what would you do - allergist wants challenge for peanuts

Judy,

We've just gone through similar circumstances with my 9 yr old son. He was diagnosed with a PN allergy at 18 mos old. We've been living w/ strict avoidance ever since. He's carried an EPI and Benedryl everywhere ever since. Through 2 moves and 3 allergist we've treated him PN. A recent move brough us to a new allergist whom wanted to retest him. His RAST test and skin prick test came back negative and she wanted to oral challenge him. (I have a couple posts about this recently). I was terrified and was literally crying when she brought this up. I email FAAN where they assured me this is the correct thing to do. Low and Behold he ate PN butter at her office (which is the hospital) and he was fine! Our lives have changed forever!! It was a little alarming to have pn butter and nuts in the house at first. I need to keep exposing him per FAAN to keep him immune. He's had Cracker Jacks for the first time...icecream out....bakery food.....chinese food...the list is endless....we joke he's gonna get fat from all the new foods he's able to try now! It's life altering not living like we were. I might add that he's had NO reaction from anything. Truly he's outgrown it.

So, I hope our story has helped. Email FAAN too for a second opinion. Had it not been for FAAN I would have tho't this new allergist was a crackpot and never ever orally challenged him out of fear! Thank goodness for this board and FAAN or I would never have found out he's not allergic anymore!

Linda

Judy:

Just to share a similar story to Linda's. Our DS was diagnosed at 2.5 years, we were very careful to avoid exposures and watched his RAST scores going down each year (he was tested yearly on around his birthday). Once they were 0, we did a skin test which was negative and then did the challenge and he passed (at the age of 5.75). Our lives have changed, he is at daycamp this summer instead of this "safe" daycare, he goes on playdates without us, we eat out and similar to Linda we joke that he will get fat. If you are not 100% comfortable with this MD get another opinion, we did. We did not test until I was ready because I knew that I would have to continue to feed him peanut products on a regular basis and I needed to be able to do that calmly so that he would not get anxious.

I wish you the best in making your decision, only you and your family can make this choice. If you do go forward with a challenge, we brought a laptop with a DVD to the allergist office so that DS's mind would be occupied and he would not "imagine" syumptoms, the test took about 4 hours.

Schnook

Hi all.

I am so glad to see this topic. My daughter is undergoing repeat skin testing next week. I almost vomited when my allergist suggested repeat skin testing and oral challenge if negative. I have not even considered the oral challenge because I am so sure that she will still be allergic. She has been contact allergic with 3 different anaphylaxis. I will be following this closely, so please post your experience.

I think I am going to contact our old doctor and see what his opinion is of this matter now - if it will change. I really trust him and like his bedside manner far more than the slick MD at the Cleveland Clinic. I may even get another opinion. Am still talking to DS because his opinion matters, too.

As I told the doc today, this is all new to us and I am not going to drag the child down the hall against his will for the test.

I welcome more opinions and thoughts and will keep you guys posted.

I have done more research on this topic.
[url="http://www.allergypreventioncenter.com/articles/peanutallergy.html"]http://www.allergypreventioncenter.com/articles/peanutallergy.html[/url]

It seems that if a child has a low peanut-specific IgE (CAP RAST test), especially if it is 2 or less, then he is a good candidate for a skin test and if that is okay then oral challenge.
[url="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?article=as0091674904013168&nav=abs"]http://www2.us.elsevierhealth.com/scripts/om.dll/serve?article=as0091674904013168&nav=abs[/url]

50% of children with a low IgE can outgrow their peanut allergy instead of the previously thought of 20%.

Interestingly enough, as the posters have said here, if you pass the oral challenge you have a better chance of maintaining this status by eating peanut concentrated foods once a month. Of course you should carry an epi pen for a full year to double check. And if you previously had a peanut allergy, outgrew it and then avoid the peanut or eat very little then you should still carry the epi pen.

[url="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?article=as0091674904022900&nav=abs"]http://www2.us.elsevierhealth.com/scripts/om.dll/serve?article=as0091674904022900&nav=abs[/url]

I am not a doctor - do not follow this advice without talking to yours. But I mean to share and this is interesting.

Will present to my son and go to take the tests and report back.

This is encouraging news for us. His initial CAP RAST was very low - so will see what the next one is.

Okay - I just got off the phone with our former allergist, whom I hold in high esteem because of his integrity, bedside manner and conservatism.

