I need advise. Please help.

Posted on: Wed, 05/30/2007 - 4:30am
mistey's picture
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My ds's allergist just called. His peanut Rast is 0.19. It has steadily decreased over the years. His first reaction was ana. when he was around 15 months. He has asthma, but it's pretty well controlled right now with a pretty heavy dose of Flovent. He has outgrown egg, wheat and dairy allergy.

The doc said that he has a 75% chance of passing the challenge. She also said that most hospitals consider >.35 as negative, but they are a very conservative hospital and consider >.10 as being negative.

Ds is entering kindergarten in the fall. I do not have to tell any of you the joy and relief we would feel if he has outgrown. But I'm also extremely scared of what type of reaction he could have if he does not pass. Could he die? What numbers could they shoot up to if he does not pass?

And last, but certainly not least, what would YOU do if he was your child?

Thanks so mcu for answering SOOOO many questions. You all are the best!!

Posted on: Wed, 05/30/2007 - 4:45am
lilpig99's picture
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mistey, have they skin tested him as well? While its good that his numbers have gone down, I myself might want to see a skin test before an oral challenge. But honestly, I don't know the true protocol, as we have no current hopes of low numbers.
I hope you find some good advice from others here....

Posted on: Wed, 05/30/2007 - 4:47am
Greenlady's picture
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Hi mistey -
Since you asked what I would do, I'll start there. I would not take the challenge yet. I'd wait at least another year to see if the downward trend continues.
I know it would be great if your son could go to kindergarten without having to take percautions, but even if he passes, you'd still need an epipen (I think it's generally recommended that a patient carry an epipen for a year after a successful food challenge.) And I know that even if my son were to pass, I'd still stress about a possible reaction if my kid was eating peanut products at school. But if he's not eating peanut products at school, then it's just as easy to treat him as PA anyway.
But if you do decide to challenge, I think you can trust your medical team that a fatal reaction is very very unlikely. I don't know about his numbers being affected, though - that would concern me.
Any challenges I'd agree to would be very conservative - I think I'd start with just a contact test, with exposure to intact skin.
But it's great news that your doctor is willing to even consider a challenge - hope your son has truly outgrown!

Posted on: Wed, 05/30/2007 - 4:56am
chanda4's picture
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If this were my son with those levels....I would go for the challenge. I would start with contact first and see how he does. If all is fine, no reaction, then I would do an ingestion(ONLY in the allergists office or at the hospital though). But his levels seem very promissing. Also the fact that he's outgrown the other 3 allergens, it really does seem possible.
If you are not ready just yet, you could wait another year. Just take necessary precautions at school until you know if he's outgrown or not. Good luck [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
JMHO
------------------
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: Wed, 05/30/2007 - 5:12am
SallyL's picture
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Personally, I'd absolutely do it! Since many (most?) challenge at 0.35 or below, I'd say at 0.19 you're pretty safe. I think a SPT first is a good idea, but I assume that's protocol?
I think if you do the challenge and he passes you'll save yourself a world of headaches and stress over this upcoming school year! If he hasn't outgrown it then he's in the safest place to have a reaction, and you'll know for sure. But given his history, it sounds like he's likely to pass (or at least that's what the allergist seems to be thinking).
But do whatever you feel comfortable with! If he does take the challenge, make sure to let us know how it goes. We'll be rooting for him!

Posted on: Wed, 05/30/2007 - 5:14am
alliedhealth's picture
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based on my literature review and what has been written by Burks and Wood personally I would challenge- they challenge when 2 or less.(50-50 chance)
It would be totally life changing for school.
Again- this is only if it was my situation
This is a challenge in a controlled major medical center
[This message has been edited by alliedhealth (edited May 30, 2007).]
[This message has been edited by alliedhealth (edited May 30, 2007).]

Posted on: Wed, 05/30/2007 - 6:12am
BS312's picture
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Because it would be life-changing (in a great way) to learn that he is not allergic before he starts kindergarten and because he has a very good chance for a negative challenge, I would be really tempted to do the challenge before school starts. Since his numbers have been trending down, you are pretty sure the result is not a false negative, correct?
We subjected our PA DD to a peanut challenge at age 4 when her RAST was suposedly zero. This result turned out to be a false negative and she almost died. The challenge was not done safely.
You might want to repeat the blood test closer to the time you would do the challenge (?August) to be sure that it is truly negative before attempting the challenge.

Posted on: Wed, 05/30/2007 - 6:16am
mistey's picture
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BS312- please explain more about your challenge. I need to know what we are or or not getting ourselves into.

