Conflicting test results - RAST vs. skin. Thoughts???

Posted on: Fri, 03/09/2001 - 11:53pm
Emily in Maryland's picture
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pHello everyone. My son skin tested positive for peanuts at 15 months with a BIG 4+. He also tested negative that time to milk and soy - both of which he reacts to. At 22 months, we took him for a RAST test. He tested negative to everything. He has never been exposed directly to peanuts although he had plenty of prenatal exposure and in the first two months before I eliminated it from my diet. The allergist recommends we continue to be diligent in avoiding peanuts and nuts and continue to always carry the EpiPen - which I strongly agree with. But what could these conflicting tests mean? I know both are known to be faulty. I am very hopeful that this is a sign he may outgrow the peanut allergy. I have no interest in exposing him anytime soon, especially when he's so young and can't tell us how he's really feeling. So, anyone have ideas about how to interpret this?/p
pThanks!br /
Emily, mom to Corey Andrew, age 22 months/p

Posted on: Sat, 03/10/2001 - 12:55am
BENSMOM's picture
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Emily, my son tested 4+ for peanuts too. He has never reacted. I would like to get a RAST test on him to see how that turns out. As you said, both tests can be faulty. I, too, live in Maryland, and when I tried to get a RAST test done, the doctor told me that the only reliable lab is the one at Johns Hopkins. I didn't get the test at that time because I had a problem trying to get them to send the blood work to Hopkins.
Anyway, there are a few possibilities. The RAST test could be wrong. Since the doctor told me he only trusts Hopkins to do it "right", maybe it's a tricky test to do. Also, peanuts can cross-react with other things (I was told grass) so maybe he's allergic to something else, and that's what the skin test reaction was. 50% of people with a positive skin test don't react to the allergen. I'm not sure what to tell you. I'm hoping for a negative blood test, and then I'd be in the same boat and don't know what I'd do either. I think I'm going to take Ben to see Dr. Robert Wood at Johns Hopkins. He's supposed to be the best around here and is one of the leading researchers on PA. I want to get a blood test on Ben, and if it conflicts with the skin test, I'd be interested to know what he says.
Sorry I couldn't really help. You just have to keep assuming he's allergic I guess, and hope for a negative skin test when he's older. Since he's never been directly exposed to peanuts, you don't know if he would react.

Posted on: Sat, 03/10/2001 - 6:40am
Helen's picture
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Joined: 05/05/2000 - 09:00

I find the lack of defnitive answers one of the most frustrating aspects of allergies. I have no answers but can completely sympathize. My child tested "very high" on the RAST, then negative on a skin test, redid the RAST, again "very high" redid the skin test with a different peanut preparation and this time he did react. His "reactions" were also not clear cut. So . . . although I've resigned myself that he is allergic I sometimes wonder. . .

Posted on: Sat, 03/10/2001 - 1:27pm
Anonymous's picture
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Emily in Maryland, I'm not sure that I'm going to be any help at all. I would like to say that I completely understand what you're going through. When I took both of my children to the allergist at the end of October, it seemed like I had a wealth of questions (and therefore thread starters for this board) because things are SO confusing.
As far as I can understand it, and it is only from other people posting on this board, certainly not the allergist or a family doctor along the way, the skin test could have been a false positive whereas the RAST test is more reliable.
Does your son have ezcema that could have affected his skin test? When my PA son came back with 5 new allergies, it turned out that he had false positives because he has ezcema on his back where the tests were done.
I know that it's probably something you have to wait for your child to be older to do, but this sounds like one of the rare instances where I would even suggest an oral challenge.
Since I definitely know my child is PA from his three reactions, I know I don't have to do an oral challenge.
However, if you're going to keep getting confusing results from both skin prick testing and RAST tests, then perhaps that is something to consider.
My concern is that your son may actually not be PA. Although I hate peanut products because of what they are capable of doing to my son, I would hate to see someone extremely limiting their diet (especially when you consider all the "may contains" and "made ins") if they weren't really PA. Do you know what I mean?
I also think this may be of more concern when your child is ready to enter the school system. How can you have a 504 Plan for him, if you even want one, if you're not clear if he is PA or not?
I think what your allergist told you was very important - that you still avoid peanut and tree nut products (simply because of your son's age) and to carry your Epi-pen (better safe than sorry), but I do think I would be investigating the pros and cons of an oral challenge for him in the future.
I hope I've been of some help, although I'm really not in the best position because I know my son is definitely PA, without him ever being tested for it.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
------------------

