Cashew nut allergy

[BuffaloFeathers]

My almost two year old ds had a severe allergic reaction today probably to cashew though I can't be entirely sure. He was fully covered in hives, facial swelling, vomitting, etc. Acc to the doctor halfway between allergic reaction and anaphylaxis. It's totally come out of the blue. He's been having peanut products with no problems whatsoever. In fact he almost daily has peanut butter but I am not actually sure if he's ever had other nuts

Does anyone have any experience with cashew allergy? I've googled it a bit and it doesn't look promising. Apparently cashew allergies tend to be severe, are more commonly associated with anaphylaxis and kids rarely grow out of them. For those with personal experience has this been true for you?

Should we avoid all tree nuts?

Also, is there a link between asthma and cashew allergy? (There might be acc to some studies but I'd like to know avout people's experience.) He has a lot of episodes of viral induced wheezing and also gets wheezy with dust or other small particles. We've been told there is a good possibility he will turn out to have asthma but he's too young to be tested.

Hi OP, not a cashew nut allergy here, but other stuff (peanuts, eggs, sesame, shellfish) so I didn’t want to not say I completely know how worrying this all is. DS did grow out of some of his allergies by the time he was about 3 (sesame and eggs)The remaining ones he’ll probably have for life.

GPs can prescribe epi pens - or at least ours does anyway. I’d get an appointment with GP and a referral for pediatrician/allergy testing and completely avoid all tree nuts in the mean time.

Yes it definitely sounds like your DS likely has asthma. Does he have a preventer inhaler? My DS was very similar at the same age and was prescribed Flixotide preventer inhaler about age 3 alongside the reliever inhaler, and that made a massive difference to it all. Every cold just became a normal cold, maybe with a bit more of a cough than most kids, instead of a mega stressful event ending in a hospital trip.

My DS is now 8 btw. I remind him to take his inhalers and other than a very heavy cold where he would be harder hit than other kids, you would in no way be able to tell he had asthma. He does a lot of sport. He also had some eczema which is very much milder now than when he was a toddler/baby. School is excellent with his allergies and he’s very aware of what he can and can’t eat. It is still worrying, but it doesn’t consume me as much as when he was small.

Thanks everyone for all the replies..l really appreciate them. I keep wondering if I'm overreacting and should just avoid cashews or if this is really as serious as it feels.

He didn't have an anaphylactic reaction. He coughed non stop, then broke out in hives and then vomitted. This was at least 30min or longer after eating the last cashew nut sweet. The piritone brought down the hives but I then thought (or imagined) that his wheezing was getting worse and his voice had become kind of weak and low. By the time we were seen at A n E he was fine. Heart rate, lungs everything normal.

OP, it sounds like your son really needs a preventer inhaler as PP stated. Get advice from this through the GP asap, even better, get him assigned to the practice nurse who specialises in paediatric asthma- there will be one and they may well know more about it in this age group than a GP. If he needs a rescue inhaler frequently then he probably needs a preventative one. This may well be why illnesses are dragging on. I didn't know this until I saw a locum when my infant son had yet another chest infection. Likely there'll be a low dose of steroids in it but it's much better and lower risk to the alternative. My son now has two preventer meds in one and it changed everything. Get familiar with Respiratory Distress signs, easy to spot when you know what to look for but easy to miss in a toddler. It's fairly common with allergy related asthma to have Cough Variant Asthma - see Asthma UK, excellent source of help. Your child may not have CVA, may not have asthma at all, but helpful to know these things as his advocate.

THIS WILL BECOME NORMAL IN TIME. 'Shouting' as I found it all really overwhelming at this point, it's what I wished I'd known. Keep posting if you need info/support, you don't need to travel alone on this route. Your child's experience could be totally different the the ones posted here.

You might be right, could be a storm in a teacup situation but given it could be very serious start there. I'd really recommend getting expert opinion, from the sources I mention as well as the health professionals

We asked about the preventer inhaler. At the moment he has only got the Salbutamol blue inhaler. When we were on holiday (India) recently we also saw a pulmonary specialist and he too recommended a preventative inhaler as he said that this many episodes (ie more than 6-8 a year) can eventually result in irreversible damage to the lungs. However, our GP said that they don't prescribe the steroid inhaler for kids under 5 years old and the NHS website confirms this. However, he has referred us to a pediatrician.

This is rubbish. They definitely can and do.

