Ah Nuts

We recently learned that our little munchkin has an allergic response to peanuts. It was an exciting day.

Throughout pregnancy, aside from the listeria ‘no’ list and medicinal herbs, I didn’t really restrict my diet. I ate eggs, seafood, and nuts, all in moderation, and continued to have what I hoped was a varied diet during breastfeeding. Neither side of our families have known allergies to food, and there are no notable cases of asthma, or anaphylactic responses in other allergies.

We started offering solids at about 25 weeks[1]. Nothing terribly exotic to begin with, combining baby led weaning with purees.

Having just restarted solids after a cold and a bout of vomiting put her off it, we were having such great success with bread-dipped-in-soup that I tried her out with a couple batons of bread with a little home-made peanut butter (just nuts and a little oil whizzed up in the Thermomix). Her first experience, and my folly in not doing a contact test first, thinking that because we’ve handled peanuts or had peanuts in our food that she’s inclined to grab for, that she’d have had touch but not ingestion contact with already.

Lesson: Always do a contact test first.

I have previously googled allergic responses to food to know what to look for, but none of it really prepared me for what to expect, and what proportionate response would be based on the reaction. I am documenting this for anyone else who is unfortunate enough to be in this situation.

Key Points

Disclaimer: I am not a medical professional. This is my personal experience, and what I have been told by the medical professionals I interacted with on the day. If in doubt, seek medical attention.

If you see hives/rash and swelling of the lips or face, contact your GP immediately. Most clinics will try to squeeze you in if an infant/child needs to be seen. If you can’t get hold of your GP, it is safest to call an ambulance, or go straight to a hospital.

Personally, I would choose calling an ambulance[2] over driving to the hospital myself. You lose time packing your baby into your car-seat and getting to your destination. And you cannot observe your baby while driving if you’re by yourself. If you call an ambulance, they can do the initial checks on site, and make the determination of whether you need to go to hospital. They will also have adrenalin on hand, and can continue to observe and administer any necessary treatments if needed en route.

Note: If you’re in Australia, I wouldn’t bother calling Health Direct in this situation. Their first response the times I have had to call them, even for something like a cold, is to see a GP or get yourself to a hospital. You can save yourself the time it takes to call them, and skip ahead to that course of action yourself.

Anaphylaxis will present almost immediately, though is unlikely to present for a first exposure. Other serious symptoms you are looking for are restricted airways and swollen tongue. Also look for obvious signs of distress. If the baby is crying, it may sound different, or if the child can speak, their voice may sound different due to the constricted airways. Their blood pressure may drop and they may become lethargic or floppy. Vomiting, while worrying, is a good thing though because it means they’re ejecting the problem substance.

Do not treat with any antihistamines or medications that can cause drowsiness, as you won’t be able to tell if the lethargy and floppiness is a symptom, or the result of the medication.

First 10 minutes

Munchkin delightedly played and nibbled on the bread and peanut butter. Her soup and peanut butter lunch was better received than any other food she had had until this point. It’s most unfortunate that the thing she had shown the most interest in thus far, she will not be able to have again, for a while at least.

Within 5 minutes I noticed redness around her face and cheeks. I had removed her two bibs and wiped her down by this point. Over the next few minutes it started to develop into hives and looked like a growing blotchy red area with lots of little welts that looked like small insect bites. Where there was redness, I started to see swelling, including at the lips. I won’t post pictures here, but you can google image search for “hives” to get an idea of what to look for.

Bub seemed a little bothered, but no more than what she is normally like close to nap time, which it was. Not tired, just fidgety. Uncertain if this was related to the allergic reaction or normal behaviour.

Parental panic has set in.

I had contacted our local pharmacy combination clinic and asked what to do. Their GP wasn’t in, and I was referred to contact the children’s hospital who recommended seeing a GP or coming in/calling an ambulance.

Next 20 minutes

The ambulance had been called and had arrived within this period.

Munchkin’s lips now resemble Angelina Jolie’s. Swelling has spread past the red area on her face. I’m seeing contact hives or swelling wherever else had touched peanut butter, like where she tugs her ears when tired, and where some dropped on her arms and legs. Even at a spot where she managed to get some peanut butter on the back of her head.

