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PostPosted: Thu Mar 19, 2009 8:58 pm 
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I feel in my gut that my son doesn’t have a peanut allergy (since he’s never tested positive) but his allergist says he needs a food challenge.

Here is our background information: I have a four-year-old son who has several allergies. When he was two he had peanut butter and started sneezing and his eyes watered and his face got red and a little swollen from the sneezing & eyes. He had just come in from being outside and with a dog, both of these factors come into play later on. At that time we took him to ER and were referred to an allergist. At the allergist he tested negative on the blood test and “borderline” on the skin test to peanuts. We found out at that visit that he was allergic to eggs (something we weren’t aware of because he had never had them). He said to come back and check again in a year. During that year between visits, we realized our son also seemed to have some seasonal allergies and dog allergies. He’d sneeze and get watery eyes and his face would turn red when he was exposed to dogs or be outside at certain times of the year – just like we saw when we thought he was having a reaction to peanuts. When we went back the following year we told him what we experienced so he tested him for those allergies, along with peanuts again, and we found that he is allergic to mold (outdoor/seasonal), but not dogs. Also at that time, the peanut test showed negative for both blood and skin test. When our son was around dogs, he continued to have a reaction, so I know a test isn’t always accurate (now he doesn’t always have a reaction – it depends on the dog and the house). During the next year our son had some tree nuts and had no reaction to those (walnuts & pecans), however he did seem to react to cashews and pistachios so we’ve been more careful with tree nuts & those warnings as well, but he’s never been tested for those. His allergist said he needed to have a food challenge to determine if he’s allergic to peanuts.

His primary care Dr. says we don’t need to go back and have a food challenge (not to put him through that), but to just assume he has these allergies and live with it, maybe do it later.

Here’s my questions & my concerns: Does he really need to have a food challenge since he’s never really tested positive? If not, then what? My view is that the doctor is assuming he has an allergy based upon the reaction we relayed to him. However, after seeing a similar reaction to dogs and outdoor mold, the peanut butter may have been a coincidence, and not a true reaction to peanuts. The “borderline” reading makes me think that it probably was just the bump that appears on every skin test, but to be safe the doctor called it borderline. We’re frustrated. I don’t know that I’d give my son peanut butter anyway, but I would like to know for sure what his allergies are (he’ll be going to school next year) and I feel like his allergist isn’t very helpful. Each time we’ve had to go back in after he’s had other reactions, instead of him doing a full panel the first time around. And when we’ve raised questions and concerns he’s kind of blown us off, treating us like dumb parents. My sister’s daughter is allergic to peanuts and she’s always had testing done by her pediatrician, while we are going to a special allergist. He runs a lot of studies with our local university so I’m sure he’s a great doctor, but I always leave there feeling more confused than ever because he doesn’t give us any information and blows us off so much. We ask questions or raise concerns and his basic answer is “hmmm.” It’s so frustrating. He seems like he’s thinking about what we’ve said, but never answers us. I’ve heard of kids “outgrowing” a peanut allergy and haven’t heard any talk of them doing a food challenge to rule out the allergy, after a positive test they had a negative one and their doctor said they had outgrown it.

Any advice? Maybe I am just being naïve or the fact that I’m not happy with the Dr is clouding our perspective.


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PostPosted: Fri Mar 20, 2009 8:01 am 
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Hi, you are seeing first hand just how difficult it is to determine what a person is allergic to. Peanut allergy is a serious diagnosis. The majority of food allergy deaths are from peanut allergy so a Dr is loath to remove that diagnosis with out being certain that the individual is really not allergic. The gold standard is an oral challenge.

Because there are false positives and negatives from both the RAST and the skin test and because the desire is to restrict the diet as little as necessary, most allergists will only test those allergens they suspect the patient to be allergic to. That means you need to react first, then have a test to confim and then, if diagnosis has been made an oral challenge to remov that diagnosis.

I hope this helps. Do ask the allergist to answer your questions or direct you to another source. Be specific, "Dr. I have some questions I would like you to answer for me." :)

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Fri Mar 20, 2009 11:46 am 
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The allergist may not have the best manner in this case, but I can see why he wants to do the oral challenge.

Because reactions to peanut can be very serious, it's a good idea to at least rule it out with the most accurate test. In this case, that would be the oral challenge.

You have to appreciate that if your boy turns out be allergic to peanut, avoidance alone wouldn't be your only strategy. You have to read all food labels, watch for cross-contamination of knives, breadboards, etc. in the kitchens of others. You'd need an auto-injector in case of emergency. You'd need to warn daycares, schools, anyone who's care you left him in.

Quite possibly your son does just get weepy, sneezing around dogs. But the only true, reliable test for food allergy is a food challenge (they do this with a small amount of the food to start - to minimize the chance of a serious reaction).

