Hello everyone,
I'm new here! I have been reading through some of your threads, which are all so helpful...thank you!
My daughter is preparing for a food challenge to hazelnut. She doesn't know about this yet, but we are pretty nervous (ok, excited, too, but nervous). I asked this question of the allergist and a nurse, but not sure what to do. If any of you have been through this or could tell me what you WOULD do, I'd appreciate it... would you bring in Nutella for the oral challenge or the actual raw hazelnut? I assume they're slightly different but that the raw hazelnut would be more accurate (?). As far as I know, she's never eaten anything with raw hazelnut before.
What do you all think?
Thanks in advance for your help!
Hello and welcome! How exciting (and scary) that your DD is doing a food challenge!
We have never done a hazelnut challenge, but I think I remember reading here that one doctor would not allow Nutella for challenges because it doesn't contain enough hazelnut to be accurate. However, just raw hazelnut sounds pretty blech to me. Hopefully those who've done hazelnut challenges will have some ideas.
Thank you for the welcome and for your reply! I wonder why the doctor is ok with Nutella. Doesn't seem logical to me. Ugh, another thing to worry about.....
I also just asked for a copy of her blood RAST test results. When they told me they were all negative, I think I was just too shocked to even ask for a copy, so I don't know the levels.
Does anyone here have any recommendations for what the range should ideally be to warrant a food challenge?
Thank you all!
Well, if they are negative, then in the absence of pretty suggestive history (that is RECENT) then that would indicate a pretty good chance of success.
We've done a hazelnut challenge.
I'd ask your doc if s/he is okay with nutella for the challenge. Honestly, the convenience factor and the texture would seal the deal for me there if I had it to do over again.
Here's what we ACTUALLY did for my DD's hazelnut challenge, knowing that she is very definitely anaphylactic to other nuts:
1. bought in-shell hazelnuts from a local grower (not an option for many people-- you'll have to get them from a local store)
2. Because said grower also handles almonds in-shell and occasionally walnuts, we WASHED THE HAZELNUTS WHILE STILL IN THE SHELLS.
3. I dried them out in a low temp oven on cookie sheets on foil-- about 250F for an hour or so
4. Then I cracked them open and extracted the nut-meats, and ground them using a new, never been used coffee grinder.
Honestly, you can see where the Nutella would be WAY easier than this. WAY. I'm not 100% sure that I would have trusted my procedure with grocery-store filberts/hazelnuts due to contamination.
We have 1 child who may be allowed to challenge hazelnut this coming year.
We're planning to do what CM suggested above -- hazelnuts in shell (will likely order online or get friend to ship to us from trusted supplier such as what CM uses above), WASHED & dried, and cracked with new nutcracker so little risk of X-contamination.
If we get some latitude, we want to schedule this child's challenge in the middle of winter when other environmental and seasonal allergies are not flaring. We hope this will give us best chance at true read on hazelnut.
Welcome to our boards!
Thank you all!
This food challenge is next week, hoping her cold is gone by then. Would you think nutella would be ok or not precise enough? The dr says he uses nutella for the hazelnut challenges, but this makes me nervous in terms of accuracy.
Thanks again!
I don't have a hazelnut suggestion but having gone through a few food challenges I do have these suggestions (I don't know how old your kiddo is)
Bring board games (that don't need a lot of space), cards or other similar busy distractions for during the challenge. Or you will find yourself staring at your kiddo, scrutinizing her while waiting for each nurse check and next dose. I found talking to DD as we played a game allowed me to watch her and notice if there were changes such as coughing, tone of voice, etc... without watching her directly. And it helps pass the time. Her challenges were about 4 - 5 hours long. I even taught her how to finger knit during one of them.
Good luck!
Please note that most domestic hazelnut growers are now NOT shipping directly to consumers-- but only to wholesaler/cooperatives.
I live in a hazelnut growing area, and I have some back-stock (which is-- I think-- what Ajas is thinking since she and I are friends)-- but our former source is no longer viable.
http://stores.hazelnuthill.com/blog/anticipated-closure-september-15-2014/ (http://stores.hazelnuthill.com/blog/anticipated-closure-september-15-2014/)
Take a change of clothes. At least in the car--in case. Your kiddo doesn't even have to know you've brought them.
These are all great tips that I haven't even thought about... thank you!
I'm going to stop by Whole Foods on my way home from work on the off chance they have package hazelnuts that haven't come into potential contact with anything else. Hmm. Should be interesting.
Curious as to why the doctor didn't balk at the idea of Nutella. Not sure if this should concern me and if I should call someone else.
Do you also deal with peanut allergy? Nutella is peanut free.
It would be difficult to tell on the packaging of the hazelnuts have come into contact with other treenuts or peanuts.
I meant to add--we did not have an IOFC. DS was negative and his (FA guru) allergist said to try Nutella and we did and it was fine.
If I had to do an IOFC and my allergist didn't balk at the Nutella, I wouldn't worry about it frankly. I'm sure the concentration is adequate. Now knowing the exact amount is obviously a problem of course.
I agree-- honestly, if the doc is okay with nutella, I'd just use it-- it's the most likely dietary source, ultimately, because of the convenience.
Things that I routinely take to a food challenge:
a) an overnight bag for me-- change of undies, comfy stretch pants, slipper socks, and toothbrush/deodorant, etc.
b) a change of clothes for both me and my DD, and an extra trash bag along with some clorox wipes
c) a couple of cans of ginger ale, or bottled water
d) portable gaming/video system
e) reading material
I tend to leave A and B in the car. The rest comes in with us in a tote bag.
