Cashew allergy? And silly advice from doctor?

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Cashew allergy? And silly advice from doctor?

Postby Feefielou » 01 Mar 2016, 21:33

Hello all, as usual I've been away from the forum for ages and ages and then suddenly reappear asking for advice. Sorry, but you guys are all so helpful!

So, Lentil started his BLW journey just three weeks ago, and so far is loving it. We have no allergies on either side of the family and with Moonbeam we made a lot of use of all sorts of nut butters during her early days of BLW because they're delicious, easy, healthy, you know the score. But little Lentil seems to react to them. First a little taste of almond butter, and he got a few little bumps on his arm which may or may not have had anything to do with it. Then a rice cake with cashew butter which he spread all over his face and neck and hands, and within minutes they were all red and bumpy. I left it ten days then today gave him a cracker with cashew butter again, to be sure that it was that and not something else. Definitely was, same thing happened. Bumpy and red as if he had lots of insect bites, almost exclusively in the parts that actually touched the food but maybe a bit further down his chest as well. No other symptoms, all gone within 40 minutes.

Now here's the thing. I am not foolish enough to think that the internet is a good substitute for real medical advice. I quite deliberately chose to try the cashew butter again on a working day so that the doctor's office would be open so that I could call immediately if I needed to. And so I did, to ask advice on what to do next. Not that I was worried for him at the time, he seemed fine and the reaction was minor, but I'd like some advice on whether I need to be avoiding cashews for ever and ever and ever, whether I should try them again in a while, whether I need to avoid other things, how far I need to go in the avoidance, etc. Our pediatrician is on holiday, apparently, but the receptionist said she would ask the other one and call me back. So she calls me later on and totally admonishes me for feeding him cashews, like really made me feel like a horribly irresponsible mother. She says "who told you you could give him that?", implying that I am only 'allowed' to feed my baby things from our doctor's list of approved foods (which, as those of you who remember me starting Moonbeam with BLW will recall, includes rabbit, veal, chard and artichokes. In a rather specific order. And 'at least one egg per week'! Not that I have the slightest objection to any of those foods, but the list might just as well say 'food'). She said 'the doctor is very surprised that you would give him such a thing, you are not supposed to give such allergenic foods until at least three years old, and your doctor who is away would also not permit it'! Um, excuse me, but WHAT? I told her that this goes against the recommendations of the country I come from, where current guidelines say delaying the introduction of potential allergens without a history of allergies in the family is not only not necessary but might actually be a bad thing. She says 'well that's not the case here' (Switzerland). But I am reasonably sure she is wrong there. I've not found national guidelines yet but the state level advice I can find, as well as the various associations of nutrition, allergists, pediatrics etc all say exactly the same as the UK and US, i.e. introduce nuts some time between 6 months and a year, there is no value to waiting, and delayed introduction might increase the chance of developing an allergy.

But, aside from whether or not my doctors' office is following national guidance and of course whether that guidance matches that of other countries; the problem is that now I don't know what to take as sensible advice from these doctors, and what to ignore. I've taken a position with both Moonbeam and Lentil that pediatricians are there to advise about illness and disease prevention, not about feeding a healthy infant; hence I have quite happily ignored their advice to start spoon feeding purees at 4 months and have cut up their lists of approved foods to use as scrap paper for writing my shopping lists. I think they would have heart attacks if they knew about BLW, so in any follow-up discussions about this cashew reaction I am going to have to tread very carefully to avoid a mammoth telling-off. But when it comes to BLW I'm comfortable with our decision and know what I'm doing. With a potential nut allergy I'm not. I have no clue. I don't know anyone with an allergy, I don't know how they work, I don't know what's dangerous, or how dangerous, or what to avoid. But I don't want a doctor telling me 'just don't give Lentil (or indeed Moonbeam, who is only 26 months old) any more nuts until the age of 3 years', unless that is actually genuinely worthwhile advice. That would have a huge impact on the diet of all four of us and on his experience at nursery where he will be starting the week after next.

So, people. What should I in fact do? Change doctors? Feed him nuts? Cut out nuts? Read the labels of everything ever? Feed him exclusively on pureed rabbit until he is three? Give him cashew butter when I am near to an A&E? Show my doctor photographs of the cashew bumps and at the same time just happen to show him some pictures of Lentil stuffing his face with roast chicken and gravy?
Brit living in France/Switzerland, Mum to Moonbeam born December 2013, Lentil born August 2015.
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Re: Cashew allergy? And silly advice from doctor?

