typical allergy testing protocols?

[becca]

We have not had testing done for a very long time, but when we did, our allergist would only test a few related allergens and a few typical environmentals.  He was opposed to testing to broadly without reaction histories to substances or foods.  We currently have the ped check her RAST for PN, TN, egg every few years.  I do think we need to see an allergist to explore environmental allergies.   

I am a member of a group on FB, and just saw photos of a very young child  covered with what looked like 30 patches up and down her back and arms.  Is this typical, or why would one need so many tested at one time?  I think I would get hives from that anyway, and I have no know allergies, but can have dermatographic skin at times. 

[hezzier]

DS had 26 environmentals tested, our new allergist prefers to spt on the arms not the back.  We then had to go back for intradermal testing of 6 items so she could make up the proper allergy shot solutions.  DS currently gets 4 shots each Monday.

[hezzier]

How old was your DD when the last testing with the allergist was done?

When DS was young, the allergist only did a pediatric panel for environmentals and maybe there were 10 spts, but they had mix for grass, for trees, etc, instead of testing each type of grass common to the area.

[becca]

Well, dd had RAST done  in the past year, just for egg, PN, TN.  No skin testing since around 8-9 years old, I do not think.  She has never had testing for any EAs other than cat, dust, I do not think.  She is + for dust and cat.  We probably have a dusty house, just maybe.   

I think we need to schedule some skin testing and really dig into purging the house so we can get her room and all th ebedrooms empty and pull the carpeting.  Lay down HW.  We want ot anyway.  Just so much junk around!  It is overwhelming, but she is miserable.  The carpeting is simply to old, even though theirs look pretty good.

So, that much testing is typical?  I mistyped above.  The picture I saw was 30 patches, as best I could count.  I was wondering if that is excessive, but sounds like your ds underwent a similar testing.

[ajasfolks2]

Becca,

Some of what I see and hear in my area of country is that some allergists go to the max on the diagnosing end of things -- yes with 30+ SPTs in one fell swoop.  I think this is part of the "test for everything" mentality that is becoming more prevalent in MDs, even if not necessary for the symptoms presented by patient.  (Sometimes "test for everything" is part of the "make sure we cannot be accused of not taking all and extreme lengths for diagnosis".)

In years past (and in older docs we see) there was/is more conservative approach -- test for just the immediate concerns and Top 8.  Come back for more testing on other things as warranted.  False positives on SPT (& then unnecessary worries or eliminations) has always been a reason given for NOT doing tons of testing all at once.

Different docs do have different approaches.  Personally, I've always wondered if the tons-of-testing-at-once is a money maker for the docs -- why not do 25 in the same time they can do 5 and then maximize profit, right?  You can run more patients through at higher $/patient in about the same time.  (If they are using those "caterpillar stamp" type pricks, then it really is fast compared to the individual hand pricks, though even those are faster now.)

[becca]

False + is my concern.  Reaction history trumps testing, right?  But, I can see with environmentals, if trying to diagnose for shots and eliminating allergens in the home, etc...  If it is reliable.  Is it?

I think we need to basically gut our home.  Sigh... 

[hezzier]

A false positive in an environmental isn't going to alter your life like removing say wheat from your diet due to a false positive.  I guess in order to ferret out what she's allergic to, you have no choice but to test a bunch of environmentals.   So hard to just use reaction history only with environmental allergies...which allergen is causing the stuffy nose?

Becca- is your DD on a daily antihistamine? 

[becca]

We have used Claritin, and Zytec, and she seems to think Claritin is better, but I think I will get Zyrtec again after this runs out.  I think she is catching more colds due to chronic sinus issues, which muddies the waters. 

This is all pretty new over the past 9 months or so.  I am guessing that since I stopped hiring cleaning help about 2 years ago, that I do not keep up with the dust an dmold/mildew issues as well as the hired help did.  I know I don't.  Back can only take so much.  So, time has perhaps allowed for more dust in her bedroom, especially, and the rooms we rarely use, as I don't clean them as often as the rooms where we live all the time.  I also think she should be doing some(most) of her own cleaning in her personal spaces, but it does not happen often. 

[hezzier]

http://allergicliving.com/2010/07/02/asthma-allergies-detox-your-indoor-air/

Posting this article because it has some good info. 

Due to the amount of hard flooring we have in this house, we invested in a robot vacuum that picks up a ton of dirt (mostly dog hair and dirt the dogs have tracked in) on a daily basis.  My sister has one also (no environmental allergies in her family) and she is amazed at how much less dust there is in the house.

[becca]

I also have area rugs in our family room and dining room and living rooms.  They never used to be an issue.  But I do need to vacuum more often.

[CMdeux]

Hezz, I think that we are going to have to get one of those, ourselves.  The third dog really puts things over the top-- it's awful.

[becca]

Do those vaccuums go over area rugs, or only on totally hard/level flooring?

[hezzier]

Yes, over area rugs and hardwood.  I only have an indoor/outdoor area rug under my kitchen table so far, I haven't found a rug I like for the family room.  I do use it in DS's room (laminate flooring), but found that the dog hair where MES sleeps in our room was just too concentrated for "fido" to pick up so I do just use a traditional vacuum for the rooms that have wall to wall carpet.  It definitely does not take the place of vacuuming on a regular basis, but makes it so much more manageable with shedding dogs.

The two competing companies are Roomba and Neato.  My sister has the Roomba, I bought the Neato...it was less expensive and great reviews on picking up pet hair.  I looked up reviews on CNET.  I've already emptied "fido" (yes, we named it, my sister's is "rover", her friend's is "spot") for today, but I will try to empty the dust bin and take a picture so you can see just how much stuff gets picked up.  I run it M-F at 8 am so I don't listen to it while lying in bed.

[PurpleCat]

DD has had skin prick test twice.  They have a "rack" of 32 pricks (one is histamine and one is saline, the rest are allergens) that goes on her inner forearm all at the same time (our allergist does not test on children's backs).

For fruits she had skin prick tests that were racks of 6 pricks they created with fruit I brought in.  These were also on her inner forearm and done at a different time.

She's had a variety of combinations of RAST testing over the years depending on our concerns at the time....foods and environmental.

DD is allergic to both kinds of dustmites.  Our allergist gave us a long list of things to do to the house and her room to make her quality of life better but suggested we make changes a few at a time until we reached a point that worked....meaning everything on her list might not be necessary to do.

This is what works for DD.

DD has carpet in her room.  She has curtains in her room.  (I originally thought we had to pull the carpet and change the windows but chose to do that last and in the end it was not necessary) Her mattress is encased.  She has a special pillow and pillow case.  I wash her sheets once a week, her blanket and quilt about once every two months.  I vacuum (I bought a Sebo vacuum with a hepa filter) her room and the whole house once a week.  She dusts her room every other week and vacuums her room once a week.  Once a year after tree pollen season I wash her curtains, 2 other times I will put them in the dryer on air only.

When she was young the allergist had us use a humidifier in her room for her asthma but all that did was make it worse, turns out dustmites love humidity.  When I stopped using that her asthma and allergies were much better.

We also have filters we change on our furnaces.

[hezzier]

Ok, so I hate to post a picture of the dirt from my house, but this is what my Neato vacuum picked up this morning.  We have two very hairy dogs that shed constantly and track in lots of dirt.

[spoiler]

[/spoiler]

I have it set to run M-F starting at 8 am.  It covers 3 rooms that are attached so today it vacuumed, recharged and then finished vacuuming.  It was done by 11 am. I think on Mondays it may recharge more than once because there is more dirt, but not sure.  This is about what it picks up daily.