Interesting information from allergist today!

Posted on: Thu, 11/11/2004 - 4:14am
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DD who is 9 saw the allergist today for her cranberry challenge which she passed. While we were talking during the twenty minutes between bites, he said her chances are 50% of outgrowing the pa. I was really surprised as she is a class 4 CAP RAST, and I know she is really sensitive because she had a reaction to a product made on shared equipment with peanuts and not stated. Anyhow, he said that the 20% of people who outgrow pa is for ALL people allergic to peanuts, but if there are no exposures the chance is actually 50% of outgrowing it. He said he has patients who, for example, decide to give their child a small bite of pb to see if the child is still allergic, and those people are the ones unlikely to outgrow the pa. But he said if you are very careful to avoid exposures, new research shows that your chance of outgrowing it is 50%. He is on staff at UCLA and is always quoting the latest studies and Dr. Sampson, so I think this information is probably correct. He also is doing studies on Xolair and pa, and said it looks really promising. He thinks in 3 to 4 years it will be available to the public for pa.

Posted on: Thu, 11/11/2004 - 5:29am
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Congratulations on the successful cranberry challenge. The news on the chances of outgrowing the allergy is wonderful. My son (6 years old) does not seem to be very sensitive to peanuts. Although he is a class 6 CAP RAST and a 4+ skin test, he has had very few real world incidents. As a result, our comfort zone is significantly wider than that for many people who post on this board. While I am pretty confident that he does not ingest peanut products, he may get topical exposure. He does not sit at peanut free table at school, he has gone to a base ball game with peanuts everywhere, etc. Did your allergist define what is meant by "exposure".

Posted on: Thu, 11/11/2004 - 5:40am
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He did not actually define it, but from the examples he gave I think he means ingestion. He was referring to people letting their kids try peanut butter, or taking a chance on food in a restaurant without checking ingredients, etc. He didn`t say anything about airborne or contact exposures. My daughter does sit at a peanut free table, so I did not really ask him about that.

Posted on: Thu, 11/11/2004 - 7:07am
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Thanks for sharing that! I like to hear stuff like that, it helps me explain to people (read: mother-in-law!) why I am hyper vigilant with my son.
Congrats on your daughter passing her challenge! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Thu, 11/11/2004 - 7:19am
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Interesting tidbit. I like those statistics MUCH better [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Here's to hoping our kids outgrow no matter what the statistic!!!
Congrats on another food challenge passed [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
------------------
***[b] ALLERGY ELIMINATOR*** [/b]
Meg, mom to:
Matt 2 yrs. PA,MA,EA
Sean 2 yrs. NKA

Posted on: Thu, 11/11/2004 - 8:34am
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This strikes me as the sort of information that could be helpful when dealing with schools who are unwilling to do much in the way of accomodating children with allergies. They are obviously not moved by how dangerous it can be for our children to be around peanut products, so maybe they'd be moved by how *beneficial* it can be to reduce the risk of exposure. The obvious benefit is to the kids themselves, but in the long run, the school would benefit by having fewer children with allergy problems.
I would define "exposure" not to just eating peanut products, but to anything that causes an allergic reaction since obviously the body is responding regardless of whether the food was ingested or not. If that's the case, we're doomed--my DD has been breaking out in hives around her mouth whenever she is in the Catholic school cafeteria (which is where the kids gather to go to religious ed. classes on Sundays and where lots of other group activities take place).
Sarah

Posted on: Sat, 11/13/2004 - 8:05am
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I love hearing this stuff! However I am going to assume that my son won't outgrow it, and then if he does I will be wildly happy! [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
------------------
[i][b]Allergy Patrol Novice[/b][/i]

Posted on: Sat, 11/13/2004 - 8:39am
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Awesome news, carefulmom!!! What a celebration to cross an allergy off the list. About the possiblity of outgrowing PA, you give us a little hope too....
Since I am new to this, I wonder about the breastmilk exposure thing-like if that will be against us being in that hopeful percentage. Did you happen to expose you child through breastmilk? Or, hopefully for me, you doc means from the point of diagnosis regardless of prior exposure, if you can keep future exposures nill you have that hope?

Posted on: Wed, 11/17/2004 - 9:47am
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What is the name of your allergist? I'm in Orange County and wouldn't mind the drive when I have my son retested in a few years. It would be nice to go to a doctor who really knows his "stuff" about PA.

Posted on: Wed, 11/17/2004 - 1:16pm
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Little Noah`s Mommy, I did expose her through breast milk. Way back then (9 years ago) they did not know that peanut protein is excreted in breast milk. And she has all those exposures from the product on shared equipment and not stated. After the reaction 2 1/2 years ago, she has had no exposures since---and I am really pretty sure of that.
Deegan, his name is Dr. Howard Schanker. Phone is (310) 312-5050. He is in West L.A. He is awesome, and definitely worth the drive.

