Preparing For a Food Allergy Challenge

Tomorrow Asa goes in for her second food allergy challenge. This time we are doing a macadamia nut challenge. I spent hours tonight making macadamia nut butter. My child better always know how much I love her! 😉

I’ve had a lot of people ask me to explain what exactly a food allergy challenge is and why we do them, so I decided to write a blog about the subject. A super common misconception about allergies is that a skin test or a blood test can tell you everything you need to know. Unfortunately, this just isn’t true. Skin tests and blood tests are good indications of allergies but they aren’t 100% accurate. The only TRUE test for a food allergy is actually ingesting it. Typically an allergist will begin with a skin test to see what shows as positive. From there, they will try to confirm the allergens with a blood test. A good allergist will only test you for things that you’ve already reacted to or that are in the same family (for example, you’ve reacted to one tree nut and so they test you for all of them). Most allergists will not run a full blood panel just to see what comes back positive because too many false positives can occur.

A good example of this is exactly why we are doing the food challenges right now. Asa tested positive on a blood panel to tree nuts. Her cashew and pistachio levels came back EXTREMELY high on both a skin and blood test. Some of her other tree nuts came back with really low numbers that are kind of inconclusive. She could be allergic, but she also could be just showing a false positive. For example, she also showed with some positive numbers to almond which she eats constantly and has no reaction to whatsoever. Her numbers to almond were very similar to her numbers for several other tree nuts, so we decided to do some food challenges for these other nuts in the doctor’s office, in a controlled environment, where she can be monitored closely and given medicine and treatment immediately if needed.

Back in February she did her first food challenge for walnut. Essentially what happens is that they give her walnut or walnut butter in doses that increasingly get bigger every 15-20 minutes. During those times they monitor her closely for any signs of an allergic reaction. Once we even had to wait an additional 15 minutes between dosing because she got the hiccups which can sometimes be a precursor to vomiting (who knew!) and they wanted to be sure it wasn’t a symptom! After her last dose, we have to sit in the office for 2 hours for them to continue to monitor for a delayed allergic reaction. If she still stays symptom-free, she is considered “passing” and is allowed to eat the food freely from then on! The visit takes about 4-5 hours total so it’s a long day at the office!

Another difficult thing to point out with the nuts in particular, is that you have to prepare either the nuts or the nut butter ahead of the appointment because nuts and nut butters that do not have any chance of cross-contamination are extremely hard to find. For example, with her macadamia nut challenge tomorrow, we have to be sure that she is ONLY eating macadamia nut and that there are no traces of any other nuts on them because that could obviously totally change the outcome of the test. Because of that, we have to wash the nuts. Yes, you read that right… we have to literally wash them with Dawn dish soap! Not once… not twice… but three times! Then we have to roast them. You can choose to eat them raw for the test, but we know Asa won’t do that, so we choose to make a nut butter out of them instead. That literally took me hours tonight because the nuts were not cooperating with me. Now I just have to pray that Asa cooperates tomorrow and eats all the doses and most importantly, doesn’t have a reaction!

As you can imagine, challenge days bring a lot of anxiety with them. While I’m so incredibly hopeful that she will pass and we can mark another nut off the “not allergic” list, there is always a part of me that is nervous that we could end up having to give her an epipen, go to the hospital, or worse. And that thought is very hard to shake. If you’re a praying person, your prayers would be much appreciated! I’ll update this post once we go and get results, but for now, please keep us in your prayers and pray for her bravery as well!

I hope this post provided a little knowledge and also helps you see the lengths that allergy parents have to go to for our kids! Being an allergy parent is not for the faint of heart, but we fight every day and our kids do too!

Making macadamia nut butter like a champ… 🙂

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