Diagnosis?

Posted on: Tue, 10/09/2001 - 1:08am
Heather2's picture
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Joined: 09/25/2001 - 09:00

One of my friend's sons is 2 weeks younger than my son and has bad exzema. About a year ago I told her he may be allergic to a food and if she could find out what it is and cut it out of his diet, his skin might improve. Well after a year of Benadryl and trying different steriod creams, she finally decided to have him tested on Oct. 1. I saw her last Friday, Oct. 5 and she told me he tested positive to peanuts, wheat, soy and every environtmental allergy there is but dust mites. She has fed him peanuts in the past and said he's been fine and she has no intention of changing his diet. She said the doctor gave her a new steriod cream to try and she's going to keep up a daily dose of Benadryl. She also was not sent home with an EpiPen. I thought that with each exposure to peanuts, the reaction got worse. If that's true, and she has no intention of chaning the child's diet - won't his reactions get worse? On Friday he had big welts on his arm and I said "oh, is that where he was tested?" and she said "no, that's just where he's scratched so hard he broke the skin and it has scabbed over" Just wondered what you guys thought of this situation. Are you as shocked as I am or am I overeacting?

Posted on: Mon, 10/15/2001 - 12:32am
CMartin's picture
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Joined: 02/18/2000 - 09:00

Heather, I think one of the best things you can do for your friend is direct her to this website and to this discussion board. It has been SO eye opening to me... disheartening at times but always eye opening!... and it sounds like your friend needs to open her eyes to the seriousness of her son's situation. Armed with information, she can then make good choices about whether to adjust his diet and so forth. Allergies CAN be deadly!

Posted on: Mon, 10/15/2001 - 4:42am
BENSMOM's picture
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Joined: 05/20/2000 - 09:00

I don't think you can jump to the conclusion that the peanuts are causing the eczema rather than the wheat or soy, but I would definitely work with the child's diet rather than keep him drugged with Benadryl and steroids. Obviously, she doesn't feel the same way, so I don't think there's much you can do but try to educate her about allergies in general. Why would she go to an allergist if she's just going to ignore the results?
Also, it seems to be common, but not necessarily true that reactions to peanut will get worse.

Posted on: Mon, 10/15/2001 - 8:31am
booandbrimom's picture
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Joined: 08/23/2000 - 09:00

Keep in mind that it takes both a positive skin test AND a positive food challenge to prove a food allergy. Skin tests are notoriously inaccurate for positives.
Incidently, it's not true that reactions continue to get more severe. For many, if not most people (per Dr. Sicherer), reactions stay about the same over time. And it's not common for skin reactions to move to anaphylaxis. Basically, mast cells get sensitized in different ways for different children. A child who reacts with skin and gastrointestinal symptoms is likely to continue to react with those symptoms in the future since those are the mast cells for his/her physiology that are triggered by the allergy. (Of course, I add the caveat here that older children and adults "progress" with regard to the systems that are affected. My son used to get head to foot full body hives - now there's no spots, just immediate airway swelling and asthma.)
It's not really relevant to ask if you're "overreacting" since each child's situation is different, and every parent is at a different place on the risk/normacy continuum, but personally I don't see a lot wrong with continuing to give a child a food he or she has tolerated in the past.
On the other hand, her kid sounds miserable. She may be feeling overwhelmed, since it sounds like the doctor really didn't address this issue or give her further guidance. Many people in this situation try eliminating one food at a time to see if the eczema clears up. The #1 culprit tends to be milk, so that's where I'd start first. Perhaps you could suggest she work with a nutritionist to get a plan in place for an effective elimination diet?

Posted on: Mon, 10/15/2001 - 10:21am
BENSMOM's picture
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Joined: 05/20/2000 - 09:00

Booandbrimom, could you clarify your statement that most people's symptoms remain the same? In one paragraph you said the reactions usually do not get worse and will remain in the same body system, and then you said the systems affected do progress. Are you saying your son is an exception, or do the systems affected normally progress? I think this is something all of us parents would love to know for sure, if there is anything that's for sure with this allergy! This question has been raised before (about whether a child who just gets hives will ever become anaphalactic) and you are the first person I've heard have anything close to an answer to this, so this is very interesting to me. Is the doctor you mentioned a colleague of Dr. Sampson--I think I recall hearing his name. Thanks!

Posted on: Mon, 10/15/2001 - 10:39am
booandbrimom's picture
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Joined: 08/23/2000 - 09:00

Yes, Dr. Sicherer is out of Mt. Sinai and on Dr. Sampson's team... I heard him speak at a FAAN conference last spring. I will see if I can dig up the paragraph in his materials about the progression of food allergies.
What I've been told by several specialists is that there is an "allergic march" with regard to the progression of food allergies and asthma. As a child's immune system matures, the mast cell targets change. In other words, a young child usually shows skin involvement, while an older child or adult will show asthma. It's the number of mast cells involved which, in turn dictates the severity of the reaction that remains stable. The doctors I've talked to had indicated that, while it's certainly possible for a child who's had only minor reactions in the past to progress to a serious reaction, the majority of serious reactions occur in people who have had serious reactions in the past. As one book I recently read said, anaphylaxis is a talent, and some people are better than others at it.
My doctor explained it as a cup: that demands on the immune system change on a daily basis, and each demand goes into the cup. If the cup is filled, a reaction occurs. The severity of the reaction is a consequence of how many mast cells are triggered, and how many potential triggers there are in the child's body. In other words, a child who only has (for the sake of explanation) 100 mast cells on his skin that can be involved in a reaction is not likely to ever progress to anaphylaxis unless his immune response changes. A child who has 100,000 mast cells involved over multiple body systems is much more likely to have a severe reaction. However, depending on how much is in the "cup" on a given day, the threshold or trigger for the reaction may vary from 1/100th of a peanut to a couple bites or more.
(The $64,000 question of course is, what can change this immune response and why do a small percentage of kids get worse, especially PA kids, when most get better? Exposure to food? Viruses? No one knows. Will your kid's immune response change suddenly? No one can predict. That's the hell of food allergies, but you have to also weigh risk and look at the odds.)
So, the system that reacts (skin vs. gastro vs. respiratory) does change as a child ages, particularly if a) the child has asthma and b) the allergy is persistent. However, that doesn't necessarily equate to a change in the number of mast cells involved.
Respiratory reactions are generally more serious, so even if the same percentage of mast cells are involved, the reality is that older children with asthma do tend to have more serious reactions than younger ones. This isn't necessarily a result of exposures though - just a maturing of the immune response.
Clear as mud? I'll admit that after years of discussion with doctors and perusal of the medical journals, I'm still not 100% clear so please - anyone - kick in anything you know about the topic and correct me if I'm wrong.

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