Posted on: Thu, 11/18/2004 - 12:10am
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So Carefulmom, it sounds like you are thinking that due to the exposures thru breastmilk, your daughter may not be in that glorious 20% to 'outgrow' PA? And her other exposures were due to having a food that was x contaminated due to shared equipment? I am sure you posted about these at the time, but may I ask what she had & how you found out later it was xcontam? And to think it sent her into a reaction---did she need the epi and the ER? Knowing a bit about it may help me explain to the inlaws and family the seriousness of even having something that may have been on shared equipment & x contaminated....and how having that happen could maybe affect the child's future allergy prognosis. Thanks for sharing!

Posted on: Thu, 11/18/2004 - 6:13am
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Her allergist thinks her odds are 50% of outgrowing it because she has not had an exposure since the shared equipment which I found out about 2 1/2 years ago. I really think she has had no exposures since then. About the shared equipment, it was imitation soy ice cream because she is allergic to milk. She ate it for years without a problem and then in April 2002, she ate it and had what looked like an asthma attack. I treated it like an asthma attack, but figured it was a reaction to something (did not know what because I read ingredients on anything that goes into her mouth). Anyhow, she was fine after a nebulizer, but I considered using epi. I decided if the wheezing came back after the nebulizer I would use epi. As it turned out the wheezing did not come back and I did not have to use the epi. I decided it was due to something she ate because she was fine, and it started immediately after eating. Her asthma is usually only when she has a cold and she did not have a cold. She had had the imitation soy ice cream, Hershey`s chocolate sauce, and sprinkles. It was on a Friday night. Monday I called all three manufacturers: no cross contamination for Hersheys or the sprinkles, but the soy ice cream was on shared equipment with milk and peanuts but not stated anywhere. The owner of the company and I had numerous conversations about the fact that I had unknowingly exposed my daughter hundreds of times,and he should state the shared equipment so the parent can decide if they want to take the chance with their child. The owner believed his cleaning was so perfect that there could be no chance of cross contamination, so that is why he did not state it. I took dd to the allergist, told him the whole story, and due to the sudden onset of the "asthma attack" right after eating he agreed it was a pa reaction. He said probably a fraction of a peanut was lodged in the equipment (which cleaning will not take care of) and then was released many batches later in a different flavor. I told all this to the owner, and told him he should put a "may contain" on the carton. He disagreed. I emailed Dr. Hugh Sampson, he emailed back and agreed with everything I said. Dr. Sampson and the owner spoke on the phone, and the owner decided to put a warning about shared equipment on the website (like all of us check the website of every product we buy-----yeah, right.) There were a couple of threads on this back in 2002---you might find them if you do a search on "WholeSoy" which was the maker of the imitation soy ice cream.

Posted on: Fri, 11/19/2004 - 3:35am
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I was wondering about what you said about your son being a class 6. Which my son is.. I just found out he has this allergy althogh I did suspect because he would throw up when he had peanuts. I was curious how cautious you are with the peanuts and cross contamination. William has ate m&m's for two years and he never had a reaction. He only threw up when he actually ate peanut butter. Just curious on your take. Thanks for any input. Kelly Quote:Originally posted by michaelsmom:
[b]Congratulations on the successful cranberry challenge. The news on the chances of outgrowing the allergy is wonderful. My son (6 years old) does not seem to be very sensitive to peanuts. Although he is a class 6 CAP RAST and a 4+ skin test, he has had very few real world incidents. As a result, our comfort zone is significantly wider than that for many people who post on this board. While I am pretty confident that he does not ingest peanut products, he may get topical exposure. He does not sit at peanut free table at school, he has gone to a base ball game with peanuts everywhere, etc. Did your allergist define what is meant by "exposure". [/b]

Posted on: Fri, 11/19/2004 - 5:52am
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At my son's 1 year well baby visit, I expressed concern to his doctor about the fact that my son didn't eat much meat. The doctor recommended that I try peanut butter (Darkmage - sound familiar). I tried this a few months later. Being a typical 1 year old, my son refused to eat it since it was new, but enjoyed playing with it and feeding it to me. Within a few minutes, his hands and face became red and swollen. We gave him Benadryl (after a paniced call to the doctor) and he did not develop any additional symptoms. The allergist confirmed the peanut allergy with a skin test. In the 5 subsequent years that we have been living with this, he has only developed a few spots around his mouth twice. I believe that I determined that one was caused because I bought the wrong chocholate chips (may contain statement). I couldn't figure out a cause for the other incident. I will not let him eat any "may contain..." or "processed on the same equipment..." foods. I will let him eat "manufactured in a facility..." foods. I know that we are not nearly as strict as other parents, however, other than the above mentioned incidents, we have had no reactions. As a result, I was very hopeful that he was outgrowing the allergy. When he was 5, a substitue aide at his school accidently gave him a peanut butter Oreo for snack one day. The teacher pretty quickly realized what happened and took it away. A piece of the cookie part was missing. We weren't really able to determine if he ate it or not. I am pretty sure that he handled the cookie. He had no reaction. I brought him to the allergist again to have him tested. He tested "off the charts" for both the skin test and CAP RAST. You can imagine my disappointment and confusion when I got the results. I still have not yet come to terms with how his test results could be so different from what we actually experience. As mentioned earlier, while I do control what he ingests, he has gotten other types of exposures with no reaction. I had pretty much given up hope of him outgrowing this allergy until Carefulmom posted the comments from her allergist. I now have hope again.

