contact reactions not severe?

Posted on: Fri, 03/02/2007 - 9:16am
LisaM's picture
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Reading an old thread that was just reraised made me think of this . . .

Dr.'s don't seem to be all that worried about contact reactions if they are not systemic. i.e. if a child has a few hives from contact, that is not considered significant.

BUT, I've read that there is concern that contact reactions can increase sensitization . . .so they can make it less likely that a child will outgrow the allergy + make it *more* likely that the child will have a more severe reaction the next time.

I quote from [url="http://www.allerg.qc.ca/peanutallergy.htm#statisticsjw"]http://www.allerg.qc.ca/peanutallergy.htm#statisticsjw[/url]

"Epicutaneous exposure to peanut protein prevents oral tolerance and enhances allergic sensitization.is the title of a publication that appeared in the June 2005 Clin Exp Allergy by Strid, Hourihane et al. The authors found that in a mice model, primary skin exposure prevented the subsequent induction of oral tolerance to peanut in an antigen-specific manner. Upon oral challenge, mice became further sensitized and developed strong peanut-specific IL-4 and IgE responses. Furthermore, animals with existing tolerance to peanut were partly sensitized following epicutaneous exposure.
Conclusion: Epicutaneous exposure to peanut protein can prevent induction of oral tolerance, and may even modify existing tolerance to peanut. Epidermal exposure to protein allergens selectively drives Th2-type responses, and as such may promote sensitization to food proteins upon gastrointestinal exposure.247 (posted June 29th, 2005)"

I *haven't* seen anyone refer to this study when considering what accomodations to make for allergic children in schools. Why not? It seems like a significant one to me. I suppose that since the study was done on a *mice model* they can't say for sure that humans will be affected in the same way . . . but still, I think it should give people pause before assuming that contact reactions especially in children are not any big deal.

[This message has been edited by LisaM (edited March 02, 2007).]

Posted on: Fri, 03/02/2007 - 10:23am
chanda4's picture
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I myself don't think contact reactions(ie being hives) are too serious....if it just stays hives. The weird thing about allergies is that reactions can go from hives to worse, and you never know until it is happening. A few examples....my 1yr old was kissed by my daughter(with milk on her lips) and she got hives. No big deal, it just stayed hives, gave Bendryl and then they were gone.
But...my 6yr old recently had a contact reaction while ata basketball game. It wasn't the hives that scared me, it was the runny nose, horribly itchy eyes(he couldn't open them to see), he was scared and crying...for about 15min I debated using the Epi. I had him in the bathroom, washing every inch of hands, arms and face off in the sink. Eventually he was able to open his eyes again...and slowly(over a 30min period) the Benedyrl kicked in and his symptoms were gone......all from contact or inhalation contact at a basketball game(we were probably 50ft from people eating peanuts, but I think the chairs were covered in dust etc...).
So I can see(just hives) not being a big deal, but then what happens when it goes beyond hives....and the fact that you never know until it's happening, is what doctors(and parents) should be concerned with.
So for me, I am nervous about contact reactions. I know several parents that are not, because nothing happens when their kids are *around* it. (I had 2 parents tell me their PA child would have been fine in that situation at the basketball game). I think this just proves how VERY different these allergies are.
I hope I understood the topic of your post.... [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
------------------
Chanda(mother of 4)
Sidney-8 (beef and chocolate, grasses, molds, weeds, guinea pig & asthma)
Jake-6 (peanut, all tree nuts, eggs, trees, grasses, weeds, molds, cats, dogs, guinea pig & eczema & asthma)
Carson-3 1/2 (milk, soy, egg, beef and pork, cats, dog, guinea pig and EE)
Savannah-1 (milk and egg)

Posted on: Fri, 03/02/2007 - 11:59am
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

