So confused

[KalenH]

Hi everyone, I'm new here and my 21 month old son has been diagnosed with egg and fish allergy.

His RAST scores are 0.8 for egg white (has been eating baked goods since starting solid foods, as well as waffles and pancakes) and 23.4 for fish. The egg allergy does not concern me as it seems to be only a raw egg allergy.

Here is where my confusion lies. His first taste of fish (fresh pickerel) was last January and he broke out in a rash on his face and two tiny little marks on his chest. He was fine by the time we took him to the hospital. He was given a dose of benedryl and prednisone and sent home. We did allergy testing in June to confirm it and the skin tests showed that he was indeed allergic. Then at the end of June we were at a friends birthday party and we were cooking up pickerel and everyone knew that he could t have any except for some people who came later. He was give a good sized chunk of it by them and gobbled it down. We gave him a dose of benedryl no more than 5 minutes later and he was absolutely fine! No rash, hives, trouble breathing, etc. He carried on his normal playing and never missed a beat.

Has anyone else had this happen? I just wish we knew for sure how he would react to it, just so I know. We carry an epi pen with us at all times. I guess a chat with the allergist is needed because I really have no answers about it. We were told to avoid all fish (and we are!) but I just wish I knew what his reaction would be.

Does anyone with a RAST of 23.4 for any food allergy go into anaphylaxis shock? I know all allergies are different, but this one is just so confusing!

[CMdeux]

Hi Kalen!

The short answer is-- the numbers are just numbers.  Some members here have RAST values far lower than that and have seen repeated episodes of very severe anaphylaxis, and I know that at least a few people over the years have had very very VERY high positive RAST's and still been able to pass food challenges.

It seems to me that you probably should revisit the allergy with a good allergist in light of the 'challenge' from last summer (albeit an unintended one!). 

It's possible that the fish was a different species, and it's also possible that your child has outgrown the allergy... also possible that the allergy isn't actually to FISH (in spite of the high RAST) but to something that fish is often highly contaminated with... like... um... shellfish.  That would explain the apparent paradox-- in the first instance, the fish was perhaps heavily cross-contaminated, and in the second, it wasn't.  KWIM??

Good luck!  This stuff is definitely not straightforward.  It's good that you are carrying epinephrine for him. 

[rebekahc]

Yes, what CM said, but just wanted to throw out another possibility - maybe the first pickerel he reacted to was contaminated with the fish he's actually allergic to.  Did they test for individual fish species or just a fish mix?  It might be worth testing individual fish species as well as shellfish.

[KalenH]

Thanks for your replies.

When they did the scratch test, they tested for cod and raw pickerel that we brought in. His wheals were not huge. As for the RAST test, I have no idea what they tested for.

The pickeral that he ate both times were caught by us in our nearby lake. There couldn't have been much for cross contamination.

I guess we'll wait until next summer when our allergist does the scratch test again. Until now...we just avoid it. I just wish I knew that if he was to eat some that it would only be the hives on his face that benedryl would take away.

[rebekahc]

Ooh, just thought of something else.  Since he reacted to pickerel once and not another time and there's little chance of cross contamination... Maybe it was a histamine reaction rather than an allergy to the pickerel?  Maybe the histamine levels in the pickerel weren't enough to affect the adults, but were enough to cause the mild hives you saw in your DS?

One thing about allergies is they are not predictable.  Just because he had facial hives last time doesn't mean he will have the same symptom next time.  Also, benadryl is for comfort and helps ease symptoms; however, it will not stop a severe allergic reaction.

[KalenH]

Yeah, that's the thing. If he was severely allergic to the pickeral in the first place Benedryl wouldn't have done anything for him when he ate it back in June. I was so ready to give him his epi pen, but since there was no reaction we left it alone.

Also, the pickeral was cooked two different ways each time he ate it. The first time, it was dipped in egg, then in a dry batter and pan friend in oil and he reacted. The second time, it was dipped in  dry batter and deep fried with no reaction. Being deep fried would have cooked it to a higher temperature than pan frying it.

[CMdeux]

Aha!!!

  I'll bet that is it.  For some reason, that eggy coating on the fish was either not cooked well enough, or was too large a dose. 

You won't know for certain until/unless you do a formal challenge with the fish, but small amounts of an allergen like egg can (and do) cause stuff like this to happen.  Sleuthing becomes second nature after a while.

Nobody knows for sure why combining egg (and/or milk, in kids that tolerate baked milk) with things in BAKED goods makes that okay for some kids whereas they can't tolerate pan-fried (or deep-fried) eggy coatings...

and it's also possible that he's been outgrowing the egg allergy over time, too.  You may have caught the apex with that fish reaction.

[maeve]

Perhaps his first reaction was to the egg it was dipped in.  The pan frying would not have cooked the egg protein long enough (as with egg in baked goods).