Food Challenge yesterday

[ar1]

I have a 8 year old who has had a peanut allergy since he was 1. He was diagnosed after having hives, becoming lethargic after ingestion.  We recently moved and went to a new allergist who ordered a RAST test. It showed he was negative to Tree nuts, eggs and his Peanut was 1.3. They ordered a food challenge. Yesterday during the food challenge they gave him the peanut butter and he complained of an itchy throat, mouth, lips. He had a exczema  flare up on on section of his face right by his mouth. He usually has a flare up there when he eats certain foods anyway, nothing to out of the ordinary. The itchyness and flare up cleared up on there own while in the office with no meds. They passed him on the challenge and said to go ahead and let him eat whatever.  Later that day I gave him 6 regular m&m's.  He had no itchiness but the spot next to his mouth did become red again.  It went away within a half hour on it's own.  Today after school I gave him 1 peanut butter cracker and 2 reeses pieces. After swallowing the cracker he immediately began complaining of an itchy throat and lip.  No exczema flare up.  I started to get nervous because he said it was hard to swallow due to the itchyness. I freaked and gave him zyrtec. But, within 15-20 min, the itchyness was gone from his lips and almost gone from his throat. Usually, Zyrtec does not kick in for a half hour. I put a call into his allergist to see what I should do. 

It is just hard after keeping a food away from him for 7 years, then being told to give it to him, then the itchyness. I am just having a very difficulty time adjusting. And am terrified of doing something wrong that will harm him. 

Does anyone have any experiences with food challenges,reactions afterwards? I feel like I am a ball of nerves and anxiety every time I give him food. But, he is a trooper and wants to try a reese's peanut butter cup tomorrow.

This is my first time on this sight, so any info or ideas would be helpful.

Thanks

[yelloww]

  welcome!  I'm no help with this but hopefully someone who can see it will chime in!

[Mookie86]

I'm not sure what to think since he gets the red patch from numerous foods.  Are they definitely not containing peanuts and not possibly made on shared equipment or cross-contaminated in some other way?

It's hard to say if the itchy throat is a PN reaction, not being used to texture, psychosomatic, or something else.  Maybe give him something with PN but don't let him know it, and then see how he's doing?

For awhile, I'd hang around and keep an eye on him for a couple of hours after eating PN products.

[ar1]

He has one spot right next to his mouth that he always itch's, I think out of habit. But if he eats more acidy food, like spaghetti sauce for instance, it always gets more irritated.  We have always been very vigilant to avoid cross contamination in foods. 

I heard back from the allergist. She said for the next 2 weeks to give him items that are cross contaminated and/or possibly have peanuts in them and see how he does. No actualy PN products.  Then after 2 weeks we will evaluate.  So I will begin keeping a log and benedryl on hand just in case. She suggested giving him a granola bar. So that is what we will try after school today.  I have been thinking about doing what you suggested and after the 2 weeks are up, sneaking him some without his knowing.  I was thinking of slipping him a tiny bit of PN butter mixed in with his chocoate shake or ice cream.  That way I could get a better idea of how it is affecting him without him expecting something "might" happen.

Wierd thing is even with the itchy throat and lips he still wants to try and find something that doesn't make him itchy

[SilverLining]

Do you have an epi-pen?

[ar1]

Yes I still have his epi-pen. And I am leaving everything at school the same for him. Did not even tell them about the food challenge.

[SilverLining]

Good idea to not inform the school until you are POSITIVE it's safe.

Was the first challenge a blind challenge or did he know what he was eating?

[notnutty]

I have a 8 year old who has had a peanut allergy since he was 1. He was diagnosed after having hives, becoming lethargic after ingestion.  We recently moved and went to a new allergist who ordered a RAST test. It showed he was negative to Tree nuts, eggs and his Peanut was 1.3. They ordered a food challenge. Yesterday during the food challenge they gave him the peanut butter and he complained of an itchy throat, mouth, lips. He had a exczema  flare up on on section of his face right by his mouth. He usually has a flare up there when he eats certain foods anyway, nothing to out of the ordinary. The itchyness and flare up cleared up on there own while in the office with no meds. They passed him on the challenge and said to go ahead and let him eat whatever.  Later that day I gave him 6 regular m&m's.  He had no itchiness but the spot next to his mouth did become red again.  It went away within a half hour on it's own.  Today after school I gave him 1 peanut butter cracker and 2 reeses pieces. After swallowing the cracker he immediately began complaining of an itchy throat and lip.  No exczema flare up.  I started to get nervous because he said it was hard to swallow due to the itchyness. I freaked and gave him zyrtec. But, within 15-20 min, the itchyness was gone from his lips and almost gone from his throat. Usually, Zyrtec does not kick in for a half hour. I put a call into his allergist to see what I should do. 

