Reaction to pesto - what's the likeliest culprit?

[glasjam]

My 15 month old daughter has been suffering from excema since she was about 3 months old - at first just an isolated patch on her face but now the whole of her legs are dry and patchy - her trunk just had a flare up, tops of her arms. To be honest they never get really seriously weepy but she does scratch like crazy sometimes and it bleeds. Tried a few things but it seems so cyclical - sometimes it looks like it has completely cleared and then it will just emerge again.

Haven't been able to pinpoint any particular thing that sets it off - she has always eaten cheese and has had a little bit of yoghurt recently to no ill effect. She has had cow's milk once or twice and didn't react but we are keeping her off it for now.
She's never had forumula and I'm still feeding her myself.

So the other day she had pasta with M&S pesto sauce and she came up in a red rash and hives mainly over face but also on arms and legs. I left it a good few months and was around someones house the other day and they served it for lunch - I took a risk and the same thing happened. It happened almost instantly and she was most put out when I took it off her!

So the obvious one is pine nuts isn't it? I have eaten snickers bars occasionally when breast feeding and have had cashew nut butter - perhaps this has also gone through the breast milk? Or could it be pecorino cheese?

I myself have a wierd and inconsistent reaction to cheese - usually plain old cheddar. Sometimes just opening a packet can cause my face to flush noticably (my other half always asks if I've had any cheese recently). So I am wondering whether I have a mild cheese allergy - or possibly annatto? It just doesn't happen EVERY time.
And I LOVE cheese!

Any thoughts especially guidance on how I should proceed with regards to nuts in general - completely steer clear myself whilst breastfeeding? Keep her away from nuts till she's 3? Have her tested?

Any help will be gratefully received.

Lots of shop bought pesto contains cashew nuts as well as pine nuts, so it could be that. Its really hard to tell and you will probably need to get professional guidance.

I react specifically to parmesan cheese which is often used in pesto.

Absolutely fine with all other types of cheese.

Not sure that helps you though.

If both times she reacted she had the same make of pesto, I guess it could be either pesto or the cheese. If they were different brands, it's likely one was parmesan so the reaction more likely to be from the pine nuts iyswim.

Maybe try both in isolation and see what happens.

There are brands that don't have cashew nuts in can't remember if it's sainsbury or tesco's own brand, try one of those to rule out the cashew.

DS's who has nut and seed allergy has come up in quite bad hives a few times but we have never worked out it is.

Some pesto has egg in it (well, lysozyme from egg is used in Grana Padano cheese). I find cheap pesto and expensive pesto tends not to have egg in.

Thanks for all your replies.

Yes I will have to check whether there is any difference between the Sacla organic pesto that I usually have and the M&S one - I thought that she had had pesto before but I could be mistaken. I will have to do a "scientific" cheese test on myself too - it's never bothered me too much but I suppose I should try and isolate which cheeses cause this reaction as it may be helpful. She's definitely had egg and again no problem.

Will investigate further and keep a Proper food diary for her.

Just to add - if you think it is the pine nuts affecting her then please proceed with the utmost caution. Nut allergy is not one to be experimenting with at home (I'm sure you know that so apologies ...)

pine nut would seem the most likely culprit. Had my peanut allergic child tested for pine nut and it was positive, although as far as I know they'd never had pine nut before.

Keep some piriton around while you're weaning and consider adding some probiotics to help with eczema.

[feeling responsible emoticon]

Apologies to all affected

I think it may be the parmasan....

My wee boy had excema for a few months when he was really tiny and we found out it was milk protein. It could be that your wee ones skin would clear up if she was taken off cheese and all other dairy products.

Some cheese/yoghurt is processed in such a way that the milk proteins chains are broken down enough for the person not to react to them. This could be why some cheeses are ok and others not.

Have you had her blood tested for allergies?

Anyhoo, good luck, allergies are rubbish!

Just to update - ended up going to doctors with daughter as her excema got much worse and she was looking quite subdued and poorly. Turns out she had an ear infection and the Dr was keen to sort out her excema. Got some steroid cream to apply for a week and some oilatum for the bath - the antibiotics for the ear-infection seem to be helping too. Mentioned about the reaction to pesto and the Dr said "we'd better do an allergy test then". Was quite surprised by this - thought Drs weren't that forthcoming with them! So am awaiting an appointment from the local hospital - hopefully that will give a clearer picture. Thanks for all your replies!

Just thought I would update on this as I always like to find out what happens when someone posts on something like this!

