Following Mixed Tree Nut Biscuit Challenge, Are the Nuts Still Included in the Diet?

Abstract

We studied the introduction rate after a negative challenge to mixed tree nut biscuit. This is a retrospective review of patients who underwent and passed mixed tree nut biscuit challenges performed at Princess Margaret Hospital (PMH) between 2016 and 2018. Follow-up phone calls were made to families to ascertain if the tree nuts included in the tree nut biscuit were still included in the child’s diet 1 to 3 years following negative oral food challenge (OFC). A total of 162 children underwent mixed tree nut biscuit challenge between 2016 and 2018 at Princess Margaret Hospital, Perth, Western Australia. A total of 141 (87%) passed mixed tree nut biscuit challenge. Of the 133 children that were contacted (8 children could not be contacted), 104 children still included some or all of the challenge nuts in the child’s diet; with 24 children completely eliminating the challenge nuts (18%), 5 children eliminated some of the challenge nuts (3.5%). We found a high introduction rate (82%); however, some families may require more support to maintain the tree nuts in the child’s diet following a negative OFC.