Posted on: Wed, 05/30/2007 - 6:37am
alliedhealth's picture
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let me add to my comment if you challenge, have it done by a board certified allergist specializing in pediatric food allergies and who has much experience with food challenges- they are very controlled and done in a stepwise manner- again- in a major medical center. But, it is a choice you have to determine for yourself.

Posted on: Wed, 05/30/2007 - 10:55am
LDR's picture
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I was in a similiar situation with my daughter (now 7). Before she entered Kindergarten, her numbers had gone down to below what they considered an allergy. I was asked to put her through a challenge. Had your concerns, so I decided I'd wait a year. I was also told that if she passed the challenge, we should add peanuts to her diet little by little. I felt so uncomfortable about that part, especially since I had just had a baby and wanted to continue to keep our house peanut free until we figured out if the baby was allergic. Decided against the challenge--to wait another year. Unfortunately for us, the numbers shot back up higher than ever before on re-testing one year later--now a challenge is out of the question. I certainly do not wish the same scenario on you, but just wanted to share our story since I'm glad I waited.

Posted on: Wed, 05/30/2007 - 11:11am
Carefulmom's picture
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I`ve always been stunned every time I read an article by Dr. Wood saying he would challenge if the chance of failing is 50%. There are many allergists who would not agree with that, definitely not ours. The main reason to do it would be so that when your child starts school, you would not really need to ask for accomodations if he passes. You could still make sure the lunch you send to school has no peanuts, but you would not have to ask for peanut free table, food free or nut free classroom, etc. It sure would make life a lot easier. I don`t think I would do it though with a 25% failure rate. However, what I`ve read shows a pass rate of higher than 75% with a cap rast of 0.19. I don`t recall the exact number. I read it at [url="http://www.aaaai.org"]www.aaaai.org[/url]

Posted on: Wed, 05/30/2007 - 12:15pm
NicoleinNH's picture
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ED
[This message has been edited by NicoleinNH (edited June 10, 2007).]

Posted on: Wed, 05/30/2007 - 12:50pm
M. Mariano's picture
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Misty,
First of all congrats on your child outgrowing many allergies! Personally I wouldnt do the challenge. I know it would be great for peace of mind with starting KDG, but I would wait one more year to see if the numbers drop a little more. Let us know what you decide. Good Luck!

Posted on: Wed, 05/30/2007 - 1:18pm
anonymous's picture
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My allergist said the protocol is to do a SPT if RAST is negative, and only to do a food challenge if the SPT also is negative. I've heard from others that they do a food challenge by first putting a little on the arm, then touching it to the lips (but not in the mouth), and then ingesting increasing amounts -- obviously assuming there's no reaction at any point during the test.

Posted on: Wed, 05/30/2007 - 3:33pm
anonymous's picture
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I would skin test first...
------------------
Stacie - Mother to:
11 yr. PA
8 yr. TNA
3 yr. PA&TNA

Posted on: Thu, 05/31/2007 - 6:10am
BS312's picture
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Mistey-
Prior to DD's peanut challenge, we had done lots of research about RAST numbers and the likelihood of a negative challenge. We had not researched how challenges are supposed to be done. We did not think to question the allergist's methodology. This was almost a fatal error. I might not believe that this could actually happen in 2003, but it did:
They gave PA DD, at age 4, about 1/8 teaspoon of peanut butter and nothing happened. They waited 15 minutes and gave her ONE FULL TEASPOON of pb, which was negligent, outrageous and incredibly dangerous. She almost DIED. She required five epinephrine injections to save her life. We were in the allergist's office for ten hours, never transferred to the ER. Maybe he didn't want to admit the seriousness of the situation. We shouldn't have trusted him. Fortunately, DD had no long-term ill effects and we developed a very healthy respect for her condition.
We didn't sue but certainly could have.

Posted on: Thu, 05/31/2007 - 10:27am
Carefulmom's picture
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Quote:Originally posted by BS312:
[b]We didn't sue but certainly could have. [/b]
In order to successfully sue, you need to have liability and damages. The liability would be clear, but the damages would be hard to prove. It would be very difficult to win more than a few dollars without significant financial damages and most attorneys won`t bother with a case that has so little monetary damages.

Posted on: Thu, 05/31/2007 - 10:37am
booandbrimom's picture
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I would challenge (and have for foods other than peanut including cashew, which he passed).
Has anyone considered that the waiting around for the numbers to drop approach may be the wrong one? Perhaps there are "windows" where the immune system is more tolerant to the introduction of foods and the RAST drops. Miss the window, miss the chance to outgrow.
Maybe the kids with the low RAST tests who outgrew peanut allergy just had lucky timing.