Posted on: Sun, 03/11/2001 - 10:17am
AmyR's picture
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Joined: 09/26/2000 - 09:00

Have you thought of having another skin test? I had a situation with my daughter a few weeks ago. She is not PA. We had her tested for environmental allergens and the nurse got confused with the order of testing so we couldn't rely on the results. From that skin test, it looked like she was allergic to one of three things (dust mites, mold or dog). We weren't positive which allergen she reacted to so we retested two weeks ago. This time she reacted to all three. We're not really sure what to believe at this point. I realize that PA is a lot more serious so it is a harder call for you. If my PA son had the same results your facing, I'm not sure what I would do either.
I'm sure I wasn't much help but I just wanted you to know that in addition to the tests not always being 100% accurate, the professional can also mess up. Good luck.

Posted on: Sun, 03/11/2001 - 11:57am
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jhi
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Joined: 03/09/2001 - 09:00

My 5 yr. old daughter has also had conflicting test results, but has a history of hive reactions (face and chest) after eating peanuts. Her first skin test was kind of negative, but was accompanied by sudden itching and a delayed reaction which the allergist didn't get to see. At this point, our allergist prescribed an epi-pen and recommended that we treat it like a PA and then retest in a year. Her second set of skin tests - a delayed reaction again, which the doctor didn't get to see. Her third set of tests: Rast - negative and a positive skin test!!
So, where are we at? We consider that our daughter has a severe PA. We will get her assessed again, but want to get a second opinion at a special allergy centre. I am very worried that if a future set of tests come up negative, she will be deemed non-PA, despite her history of delayed reactions.
There is nothing that I want more than to have her not allergic to peanuts, but I want to make sure that the doctors making this decision are considering her unusual history.
Sorry to not offer any solutions, but I thought you may be interested in my situation.

Posted on: Fri, 03/16/2001 - 4:17am
4jesters's picture
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Joined: 03/16/2001 - 09:00

Skin tests do pose a risk, as you can react to the allergen. We are talking intradermal, right?
As for RAST, it is safe, although there is alwayss a possibility of a "false negative." If it comes back positive, it's positive, but if it comes back negative, it could be error.
My son tested positive to 40 foods. Nothing was lower than a 2+. Peanut, egg, soy were 5+. Whey, casein, corn, peas were 4+, and wheat, rye, barley, beef were 3+. Rice, oats, apples, pears, pork, sweet potatoes, carrots, bananas, peaches were 2+. I can't remember the rest.
What does he eat? Well, he can tolerate some things if I rotate them, and, I don't want to bring up controversial issues, but, were are taking him to a Dr. that uses BioSET (branch off of NAET) to treat allergies. We have experienced great success so far. He has been to see her about 10 times since Sept., 2000 and can eat wheat products and dairy products now. He is starting to eat corn products as well.
Mainly, it's yogurt, applesauce, Cheerios, bananas, pears, sausage, bacon, ham, chicken, beef, carrots, potatoes, rice, grapes, cheese, milk, and juice. Pretty tough to come up with creative menus!

Posted on: Fri, 03/16/2001 - 6:30am
SusanMO's picture
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Joined: 03/13/2001 - 09:00

All I can say is food allergies are so confusing!!! Confliciting test results, conflicting doctor opinions, a whole array of varying reactions, etc. etc. My son too tested positive for skin and negative on the RAST. However, he has had a history of reactions. We did a food challenge (I started a thread on this) earlier this year because my doctor thought my son may have outgrown his allergy because of the negative RAST. WRONG!!!! So......my advice to you, is don't believe the RAST to be the gospel truth just yet. Still avoid peanuts, carry that Epi and be safe!

