When to oral challenge (almonds)

[brownie]

DS12 is off the charts allergic to peanuts and also allergic to walnuts with a plethora of other mild nut allergies showing up on RAST.  We have avoided all peanuts and treenuts since 6 months bc older brother was diagnosed with PA.  2 weeks ago we skin tested to almond...negative (but I have no reference point; he showed a moderate response to peanut at 4 years old via skin test and since then we've only done RAST for everything).

Today the nurse called.  The allergist offered an oral challenge to almond with a RAST of 0.59.  That still seems high to me...in fact the old labs I have show that as class 3!  But they said below 0.35 is negative for this test.

So I am not sure whether to do it...
In favor: Add 1 more food for the whole family; possibly help his system to calm down a bit with a related food; if it goes badly, he would at least finally know what a reaction is like; his black bean was a 0.35 and he is eating that now in small quantities with no issue; he's technically never had a nut ingestion reaction in 12 years - eyes swelled under a walnut tree and vomited to black bean which subsequently showed a positive test

Against: He is an anxious kid and may "react" regardless with vomiting so it may get stressful and confusing; don't know that his skin is very reactive so I don't really trust the skin test; HE REACTED TO SITTING UNDER A WALNUT TREE!!!; won't change our lives much at all...he still has to avoid walnuts and peanuts

If the RAST had been negative, I would have signed on for the oral challenge right away.  I guess my big question is how do I interpret a 0.59 RAST to almond? Is it borderline negative as our Dr seems to think (and I adore him but I think his main evidence is the negative skin test which he sees as more important and this may be true for the majority...just not sure it applies here) or is it Class III (ie a moderately positive response) like my old labs show.

Thanks!  Brownie

[ninjaroll]

Yes, because almond is more in the drupe category and SPT is negative. That is contingent upon your doc being very good at interpreting IOFC. None of this only sorta reacted so give him a pass.

[TwoDDs]

DD was offered a challenge with a rast of .93.  As well, it appears I can choose from her tree nuts with two exceptions, but one of my choices has a rast of 2.03.  That's Dr. Wood at JHU for a child with a very high peanut rast.  He seemed confident said something along the lines of "there are a number of tree nuts that I don't believe will cause any problems for her."   That's all the help I can be - the challenge is set for late next year.

[brownie]

So did Dr. Wood give you a rationale for why he believes they will cause no issue?  I believe DS is actually allergic to walnut and they offered to challenge that too despite a 4 on the RAST if he were to get a negative skin test. Now that I say that, I guess I should be more motivated to give the almond a try because if were actually not allergic to almond and then we also tried walnut successfully, we could drop all treenuts off our family allergy list.  I think that's a horrible long shot but it would be worth it.

He had a positive histamine and positive to dog, cat and ash tree, all similar in size to the histamine control.  The cat and ash tree subsequently came out low positive on the Rast.  Dog was negative on Rast but has been positive before.  So I guess I see some consistency.  That said, I looked at those little bumps on his skin and it was not analytical enough for me!

Brownie

[lakeswimr]

Personally I would want to challenge anything a good allergist that I trust felt was worth challenging.

DS's allergist pushed me to challenge sesame for DS and even though I was sure he would fail, he passed.  He passed almonds last year and it is the most useful tree nut in my opinion--almond milk, almond ice cream, almonds, and etc. 

[brownie]

Thanks.  I appreciate that and I am leaning toward yes now - if I can convince my son.  I trust the allergist...I just worry that he is going based on trends and not individual knowledge of my son.  Brownie

[hezzier]

I'd go for it, assuming you trust your allergist.  I wish our's would offer challenges to DS.  We haven't been with her a year yet and just finished up weekly allergy shots so I am hoping there will be some in DS's future.

[GoingNuts]

DS did an oral challenge to almond last year, and he passed. His allergist is @ Mt. Sinai, and even though his RAST and SPT weren't completely negative (don't remember his RAST # and he had a small wheal), she felt he had a good chance of passing - and he did. 

It has literally been life changing. Almond butter and almonds have given him a great source of non-perishable protein which has been great for traveling.

She thinks he might pass chick pea too, but he has no interest in doing it. Stinker.

[CMdeux]

Yup-- this is the next on on our list.  I think that DD is actually allergic, and her SPT to it come and go, but... she DID pass hazelnut with no problems, though we know she is highly allergic to pistachio/cashew and now, evidently to walnuts.

I'd go for it if you trust your allergist's judgment and s/he knows your child well. 

Just make sure to bring in something that is a look-alike that can serve as a "control" and then the allergist can switch them over at some point in the first four doses.  That's what we always do just to make VERY sure that anything subjective is real.  DD has never ""reacted"" during such a challenge, by the way (that is, with psychosomatic complaints). 

[brownie]

CMDeux, My husband just said the same thing...see if we can do the challenge blinded.  I will have to ask and also figure out how that would work.  I can't think how I would manage this unless I crush it into a powder ahead of time.  But I am concerned about this.  I thought his bean reaction was psychosomatic until the test came back positive...because he didn't want to eat it and then he vomited.  He was young then but he is my anxious/emotional kiddo.

[spacecanada]

What about almond butter?  You could mix in bits of almond butter into sunbutter or something else that is similar but safe.  One would mask the flavour of the other maybe?

[brownie]

That's a good idea if there's a safe almond butter.  He is opposed to using almond butter because of the stronger flavor, but I should at least try at home to get him used to the flavor by trying sunbutter ahead of time.
Brownie

[spacecanada]

Blue Diamond is safe for PA but not sure about cross contact with other nuts. I think Barney butter is safe for PA but again not sure about other tree nuts. Worth a call.

[CMdeux]

I used hazelnut meal (made in a cheap coffee grinder that I figured I could pitch if the challenge were a fail) and flax seed meal for our last challenge-- allergist mixed them into applesauce.

[GoingNuts]

Barney Butter is safe for PN and TN (except coconut). Blue Diamond is no longer safe for other tree nuts.