Posted on: Fri, 11/19/2004 - 5:53am
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I would be so interested to read the study/article that references the 50% theory...and share it my allergist if he hasn't seen it yet. If it's not too much trouble, it would be great if they would let us know how to find it.
Thanks so much for posting such encouraging info!!!

Posted on: Fri, 11/19/2004 - 7:31am
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Keep in mind, that the true gold standard test is a food challange with the food.... if there's no reaction it does not matter what the Rast and skin test say.
There's an immonological memory in each individual (in other words the skin test remains positive sometime for life and sometimes not as if the body remembers what it used to fight). I one saw an allergist that told me his skin test was positive but could eat peanuts safely. This also happened to my son (milk allegy) he outgrew the allergy passed a food challange but the skin test for milk was still positive minutes before the challange. A decision to do the challange is taken depending upon the CAP Rast ku/ml result. There are different parameters for different allergens. Hope this helps.

Posted on: Fri, 11/19/2004 - 7:57am
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My allergist said the same thing about the skin test. That is why we did the CAP RAST. Michael's result was >100 Ku/L which is a class 6. The allergist indicated that he would only recommend an oral challenge if the result was <3.50. He feels the risk is way too high and I agree. I just can't understand how he could have such a high number and not be more sensitive.
I don't let my son eat regular M&M's. I work in a manufacturing plant. Most of the complaints we get from our customers are due to contamination in some form. It is very hard to clean equipment and be confident that there is no contamination present from prior runs. I am sure that 99% of the time M&M's or other products containing the warning "manufactured on equipment ...", would be safe for my son to eat, I just don't want him to experience the 1% when it is not.

Posted on: Fri, 11/19/2004 - 10:23am
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I agree with you a class 6 with a Ku/ml greater than 3.5 for peanuts is way too risky and I agree with his decision. But reading of positive skin test and basing decision only on those may not identify kids that successfully outgrew the allergy.
There was a kid in my son's prior school that had a very severe reaction at 1 year old, with hives and severe facial swelling he's now 6 and became completely tolerant. I guess the mother found out he was tolerant by feeding him peanut butter again sometime later (I cannot believe she did a food challange in her home, I guess she did not fully understand how serious this allergy could be and she was just plain lucky!!)I doubt she did any rast or skin prick test...

Posted on: Fri, 11/19/2004 - 11:17am
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This thread is so informative and helpful! Carefulmom, was your daughter's reaction 2 1/2 years ago from the soyicecream her only reaction (though as you say she may have been 'exposed' by eating the icecream and just not having an obvious reaction many other times)? I applaud you for all you did to get the manufacturer to do at least something about the xcontam issue! So, your doc believes if there are no (or very few/minor?) exposures, a child may have a 50% chance to lose PA; did he have any time frame/like how many years of no exposure? See where I am going with this...wondering if noah at 11 month has how many years of his mommy being ULTRA cautious about everything before there may be a nice PA free celebration. This kind of info may also help our family members who may not understand why we won't be visiting peanut infested homes anytime soon.
Michaelsmom: what kind of chocolate chips caused your son's reaction?

Posted on: Fri, 11/19/2004 - 1:29pm
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Her allergist is referring to absolutely no exposure, which is why I was so furious at WholeSoy. He did not say how long a period of no exposures in order to have hope of outgrowing it. I do know that her cap rast at age 9 was about the same as age 5. We discovered that WholeSoy was cross contaminated two days before her 7th birthday. So during the 4 year window between tests, she had exposures several times a week for two years, and then no exposures at all for two years. Since her cap rast was the same, who knows what it would have been if I had never given the cross contaminated WholeSoy. So anyhow, she is getting another cap rast in March. That will cover an 8 month window of (hopefully) no exposures at all. I would be thrilled if it would even come down a little.
You asked if that one reaction to the WholeSoy was her only reaction. During the two years I gave it, there were a few times she would eat it and cough a little (maybe 3 or 4 coughs). I thought that was just because it was cold. After she had the "asthma attack" reaction, I decided that the little cough she would sometimes get was a reaction to cross contamination also. Interestingly after that I started making our own ice cream (talk about a lot of work) and she never coughs after eating the ice cream I make, so that pretty much answers it.
I have a comment (unsolicited) about the relatives, having been at this food allergy thing for 9 years now. It does seem that just about everyone on this board knows someone who has control issues, and the pa does seem to bring that out (meaning when we won`t put our kids in unsafe situations, people who have a need for control seem to get upset). So I don`t know your relatives, but if they try to talk you into bringing him anyhow, here is my unsolicited advice. There are people on this board who are constantly trying to educate their relatives and never get anywhere. I don`t have that problem with my relatives, but I had that problem with the mother of a good friend of dd`s back in first grade (no longer friends due to her constant need to put dd in unsafe situations). Well, anyhow, here is my advice. I think it is fine to explain,...but if they start to challenge you or tell you you are overreacting, I would save yourself the stress and not engage in that. You should not have to have multiple conversations explaining why a house where peanuts are shelled several times a week is unsafe for a crawling toddler who is at an age where babies put everything they see in their mouth. You tell the relatives it is unsafe due to the shelled peanuts and that`s it. I personally would not have multiple discussions about it. That is one thing I have learned after 9 years of this. People either choose to understand or choose not to understand. If you explain it and they choose not to understand, you don`t have to explain your reasons over and over. I am sure some people will read this post and disagree, but this seems to come up quite a bit around holiday time, with relatives trying to pressure people on this board into putting their kids in unsafe situations.
[This message has been edited by Carefulmom (edited November 19, 2004).]