This sounds exactly like my 18 year old son. He has a cashew and pistachio nut allergy (didn't know until this thread they went hand in hand). He does avoid all nuts now but I don't think he's allergic to any others (he eats toblerone with almonds in). When he has a reaction his face swells up, he comes out in hives and he vomits. With pistachio the reaction is less severe. Drs not really that interested and just told us to avoid as we clearly know what he's allergic to.

When he was younger he had a several asthma type episodes resulting in hospitalisation although they wouldn't officially diagnose him with asthma. They suggested that it was just his reaction to a chest infection. He had the blue inhaler but he grew out of the asthma attacks in his teens.

@BuffaloFeathers The NHS do prescribe preventer inhalers to under 5s, we’ve had one since Feb last year at 18 months and it has been a life changer, but it needs to be prescribed through the hospital. One puff in the morning and one at night and we’ve not needed to increase it so far. He’s had drastically fewer episodes of croup and viral wheeze since. We had a 3 month period where he was admitted to hospital every few weeks - recurrent tonsillitis used to be the main culprit and it really affected his breathing when he got sick. Like others have said eczema and asthma go hand in hand with allergies. He had his allergic reaction at the same time, which presented as fully body hives and he was referred to the allergy clinic by A&E. We were advised to avoid all nuts in the meantime.

Following slow introduction of the other nuts, his peanut skin response reduced over the next couple of tests and now he doesn’t have a reaction. His eczema is pretty much gone, although we still use emollients as his skin can get quite dry. The allergy clinic are optimistic that he will grow out of his cashew/pistachio allergy but I’m prepared for it to be lifelong.

Any known cross reactivity with sesame seeds? Soya?

Every individual is different which is why you really need to get a full skin prick screening of all the major allergens to confirm which allergens they are reacting to. Our paediatric allergist told us that any allergic reaction to nuts warrants immediate prescription of two Epipens. The risks are too high to mess about. It's really not something that can be managed by GPs.

Any allergic reaction? So not just an anaphylactic reaction? The doctor at A n E told me that of he'd had an anaphylactic reaction then she could have referred him to the allergy clinic. But since it was only an allergic reaction she can't and the GP will have to do it. However, she didn't think it's urgent. She said if he has repeated allergic reactions to cashew then I can go to the GP and ask for a referral. Do you think I need to go now? I don't want to look like I'm over reacting to everything as I'm already trying to push for the pediatric appointment for his wheezing. I was thinking of mentioning it then (during the pediatric appointment) but that won't be for months. Or should I just go straight to private (if available in our town).

The coughing you mention has always been flagged to me by our allergist as a strong "warning" of anaphylaxis. Basically, they are struggling to breathe, which is why they are coughing. Our allergist also advised that these reactions often get more severe with each subsequent exposure to the allergen. My child has never had anaphylaxis but her allergist says any subsequent exposure to cashew has about a 75% chance of anaphylaxis. You really don't know how severe their allergy is until you've done a skin prick test, or a blood test, or both.

Oh no @ coughing. So he first kept coughing continuously for about fifteen minutes. Then the cough seemed to subside a but. He still coughed but not non stop. Then maybe ten minutes later I noticed the hives, which spread all over his body (ie till his thighs) rapidly. Again about the minutes later he threw up.

If it was an allergic reaction or even the beginning of a mild anaphylactic reaction can it go away on its own? He did have piriton. Could the piriton have helped avoid anaphylaxis?

We have started being very careful about what we give him to eat, ie avoiding anything with tree nuts really or anything where we don't know exactly the ingredients. Have been calling around for a private consultation but I'm also going to take him to our GP to discuss this. At A n E they didn't seem to think it's anything that requires investigation for now so I'm still wondering if I'm overreacting.

Hi OP, to me you are describing an early anaphylactic reaction - the coughing and weak low voice are warning signs. Please push for a referral. Lots of allergies here too requiring epipens but you do learn to adjust and manage your kids diets, so wish you lots of luck.

Thanks for the reply. Can a mild anaphylactic reaction just go away on its own (or go away with piriton) without needing adrenaline and without progressing into a full blown reaction?

I don't know. Maybe it doesn't matter what category it falls into and I'm not sure I'm even so bothered about what it was especially considering that the next reaction could be stronger anyway.

I'm going to take him to our GP this week and ask for a private referral.

