Tree Nut Diagnosis

Everyone's experience with their allergy diagnosis is different and unique.  I often get asked about Fletcher's diagnosis, so I thought I'd share our experience. You can read more about his milk and egg diagnosis here.

Fletcher had eaten nuts before.  Even with his milk and egg allergy we were never concerned about them being an issue.  Nuts aren't a regular part of his diet, but he'd definitely had eaten them on a few occasions.  So when I was eating trail mix one day and Fletcher asked to have some, I didn't think anything of it.  He grabbed a couple pieces and stuffed it into his mouth.  Within a minute, Fletcher threw up. Vomit, besides being disgusting and gross and not fun to clean out of shag carpet is also very scary. But while it happened, my first assumption was that he had swallowed something the wrong way.  But immediately after he tossed his cookies (or nuts in this case) he started licking my pants.  Strange, I know. It was if he was trying to get the taste off of his tongue.  Then he began to sneeze, a ton.  Multiple sneezes, for what seemed like hours. His face also swelled around his eyes and his nose started running like a faucet.  I gave Fletcher Benedryl and debated giving him a shot of epinephrine. Knowing what I know now about these sorts of allergies, I should have, but I was scared and wasn't even certain what was truly happening.

Fletcher recovered fine from that first reaction.  I dissected the trail mix trying to figure out what it could possibly have been.  It couldn't be the nuts.  IT COULDN'T.  He'd had nuts before!  The only other thing it could be was coconut.  Coconut milk had never sat well with him.  Since he's allergic to milk we had tried it as an alternate, but it had always given him diarrhea.

The only other thing I thought it could possibly be was the cashews. I tried to wrack my brain to try and remember if he'd ever had cashews before.  I couldn't remember.  So either coconut or cashews.  

 

Throwing a ball, not a nut - because that could be dangerous.

Throwing a ball, not a nut - because that could be dangerous.

Since we see our allergist fairly regularly anyways I decided to just avoid nuts and coconut until our next scheduled appointment.  But then a month later, I was eating coconut chips.  Such a random thing, that I never eat but they looked so yummy when I was cashing out at Winners.  Fletcher wanted some and my brain shut off momentarily.  I gave him one little coconut chip. One measly coconut chip.  As I was putting the bag down my brain caught up to my action and in that moment I looked over at Fletcher who was spitting onto the floor. Then he frantically started licking my leg again.  Damn.  I swear, he didn't even swallow it.  It was so quick.  His eyes swelled, his nose ran, he sneezed and sneezed. 

So I gave Fletcher more Benedryl. Again, knowing what I know now,  I really should have given him the epipen. Allergies like this can escalate so quickly and you just never know what might happen.  Mom guilt has me feeling pretty bad about this.  Clearly he survived these experiences, but it could have taken a turn for the worse, as many anaphylactic reactions do.

I called the allergist soon after to see if I could get in earlier.  This second experience had me really freaked out. I started reading about all the things that coconut was in and I was scared I would make a mistake and I really wanted to get a proper diagnosis.

My allergist and her staff are truly awesome.  They got me in within a week or two.  They told me to bring in what he had eaten, so I went out and bought more coconut chips, and also bought some real coconut to test as well.

At the allergist office they have lots of things they can test you or your child for like nuts and eggs and milk and seasonal stuff, but they don't have everything.  So this is why I had to bring a sample in.  The nurse took a piece of coconut chip and a piece of coconut and mashed them up and pricked him separately with a piece of both.  Then we we went back to the waiting room.  This is how most allergy appointments go for us.  Get pricked, go wait, get pricked again, go wait, get results.  

So after 15 minutes we went back to see the nurse, his results were negative for both pieces of coconut.  I had explained the whole story of what had happened to Fletcher and she was certain their was an allergen that had to be the culprit.  So she tested him again, and again.  I love that she didn't just say, nope, not allergic!  She believed me and wanted to get to the bottom of it.  

After 3 tests, she brought the allergist in to get her opinion.  I told the whole story and then the nurse and allergist looked at each other and it dawned on them. Cross contamination.  It wasn't the coconut.  It was something in the coconut chips.  You know, "may contain tree nuts"?  Yes, that is what he was reacting too – the "may contain".  So they set him up with a tree nut panel on his arm.  They tested for almonds, cashews, brazil nuts, pistachio and walnuts.  He came back positive to cashews and pistachios. 

We do a whole lot of baking together.  It's safe and fun and he likes to lick the spoon.

We do a whole lot of baking together.  It's safe and fun and he likes to lick the spoon.

So now that I know this I'm extremely careful.  Obviously I know to avoid cashews and pistachios and that isn't too hard.  We have to also be super careful about anything that says "May contain tree nuts", because I know from experience it is something to take seriously.  The smallest trace can cause an anaphylactic reaction, that requires immediate epinephrine – which next time (let's hope there is not next time) I will give it to him without second thought. 

I am now officially a helicopter mom when it comes to food, but I have to be and I'm okay with that.  Stay tuned to learn about Fletcher's food intolerances too.  Yay!