minutes during food challenges) from the nurse and the doctor.  We alerted them to his sleepiness and the doctor said his heart rate was normal.  Normally, our allergist said, heart rate would rise in the effect of lethargy from an anaphylactic reaction.  Because of the stomach pain, sleepiness, and rubbing of the eyes we decided to wait an extra 15 minutes before we gave him the next “dose” of cookie, which would have been 1/4 of a cookie.

Superman went back to watching his movie, while we waited to see if he could have the next portion of cookie.

About 6-10 minutes later he was complaining of even more stomach pain.  We convinced him to try the bathroom again, still truly thinking it could either be hunger (food challenges are done on an empty stomach, so he’d had no breakfast) or a bit of constipation.

As he stood up to go to the bathroom, his face got pale and he said something to the effect of, “I don’t feel good” and “I need water”.  I got up to get the nurse or doctor, and as I walked out the door I could hear him vomiting behind me.

At that point the doctor was walking in and it was no question that he was experiencing an anaphylactic reaction as he vomited a second time.  Epinephrine was given immediately and the reaction stopped in its tracks.  I’m going to say that again.  The REACTION STOPPED IN ITS TRACKS.  I’m repeating that to remind you of the life-saving power of epinephrine and why you should carry TWO auto-injectors with you at all times.  (I’m pretty passionate about spreading that news.  Epinephrine has saved my child’s life 3 times now, and I’ll sing it’s praises until there’s a cure for food allergies.)

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

After his shot of epinephrine, and asking for a band-aid.

Why did we go ahead with this food challenge?

Our allergist, my husband, and I, felt he was really ready.  His most recent blood test results were very low.  Despite a small positive reaction on a skin test last year, everything still showed a green light for a BAKED egg challenge.  According to this article on American Academy of Allergy Asthma and Immunology (AAAAI), those that can tolerate baked egg are more likely to outgrow their egg allergy and then tolerate regular egg.

His component testing results were:

Egg White specific IgE 0.75.
Ovalbumin is 0.89, and ovomucoid is 0.35.

Ovalbumin is the main protein found in egg white, making up 60-65% of the total protein.
Ovomucoid is a trypsin inhibitor found in raw egg white.

I found this article interesting as I was researching ovomucoid.

Do I regret doing the food challenge?

No.  I can’t beat myself up over something that I made an educated decision on.  I never would have agreed to it if there was any doubt in my mind.  Our allergist was completely surprised that he didn’t pass, and I know he wouldn’t have suggested the challenge if he doubted that it would be successful.  What I learned from this experience is that LETHARGY is his first symptom to an anaphylactic reaction upon ingesting baked egg.  We are to use his auto-injector upon known ingestion of an allergen, or suspected ingestion with the symptom of lethargy.

What’s the takeaway?

Food allergies are unpredictable.  Food allergies are different for everyone, including the type of reaction, and not excluding a person’s tolerance for an allergen.  What I DON’T want you to do is compare your child’s blood test results to my child’s and make a prediction, or base decisions off of our experience.  What I DO want you to do, is talk your board certified allergist about future food challenges and make a plan based on your set of allergies and testing results.

P.S. **Never do a food challenge at home.

The good thing is that he was able to still enjoy a birthday party that afternoon with friends at the local splash park.  He took it easy while I watched him like a hawk for a biphasic reaction.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

Having fun at the splash park!

**Disclaimer:  I am not a medical professional or doctor and this website is not intended for medical advice.  Please consult your board certified allergist for medical advice.  Do not attempt food challenges at home.  In an emergency, call 911.

Has your child had a an unsuccessful food challenge?  What did you learn from it?  Please comment below and share your thoughts!

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

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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!

tree.nut.label

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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