Posted on: Mon, 11/22/2004 - 12:34am
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Little Noah's Mommy - It was a really stupid mistake. I had intended to buy Neslte's semi sweet chocholate chips. I mistakenly bought one of their more specialty varieties instead. It has been years since the incident so I don't remember the name of the chips and the Nestle web site is down right now so I can't try to look it up. The bag clearly was labelled with either a "may contain..." or "manufactured on the same equipment...." warning statement. I was in a hurry and didn't pay close enough attention. It was my mistake, not a labelling problem. Luckily, Michael only ate 1 cookie made with these chips and had a very mild reaction.
Carefulmom - What is your allergist's plan for monitoring and testing your daughter i.e. frequency of CAP RAST tesitng, at what IgE level would he recommend an oral challenge, etc.

Posted on: Mon, 11/22/2004 - 10:21am
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He did a cap rast at age 5 and repeated it at age 9. He is repeating it again in March (last one was June of this year) only because the milk was close to normal. I am not sure what cutoff he uses to do a challenge. Egg was 0.11 with normal being 0.10, and he did a challenge which she passed. Milk was 1.02 and he said it was too high for a challenge. I think his age for when to repeat it depends on the value, and if there is hope that it will be low enough for a challenge. At age 5 they were all too high and not close to low enough for a challenge, so that is why he waited 4 years to repeat it.

Posted on: Sun, 03/04/2007 - 12:31am
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Re-rasing for Gail W. Wanted to add that since we started our strict avoidance, cap rast fell from 34 to 15 to 12. Fingers are crossed......

Posted on: Sun, 03/04/2007 - 12:38am
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Thank you Carefulmom. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
What is the study he is using?

Posted on: Sun, 03/04/2007 - 12:50am
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I have no idea. The conversation was two years ago!

Posted on: Sun, 03/04/2007 - 1:12am
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Quote:Originally posted by Carefulmom:
[b]Re-rasing for Gail W. Wanted to add that since we started our strict avoidance, cap rast fell from 34 to 15 to 12. Fingers are crossed......[/b]
I know this is an old thread...but what about my son Jake, his caprast has gone form 50 to 37.5 to 21.70...I havn't given him bites, but he has had accidental exposures and reactions.
I wish food allergies were black and white...there is way too much grey area and it;s hard to know what to believe and what not.
------------------
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: Sun, 03/04/2007 - 2:12am
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I don`t think one can really draw a conclusion from one person`s experience, like your ds`s or my dd`s. That is why they do studies. The studies show that with strict avoidance the chance of outgrowing is 50%. Me, I will try for that 50% for my dd. Like Nicole posted in the other thread, it would be great if our kids could just be "normal" kids, but the reality is they can`t. They have to worry about life and death every day, whereas most kids don`t. I, like Nicole, don`t feel guilty telling dd she cannot do something, if I believe that in the long run it will improve her chance of outgrowing. She wants more than anything to outgrow.
[This message has been edited by Carefulmom (edited March 04, 2007).]

Posted on: Sun, 03/04/2007 - 2:56am
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Gail W, I don't know the specific study that Carefulmom's allergist is referring to but here is one study. On page two at the bottom btw.
[URL=http://www.aaaai.org/patients/advocate/2003/fall/fall03.pdf]
ps. Carefulmom, Thank you for your diligence in keeping updated and sharing it on pa.oom, this "old" news is new to me.
[This message has been edited by SkyMom (edited March 04, 2007).]
[This message has been edited by SkyMom (edited March 04, 2007).]

Posted on: Sun, 03/04/2007 - 9:31am
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Thanks SkyMom and Carefulmom.
Basically, the 2003 study says patients with[b] low peanut-IgE levels [/b]have a 50% chance of outgrowing their peanut allergy (JACI Jul 2003; David M. Fleischer, MD, et. al). I'm trying to obtain a copy of the original article to see the definition of "low peanut-IgE levels".

