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PostPosted: Mon Sep 08, 2008 1:25 pm 
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Joined: Fri Apr 06, 2007 9:01 pm
Posts: 69
Location: Ontario, Canada
During my sons's routine physical last month I asked about when he should go back to the allergist. I think he should be prescribed an epi pen before he starts school next year (even though he has not had an ana reaction) and our Dr won't prescribe it because the allergist's notes say my son is at low risk of ana reaction - I'm okay with this because we have an epi for him anyway and I recall the discussion with the allergist at the time.

The allergist's notes said my son should go back between the ages of 2 and 5 - he's just turned 3 - for additional testing, so the doctor sent in a referral. The allergist's office called Friday and we're going this Wednesday morning.

At the original appointment my son was 13 months old so the allergist did only 5 skin pricks for things I had seen reations to or they felt were common (egg, milk, soy, dust and dog - only positive for egg and milk). I'm not sure what to expect this time. I only have 1 other thing I've seen reactions to since the original appointment.

What do you think will happen on Wednesday? What should I be doing, asking, etc.?

Btw I wasn't very impressed with the allergist's attitude when we met before. He spoke mostly to the student who handled the case and very little to me. So, I'm a bit nervous about going there again.

_________________
Jan, mom to 3 boys
DS#3 - eggs, cats, dust, eczema, avoiding nuts as a precaution
DS#2 - seasonal allergies
DS#1 - no allergies
Me & DH - seasonal allergies


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PostPosted: Tue Sep 09, 2008 7:02 am 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6468
Location: Ottawa
Your appointment should be similar to the last in that the test will be another skin prick test. You will probably be asked if your son has had any more reactions.

Allergic reactions are very difficult to predict. It takes years of experience to be able to determine the risk of anaphylaxis. Some of the determining factors are the type of allergen. Peanuts are usually an automatic prescription for an auto-injector because such a small ammount can cause a large reaction. Contributing health factors such as asthma intensify the issue. Studies have shown that when deaths occured asthma was a contributiing factor. The size of the wheal is also taken into concideration but it is not the sole determining factor.

You have a right to be treated as an integral part of your childs health care team. It will be you who makes the decisions 24/7 and you need the information to do this. Ask why the Dr is or isn't giving a prescription for the auto-injector. Ask what other foods you should be avoiding. Ask when you can introduce new foods from the top 10 allergens. Ask when you should make the new appointment. Ask when you should go to a hospital and how long you should stay.

Write down your questions before you go. Bring a sheet of paper and a pen. When you enter the consulting stage of the visit, take a seat and do not stand up until your questions are answered. "I have a few questions and I would like your advice..."

If you don't feel that you can speak with your allergist, you may want a second opinion. This is a relationship that you will have for some time to come.

_________________
Moderator
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: Thu Sep 11, 2008 5:19 pm 
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Joined: Fri Apr 06, 2007 9:01 pm
Posts: 69
Location: Ontario, Canada
Thanks for the advice Susan. I did take a written list of questions but I only had the opportunity to ask one of them. I am asking around for names of other allergists people have seen in my town just in case I want a second opinion.

Here's the update I posted on another website I belong to:

I should preface this by saying I am not impressed with the allergist who saw J which may colour my story but I’ll try not to let that happen.

J went to the allergist’s office on Wednesday morning and the first comment from the receptionist made me a bit nervous. They weren’t sure why J was there – even though the report sent to our family doctor 2 years ago said he should go back when he was between 2 and 5 years old – so he had been booked for a “first” visit.

The lady who does the skin prick tests looked at his records and we decided to do 7 tests; egg, milk, cat, dust, soy and two that escape me now. After the ten minute wait she checked him and said “oh, we have egg, milk, cat and dust”. Then we went to wait for the intern.

The intern interviewed me, asking about reactions in the past two years. I explained that J had very limited contact with milk or eggs, that we have a cat but I have witnessed reactions to other cats and to dogs, and about the springtime sniffles, itchy eyes, etc. I told her that J reacted most recently to one bite of pasta sauce containing milk. His reaction was red rash on his face for about 2 days, itchy, eczema like skin for a week and diarhea for a few days. I told her he’s never had breathing problems or an ana reaction. J wouldn’t let her look in his nose or throat.

