5 year old just started developing nut allergy

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Hi just wondering if anyone been in similar situation. My 5 year old never had a problem with eating nuts. But earlier this year she had a reaction to pesto and then a pistachio chocolate bar. We avoided nuts ever since and We have now had her allergy testing done on the nhs. She is allergic to all tree nuts like walnuts, pistachio, pine nuts and cashews. Weirdly she’s not allergic to peanuts but the nurse said peanuts are ground nuts and not tree nuts.

just feeling really anxious now with what’s to come. Will she get worse and how will I know if she needs an epi pen? The nurse said because we gave her pirtize on her last reactions and that stopped it then she won’t need epi pen for now.

she can still eat Nutella too which is strange. I just don’t understand it all.

but the nurse said it’s unlike shell outgrow the allergy because she wasn’t born with it.

we will carry piriton with us at all times now.

this is all new to me and worrying :(

Does she have hay fever? What did the reaction look like?

Allergies to tree nuts can be caused by a birch pollen allergy. The nuts and pollen have a similar structure that triggers the immune response. If it’s this then look up pollen food allergy syndrome.

The nurse is right, as piriton resolved the problem then continue to give that as first aid if she has a reaction.

Are you seeing an allergy consultant?

She doesn’t have hay fever and at the hospital they skin pricked her for pollen too and she didn’t react.

im just worried it’s going to get worse and we don’t have an epi pen :(

Peanuts are a legume, they’re not actually a nut at all. They’re more closely related to peas, beans and lentils. That’s why she’s not allergic to them.

If they thought it likely she’d need an EpiPen they would have prescribed one. If her reactions seem to worsen over time make a new appt and ask for one.

Can you afford private and are you anywhere near london?

If so I'd really recommend Adam Fox and team

https://www.instagram.com/dradamfox?igsh=MW4xcjNyaDBxazBhbg==

My DS has been under the care of an NHS allergy clinic for many years and gets a skin prick test every year, followed by a consultation with a specialist. I am surprised they only got her tested but not follow up consultation to answer your questions and assess the situation!

The thing with allergies is that the skin prick test is just a predictor of an allergy but doesn't tell what the reaction could be. For instance, my DS has had a negative SPT for several years in a row on 3 different tree nuts he was previously allergic to, so we did a food challenge for all 3 of them (individually, in different sessions). He only passed one and he was very sick on the other two! On the other hand, the first set of tests he had when he was a baby showed he was allergic to fish....despite the fact he was eating fish regularly with zero reactions!

If I was you I would push to be referred to a consultant. She needs regular testing and a plan of action (nowadays you really have many options, including OIT).

Allergies to tree nuts can be caused by a birch pollen allergy.
My DD has this she also avoids peaches nectarines and apples because of birch pollen allergy. She is in her 20s now reaction never got any worse she just takes antihistamines before she is going to eat anything that affects her.

Thank you. We got a letter to say a follow up in 6 months but that’s it. And told to keep piriton on us as that’s what managed her allergy last time she reacted. But I know things can change.

her skin test measurements for pecans was 13mm and for cashew 9mm the rest 7-3mm. do you know if this is a big reaction?

Nutella is made with hazelnuts so it’s a different nut to the ones she’s allergic to. You don’t have to be allergic to them all, you can just be allergic to one or more types, though I think some are related so if you’re allergic to one you’re very likely to be allergic to the other. For example, a cashew allergy means you’re quite likely to be allergic to pistachio and vice versa. Walnut and pecan allergies are more likely to coexist with each other as well.

Sometimes it can be hard to buy a single nut type without warnings about traces of other nuts as possible contaminants too.

What sort of symptoms does your DD get when she has a reaction? That’s usually the determining factor in prescribing an epipen as far as I know. My DC wasn’t prescribed one at first but was after a while.

The skin prick and blood tests only show a likelihood for allergy afaik. My DC’s results meant he had a 90 - 95% approx chance of being allergic to peanut, but he had to have a food challenge at a hospital to see if he really did have the allergy.

I’m not sure what the nurse meant about being born with the allergy, but children are unfortunately much less likely to grow out of tree nut allergies that out of things like egg. DC has tree nut allergies too. Looking on the positive side they are easier to avoid than things like egg, milk or wheat (we also have egg allergies) and people also tend to take them more seriously in restaurants etc.

Just to add, if she does definitely have a pine nut allergy after all the testing, then be a bit careful around this one. Under the current UK and EU regulations any of 14 allergens must be highlighted in the ingredient list when they appear in pre-packed food. The 14 are Cereals containing gluten, Crustaceans, Eggs, Fish, Peanuts, Soybeans, Milk, Tree Nuts, Celery, Mustard, Sesame Seeds, Lupin, Molluscs, and SulphurDioxide/Sulphites.

However pine nuts are not among the 14 and you will not see them highlighted on ingredient lists. (They will be listed as a ‘regular’ ingredient but not highlighted iyswim.) They are not included in the tree nut warnings here. I think they are included in allergy labelling in the US (but please check this for yourself!!)

Oh thank you. Her reaction when she ate pesto was itchy throat and hives around her and in her mouth. Itching her neck and before we could give her pirition she projectile vomited 3 times. She used to eat pesto but not for a while so she has def developed this in the last year. They said it would have been the pine nuts in the pesto.

Pesto is traditionally made with pine nuts but very often things like cashew are used instead. Do you know what ingredients were in the brand she reacted to? Did she have skin pricks for pine nuts too?

The definition of anaphylaxis varies from place to place. In the UK it’s not defined as such unless the respiratory or cardiovascular system are compromised afaik. Other places consider it an anaphylactic reaction as long as it’s a systemic reaction, so for eg when both gut and skin are involved. But the UK considers a response to food in the gut as a local rather than systemic reaction.

DC was prescribed an epipen when he had breathing difficulties after eating egg, not before he developed breathing difficulties. He also has asthma which makes allergic reactions worse. Does your DD have asthma?

I found this article useful and it explains some of what I mentioned above. Sorry I can’t seem to link it.
‘Myths, facts and controversies in the diagnosis and management of anaphylaxis’
Katherine Anagnostou, Paul J Turner

My experience is that some physicians err on the side of caution when it comes to nuts and prescribe the epipen anyway.

Just to add, the word anaphylaxis is very scary I know, but it’s mostly okay. Allergies can be unpredictable which is the scary bit really. I’d push to see a consultant or specialist team and be guided by them.