How to tell anaphylaxis?

[IE00]

Hi my 9 month old DS had a skin prick test and is allergic to most tree nuts. He had the largest reaction to cashews and pistachios. He has had peanuts before and could handle 1/4 teaspoon but came out in hives after 1 teaspoon. I'm wondering if he could have an anaphylactic reaction to cashews and pistachios, can you tell by the size of the reaction to the skin prick test? I'd like to know to know whether to completely remove them from the house (my DD loves pistachios) or just get him to avoid them.

Frustratingly, the size of the wheal doesn't dictate how serious the allergy is, just how likely the child is to react to the food.

Any IgE allergy (and if he's had hives to peanuts he is IgE to peanuts) has the potential to cause anaphylaxis and one reaction doesn't determine the next. So you could have a mild reaction to the food one day, and anaphylaxis the next.

If it's something you'd consider, oral immunotherapy (oit) is starting to take off in the UK and it's thought doing it as young as possible is the best as it can lead to outgrowth and serious side effects are rare.

You basically give a tiny bit of the food each day, slowly increasing the amount given and hoping the body starts to tolerate it. It's all done in a very controlled and safe manner, under doctor supervision.

For peanut, Palforzia is offered on the NHS.
For tree nuts, you'd likely have yo go private.
We use Dr Brough at the Portland and its been fantastic.
I think Dr Adam Fox and Dr Du Toit also offer nut OIT.

Initially we removed all of my son's allergens from the house but gradually, over a couple of years, felt safe having them around.

He knows to steer clear and we wash hands before touching him. I also don't kiss his skin if I've recently eaten his allergens.

If my son was only allergic to nuts, I'd probably consider a nut free house, just for peace of mind. I think it's a very personal decision though, especially if the rest of the household enjoy eating them.

It will vary from person to person but when I have gone into anaphylaxis I get tingling along my jaw line which the moves up and starts to swell. First my lips then my cheeks and eyes as it moves up my face.
I get a ticklish dry cough but nothing makes it feel better.

The thing I didn't realise until I had them myself was that the reaction does go bam to full anaphylaxis. The first time it was probably 30-40 minutes from the first signs of a reaction to let's get to a and e. The second time it was probably 30 minutes from first signs to an ambulance being called. There was plenty of time in both cases to get medical help. General rule is if you suspect anaphylaxis treat as if it is anaphylaxis. Speak to your doctors about an allergy action plan for your child. It will tell you what to look for with all the different reasons

Thank you. We actually got the allergy test from Dr Brough, she was very good.

I didn't realise there's no connection between the size of the wheel and the severity of the allergy, that's interesting

@Alloveragain3 my last post was for you.

Did you do OIT with Dr Brough? She didn't suggest Palforzia, she suggested just normal Skippy peanut butter...

Ah, no way!

Yes, we do OIT with her for sesame and baked milk at the moment.

Going to start egg and nuts soon.

She does use "real ingredients" with us. I think most allergists use real peanut butter, but GPs can use palforzia as it's all pre-measured. I guess it's more of a blanket treatment plan while allergists can male a more tailored plan.
However, this is just me guessing!