Not sure what to think of test results

[mkevsmom]

Hi! I'm new, though I have been lurking for a bit. I have a 9 year-old daughter who had hives about 4 hours after eating almond butter for the first time at age 3. We had her tested for allergies and it was negative. Took a year to get a food challenge, and she was not allergic. We were told to try some other nuts at home, and she was fine, though she hates peanuts.

I have a 4 year-old who was just a very rashy kind of kid. I suspected some food allergies, so the ped sent us for the RAST at age 2. Everything was negative. I still didn't introduce nuts or shellfish or fish, and had this nagging feeling, so went to the allergist. Then when she was 3, we discovered her shellfish allergy. She had a reaction (red around eyes and mouth) after I ate shrimp and then quickly washed my hands with her and made her a plate of food we brought from home. I was trying to slowly take more risks because the allergist mentioned that shellfish allergies were not as common in kids as some other allergies. It was confirmed with SPT. Shrimp was positive, Mixed shellfish +, Lobster was negative and fish was negative. We avoid all fish and shellfish with her until for right now.

I have suspected peanuts and tree nuts as well, so the allergist did a SPT. During the test, peanuts and 2 tree nuts came up positive half-way through the test. The nurse commented on them when she came to check on her. They all went down to a negative by the time the timer went off and the doctor came to read the results. He says that's still a negative result, but could see I was still nervous about it and said, "I don't imagine you'll be giving her nuts any time soon." His opinion all along has been that it's better to just avoid anything I am suspicious of, and give her time. I think that's fine, but nuts are more of an issue at preschool, and I just want some real answers.

In the fall, my parents bought a new house, and every time we visited them, my little one would get a rash on her hands and wrists. Like dry red patches, sometimes with a hive mixed in. The rash goes away with Benadryl. It happened 3 or 4 times. We tried blaming their soap and brought our own. We always bring her own food and use paper plates and plastic utensils. My parents don't even eat shellfish at home any more because they can't enjoy it without worrying about leaving some protein somewhere and causing her to react. Finally, my mom realized the wipes she began using on her leather sofa had almond oil and natural oil (which she learned after calling Old English can be any nut oil). She washed her sofa down twice with Dawn dish detergent and put a sheet over it when we last visited, and no rash. I'm really bummed about this because I was holding on to that technical negative somewhere in my brain, even though I said she was allergic to nuts. I never believed it fully.

So I guess what I am wondering is where would you go from here? She hasn't had a RAST since she was 2, so maybe request a RAST. I'm curious if anything will turn up + on it this time. The allergist may question putting her through that, but I would prefer to have a lot of info. Plus, she's pretty tough when it comes to needles anyhow.

Thanks for reading my novel!

[PurpleCat]

What are your thoughts about the allergist?  Does this doctor specialize in pediatric patients?  Does this allergist have many patients with food allergies?  (a friend started with an allergist who dealt more with environmental allergies like pollen and was amazed when she changed to one that had more food experience.)  Is it time to consider a second opinion?  What does your pediatrician think?

Those are the questions that came to mind when I read your post.  It is not worth the stress for anyone in your family to be avoiding foods if there is no true allergy.  Testing can have results that are not exact.

My DD tests positive for shellfish.  However, she can eat shrimp, she can not eat any other shellfish.

My DD tests negative for mollusks.  She eats scallops all the time.  However, clams cause an allergic reaction.

Reaction trumps testing.  I would want to do an in office food challenge for something you question.  You have an immediate caring medical staff if anaphylaxis occurs.

[booandbrimom]

I would not conclude from anything you wrote that she has a true almond allergy. She might just have sensitive skin.

IMHO, avoiding allergens is the worst thing you can do. All the current advice is to keep them in the diet, the sooner the better. Kids who are allergic do not seem to develop an allergy with exposure - it's already there, whether they're exposed early or late. Delaying allergies gives kids a bigger window for sensitization.

"Red around the eyes and mouth" is not really a full-out allergic reaction. Shellfish sensitization can be related to cockroach/dust mite exposure rather than being a true allergy:

http://www.ncbi.nlm.nih.gov/pubmed/21872304

I guess I'm just surprised your doctor is running panels of testing without there being a true history of allergic reaction. It's not recommended practice anymore:

http://www.sciencedaily.com/releases/2011/12/111226093350.htm

[mkevsmom]

It's a strange relationship with the allergist. I used to go to him, and his bedside manner bugged me, so I quit going. Then my parents started going to him, and he was great for them. I think he is better with asthma than he is with allergies. He's definitely still of the opinion that you should delay introducing things like nuts. I have been tossing around the idea of a second opinion. This is not a pediatric allergist, and I have been a little frustrated with him because he can be easy to talk to at times and then other times, not so easy. I tried explaining that, while it wasn't as tricky to avoid foods when she was a toddler, preschool makes it more tricky. And even today, we passed a cupcake shop that had been on Cupcake Wars. We would have loved to go in and passed up the opportunity because of a *possible* allergy. The allergist doesn't seem to understand what is involved with avoiding allergens.