Ended up getting an appointment at the dermatology department at the local children's hospital which I was a bit confused by. I posted about this separately because the consultant had never heard of pesto and couldn't see pine nuts on her list of nuts! When I said that I thought I was coming in for an allergy test, the dermatological consultant said "if I sent you up to the allergy clinic on the basis of what you are telling me they wouldn't thank me for it!" So I left feeling like it had been a waste of everybody's time.

Was a bit disheartened by this but eventually mentioned it to my doctor when I went in for another routine appointment for my child in January. This GP was persuaded to refer me on for an allergy test thankfully.

This is some months down the line and I nearly didn't go and had got quite casual about it - thinking, oh well just don't give her pesto again - who needs an allergy test?

She had the skin prick test for all nuts and her skin came up quite majorly on cashews (so that pesto probably contained cashew) and pistachio and was positive for most other things - I think Hazelnuts and Walnut didn't provoke a reaction.

So there you have it - I have entered the world of nut allergy. No underlying respiratory problems so no need for an epipen - the doctor said that there were risks to administering adrenalin inappropriately and they were dangerous things to have around the house(!?) Do the usual and keep clear of anything with traces, packaged in a factory with nuts blah blah blah.

Am sad because Houmous is a regular in our house and she loves it (she's 22 months now) Have been told to avoid at all costs now. Will be going back for annual re-tests.

Am having to do a mental shift on this from being very casual about it (so she can never have pesto again boo hoo!) to being very vigilant and mindful. Have had piriton in my changing bag for ages and nearly took it out the other day because it was heavy - will be staying there for good now!

Hi - sorry to hear the results were positive to various nuts, but it's definitely best to know

So why do you have to avoid houmous? Did your DD test positive for sesame seed allergy? What else did she test positive for, or was it all nut-related things?

Sounds like the derm consultant was rather unhelpful but good you managed to get a 2nd referral afterwards. Have you been told what the follow-up care will consist of?

Hi cuppachar - no follow up as such - just told to keep away from nuts and sesame seeds so that means houmous - it's just the advice that they give. Will get called for a re-test in a year's time. Was only tested for nuts because she hasn't had an obvious reaction to anything else. She reacted positively to cashew, pistachio with big hives almost immediately and there were smaller but positive reactions for pine nuts, almonds, brazil, peanuts from what I can remember. I kind of switched off as to the ones she reacted positive to when they told me that one positive nut response would equal a ban on ALL nuts. As you say, definitely best to know.

If your DD loves houmous, you can make something similar by bashing up tinned chickpeas with lemon, garlic and olive oil. Is yummy! No need for the tahini.

I'm a bit surprsed they told you to avoid sesame, as my DD tested positive for peanuts but neg to sesame, and LOVES houmous! I'm not sure if anyone else would know the reason? We were told to avoid all nuts (due to the risk of cross-contamination with peanuts) but that seeds are fine.

TBH, although nut allergy is a bit scary, I haven't found it all that hard so far (touch wood!) avoiding nuts, and DD's nursery are very allergy-aware which has helped - they even contacted the hospital themselves to arrange for an allergy nurse to come in and give them all training. Is your DD in nursery?

glasjam, you could try making your own pesto, the thought of never having it again makes me shudder!

glasjam - my child has no respiratory problems but has had breathing problems after eating nuts, including one reaction where we had to use the epipen. A child as young as yours may outgrow their allergy and probably will be fine with avoiding nuts and taking piriton when necessary. If they havn't outgrown the nut allergy by 5 then I would really urge you to press for epipens. Don't be tempted to try them with nut at home and phone an ambulance immediately if they show any breathing problems or if they become floppy.

Epipens are not dangerous things to have at home but it could be fatal not to have them when needed. Many doctors seem to have a totally erroneous idea of the risks associated with adrenaline inhjections. There were problems with adrenaline administered in hospitals in a different way. There have also been some sore fingers when someone has accidentally put the adrenaline in their finger. Warm water is usually sufficient to deal with that. They are life savers and sanity savers.

actually that's a good point tatt - DD has no respiratory problems usually either (and nor do I) yet we were both prescribed epipens for our food allergies, and I did have breathing problems during my one serious reaction...

When I was prescribed the epipen (by the allergy specialist) I was told there were no real problems with taking it, and if in any doubt whether to use it or not, do use it.

Interesting points - thanks everyone. Firstly will have a go at tahini free houmous and pesto without pine nuts and cashews (so I guess that would be parmesan, oil and basil?).