Postby mamapup » 01 Mar 2016, 21:52

Oh dear, not a fun situation in which to find yourself.
From my limited experience of European mainland and weaning (my weirdo brother in Belgium) I think Europeans have a much more traditional view on weaning than we might here. Although to be fair, you are the only folk I've ever spoken to about weaning in the UK so it might be more traditional here than I imagine too!

However, everyone in my refined south London circles has given their kids nut butters from early on and none of us ever felt that strange.

I don't know anything about allergies I'm afraid but I'd certainly make it clear you're not interested in their views on weaning, only on figuring out if lentil is allergic to nuts or not.

Good luck.
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Re: Cashew allergy? And silly advice from doctor?

Postby Treeb » 01 Mar 2016, 23:20

Do you think you can get a referral to see an allergist? A had a similar rashy reaction after having sesame tahini early on. Our pediatrician quite sensibly admitted that she didn't have enough allergy knowledge to advise, and immediately referred us to a pediatric allergist. They did skin prick testing which showed an egg white allergy but no sesame allergy. However, we have been advised to avoid sesame until she is a year old due to the rash, at which point we will retest and reevaluate. We have an epi-pen for the egg allergy, but were told it is still good to give her eggs in baked goods, just not scrambled egg/omlette/etc. and she can also have any other "allergen" foods including nuts and seeds without restriction.
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Re: Cashew allergy? And silly advice from doctor?

Postby ches » 02 Mar 2016, 00:29

Ooh yes, referral would be good. The 3 years thing is because of cooking hazard on whole nuts, not allergic potential! I'd change doctors too unless there were some redeeming features. Your info is consistent with recent research, your doctor is out of date.

In terms of allergens, my understanding (from fb posts of a friend whose DS has EoE & is allergic to most of the top 8 allergens and then some) is that the severity of previous reactions is no indication of the severity of future reactions. In other words, the next one could be anaphylactic. Not trying to scare you, but I'd want to talk to an allergist and maybe get an epipen.
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Re: Cashew allergy? And silly advice from doctor?

Postby Brigitte » 02 Mar 2016, 05:25

Hello there! My daughter is allergic to cashews and pistachios, so I know a bit of what I'm talking about!

The reaction you've described may be hives, and is pretty serious. Please do not give that particular child any more cashews (yes, all read ingredient labels closely for all traces) or for that matter any nuts at all until you have seen an allergist who can do some testing and advise you further. Cashew allergies are also closely related to pistachios, mango, and poison ivy, so maybe until your allergist appointment you should avoid those things as well. If you ever purchase any South American foods, know that in those regions the fruit of the cashew tree and its juice are commonly consumed, so watch out for those too, called "cashew apples" or "maranones". One last bit of tricky business: sometimes pesto is made with cashews or pistachios instead of pine nuts. Always know the exact ingredients of your pesto before feeding it to your nut-allergic child.

Did you notice any other symptoms along with the rash/hives? Any diarrhea or vomiting, fainting or low blood pressure, lethargy, complaining of cold, itchy or swollen lips or tongue or mouth, and especially any changes in breathing (my daughter sighs a lot when she's having a reaction)? Our allergist defines "anaphylaxis" as any reaction where more than one body part/system is affected. For my daughter it is hives, itchy tongue, and altered breathing.

If you feel worried about a repeat reaction before seeing an allergist, you could buy an epipen (tell the pharmacist it's for an infant, you don't want the adult dosage one!), but they are pretty expensive so it's okay to hold off if you feel you can keep your child safe for now. Epinephrine (the medication in an epipen) is a very safe medication to use, so do not hesitate to use it if it's looking necessary. Always go to the emergency room or call an ambulance immediately after using an epipen. An epipen may only be effective for 15 minutes or so, at which point the reaction may return stronger than before. If this happens, you'd like to already be in the ER for prompt attention. Do not give any children Benadryl or other anti-histamines for an allergic reaction unless your own doctor/allergist has specifically told you it's okay for your specific allergy. Benadryl can also mask an allergic reaction, and it can come back with a vengeance after the medication wears off. It can also interfere with medical personnel's ability to accurately diagnose your allergic reaction. Keep a close watch on your child for 24 hours after an anaphylactic reaction, it may recur.

