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Posted on: Tue, 08/19/2003 - 2:18am
e-mom's picture
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Well just an update. I had both ds #1 (pa) and ds #2 RAST tested yesterday.
The nurse who did our checking in, weighing, etc. was surprised that we only had a peanut allergy (her response, "oh, that's it? with a puzzled look on her face) and I sensed she was wondering why we were even there.
Then the allergist came in. She kept talking about skin testing. I had told her that in no way was I going to do another skin test for ds. She wanted to know why. I told her that I did not want to inject peanut protein into his system for fear of making his allergy worse and/or causing a reaction (in so many words).
She said that it would not do that and wanted to know where I got my information. I said that I had been doing a ton of research and that is what I came up with and that I believed it.
She informed me that skin testing was the most accurate way to test. I then told her that I wanted to start monitoring his "numbers" and then make an educated decision to possibly have him skin tested at a much later time.
She kinda shrugged her head and basically said that I was the mom and that she was just the allergist. Whatever I wanted to have done she would agree.
My friend, who recommended this allergist, was very surprised at her response about not making the allergy worse if you do a skin test. My friend had a skin test done a couple of years ago for shellfish (she already knew she was allergic to shellfish but I guess she wanted to triple check? I don't know) and shortly after (still in the allergist's office) the skin test, she had to be given an epi-pen because she started having an anaphylactic reaction.
Mind you this was at the same allergist. Fricken quack allergist...go figure!!
So now I have to wait about 1 week for the results. I'll post the results when I get them.
Oh, I almost forgot. After the boys had their blood drawn (which they did absolutely great with) the nurses asked if they wanted a SUCKER!!! [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img] They could have very discreetly asked me first and THEN made the big announcement to the boys. So I let the boys have them (they were still wrapped) and told them not to open the suckers.
I had brought my own treats because ds had requested we bring them. I just knew that there would be some sort of "food" involved. UGH!!!

Posted on: Tue, 08/19/2003 - 3:35am
austin2001's picture
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nikky,
sorry not to reply so soon...i havent been on the PA.com website too much lately! you asked:
austin2001,
You mean your daughter was skin tested positive at 17 months and continued to eat it with no reactions? (except maybe the excema and asthma?) Did she retest negative now? I'm confused. Was this maybe a "minor" peanut allergy? My one allergist told me that his daughter had excema and hives from peanut as a child but now eats it with no problems. He said it was just a mild allergy.
My daughter was skin tested at 3+ for peanut at 17 months of age. She ate peanut butter (a lot) back then and still does now (0nly occassionally due to PA little brother - ie peanut free house). The thing about it was that we didn't KNOW she was 3+, nor were we educated about it...we didn't find out until my son was discovered to have the allergy and I had both kids at the new allergist. We had retested a lot of environmentals on my dd (who has asthma) and I asked the allergist to test her for peanut. She looked back in my dd's chart and told me the news then and there. my daughter was almost 4 years old at the time. The allergist saw no reason to retest since dd can consume it w/o problem. She said it was most likely a false positive...makes me wonder though- I'd love to think she outgrew it - with the hopes of my PA ds doing the same one day.....
hope that explanation helps...
allison

Posted on: Tue, 08/19/2003 - 3:39am
StaceyK's picture
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Joined: 05/06/2003 - 09:00

.
[This message has been edited by StaceyK (edited October 21, 2004).]

Posted on: Tue, 08/19/2003 - 5:04am
jayjay's picture
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Joined: 04/12/2003 - 09:00

I just took my almost 4 year old son to a new allergist,she thinks that the 3.81 ku/l that he had on his cap rast from a year ago could possibly be a false positive because he has never had a reaction and goes to preshcool with other children who eat peanut products. She wanted to skin test but I refused and ask for another blood test which we are going to do tommorrow(whatever happen to taking blood in the Doctors office)as soon as we can get to the lab. She said that false positives can occur if the blood is not separated correctly or they can even get the blood mixed up as well as a child being very young.He also tested positive to egg whites, milk,wheat,and soy and has continued to eat them since a year ago without a problem so we know for sure that they were FP results,as far as peanut ,he has never had any peanut product on purpose and continues not to have any, but I am sure with 2 years of preshool if he had the allergy I would have a sign by now. What do you think.

