Almond Allergy Challenge – What’s That?

Our son has been diagnosed with a peanut and tree nut allergy since the young age of five months old.  Since diagnosed, our home became a safe peanut and tree nut free oasis for him.  Over the last two years and 4 months, I have absolutely dove into the world of food allergies, learning all that I can to educate ourselves and to help our much loved toddler learn to navigate through the world with his allergies.

Each year, we see our pediatric allergist for an annual appointment to review his progress.  During these visits, we repeat test the peanut and almond allergy with the hope that, since our son is so young, they will some day be outgrown.  Current research continues to suggest that only 20% of children out grow a peanut allergy and 9-10% of children out grow a tree nut allergy.  This June, much to our surprise, our son’s almond (tree nut) allergy test came up negative.  Our son continues to test positive and severe for an allergy to peanuts.

Though we celebrated the news of the negative almond test results, we were surprised at the mixed emotions that surfaced after leaving that appointment. For over two years, we had kept our son safe by enforcing a strict avoidance of peanut and tree nuts in our lives.  We now worried (greatly) that if we introduced almonds into his world that it would confuse him and most importantly, that it would confuse others around him.  There is no room for confusion when your son is still diagnosed with a severe peanut allergy.  So I took a month to think hard and to have several discussions about what the best plan was for our family and to continue to keep our son safe.

I ultimately came to the decision to move forward with our allergist’s recommendation to have a food allergy challenge and then decide on a safe food plan after we received the results.  Our food allergy challenge was completed to verify that our son’s almond allergy was truly out grown.  Food allergies can trigger serious and deadly reactions in people, so there are risks to this test. All food allergy challenges must be completed under a physician’s care, in an allergist’s office or hospital that has access to medications and specialists to control reactions like anaphylaxis.

So what happened at our almond allergy challenge?

My son and I were welcomed by the staff and we were brought into the examining room where we were told to get comfortable for our three hour almond allergy challenge.  I had a bag full of epipens, games, coloring books, crayons, books and an iPad loaded with episodes of the “Bubble Kuppies” and movies.  My son and I immediately got comfortable on the floor and started to play a game of Don’t Spill the Beans.  While we played the game, a nurse skin tested his back to the almond butter that we brought for the challenge.  Our son got three needle pricks to his back (photo above): the Histamine and Antihistamine controls for a positive and negative response and a third prick for the almond butter.

Several minutes later, our allergist came in to examine our son.  He checked his breathing, his skin condition and read the results of the skin test.  The results were still negative, so we began the food challenge immediately. During this test, our son was given gradually increasing amounts of almond butter to eat every 15 minutes while the doctor and I watched for symptoms.  It’s a bit nerve-racking to to go from strict avoidance to offering your baby almond butter off of a spoon, but I did it and after his first 1/4 teaspoon of almond butter our son said, “Yummy!!!  I want more”.  (Whoa!  Slow down, Cubby!)

We continued offering almond butter every 15 minutes until our son had tolerated a full serving of the food.  At that time, offering food was stopped and our son was observed for any late-phase reactions for about two and a half hours after the last dose of food. During that phase of the challenge we continued to play games and the allergist and I discussed next steps.

At the end of the observation, our allergist congratulated us.  Our son no longer has an allergy to almonds.  No hives, no swelling, no increased heart rate, no vomiting, clear breath sounds…he was safe.  He passed. I exhaled.

So does this mean that we can run out and celebrate with  Almond Joys, Marzipan cookies and Almond horns?  

Unfortunately, no.  You see, in the world of allergies things are never quite that simple.  The tricky thing about almonds and almond products is that they are typically sold by companies that also sell peanuts and peanut products.  And since our son still has a severe peanut allergy, the risk for cross contamination (peanut dust/protein) on or in almond products like nut butters is still a concern and worry for us.  So though he’s outgrown his almond allergy we still face restrictions to keep him safe.  Our allergist stated that unless we are actually cracking almonds out of the shells ourselves or are buying them from a company that deals exclusively with almonds – we can’t consider almonds or almonds products safe for our son.

Additionally, our allergist now recommends that we offer almonds in our son’s diet 2-3 days a week to continue to support his tolerance of the protein and he strongly suggested that NO ONE offers our son any almond products unless under direct supervision of myself or my husband.  So that brings me to our new food allergy plan…

Strict avoidance to all peanuts, peanut products and foods that are processed in plants that also processes peanuts.  At the recommendation of our allergist, I will now be offering our son designated, safe almond products (that have zero risk of cross contamination with peanuts) under our care only.

Our strict family rule still remains: Please do not feed the Cub.  No one feeds our son accept for us.

Tonight our son asked for another spoonful of almond butter after dinner and I said yes (reluctantly still).  He took a bite, said, “yummy” and ran off to play.  My heart still flutters when I watch him eat it and I still watch him like a hawk afterwards.  I am sure it will take some time to get used to this out grown allergy and for the fear to leave my heart.  However, I am extremely grateful that our son has conquered one of his food allergies.  May we be as lucky with the peanut allergy some day.  Until then, we are educated and prepared to keep our baby safe.

A special thank you to the wonderful team of allergy moms over at the No Nuts Moms Group that were a big help in sharing advice that helped us to prepare for our challenge, with suggestions for peanut free, almond products to use for the challenge and for their support. There is always a mom that walks ahead of us or behind us in their food allergy journey that quickly lends helpful advice or words of encouragement.  We love all of them and this blog and my participation on other blogs is how we pay it forward.

As always, thanks for reading and keep your nuts to yourself!

Chew Chew Mama

Per Our Allergist Recommendation, we are currently using the products below for our son.  I am in no way endorsing these products. Please be sure to check labels constantly and make food decisions with your allergist. Manufacturing processes change often, so it is important to be diligent to always be aware what you are serving your children to keep them safe.

Blue Diamond Almond Milk and Almonds (currently produced in a peanut free facility, per their website: “Blue Diamond branded products produced in our facilities are peanut free.  We do not process, manufacture, store, or handle peanuts or peanut products in our facilities.”)

Barney Almond Butter (currently produced in a peanut free facility)

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