With the shrimp, I forgot to mention that her eyes were puffy and she seemed worried and refused to eat anything at all after just a few bites of her pasta. The creases under her lower eyelids were gone from her eyes being puffy, but her whole face didn't swell up or anything. A nurse practitioner was there.  I was on watch and see mode, and she urged me to give Benadryl because she said it definitely looked like an allergic reaction to her. My older daughter went to the pediatric allergist in the area, and it took a year to schedule a food challenge. I didn't really care for him either, but I got the sense that he was more up to date. The current allergist is easier to get in to see, and he is great with my older daughter's asthma.

Even if the shrimp is a true allergy, it's not as limiting for a kid as a nut allergy. The more I think about it, the more I see I need to look into another doctor in the area. I was so annoyed that my older daughter had to avoid nuts for a year while waiting on the challenge, and we could be doing it all over again. Frustrating. Thanks for the input.

[mkevsmom]

I keep going back and forth on switching. I believe the current allergist would do a food challenge if I requested it for peanuts and/or tree nuts. I also know he could get her in sooner, and she would not have to skip breakfast and just do liquids. He lets them eat normally, where the pediatric allergist that I would switch to, makes them skip breakfast and bring only liquids, if I remember correctly. Which is the norm? I think the challenge took a lot longer with the pediatric allergist too.

[LinksEtc]

For the last challenge dd did, we were told to skip breakfast & just allow liquids.

[booandbrimom]

My son has never done a challenge without a 12-hour fast. If they're vomiting, doctors want an empty stomach and they don't want interference from other food in the stomach.

Also, quick challenges are not always a good thing. There's a threshold dose that a child has to reach to have a reaction. If you give a kid a bunch of an allergen, the reaction can be worse. With my son's challenges, they actually spread out the doses a good bit because it takes him longer to react and the last thing they wanted to have happen was for him to suddenly have everything hit.

Have you addressed any of these concerns with either doctor? I would think that would be the starting point.

[mkevsmom]

We've talked about the food challenges. He was kind of back and forth, willing to do them if I want to, but if it were up to him entirely, he'd just continue avoiding foods. Seems like he had a different response each time I brought it up, so that is just me putting together the pieces. She sees him every 3 months lately. I double-checked with him about fasting and let him know I was nervous about a reaction at home after the challenge. He basically reassured me everything would be OK, and it was. We were both pretty sure lentils were going to be OK, and that is the only in office challenge she's had. I think he's not as sure with nuts, which is why he goes back and forth. But he doesn't always explain his thinking and sometimes it seems like he'll get annoyed if I ask too many questions, which I don't like. I have told him that I am concerned that I am just being over-protective and concerned that we are avoiding foods that we don't need to avoid, but since I make sure that she gets what she needs nutritionally, he feels it's better than taking risks. If I had another option that I liked, I would have switched already, basically. I like direct. Don't say to me- The SPT is technically negative (even though the nurse said it was positive half-way through), but that you don't imagine I'll be giving her nuts anytime soon. Say, "This is negative, here is my plan, how does that sound to you?" I think it was just too much for me to process being told positive, then negative, but is he saying he wants me to keep avoiding? Is that his suggestion or just that he can see I wasn't sure what to believe about the results? Because by the time I got home, I was thinking I would want to challenge nuts.

I think I need to figure out whether or not I trust him to do the challenges. Maybe it would help to know how backed up they are at the children's hospital as well.

[twinturbo]

I'm not sure what made you suspect food allergies in the first place.

[mkevsmom]

Sorry-- I was afraid of being too long-winded, so I cut out some of the details. Basically, I was trying to figure out what was causing eczema and hives at the start. I mentioned it to the pediatrician and also to the allergist (my older dd goes to him for asthma). I asked how they both felt about me just trying nuts with her, and they both felt it was better to proceed with caution, given the fact that there are a ton of allergies in my family, including a couple of people with food allergies. I decided to take her to the allergist because she has environmental allergies, and I was hoping he could help me figure out the rashes and random hives. Our first apt was just checking her out, confirming that she showed all signs of environmental allergies, and he had us start Zyrtec. No testing at that point. Zyrtec cut back a lot of the rashes. My plan was to continue to systematically introduce new foods. Then she had the reaction to the shrimp, which I was hoping was just to the dog.

He did the SPT for shellfish and fish. Once the shellfish came back positive, I decided to try to be patient about nuts. We were in a tiny waiting room and a woman was eating peanut butter in there. My daughter started rubbing her eyes and got really worried about the woman. I figured that she was just worried because she knew she can't eat PB herself. I told myself it didn't mean anything and to quit looking for signs. Then my little one was playing with the neighbor's dog, which had been licking a peanut butter jar. After she was playing with the dog, I noticed the jar. I didn't saying anything about it; I just kept an eye on her. She was rubbing her eyes and had a few small hives on her face and chest. That's what made him want to do the SPT for peanuts and tree nuts.

With my older daughter, I waited till she was 3 to try nuts based on the family history. She had hives after trying the almonds, although it was 4 hours later. I took a pic and showed the doctor. The doctor still wanted me to do the testing and food challenge with her to be sure. That took a year, and I felt like it caused her to worry for nothing, even that allergist said she could have had an allergy that was outgrown or it could have been random hives. That we had to treat it as a true allergy until the food challenge, which took a long time to schedule because it's a busy office.

Hope that makes more sense.