Is Blood Test necessary for toddler at this point

11 replies [Last post]
By melissiabeth on Thu, 06-15-06, 14:39

I was wondering if I could get some of your opinions about RAST testing. My 20 month old daughter tested positive via skin testing for a peanut allergy about a month ago during allergy testing because of her eczema. She has never had a known reaction. Our allergist gave us epi pens, told us to read labels and said he'd retest her when she was five via skin test and sent us on our way. He doesn't do blood testing, he feels they are unreliable. We went back for an ezcema check and he answered alot of our questions- I was concerned over the lack of information we received on our first visit- my pediatrician suggested we follow up with a pediatric allergist who would give us more information and she said we needed to have the blood test too. We have an appointment in August.
Here is my question- do you think it is necessary at this point to get the blood test. I obviously want her to have it at some point to track the progression of the allergy but at this point I am uncomfortable with her getting her blood taken. She won't even sit still to take her daily medicine and we have to hold her down to get her lotion on or even to brush her teeth. Even if the test was totally negative she still had a positive skin test so we wouldn't be able to change anything we are doing . Does the benefit of knowing the scores outweigh the difficultly she may have with test? I appreciate your views on this.

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By turtle on Thu, 06-15-06, 15:30

My son was about your child's age when he was diagnosed with a peanut allergy by skin test. He has not had any reactions, but was having some asthma issues. He had a RAST test about a year or so after his first skin test. He was negative.

Our allergist recommended another skin test this past winter and possibly a food challenge since he had the negative blood test. Much talk of false positives and false negatives. The skin test was positive again-and pretty big too. So he is still considered allergic and they may test him again before he begins school. My son is now 4.

For me, I wanted the blood test. I wanted to have an idea of the levels and if he was decreasing over time. The negative test was hopeful. My husband felt, although never directly said, that the first scratch test was wrong anyway. The second positive skin test just affirmed that yes, there is an allergy and we were no different after the test than before. I hope he outgrows it.

As far as the blood draw, it is no worse than an immunization. Those are not optional. A good tech is the key. My son cried just a second, and he is a drama queen .

Good luck with whatever you decide.

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By SallyL on Thu, 06-15-06, 17:43

My DD was diagnosed the same way - no reaction before, but positive skin test. My doctor did not do a RAST but plans to do another skin test one year later.

Personally, for us, I see no benefit from a RAST test right now. I can't put my 2 year old through that since it won't cure her nor would we treat the allergy differently. I don't care what levels are since, again, we won't treat it differently.

I don't see blood tests and immunizations the same, personally. Blood tests require you to stay still much longer - very difficult for most toddlers (especially mine! LOL) and for me, they definately hurt more. If she moves, it would be quite painful for her. I don't want her to be terrified of the doctor's office (it's happened before).

I would like to know what the RAST levels are, just for curiousity's sake, but not enough to do a blood test on a my toddler.

A lot of other posters have mentioned they've requested the RAST rather than the prick test to avoid exposing their child to more peanut. I haven't done the research, but I can understand that as being a valid reason to go for the RAST. But I can't see me approving a RAST if he is doing the skin test anyway.

That's just my opinion...I know others will feel differently but I'm thrilled she doesn't need a blood test.

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By Carefulmom on Fri, 06-16-06, 01:15

The skin test is an exposure. My dd got sensitized to egg by a skin test (1st exposure was the skin test, it was negative, I gave her two bites of scrambled egg three days later and she went into anaphylaxis). I would choose the blood test any day, even in a toddler. After all, the way the parent handles the situation has a lot to do with how the child does---they take their cues from you. When dd had to have a blood test as a toddler, I would bring a wrapped present and give it to her immediately after. It is really just a few seconds of pain. I would hold dd on my lap, so she couldn`t move. But if the parent is fearful, the child definitely senses it and picks up on that.

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By Corvallis Mom on Fri, 06-16-06, 02:21

I understand your nervousness about putting your toddler through it. My DD had to be HELD DOWN by [i]two[/i] phlebotomy techs when she was 12 months. She only weighed 18 pounds, but boy could she fight.

Anyway, fast forward to three years old, and she was [i]fine[/i] about the blood draw. Really.

Anyway, just told you that to tell you that I would do the RAST. Not because it is going to change anything... but it sets you up for a challenge if your child outgrows just before school aged. If you don't have this first data point for another year, your allergist won't know what it was.... and will probably want to wait an extra year before considering a challenge. That might mean two years of school issues instead of just one or none.

So I'm just offering a gentle suggestion that you might be limiting future treatment decisions/options if you don't. (Of course, this is no kind of insurance for anything [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] But you knew that.)

