Advice appreciated...negative blood test for PN??

[IowaMom]

I'll try to make this short- having problems concentrating as I just received the results back from DDs PN test and it was <.35.  Brief hx:

Reaction at age 2 involving skin and flushing only.  Tested, and at that time I believe it was around 2.0.  Tested again a year later, and I think it was 1 something.  3 years ago, it went down to .45, so we had her skin tested.  Her wheal was something like 17mm, so we went about life as usual.  2 years ago, blood test jumped up to 11.  I didn't have her tested last year, and this year it's negative.  They sent me an email that I should set her up for skin testing, but I've long wondered whether or not her eczema (which she still flares once in a great while) had anything to do with her large hive when we skin tested.  I'm feeling that maybe it's time to just do an oral challenge, but not sure if the doc is going to feel that way.  Unfortuantely, my daughter has SEVERE anxiety when it comes to medical procedures AND her PN allergy, so I have no idea how I would get her to do an oral challenge.  It took 3 of us to hold her down for the blood draw.  Is there some kind of medication they can give her beforehand to help her relax?? Unsure if anxiety symptoms would skew the challenge.  I know I'm rambling. I just have no idea what to do at this point, but if DD has outgrown as all of you well know it would be like winning the freaking lottery!  Any advice would be much appreciated. Thank you in advance!

[Macabre]

How old is she? 

It seems like a double blind placebo oral challenge might be a good idea if you go the IOFC route.  If she is old enough to tell you symptoms, I would consider that route. 

Wow--that would be incredible!

[CMdeux]

 

What Mac said.  That would be really terrific!!

If your doctor isn't sure how to set up a placebo controlled challenge (single-blinded-- so s/he knows, but you and your DD don't), we can help give you an idea of how that works.

It's how we always do challenges with my DD, because her earliest symptoms tend to be subjective, but also severe enough that waiting on objective ones while you continue piling on doses is a-- well, it's not a good idea.

[GingerPye]

Wow, how wonderful that would be!!

My kids had the same anxiety about blood draws --- Emla cream helped a great deal. 
As far as eating the allergen during a challenge --- well, twice we had tried with DS and he just refused.  Therefore the allergist stopped the challenges and said we needed to wait until he was mature enough to understand (and not freak out about) what we were trying to do.  Which did happen.

Otherwise, that double blind placebo challenge sounds promising.

[IowaMom]

Thank you everyone for your responses! One thing I"m struggling with is whether to repeat the skin test.  I guess I feel like if it's negative, great- then I won't worry about a challenge as much.  But if it's not, how would I know if it was a false positive?  And, if positive, do I still ask for a challenge??

[CMdeux]

Honestly, our understanding is that skin testing is of quite limited utility with stuff like this.  Skin tests can remain positive without a clinically meaningful allergic response, and in some people the skin tests aren't as meaningful for foods as they are for other individuals.  It depends, I guess, on how reliable they've been as an indicator of clinical allergy in the past-- for this individual.

In my DD's case, for example, she has a history of not producing very impressive skin responses to things she's actually allergic to.  We've not seen a "false positive."  So if SHE skin tests negative, I'm still not much at ease.  If she skin tests positive, I'm seriously freaked.

[GingerPye]

never mind.  I see CM addressed it.