Posted on: Tue, 08/19/2003 - 7:41am
e-mom's picture
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Joined: 04/23/2000 - 09:00

Quote:Originally posted by StaceyK:
[b]So it is the general feeling in the group that skin testing at a young age could count as an exposure and therefore cause my son to have an allergy more severe than he would have with no exposure before 3? He is only 17 months. He is scheduled for a skin test on 9/25 because his sister has one. Should I cancel that?[/b]
StaceyK,
The only thing that I can say is that my ds #2 (just turned 3) has NEVER had peanuts, nuts or any "may contains". He eats what ds #1 (pa) (age 4 1/2) eats. At this time, I did not want to skin test ds #2 because of his age. In a few years, I will probably have ds #2 skin tested [b]IF[/b] he has not had any type of reactions.
As far as ds #1 (pa), I will most likely get him blood tested every year or every other year, compare the RAST or CAP RAST numbers to see if they are lower each years, etc. and then make a determination on whether to have him skin tested at a much later date.
In my opinion, yes the skin test for peanuts would count as an exposure.

Posted on: Tue, 08/19/2003 - 7:57am
e-mom's picture
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Quote:Originally posted by jayjay:
[b]I just took my almost 4 year old son to a new allergist,she thinks that the 3.81 ku/l that he had on his cap rast from a year ago could possibly be a false positive because he has never had a reaction and goes to preshcool with other children who eat peanut products. She wanted to skin test but I refused and ask for another blood test which we are going to do tommorrow(whatever happen to taking blood in the Doctors office)as soon as we can get to the lab. She said that false positives can occur if the blood is not separated correctly or they can even get the blood mixed up as well as a child being very young.He also tested positive to egg whites, milk,wheat,and soy and has continued to eat them since a year ago without a problem so we know for sure that they were FP results,as far as peanut ,he has never had any peanut product on purpose and continues not to have any, but I am sure with 2 years of preshool if he had the allergy I would have a sign by now. What do you think.[/b]
jayjay,
My ds (pa) (4 1/2) is going on his 3rd year in preschool. He has never had any type of reaction at school or anywhere else for that matter. His first and only reaction was when he was 17 months old; ate a tiny amount of creamy peanut butter, about 10 minutes later half of lower lip swelled and he had about 12 blisters around his mouth,
about 10 minutes after that it ALL vanished
on it's own.
His preschool is sooooooo good with his peanut allergy. They stopped serving and letting in peanut butter. When they do any cooking (which is only 3-4 times a year) they ask me several days in advance to check the ingredients for them. If there is something that doesn't work, I give them a substitute.
He eats snacks at the preschool that I provide for him. While the other kids eat the preschool snacks (which are pn free but I feel a more solid peace of mind to send our own snacks--the preschool only buys the generic brands from a generic store and I know that their labeling is not accurate).
Anyway, it does cross my mind as to whether he is allergic or have we just been really good with avoiding the peanut items. I have no idea. I sometimes feel like it's just a big guessing game. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Posted on: Sat, 09/06/2003 - 11:08am
e-mom's picture
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Joined: 04/23/2000 - 09:00