She didn't get tested for sesame seeds - but did for pine nuts and had a mild reaction to it. The guide to managing nut allergy that I was handed out states "Pine nuts and sesame seeds are not nuts but can cause allergic reactions and are commonly avoided" - I guess this is where their advice to stop eating houmous comes from. I haven't seen a reaction from her when she eats it but maybe it was a more subtle reaction - maybe it aggravated her excema and I didn't make the connection? Am very tempted to let her keep eating it but probably won't!

Regarding the epipen - yes, I wondered about this after reading other peoples' posts on here and that evidently many other people had them. Will maybe press for further advice on this. WIthout looking into this further I would be thinking - oh well, avoid all nuts and all will be well - if any accidental ingestion of nut contaminated foods occur then out comes the piriton. Am a little bit worried that any further reaction could be much worse - had kind of got the impression that as she had only come out in a nettle rash that her allergy was "mild" - I realise that this is not necessarily the case. Early days in my research obviously - will be regularly visiting this board no doubt!

Would strongly encourage you to get in touch with the anaphylaxis campaign, or check out their website. Medical advice can vary, but in my experience of my nut/egg allergic 9 year old, all children with nut allergies should be prescribed 2 epi-pens for home, and 2 for school/daycare. Nut reactions can worsen with repeated exposure, so what your child experienced last time may not be the same kind of reaction that happens the next time they accidentally come into contact with a nut. At 6, my son required 3 epi-pens in hospital for a reaction to hazelnut that began not looking too serious. Don't want to scaremonger, but adrenaline only lasts 10 minutes in the body before it is broken down. He recovered really quickly, and was (and is) absolutely fine and healthy, but I really wouldn't take any chances. Push for an epi-pen, and if you need support to do that, get in touch with the campaign - they are great and run regular national training sessions for parents of allergic children. They also have a phone advice line. After 9 years, this is just a normal part of our lives, and isn't nearly as scary as it used to be. My son is healthy and happy, and fully understands and manages (with us) his own allergies. It can be a bit of a head trip working out how seriously to take a new allergy, so I would urge you to keep doing what you're doing and talk to other parents. Can't emphasize enough how supportive the campaign is though...good luck.

glasjam the problem is that many reactions to nut can be dealt with by piriton, especially in very young children and those who initial reaction doesn't affect their breathing. Therefore most epipens prescribed are not used and doctors see it as a waste of money.

However they can't tell you (because no-one can) if your child will be one of the ones that will have a serious reaction. As a parent I see a cost of about 60 pounds a year for 2 epipens and I think that's cheap insurance for my child's life. I understand the economics but I still wanted epipens. I'm quite convinced my child is alive only because I had them.

So I don't want you to feel your child is massively at risk - yet - without an epipen. Their risk is greater crossing the road. But there is a small risk and if you accept the medical advice you've been given you need to be alert and prepared to call 999 in a hurry. Then you arrange repeat testing when your child's risks may be greater.

Thanks all. You know I almost thanked the Dr when she said she wouldn't be prescribing an epipen - I think I said "good, I don't want one!" I think this was just a knee jerk reaction on my part and I interpreted her not giving me an epipen almost as confirmation that I had nothing to worry about really.

I very much hear what many of you are saying. Who's to say what her next reaction will be? A lot to think about...

Regarding the anaphylaxis campaign - do you have to become a fully paid up member to avail yourself of its services? I saw mention of £17 per year - small fry I know if they are as invaluable as they sound in terms of support but just wondered if it was absolutely essential (money being non-existent tight and all that!)

Just looked on website of anaphylaxis campaign, and it looks as though you can use their phone helpline without being a member. The website outlines what the £17 pays for, but I think it includes product alerts (when food manufacturers change ingredients), their magazine, and online forum membership. The website might help you to decide whether you want to join now or not (I'm not on commission, honest!) I have found their parent sessions really helpful, and it is useful to meet other parents who live locally whose children have allergies. This has probably been the most useful part, and I'm not sure if you can attend these without being a member, but they would be able to tell you if you rang. Hope this helps. There is a lot to think about, but at least you know now. Knowledge isn't everything, but it helps us parents of allergic children to feel a bit more equipped.

just wanted to add, dd1 has an epipen due to nut allergy peanuts being the worst followed by other nuts, almonds are OK but I don't encourage them, however she has NO probs with sesame and can eat humus no problem. Sadly she is one of those who hasn't grown out of this (or her eczema) but she is old enough to manage herself now.

Ds 13 is allergic to nearly all treenuts except cashew and is allergic to seseme . He also was allergic to peanuts but seems to have outgrown it.
He was never prescribed an epipen because his breathing was not affectet.