Bub was alert, and unfortunately rubbing her face in tiredness. Some of the swelling spread to the places she was rubbing as well. I gave her another wipe down to remove whatever residue may have remained.

The severity of her symptoms seemed to peak around when the ambulance arrived.

The paramedic checked bub’s heart rate, blood pressure and oxygen saturation (bub found this monitor great to chew on). He listened to her heart and lungs and checked her visual responsiveness. I was asked about the contact (how long, how much, when did I see the reaction) and about any family history of allergies, asthma or anaphylaxis.

She seemed alright, and the symptom severity was starting to plateau, but they wanted to bring her in anyway to be seen by a doctor just in case. This still counted as emergency response[3].

Bub doesn’t ordinarily complain loudly, so it was hard to tell if any of what was happening was troubling her. It certainly bothered me more. She seemed more put out that I wasn’t getting her down for her nap than anything else. More so when we got her into the ambulance because a car trip means she’s not napping, and now she’s getting things attached to her, and getting tethered with cables for monitoring so she can’t move her arms around as much as she’s used to. There were many expressions of curiosity and furrowed bothersomeness. ie. “This is super annoying, mummy.”

Next 90 minutes

The swelling and redness was still going down on the way to the hospital, and continued to improve while we waited to be attended to (not that long).

Munchkin’s vitals were checked again by a registered nurse, then a doctor came by and she was given some (non-drowsy) antihistamine. We were told no nuts of any sort until we see an allergist. They’d sent a referral on, but we were advised that it could be six months before we get an appointment (apparently average).

They kept us there for about 15-20 minutes more just to be safe, then gave us the all clear to go home.

I changed bub’s nappy while we were waiting, and her whole abdomen was red and blotchy with hives. Her pelvic area was also pretty red. She didn’t seem troubled by this though, even smiled some. Temperament was all pretty normal.

Later on

By evening, a few hours later, the hives had gone but her skin was still red. It looked like drool rash now, so not as bad.

A few hours after that, the spots that were still red were her face, and around her neck and elbows, where I’d normally see sweat rash. Her abdomen was still red, her pelvis was clearing up.

By next morning her complexion was clear again.

As our bub is pretty chill most of the time, I won’t know how much of the day bothered her. I remember when I had hives from hayfever when I was younger I would have to fight not to scratch, but I didn’t notice her try to scratch at all. If your bub isn’t a honey badger, you may get a much different response.

And again, I must emphasise I have no medical background, so if you’re concerned at all about your bub’s condition, seek medical attention. But I hope this account will help you out should you ever find yourself in this situation.

We ended up getting an appointment with an allergist through the public system[4] within 3 months of that first reaction, and have been given the all clear to start introducing other nuts. Still no peanuts, but foods labelled “may contain traces of nuts” are okay. We’re also quite literally now members of the Epipen Club, and have an Anaphylaxis Action Plan.

Over time, bub will be re-tested, and if/when her response becomes favourable, we may be offered a challenge test. Some bubs grow out of initial allergic responses, so we’ll just have to see what happens down the track. Wish us luck, but we still have to wait 12 months before this treatment plan may be offered.

Extra: How to Use an Epi-Pen

Note: The protocol in the UK and Australia/NZ was revised in 2017 changing from 10 seconds to 3 seconds.

[1] The child nutritionists we’ve heard talks from recommend introducing solids at approximately the 22-26 week mark. And the current recommendation is not to introduce high allergen foods too early (before 4 months) or too late. Basically everything is free game.

[2] The cost of this without private health insurance with ambulance cover is about AUD$900. I like private health insurance.

[3] As evidenced by the invoice for the ambulance. Non-emergency response would not have been covered by insurance.

[4] As the referral was sent on through the public system, we weren’t sure how long we were going to have to wait. But we received our appointment letter pretty much the day we were going to try to get a private referral. Anecdotally, it could take 6-18 months to get an appointment through the public system, and up to 9 months with a private specialist. Going through public, you do not have to pay for the initial consult, but a private allergist could cost AUD$400+ before Medicare rebate. The initial consult is also not covered by private insurance (specialist appointments), but the treatment may be depending on your coverage.