In my book, it would be worth doing for the peace of mind. This would tell you definitively whether your boy's food allergic. And then if he was, you'd learn/know what precautions to take. Hope that helps.

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Allergic to soy, peanut, shellfish, penicillin


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PostPosted: Fri Mar 20, 2009 1:16 pm 
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Thanks for your replies!

Just so you know, we are very careful about this allergy still, even though I have other feelings about it. I probably sounded like a neglectful and in denial mother, but I'm not at all. Just confused about it all. I do carry an epipen for my son and there's one at his preschool too. We bring his own snack to preschool all the time as well and I'm very careful in our home. We were avid label readers to begin with because we're vegetarian so doing that was nothing new to us. I nursed my son until he was two and when he was 9 months old we realized he had a dairy allergy (through me consuming dairy products) so we also gave up dairy and eggs at that time and went vegan (we didn't find out until later that he was even allergic to eggs). He outgrew the dairy allergy, and we have four kids and they sometimes have dairy but none of them consume eggs. My husband and I don't eat either of them so they're never even in the house.

I think we'll probably try to do the food challenge this summer, before school starts so I have a better idea of what his allergies are once he's in kindergarten.

Thanks again!


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PostPosted: Fri Mar 20, 2009 2:53 pm 
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Oh no, you didn't sound neglectful - hope I didn't imply that!

Just thought that if you're new to food allergy, the tests alone can be confusing. You can get either false positives or negatives with the skin-prick test and immunocaps (mostly false postiives).

But the oral food challenge is considered very accurate - the gold standard. The allergists just don't use it in cases where there's a high risk of anaphylaxis.

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Allergic to soy, peanut, shellfish, penicillin


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PostPosted: Fri Mar 20, 2009 3:22 pm 
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The food allergies aren't new to me, I think I'm just feeling really confused because the dr isn't the most helpful, and overwhelmed with him going to school in the fall. His preschool (in the school system) doesn't seem to be the most knowledgeable about it and with two older kids in school I see all the food that is brought into the classroom on a regular basis that he can't eat. The teachers just don't seem to take it seriously and his preschool teacher kind of acts like it's annoying, and that worries me. He is really good about it though and we don't make a big deal about stuff he can't have because I make him equally good (actually better) tasting stuff at home. It's just a drag worrying about it. I'm sure everyone else with food allergies feels the same way.


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PostPosted: Fri Mar 20, 2009 5:14 pm 
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Why don't you make an appointment to discuss your concerns with the school? Your child is probably not the first at the school with food allergies.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Sun Mar 22, 2009 7:13 pm 
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Joined: Fri Jan 09, 2009 1:36 pm
Posts: 37
[quote="mtpete"]I

His primary care Dr. says we don’t need to go back and have a food challenge (not to put him through that), but to just assume he has these allergies and live with it, maybe do it later.
.[/quote]



Welcome,

I have to say that i am shaking my head that your primary care Dr. is saying to just assume he has these allergies and live with it, not to put him through a challenge. What is there to put him through..eating the PB in a controlled setting..a little worry. Honestly, if you fully feel that this PB allergy is not what they are saying it is, i would first...seek a new allergist if possible that can answer your questions fully and is up on the latest allergy info. The fact that he tested mildly positive on his skin tests, and neg. on his bld test tells you little. An oral challenge is the only way to know for certain. Many allergists have guidelines with the bld work, and challenges, but they could tell you what they are in your circumstance. Generally if the bld. work is above a certain number the risk is too high and they wouldn't do the challenge. But your son's was neg. . My son for the last three months has been undergoing food challenges. We hope to rule out all of them. If you look back at my postings you will see that he did test positive on his skin test for both almond, and hazelnuts, and mild-mod positive on his skin tests, peanut was neg. for both. Well, he passed ALL of his food challenges so far and is eating them weekly if not daily (esp. hazelnut, he loves Nutella ;0) } Thankfully we found an allergist that was proactive and who did challenges. He said had our son been his patient years ago he would've challenged him then. So as you can see allergists can be very different in thinking. I know it's scary to think about giving the very thing they have been allergic to but i can tell you personally i'm Sooooo glad we did. We put our fear aside and did the challenges. Just to see my son's huge smile now that he can eat many of things he avoided for years, is worth every grey hair. I know some people genuinely have food allergies and shouldn't be challenged, but your son's sounds like one that should be.
My son's allergist says so many people avoid challenges out of fear and it's a shame because they are restricting their diets for nothing. We are examples that you can have positive skin and bld tests and still tolerate the food allergen.
IMHO you should seek another opinion. Good luck. If you have any further questions about challenges i would be happy to answer them to the best of my ability.

Suzanne

Son recently passed peanut, almond, hazelnut challenges. Still pos. to all other tree nuts but oral challenges are booked for all the nuts in question for near future. Age 10


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