Posted on: Sun, 03/04/2007 - 11:07am
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But we really don`t know if this is the same study dd`s allergist was talking about or not. When he and I had this conversation her cap rast was 34 and he said based on what he read, dd`s chance of outgrowing was 50% with strict avoidance. 34 is not really a low cap rast--she was class 4.

Posted on: Sun, 03/04/2007 - 12:25pm
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Is IgE level the same as CAP Rast score?
I would be very interested in knowing what study/information your allergist is using. . .

Posted on: Sun, 03/04/2007 - 12:39pm
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Usually, but not always. It really depends on the context. I just tried to find the article that SkyMom posted from the AAAAI website, but I cannot get that to turn into a link. Can someone post the link to it?
[This message has been edited by Carefulmom (edited March 04, 2007).]

Posted on: Sun, 03/04/2007 - 11:06pm
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I couldn't use the posted link either, but you can find the article on-line. We had to use ScienceDirect to access. Anway. . .
[b]The natural progression of peanut allergy: Resolution and the possibility of recurrence[/b]
David M. Fleischer MD, Mary Kay Conover-Walker MSN, RN, CRNP, Lynn Christie MS, RD, LD, A.Wesley Burks MD and Robert A. Wood MD
From the Department of Pediatrics, Johns Hopkins University School of Medicine and the Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital.
Received 7 February 2003; revised 27 February 2003. Available online 24 July 2003.
Abstract
Background: It was once thought that peanut allergy is a lifelong problem. We previously reported that about 20% of children outgrow their peanut allergy and that more than 60% of patients with a peanut-IgE level of 5 or less passed an oral challenge.
Objective: The goal of this study was to further describe the natural progression of peanut allergy by reviewing patients who have undergone oral peanut challenges since the previous study.
Methods: Patients with peanut-IgE levels of 5 or less were offered a peanut challenge. Those who passed were further evaluated by questionnaire to assess reintroduction of peanut into their diet and whether any recurrence has occurred.
Results: Eighty-four patients were evaluated, and 80 underwent complete analysis. Fifty-five percent with peanut-IgE levels of 5 or less and 63% with peanut-IgE levels of 2 or less passed challenges, compared to 61% and 67%, respectively, in our previous study. The 4 additional patients passed peanut challenges in this study after previously failing. Three patients with initial anaphylactic reactions and 2 patients with initial peanut-IgE levels greater than 70 passed their challenge. Follow-up of those who passed in both studies showed that the majority of patients reintroduced peanut into their diet, but that continued label reading, infrequent/limited ingestion, and aversion to peanut were all common in this population. Two patients had suspected subsequent reactions to peanut after passing their challenge.
Conclusions: Patients with a history of peanut allergy and peanut-IgE levels of 5 or less have at least a 50% chance of outgrowing their allergy. Recurrence of peanut allergy may occur but appears to be uncommon. (J Allergy Clin Immunol 2003;112:183-9.)
<><><><><><><><><><><><>
Could you confirm with your allergist that this is the study to which he was referring?
[This message has been edited by Gail W (edited March 05, 2007).]

Posted on: Mon, 03/05/2007 - 7:28am
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It wasn`t this study. The study he was talking about didn`t have anything to do with IgE levels. It was about how with strict avoidance the chance of outgrowing is 50% and not 20%. 20% is for all people with pa whether they practice strict avoidance or not.

Posted on: Mon, 03/05/2007 - 7:49am
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I can't find a study that matches what your allergist told you. <> I've looked for a couple hours, and maybe I've missed it or I'm not looking in the right places. I don't know.
It would be appreciated if you could find it and post it.
Thanks. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Mon, 03/05/2007 - 8:51am
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Isn't there something, too, about children who have only a peanut allergy and not multiple food allergies having a greater a chance of growing out of PA? I feel like I read that somewhere . . .has anyone heard that?

Posted on: Mon, 03/05/2007 - 10:06am
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From memory I seem to recall that 20% on average outgrow severe peanut allergy but that multiple food allergies, such as egg white for our daughter, reduce the likelihood. I agree with "Darkmage" from this thread in 2004 who was assuming that his son would have the allergy for life ... then if he outgrew it it would be a tremendous bonus.
We are working very hard to avoid further peanut exposure. To date I am not sure that she ate even a quarter of a peanut! A fragment was all that it took! Our daughter would certainly have had exposure in breast milk during her first six months as well ... we had no idea at that time. Education for new parents is needed in this area!
NP. (edited for grammar)
------------------
[url="http://www.NoPeanutsPlease.com"]www.NoPeanutsPlease.com[/url]
[This message has been edited by NoPeanutsPlease.com (edited March 05, 2007).]