I agree... it is a very individual thing.
DD has had VERY few contact reactions because our comfort zone doesn't allow us to be in very many of those situations. But one recently (to pn, we are [i]fairly sure[/i] though the source was absolutely unclear and it is likely the amount involved was truly tiny...) involved both hives AND an asthma episode. Allergist agreed that epi seemed kind of extreme there-- but even Benadryl didn't take the edge off for almost 40 minutes. I wondered at the time.
Inhalation reactions tend to be more predictable-- though they certainly look scary enough. Asthma, red-rimmed eyes, sniffling, hives over exposed skin. I only count those as true "aerosol reactions" if the symptoms [i]resolve WITHOUT medication[/i] when we change DD's environment (by leaving). So we rarely medicate those. But contact rxns (for DD) never go away on their own.
Technically, both exposures lead to mildly anaphylactic symptoms, at least in DD.

Posted on: Fri, 03/02/2007 - 12:56pm
Carefulmom's picture
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Joined: 01/03/2002 - 09:00

I avoid all contact and airborne situations for dd, although she has never had a contact or airborne reaction. I also believe that it increases the risk of a more serious reaction next time. Besides, it is so common for pa to become airborne sensitive or contact sensitive with each exposure. So when I see people posting that their child is not airborne sensitive or contact sensitive, I think to myself "not yet". It can happen any time. You don`t want to think your child is not airborne or contact sensitive and then they have a reaction during an airborne or contact exposure at school.
Dd`s cap rast fell from 34 to 15 to 12. Maybe the fact that we avoid all airborne and contact situations helps.

Posted on: Fri, 03/02/2007 - 1:10pm
anonymous's picture
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Joined: 05/28/2009 - 16:42

Quote:Originally posted by Carefulmom:
[b]I avoid all contact and airborne situations for dd..[/b]
Carefulmom, I'm curious how you do this. If I recall correctly, you homeschool, so that would avoid the school issue. How do you avoid all contact and airborne situations, though? To me, any time my child leaves the house, there's the possibility of a contact reaction (and like you pointed out, he could become airborne allergic at some point). I hope this doesn't come across critically, for that's not at all my intent. I'm asking to learn more about how to reduce this risk. I've read many of your posts that are so well-thought out and knowledgeable.

Posted on: Fri, 03/02/2007 - 9:20pm
NicoleinNH's picture
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Joined: 06/21/2003 - 09:00

ll
[This message has been edited by NicoleinNH (edited June 10, 2007).]

Posted on: Sat, 03/03/2007 - 12:18am
Carefulmom's picture
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I don`t homeschool. And let me rephrase what I said. I avoid all KNOWN contact and airborne exposures for dd. Yes, there is always a chance of an unknown contact exposure (probably not an unknown airborne exposure though, since if someone were eating peanut products dd knows to walk away). So as far as a contact exposure, there is always the chance of residue somewhere, but any known contact exposure would be avoided. If another child ate pb, dd would know to make sure that the other child washed her hands before dd went near her. Dd does not touch objects in public places that could have residue and looks very carefully for crumbs before she sits somewhere. So I think she is extremely good at avoiding contact situations. I can`t think of any situation where she would have a contact exposure. I taught her how to avoid contact situations around age 6 or 7 and she is very careful. She notices crumbs that are the size of a speck of dust.

Posted on: Sat, 03/03/2007 - 12:27am
chanda4's picture
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Joined: 12/14/2006 - 09:00