Thank you again! Yes, Nutella is most likely source here, but if we were to travel, say, to Europe one day (who knows when!) I think we'd find more with actual hazelnuts. It may be sufficient, though. I'll investigate between now and next week.
Thank you!
Nutella is very common in Europe. I was so, so glad that we had this in our back pocket when we were in Europe. It was really a relief not to fear all of the little crepe stands in Paris, for example, and the tiny neighborhood shop in Dublin had little jars of the stuff, even, which delighted my DD no end.
Running to work, more later. How old is your DD?
She's 5 :)
I had to take her to the pediatrician this evening because she's had this nagging cold and it turns out that she has an ear infection and possibly a sinus infection, so starting tonight, she's on amoxicillin! I guess I need to reschedule (yet again)... her food challenge is scheduled for next Tuesday.
I'd want to reschedule. You might want to double check with allergist, before you give up the appointment. But I'm betting it's a no-go until off antibiotics and totally well.
Definitely. I would be more comfortable with that anyway.
Another thing that's got me anxious is that her blood test, which showed she's negative for all tree nuts, was done at the end of July, so exactly 2 months ago. Would you repeat it at this point? I guess I'm just still in shock that it was negative!
Probably not, but that's me. It would also depend upon her history with hazelnuts.
Well, thankfully "just" rash-type reactions, but we've been insanely vigilant. The poor kid can't eat anything without me inspecting the ingredients, the website etc like a hawk.
I think the allergist plans on doing a skin test the morning of the food challenge. Is the skin test more accurate than the RAST? This is what I think they've told me, but not sure. If so, then what was the point of the blood test?
Thanks again for everyone's help!
Well, skin tests can remain positive (or just BE positive) in the absence of a clinical allergy, so... if the skin test is NEGATIVE, that's a really good indicator for a pass.
On the other hand, if you take daily antihistamines, bring them with you the morning of-- that way you can get those on-board immediately after that skin test.
(BTDT, btw.)
Thanks for the tips! I had no idea about that re. the skin tests. Well, I take that back. The allergist did say that the skin tests are more reliable (my word, not his), but that adding a RAST test to the mix would paint a fuller picture and, if both negative, a food challenge would be warranted. At least now I know that he knows what he's talking about.
Can you tell I'm nervous for her?
I think that as a parent, you'd have to be pretty callous or at least unaware to NOT be going into a food challenge with at least some level of nervousness!! :thumbsup:
The trick is in breathing deeply (or appearing to) and seeming reasonably relaxed and calm in front of your child during the challenge.
This is where I confess that we never, ever challenge on a day that DH is out of town, right? Because I want him to be a five minute ride from the ER.
But typically the general wisdom is that skin tests have a higher false positive than blood tests, so in that way they are less accurate.
However, if you have a skin test morning of and its negative, that's a good sign.
My thinking--and I could be wrong here--is that it may also help to gage reactivity/responsiveness that day. For instance, if they do a histamine or saline control with the SPT, that could also tell the doc where your kid is. It may not have a predictive value for the challenge itself, but it may help to provide some information about how your kiddo is responding.
Hi Macabre,
What doe that mean? I'm not sure what SPT is.
Thanks!
skin prick test.
It's generally thought of as less reliable than blood tests. Though as CM mentioned, a negative result could mean some great things before a challenge!
Really I would probably go ahead with a challenge even with a small, positive wheal on a skin test. As long as it wasn't, you know, HUGE like a nickel sized one or larger.
Don't know if the food challenge is over, but wanted to say that my son underwent a hazelnut food challenge 4 weeks ago using Nutella. He had tested negative on a skin prick test and a very low positive on the RAST. He passed the challenge!
Hi Irene,
Congratulations! That's awesome! How old is your son?
My daughter's test is on Tuesday. I have a tub of Nutella in hiding at home (in hiding from the rest of us as much as from her...that stuff is addicting). My husband also found a package of roasted unsalted hazelnuts at a local market. I don't know if they're ok to use. It's packaged by the store, so they don't even know about cross contamination, so we'll see. I have it in case.
I assume your allergist was ok using Nutella vs actual hazelnuts, but do you know if that means your son can confidently eat an actual hazelnut or something other than Nutella with hazelnuts? I just want to cover all our bases so not sure if they'd try both at the test.
Thanks!
QCMamma,
Yes, the allergist was okay with Nutella and my son can eat all forms of hazelnut now (as long as they are not contaminated with peanut because he's still allergic to peanuts). He's 12. We have been undergoing food challenges for various tree nuts since June. The pistachio challenge was the hardest because I used actual pistachio nuts and he did not like them! I am using nut butters from now on because they taste better. He loved the Nutella.
I understand your being nervous about the challenge. I was nervous about the first one too, and I did not let my son know because I did not want him to be anxious as well. I pray all goes well for your daughter on Tuesday!
Irene
Thank you!
I haven't told her yet either. She's only 5, but we've basically scared her and everyone at her school, too, because of nuts :-[
This has a lot of good info that you might find helpful. :heart:
Demystifying Oral Food Challenges
http://www.kidswithfoodallergies.org/docs/Demystifying-Food-Challenges-for-Food-Allergy.pdf?pdf=Oral-Food-Challenges (http://www.kidswithfoodallergies.org/docs/Demystifying-Food-Challenges-for-Food-Allergy.pdf?pdf=Oral-Food-Challenges)