Is my son allergic or not????

Posted on: Thu, 07/27/2000 - 6:37am
BENSMOM's picture
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History: my son was tested for peanut in May because he reacted to Walnut. Skin prick test was positive. Up until that time he had tasted peanut butter and picked peanuts off dessert and eaten it. Don't know if he ever ingested peanutbutter or just had it on tongue. Also ate granola bars with peanut flour every day. Never any reaction whatsoever.

Had my son re-tested today with skin prick test because I had concerns with the validity of the last test. Was positive--4+. The most severe. I couldn't believe it. Doc said that means he is more sensitive--would react to smaller amount of allergen. But he's never reacted. Hmmm.

Then they said there could be a cross-reactivity with grass. Some grass has the same family of protein as peanut and since my son has some hayfever, allergic rhinitis, wheezing, maybe he's allergic to grass. We skin prick test for grass (my 4 yr old son screaming the whole time [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] ) It's positive. This makes me hopeful that he is not really allergic to peanut. Doc could not give me statistics. Also, I've never heard of this. I saw something on the FAN conference notes about cross-reactivity with citrus fruit or something, but not grass. Will have to investigate further. Also saw somewhere here that peanut flour doesn't contain the protein, but doc said it does.

We didn't have the RAST test done like I planned because of issues with the lab. May get it done later. Doc thinks it's not necessary. I asked what if it were to come back neg? He said that wouldn't happen. I asked what if it were to back low? He would be very surprised if that happened. Basically just shrugged--wouldn't know what to think.

So is he allergic or not?? Highly sensitive/allergic on skin test, but never reacted. Allergic to grass which could cause pos skin test to peanut. Doc said that some people develop hayfever as adults, but were exposed as kids. I said I thought that if you eat a peanut and don't react, you aren't allergic. He sort of nodded and shrugged. Seemed to know his stuff, but didn't know what to make of this. Said he may not be allergic, and it could just be the grass. Unfortunately there is no way to know for sure until he eats a peanut. My only choice is to continue as though he is allergic, and see what happens some day when he accidently ingests peanut.

So frustrated but hopeful.....

Posted on: Thu, 07/27/2000 - 7:20am
DM2's picture
DM2
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FRUSTRATION! I am sure these doctors just don't have all the answers but quess what they probably don't like to admit it. I am very curious to see how that rast test comes out. It sure would great if it was negative. I have been looking forward to my sons third bithrday also, just hoping those numbers will be gone but now I am not so hopefull.I think we are all new to these allergies to some extent and knowledge is the only thing that is going to keep us going and this web site of course. Take care Bonnie

Posted on: Fri, 07/28/2000 - 2:39am
BENSMOM's picture
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Just want to clarify about the peanut flour. I thought I saw somewhere that peanut flour doesn't contain the protein, but I searched here and FAN and it does. There was one story from a dad whose daughter reacted to something with peanut flour in it. Just didn't want anyone getting the wrong info from my first post. Also, now I KNOW he ate peanut flour nearly every day for 6 mos to a year and never reacted. What's a mom to think?

Posted on: Fri, 07/28/2000 - 3:03pm
DebO's picture
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Hi Ben's Mom
Many of the papers I have read comment on allergy developing with exposure or sensitization - since an allergy is your body defending itself from a protein or substance that is not usually harmful but that your body perceives as harmful. This is why you must first be exposed to the allergen before you become allergic - it is like getting sick with a virus and then developing some resistence to the virus.
Anyway, there is no "rule" that you will develop the allergy the first time you are exposed to the substance. There are many adults who develop allergies later in life after eating something all their life!
I just want to add that I can remember my daughter feeding peanuts to a squirrel at my mother's house 3 years ago and yet her second reaction was from merely touching a peanut shell two years later!
Mind you, it would be wonderful if your child were not really allergic and I wish you all the best.
deb

Posted on: Mon, 07/31/2000 - 6:24am
Kathryn's picture
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Perhaps you could explore a food challenge scenario with your doctor. In a hospital with medical personnel available you could introduce a tiny amount of peanut butter. Food challenges are often the answer if skin and rast testing is ambiguous. They are scary to contemplate though.