Posted on: Fri, 06/14/2002 - 10:13am
5boysrus's picture
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Joined: 06/06/2002 - 09:00

If any of these posters are still on this board I would like to know how things are for them now. My son had 5+ test for peanuts and negative (.05-whatever that means) for RAST. Don't know what to think. Never has had serious reaction but has been having more reactions to being around peanut and eating a cookie with it in (chest tightness, some intestinal symptoms over a day). ?? Emotional or allergic? not sure. probably goign to do food challenge sometime this summer.

Posted on: Sat, 06/15/2002 - 10:11am
BENSMOM's picture
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Hi 5boysrus, I'm still around. I did take Ben to see Dr. Wood at Hopkins and had a CAP RAST done on him. It came back over 100--off the charts [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]. Both the doctor and I were very surprised and his only explaination was that perhaps Ben had never been exposed to enough peanut to have a reaction. It wasn't the news I was hoping for. As for your son, I read some of your other posts and don't know what to tell you. It's hard to say if he's allergic or not, but the RAST result sounds promising.

Posted on: Sat, 06/15/2002 - 10:47am
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Joined: 05/28/2009 - 16:42

Emily, My daughter's allergist told me last week that a 0.0 on a cap rast is ZERO. End of discussion. I am confused by some posts here that the blood test can have false negative results. That is exactly the opposite of what I was told.
I understand that the skin test for peanuts often has false positives and the cap rast for peanuts often will show a "sensitivity" but that person may not actually have an allergic reaction to peanuts.
Has anyone else been told that the cap rast test can have false negatives?

Posted on: Sat, 06/15/2002 - 1:04pm
5boysrus's picture
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Joined: 06/06/2002 - 09:00

I really appreciate you taking the time to respond. We decided to send him to camp as if he is allergic just to be safe--mostly due to the recent episodes of feeling like his chest is tight and stomachache after accidentally eating a cookie with peanutbutter in it. Tonight at a restaraunt he tasted his Dad's ice cream that was part of a sundae with walnuts in it. (He is 5+ on a skin test for english walnuts) and experienced mild chest tightness (doesn't affect his breathing or anything) for 2 hrs. So I figure it is worth the $20 for the epipen prescription that my pedi was willing to prescribe for camp. THEN when he comes home we are going to ped (who handles allergies too) and doing food challenge for peanut. I am probably being overcautious but as someone else mentioned I will be able to relax more about him being a distance away. Open to others thoughts on the whole mess!

Posted on: Sat, 06/15/2002 - 10:48pm
DRobbins's picture
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Joined: 07/19/2001 - 09:00

Quote:Originally posted by K'sMom:
[b]Has anyone else been told that the cap rast test can have false negatives?
[/b]
Yes, I've been told this. When I first suspected that my son was allergic to peanuts, our pediatrician did a RAST test, but warned us that even if the results came back negative, he wanted us to keep our son away from peanuts, since RAST tests could give false negatives.
OTOH, he felt that if we got back a positive RAST result, then we could be sure my son was truly allergic (despite his mild and subjective symptoms). Unfortunately, the results were positive.
As far as skin tests go, I've read here in many posts about false positives, and I may have experienced this myself -- I tested positive on skin tests to almonds and Brazil nuts, despite the fact that I've been eating nuts all my life with no symptoms that I'm aware of. So either my tests showed a false positive, or I truly am allergic to those nuts, but my reactions are so mild that I can't detect them.
I've never heard anyone here mention having a false negative on a skin test, but I have experienced one: I have clear symptoms of an allergy to bananas, but my skin test results were negative.
Hope this helps,
Debbie

Posted on: Sun, 06/16/2002 - 2:09am
5boysrus's picture
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Debbie,
Are you allergic by any chance to Ragweed? My two boys who are allergic to Ragweed also get itchy mouth when they eat bananas. Even though they have no positive allergy test to bananas. About a year ago I read a research article that found that individuals allergic to ragweed often react this way to banana and has something to do with the plant. Sure wish I had saved that article so could re-read it or share it. Terri

Posted on: Sun, 06/16/2002 - 4:33am
DRobbins's picture
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Joined: 07/19/2001 - 09:00

