For this article, use will be made of the personal experience of 1 of the founders of Vini Mini. Laurie is on the with her middle son Viggo peanut clinic in the Reinier de Graaf Gasthuis . The procedure may be slightly different at other hospitals, but this gives an overall picture of the method.
The content of this article has been verified with the pediatric allergist of the Food Allergy Prevention Taskforce.
Whether you're better off giving peanuts and eggs in the hospital or at home depends on your baby's age and risk factors
First answer the 4 questions in the test to see if you can also give peanut and egg to your baby at home.
In the following situations, it is recommended to give peanuts and egg in the hospital
- Your baby is older than 8 months and has moderate to severe eczema
- There is an earlier acute reaction been on another food
Discuss the best route with the doctor in the following situations
- Your baby is between 6-8 months and has moderate to severe eczema
- There is a food allergy in the family or another reason that you are nervous to introduce at home
How does an introduction to the hospital (clinical introduction) 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 clinics with all facilities for babies and with the necessary manpower and equipment if there is a reaction. (Pediatrician) allergists, pediatric dieticians, doctor's assistants and pediatric nurses work together there.
Which hospitals can I go to to give peanuts and eggs to my baby?
See below, among other things, where you can go with your baby:
- Reinier de Graaf Gasthuis, Delft
- Martini Allergie Centrum, Groningen
- Noordwest Ziekenhuizen, locatie Alkmaar
- Deventer Ziekenhuis, Deventer
- Elkerliek Ziekenhuis, Helmond
- Catharina Ziekenhuis, Eindhoven
- Erasmus MC/Sophia Kinderziekenhuis, Rotterdam
- Amsterdam Universitair Medisch Centrum, Amsterdam
- Diakonessenhuis Utrecht
- Albert Schweitzer Ziekenhuis, Dordrecht
The hospital will call you prior to the appointment to coordinate further
If you have been referred via the 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 the hospital's procedures so that you can properly prepare for the visit.
Before the appointment you will be called by a pediatric dietitian 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 peanut or egg. For this, a drop of allergenic protein is pricked in the arm of the baby. After 15-20 minutes, the puncture site on the skin is viewed and assessed for a response. Based on the magnitude of the reaction of the skin prick test, it is determined whether and to what extent antibodies are present.
This sounds scarier than it is, but it's not that bad in the end. The bumps can itch, so you should try to keep your baby from touching the spots as much as possible.
If there is no response, your baby will be given peanut or egg in a fruit or vegetable bite for the first time that same afternoon through an open food challenge test.
If there is no response to the skin prick test, peanuts and egg will be given to your baby the same day through a food challenge test
First, a consultation with the pediatrician-allergist takes place
First of all, a consultation with the pediatrician-allergist takes place. Your baby is weighed and measured and checks such as temperature and breathing take place. In addition, the baby's eczema is thoroughly examined and assessed. This is the starting point and can be compared to a possible allergic reaction.
Then the food challenge test starts with increasing steps peanut or egg
After this physical examination, the food challenge test starts.
If there has been 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 peanut bite. At each step, the nurse completes a checklist that looks at allergic symptoms such as hives, runny nose, watery eyes, abdominal pain, nausea and/or crying. In the event of complaints, the provocation is discontinued. Depending on the severity of the complaints, 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 during 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 of the first consultation.
The food challenge test basically works 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.
After going through the test, it is important that you continue to give peanuts and egg!
If there are no reactions to the provocation and the doctor has examined and discharged your baby, the test has gone well and your baby can eat peanuts and egg!
The dietician will provide an information pack for this, because it is very important that KEEP giving you the weekly dose of 3 teaspoons peanut butter and ½ egg until your baby is 1 year old. You can use the use my first peanut Follow-up kit.
Tips for clinical introduction to the hospital
A clinical introduction is tough, but the team and location are very good
For Viggo, various provocation tests have been performed in the hospital (including peanuts, cashew nuts and milk). They are long, grueling days, because your baby is not allowed to eat and drink in between and with the naps things also go completely wrong. In addition, you are constantly worried about seeing a reaction.
Laurie can, however, recommend a clinical introduction to the Reinier de Graaf Gasthuis to anyone (and other peanut clinics will be just as good). A team of experts is available who are very sweet, professional and nice and are open to all your questions. The location is also top notch; with a very nice and beautiful play area!
Prepare for the provocation test
- Make sure your baby can eat a snack first.
Start offering mashed fruit and vegetables at 4 months. It is recommended to start with vegetables and to give 1 variety at a time and to offer this 10 times. Suitable vegetables are cauliflower, green 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 fruits and vegetables.
- You are asked to bring your own baby food for your baby
- Make sure your baby has not eaten too much before you start the challenge test, because they are really large amounts that they need to eat
- Make sure your baby is not sick; otherwise you have to reschedule the appointment
- Get the eczema under control
- 3 days before the test you should no longer give antihistamines (anti-allergy medicine)
- Do not introduce any new foods 1 week before the test
- Bring something to eat and drink for afterwards. Bottle feeding/breastfeeding/water is allowed
- It's going to be a really long, tiring day. Keep that in mind so that you can take it easy the next day.