Woke at 6:30 to get our wet wraps out of the way before heading off to NJH to meet with doctors. When we arrived Nurse Amy thought her skin looked so good that we would be able to skip the mid-day wet wrap (yay!).
We met with one of the fellows, Dr. Lanser, who works under Dr. Leung (main derm guy) and Dr. Fliesher ( head food allergy guy) who went over her blood test results. Peanut, almond, hazelnut, sesame, and wheat are too high on skin and blood tests, and way above the safe range to food challenge. We’ll have to wait until tomorrow to speak to Dr. Fliesher about possible food challenges for baked egg and/ or milk, which test too high in their raw forms to food challenge today.
We can challenge pine nuts and cashew nuts today. I ran over to Sprouts (similar to Whole Foods) across the street and found cashew nut butter and raw pine nuts for the challenge. It felt like contraband, but I wasn’t nervous at all about the challenge as these were foods that had always tested relatively low but avoided ( as advised by our allergist) since they were tree nuts.
Nurse Amy mixed whole pine nuts with chocolate syrup and started with 4 slowly increasing doses 20 minutes apart.
Zoey gagged a couple times but was a real trooper with each dose. Nurse Amy is another excellent nurse who we’ve worked with during the day, and was able to coax Zoey gently through each excruciating bite. Getting Zoey to eat anything new is really difficicult, let alone something she had to chew and swallow, and we were honest about it being a potential allergen. We needed to have Zoey tell us if her stomach hurt, or if she was itchy anywhere.
The final dose of pine nuts was the hardest for Zoey, and she asked if she could have the stuffed snow leopard she spotted in the prize closet last week. Amy had Courtney in child life go out and get another white tiger, as the one in the closet was awarded to another child last week. This is why we are at NJH, because they go so far for patient success.
And …by 2 pm she was officially cleared to eat pine nuts!
After her nap we moved right on to cashews, in which she had somewhat higher test numbers. After the first dose she had a few pinprick hives but I think this was a contact reaction from the wagons we ride in to pass time on the unit.
Amy and Dr. Leung inspected the arm and if all was ok in 20 minutes, they would repeat the first dose. The cashew butter was much more palatable to Zoey so this was much easier, though she was a little sick of eating just pine nuts, chocolate syrup and cashew butter for the last 8 hours. By 6pm we finished the last dose without a problem!
Hooray! Zoey can eat 2 tree nuts after avoiding all of them her entire life!
When I get home I’m going to make cashew and pine nut bread, cookies, frosting, crackers, pie crust and anything else I can throw it in.
After a completed challenge, she still needs to stay for an additional 2 hrs for observation so we’ll hang out here on the unit until 8 pm and try to get her bath and wet wrap in after that and head off to bed.