Recap 4: The Peanut Challenge

Dave is allergic to peanuts and fish. This increases Sam's chance of having some allergy, although not necessarily to the same things. The research on how kids develop allergies is mixed. Some people believe kids should be exposed earlier than later to certain foods while others believe those foods should be withheld. We don't have peanuts or fish in our house, so Sam had neither until yesterday.

At his two-year well-baby visit, our pediatrician recommended Sam get tested for food allergies. That sounded preferable to anaphylaxis in the middle of our regular routine so we made the appointment. The allergy doc, however, informed us that testing before a reaction is actually "controversial" because of the possibility of false positives. But since we were there for the appointment, he went ahead. Sam's skin test showed a reaction to peanuts and cats.

Due to the issue of false positives, the follow-up protocol to a skin reaction is "The Peanut Challenge." (In case you are wondering, there is no such thing as a "Cat Challenge.") We had ours yesterday. It went like this.

Dose 1: Sam takes this one rather easily. We had been talking up peanut butter for days and told him he couldn't have this special treat until his appointment. He is disappointed that the doc won't let him have it on the Ritz cracker as promised but offers a tongue depressor instead. Once the peanut butter is in Sam's mouth, he is like, What the hell is this stuff and why would you make me eat it? I coax him to swallow and we begin the wait for a reaction. Nothing happens.

Dose 2: Fifteen minutes later. The peanut butter on the depressor is double the amount in Dose 1. Sam is not having it. He turns away and seals his lips. We wrestle. I sit him on my lap. He smears the peanut butter on my pants. I am covered in it and understand why they call this a challenge. The doctor promises Sam a sticker. Sam reluctantly opens his mouth and I shove in the brown goo. Sam lets it hang there on his teeth. I keep telling him to chew. He looks at me confused. Finally he swallows. Nothing happens. Sam has a sticker.

Dose 3: I prep Sam for fifteen minutes between doses. This is what will happen, I say. The doctor will give you the peanut butter and you will eat it. You will get another sticker. Sam says, yeah. When the doctor gives him another doubled dose, Sam refuses. He cries. He wrestles away. He is hot and red. I tell him Greysen loves peanut butter and would be so proud if Sam ate it. Sam pauses. He opens his mouth. Takes the peanut butter. Swallows. Nothing happens. Sam has two stickers.

Dose 4: Between doses nurse Julie checks Sam's blood pressure, his pulse, his skin. All is well. They draw pictures on the examining table paper. We chat. The doctor comes in. The dosage now stays the same. It's a full teaspoon of peanut butter. I offer the depressor. Sam seals his lips. The doctor steps out and returns with a Superman sticker. You will not get this until you eat the peanut butter, he says. He has grown impatient. It works. This is not how I want to parent, I think. But whatever. Nothing happens. Sam has three stickers.

Dose 5: We wait a long time for the doctor to arrive. Julie lets Sam listen to his heart beat. I listen too. It's cool. Julie shows Sam how to take his blood pressure. They are friends now. Julie has four boys of her own. That's a lot, I think. We've been here for two hours now. The doc finally arrives. I tell Sam we can go home soon if he eats this one quickly. He does. Relatively. Julie does a dance with him. Nothing happens. Sam has four stickers.

Dose 6: We are ready to go home. The wait is longer than fifteen minutes but not quite as long as before. Sam eats plain Ritz crackers. We read books. The doc comes in. Would you like one more sticker, Sam? he asks. Sam says, two. Hell yeah, I think. You've earned two. The doctor agrees. Sam eats the final dose. He has six stickers. Sam must be observed for another hour before we can leave. Sam and I both have cabin fever. He is silly. I am exhausted. Hey! he yells. Go! he shouts at the door. We read an animal book. He tells me the pig is a cow. The dog says meow. We laugh. Julie smiles.

An hour slowly goes by. Sam does not react. He passes The Peanut Challenge! We paste his stickers to the back of a form letter about sinus infections and take a picture. Julie doesn't want to be in it. We get in the car and drive home. I ask Sam if he'd like a peanut butter and jelly sandwich for lunch. He says, no.