He says that he would do the cap rast test and see where that is at. But he would not recommend going further at this time because he wants to see more research. He would only want to do the skin test and oral challenge in an emergency room, which the insurance won't pay. And he says the research about getting the allergy back, especially when peanuts are involved, is too shaky right now.

He is going to double check so I might have another update. But for now we will stay on the conservative side and hold out for more research.

I do agree - I am heavily involved in nutrition research so I realize the importance of having numerous studies to prove a point over time.

He is worried about what would happen if someone were to ingest a lot of peanuts a few years down the road - there is no research that shows the safety of that.

All this is new.

At SOME point you can retest for peanut allergies, and see if he IS or IS NOT alelrgic.

If he isn't ready to test, and doesn't WANT to test... I'd go with what HE wants...
Sure, he's 5... But you've been PN free for sometime now, and you know the drill.

We've been PNF for 5+ yrs for Caitlin, and DW (Ann) is anaph. to peanuts and has been all her life...

Life goes on without peanuts... truly.

Jason
Caitlin 4-17-00 Allergic to Dairy, Egg, Wheat, Bananas, Grapes, Rye, Sesame, Beef, Garlic, Mustard, Onion, Peas and Avoiding Latex and all Nuts
Sara 2-13-98 NKA (Avoiding Nuts)
Meghan 2-28-03 NKA (Avoiding Nuts)
[url="http://community.webshots.com/user/jtolpin"]http://community.webshots.com/user/jtolpin[/url]

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[b]* Obsessed * [/b]

I would get the RAST test done out of curiousity. I just took my 3 1/2 yr old for the bloodwork today, and there's no risk in having the blood drawn....15-20 secs of discomfort. If it's positive, then you know. If it's negative, then you can decide where you want to go from there.

Just my thoughts... [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Quote:Originally posted by jtolpin:
[b]
Sure, he's 5... But you've been PN free for sometime now, and you know the drill.

We've been PNF for 5+ yrs for Caitlin, and DW (Ann) is anaph. to peanuts and has been all her life...

Life goes on without peanuts... truly.

[/b]

Thanks - and yes - we do know the drill. BTW - he was 5 when he got the allergy - so that is different from being an infant and then turning 5. Will keep you posted on what the doc says.....

[This message has been edited by JudyDoherty (edited July 20, 2005).]

Quote:Originally posted by Ree:
[b]I would get the RAST test done out of curiousity. I just took my 3 1/2 yr old for the bloodwork today, and there's no risk in having the blood drawn....15-20 secs of discomfort. If it's positive, then you know. If it's negative, then you can decide where you want to go from there.

Just my thoughts... [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img][/b]

Thanks - while it is good to watch the CR test, it is not an indicator. There are plenty with 0 who are still allergic to the oral challenge. My doctor's wife is one of these - so he is very aware of the issues.

A friend of ours child tested at Level 6 for the CAP test. To my surprise the allergist smeared peanut butter on his skin with no reaction. She then proceeded to do a skin prick test which resulted in using the Epi-Pen. In my opinion I'd steer clear of any challenge without furthur info. Too risky for me.

After reading that thread (older thread that was bumped) about how 10% don't make it despite using the epi, I'm very very reluctant to EVER let my dd have an oral challenge.

Gale

[This message has been edited by gw_mom3 (edited August 15, 2005).]

Well, there is a big difference between doing a skin test on someone who has a cap rast class 6 versus doing a skin test on someone with a negative cap rast.

And since I have a copy of the study with the 10% and just read it three days ago, I can say that they were not in a doctor`s office with all kinds of medical equipement available where at the first symptom treatment would start. One was away at camp, one in a college apartment, and two were in restaurants. Those 4 people were the 10%. None were near medical care, and no one really knows if they did or did not get epi right away. The 10% was based on a questionaire filled out by surviving family members who may not have even been present for the reaction. It was simply their best guess how soon the epi was given.

If my child had a negative cap rast and negative skin test, I would do the challenge.

Memory cells are produced everytime the antigen is introduced into the system.

Microbiologist agree that memory cells last for 5-7 years. Therefore, I would not submit to a food challenge, but I would not be against a blood serum test. Good luck.

Edited to add that my son was also dx at age 5, so we will be waiting as well.

[This message has been edited by Jooser (edited August 15, 2005).]

If my dd tested negative on skin and rast, I would also challenge. But I would listen to our allergist if he suggested waiting until a certain age, or a repeat of the tests after a certain period of time, to check for any false negatives and such.

We are waiting on RAST results right now! becca