DD\'s \"Touch Challenge\" at allergist\'s office today

Posted on: Thu, 08/21/2003 - 3:53am
Gail W's picture
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This morning my 9 year old TNA/PA daughter, Mariah, had a "touch challenge" at her allergist's office (St. Louis Children's Hospital). I thought I'd share some details about our experience...

[b]Background:[/b] Mariah has been sitting at a "Peanut Free" table in the school cafeteria since kindergarten. She will enter 4th grade next month. Last year, the PF table was a smaller table that sat only 6 students. Mariah hated the table because it [b]looked different[/b] than the "regular" tables and because it offered [b]fewer seats for friends [/b]to sit with her. Over time, the table developed a stigma where no one wanted to sit there. It was very hurtful for her and the school got involved too late to really address the situation effectively. So.... the purpose of today's "touch test" was to try to recreate what would happen if Mariah sat at the "regular" cafeteria table as she [i]very[/i] strongly desires.

[b]The "touch challenge"[/b]: This "challenge" was conducted at our allergist's office which is located at a hospital. We were not aware ahead of time what the exposure would be. Mariah stayed at a table and was asked to draw with a magic marker. She was monitored (lung sounds, peak-flow, BP) regularly. pretty early on, Mariah started having some visible facial hives and reddness around her eyes. They gave her another marker about every 15 minutes or so (total of 4) and continued to monitor her vitals. The nurse and our allergist played "hang man" and "tick tack toe" with Mariah so that they could readily observe her. Some of her intial hives and reddness resolved, and some other new ones appreared. Her upper lip had some minor swelling on one side, and she a slight runny nose. We were in the office for about 2 hours total. She washed her hands (at her own request) twice, but was not treated w/ benedryl.

[b]Details we learned afterwards:[/b] We learned that the table had been smeared with about 1 tablespoon of peanut butter and then cleaned with soapy water. They believed this contact would be a larger exposure than what would likely occur at a typical school cafeteria table where a previous student had a PBJ sandwhich. Peanut butter was also put on two of the markers and then cleaned off with a paper towel... one with a cleaner and one without.

[b]Conclusions:[/b] Mariah resolved almost all of her symptoms (hives, reddness, slight swelling) without any medication before leaving the hospital. The exposure did not affect her breathing/asthma. Based on this limited "challenge", our allergist will support Mariah sitting at the "regular" table provided that: 1.) the table is cleaned just prior to her sitting there, 2.) she moves away from someone sitting next to her w/ PB, 3.) she reports her symptoms to the cafeteria monitor.

These changes will be reflected in Mariah's IHP that we will review with the school staff next week.

Mariah is very happy. I'm a little hesitant. I guess we'll try it this fall and see how it goes. I'd like to hear everyone's thoughts about this "challenge" and what you would do if you were in my shoes.

Also, has anyone else had this type of challenge done by their allergist?

Thanks,
Gail

[This message has been edited by Gail W (edited August 21, 2003).]

Posted on: Thu, 08/21/2003 - 4:03am
CorinneM1's picture
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Frankly I am a little surprised that your allergist would recommend this. Seeing that this could then potentially happen on a regular basis or even daily basis at non PF table...won't this effect your daughter's ability to stay in class? Meaning if she has a reaction (and seeing that the area was clean)from touch and it takes 2 hrs for her symptoms to go away, wouldn't she then be out of the classroom for at least that same amount of time for monitoring?
I would push for a larger PF area or tables where her friends could join her rather then place her in a situation where she could/would be uncomfortable, and out of the class room for periods at a time.

Posted on: Thu, 08/21/2003 - 5:41am
Sandra Y's picture
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Gail,
I think if I were you, I'd feel encouraged that my kid is able to come in direct contact with peanut residue but not have a serious reaction. I suspect that my son would do well in this type of challenge, since he has never had a reaction at school in spite of very few safeguards in place to protect him from residue. But seeing an actual challenge like this must be reassuring.
From what you posted, it sounds like the challenge presented Mariah with a worst-case scenario and that the lunch table will actually be safer than the "challenge" table so, like you, I would probably feel comfortable dispensing with the PF table, especially at her age.
Thanks for posting this. I found your description of the challenge very interesting!