Sorry to be so dire, but I've been there, and I'm just passing on what I know from what my cashew-allergic child's allergist has told us! The good news is that you're absolutely correct about trying to introduce common allergenic foods early, I believe current research says even at the age of 4-6 months (so for 6-month-old BLWers, that means ASAP). Now that you've observed an actual reaction to nuts, stay safe and avoid them completely until you have seen an allergist who can test and advise you further. Carry on with introducing all other foods (except honey, excessive salt, and any outright choking hazards due to shape/size/firmness, as per BLW).
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Re: Cashew allergy? And silly advice from doctor?

Postby Brigitte » 02 Mar 2016, 05:29

I love my kiddos! Two April girls (2011 and 2013) and a May boy (2016). I guess we have spring babies in this family.
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Re: Cashew allergy? And silly advice from doctor?

Postby Feefielou » 02 Mar 2016, 08:44

Thank you so much people, I knew I could rely on you! I think after reading your responses we will seek out an allergist and go directly-- we don't need referrals in Switzerland, so we can do it of our own accord. The doctor's office yesterday said to just wait until Lentil's next check-up but that's three months away, so it's probably a good idea not to wait three months and then get a potentially unsatisfactory answer.
Brit living in France/Switzerland, Mum to Moonbeam born December 2013, Lentil born August 2015.
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Re: Cashew allergy? And silly advice from doctor?

Postby Kitcameron » 03 Mar 2016, 08:43

Hi,

Can I jump in and ask an allergy question too? CM had been getting hive like reactions for a few weeks but we couldn't nail down to what. I took her to the dr who gave us portion for when it's really itchy and said if it got worse or she had trouble with breathing mock (obviously for breathing go straight to A&E) and shed refer me to an allergist. I've tried keeping a food diary but I can't pin anything down. I say hive like because I wouldn't say it always looks as severe as the NHS choices picture of hives. The dr didn't mention hives, I googled it. She said it looked like an extreme nettle rash, but that was based on a photo as typically CM had cleared up a bit by the time I got an appt.

Anyway, she's not been as bad the last couple of weeks, she keeps having little flare ups but not as severe as they were. I don't k ow whether I should just keep an eye on her or try and get her allergy tested anyway. I a bit worried I'm going to inadvertently give her something she's allergic to and cause a more major reaction.

Reading is through u think maybe I'm being a bit OTT and I should just keep an eye on her unless it does get worse and then take her back again.
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Re: Cashew allergy? And silly advice from doctor?

Postby Brigitte » 04 Mar 2016, 03:47

I love my kiddos! Two April girls (2011 and 2013) and a May boy (2016). I guess we have spring babies in this family.
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Re: Cashew allergy? And silly advice from doctor?

Postby Kitcameron » 04 Mar 2016, 19:05

I'm not certain but dr seemed to think it most likely. She had a bit of a flare up again yesterday and I had to give her Piriton at bedtime because she was complaining if being itchy. It's not been as bad recently so I don't feel like it's been bad enough to take her to Drs.
Mummy to Slinky Malinky (Sept. 12) and Chunker Munker (June 14.)
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Re: Cashew allergy? And silly advice from doctor?

Postby sabrina fair » 04 Mar 2016, 20:22

Just to add to the excellent advice you've got so far...monkeyboy was allergic to Brazil nuts (confirmed by a prick test) but seems to have grown out of it at age 4. We're awaiting an appointment for a food challenge to double check, but his last prick test and blood test came back negative. Just to give you hope you may not be studying labels forever! Also, we weren't advised to avoid all nuts, though that may be because of the nature of Brazil nut allergy compared to other nuts (we're in the UK and under the allergy specialists at our children's hospital).
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Re: Cashew allergy? And silly advice from doctor?

Postby Brigitte » 04 Mar 2016, 20:41

Once you've seen an allergist, by all means follow whatever advice they give you. We only need to avoid cashews and pistachios now, and are actually encouraged to keep exposing her to other nuts lest she develop further allergies.

I was just saying to avoid all nuts until you see an allergist, as we were advised to do by the emergency doctors after our first reaction. Better safe than sorry when it comes to serious nut allergies.
I love my kiddos! Two April girls (2011 and 2013) and a May boy (2016). I guess we have spring babies in this family.
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