Yes, Terri, I am allergic to ragweed. So I guess my itchy mouth when I eat bananas could be a cross-reaction to ragweed pollen. I have similar reactions to eating canteloupe. I've never understood how it's determined if an allergy is "just" a cross reaction, and if it is, whether that means the allergy is less severe.
I'm also allergic to birch, and have been told by my allergist that my positive skin test to almonds could be a cross-reaction to the birch pollen. But since there's no way of knowing for sure (and since I don't eat peanuts or nuts anyway for fear of exposing my son to them), I just avoid nuts anyway.
Debbie

Posted on: Sun, 06/16/2002 - 8:54am
5boysrus's picture
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Okay, now I wonder if peanut can be a cross reaction, and if so what is it related to?

Posted on: Sun, 06/16/2002 - 9:46am
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Joined: 02/24/2002 - 09:00

DS had several false negatives on his skin test (although the PA and TN did show up). He had reactions and subsequently tested positive via RAST to several foods that showed no wheal on his skin test. From what I've read false negatives on the skin test are more common in younger children and those with eczema. (DS was 14 months when tested) Non-IgE mediated reactions won'tshow up on a skin test either. I suppose there's always a chance that the sample used for the test was bad.
Soy is sometimes cross-reactive with peanut, and did I read that sesame may be as well? Maybe someone else will have better information on sesame. I just know that we are avoiding it for some reason- can't remember why!

Posted on: Thu, 01/23/2003 - 9:25am
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Joined: 07/23/2002 - 09:00

Hi all, I'm raising this topic to the top again, because I am finally going to be able to take my child into the Asthma & Allergy specialists here in town. They insisted that I wait until he turned 3 before they would see him without a referral - and my (bleep!) pediatrician refused to give me the referral.
So - vent mode off now - I am finally going to see an allergist. My son had a HUGE reaction to peanut butter at 13 months - his head swelled up like a basketball, his face turned bright red, and he had little white fever blisters all over his face. Then he wasn't able to breathe correctly - sounded awful. Even the paramedic in the ambulance was spooked - he was hollering at the other guy to turn the lights & sirens on - and get us there FAST because Michael wasn't responding the way he should be to the epinephrine.
That being said - I'll not opt for any skin tests. But I'd like to hear some of you current participants views on RAST tests, and whether your doctors would perform them.
My son has never had any reactions since - most of me is just really thankful, but part of me wonders about it - I can't hardly imagine that I've been that diligent.... But boy, that first reaction was SO bad, I'd hate to ever risk it again...
Sherlyn

Posted on: Fri, 01/24/2003 - 10:26am
caryn's picture
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Joined: 11/20/2002 - 09:00

hi
I was going to start a thread on this tonite and here it was....
My son tested 4+ on the skin test for peanuts at 26 months old - we have had several minor reactions since and decided to switch allergists and search for more allergies - we had him skin tested for twelve items - not peanuts- last week (28 months old) the test was inconclusive as the positive control did not show up - so we had a blood test done - a RAST not a CAPRAST - I asked to be sure. We got a call from the office today that all were negative including peanut - I said wait a minute I need to talk to the doctor but he had left for the day!
So for now we are not sharing the blood test info with anyone for fear they will think he is not allergic - after talking with the doctor hopefully we will gain more insight.
any suggestions???

Posted on: Fri, 01/24/2003 - 12:22pm
KarenH's picture
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Joined: 09/21/2002 - 09:00

Hi Debbie
I also have a pollen allergy(I'm not sure which trees), and I have been tested positive for almonds, walnuts, hazelnuts, and a variety of fruit. It's called Oral Allergy Syndrome. I used to not think the cross reaction was that severe until I had a pretty good reaction to peanuts as well the other night. From what I've read, if you react to nuts, it IS just as a bad as a regular allergy. I carry an Epi Pen and avoid all nuts myself. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
I've also had a hard time with my allergist, who refused to test me at all for peanut, saying that the rast test was expensive and unreliable, and that I was not a candidate. Never mind that every time I ate peanuts I had a reaction, and every time it got worse. Needless to say, I'm switching allergists. This last reaction scared me that much, even though it wasn't severe enough for me to use the Epi.
[This message has been edited by KarenH (edited January 24, 2003).]

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