Dr Hive--nut allergy question

[Cinder]

Can a person be allergic to one specific type of tree nut and not others?

 

Several years ago ds1 had an allergic reaction--difficulty breathing. It happened twice, both times after eating ice cream. So we went in for allergy testing. We thought it might be milk. Turned out he's allergic to all kinds of pollen, and both times we'd had our ice cream outdoors. The allergist told us it would be extremely unlikely for someone to develop a milk allergy at ds1's age but very possible to develop a nut allergy. So he was tested for nuts and that turned out negative.

 

Fast forward to this month. In an effort to cut down on junky snacks ds1 has taken to eating macadamia nuts. He doesn't eat a lot of nuts normally, just what might be in a cookie or candy bar but never just plain nuts. This past week he's eaten plain macadamia nuts--at least 1/4 cup--three times. He just told me this morning he had such trouble breathing last night he nearly woke me to take him to the ER. He didn't though, just called me after he got to school this morning. (He leaves very early to commute to college.) But he said he had trouble breathing those other times he ate nuts. The nuts seemed to be the common factor in the times he had breathing trouble.

 

My question is can he be allergic to just macadamia nuts? I've always heard of people with nut allergies being allergic to peanuts and/or tree nuts but not specific nuts. Or should he avoid *all* nuts? I also wonder if maybe the pollens on those days were high. But he doesn't spend much time outdoors. I guess we can't be sure without testing. I've already called the allergist's office and am waiting for a reply.

 

Well, while I was typing this the nurse called me back. It is possible to have developed a nut allergy between then and now. And it is possible for him to be allergic to just one nut though there are common allergens between macadamias and the nuts in their testing panel. So if we suspect a nut allergy he should avoid all nuts. We'll only be sure with testing.

 

Still, I wonder what the Hive's experiences have been with nut allergies, particularly those not detected in childhood.

[YaelAldrich]

Yes, you can be allergic to only one kind of nut, but there can be cross-reactivity with other nuts since many have similar proteins.  I have a peanut allergic daughter but she is only 7 and she is going through oral immunotherapy to make her safe to eat peanuts.  If he is allergic to only one nut he may be able to do this too. 

[Spryte]

 

Well, while I was typing this the nurse called me back. It is possible to have developed a nut allergy between then and now. And it is possible for him to be allergic to just one nut though there are common allergens between macadamias and the nuts in their testing panel. So if we suspect a nut allergy he should avoid all nuts. We'll only be sure with testing.

 

 

Yes, all very true.  It looks like there's a trip to the allergist in your near future.  I would definitely make sure he avoids all nuts in the meantime, and your regular doc may Rx an epipen, just in case, while you're waiting to see the allergist.  In fact, I would ask for that, since reactions can change drastically from episode to episode, and may worsen quickly.  Please do ask for an epipen while you get this sorted out.

 

 

ETA: it is not unusual for a person to be allergic to one type of tree nut, or only a few, but to state "allergy to tree nuts" because there is so much potential for cross contamination in packaging, etc, or cross reactivity between nuts.  DS was allergic to most tree nuts till he was a bit older, and is now primarily allergic to only 2, but our allergist is adamant that we avoid them all, and will not even do an in-office challenge of the others because the risk is so high.  DS may be a different animal though, as he has many LFTAs, and a long history of anaphylaxis.

[sbgrace]

You can be allergic to just one nut.

My husband's anaphylaxis developed as an adult (35 or so). He had some minor trouble swallowing/breathing eating the food he had never before had any issues to on several occasions before he went into full anaphylaxis.

 

Your son needs an epi pen. A good primary care doctor will often do an epi pen while the person waits for an allergist appt. Can he see a health care provider on campus? I would avoid all tree nuts until he can talk to an allergist. Some tree nuts have proteins in common with others. My son's tree nut allergies aren't to macadamia, so I'm not sure of it's cross proteins if any. Most allergists want tree nut people to avoid all tree nuts because of cross contamination potential among nuts in processing. But your son may be different. Make sure he's aware of cross contamination potential in bakery goods and chocolate type things particularly.