Posted on: Mon, 07/31/2000 - 7:22am
BENSMOM's picture
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Kathryn, I've thougth about a food challenge, but I haven't even had him RAST tested yet. And even if I felt comfortable with it and wanted to do it, I'm not sure I could find a doctor to do a food challenge on a kid with a 4+ skin test and maybe a high RAST score too. The allergist I went to never mentioned it. He just said I'd have to wait and see what happens when some day he accidentally has peanut.
I think I'm finally starting to come to terms with it and consider us to be lucky that he has never reacted. I think he's one of these kids that is a little allergic to just about everything, but not severely. I'm thankful he does not have asthma (wheezed once), no longer has eczema, and doesn't appear to react to most nuts, even though tested positive. After 2 months, I'm finally getting to a place where I'm accepting it for what it is--a lifelong peanut allergy. I may still have him RAST tested, I am still looking into a connection with grass (if he becomes desensitized to grass, would he be desensitized to peanut too?) etc. But I'm not feeling the frustration I was last week. Sorry to ramble!

Posted on: Wed, 08/02/2000 - 4:56am
BENSMOM's picture
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Well, here I go again. I keep posting to my own topic. I sent FAN email, and here is the email followed by their response. It's long, but I thought it was worth posting.
At 08:37 AM 8/2/00 -0700, you wrote:
>Dear FAN,
>
>My allergist told me that grass allergy, specifically
>Timothy and Burmuda grass, can cross-react with
>peanuts. My son tested very positive (4+) on a skin
>test to peanuts, but has never reacted. He also
>tested very positive to both grasses. I have been
>unable to find any information on this. Could you
>tell me if this is true, and point me to some
>articles/information on this? I'm not sure what this
>means for my son's peanut allergy.
>
>Thank you.
Response:
False positives are very common on tests for food allergies. An
individual
who can eat peanuts/peanut butter with no symptoms would not be truly
allergic.
This article appeared in the October/November 1999 issue of Food
Allergy News
Copyright 1999 The Food Allergy Network
A Member Asks
"My son tested positive for peanuts, but never had any prior reaction.
He
had eaten peanut butter sandwiches three times a week. The doctor said
he
was just 'lucky' not to have reacted and we were told to eliminate all
peanuts from his diet. Do you agree?"
The diagnosis of peanut allergy is increasing, owing both to a real
increase in its occurrence and also possibly to misdiagnoses. Peanut
allergy can only be diagnosed when characteristic symptoms (skin,
gastrointestinal, and respiratory) occur within minutes to a few hours
of
peanut ingestion.
If your child eats peanut butter sandwiches three times a week without
experiencing any symptoms, your child does not have a peanut allergy.
In a
sense, he has had negative peanut challenges thrice weekly. The
presence of
allergic IgE antibody to peanut is not sufficient to diagnose peanut
allergy without the presence of symptoms when peanut is ingested.
Allergic
antibody to peanut merely raises the possibility that peanut allergy
may
exist; symptoms associated with peanut ingestion are necessary before
diagnosis of peanut allergy can be suspected.
Studies suggest that somewhat less than half of those children below 3
years of age with positive peanut skin tests or peanut specific-IgE
really
have clinical symptoms on peanut ingestion. However, older children
with
peanut- allergic antibody may be proven allergic to peanuts.
Your child does not need to avoid peanuts, since he is not allergic to
them. He should continue to enjoy and savor them.
Robert S. Zeiger, M.D. is a member of FAN's Medical Advisory Board. He
is
Chief of Allergy, Kaiser Permanente, San Diego; Clinical Professor of
Pediatrics, University of California, San Diego.
This article appeared in the October/November 1995 issue of Food
Allergy News
Copyright 1995 The Food Allergy Network
ABCs of Allergy Testing
by James P. Rosen, M.D.
Dr. Rosen is a member of The Food Allergy Network Medical Advisory
Board.
He is Assistant Professor of Pediatrics at the University of
Connecticut
School of Medicine and is in private practice in West Hartford, CT.
Adverse reactions to foods can be categorized as either a food
intolerance
or a food allergy (food hypersensitivity). The main difference between
these two categories is that a food intolerance does not involve the
immune
system and a food allergy does. A food intolerance such as lactose
intolerance is caused by an enzyme deficiency in the gastrointestinal
tract.
Since many of the symptoms of adverse reactions to foods can be similar
in
both food intolerance and food allergy, how do you differentiate
between
the two? First and foremost, one needs to see a competent allergist
trained in the evaluation and management of adverse reactions to foods.
The evaluation of a patient with suspected food allergy includes a
detailed
history, physical examination, and laboratory tests to detect
antibodies
directed against the suspected food. Antibodies are proteins that are
found primarily in the bloodstream and function to help the body fight