Posted on: Thu, 05/31/2007 - 10:58am
anonymous's picture
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Quote:Originally posted by BS312:
[b]Mistey-
Prior to DD's peanut challenge, we had done lots of research about RAST numbers and the likelihood of a negative challenge. We had not researched how challenges are supposed to be done. We did not think to question the allergist's methodology. This was almost a fatal error. I might not believe that this could actually happen in 2003, but it did:
They gave PA DD, at age 4, about 1/8 teaspoon of peanut butter and nothing happened. They waited 15 minutes and gave her ONE FULL TEASPOON of pb, which was negligent, outrageous and incredibly dangerous. She almost DIED. She required five epinephrine injections to save her life. We were in the allergist's office for ten hours, never transferred to the ER. Maybe he didn't want to admit the seriousness of the situation. We shouldn't have trusted him. Fortunately, DD had no long-term ill effects and we developed a very healthy respect for her condition.
We didn't sue but certainly could have. [/b]
Whoa!!!!!! How frightening, and unbelievably irresponsible. Did you report this to the medical board?

Posted on: Sun, 06/03/2007 - 11:28am
mistey's picture
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Booandbrimom- that is a VERY interesting question. One that I have not thought about.
Anyone know the answer to this?
If not, I may just put it out there as a topic to itself.

Posted on: Sun, 06/03/2007 - 11:54am
anonymous's picture
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If it were me I would challenge. Did they do a SPT and what happened with that? Are they going to do the challenge in the hospital? Good luck whatever the choice you make [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Sun, 06/03/2007 - 1:27pm
NicoleinNH's picture
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WO
[This message has been edited by NicoleinNH (edited June 10, 2007).]

Posted on: Sun, 06/03/2007 - 10:48pm
mistey's picture
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Our allergist said that she would skin test if I wanted her to do so. She said that often times there are false positives and this causes parents to not do challenges that they would otherwise do and and most likely still pass. She did say that if we wanted one, she would definately do one.
It's a hard decision, because my husband tested positive on a skin test, I think around class 3, but he does not react to peanuts at all.
Yes, this would be done in an allergist's office, but the office is within a major Children's Hospital. She is also board certified and I'm sure she follows standard protocal.
We still haven't made a decision yet, though.
Still considering Booandbrismom's question.

Posted on: Mon, 06/04/2007 - 12:42am
saknjmom's picture
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My DS had rast test which showed negative to 2 types of shellfish, egg whites and almost negative for peanut. Previously rast had showed positive for all, but I don't know the numbers.
The peanut had decreased significantly and the dr felt that he probably had outgrown and wanted to challenge if SPT yielded similar results.
SPT came back negative for all except the peanut. The wheal was 16mm which is the same it has always been for spt.
So, for me and DS's doctor, a challenge would not be appropriate for him due to the conflicting results.
The problem is that maybe the spt is a false postive...maybe it is not. I'd rather be on the safe side and continue with the assumption that he is allergic than put him in harm's way with a challenge that could be disasterous.
If his spt was very low or negative, I would be more open to a challenge.

Posted on: Mon, 06/04/2007 - 1:03am
jtolpin's picture
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Me? I would RAST.
If negative, or low, I would SPT.
If pass SPT, I would IOFC.
If pass that, I'd consider yourself golden.
Joy and relief from K at no allergy? Sorry. I dont buy that. I think you can still have joy/relief from K WITH FA's... just get the right policy in place (see 504 meeting in schools forum) [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
But I see your point, enough to realize that you WANT your child to be allergy free. Maybe it happens, maybe it doesn't. Whether you test/or not, your child can still have a fun K, right? [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
Jason
------------------
[b]* Beyond Obsessed * [/b]

Posted on: Mon, 06/04/2007 - 3:12am
anonymous's picture
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Joined: 05/28/2009 - 16:42

I can only hope that i have this decision to make in the future.
I would SPT first- if negative, an oral challenge, with a pediatric allergist in the hospital.

Posted on: Mon, 06/04/2007 - 5:55am
julieneaman's picture
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Joined: 01/11/2004 - 09:00

Mistey,
We just went through this in March. DS also will enter Kindergarten. We had him skin tested the morning of the challenge, and was neg, but he failed the challenge. It didn't take much either. I would do it again, though, if it meant he might be able to go to school with a lighter load, KWIM?
Let us know what you decide.
Julie

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