Below is a link to the following that describes Skin testing, Rast, etc. that I thought was very helpful.
[url="http://www.allergycapital.com.au/Pages/gpaltst.html"]http://www.allergycapital.com.au/Pages/gpaltst.html[/url]
Total IgE
It is now known that IgE is produced by plasma cells, predominantly in lymphoid tissue adjacent to the respiratory and gastrointestinal tracts. Adult levels of IgE are reached by the age of 10 - 15 years, and are present in a non-linear distribution in the population, with seasonal variation of two to four fold throughout the year.
Elevated Total IgE is observed in only 30% of patients with allergic rhinitis, 60% of patients with asthma and in 80 - 90% of patients with significant atopic eczema. It can also be elevated in 10 - 20% of patients with non-allergic rhinitis or non-allergic asthma, or other conditions such as allergic bronchopulmonary aspergillosis, some forms of immunodeficiency, neoplasia such as lymphoma, and parasitic disease.
The measurement of Total IgE is the sum total of multiple individual allergen specific IgE levels. Total IgE therefore has a poor positive or negative predictive value for the presence or absence of atopic disease. A more useful test is the measurement of allergen specific IgE by either skin testing or RAST testing.
RAST Testing
RAST stands for Radioallergosorbent test. Allergen specific IgE is measured from blood samples. In general, skin testing is more sensitive and specific, and has the advantage of lower cost and almost immediate results. The main indication for RAST testing is when skin testing is either impossible or unreliable. Examples include dermographism (where the patient will weal and flare with any skin trauma regardless of allergy), severe dermatitis (skin testing needs to be performed on relatively intact skin), lack of cooperation (eg: young children) or where access to skin testing facilities is difficult or impossible. False positives and negatives do occur, the former particularly in patients with atopic eczema.
Medicare currently rebates patients for only 4 tests at a time. Rational and cost-effective use of RAST testing for aero allergen sensitivity therefore uses allergen mixes such as grass or weed mixes, dust mite and mold mixes. In the absence of a clear history of food-allergic problems, RASTs for food mixes often provides confusing or misleading information.
The technical aspects of RAST testing are quite interesting. Allergen is first bound to the surface of "discs", most commonly made from nitrocellulose. A disc is then incubated with the human test serum. If allergen-specific IgE is present, it will bind to the allergen and thus the disc. Excess serum is then washed away, and the disc incubated with an a radiolabelled ANTI-IgE antibody, then washed as before. The radioactivity of the disc is measured and compared to standards. If the disc is radioactive, then the radiolabelled antibody must be bound, which means that the original serum must have contained IgE against the allergen bound to the disc. The higher the radioactivity, the greater the amount of IgE in the original sample. Unfortunately, RAST testing suffers from problems of poor sensitivity and specificity for predicting the presence or absence of allergic disease. In general, skin testing is more sensitive.
Skin Testing
The presence of allergen-specific IgE may be evaluated by skin testing, which results in the introduction of small amounts of protein into the dermis by pricking the skin through a drop of allergen extract. If the patient is allergic, this allergen will cross link to IgE molecules on the surface of cutaneous mast cells, resulting in histamine release, and the observation of a weal and flare after a period of 15 - 30 minutes. This is why antihistamines can inhibit the results of skin testing. It should be remembered, however, that not all patients with symptoms of asthma, respiratory disease or eczema are atopic. Approximately 20% of patients seen with asthma, eczema or symptoms suggestive of allergic rhinitis have no evidence of atopic disease whatsoever. The implications of such findings are that allergen avoidance measures, and desensitization are not warranted.
Indications
Skin testing is indicated for the evaluation of patients with suspected atopic disease such as allergic rhinitis, asthma, atopic eczema, or allergic or anaphylactic reactions to either foods, venoms or drugs. Correct interpretation of results will allow for appropriate advice to be given regarding allergen avoidance if possible, as well as the identification of clinically relevant allergens for desensitization if that is indicated.
Procedure
Skin testing is most commonly performed on the forearm, although the back is sometimes used, although is more sensitive than the arm. The arm is first cleansed with alcohol (several times if patients have used moisturizers recently; otherwise allergen extracts run). The arm is then marked with non-indelible ink, and drops of a negative control, positive control (histamine) or allergen extract are placed close to the marks. The skin is then pricked with a small lancet without drawing blood. The lancet is wiped with an alcohol swab between each allergen, thereby removing essentially all residual allergen from the previous test. At the end of the procedure, the arm is dabbed lightly with a tissue to remove excess fluid. The test is read between 15 and 30 minutes later and the size of the weal and flare is compared to that of the positive and negative controls. A negative control checks for evidence of dermographism, whereas the positive control serves as a check for patients who have inadvertently ingested antihistamines (such as in some cough medicines) or other drugs with antihistamine activity (see below).
Alternative methods such as scratch testing have generally abandon because of poor reproducibility, and increased discomfort to the patient. Intradermal skin testing is practiced in some countries, but in general whilst more sensitive, is more likely to lead to false positives which are not clinically relevant. Intradermal testing is most commonly used for evaluation of patients with potential antibiotic sensitivity or insect venom allergy.
False negative skin tests
A number of factors may influence the interpretation and performance of skin testing. It is a reliable test of presence of allergen specific IgE in patients of all ages, although infants tend to give smaller weals and have a higher incidence of false negatives. Positive reactions therefore need to be compared to the size of the positive control. An increased incidence of anergy (falsely negative skin test) is seen in elderly patients, in patients with malignancy or on haemodialysis, and occasionally in patients with peripheral neuropathy such as diabetes.
Since false negatives may be also seen in patients who have suffered from a recent episode of anaphylaxis (presumably due to exhaustion of mast cell mediators), it is usually recommended that patients requiring evaluation for anaphylaxis should have their investigations deferred for 4 - 6 weeks after the event. A number of medications can also influence the results, antihistamines in particularly. Phenothiazines as well as tricyclic anti-depressants have antihistamine activity, and therefore need to be avoided for 1 - 2 weeks prior to skin testing. Most conventional antihistamines should be ceased 5 - 7 days before evaluation. The exception is Hismanal (Astemizole), which can give false negative reactions from 4 - 6 weeks after cessation. Ranitidine has been reported to inhibit skin testing, although in general this is rarely observed. Long term oral steroids at a dose greater than 25 mgs can inhibit skin testing, as can potent topical steroids.
False positive skin tests
False positives are observed from time to time as well, particularly when skin testing with food derived extracts, or when testing patients with atopic eczema. Skin testing therefore always needs to be evaluated in the context of a clinical history. Random skin testing with food derived extracts or with aero allergens will give misleading results unless interpreted appropriately. The evaluation of patients with non-specific and non-allergic symptoms by skin testing with a battery of common food derived allergens almost inevitably leads to misleading results and inappropriate therapy.
Eosinophils
Eosinophils are specialized white cells that are designed to kill worms and parasites. They also can cause inflammation in the tissues in allergy. High levels are most commonly observed in blood samples from people with Hay fever, asthma and atopic eczema.