off
invading organisms such as bacteria and viruses. The major antibodies
are
known as IgG, IgA, IgM, and IgE. Without these antibodies, we would
die
from overwhelming infection. One of these antibodies, IgE, is found in
much higher concentrations in allergic individuals. IgE is extremely
important in the development of the allergic response, like those seen
in
hay fever, atopic dermatitis, asthma, and food allergy. Although other
antibodies such as IgG, IgA, and IgM are produced by the body in
response
to the ingestion of foods, the role they play in food allergy has not
been
clearly identified. Therefore, measuring these antibodies to specific
foods has very limited usefulness. Thus, for diagnosing food allergy
one
should be concerned only about detecting specific IgE antibody to a
food
allergen and not about measuring IgG, IgA, or IgM to that food.
Allergens are usually proteins including food proteins such as milk or
inhalant proteins such as pollens to which the body makes an immune
response. This response in the allergic patient is to produce IgE
antibody
specific to that allergen.
Allergy Tests
In order to evaluate patients with food allergies, proper
identification of
the allergen (food) responsible for the allergic reaction is crucial.
To
identify the food, detection of specific IgE antibody is essential.
There
are two primary methods to assess the presence of allergen-specific IgE
antibody; skin testing and blood testing (Radioallergosorbent test, or
RAST). Another blood test, the Enzyme Linked Immunosorbent Assay
(ELISA)
is primarily a research tool.
Skin testing is the preferred method over RAST testing to detect IgE
antibody because it is simple, more sensitive, less expensive, and more
readily available, and it appears to have a better relationship with
clinical symptoms.
There is, however, a place for RAST testing in those patients who have
a
history of a severe life-threatening reaction to a food and one would
not
want to run the risk of having a systemic reaction to skin testing.
Also, one could certainly do RAST testing in young infants whose skin
reactivity may be poor, or in those individuals who have such severe
and
extensive atopic dermatitis (eczema) that it is difficult to find
portions
of the skin that are clear enough for the proper placement and
interpretation of the skin test.
Skin testing can be performed by two methods, known as the scratch, or
prick skin test (PST), and the intradermal skin test (IST). The PST is
the
preferred skin test because it is less painful, more specific, and less
apt
to produce a systemic reaction.
The PST is performed by placing a small drop of the food extract on the
skin and then scratching the skin lightly through the drop using a
specialized probe or needle. The IST is done by injecting a small
needle
filled with an extract of the food allergen to be tested under the
skin.
In both types of skin tests, if allergen-specific IgE antibody is
present,
a reaction similar to a mosquito bite occurs within 15 minutes.
Intradermal skin tests are not used in the evaluation of food allergy,
but
are valuable for inhalant, insect, and drug allergy testing.
A positive prick skin test to a food only indicates the possibility
that
the patient will have a reaction upon eating the food. A negative PST
to a
food virtually confirms that the patient is not allergic to that food.
The
exception is in children under one year of age. For them, skin
reactivity
might be poor and the doctor may order a RAST test.
Therefore, the PST is an excellent test for excluding IgE-mediated food
allergy but does not 100% confirm the presence of food allergy. A
double
blind placebo controlled food challenge (in which neither the patient
nor
the doctor knows whether each oral dose is the actual food or a
placebo) is
often needed to confirm positive skin test results.
Do Medications Interfere with Allergy Testing?
Most antihistamines need to be withheld for about three days prior to
skin
testing. Antihistamines affect skin test results by interfering with
the
release of the chemicals that would cause allergic symptoms.
Conclusion
Since many of the symptoms of adverse reactions to foods can be similar
in
both food intolerance and food allergy, the detection of IgE antibody
to a
food, combined with a history of symptoms and a physical examination,
provides an excellent means of diagnosing food allergy.
***
This article appeared in the April/May 1998 issue of Food Allergy News
Copyright 1998 The Food Allergy Network
Food Allergy Testing: Questions and Answers
By Scott H. Sicherer, M.D.
Who should be tested for food allergy?
Testing should be considered when symptoms such as hives, redness of
the
skin, itchiness, swelling of the lips or eyelids, throat tightness,
wheezing, breathing trouble, coughing, vomiting, or diarrhea occur
shortly
after eating. Some chronic illnesses are sometimes associated with food
allergy, including eczema (atopic dermatitis) and infantile digestive
problems (significant vomiting, diarrhea). Asthma and hay fever are not
commonly associated with food allergy.
What do the tests measure?
The tests determine the presence of IgE antibody directed to particular
foods. (IgE is the allergic antibody which mediates most food allergy
