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Entries in tree nut allergy (2)

Wednesday
Aug182010

Peanuts or Tree Nuts for Children and Babies?  

There is controversy about when to give a baby or young child peanuts or tree nuts.  Some doctors recommend introducing these foods at about one year.  Others suggest waiting until two or more years of age. Tree nuts include almonds, beechnuts, brazil nuts, cashews, chestnuts, gingko, hazelnuts, hickory nuts, macadamia nuts, pecans, pine nuts, pistachios and walnuts. Peanuts are not a tree nut--they are part of the legume family as are peas.

As a parent of two food-allergic sons, I am grateful that our sons’ allergist instructed us not to give them peanuts or tree nuts until at least five or six years of age.  I think the old adage, “An ounce of prevention is worth a pound of cure,” is perfect advice this situation. Our sons are now six and seven years old.  Both had a dairy allergy and egg allergy.  One year ago our youngest outgrew his dairy allergy.  Neither child has developed a peanut or tree nut allergy--probably because we haven’t given them any peanuts or tree nuts.

As a parent of allergic children, I remember feeling the angst of wanting to know if either son would be allergic to peanuts or tree nuts.  This “need to know” feeling was strong and the ambiguity bothered me.  The ambiguity also bothered me when I explained the situation to others.  For example, it was harder to respond to teachers when they asked, “Is he allergic to peanuts or tree nuts?”  My answer was and still is, “My sons don’t appear to have an allergy to peanuts or tree nuts but we haven’t given them any nor do we plan to until they have fully outgrown their other allergies to dairy and egg.”  We’ve kept them in peanut and tree nut free classrooms, although they are allowed to sit next to others at lunch who may be eating peanuts or tree nuts.

Normally I don’t get to explain the details behind our avoidance: Our allergist explained and my research has demonstrated to me that a child who develops food allergies can have an immature or problematic digestive system.  For instance, if the child has taken a lot of antibiotics during their young life then the bacteria which normally reside in the child’s digestive track, a.k.a. intestine, can be destroyed.  When it isn’t replenished through probiotics (like acidophilus or many other strains), the intestine wall can actually become damaged to the point where tiny holes are created in it.  This is called ‘leaky gut syndrome’ and can be very difficult to diagnose (and see).  But one negative result is that food particles can leak through the intestine wall without being properly digested.  Then the liver must cleanse the blood of these particles and sometimes the immune system creates antibodies to attack them.  Once the antibodies are created the allergic reaction is in place.

Since our sons had food allergies (to dairy and egg) we were extremely wary and afraid of introducing peanuts or tree nuts since the likelihood was high that an allergic reaction would be created.  So we waited, and waited, and waited.

Only once our younger son outgrew the diary allergy just after his fifth birthday, did I give him a peanut.  When I did, I made sure it wasn’t dry roasted, since those are cooked at such a high temperature that some believe changes the protein and contributes to the creation of a peanut allergic response.  An other option would have been to give him boiled peanuts, which are more common in China, and where they have a lower allergy rate to peanuts.  Dry roasted peanuts are cooked at temperatures around 400 to 500 degrees.  Water boils at around 200 degrees--a substantially lower temperature.  Because I had a hard time finding either natural, raw or boiled peanuts, even at our local natural foods store, I purchased a box of “natural, organic, raw” peanuts over the Internet from a state across the county.  When they arrived, I gave him one-half a peanut each day for several days until I was sure he could tolerate them.  I still haven’t tried tree nuts.  As for my older son who is now seven and one-half, we have not given him peanuts or tree nuts, because his dairy and egg allergy remain present. 

Our caution in exposing our sons to peanuts and tree nuts even took place in the allergist’s office.  When they were skin prick tested we opted not to have the peanut or tree nut allergen injected into their skin because we didn’t want to expose them to the protein via skin,  Could this possibly trigger an allergy?  Some say yes, others say no.  But being the parent of the beloved child, why throw caution to the wind and give it a go?  No, we prefer the saying, “Better safe than sorry.”  So we had our sons tested for peanut and tree nuts using the ELISA or RAST blood tests when they were about three or four years old.  All blood test results came back negative for allergy to peanuts and tree nuts.  But we still didn't give them either of these foods.

So our life continues at ages six and seven with avoidance of peanuts and tree nuts.  Our riskiest behavior will involve occasionally purchasing food that was manufactured in a facility that creates peanut or tree nut products.  But for the most part we try to avoid that as well.  We will wait until there is evidence that each of our sons’ digestive systems are healed and immune systems are less likely to attack protein particles before taking the next steps. 

As a mother and researcher of food allergies, I personally think that if a child has other food allergies when they are babies, such as an allergy to wheat, soy, egg, fish, dairy or any food, then that child shouldn’t be given the dangerous allergy-foods of peanuts, tree nuts or shellfish until they are older (5+) and have outgrown all of their other allergies.  As for children without allergies, I’d still wait until the child was at least three or four to introduce peanuts or tree nuts.  My two cents.