Posted on: Mon, 03/05/2007 - 11:05am
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Quote:Originally posted by Gail W:
[b]I can't find a study that matches what your allergist told you. <> I've looked for a couple hours, and maybe I've missed it or I'm not looking in the right places. I don't know.
It would be appreciated if you could find it and post it. Thanks. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img][/b]
Sorry, but he never gave me the study. It was simply something he told me as we were doing the food challenge in his office.
Friday Mom, I read the same that they are more likely to outgrow if they are only pa (not sure that includes tna or not). I read that if they have other food allergies besides peanut, they are less likely to outgrow the peanut. That is why I am shocked that dd`s numbers to peanut are coming down. She is allergic to milk and used to be allergic to egg. I also read that early onset pa is more likely to outgrow. That is definitely not us. Dd was diagnosed pa at age 5. However, she had never knowingly had peanuts, so she never had a reaction. Maybe if I had given her pb at a young age, she would fit as early onset pa.
[This message has been edited by Carefulmom (edited March 05, 2007).]

Posted on: Thu, 03/08/2007 - 12:28pm
GinaC's picture
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Actually the "outgrowing" due to strict avoidance is an area of great interest to me.
I dont believe that avoiding does increase your chances of outgrowing. If anything, it may make things worse. (there is an article out there titled "The ice cream parlor challenge could be a killer" that talks about how allergies often worsen after a period of avoidance)
We've seen two of the leading pediatric allergist (one at Mt Sinai and one at Johns Hopkins) and I've asked them both. No study.
I was told that the theory that total avoidance increases your chances of outgrowing actually came from a study on pollen.
I also attending a US-Canadian conference just last fall where we were briefed on the latest research. No studies on this.
Actually, the immunotherapy is proving that the exact opposite is true. Minute and increasing amounts over time actually induce tolerance.
Dr Sicherer in one of his books or perhaps a journal article talks about a study where they tested IgE levels before and after a food challenge and there is NO change in the child's food specific IgE level.
In other words, that exposure does not alter the course of the allergy.
Our doctor at Johns Hopkins told me that the truth is they dont know why some kids outgrow and some dont.
If there is any study that shows that avoidance increaases one's chances of outgrowing, I'd sure like to see it.
I'm not advocating giving your child foods to which he/she is allergic. I just dont believe that the avoidance will mean he will outgrow his allergies.
Take care,
Gina
[url="http://www.AllergyMoms.com"]www.AllergyMoms.com[/url]

Posted on: Thu, 03/08/2007 - 7:25pm
jtolpin's picture
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Im with Gina on that one.
Avoiding allergens avoids reactions.
Does it hurt the chances of out growing? I dont know.
Does it help the chances of out growing? I dont know.
If it DOES hurt the 'outgrowing' process... what do you do? Give food and hope for no reaction, or give food to HELP the situation later... a conundrum at best. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]
Jason

Posted on: Thu, 03/08/2007 - 11:43pm
GinaC's picture
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No, I'm not advocating giving the food when allergic even when studies are showing that minute amounts over time may induce tolerance.
That is only done under a strictly controlled medical setting.
But I do think that we need to let parents off the hook for accidental exposures (this does not appear to diminish ones chance of outgrowing)
And until I see a single study that shows that total avoidance increases ones chances of outgrowing, I will continue to challenge this outdated theory.
Take care,
Gina
[url="http://www.allergymoms.com"]www.allergymoms.com[/url]
[This message has been edited by GinaC (edited March 09, 2007).]
[This message has been edited by GinaC (edited March 09, 2007).]

Posted on: Thu, 03/08/2007 - 11:49pm
Carefulmom's picture
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Quote:Originally posted by GinaC:
[b]
1. We've seen two of the leading pediatric allergist (one at Mt Sinai and one at Johns Hopkins) and I've asked them both. No study.
2. I was told that the theory that total avoidance increases your chances of outgrowing actually came from a study on pollen.
3. I also attending a US-Canadian conference just last fall where we were briefed on the latest research. No studies on this.
4. Actually, the immunotherapy is proving that the exact opposite is true. Minute and increasing amounts over time actually induce tolerance.
5. Dr Sicherer in one of his books or perhaps a journal article talks about a study where they tested IgE levels before and after a food challenge and there is NO change in the child's food specific IgE level.
In other words, that exposure does not alter the course of the allergy.
6. Our doctor at Johns Hopkins told me that the truth is they dont know why some kids outgrow and some dont.
Take care,
Gina
[url="http://www.AllergyMoms.com"]www.AllergyMoms.com[/url]
[/b]
Sorry, I don`t know how to put in a quote and then comment on specific paragraphs, so I had to number them. If anyone knows how to put your own comments into a quote, let me know.
1.2.3. I have seen several studies showing that exposure decreases chance of outgrowing on the website for the American Academy of Allergy Asthma and Immunology [url="http://www.aaaai.org"]www.aaaai.org[/url] Spend a few hours there and you will find them.
4. This was addressed in the last FAAN newsletter. There was a study on immunotherapy and they specifically stated that IF it works (and that is a big if), it is because the quantities are minute, strictly controlled, and increased a tiny bit each time. They were extremely clear that this does not similate the real environment (such as school) at all, and that NO conclusions should be drawn about exposures in an uncontrolled setting. They also stated that no conclusions can be drawn about whether immunotherapy even works, because the number of people in the study is so extremely small.
5. He is on the board for FAAN which is partially funded by the peanut industry.
6. Is this the same well known doctor at Hopkins who has written articles stating that he will do a challenge if there is a 50% chance the person will fail? He is quite well known, so I would have to assume that is who you are referring to.
[This message has been edited by Carefulmom (edited March 09, 2007).]

