Baked milk challenge - the results are (kind of) in

I posted last week about readying the kids (and myself) for a baked milk challenge.  Our hope was that passing the baked milk challenge would allow us to start gradually introduce baked milk in their diets, which research has shown, may open the door to outgrowing their milk allergy down the road.  So how did the kids do?

We came.  We scratched.  We reacted.  We didn't eat.  :(

Yup.  The kids did not even pass the initial skin test in which they get a tiny prick and the baked milk item is applied directly onto their open skin.  The kids had to pass the skin test  before it was deemed safe to proceed with the riskier eating of a known allergen.  So the kids didn't really get to take the "food" challenge. 

The outcome of the baked milk challenge was disappointing but informative nonetheless.  The kids' allergist had had the forethought to order skin testing for peanut and tree nut allergies since the kids were already going to be getting pricks for the baked milk.  So we did learn more about the kids' allergies from the visit. The results of Ryken's tree nut allergy tests were consistent with the history of his blood tests:  significant allergic reaction to walnuts and pecans.  He did not react to any other tree nut on the panel.  (Ryken did not undergo a scratch test for peanuts.  Our allergist explained that results of the IgE blood allergy test for peanuts are very predictive of whether someone is allergic to peanuts.  He registers as severely allergic to peanuts so there is no need to put him through an extra, risky test.)

Ryken: 5 and 6 are pecans and walnuts. Far right is the baked milk.

Callan's results were the most eye-opening to me.  According to our allergist, a wheal size between 0 and 2 is considered a negative reaction to the skin test.  While Callan did measure 1s and 2s for almonds, brazil nuts, hazelnuts, pecans, walnuts, pistachios, and peanuts, none were considered reactions.  He tested negative to peanuts and all tree nuts!  The numbers of Callan's previous blood IgE allergy tests had indicated mild allergies to most of these nuts.  Also significant to me was seeing that Callan developed a larger wheal in response to the baked milk than Ryken.  This info followed by a rash on his face from being touched on the face by a child eating a buttery cookie confirmed to my husband and me that Callan's milk allergy is growing more severe.

Callan: the upper left is the control histamine.  Far right is the
baked milk. All clear for the peanuts and 7 tree nuts tested!

The world of allergy testing is still a confusing one for me with different kinds of tests.  Our allergist thinks that we can look upon the skin and blood testing as complimentary but she does believe that the skin test is a better predictor on whether someone does indeed have a food allergy.  She was quick to point out that the skin test is still not 100 percent accurate and told about a patient who had a very strong skin reaction but ended up passing the food challenge without any incident.  Food allergies are such a complicated problem.

In light of Callan's results, we have scheduled a peanut food challenge for him for next month.  It certainly will be a challenge as Callan was very resistant of going through with the allergy appointment this time.  I hope he passes -- not that we would bring peanuts into his diet or into the house with Ryken's strong peanut allergy.  But it would give us some peace of mind if we knew he wasn't at a heightened risk for an allergic reaction when he starts grade school next year. 

My kids have both been consuming almond milk and store-bought almonds without problem.  I plan to continue this.  However I don't foresee introducing any other tree nuts into the kids' diets.  I feel better about not increasing the risk of eating something that may have had cross contact with nuts unsafe to Ryken.  Yeah, I know, I am taking a bit of a risk with almonds but I am hoping to keep this one source of nut protein available to us.  We definitely have our EpiPen Jr. sets with us at all times.