It is just hard after keeping a food away from him for 7 years, then being told to give it to him, then the itchyness. I am just having a very difficulty time adjusting. And am terrified of doing something wrong that will harm him. 

Does anyone have any experiences with food challenges,reactions afterwards? I feel like I am a ball of nerves and anxiety every time I give him food. But, he is a trooper and wants to try a reese's peanut butter cup tomorrow.

This is my first time on this sight, so any info or ideas would be helpful.

Thanks

Bold mine.

Hummmm....those symptoms would mean a fail for us.  We have done a food challenge for soy after negative skin test and very low RAST.

I just wonder if he truly passed.  What criteria do they use for a pass/fail?

I'm not sure what giving him potentially x-contaminated food is going to show because there is no way to know if the allergen actually is present in the food.  So if he doesn't react, it may just mean that particular item wasn't contaminated.

I know I'm asking more questions than offering help, but I am just confused... 

[becca]

It does not sound like a pass to me either, but we have not done a food challenge.  He sounds uncomfortable.  Def. watch and be careful. 

[twinturbo]

We've done oral challenges but all have been quite clear either spectacular failure or suspected to never be allergic in the first place. We also have multiple allergens that are life threatening. Peanut is just the one I would finger as the one out of all of ours to not leave to estimate. While we have neither had the opportunity to challenge peanut or participate in a desensitization it sure sounds like some of the symptoms I've read where the kids reach their threshold. Obviously I am not a qualified medical professional and you and your doctors will determine what is best for your child but personally I wonder if this could be a case of a large threshold/high tolerance. Even if it's not a true pass for wholesale consumption of peanut it may be enough to improve quality of life. 

So hard to say but that's what came to my mind based on those descriptions.

[booandbrimom]

ar1, what you're describing is what's making us crazy in our house!

Our son "passed" a baked milk challenge last summer. However, he often still has mouth and throat symptoms after consuming baked milk. We have pushed ahead, although we've tried to find that perfect balance between enough milk and no symptoms.

About a week ago, he also had a peanut challenge as part of the FAHF-2 trial. His numbers are very low - lower than your son's. However, he's also had a real reaction to peanuts as a toddler, so we know he is (or at least was) allergic in the past.

During the trial, I asked them what they considered a pass. If he had itchy throat, lips, etc., but no other symptoms, would they put him in the trial? They said they would need more objective symptoms, or that the throat/lip discomfort would have to escalate, not just stay the same, to get in the trial.

I then asked whether they would call it a pass if he had just mouth/throat symptoms. The doctor wouldn't give me a full-out answer because she said she's not my child's allergist, but she said they generally don't consider those symptoms to be a clean pass and that our allergist might have us avoid another year.

It is VERY confusing. I know very few people whose kids were actually allergic to something (not just test results) who can all of a sudden just eat their allergen without symptoms. This seems like a gradual process. The problem is knowing when to introduce the allergen. In our case, milk causes anaphylaxis when it's raw, so the issue is very similar to introducing peanut - if we go too far, we could tip him over into a big reaction. (That hasn't happened yet, but there have been some anxious Benedryl and watch moments (and yes, we do this with the blessing of our allergist).

This is not for the faint-hearted. We're all so conditioned for avoidance that I wonder what our community will do if this turns out to be the only path through.

I don't know if any of that helped. Just want you to know you're not alone!

P.S. One thing they did during our trial was a peak flow assessment. They DID see a drop in peak flow at a point that surprised me - when he just had the "lump in the throat" sensations. You might want to establish your son's peak flow and keep an eye on that as another way to tell if you've gone too far with introductions.

