1yo first allergic reaction - what next?

[AbbyHammond]

My 1yo had an allergic reaction the other day after eating pesto (so I'm assuming it was cashew nuts?). She came up in quite dramatic hives on her face and neck while eating it and we gave her piriton pretty quickly which sorted it out.

I don't really know anything about allergies though and not sure what we should be doing other than avoiding cashews. Are the reactions likely to get worse? GP just said to call an ambulance if she can't breathe.

It's usually pine nuts in pesto I think. I would personally see if there is allergy testing they can carry out, I wouldn't want to wait for her to stop breathing before doing something! Nut allergies are usually very serious-hope you find out which ones she is allergic to x

?? Didn't the GP refer to an allergy clinic?

She needs to be tested for allergies, and have a treatment plan prepared by specialists, which may involve an epi pen . They can also prepare documents to give to nursery, etc, stating what she is allergic to, and what needs to happen if she has a reaction. They can also advise on how to introduce new foods.

Please go back to your GP and ask for a referral. It's important this is dealt with properly.

Having said all that, it is not uncommon for kids to grow out of allergies that appear under 2 years old, so don't panic. But do get expert advice.

Some brands of pesto bulk up with cashew nuts.

It's traditionally pine nuts, but mostly cashews these days as cheaper I guess. I'm assuming it was the cashews causing the reaction rather than anything else in the pesto or the pasta though.

Would I be able to get allergy testing through the GP or is it private?

GP didn't mention any further testing, just said not to give her any more nuts and give piriton if she has hives/call an ambulance if that doesn't work.

The GP should arrange it, but there will likely be a wait on the NHS. The clinics are usually held in hospitals, but services are over-subscribed and under-resourced (quelle surprise). For example, in London here are clinics at St Mary's Paddington, and I think St Thomas's, and possibly elsewhere too.

The GP sounds profoundly in need of a CPD update.

You need proper testing. GPs not always good with allergies - get a referral to hospital. Has she eaten other nuts previously?

My DD reacted to hummus after which the doctor referred her for allergy testing. We got the results and very little advice so recently went private to have the tests redone and a full management plan drawn up including epi pens, nutritionist, next testing dates (for peanuts we have been advised to have her tested every 5 years until the age of 15), etc.

She's absolutely fine with peanuts and eats peanut butter often.

I think she has had pesto before, maybe once or twice - but don't remember a reaction. She does sometimes get a bit red round her mouth when she eats due to eczema/sensitive skin so possible she's had a mild reaction and I haven't noticed?

Don't think she's ever had hazelnuts, walnuts etc though.

Get gp to do a referral to allergy clinic. My local hospital runs one as do lots of other hospitals I'd imagine.

gg96cgp - where did you get private testing done?

Peanuts are legumes - pine nuts are in the family of tree nuts so not related. Entirely possible to be allergic to one and not the other.

Red/ sore mouth is a classic early allergy sign - the reaction gets worse with each exposure.

It really does sound like you need to see a consultant for proper testing and advice.

Think cashews are tree nuts whereas peanuts are ground nuts (or legumes).

I am astonished that your GP did not refer you to the nearest hospital paediatric allergy unit. That is deeply concerning

This is not something you should be arranging private testing for.

You need to escalate this at GP practice in the first instance via the Practice Manager.

And pine nuts are seeds not nuts

You need to keep a food diary for a couple of weeks with everything she’s eaten and drunk, noting any reactions. You can then take this to the gp and ask for a referral. In my area the referral was to a dietician, who then made a further referral to the allergy clinic for skin prick tests.

Hi OP. Apparently it is quite common to also be allergic to pistachio nuts if you are allergic to cashew. My son (allergic to both) is under consultant care at a London hospital and this is what we have been advised. Insist on a referral to the paediatric allergy clinic. Allergies can be much worse on later exposure, it isn’t worth the risk.

Your DD may be allergic to tree nuts. As there are many it would be worth getting your DD tested. My DS has been under an allergy team since he was 1 however he was very ill as a baby, vomiting ++, hives, eye swelling, asthma and it took him to lose lots of weight ontop of that for him to be referred for testing. He ended up being allergic to sesame, nuts, eggs, wheat and tomatos. He carries an epipen and has daily cetirizine. As this is your DD first reaction there is likely to be a protocol around when to refer and as the reaction would be deemed mild the GP may not refer. So you may need to think about going private..

Btw it took 9months to get as far as the allergy clinic but because of the food diary, I was clued up on what to avoid.

Everything Tolleshunt said. Don't be put off and get referred to paediatric allergy clinic. Similar thing happened to my son at that age and we've had Epi-pens since. Pistachios are apparently the evil twin of cashews so never give those - it is usually cashews not the pine nuts that is the culprit in pesto. There's lots to learn but also lots of expertise - start straight away on referral.

As this is your DD first reaction there is likely to be a protocol around when to refer and as the reaction would be deemed mild the GP may not refer.
Yes, I was wondering about it just being a mild reaction - I was thinking that because we had piriton and gave it to her within a few minutes of her eating it, we don't know how bad it might have been if we didn't have any antihistamines Scary to think it could have been worse if we hadn't had some to hand.

Should we avoid all nuts or just cashews?

Is it still ok to give her peanuts?

Don't be fobbed off, OP, it really isn't worth it. Keep on at them till they refer.

If she hasn’t had a reaction to peanuts and has eaten peanut butter regularly, there is no reason to stop her eating them.