Sunday
Oct112009

Outgrowing Food Allergies

Is there a chance that children can outgrow their food allergies? It appears so, based upon official studies and unofficial stories. For instance, my younger son, who just turned five, had his annual allergy skin prick test just before his birthday. He had shown positive for egg and dairy since he started skin prick tests when he was two. We never actually fed him these foods, except one bottle of cow’s milk formula the nurse gave him (by mistake) on the day he was born.

Now finally, his skin prick test for dairy, at age five, came back negative. We were then referred to a larger office of allergists where they conduct "challenge tests." But before the doctor to whom we were referred would do a dairy challenge test, she insisted on a blood test. She said that only if both the skin prick and the blood test come back negative is there a solid chance that the child has fully outgrown the allergy. So two weeks later we had the blood test done and another week passed until we learned that the results were negative, which was good news.

We scheduled our “challenge test” and my son had to miss a day of school. It lasted three long hours, but my son passed the test and was able to consume six ounces of organic 2% cow’s milk in increasing amounts over the first two of the three hours. After the test, I was exhausted--emotionally. I had tried not to get too excited, for fear of disappointment, but when I found out he was okay, the thrill I had dreamed of was lacking for me. I think I had prepared myself for failure, so was somewhat hardened which left the happiness factor out in the cold to a certain extent. It took about a week before I shared the good news with my friends and some others. Yes, this reaction is weird, but that’s what happened. Now about a month later, I feel relief, and I guess happiness, but I think I am still quite guarded, probably from a continued fear of disappointment.

Enough about me, upon seeing my older son get off the school bus, I wondered, "What do I tell my six-and-one-half year old still allergic to dairy?" Well, I told him that he should be happy for his little brother. He responded, “Oh!” and his eyes lit up a bit. Very sweet. Then I said, “and because your little brother has outgrown his allergy to cow’s milk it could mean that you are next because you and he are so much alike.” It is wrong to set up this hope? I don’t know, but hope is something you can live on for a long time. So I will indulge in it as much as I can. Coincidentally, a couple of weeks before all of the success of my younger son, his older brother said for the first time, “I wish I didn’t have food allergies,” one night just before going to sleep. I assured him he would outgrow them someday. Then sometime over the next week, during dinner, something inspired me to tell my boys that food allergies really aren’t that bad because there are a lot worse things that can happen to a person, then I proceeded to list them off. Not sure this was the right thing to do, but it did stop any further “whining” about our situation.

I can only attribute my younger son’s success in outgrowing his allergy to strict avoidance. My husband and I are extremely careful about not giving him any foods that contain dairy, even in trace amounts. Other than that, we try to reduce stress in our lives as much as possible and give our kids their time to be quiet and play as they wish--which supports the toxic load theory. Sometimes this means not signing them up for another session of soccer or t-ball so they can relax on Saturday mornings rather than rushing out for yet another activity. Also, I faithfully give my son a dairy-free multi vitamin and dairy-free probiotic supplement every morning.

What about other food allergies? What are the average rates for outgrowing those?

80% or “most” of children will outgrow these allergies by the time they are 16 and as early as age 3:

  • Dairy (cow’s milk products)
  • Egg
  • Soy
  • Wheat

As many as 20% of children will outgrow their allergy to:

  • Peanut

About 10% will outgrow their allergy to:

  • Tree nuts (almonds, brazil nuts, cashews, hazelnuts (filberts), macadamia nuts, pecans, pine nuts (pignolias), pistachio nuts and walnuts. Note: Peanuts are part of the legume family and are not considered a tree nut.)

As for fish and shellfish, most research says the allergy is normally life-long. But perhaps some reactions can be outgrown. For instance, my father had reactions of severe nausea and vomiting after eating scallops and shrimp as a teenager and in his early twenties.  He recalls, "The first instance was in New York. I was about sixteen years old when I went to lunch with one of my friends. Then I went back to work. Once at work I vomited so badly I had to go home.  Another time was when was in college when I was about twenty years old. I ate at the college restaurant and vomited again.  In both cases the other people had the same food and were fine, so I concluded that the food wasn't bad--it was my reaction to it. So I swore scallops and shrimp off."  The good news is that in his mid-twenties, my mother convinced him to try eating these scallops one night.  He tried and he was fine!  Over the past forty-five years, he has been able to eat scallops and shrimp without a problem.

The above statistics were taken from articles located at:

http://www.aanma.org/2009/02/when-will-i-outgrow-food-allergies/ 
http://allergies.about.com/od/fa1/f/outgrowmilk.htm 
http://www.aaaai.org/patients/publicedmat/tips/foodallergy.stm