The day before my daughter’s peanut oral food challenge I found myself, kid-free, in the grocery store scrutinizing the labels of jars of peanut butter. I wanted to ensure whatever I purchased contained only peanuts and had not been cross contaminated with any tree nuts. I felt like a deviant, as if I should apologize to the cashier for buying such an atrocity as peanut butter.
I will admit that I was very nervous the days leading up to her appointment. Just as you, I’ve read all the food allergy horror stories. We got through our son’s anaphylactic reaction unscathed (despite receiving inappropriate advice from our pediatrician’s office), but we were naïve and uneducated then. Now I know what can happen and how quickly things can go south, and knowing that she’d be in a safe place during the food challenge did little to diminish my worry.
I also teetered on the thin line between adequately preparing my daughter so she’d recognize an allergic reaction and would speak up promptly versus instilling fear in her and having her cry wolf because I’d panicked her into psychosomatic symptoms.
The day before the appointment my son asked her whether she was scared and she responded with an emphatic no. He said, “Well, eating peanut butter sounds scary to me!” I tried my best to match her laid back attitude and quiet my son’s commentary.
Morning of Food Challenge
Our allergist was giddy, kind of annoyingly so. But I knew he was curious and nearly as eager as I was to find out whether she was sensitized to peanut. Though he didn’t exactly say so, it was obvious to me that his best guess was that she was not peanut allergic.
He explained that my daughter was completely safe, that they would monitor her extremely closely and would halt the challenge if at any time she exhibited symptoms. He explained the procedure and then left so the assistant could proceed.
The assistant checked my daughter’s skin thoroughly and, with a pen, circled bruises and other marks so we could easily determine whether she had any new rashes on her skin during the challenge. She took her vitals, including her lung function using a volumetric spirometer.
She was given 1/8 teaspoon of peanut butter that she ingested right off the measuring spoon. The assistant set a timer and kept an eye on her. After five minutes she checked my daughter’s vitals and looked over her skin and asked her how she felt (she was fine). After another 10 minutes, my daughter ate twice as much and was checked again after 15 minutes. This continued, with the assistant leaving the room between doses and checks, until she’d eaten a full two tablespoons of peanut butter, much of which having been smeared on some bread I’d brought. At one point about halfway through the challenge the assistant thought she’d heard some irregular lung sounds, but the allergist listened and said she sounded fine.
Three hours after walking in the door of the allergist’s office, we were packing up all our toys and getting ready to leave. The allergist said everything went great, and although extremely rare, it was still possible for her to have a reaction so we should continue to monitor her for the next 4-6 hours.
On the drive home my mind raced thinking about the freedoms my daughter would enjoy not having to worry about avoiding peanuts, as well as the jealousy and other challenges we’d face with having one child with severe food allergies and one without. Those thoughts and concerns would soon be quashed.
Around six o’clock that evening I sent out an email to our extended family explaining that she, for all intents and purposes, had passed the peanut challenge and to be sensitive to what that means for my PA son. Then I sat down beside my daughter and noticed some redness on one of her legs. She allowed me to take a closer look and there was a slight rash on the backs of both thighs with one prominent hive. The next morning, the rash was still there, not raised but definitely there. I honestly don’t think I’d have noticed the rash the previous night or the next day if I hadn’t been looking for it. It wasn’t bothering her at all so I sent her to school and called the allergist’s office when they opened. They advised giving her a daily dose of antihistamine until the rash subsided (it was gone the next morning). He also recommended another food challenge to confirm a peanut allergy. (What!?) My response was that we were done for now, we would continue to avoid peanut, and we’d see him in a year! (Bottom line, my daughter is peanut allergic.)
If your child is scheduled for a food challenge, here are some tips:
- Ask whether you need to bring the allergen being tested or whether it will be provided. And ask whether your child is allowed to eat other snacks and drink during the food challenge. For example, for a peanut challenge, your child will need safe crackers or bread as the challenge progresses.
- Expect to be in the allergist’s office for a long time. Bring age appropriate entertainment (puzzles, crayons, toys, iPad, etc.).
- Accurately prepare your child by explaining the procedure and allow him to discuss his feelings about it and reassure him as needed. Don’t project your fears or anxiety onto your child. You can discuss your own scary thoughts with a trusted adult.
- Remember: the food challenge doesn’t end when you leave the allergist’s office. Continue to monitor your child for the next six hours.
- Allow your child to talk about and work through his emotions, especially if the child had a severe reaction or an allergy was otherwise confirmed.
- Avoid talking about whether the child failed (or passed) the challenge because those terms make it sound like the child had influence over the outcome. Use more neutral language, such as an allergy “was confirmed” or “ruled out,” when talking to others and to your child.
I honestly didn’t care what the food challenge outcome was; my only hope was that my daughter didn’t suffer a severe reaction and subsequent emotional trauma. (She’s extremely sensitive.) I definitely got my wish because as far as reactions go, she couldn’t have had a milder one.
The one thought that haunts me though is…Did I ruin my daughter’s chance of outgrowing the allergy by doing the food challenge? I’ve read that strict avoidance with no exposures is the best bet for outgrowing a food allergy. My daughter’s reaction was so mild…maybe she was “in the middle” of outgrowing it and now that’s she’s been exposed, her immune system is in overdrive and her chances of outgrowing it have decreased. Only time will tell. But even so, * I wouldn’t have changed my decision to go forward with the food challenge. At least now we know that we are justified in having her diligently avoid peanut and carrying epinephrine for her.
*I can’t find scientific justification for this fear, which is why I crossed out these thoughts!