[ar1]

Thank you everyone for all of your support and thoughts.

Since I spoke to my allergist we have avoided actual Peanut butter/peanuts. But have moved ahead with items possibly cross contaminated. 

He has had several granola bars, which my allergist said are notorious for peanut cross conatamination, he has had several helpings of different candies, regular m&m's, pretzel m&m's, kit kats, twix bars, cookies. I have been recording everything and so far there have been no issues. No exczema flare-ups, hives, throat, mouth issues.

I agree, it is just so confusing. When I gave him 2 reeses pieces the other day. He ate them fine, knew they were peanut butter. Wasn't until the peanut butter cracker that he started complaining.  So I am wondering if he would react the same to an actual peanut. Maybe it is jus the peanut butter and how it coats his throat and mouth that causes the issue? I can imagine that having consumed Peanut butter such a long time ago, the consistency would by very strange for him.

If the allergist suggests actual introducing a PN product after the 2 weeks are up, I am going to discuss doing a peanut m&m or something along that line. He has already told me he really wants to try a peanut. I am thinking that is he was seriously uncomfortable (breathing wise) he would not be so eager to try new things?

Honestly, I don't care if he can actual eat PN products or not. I just want to be sure it will not cause ana reaction.  He seems to be doing fine with possible cross contaminated items, which opens up a whole new world to us on it's own


Twinturgo, This thought really stuck a cord with me.
"So hard to say but that's what came to my mind based on those descriptions. if this is a case of large threshold/high tolerance.  Even if it's not a true pass for wholesale consumption of peanut it may be enough to improve quality of life."

booandbrimom,
Could you explain more to me on how to identify his "peak flow".  I also figured a itchy throat and mouth would not be a pass, obviously I was wrong. There was never any swelling or problems breathing during the challenge, no hives. And all symptoms cleared on there own within about a 1/2 hour to 40 min during the challenge. It was weird thought becuase they just gave him a spoonful of peanut butter to start. Not a little amount.  To be honest I was pretty freaked out!

[booandbrimom]

booandbrimom,
Could you explain more to me on how to identify his "peak flow".  I also figured a itchy throat and mouth would not be a pass, obviously I was wrong. There was never any swelling or problems breathing during the challenge, no hives. And all symptoms cleared on there own within about a 1/2 hour to 40 min during the challenge. It was weird thought becuase they just gave him a spoonful of peanut butter to start. Not a little amount.  To be honest I was pretty freaked out!

I assumed he had asthma...so many of our kids do! A peak flow meter is just a little hand-held tube that kids blow into. The harder they blow, the higher the dial on the device moves. To determine top peak flow, you just have your kid do it as hard as they can, two or three different times, and take the best measurement. If you see that measurement drop during a food allergy reaction, it could indicate swelling in the airways. (If he's not asthmatic, though, this is probably not helpful.)

You might want to ask your doctor about the new peanut component test that's out. Perhaps your son has a birch pollen allergy and the peanut sensations are just cross-reaction. One thing we've learned very clearly with baked milk - the proteins can be VERY different from food to food. I know peanut proteins are not as labile as milk, but I'm guessing that different types of processing (M&Ms vs. crackers) may cause different levels of allergenicity.

[Mookie86]

PB is such a weird texture.  Maybe hold off awhile on it and focus on other PN sources?  The fact that he ate the Reese's Pieces without problem is promising!  Obviously he can tolerate some PN. 

[cmf]

I just want to be sure it will not cause ana reaction. 

Yes! That is EXACTLY the point of a food challenge. You can 'pass' on the day of the challenge but the real test is being able to consume it on a regular basis for the next couple of weeks. My son developed anaphylaxis to his peanut challenge on day 5 (was having 2 tsp per day without issue but then had throat swelling)....but this is the whole point of the challenge as you cant say you are 'not allergic' unless you can demonstrate that you can eat it in large amounts on a regular basis.

Can you hide the peanut butter in something if you arent convinced its not a real reaction? (you can mix it into a chocolate paste or similar-put it into home made biscuits?)

Good luck-its a great one to know that youre not 'allergic' to any more as its everywhere and cross contaminates so much.
cheers