Posted on: Fri, 03/09/2007 - 12:49am
BriandBrinasmom's picture
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Carefulmom, I've spent time on the aaai site at your direction this week, and have spent a good deal of time there over the past 10 years in general since I'm very interested in this research. I have not seen these studies you're talking about.
Can you please post the link(s) if this is something you want to discuss?
Some studies from Medline to consider:
#1
We analyzed, from the literature, the balance benefit/risk of a strict avoidance of peanut in children with peanut allergy. The benefits of a strict avoidance diet seem limited: reactions to the low doses and to the peanut oil refined are rare and most often slight. It is not proven that a strict avoidance facilitates the cure of allergy. On the other hand, strict avoidance could induce a worsening of allergy, with deterioration of quality of life, creation of food neophobia. In case of cure of allergy, it is difficult to normalize the diet after a strict avoidance. Outside of the rare sensitive patients to a very low dose of peanut, for which a strict avoidance is counseled, the report benefits risk is in favor of the prescription of adapted avoidance to the eliciting dose. For the majority of the peanut allergic children, it seems to us that the avoidance can and must be limited to the non hidden peanut.
[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16828543&query_hl=2&itool=pubmed_docsum"]http://www.ncbi.nlm.nih.gov/entrez/query...l=pubmed_docsum[/url]
#2
Nine of 20 patients who had previously reacted to a TN passed challenges, so that 9 (8.9%; 95% CI, 4% to 16%) of 101 patients with a history of prior TN reactions outgrew TN allergy. Fourteen of 19 who had never ingested TNs but had detectable TN-specific IgE levels passed challenges. CONCLUSIONS: Approximately 9% of patients outgrow TN allergy, including some who had prior severe reactions.
[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16275381&query_hl=13&itool=pubmed_docsum"]http://www.ncbi.nlm.nih.gov/entrez/query...l=pubmed_docsum[/url]
[COMMENT: resolvers were both avoiders and those with previous exposures.)
#3
BACKGROUND: Cow's milk allergy (CMA) affects 2.5% of children less than 2 years of age, but about 80% become clinically tolerant within the first 3 years of life. Casein is one of the major allergens responsible for CMA and seems to play an important role in persistent allergy. Previous studies on egg allergy suggested that linear epitopes are associated with long-lasting food allergy. OBJECTIVE: The aim of the study was to identify IgE- and IgG-binding epitopes on alpha(s1)-casein and to determine whether the patterns of epitope recognition are associated with the natural history of CMA. METHODS: According to the known amino acid (AA) sequence, 96 overlapping decapeptides representing the entire length of alpha(s1)-casein were synthesized on a cellulose-derived membrane. Sera from 24 children with milk allergy were used to identify IgE- and IgG-binding epitopes. RESULTS: Six major and 3 minor IgE-binding, as well as 5 major and 1 minor IgG-binding, regions on alpha(s1)-casein were identified. Two IgE-binding regions (AA 69-78 and AA 173-194) were recognized by the majority of patients over 9 years of age with persistent allergy (67% and 100%, respectively) but by none of the children less than 3 years of age who are likely to outgrow CMA. No differences in IgG binding between the groups were observed. CONCLUSION: There appears to be a difference in epitope recognition between patients with different natural histories of CMA. Screening for IgE antibodies to these epitopes may be useful in identifying children who will have persistent milk hypersensitivity.
[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11174208&query_hl=45&itool=pubmed_docsum"]http://www.ncbi.nlm.nih.gov/entrez/query...l=pubmed_docsum[/url]
[COMMENT: strict avoidance would not play a role if this is true, because the *type* of allergy that is outgrown is different.]

Posted on: Fri, 03/09/2007 - 12:50am
jtolpin's picture
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Quote:Originally posted by Carefulmom:
5. He is on the board for FAAN which is partially funded by the peanut industry.
1) Oooh. A conspiracy. Do tell. Do you think he's in cahoots? Got the peanut industry in his back pocket, so to speak?
Or are you just commenting on 'facts'.
2) Gina, I hear you. Didnt mean to imply that we SHOULD be giving minute exposures to kids... just thinking out loud (a la ATM...)
Jason
------------------
[b]* Beyond Obsessed * [/b]

