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PostPosted: Thu May 10, 2007 12:56 pm 
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Joined: Wed Mar 01, 2006 12:52 pm
Posts: 14
Location: Pembroke, Ontario
Hi,
My daughter is 3 1/2 years old and allergic to peanuts. We are due to see Dr. Ham Pong at the end of May. At our last visit 18 months ago, he said quite possibly he may want to food challenge her before she starts school in the fall. I will give you a bit of background. She has never had an anaphylatic reaction, has had some mystery hive bouts (but none that we could directly link to peanuts). She was diagnosed PA at 12 months. We were having her tested because she had some trouble as an infant with soy and milk formulas. They has tested her for PA and this is how we found out. The only known contact she has had is she picked up a peanut off ther floor in my aunt's hotel room around 11 months and put it in her mouth. She has no reaction. Her skin test has been positive. 2mm wheal and her blood test was positive, she scored a 2. Would you let the doctor go ahead with a challenge? I am really worried about this, and I am very unsure about what to do. Very stressed at this point as the appointment is getting very close. Any suggestions about questions I should be asking the doctor? Any help would be great.
Thanks
Karen


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PostPosted: Thu May 10, 2007 1:22 pm 
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Joined: Thu Sep 22, 2005 11:39 pm
Posts: 1141
Location: saskatchewan, canada
Quote:
blood test was positive, she scored a 2.


Are you refering to a RAST here? From my understanding...if the RAST score is below 0.35 then a food challenge would be appropriate.

_________________
DD age 9 1/2 -peanuts, nuts,
DD age 7 1/2 - milk, eggs, chicken, peanuts, treenuts, cats, dogs,
DS age 2 1/2
Husband- asthma, eggs, treenuts, fish, shellfish environmental
Self - penicillan, eurithromiacin, mild laytex allergy.


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PostPosted: Thu May 10, 2007 1:57 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
What is the purpose of the food challenge?

If it is believed that someone has outgrown an allergy, tests negative, then I would say do a food challenge.

But, if your daughter tests positive, I don't see any advantage of a food challenge. Does the doctor think it's a false positive? (It does happen.) Or, does he want to know if your child will have an anaphylactic reaction before starting school? A challenge won't answer that -- it will only show what her reaction is on that particular day -- the next reaction could still be anaphylactic.

Will there be different precautions in place dependent on the result of the challenge?

******

Every exposure is an exposure.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu May 10, 2007 2:56 pm 
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Joined: Wed Mar 01, 2006 12:52 pm
Posts: 14
Location: Pembroke, Ontario
Hi,
Thanks for your quick response. To answer some of your questions, I was referring to the rast test when I said she scored a 2. I am not really sure why he wants to food challenge her, (sounds like a stupid response) however, it was 18 months ago and it was the last thing he mentioned. He seems to think she has a good chance of outgrowing the allergy. He has never said he thinks it is a false positive, but I will most certainly ask when I go. I know for sure he is going to skin test her again before he decides anything. Have you ever heard of anyone being food challenged when they were having positive skin and rast tests? My first instinct at this time would be no challenge but I want to make sure I have all my facts and info straight before I go. Thanks for your help!!!!!!

Karen


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PostPosted: Thu May 10, 2007 7:38 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
It's not a stupid response at all. I don't always know why my doctor wants some specific test done. That's why he gets paid the big bucks. :lol:

Ultimately, it is your decision whether or not to allow a food challenge. If he feels your daughter might outgrow the allergy, maybe his intention is if she tests negative he wants a food challenge before fully believing it isn't a false negative. In that case, I think eating it in an allergists office or a hospital is a great idea. Much better than the first try being at home.

If she tests positive again (or no test is done) and he wants to do the challenge, ask him why and decide whether it sounds like a reasonable reason. Decide in your own mind -- if she tests positive but does not have a reaction at the challenge, will you change anything about your diet or reading labels.

Good luck, and let us know what happens.