personally(to kind of reply to Carefulmom) I do understand the idea about no exposures lessening reactions, and it is good her child's levels have come down. But then you have my kid, who has had many contact, inhalation and consumed exposures...and his numbers were 51, then 37.5, then recently 21.70....this is just so darn individual, it's crazy.
To be honest, in my opinion, I don't think exposures will make reactions worse the next time around. I know many will argue it will..but unless it is controlled exposure each and every time, there is no way of determining that the next reaction will be worse(because you don't know the level of exposure that will cause the reaction).
Consider the Duke study, those kids are given exact doses(exposures) of peanut powder....
I do think this is so VERY individual that some kids/adults will not react to inhalation or contact. I don't think that *they will*....they just aren't as sensitive. One of the moms who commented to me that her child would have been fine at the same basketball game we attended(where 170 people were eating peanuts) but that is maybe because her childs peanut caprats is just 1.7, her child does NOT have asthma....I think all these things come into play and that is what determines how severe a reaction will be.
With that said, my child is a 21.70, he does have asthma, he does have eczema...so I do think he is more sensitive then a child with a lower caprast, with no asthma and with no eczema.....it's so very individual, and I think that makes it even harder for the general public to understand, why one parent is so protective and the next parent isn't. I think the public generalizes these kids, so if one PA child *can* sit amongst people eating peanuts, then why can't all of them. Also, onemore thought...do I think because other kids aren't having reactions that I am doing something wrong....honestly I don't, I think I am doing everything I can, I do make a mistake here and there, but I am just as careful as the next parent....my kid is just really sensitive(because I do have kids that aren't as sensitive and they have no reaction history with other food allergies). IMO [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
------------------
Chanda(mother of 4)
Sidney-8 (beef and chocolate, grasses, molds, weeds, guinea pig & asthma)
Jake-6 (peanut, all tree nuts, eggs, trees, grasses, weeds, molds, cats, dogs, guinea pig & eczema & asthma)
Carson-3 1/2 (milk, soy, egg, beef and pork, cats, dog, guinea pig and EE)
Savannah-1 (milk and egg)

Posted on: Sat, 03/03/2007 - 12:56am
SkyMom's picture
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Joined: 10/27/2001 - 09:00

This last post really reminded me of how different pa can be. Even though we don't go to the extent that most here do, my dd's rast are as high as her initial test after ana. reaction, and this is with no reactions (ingested, airborne inhaled etc).
I can totally see how one child with a low rast can react to minute contact and another with off the chart levels can have no reaction. I think this just makes pa even more frustrating to us.
We would be in that crown with peanut around us with no reaction, even though we would move asap. When I educate those that know dd or are introduced, that her lack of reaction does not mean that most others with pa are extremely sensitive to airborn/contact and not to go by by dd's pa.

Posted on: Sat, 03/03/2007 - 1:10am
Carefulmom's picture
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My point was really that just like any pa is has the potential for anaphylaxis, any pa has the potential to become airborne sensitive or contact sensitive. So when someone says their child is not airborne sensitive or contact sensitive, that just means that are not airborne/contact sensitive today. It is pretty much undisputed that the older someone is the more likely they are to have airborne or contact reactions. Just because has a child has not had one at age 6 or 8 after airborne or contact exposures does not mean they never will. The older someone is the more likely they are to become airborne or contact sensitive. So it is easy to have this false sense of security that if your child has had airborne or contact exposures and no reaction that they never will. But according to the American Academy of Allergy Asthma and Immunology, that is not the case.

Posted on: Sat, 03/03/2007 - 1:38am
Gail W's picture
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Joined: 12/06/2001 - 09:00

Quote:Originally posted by LisaM:
[b]I *haven't* seen anyone refer to this study when considering what accomodations to make for allergic children in schools. Why not? It seems like a significant one to me. I suppose that since the study was done on a *mice model* they can't say for sure that humans will be affected in the same way . . . but still, I think it should give people pause before assuming that contact reactions especially in children are not any big deal.[/b]
In addition to what's been posted above, there's a middle ground not acknowledged in that statement.
*My* allergist is aware of the study and *we've* discussed it. In the context of school accommodations. In the context of living. It gave *him* pause. It gave *US* pause.
And *we* (collective "we" namely both parents with one being a physician and our allergist/pulmonologist) still do *not* consider contact reactions "not a big deal".
Would someone kindly point me to the data showing that reduced exposure results in a lower CAP Rast score. Were there 'double blind' studies on this?
Would someone kindly point me to the data using CAP Rast scores as a factor in determining accommodations (or 'degrees of avoidance' or whatever we want to call it).

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