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By melissiabeth on Fri, 06-16-06, 03:47

Thank you all for sharing your views on this. My husband feels like we should get the blood test. I am still unsure but our appointment isn't until the beginning of August so I have some time to think about it. She did really well during the skin test including the controls there were 27 different foods tested. She did wiggled alot and barreled herself into my chest but really the hardest part was keeping her from scratching her back while waiting to get the results. I hate to admit this but I think one of my other fears is if it comes back really high- I'm going to be even more anxious then I already am about this allergy. Which makes no sense since if it is low then I'm not going to change what we are doing and I know that blood tests and skin tests don't predict what reactions will be but still.....

SallyL-
Thank you for your view on this- I too am curious but I'm not sure if I should wait for the test until next year when she would go for her yearly appointment and might handle it a little better. She's just so squirmy and quite the kicker. It's a huge fight to even comb her hair.

Carefulmom-
Thank you for the suggestion about the wrapped present- I think I will use your suggestion when the time comes- a present wrapped in Elmo wrapping paper- she would love it [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] I do my very best to remain calm!

Corvallis Mom
You make a good point about setting a data point for tracking the allergy and possibly getting to the point where we could have a challenge. My daughter will just turn six when she starts school- so if I decide not to do it in the summer I will not wait any longer then next year to get it done. That will give us 4 years of results before starting kindergarten. Do you think that will be enough time or should we go for the extra year.

Again Thank you all.

[This message has been edited by melissiabeth (edited June 15, 2006).]

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By mcmom on Fri, 06-16-06, 16:14

My older child is PA - when my younger one was 4 we did a blood test. I did not want to do a skin test as it is an exposure. The Rast test was negative. He cried when they did the test, but it was over in a minute, and it was worth it to us not to expose him to allegens at such a young age - plus, with a blood test they can test for so many allergens at once. It was well worth it for us.

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By Edinview on Fri, 06-16-06, 19:45

I agree with everyone here that it's important to have the RAST test. If nothing else, it will give you a baseline.

My son was diagnosed with PA at age 2, they used a CAP RAST to confirm diagnosis. We also did another CAP RAST at 3 yoa, and just this last week, at 5 yoa.

When he was 2, it took a couple of us to hold him down for the blood draw at the pediatric allergist's office. At 3 and 5 he held still by himself at the local children's hospital. The things that helped him hold still were that before we started for the lab,I told him what was going to happen, and that there would be pain for a few seconds, but also gave him that bad news along with some other information about what they do with the blood (put it into a tube and then centrifuge it so that the blood separates, then I tried to explain and draw what an ELISA test looked like and how we could use the ELISA test to find out how allergic he is to peanuts.) The information overload was supposed to give him the info about the needle stick, while directing the focus towards the non-painful part of the process. That seemed to help him mentally prepare.

I ended up taking him to the Children's hospital for the last two blood draws because I liked their phlebotomists and their child friendly set-up. All of the staff were excellent with children. No appointment necessary, and I called ahead to find out when their off-peak hours were and to make sure they had the Dr's order for the test.

The other thing that helped my son during the actual draw was that I talked to him and held him on my lap and touched a different part of his body like his face or his leg and asked him to think about how it felt on that part of his body so he had something to distract him from the needle stick. It seemed to help, and it didn't make anything worse.

Sorry for the long reply, hope some of this info helps.

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By Darkmage on Fri, 06-16-06, 20:49

I'm one of those who likes to see the results from the blood test, and how they may change over time. I'm aware that they may not be exactly accurate, but I'm avoiding another skin prick test for as long as possible. In fact, our allergist really pushes the skin test, and tries to talk us out of the blood test (never really gives a reason). So we have our ped. order the blood test, and we are looking for a new allergist.

ds was 3 years the first time and didn't cry at all. He was 5 years the second time and cried. But that was just after getting his MMR shot, so I can't blame him. The techs always tell him to look away, but I tell him that he can watch if he likes, and seeing the blood run thru the tube is pretty cool. He sits on my lap, and I hug him thru it. Then we go to the store and he gets to pick out a little toy.

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By melissiabeth on Tue, 09-05-06, 18:13

I had my second allergist appt for my daughter in August he gave us a prescription for the RAST and I waited a whole month but we went and did it today! The second allergist is the head of asthma and allergy at a children's hospital and he said since the false positive rate for skin testing is 50% on kids with ezcema that it would be beneficial to have the RAST. I decided to just do it since it will be good to track her numbers over time!

It actually was NO WHERE near as bad as I thought it would be. We were in and out in like 10 minutes and although she screamed like crazy and tried to get away and it was horrible- it was only able for a few minutes. By the time she left with her stickers she was totally fine!

Thanks again for all of your advice!

Now i just have to convince myself not to get freaked out if the results are high [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By Momcat on Tue, 09-05-06, 23:39

I'm glad it was ok! Let us know when you get results [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Cathy

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By melissiabeth on Tue, 09-19-06, 14:11

The results are in- .83. This is very encouraging- so here's to strict avoidance and hopefully retesting will prove negative at 5!

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