Giving Peanuts, Eggs and Nuts to Your Baby in the Hospital

This article draws on the personal experience of Laurie, one of the founders of Vini Mini, whose son Viggo was treated at the peanut clinic of the Reinier de Graaf Gasthuis. While procedures may vary between hospitals, this provides a general insight into the working method. Furthermore, the content has been verified by a pediatric allergist from the Taskforce Prevention Food Allergy.

Whether it is better to give peanuts, eggs and nuts in the hospital or at home depends on the age and risk factors of your baby.

First answer the 4 questions in the test to see if you can also start at home.

In the following situations it is recommended to give peanuts, eggs and nuts in the hospital

1. Your baby is older than 8 months and has severe eczema
2. There has been a previous acute reaction to another food

In the following cases, consultation with a doctor is advisable:

1. Your baby is between 6-8 months old and has severe eczema
2. There is a food allergy in the family or there are other reasons that make home introduction exciting

Clinical introduction in the hospital: how does it work?

How do you make an appointment at the hospital?

You contact your GP and he or she can refer you to one of the hospitals where you can do a clinical introduction. These are specially equipped outpatient clinics with all the facilities for babies and with the necessary manpower and equipment if a reaction does occur. (Pediatric) allergists, pediatric dieticians, doctors' assistants and pediatric nurses work together there.

Which hospitals can I go to for a provocation test?

See below, among other things, where you can go with your baby:

• Reinier de Graaf Hospital, Delft
• Martini Allergy Center, Groningen
• Northwest Hospitals, Alkmaar location
• Deventer Hospital, Deventer
• Elkerliek Hospital, Helmond
• Catharina Hospital, Eindhoven
• Erasmus MC/Sophia Children's Hospital, Rotterdam
• Amsterdam University Medical Center, Amsterdam
• Deaconess House Utrecht
• Albert Schweitzer Hospital, Dordrecht

Before the appointment, the hospital will call you to make further arrangements.

If you have been referred by your GP, the doctor's assistant or planner of the provocations will call you to coordinate and verify the appointment. You will then receive a letter with an invitation and the necessary information with procedures of the hospital so that you can prepare well for the visit.

Before the appointment, you will be called by a pediatric dietician with additional questions and you can also ask questions yourself so that everything is clear.

The day starts with a skin prick test

The day starts with a skin prick test, which checks whether your baby has already produced antibodies for the food. For this, a drop with allergenic protein is pricked into the baby's arm. After 15-20 minutes, the prick site on the skin is examined and assessed for a reaction. The size of the reaction from the skin prick test determines whether and to what extent antibodies are present.

This sounds scarier than it is, but it's not that bad. The bumps can itch, so you should try to keep your baby from touching the spots as much as possible.

If there is no reaction, your baby will be given peanut, egg or nuts in a fruit or vegetable puree for the first time that same afternoon using an open food challenge test.

If there is no reaction to the skin prick test, peanuts, eggs or nuts will be given to your baby the same day via a food challenge test

First, a consultation with the pediatric allergist takes place

First, a consultation with the pediatric allergist takes place. Your baby is weighed and measured and checks such as temperature and breathing are performed. In addition, the baby's eczema is thoroughly examined and assessed. This forms the starting point and can be compared to a possible allergic reaction.

Then the food provocation test starts with increasing steps of peanut, egg or nuts

After this physical examination, the food provocation test begins.
If there is no reaction at all to the skin prick test, this is done in 2 steps. Every half hour your baby gets an increasing amount of food with peanuts, eggs or nuts. At each step the nurse fills in a checklist looking for allergic symptoms such as hives, runny nose, watery eyes, stomach ache, nausea and/or crying. If there are any symptoms, the provocation is stopped. Depending on the severity of the symptoms, the same step is sometimes repeated or medication is administered.

If there is a reaction to the skin prick test, an appointment will be made for a food challenge test

If allergic antibodies are measured in the skin prick test, there is still a good chance that an allergy can be prevented if the baby is younger than 11 months. Laurie experienced this herself with Viggo! A food challenge is then scheduled to see if an allergy has already developed. This appointment is usually within 2 weeks after the first consultation.

The food provocation test works in principle the same as described above. Only now more steps (4 or 8 in total depending on the size of the reaction of the skin prick test) are given, in order to reduce the risk of a reaction.

Tips for clinical introduction in the hospital

A clinical introduction is tough but the team and location are very good

For Viggo, various provocation tests were done in the hospital (including for peanuts, cashew nuts and milk). These are long, exhausting days, because your baby is not allowed to eat or drink in between and of course the naps go completely wrong. In addition, you are constantly worried about whether you will see a reaction.
However, Laurie can recommend a clinical introduction at the Reinier de Graaf Gasthuis to everyone (and other peanut clinics will be just as good). There is a team of experts ready who are very sweet, professional and kind and open to all your questions. The location is also great; with a very nice and beautiful play area!

Prepare for the provocation test

• Make sure your baby can eat a bite first.
  Start with mashed vegetables and fruits at 4 months. It is recommended to start with vegetables and give 1 type at a time and offer this 10 times. Suitable vegetables are cauliflower, peas, beans, broccoli, carrots or pumpkin. If you want to try fruit, start with banana, peach, pear or melon. If this goes well, you can try other types of vegetables and fruits.
• You will be asked to bring your own baby food for your baby
• Make sure your baby has not eaten too much before you start the provocation test, because they really have to eat large amounts
• Make sure your baby is not sick; otherwise you will have to reschedule the appointment
• Keep the eczema under control
• You may not take any antihistamines (anti-allergy medicine) for 3 days before the test.
• Do not introduce any new foods for 1 week before the test
• Bring something to eat and drink for afterwards. Bottle feeding/breast feeding/water is allowed
• It's going to be a really long, tiring day. Keep that in mind so you can maybe take it a bit easier the next day.

After completing the test, it is important that you continue to give peanuts, eggs and nuts!

If there are no reactions to the provocation and the doctor has examined and discharged your baby, then the test went well and your baby can eat the food!
The dietician will provide an information package for this, because it is very important that you CONTINUE to give peanuts, eggs and nuts weekly until your baby is 1 year old. You can use my first Follow-up kit for this.