Posted on: Mon, 09/08/2003 - 4:54am
e-mom's picture
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Joined: 04/23/2000 - 09:00

Quick update:
The allergists' office did not run a RAST test.
For some unknown reason, they forgot to order the fricken test!!
However, they did run a CBC and and IGE but no RAST.
Can't even begin to tell you how ticked off I am. Now the kids need to get the blood work done all over again.

Posted on: Fri, 09/19/2003 - 7:18am
e-mom's picture
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Joined: 04/23/2000 - 09:00

Well, FINALLY, got the results back. The boys had to get their blood drawn again.
And we have some good news,
Ds #2 (age 3) tested negative. His RAST blood test showed that he was 36.5%, Class 0 = Absent/Undetectable
Ds #1 (turns 5 in November) tested positive (which we already knew from previous reaction). His RAST blood test showed a 325%, Class 3 = High Level
So now we start monitoring his numbers for about 5 years to see what's going to happen.
Below is the RAST chart they gave me. (This is supposed to be a table with 4 columns and 9 rows of stats.)
Class
0
1/0
1
2
3
4
5
6
KU/L
<0.35
(this space left blank)
0.35-0.70
0.71-3.50
3.51-17.5
17.6-50
51-100
>100
% Response
<60
61-70
71-110
111-220
221-600
601-2000
2001-6000
>6000
Level of Allergen Specific IGE AB
Absent/Undetectable
Equivocal
Low Level
Moderate Level
High Level
Very High Level
Increasing Level
Increasing Level
This test was done by Quest Diagnostics Incorporated, Wood Dale, Illinois
[This message has been edited by e-mom (edited September 20, 2003).]

Posted on: Wed, 10/29/2003 - 4:43am
Driving Me Nutty's picture
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Joined: 05/01/2003 - 09:00

Looks like a no-win situation here - false positives from both skin and blood tests. I can't decide what to do. My dd has only had a CAP RAST done for PA and the allergist didn't want to run it for an across the board/random testing of other foods. So I'm trying to find a new allergist. But which method....? I guess if I want to have her tested for tree nuts then I should find an allergist that will oblige my request and run a comprehensive CAP rast.
any thoughts? Thanks!
Pamela
------------------
Mom to 2 y/o Karissa (PA >100 CAP RAST)

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