In the kindest way possible, I don't think A&E did their job. What you are describing is a very significant allergic reaction (hives everywhere, vomiting, coughing) and this is not the kind of thing that "doesn't need further investigation." Quite the opposite in fact. Perhaps you are in a bit of shock about it still, but please do not allow the GP to disregard this. When you have the appointment, do not minimise what happened. Be very clear and direct that there was vomiting, coughing, and full body hives. It really sounds to me like this was a full blown, very serious allergic reaction. We are not talking about a bit of redness/hives around the mouth.

Just to reiterate, I think this has been covered by other posters. There is really no distinction between having an allergic reaction or an anaphylactic reaction. Just because it didn't reach anaphylaxis this time doesn't mean it won't next time. It's an immune response and lots of different factors come into whether it will be mild or severe (quantity, illness, random acts of god! etc).

My son has a relatively rare allergic response but the lack of knowledge at gps and a&e is really quite shocking. You need to be seen by a paediatric allergist asap.

Also skin prick tests and blood tests will not tell you how severe the reaction might be. They just tell you whether the body is having an allergic response or not. With any nut allergy I would assume that a severe reaction could happen at any time and be prepared for that in all scenarios.

I saw that you mentioned cross reactivity to other things, soya, sesame etc. are these things that are regularly in your child's diet? They don't tend to test for things that the child is regularly eating. Once you figure out what this is it's important to keep all allergens that are tolerated in the diet regularly as prevention. The consultant or a dietitian will advise the amounts that ideally need to be consumed each week.

Also you mentioned buffalo milk as a possibility. Please mention this to the allergist as they will be able to test for it (you will probably have to supply it) but immediate reactions tend to happen within 2 hours of consumption so if the buffalo milk was outside this window it's likely it wasn't the cause.

And if nhs wait times are very long and you can't afford the fee to go privately I would seriously consider paying privately to speak to a paediatric allergy dietitian. They will be significantly cheaper than the consultant but can advise exactly what you should be avoiding/excluding and what not. You don't want to take things out unnecessarily.

There’s really not such a thing as a mild anaphylaxis. If he was coughing it could have gone either way. The piriton would have helped but in all honesty, the next reaction is likely to be severe. A&E didn’t do their job, they should have made a referral to the allergy team. The cough was the first thing I noticed, the hives came later. Poor ambulance response times had been in our local press the week before and as soon as I heard the cough I knew it was a cause for concern so I bundled him into the car right away. He had hives by the time I got him in the car, my other half phoned the hospital to say I was on the way, paramedics met us at the hospital door and took him while I parked, the coughing is a sign that the airway is closing - it’s serious. We were seen at clinic within 2 or 3 weeks, it was really quick (N.Yorks)

When we were doing the nut tests I used to drive us to hospital and do them in the car park. It’s not worth watching and waiting x

OP, this is serious, A&E are hit and miss (mostly miss) with their allergy knowledge. He needs epi-pens now and referral for skin prick and/or blood tests. No nuts/tree nuts until you have the epi-pens. I don't know how you go about it now, DS is 12 and has 6 food allergies and epi-pens prescribed by the allergy clinic we went to when he was about 2. He also has asthma and hay fever and had eczema as a baby (outgrown now). In my experience allergy clinics are much less blasé about it - at A&E, when DS was 1 and had a bad reaction to sesame, I was told it is "trial and error" with what he can and can't eat. The consultant was horrified.

I don't know where in the country you are, but the bigger the allergy clinic, the better the service (at least it was for us) and the least likely you are to be fobbed off. It is very scary now, but it does get easier, and although it shouldn't be, a way of life. You adapt to it and move on. Yes I also wonder how it is to just go on holiday and just pop into a restaurant or buy a sandwich. My hope is also medical research.

Good luck to you on this difficult journey and don't think for a moment you are exaggerating - it shouldn't be like this but make a nuisance of yourself. Call Anaphylaxis UK and Asthma UK first.

Also, there are many so called allergy tests without a real scientific basis, such as hair tests. Avoid, the only test supported by science is skin prick or blood tests done by an allergy clinic, there are many quacks out there preying on people's insecurities and vulnerabilities.

It’s sounds like a strong reaction. The coughing and weakened voice are concerning. Please push for testing and get epi-pens prescribed. Repeated exposure can result in stronger reactions. Our allergist was very concerned about a similar reaction to cashews in our DC and we were lectured by her, the nurse, A&E about how serious this was.

It is scary but we are fortunate to have access to doctors, medicine, good labelling (the allergens we are monitoring for are on the list of commonly reported allergens; can’t express how grateful I am for that). We’ve raised DC from an early age to take on and be responsible for managing allergies and asthma.