Oh! And to answer your question, I don't recall anyone posting about doing a challenge when they tested positive. That doesn't mean it doesn't ever happen -- just that I don't remember it.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu May 10, 2007 11:01 pm 
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Joined: Thu Sep 22, 2005 11:39 pm
Posts: 1141
Location: saskatchewan, canada
Quote:
I was referring to the rast test when I said she scored a 2. I am not really sure why he wants to food challenge her, (sounds like a stupid response) however, it was 18 months ago


Is your doctor planning on re-testing (RAST) prior to the food challenge?

My oldest daughter scored 0.65 on her RAST at her last appointment. My doctor was quite insistent that she was still potentially anaphylactic and to continue obsessively monitoring her food...and that she is NOT a candidate for a food challenge.

_________________
DD age 9 1/2 -peanuts, nuts,
DD age 7 1/2 - milk, eggs, chicken, peanuts, treenuts, cats, dogs,
DS age 2 1/2
Husband- asthma, eggs, treenuts, fish, shellfish environmental
Self - penicillan, eurithromiacin, mild laytex allergy.


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PostPosted: Fri May 11, 2007 10:21 am 
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Joined: Tue Nov 29, 2005 4:04 pm
Posts: 2044
Location: Gatineau, Quebec
I would think that the allergist would ensure that there are up-to-date skin prick test and RAST test results before going further with an oral challenge. Along with the patient history, that is what allergists base their decisions on regarding doing an oral challenge - the test results. So I would think that he will do both tests again before proceeding further.

If it were me, I would ask what percentage of his patients have passed the oral challenge when they have had X test results (X being the results that you get at your next visit and with the next RAST blood test). That might give you some indication of how it might go. I like to think that see an allergist would not suggest an oral challenge if s/he didn't think the patient would pass. What is the point of doing that?

I would also ask for a written explanation of exactly how the challenge will be done. It will be done in-office with Dr. Ham Pong, I believe, because CHEO no longer allows oral challenges to be performed in the hospital (as far as I know).

Last fall, my older son (8 years) had mild positive results for his peanut SPT and RAST tests, and our allergist (who works with Dr. Ham Pong) said he was a candidate for an oral challenge . I am okay with that but my son is not, so we are respecting his wishes for the moment. He wants to wait until he is 9 or 10. (I will let you know what he says when he reaches that age!!) I am not comfortable insisting that he do the challenge - because what if he did react... and then I would feel terrible that I'd insisted. (And I know this totally goes against my previous comment about the allergist not suggesting the challenge unless they thought the patient would pass.)

On the other hand, there are kids who outgrow a peanut allergy (and I'm sure there are some who were perhaps never allergic in the first place) so it is worth looking into, in my opinion. I also know that they stop challenges as soon as the slightest symptom appears (e.g. one hive).

Just fyi - we have had 2 members of my local (Ottawa) support group whose kids have outgrown their peanut allergy.

But as AnnaMarie said, ultimately it is your decision. If you are not comfortable doing it, you don't have to do it.

It really is one of those situations where you wish you had a crystal ball, I know...

K.

[Edited to indicate that an oral challenge with Dr. Ham Pong will be done in-office. Allergists in other cities may be able to do oral challenges in hospitals.]

_________________
Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


Last edited by KarenOASG on Sat May 12, 2007 7:32 am, edited 1 time in total.

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PostPosted: Fri May 11, 2007 11:26 am 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
Quote:
(And I know this totally goes against my previous comment about the allergist not suggesting the challenge unless they thought the patient would pass.)


Doesn't really go against it. If an allergist had a magic ball and absolutely knew the challenge would be passed then there would be no need for it at all.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Sun May 13, 2007 6:45 pm 
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Joined: Wed Mar 01, 2006 12:52 pm
Posts: 14
Location: Pembroke, Ontario
Thanks for all your responses. It answered many of my questions and provided me with the information I was looking for. I most certainly feel I can go in to the appointment prepared now with the information I need.
Her appointment is at the end of May and I will post after the appointment and let everyone know how it went.
Once, again thanks for the support!!!!!! :D


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