I never sleep well the night before an oral food challenge and last night was no different.  So this morning, after a sleepless night, Sahil and I left for Burlington at 8 am and got there just in time for his 9 am appointment.  It was the same a few weeks ago when he did the cashew challenge.

Cashew challenge

At the end of February Sahil had a cashew challenge.  Just like the almond and walnut ones, the first dose was a speck of the nut and then after waiting 15 – 20 minutes the dose was gradually increased to 1/3 cashew, 1/2 cashew, 1 cashew, 2 cashews, and finally 4 cashews.  This was done over the span of about two hours.  We stayed an additional two hours to be monitored and thankfully he did not have a reaction and successfully passed the cashew challenge. Passing cashew clears him to eat pistachio but we haven’t tried feeding him those yet.

 

Today we returned for the hazelnut challenge.  Out of all the tree nut challenges Sahil was most looking forward to passing hazelnut so he can try Nutella.

Hazelnut challenge

For younger kids, hazelnut spreads like Nutella are commonly used for the oral food challenge (OFC) but can cause stomach aches due to the large amount they have to ingest.  For example, two tbsp of Nutella is equivalent to one hazelnut and an oral challenge usually involves ingestion of 7 or 8 nuts over 2 hours.  So we took actual hazelnuts which I shelled the night before.

9:04 am – the first dose was a tiny piece which he said he hardly tasted; 5 minutes later he started scratching just under his lower jaw. I looked at it and it looked red but was it red from scratching or a reaction to the nut?  The nurse assessed the area and felt it was fine to proceed to the next dose since there were no other signs or symptoms of an allergic reaction.

9:20 am – he ate another small piece which was about three times bigger than the first piece; about 5 minutes later he complained of an itchy spot on his upper back.  I checked and there were 2 red areas on his back; the spot under the chin had subsided.  Dr Hanna came in to check the red spots.  She assessed his airway and breathing which were both normal and so gave the go ahead to continue with the challenge.

9:38 am – he ate a piece of hazelnut which was less than 1/4 – he had no complaints of itchiness.

9:52 am – Sahil ate 1/2 hazelnut. He said he was not scratchy but if I asked him “Do you feel scratchy?” then he focussed on himself and said “Now I do in 3 places”. So I stopped asking him.  He started to scratch his upper right arm about 10 minutes after the dose but there was no redness.

10:08 am – Sahil ate a whole hazelnut.  He was scratchy at the corner of his right eye, and on the back of his thigh but no redness appeared.

10:23 am – Sahil ate two hazelnuts & was feeling fine.

10:38 am – Sahil ate four hazelnuts. It took him 16 minutes to eat them all and there were no symptoms of an allergic reaction.

He finished eating the hazelnuts at 11 am.  We stayed until 1 pm when Dr Hanna assessed his airway, breathing and skin.  He was asymptomatic and so passed the food challenge to hazelnut. It was unnerving to see the red areas at the start of the food challenge and I wasn’t sure he would pass.  Dr Hanna said this can happen due to the anxiety caused by doing the food challenge or it could be the immune system detecting the allergen but not proceeding with reaction.  He is to eat two hazelnuts 2 or 3 times a week to ensure he doesn’t lose the tolerance.  There have been cases of people passing OFC and not incorporating the food in to their diet on a regular basis and then developing allergy to it.  I will definitely feel better once he has a few more servings of hazelnuts over the next few days.

Summary

Sahil can safely eat: 

√ Peanut (2 per day)                            

√ Almond                                                

√ Walnut 

√ Pecan

√ Cashew                                             

√ Pistachio

√ Hazelnut

Dr Hanna said we could test the brazil nut, macadamia nut and pine nuts ourselves at home in the same way an oral food challenge is conducted in their office.

Next steps: Sahil will return to see Dr Mack in April to check in on his peanut oral immunotherapy.  At that time he may also be tested for Soy. We are hoping that the peanut OIT has lessened his allergy to soy since peanuts and soy are in the same family (legumes).

With every visit he is closer to freedom.