Darrell Sapp, Post-Gazette Nurse practitioner Beth Allison keeps an eye on her patient Maggie Goldman, watching for a possible allergic reaction after the 4-year-old ate a peanut in a "food challenge" at Children's Hospital. Despite being diagnosed with peanut allergy when she was a baby, it turned out she is not allergic now. Click photo for larger image.

Until a few weeks ago, 4-year-old Maggie Goldman had never lunched on a peanut butter sandwich, munched honey-roasted peanuts or crunched peanut M&Ms.

She's free to eat any of those treats now after undergoing a "food challenge" that showed despite earlier indications to the contrary, she was not allergic to peanuts.

"It feels like we have a whole new life," said Maggie's mom, Katie Goldman, of Mt. Lebanon. "It's unbelievable. It's been great."

When the girl was 7 months old, she had severe eczema and wasn't growing well according to standard pediatric growth charts. Her doctor advised that she be tested for food allergies. The bloodwork suggested she was sensitive to peanuts, sesame and egg.

So until about five weeks ago, Maggie had never tasted those foods.

"We went to a complete peanut and egg lockdown in the house," her mother said. "We were instructed to avoid those allergens [and] I was avoiding those allergens, as well, because she was still nursing."

Maggie's older brother, Ike, doesn't have food allergies, but he learned to be careful about washing his hands if he touched peanuts, and he didn't mind eating substitutes, such as soynut butter.

Out of necessity, Mrs. Goldman became a diligent reader of ingredient labels on groceries. She called food companies when she was unsure and grilled restaurant waitstaff about how, and with what, meals were prepared. And, once Maggie was old enough for it, she always kept on hand an EpiPen, which automatically injects epinephrine, in case the girl had a severe reaction.

Recently, a friend with a child who had food allergies also suggested Maggie see Dr. David Nash, an allergist and immunologist at Children's Hospital. After repeating conventional tests, he told the Goldmans that Maggie might not be allergic to peanuts anymore, and suggested a food challenge to be sure.

During that procedure, the child is given initially a tiny amount of the suspect food, which is then doubled at 15- to 20-minute intervals, explained Dr. Todd Green, who specializes in food allergy at Children's. The child is closely monitored and regularly examined.

Reactions can manifest as skin symptoms, such as redness, itching and hives; gastrointestinal problems, such as nausea and vomiting; and respiratory issues, including coughing, wheezing and respiratory distress, he explained.

"If there is any kind of reaction, we treat the patient and stop the challenge immediately," Dr. Green said.

The whole process takes several hours if all goes well, so "we tell people to bring DVDs and games to play."

In Maggie's case, medical staff suggested getting her cooperation by not giving her breakfast that morning and choosing a tempting snack, namely honey-roasted peanuts.

"It was sweet and it tasted good and she was starving," Mrs. Goldman said. Although since she was 2 the girl would ask whether a food item was safe, "she's one of those kids who is game for anything," her mom added.

Mrs. Goldman admits she was white-knuckled as Maggie popped the first peanut into her mouth and the challenge began.

"I spent her entire life training her, [saying] 'Look, this isn't for you, you have your alternative snack and it's just as good,' " she said. "But it worked out great and it's been a very positive experience. We're very excited about it."

After a total of 39 peanuts and no reaction, it was clear that Maggie was not currently allergic to them, if she ever was.

"It was like the weight of the world was lifted," Mrs. Goldman said. Her concerns about the girl's ability to avoid allergens had been growing as Maggie got closer to entering school and other situations where Mom wouldn't always be around to supervise.

Some patients appear to have allergies according to blood tests, but don't have a problem when eating the food, Dr. Green said.

Still, "there are patients with clear-cut histories and the lab testing is consistent," he said. "Those are patients we would not usually challenge."

One out of five children outgrows peanut allergy by school age. Even more children, some 80 percent, outgrow milk and egg allergies, he noted.

"You can outgrow an allergy and have it recur, as well," Dr. Green said. "There still is a lot of mystery and, luckily, there is a lot of work going into this."

Allergy specialist Dr. Ronald Landay, of Asthma & Clinical Immunology Associates, said he repeats skin and blood testing in allergic patients periodically to see where they stand.

The purpose of a food challenge isn't to prove an allergy exists, but to verify it doesn't, he noted.

"I have to be very much convinced that this is very safe and it is highly likely there is no allergy and we have no evidence of ongoing allergy before I'll even consider doing it," Dr. Landay said. "It's not appropriate for every food allergic patient."

Some children are so sensitive to peanuts that even a whiff of it sets off an allergic response, said Dr. David Skoner, director of allergy, asthma and immunology at Allegheny General Hospital.

He takes care of a handful of families who stopped going to baseball games at PNC Park, in one case because their child had a reaction when people in nearby seats shelled peanuts.

With firsthand knowledge of how disruptive food allergies can be to daily life, Mrs. Goldman considers her family to be very lucky.

Maggie was thought to be sensitive also to eggs, and for years her mother baked her special egg-free treats. After repeating skin testing, Dr. Nash allowed the girl to eat conventional baked goods. If she has no problems, she can try well-cooked French toast and more "eggy" preparations. Eventually, she might undergo another food challenge.

Indulging in pastries holds more appeal than eating peanuts for Maggie.

"She'd wanted a Smiley cookie forever," her mom said, adding now that she's had them, "she's a huge fan."