 

 

[RkyMtnMom]

My 7yo dd is just allergic to hazelnuts. But almost every other nut product i look at says there may be cross contamination with hazelnuts, so we usually just stay away from them all. 

[Occasionally]

Just adding my agreement. DS8 was diagnosed with peanut and walnut allergies when he was 15 months old. He was tested for a whole slew of different nuts, but was only positive for those two. We were told to avoid all nuts due to possible cross-contamination issues.

[Cinder]

Thanks for all the replies. I hadn't thought about an epi-pen; I'll look into that.

 

Follow-up question I forgot to ask the nurse: What about peanut oil? He often gets lunch at Chick-fil-a while at school. They cook in peanut oil. If he's allergic to nuts should he also avoid peanut oil?

[Eagle]

Anaphylactic reactions often get worse each time you are exposed to the allergen. Just because he was ok without going to the ER this time does not mean that he will be ok next time. Please ensure he gets an epi-pen or Allerject immediately.

[Spryte]

Thanks for all the replies. I hadn't thought about an epi-pen; I'll look into that.

 

Follow-up question I forgot to ask the nurse: What about peanut oil? He often gets lunch at Chick-fil-a while at school. They cook in peanut oil. If he's allergic to nuts should he also avoid peanut oil?

 

Peanuts and tree nuts are different animals, and different allergies.  They are not in the same family - peanuts are a legume.

 

If he were to have a peanut allergy, the answer to this question would depend on whether he reacts.  Generally, "they say" that peanut oil is okay (not cold pressed), because of the production.  But everyone has a different comfort level on that one, and some people react despite the peanut oil being "okay."  DS clearly reacts to ChickFilA - hives around the mouth, and throat/breathing issues.  So peanut oil is not okay for him.  But he's allergic to both peanuts and tree nuts, among other things, not just tree nuts.

[Karen in CO]

If he's allergic to peanuts, then no peanut oil either.  Peanuts are in the legume family and aren't nuts.  I'm allergic to peanuts, Brazil nuts and pecans along with some weirder things.  Many people allergic to tree nuts also have other allergies including peanuts.

[Dana]

From here: (p63)

An allergy to one tree nut does not necessarily mean an allergy to others although this is often the case.

Coconut is often not thought of as a tree nut, but it shares some proteins with walnut. Nutmeg and water chestnuts are not nuts.

Nut oils generally contain the nut protein.

 

Very good resource: FARE

 

:grouphug:

[Outdoorsy Type]

You can also have a thing called cross pollen allergy. It can cause those with tree, pollen, etc. allergies to react to fruits, vegetables and tree nuts. It wouldn't show up on an allergy test (to my knowledge) but it does cause mouth pain, swelling, and sometimes anaphalaxis.

[wapiti]

Agreeing with the others - I would definitely avoid all nuts until you can get in for testing and get an epi-pen.  If there's a tree-nut allergy, I'd avoid all tree nuts due to the cross-contamination issue.  Something like 50% of people with peanut allergy are also allergic to tree nuts, though I'm not sure what the statistic would be going in the other direction.

 

My ds11 was known to be allergic to peanut since he was 1 y.o.  It wasn't until he was 9 or 10 y.o. that he tested positive to tree nuts, but then it was every single tree nut that he was tested for (several), even though he had no known exposures, as he was avoiding tree nuts anyway.  Oddly though, he also tested positive for coconut though he has eaten it many times and never had a reaction that we are aware of.

[Serenade]

I once saw a chart, years ago, that groups tree nuts that were in the same category -- I wish I could find the link. But if a person were allergic to one nut in a particular category, then that person had a good chance of being allergic to another nut in that category. I was hoping I'd find a category that was safe for my son, but it didn't work out that way for us. He seems to be allergic to all tree nuts, except for pine nuts, and I'm not sure they are even considered a nut.

[Dana]

I once saw a chart, years ago, that groups tree nuts that were in the same category -- I wish I could find the link. But if a person were allergic to one nut in a particular category, then that person had a good chance of being allergic to another nut in that category. I was hoping I'd find a category that was safe for my son, but it didn't work out that way for us. He seems to be allergic to all tree nuts, except for pine nuts, and I'm not sure they are even considered a nut.