Posted on: Fri, 03/09/2007 - 1:12am
Carefulmom's picture
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Briandbrina`smom, sure I would be happy when I have a few hours free to go to the AAAAI site and find some studies for you. About the ones you posted, they really don`t show anything either way about whether strict avoidance does or does not improve chance of outgrowing.
1. This was a population in France and characteristics of peanut allergy varies from country to country.
2. Sure, some people who avoid don`t outgrow, some people who don`t avoid do outgrow. I don`t think anyone would say that all who avoid will outgrow and all who have ongoing exposure will remain allergic. So this study doesn`t really show anything one way or the other as far as whether avoiding increases your chance of outgrowing.
3. This study also does not address whether strict avoidance plays a role or not. Showing that there are different proteins involved in different cow`s milk allergy patients really has nothing to do with whether for a given protein avoiding will or will not decrease chance of outgrowing.
Jtolpin, I am really not drawing any conclusions, just saying that when someone does a study showing something, one must look at who is funding it. Look at all the studies "proving" smoking does not cause lung cancer, studies which were funded by the tobacco industry.

Posted on: Fri, 03/09/2007 - 4:41am
jtolpin's picture
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Quote:Originally posted by Carefulmom:
I am really not drawing any conclusions, just saying that when someone does a study showing something, one must look at who is funding it. Look at all the studies "proving" smoking does not cause lung cancer, studies which were funded by the tobacco industry.
To me, and maybe to others (although they haven't/won't chime in), it seems like you ARE drawing a conclusion. The way [I] interepreted your comment:
Quote: 5. He is on the board for FAAN which is partially funded by the peanut industry
To me? That means that YOU think that FAAN is not entirely playing on a level field, since they get money from peanut industry, and therefore are biased.
Or if I'm mis-interepreting your comment, I apologize.
Regardless of what you say, I s'pose it doesn't matter. People believe what they believe, and if people think that minute traces cause/don't cause 'outgrowing' then that is their choice to make, conspiracy or not... It's too bad. I like a good conspiracy.
Jason
------------------
[b]* Beyond Obsessed * [/b]

Posted on: Fri, 03/09/2007 - 6:54am
GinaC's picture
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Carefulmom,
I dont believe that you "have seen several studies showing that exposure decreases chance of outgrowing on the website for the American Academy of Allergy Asthma and Immunology [url="http://www.aaaai.org"]www.aaaai.org[/url] "
There are all kinds of doctors out there but I have to tell you that I am in shock that a doctor would tell a patient with a rast to peanut of 34 at age 9, that they have a 50% chance of outgrowing this!
Please provide a link to any study done at any time , any where, that refereneces 50% of patients outgrowing a peanut allergy.
You have a right to your opinion and if your doctor thinks that total avoidance will help your child outgrow and if you believe that, then you have every right to do so.
But I dont feel its appropriate to (surely unintentionally) mislead others who may be new to this by saying that there are studies out there that show this.
It can put undue stress on parents and even create false hope. It can make parents want to tear their hair out looking for reasons why their childs numbers go up--when this may have nothing to do with exposure.
Gina
[url="http://www.allergymoms.com"]www.allergymoms.com[/url]

Posted on: Fri, 03/09/2007 - 6:58am
LisaM's picture
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While I haven't seen the studies which back Carefulmom's view on exposures *preventing* the outgrowing of allergies, I have read a document where a well known allergist and researcher makes a statement to that effect.
The idea that ingesting trace amounts allows for tolerance *and* the idea that ingesting trace amounts prevents the child from outgrowing the allergy are not mutually exclusive.
See [url="http://www.fda.gov/OHRMS/DOCKETS/AC/05/transcripts/2005-4160t1.htm"]http://www.fda.gov/OHRMS/DOCKETS/AC/05/transcripts/2005-4160t1.htm[/url]
This is from page 55:
"Here is where we may have very different
thresholds. We may have a threshold that this child, say, with milk allergy -- they know for a fact that they can eat this bread that has whey as the tenth ingredient and never have a symptom.
They are perfectly fine with it.
What we have found that getting that bread
on a regular basis may keep their immune system more revved up to maintain the allergy so this thing that is way below their threshold for reacting acutely may still drive the immune system to maintain the allergy and prevent them from outgrowing the allergy."

Posted on: Fri, 03/09/2007 - 7:06am
Adele's picture
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Some interesting info from:
[url="http://www.allerg.qc.ca/peanutallergy.htm"]http://www.allerg.qc.ca/peanutallergy.htm[/url]
2) L'Actualit

Posted on: Fri, 03/09/2007 - 8:13am
GinaC's picture
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These are both interesting but neither one mentions any study that supports what carefulmom posted.
" if there are no exposures the chance is actually 50% of outgrowing it."

Posted on: Fri, 03/09/2007 - 10:26am
Adele's picture
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Hi GinaC,
Does it really matter? A study is just that - nothing definite.
My point is that there is little known about PA.
I've read that 100% avoidance of the allergen may help a person to outgrow it, yet the Duke study that Melissa and her son are involved in, lessens the severity of PA with daily intake of the allergen.
Who knows?

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