Posted on: Thu, 08/21/2003 - 5:48am
ACBaay's picture
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Joined: 03/19/2002 - 09:00

I don't want to add to your worry, but I would be concerned that she might either rub her eye or eat something with the pb on her. Her reaction from the pb contact on her skin did resolve on its own, but you don't know how she would react if it got in through one of the mucous membranes.
If the pb-free area can't be made more appealing, and she really wants to sit at the regular table, she could bring either a placemat or small cloth (I've heard of people using bandanas) to eat on. Also, is there a way to make one end of the table pb-free to serve as a buffer.
Good luck,
Andrea

Posted on: Thu, 08/21/2003 - 7:26am
Peg541's picture
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Gail,
Thanks so much for such excellent reporting on a touch challenge.
I thought it was conducted in a very intelligent and rational way.
I think I would feel comforted by the results and the doctor's advice.
I am reluctant to say what I really want to say which is "if the symptoms went away without treatment then the exposure seemed self limiting and that is good news."
The reason I am reluctant is beause I really know nothing about repeated small maybe unnoticed exposures somehow becoming cumulative and making her antibodies multiply.
I still say this is good news and it gives me courage to send my son off to eat in a college cafeteria.
Additional: When I told this to my son he did not agree with me. He said it felt like "wait and see" to him and he would rather not chance it. He will be off on his own in a few days and I think I have to agree with him. For him it is not a good idea because he is 18 and too many years of avoidance have gone on for him. I still say it is worth a try for a nine year old. As long as she is aware of her symptoms and tells the monitor.
Peggy
[This message has been edited by Peg541 (edited August 21, 2003).]

Posted on: Thu, 08/21/2003 - 8:35am
Gail W's picture
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Thank you all so much for responding. It felt so good to come back and see your posts. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
I think I feel what you all have said, "reassured" to some extent, worried about the potential for more frequent reactions ~and the cost of that in terms of "cumulative exposures" and perhaps a lessened ability to concentrate in class due to allergy symptoms (or grogginess if treated w/ benedryl).
It's hard for me because I feel I am now switching sides w/ the school: I'm asking the school to relax the safeguards which I worked so hard to create in the first place. I am learning that managing this allergy is a constant "work in progress".
Andrea, I agree with you 100% about the allergen entering the body through mucoal membranes (by rubbing eyes with fingers having peanut butter residue on them). This is precisely the premise of conducting this type of challenge. Mariah's eyes were definitely red, itchy, and there were several hives underneath. I suspect that wiping her runny nose with her "contaminated" fingers also contributed.
I'm not sure about the exposures being 'cumulative', Peg. I'd be interested in hearing more of your thoughts on that. The allergist explained that [i]when [b]all conditions [/b]are controlled that reactions are likely very consistent[/i]. But the tricky part is that conditions are never completely controlled (child may have a weakened immune system one day due to virus, the amount of allergen is variable, etc) in everyday life. So there is only so much that one can conclude...
I do worry, as CorinneM1 said, that if Mariah has these reactions that it will affect her ability to learn (allergy symptoms or grogginess if benedryl given).
I think the saddest (or maybe 'most powerful' would be a more accurate description) part for me is witnessing Mariah's drive to be "normal"... and how improtant it is for her to not be different. I wasn't really prepared for that part yet... Mariah's 9 and I didn't think I'd be dealing w/ these "peer' issues until closer to teenage years. But yes, as Sandra pointed out, this was intended to be a 'worse-case scenario' in terms of the amount of residue. So, I feel 'reassured' in that her symptoms resolved untreated.
We'll see. If she has multiple reactions, we'll re-evaluate. Our school is a wonderful, safe place for her to start learning more self-responsibility. I truly feel a partnership with our school and she'll get tons of support. In just 2 short years she will enter junior high.... and I want her to make a smooth transition. I want her to have experienced learning to manage herself at school and to have confidence in her ability to do so [b]before[/b] she enters those junior high school doors.
Ah Peg, I'm feeling a growing pain! Can you tell I'm giving myself a pep talk? [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img] I hope you know how important your experiences are to those of us who need someone who's 'been there'.
Thanks everyone,
Gail
P.S. Peg, have you seen that commercial for MasterCard where the parents send their son off to college? Shows the cost of swimming lesson for an infant, hockey camp for a child, and as he gets older it show "the cost of letting go" as he goes to college? I think of you every time I see that commercial...
[This message has been edited by Gail W (edited August 21, 2003).]

