help Us keep Julia safe//Managing her allergies:

• Julia is allergic to cashews, pistachios, walnuts, and pecans. She may be allergic to other foods (most likely other nuts). We will update this with additional allergies if more arise. Last update: June 19, 2025.

• Do not feed Julia any of the foods she is allergic to. Read food labels carefully as nuts can be hidden ingredients in different foods (vegan foods, pesto, lots of asian cuisines, etc). She also cannot eat anything that contains a label stating the food was “manufactured or processed on equipment that processes tree nuts.” Avoiding these potentially cross contaminated foods is a true crucible and requires really careful label reading. We (parents) should be the only ones deciding on if she can eat unlabeled foods (ie: restaurant/bakery items), as that is a risk calculus that only we should make.

• Do not bring any foods Julia is allergic to into our home. We are trying to ensure our home remains a very safe place for Julia, and given that she is at the stage of infancy where she explores by putting things in her mouth, keeping our home free of her allergens is very important.

• If your child (or you) have eaten the foods Julia is allergic to before visiting our home please make sure your hands, face, clothes, etc are clean before coming into our home (or before interacting with Julia out in the world).

• Beyond these physical risks, the biggest other risk is social. Please keep loving, snuggling, and playing with Julia. She is a very sweet baby and she loves spending time with people who love her.

Epipen Jr—In the event of a major reaction

People can be afraid to use EpiPens because it can be unnerving to administer a shot, BUT if Julia is having an allergic reaction that includes ANY of the following:

1) Full body hives

2) Any facial swelling

3) Vomiting + any hives

4) Any signs of difficulty breathing

5) Major shifts in personality

6) Limpness or any changes in level of consciousness

THen GIVE HER the EPI PEN JR IMMEDIATELY

EpiPen Jr (adrenaline dosed for children) is THE treatment for a severe allergic reaction. It works best when given early in the allergic reaction. You do NOT wait until the symptoms have gone from bad to worse to give the shot. You give it when the symptoms first appear. EpiPens come in a two pack because there can be something called a “biphasic reaction” where the symptoms resolve but then return (this can happen in a matter of minutes or in a matter of hours). If you give Epi, symptoms resolve, and then reappear, go ahead and give the second Epi. Anytime you’ve given Epi you are also calling 911 and going to the hospital to be monitored. Even if Epi wasn’t totally clinically necessary, it is much better safe than sorry. There are no major ill effects from using Epi.

Watch this video for a demo/information on EpiPens. Blue to the sky, orange to the thigh. Don’t pull the needle out too soon (or the medication won’t get in)… You’ll be nervous so sing a “Row Row Row your Boat” with the Epi Pen inserted to make sure you don’t pull the needle out too soon.

Our EpiPen Jrs are on the built in cabinet next to our dining table and inside our diaper bag.

Updates on allergen introduction and tolerance—last update June 20:

We had a major setback on June 10th where Julia reacted (face hives) to a teaspoon of mixed nut butter containing peanut, almond, walnut, hazelnut, and sesame that she had previously been tolerating. The feeding on June 10th was her 35th exposure to peanut butter, 29th to almond butter, 23nd to walnut butter, 18th to hazelnut butter, and 14 to tahini. 

Because the reaction on June 10th was a mix, we are now in process of retesting each of the nuts individually. We are starting with an even smaller dose than before and building up to a teaspoon (we hope) over the course of 11 days. We will work our way through these microdosing spoons the first three days, and then this miniature teaspoon set and then eventually to a 1/2, 3/4/ and full teaspoon. We hope. So far she has reacted with hives to walnut (microdosing). A reaction to walnut means a presumed allergy to pecan because the proteins are so similar (just like her reaction to cashew means a presumed allergy to pistachio).

She had a reaction to walnut on the afternoon of 6/14, which appeared to fully resolve without need for medication. But the morning on 6/15 she woke up early and started vomiting repeatedly and at one point a small rash appeared. Our pediatric urgent care line advised us that it could be a very delayed biphasic reaction and told us to give Epi and call 911 which we did. The ER doctor said it is unknowable whether this was a very ill timed, totally unrelated illness, or if this was allergy related.

It feels so deeply disheartening that she could develop an allergy to something we thought she was in the clear on. Our allergist said that because she is so young, we could just be watching these allergies develop real time. It has put us back into a place of feeling like food is very scary. Food being scary makes socializing hard since food is so often part of socializing.

We know this isn’t the hardest thing a parent could have to navigate by a very long shot, but nevertheless we are feeling very daunted by it at the moment. Centralizing where we share information is helpful because we are feeling snowed under by life in general + allergy, so we know we are not going to be the best at getting back in touch or sharing updates individually.

Beyond more hours in the day and more sleep— this video really sums up what we need most from other people in their communication about Julia’s allergy with us. Thanks for caring. Thanks for understanding that we are hanging on by fingernails and not at our best.

4) Pursue Immunotherapy

Pursue immunotherapy as a buffer against catastrophe, and in the best case scenario, as a pathway towards expanded food freedom