reactions.) Some laboratories offer other types of testing (cytotoxic
testing, IgG antibody testing, provocation/neutralization, and others),
but
these should be considered unproven and experimental.
What types of tests are available?
Two commonly used tests are blood (IgE RAST) and skin prick tests. The
blood tests require a small sample of blood to be sent to a laboratory,
where the amount of IgE antibody to the specific food is measured. The
result is reported as a numerical value, or "class."
Skin tests are performed by exposing a tiny area of scratched skin to
the
food being evaluated. This is accomplished either by pricking the skin
with
a small needle or probe through a drop of the food extract, or by using
a
pricking device that has been pre-soaked in the extract. A positive
skin
test results in a mosquito-bite-looking reaction at the site of the
test
within minutes.
How are the tests interpreted?
The easiest test result to interpret is one which is negative; it is
very
unusual to have IgE-mediated reactions to a particular food when the
skin
or RAST test to that food is negative.
Unfortunately, the interpretation of positive tests is not so
straightforward. Positive tests indicate that IgE is present but do
not, in
isolation, prove that a reaction will occur upon ingestion of the food.
In
fact, people who "outgrow" their food allergy usually continue to have
a
positive test result to the food for many years.
To further complicate matters, some proteins in foods are
cross-reactive
with similar allergenic proteins in non-foods (pollen) or in other
foods.
This cross reactivity can lead, for example, to a positive skin test
for
soy in a person with peanut allergy, or a positive test to wheat in a
person with grass pollen allergy, even though the person has not had
symptoms of an allergy to those cross-reacting foods.
Do the test results indicate the level of severity?
Neither the size of the skin test reaction nor the level of specific
IgE
antibody in the blood test necessarily correlates with the type or
severity
of symptoms. Consider an allergy evaluation with a "2+" positive skin
test
and a positive RAST test to peanut. One person with these results may
be
eating peanut every day without symptoms, while a different person may
experience anaphylaxis from peanut. Similarly, that second person may
experience only an itchy mouth on one occasion, anaphylaxis on another,
and
a mild case of hives on yet another occasion of peanut exposure.
The level of specific IgE antibody measured using a particular method
of
RAST test (CAP-RAST FEIA) reported in units called kUa/L, which
indicates a
concentration of specific IgE) was recently reported to be useful in
determining the chance of true reactivity to certain foods. For
example, an
IgE antibody level of over 6 kUa/L to egg, over 32 to milk, over 15 to
peanut, and over 20 to codfish were highly predictive (greater than 95%
chance) of having some type of allergic reaction among highly allergic
children. Unfortunately, lower values, unless virtually undetectable,
may
still indicate a potential for having an allergic reaction. This test
may
prove useful in following levels of particular IgE antibodies over time
to
see if they are falling (perhaps indicating that the allergy is being
outgrown).
As you can see, the interpretation of these tests can be quite
confusing.
Your doctor must always interpret these tests in the context of the
individual medical history. Even the selection of which foods to test
must
also be decided carefully and in the context of the medical history
since
up to one half of positive tests may not accurately reflect an allergy.
Lastly, like any test in medicine, the results are occasionally wrong
and
should be repeated if an error is suspected.
Is there a definitive way to determine whether someone is or is not
food
allergic?
Oral challenge tests are definitive but carry a risk of serious
reactions.
These tests are conducted by giving gradually increasing amounts of the
suspect food under a doctor's supervision while observing the patient
for
symptoms. These tests should be performed only by trained personnel,
with
emergency treatment immediately available. The tests might be used to
verify the accuracy of a positive IgE test, to determine if an allergy
has
been "outgrown," or for a variety of other reasons. In cases of
non-IgE-mediated reactions (some gastrointestinal allergies), an oral
challenge may be the only definitive way to diagnose a food allergy.
In summary, food allergy tests are helpful in identifying or excluding
food
allergy as a cause of symptoms, but decisions regarding what tests to
perform and how to interpret them are complex. Furthermore, removing
foods
from the diet or adding foods back to the diet can have serious medical
consequences. Your doctor will interpret the test results within the
context of your complete individual medical history and will use the
results as just one of several pieces of information to guide in
decision-making. Improved food allergy tests are in development and
will,
hopefully, provide more definitive results than those currently
available.
Scott Sicherer, M.D., is Assistant Professor of Pediatrics in the
Division
of Pediatric Allergy and Immunology, Mount Sinai Medical Center, New
York
City.