She went to get the allergist – gone about 2 minutes – the allergist spoke to the intern to get the low down but kept glancing at me. He asked a few questions about the type of reactions J has had both initially and in the time since his first visit. I explained them again. After that he said he thinks J has outgrown the milk and egg allergies. He said we need to talk about the dust allergy – seemed urgent. He and the intern decided to send J for blood work for RAST. He thinks he’ll suggest a food challenge and we’ll discuss the dust allergy after he has the RAST results.

Two years ago the allergist recommended delaying introduction of peanuts/nuts so I asked about when/how to do that and his response was (this is exactly what he said) “Do what you want”. At least he followed up by saying the thinking has changed lately and he no longer supports waiting to introduce foods. He said I can give J a PB sandwich and call if there is a reaction.

I overheard him telling the intern that a rash on the face, eczema and diarhea are not good signs of a food allergy. Not sure what to think since these were the same symptoms that lead our family doctor to send J two years ago.

So, off I went to the lab to get J’s blood drawn. He was not a happy boy but did very well all day. J goes back to the allergist for the results on October 8.

Since then I've looked online and I see conflicting reports about the accuracy of the skin prick and RAST tests. I think my son will end up doing a food challenge. I hope everything goes well.

_________________
Jan, mom to 3 boys
DS#3 - eggs, cats, dust, eczema, avoiding nuts as a precaution
DS#2 - seasonal allergies
DS#1 - no allergies
Me & DH - seasonal allergies


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PostPosted: Fri Sep 12, 2008 6:46 am 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6468
Location: Ottawa
Did you even get to speak to the allergist or were you dealing with the intern? Did anyone record the size of the wheals (hives brought on by the skin test)? Our allergist braws in pen around the wheal and then uses a pice of tape to remove the ink and place it in the patient file. Size of the wheal alone is not enough to make determinations from but it is a useful piece of information.

I would not be happy if I was not speakign directly to the allergist and I would ask for a secnd opinion if another allergist is available.

Re; skin prick tests and RAST tests. Each test has it's own merit and also it's own flaws. The gold standard is the oral challenge. If you can eat the food without a reaction you do not have a life threatening allergy. It reminds me of medevil times when they would tie up a woman and through her into the lake. If she drowned she was not a witch; if she survived, she was burned at the stake.

I spoke to my daughters allergist about the irony of being an objective thinker in such a subjective field. He tended to agree with me and said that this is why you truly need an allergist to interpret the reactions. It takes years of experience to bring all of the pieces of the puzzle (family history, reactions, missed reactions , behaviours, exposures etc) together with all of the current research and statistic available and for all of this to be able to make an informed opinion as to the severity of the allergen and the oath to follow for optimal health...it is not as simple as reading a test result.

_________________
Moderator
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 Sep 12, 2008 9:02 am 
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Joined: Fri Apr 06, 2007 9:01 pm
Posts: 69
Location: Ontario, Canada
Thanks for the reassurance Susan.

The lady doing the skin pricks did measure the wheals with a ruler. I am not sure where she recorded the results as she didn't share them with me.

I had little opportunity to speak with the allergist, once he entered the room it was to speak with the intern. All of the history, etc. was done with the intern. The allergist came in to give his "announcement" and see what the intern wanted to do as follow-up.

I will take J back for the RAST results and I'm sure he'll need to do the challenge but I don't think we will be doing any more follow-up with this allergist.

My biggest concern is that the allergist is only looking for an anaphalactic allergy which I don't think is the case here. I think he's ignoring that there may be a food allergy without an ana reaction.

I've been doing some research because this is really bothering me. I found the following quote from J's allergist in a Today's Parent article "(Mild rashes around the mouth don’t necessarily signal allergy, notes Moote, since this can occur when acidic foods such as tomato sauce irritate the skin.) ". I think this is part of the problem - the food J reacted to last was spaghetti sauce, but he doesn't react to any other tomato sauces just Ragu which has milk in it. I actually thought he might have problems with tomato before he first saw the allergist because Ragu was our regular sauce, after reading the label we stopped using it and no problems with sauce since then other than the mistake at daycare. The reaction wasn't just a rash around the mouth it was all over his face and his eczema popped out and he had diarrhea.

I must try to be more patient and not let this upset me so much.

_________________
Jan, mom to 3 boys
DS#3 - eggs, cats, dust, eczema, avoiding nuts as a precaution
DS#2 - seasonal allergies
DS#1 - no allergies
Me & DH - seasonal allergies


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