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My Tree Nut Challenge


Please bring the following:


  • Bring one (1) ounce or thirty (30) grams of approved shelled nut (please remove shell before the visit), or 2 tablespoons (30 mL) of nut butter. If bringing a processed product, it is best if labeling states no cross-contamination with other foods that may be an allergy risk for the patient. You may make your own homemade nut butter. It is okay to bring any bread or crackers the patient has tolerated in the past on which to spread a nut butter, especially if you think greater volumes (ex. 1 tablespoon) may be difficult to eat alone.

  • Our office suggests brands that are unlikely to be contaminated with other common food allergens. However, it is recommended that you confirm these products are still free from contamination of your allergens before purchase, as manufacturing practices may change at any time.


  • Almond - Barney Butter (coconut in facility), Wonderful brand, Julie’s Real (may contain coconut), Madi K’s, Elmhurst Almond Milk

  • Cashew - Sunshine Nut Co., Manna Organics, Julie’s Real (processed in facility with tree nuts), Artisana Raw Organic Cashew Butter (made in a facility that processes tree nuts but not peanuts, dairy, soy or gluten)

  • Pistachio - Santa Barbara Pistachios, Wonderful Brands, Keenan Farms, Fiddyment Farms

  • Walnut - Fastachi Raw Walnut Butter, Crazy Go Nuts, Derby Walnuts, Fillmore Farms, Hammons Black Walnut, Olson Trading Company, Elmhurst Milked Walnuts (will need to drink 8 ounces)

  • Pecan – Green Valley Pecan Company, Pearson Farm, Surratt Farms, Purely Pecan

  • Hazelnut - Fastachi Roasted Hazelnut Butter, Nutella (if not allergic to milk), Nutiva (not if coconut, milk or soy allergy), Laurel Foods, Elmhurst Milked Hazelnuts (will need to drink 8 ounces)

  • Macadamia Nut - Wilderness Poets Raw Macadamia Nut Butter, Hamakua Macadamia Nut Co. (plain or salted only)




Can we have a Food Challenge if the patient is sick?

If the patient has a fever, flu-like symptoms, cough, wheeze, hives, worsened eczema, widespread rash, throat symptoms, vomiting, or other significant illness symptoms, the procedure will most likely not be done.  Please contact the office to discuss symptoms and reschedule the challenge if needed.  You may also keep the appointment to have a full illness assessment and to determine if the food challenge should be cancelled.


Food Challenge guidelines and what to expect

  • Please stop using antihistamines beginning 3 days prior to appointment. There is no need to stop asthma medications or nasal steroid sprays. Please call the office if you are unsure what medications to stop.

  • No food should be given to the patient 2 hours before arriving for challenge. Clear liquids are okay.

  • Please be prepared for the challenge appointment to last 2 to 4 hours.

  • The patient will be given small, increasing doses of the product every 15 minutes until a full serving size has been ingested. We will watch closely for any signs of a reaction, and vital signs will be taken before each dose and for an observation period after the last dose.


What are the risks of having a Food Challenge?

An allergic reaction may happen. The reaction may be similar to the patient’s first reaction or it could include new symptoms. Symptoms may include hives, swelling, shortness of breath, wheezing, coughing, vomiting, or diarrhea.


What happens if patient has a reaction?

The practitioner will examine the patient, and depending on symptoms, medications may be given such as antihistamine, anti-inflammatory steroid, or an epinephrine injection in the thigh. The patient will stay extra time for observation until stable to leave the office.


Expectations after passed challenge

  • Patient will be cleared to eat food item 24 hours after challenge is completed.

  • The food should be included in patient’s diet at least once a week or as directed by the practitioner.

  • Follow up with your practitioner with any other questions or concerns.

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