Nuts. Allergy!

Allison, whose name was ranked #47 among newborn girls in 2007, has a question about nut allergy: “We just (inadvertently) figured out that our 6 year old son is allergic to pecans. His reaction isn’t life threatening — his eyes swell up and get itchy. What should we do (other than obviously teach him to not eat pecans)? Do we need to get him tested officially? Tell the school? Anything else?”

The first step, as you said, is to avoid pecans: teach him not to eat them, and to ask adults about the nut contents of food, and get used to reading labels on things like cookies or brownies. Since he might not be able to tell the difference between a pecan and another nut by just looking, it’s probably best for him to learn not to eat anything that looks like a nut unless it’s OK’ed by you. Definitely, tell the school, tell grandma, and tell any of his friend’s parents before you drop him off for the afternoon.

You should also travel with Benadryl at all times, and keep some in your house. Make sure grandma has some too. Talk with your pediatrician about specific dosing and usage of medications, and whether you ought to carry injectable epinephrine. People at the highest risk for life-threatening nut allergies are those who have had any sort of nut reaction in the past and who have a history of asthma or wheezing.

Allergy testing can be useful to see if he’s also allergic to other tree nuts, or to peanuts (there are often cross-reactions.) If he’s already had peanuts and other kinds of nuts, and never reacted, there is no need for testing. But if you’re not sure if he’s had different kinds of nuts, it’s a good idea to do a “nut panel” to see if he’s likely to be allergic to other nuts.

Visit the Food Allergy & Anaphylaxis Network for more info—it’s an excellent, non-profit web resource with good info on nut and other food allergies.

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2 Comments on “Nuts. Allergy!”

  1. Jennifer Cumbo Says:

    Hello – my son is 6 y.o. and last Christmas was eating pistachios and had a violent allergic reaction to them. His nose started dripping nonstop, his ears were bright red and his throat began to close up. We rushed to the ER and they treated him. They also told us to get him tested for allergies. It took us 4 mos. (!) to get an appointment with the pediatric allergist. At the allergist, they had to wrap him in a bed sheet and 4 women had to hold him down to keep his arm still and draw his blood (hey, it sounds cruel but he survived and it was necessary). Blood test is only true way to tell what he is exactly allergic to. Turns out he is allergic to all tree nuts: pistachios (obviously), pecans, walnuts and hazelnuts. Peanuts are okay which is good as he loves PB&J. Your son is allergic to pecans I would avoid all TREE NUTS especially until he can be tested specifically. The ER told us to avoid all nuts until getting my son allergy tested although we kind of knew he was not allergic to peanuts as he had been eating peanut butter for a while without incident.

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  2. Dr. Roy Says:

    Peanuts are separate from “Tree nuts”– walnuts, pecans, pistachios, brazil nuts, etc. Though there can be cross reactivity from peanuts to the tree nuts, it isn’t that common. As Jennifer pointed out, since her son had eaten peanuts commonly without problems, she knew he wasn’t allergic, and there really wasn’t any reason to restrict peanuts after his pistachio reaction. It was smart, though, to avoid all tree nuts until testing.

    It’s too bad it took so long to get into an allergist. A pediatrician can order the same kinds of allergy blood testing as an allergist, so I’m not certain the 4 month wait was necessary. In any case, now you know, and you should be carrying Benadryl and epinepherine with you at all times, with good instructions from the allergist regarding when and how to use these medicines if your son is exposed to these nuts again.

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