Posted on: Thu, 08/21/2003 - 8:48am
MommaBear's picture
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Quote:Originally posted by Gail W:
[b]Conclusions:[/b] Mariah resolved almost all of her symptoms (hives, reddness, slight swelling) without any medication before leaving the hospital. The exposure did not affect her breathing/asthma. Based on this limited "challenge", our allergist will support Mariah sitting at the "regular" table provided that: 1.) the table is cleaned just prior to her sitting there, 2.) she moves away from someone sitting next to her w/ PB, 3.) she reports her symptoms to the cafeteria monitor.
These changes will be reflected in Mariah's IHP that we will review with the school staff next week.
Thank you for taking the time to post this.
To me, it looks like a "Risk/Benefit" analysis (Informed Consent?) and quite possibly, a "Comfort Zone"? (I [i]finally[/i] found a way to explain the only way I can accept the term!!) No raised eyebrows either. In this case, a calculated decision based on [b]Knowledge[/b], not the lack of it?
Pretty powerful stuff.
MommaBear [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Thu, 08/21/2003 - 8:53am
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Joined: 09/23/2002 - 09:00

Just wondering.............
Is this "challenge" going to be written up as a type of clinical study in a professional journal? Although the population sample was small (ie: one), It sounds as if it was conducted under some pretty exacting conditions. Measurable, definable, etc........
Let us know! [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]

Posted on: Thu, 08/21/2003 - 9:02am
Gail W's picture
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Joined: 12/06/2001 - 09:00

Quote:Originally posted by MommaBear:
[b] To me, it looks like a "Risk/Benefit" analysis (Informed Consent?) and quite possibly, a "Comfort Zone"? (I [i]finally[/i] found a way to explain the only way I can accept the term!!) No raised eyebrows either. In this case, a calculated decision based on [b]Knowledge[/b], not the lack of it? [/b]
Hey there MommaBear! Yes, I agree with this completely. We weighed the 'cost' to relinquish some 'safety' in order to gain some 'normalcy' for Mariah. We will learn whether or not this was a wise trade-off on this 'safety vs. normalcy' continuum.
BTW, I spoke to the school principal today and we agreed to keep all the other safeguards (e.g. no food in classroom ) in effect. We thought it best to only make one change at a time. She consulted with the Board Office, and said I need to provide the school with a letter from our allergist stating these new recommendations. (Document, document, document... [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img])
No plans for a write up, though it would make a good 'in the field' type of feature.
[This message has been edited by Gail W (edited August 21, 2003).]

Posted on: Thu, 08/21/2003 - 10:27am
Tamie's picture
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Joined: 09/23/2002 - 09:00

It is nice to know that you have an allergist that would do this kind of study. I've heard from a lot of people that their allergist just wouldn't take the time to do this, including my dd's. I also think that a napkin or some sort of a placemat is a great idea,I forgot who mentioned the bandana idea, but that is a great idea....maybe your dd will start a trend with her friends!! In my opinion, I think that if your dd wants to do this and is responsible, which she appears to be, then that's great, and I wish both of you the best of luck!
Tamie

Posted on: Thu, 08/21/2003 - 10:49am
MommaBear's picture
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Quote:Originally posted by Tamie:
[b]It is nice to know that you have an allergist that would do this kind of study. I've heard from a lot of people that their allergist just wouldn't take the time to do this, including my dd's. [/b]
Possibly a "Professional Courtesy"? Particularly if a Professional feels comfortable with certain persons experience and Candor is welcome?

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