No Nuts About It: When Your Child Has a Peanut Allergy

I remember the first time I gave my daughter Emelia peanut butter. She was about 16 months old.

Being a dietitian I knew that peanuts were no food you wanted an allergy to — not that you would want an allergy to any food, but this is one in particular you hope against. Many of the other food allergies are outgrown, but nuts, well you have about a 20% chance of eventually outgrowing. And while any food allergen has the potential for anaphylaxis, nuts are more likely to induce a potential deadly reaction, and they cause most of the severe and fatal reactions that occur.

The studies were not conclusive as to when to introduce nuts to infants when I was weighing my options with Emelia. In 2000, the American Association of Pediatrics recommended delayed introduction for infants genetically at risk for food allergy until the age of three. However, they rescinded these guidelines in 2008 after finding this recommendation was without good scientific evidence and actually saw peanut allergy tripling from 1997 to 2008. Some studies suggested we were waiting too long in this country to introduce nuts. I decided to try her on peanut butter at 16 months because this age seemed right in the middle of the controversy.

The Peanut Butter Test
I knew of no food allergies in our families, so there I was, putting one of my favorite foods on toast for her and crossing my fingers that my little picky pants would not only tolerate it, but that she might actually like it. Like most foods I put in front of her, she seemed only mildly interested. It made its way to her face, but I can’t attest that she actually ingested any.

A few minutes later I noticed a small, but notable rash on her cheek and mouth area.

“Ok,” I thought. “Let’s not get too excited. We’ll talk to the pediatrician at her upcoming appointment and see what she thinks.”

The pediatrician said to try it one more time. So I took a deep breath and loaded up another piece of toast and offered it up. Again, not very interested, but this time the rash was bigger. After this reaction, the pediatrician told us to see an allergist, since potential nut allergies are nothing to bat an eyelash at. Sure enough, skin and blood tests confirmed what I suspected: My daughter had a peanut allergy.

It was kind of a big head spinning experience getting that diagnosis. Even for a dietitian. Next thing I knew the allergist was demonstrating how to use an epi-pen and gave us handouts on label reading and suggestions for how to keep our child safe in day care. All of a sudden we were in this other club, and not one I particularly wanted to be in. And I really did not want my daughter in this club.

“Give this diagnosis to me, not to her,” I though. Unfortunately, that wasn’t an option.

Next came the real education process on how to keep her safe.

Safety through Education
I am still learning, but doing my best to try to keep Emelia’s life as normal as possible each day. It sounds easy: Just don’t feed your kids peanuts or any peanut products.

I wish that was the case. Peanuts and peanut products (like many other of the top 8 allergens) are widespread in our food supply. She was first diagnosed when she was under 2-years-old, so we first focused on removing everything from our house that was unsafe for her so that our home would be a safe eating zone. Some families do this and others do not. I want our home to be a place where she can eat anything, but this is not always realistic in some families with multiple children and multiple allergies.

Our allergist also said that our day care had to be nut-free or we needed to find another provider. We had a wonderful day care provider who was willing to make these provisions.

This fall we moved to preschool, and I narrowed down the options by those who were nut-free and then curriculum. Since the preschool’s food comes from the public school system, I have chosen to pack her meals from home every day. I try to match close to what the other children are eating so that she doesn’t feel much different from the other kids. Believe me, if I don’t send pizza on the days they have Domino’s pizza, I’ll be in trouble.

Educating family and friends has been another process as well. I remember one of my family members asking me if I had recently “tried her on some peanut butter” as a home trial.

I think my eyes probably bugged out of my head as I said, “No, because that could kill her.”

When I hear comments like that I try not to get upset because I know they mean well; they just are not educated and I need to spend more time educating them.

You never realize how many family and friends feed your child from buffets or snack tables. I think for the first year I wanted to place a sticker across her forehead that read, “Don’t feed me.”

I also made a four-page handout on how to make a safe food for her if they wanted her to be able to try their dish at a family potluck.

My poor family having a dietitian in the family! They generally get the guide re-emailed to them before each holiday, but they don’t seem to mind. I am very blessed with a fantastic family that loves her and has listened intently to the informal in-services and asked lots of questions along the way.

We pray every night that Emelia may outgrow her allergy and that a cure or treatment is found for everyone inflicted with allergies. As I kiss her goodnight, I am so thankful that she does not have a terminal diagnosis, and yet she could be taken from us at a moment’s notice next time she eats. Deep breath. We’ll face each day and its challenges one day and one meal at a time.

VanBurenKatie VanBuren is a clinical dietitian with ProMedica Bixby and Herrick Hospitals. She has 19 years of experience, with 17 of those being with ProMedica.