allergist wants to do PN oral challenge.

Posted on: Thu, 06/28/2007 - 6:08am
new2PA's picture
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Took DS to allergist today for his bi-annual visit and to discuss the bloodwork her got back a few weeks ago.

Allergist looks over labwork, we discuss a few things and then he says it's reasonable to look at an oral challenge if I wanted to. OMG! WHAT?!?! I was floored. "Happy", but floored. Shocked may be a better word.

When we first started seeing the allergist, he said DS's RAST would have to be zero for peanut before he'd even entertain the idea of an oral challenge. He'd have to have the zero RAST, THEN a neg SPT, then he'd consider the oral challenge. So, b/c of this, every year when he gets his bloodwork, I dont even think about an oral challenge...b/c it's not zero.

First RAST was 4.59, then 1.19, then .81 (2007). So we're on our way to the allergist today, and I'm wondering just exactly what we're going for, b/c there was "nothing" new, so I decide: we'll go in, he'll review the labwork, look at his eczema, and tell us to come back in 6 months.

He comes in, looks over the blookwork, asks about and looks at his eczema, looks at the PN RAST and says he think's it's reasonable to consider an oral challenge. I reminded him what he'd said a few years ago, then he said "well I may have over stated that". He said that b/c DS has not had any reactions in 4 years, no known peanut exposure, and that we were made aware of the PA b/c of the RAST rather than a reaction, and that he'd passed the "critical" point for PN, which is 1/4 of the original RAST, he thought it reasonable to look at the oral challenge, but we could wait if I wanted to. It's not scheduled yet, we're waiting for them to call.

Incidentally, the RAST showed 8.33 for cats. We have 2 cats in the house, and have had for over a year. I told the dr that and that he doesnt seem to have any problems with the cats, and he said not to worry it.

Posted on: Thu, 06/28/2007 - 11:20am
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Joined: 01/16/2007 - 09:00

Yikes... I don't think I would do that.. I thought maybe a skin prick test next... but I don'tthink Iwould be comfortable with an oral challenge.
Therese

Posted on: Fri, 06/29/2007 - 3:56am
momster's picture
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Joined: 06/29/2007 - 09:00

My son, age ten, too has negligible Rast tests. For the last 3 years his skin test has been positive. One month ago he accidently ate chocolate with peanuts, without any reaction. He will do the peanut challenge in July. The allergist thought the skin test was a false positive due to a cross sensitvity with birch pollen allergy. I might add he has not had an allergic reaction since age 2. I would go with the skin test. Good luck

Posted on: Fri, 06/29/2007 - 4:41am
hopechapel's picture
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Joined: 12/11/2005 - 09:00

Unscientific opinion:
I'd be overjoyed and go for it. My strict allergist said the same thing yours did about zero. But I've read of others doing it different. But that is me. I want out of this. Not a scientific opinion.

Posted on: Fri, 06/29/2007 - 5:50am
Sarahb's picture
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Joined: 01/22/2007 - 09:00

I would go for it. Especially since your son hasn't had a reaction to peanut. I would do it. I'd be scared though.
Good luck.

Posted on: Fri, 06/29/2007 - 8:13am
new2PA's picture
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As long as DS doesnt have a reaction between now and Aug 10, we're going ahead with the food challenge.
The dr seemed comfortable with it, I'm happy with the drop in RAST level over the years, and it's a good time to do it. DS goes into kindergarten this year. Daycare has been more than accomdating with his allergies, and I'm sure school isnt going to be as easy.
I've done a little research about is since yesterday and I did find one article that suggests that as many as 50% pass an oral challenge if the RAST level was low. I dont believe everything I read on the internet though. Anyone can post anything on the internet. I have only had limited time to research it since yesterday.
Granted, this doesnt mean DS will pass and I know that. The dr said basically "if he breaks out in hives, we'll know that .81 is a critical point for him." If he passes, wonderful. If he doesnt pass, then we will continue life as we've learned to live it, and it will be OK.
We are scared and excited both at the same time.

Posted on: Fri, 06/29/2007 - 9:19am
new2PA's picture
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this is where I read about 50% outgrow PA. It's old info, but it came from Mt Sinai from what I understand.
[url="http://fusion.mssm.edu/media/content.cfm?storynum=193"]http://fusion.mssm.edu/media/content.cfm?storynum=193[/url]

Posted on: Fri, 06/29/2007 - 4:01pm
mommamia8's picture
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Joined: 11/13/2005 - 09:00

Here is a link:
[url="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11174206&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11174206&dopt=Abstract[/url]

Posted on: Fri, 06/29/2007 - 9:33pm
Ree's picture
Ree
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Quote:Originally posted by mommamia8:
[b]Here is a link:
[url="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11174206&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1117 4206&dopt=Abstract[/url] [/b]
I was looking for that - thanks!!
Why don't any of these studies reference SPT size? Should we not to these into consideration? I thought I understood and now I"m confused again... [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Posted on: Fri, 06/29/2007 - 11:49pm
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Joined: 05/28/2009 - 16:42

Wow, New2PA! What great news for you!
Re: SPT -- our MD maintains that a negative is a negative, but a positive SPT is only a maybe. There are lots of false positive skin tests.
I'm really, really hoping for you!! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
[This message has been edited by Sammy's Mama (edited June 30, 2007).]

Posted on: Sat, 06/30/2007 - 12:46am
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

A recent Aussie study took a look at just that-- how many PST might be false positives and at what wheal sizes does it actually become clinically predictive.
Here's a link.
[url="http://uumor.pair.com/nutalle2/peanutallergy/Forum16/HTML/000263.html"]http://uumor.pair.com/nutalle2/peanutallergy/Forum16/HTML/000263.html[/url]

Posted on: Tue, 07/03/2007 - 2:07am
16pamom's picture
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Joined: 05/16/2007 - 09:00

HI
my doctor suggested the oral challenge he said that he would never do one if he thought the patient would have a reaction. well what do you know my daughter went full blown ana right there in the allergist office, low bp, huge lips, huge tongue, tight chest, hives, and then the epi and off to the hospital for a night. so it all depends on your comfert level. my allergist apologized and said that he has never heard of the negative blood work and posotive oral. good luck
staci

Posted on: Tue, 07/03/2007 - 3:21am
mistey's picture
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Joined: 01/18/2004 - 09:00

Staci- what was your child's rast # when this happened?

Posted on: Tue, 07/03/2007 - 3:57am
Adele's picture
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Joined: 01/31/2005 - 09:00

I think the rules for adults with PA may be different. I have read that the older you get, the less reactive the skin.
My positive SPT wasn't huge....I don't know the size but it was like an itchy mosquito bite the same size as the histamine wheal. Yet I am most definitely allergic to PN and have had many reactions (prior to being diagnosed) including anaphylaxis which is how I was finally diagnosed.

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