Posted on: Wed, 08/02/2000 - 2:05pm
redtruck's picture
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Joined: 01/23/2000 - 09:00

Hi Bensmom,
Our child have some similarities. My daughter had a small reaction to a walnut last year. She earlier (that year) for the first time tasted peanut butter, but didnt really eat it, just put it on her tongue on piece of toast and then said she didnt like it. She had hazelnuts and almond cookies.
But only had a few hardly visible hives around her mouth after eating a piece of whole walnut.
She skin tested positive to peanut, and walnut, but not to other nuts.
The grass thing didnt come into play, and she didnt have peanut flour, but probably had many "may contain nuts" products.
Luckily, she never had any other reaction.
I sometimes wonder if she's really allergic or not too, but i obviously err on the side of the test. Assuming she is, we take all the precautions and have altered everyone around us lives (especially for b-day cakes).
I mean most likely she is allergic (but i guess until i see her actually have a reaction, there's a part of me that just doesnt (or doesnt want to) believe she's really allergic!
But we couldnt possibly give her an oral challenge and have her possibly go into anaphyllaxis (even it is at a hospital).
So we go on, and hope she never has a reaction, and eventually a cure or something comes up!
Best of luck, and keep posting any new info!

Posted on: Wed, 08/02/2000 - 2:36pm
Anonymous's picture
Anonymous (not verified)

BENSMOM - That is the greatest post I have read in a long time. The articles you forwarded from FAN were FANTASTIC....So many of my concerns/questions have been answered. I actually had also called my allergist last week and got some of the same type of answers, but this was GREAT!! My daughter is only 16 months old with PA, but we are going to have her re-tested in another year and a half or so..My doctor recommended CAP-RAST (to see if her score is low/lower) and then perhaps a skin/prick test. I pray she is one of the 10-20% who outgrow...however, since she did have a severe reaction on her 2nd exposure..who knows. Atleast I can look forward to the "cure" they are working on!! Thanks again.

Posted on: Wed, 08/02/2000 - 11:54pm
BENSMOM's picture
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Joined: 05/20/2000 - 09:00

redtruck, I didn't know your daughter was so similar to my son. My son also reacted to walnut (swollen lip) and then was tested for everything. He was pos to almost every tree nut, but has eaten almond with no problem even though he was positive for it. Anyway, I try to keep track of the people with kids who have never reacted to see what everyone else is doing. I sometimes feel like I'm the only one who has trouble accepting this. I know dit's child has never reacted, and you and she seem to accept that a peanut could kill your children. I have trouble accepting this, but of course, at the same time, I don't want to take any risks.
The allergist I went to thinks a RAST test is unecessary. After reading the FAN article on the CAP-RAST I would like to have that test done and see how the numbers turn out. I also don't understand how you can be considered NOT allergic and still have IgE antibodies to peanuts. As far as oral challenge goes, I feel he was already sort of challenged with the peanut flour he ate in granola bars for months on end. But, with the positive test, it seems like even if he is considered not allergic now, he is predisposed to become allergic, which puts me back at square one. But, as I said, I still don't understand what it means to have the antibodies and supposedly not be allergic.
Thanks for your response, and yours too kathryn 65. I was starting to feel like I was talking to myself! Dit, dtaylor, and anyone else who has kids who have never reacted, I'd love to hear from you guys. What do you make of all this? Do you have trouble accepting this allergy?

Posted on: Thu, 08/03/2000 - 12:52am
Anonymous's picture
Anonymous (not verified)

I have a question regarding all of this. I am sure many of you have heard of the statistic that 10-20% of kids outgrow this peanut allergy...Does anyone know if this applies to the kids that have tested positive BUT NEVER reacted (like you Bensmom). Or does it apply equally to children who have had a reaction and then grow out of it...Very curious....It seems easier to say that it would apply to the kids that never had a reaction in the first place....any comments

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