 

The book I have mentions some cross-reactivity (I know cashews and pistachios cross react), but due to cross-contamination issues, avoidance of all tree nuts is usually the safest :(

[Serenade]

The book I have mentions some cross-reactivity (I know cashews and pistachios cross react), but due to cross-contamination issues, avoidance of all tree nuts is usually the safest :(

 

 

What book to you have?

 

I saw this great chart once on the internet, and I have not been able to find it again.  (I lost my bookmarks in a computer change.)

 

I believe walnuts and hickories were also two that were related.

 

Interestingly enough, my son is allergic to walnut, however, since toddlerhood (he is 11 now) he has played with hickory and walnut shells (the outer cases, they look like balls) in our yard and they have never bothered him.  I think his walnut allergies are not as severe as his other nut allergies, and I'm wondering if that's why.  (Note, we didn't actively think on the walnut cases as being any particular hazard, it's just something he did, KWIM?  I think if I were to do it all over again I would never have let him play with them!   I don't know why it took so long to click with me that he was playing with an allergen!  Gulp!)

[Dana]

What book to you have?

 

I saw this great chart once on the internet, and I have not been able to find it again.  (I lost my bookmarks in a computer change.)

 

I believe walnuts and hickories were also two that were related.

 

Interestingly enough, my son is allergic to walnut, however, since toddlerhood (he is 11 now) he has played with hickory and walnut shells (the outer cases, they look like balls) in our yard and they have never bothered him.  I think his walnut allergies are not as severe as his other nut allergies, and I'm wondering if that's why.  (Note, we didn't actively think on the walnut cases as being any particular hazard, it's just something he did, KWIM?  I think if I were to do it all over again I would never have let him play with them!   I don't know why it took so long to click with me that he was playing with an allergen!  Gulp!)

 

I linked it to amazon in the post... Understanding and Managing Your Child's Food Allergies.

 

It says walnut and pecan usually coexist.

It also says "Coconut is often not thought of as a tree nut, but it shares some proteins with walnut."

 

My son is 11 as well & used to play with nut shells at the playground (before... and even after his anaphylaxis, I think). His allergist at the time said that the shells didn't contain much of the protein and unless there was a contact issue, he should be safe.

 

I'm still yelling at him not to put his hands in his mouth and not to hold a pencil in his mouth. Really scary and dangerous habit!

[Serenade]

I linked it to amazon in the post... Understanding and Managing Your Child's Food Allergies.

Thanks. Somehow I missed it.

 

It says walnut and pecan usually coexist.

It also says "Coconut is often not thought of as a tree nut, but it shares some proteins with walnut."

My son is allergic to walnut, but he is fine with coconut, and I'm so glad for that.

 

My son is 11 as well & used to play with nut shells at the playground (before... and even after his anaphylaxis, I think). His allergist at the time said that the shells didn't contain much of the protein and unless there was a contact issue, he should be safe.

You know, I probably never made the connection because my son played with these nuts before he was diagnosed. It was years later that I made the connection...

 

I'm still yelling at him not to put his hands in his mouth and not to hold a pencil in his mouth. Really scary and dangerous habit!

You know, I've never thought about pencils at all! Now you've given me something new to worry about. Although he doesn't seem to be much of a pencil chewer.

[Spryte]

 

I'm still yelling at him not to put his hands in his mouth and not to hold a pencil in his mouth. Really scary and dangerous habit!

 

Keep yelling.  Don't stop.

 

DS (10) began biting his nails in the last year or so.  He hid it from me for a long time, but now it's out.  :(

 

We were at the grocery store, and nearly had to use the epipen because of it.  He pushed the cart, then bit his nails.  Twice.  I caught him both times and told him to stop.  Sure enough, he had a reaction.  No epipen, but it required sitting on a bench with the epipens beside us, open, Benadryl and an emergency inhaler puff.  It was around the holidays, and they were giving out various samples.  There were walnut products in the store (they always seem more prevalent during the holidays).  DS has many allergies, but I suspect walnuts in that case.  We are still working on the nail-biting.  So scary.

 

Feel free to share that story with nail-biting allergic kids.