Need opinion-peanut challeng yesterday.

Posted on: Tue, 10/29/2002 - 12:43am
Anonymous's picture
Anonymous (not verified)

Sorry if this post ends up being VERY long-My son has had many small reactions prior to the age of 4 after taking a bite of a peanut butter product and spitting it out (never actually swallowed one). He has never liked the taste or smell of it but we never thought it was due to an allergy. He would sit there for 2 hours and cough uncontrollably. Did this make us question peanuts? Yes. But when we mentioned it to the pediatrician she said, "Just don't give it to him." In Dec. of 1999 he was at the next door neighbors house and they gave him a peanut butter cracker. They later informed me that he took one bite, spit it out in the dirt, and ran home. He was coughing, gagging, and couldn't swallow (saliva pouring from his mouth). This made me very suspicious but still could not get a referral to the allergist. In April of 2000 he ate 3 small pieces of cashews. Within 15 sec. he had hives all over, coughing, excessive saliva, vomitting, and diarhea. After all of this he got very tired and would just stare into space. I believe his blood pressure was dropping. We did not have the EpiPen but would have administered it if we did. I called the pediatrician whose nurse called us back in 25 minutes and told us he would be fine, just to give him 1 tsp. of benadryl.

When he was skin tested in 2000 we found out he was allergic to peanuts, pistachios, and cashews (plus environmental0. His wheals were bigger than an orange. We continued to be very diligent about avoiding nuts and reading labels, contacting manufacturers. His next skin test in 2001 showed positive to peanuts and pistachios (wheal size 17mm) but negative to cashews. He also tested positive to almonds and sesame. He physically reacted to the skin test with throat itching and diarheea. He did have one minor reaction that year.

Several months ago he was RAST tested and the cashew (which was negative on the skin test) and pistachio showed up positive but the peanut was a class ZERO. The allergist recommended a food challenge. He is six years old now and has not had a reaction in almost 2 years. It took at least four months before Jacob would even be slightly comfortable with this idea. He cried each and every time I mentioned it. He finally agreed to it and yesterday was our BIG day.

We showed up at 1:00 and they talked to us for a long time. They put some pb on his wrist and waited for 10 minutes. Then, when I was outside eating in the van (my husband was with him), they put some on his tongue. As soon as I entered the room he told me his tongue was burning but I completely forgot to mention that when the allergist returned as things got very chaotic when she entered the room. She checked his stomach, face, back and arms for hives. He was continually asking for a drink of water. At one point I noticed a red mark on his neck, very visible, but she missed it. Her opinion of this was that he must have scratched his neck. Next they attempted to give him a larger bite of pb and he completely freaked (understandable as for the last 3 years we trained him never to touch it). The allergist actually told him that he COULD NOT react and that the challenge was for to calm the parents fears and to give us confidence. He was spitting it out and rubbing his hand around his mouth trying to get it out. I took a napkin and wiped it off also. My husband left immediately to buy some reeces pb cups or pb filled M&M's as we thought he might like the taste of those better. Within five seconds of his departure hives started to appear all over his face. His chin, cheeks, and one eye had hives on it. They did not want to treat this as a reaction. He was scratching his face but the allergist wanted to continue with the challenge. She INSISTED that he could not be a class ZERO and react with hives from that small amount. Her theory was that he must have irritated his skin while rubbing it off that he reacted in comparison to a skin prick test. You can still react to it many years after outgrowing the allergy. Finally, he started to become paranoid, his face was red and splotchy, and she decided to stop and gave him Benadryl. Her reccomendation was to wait another year. We had to stay for at least an hour waiting for the hives to disappear and during that time another hive did appear on his wrist.

My husband and I were discussing this yesterday evening as I wanted his opinion on the situation. He thought that since his prior reactions were anaphylactic then this would be also. However, I reminded him that each reaction could be different and that from our son's past experience his reactions always increased in intensity with each exposure but since this was his first one in years then it may have gone back to being minor.

He does not have excema but he does have asthma. Please let me know what you think of this....thanks.

Posted on: Tue, 10/29/2002 - 1:34am
becca's picture
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Joined: 05/22/2001 - 09:00

Your post made me feel so sorry for your little boy! Poor guy. I have wondered how it must be very scary for our kids to do these food challenges. Glad he did not have a more serious reaction. It certainly seems like he is still reacting to me.
I do not think a single blood test can say that it is impossible to react. For one thing, the test could be flawed, an error could cause a false report, any number of things. And I am sure there is a standard incidence of the test sometimes just being wrong. I think it might bear having a few neg. tests over a couple or few years, maybe you did say that, before challenging. Even then, I think you could still have a sensetivity, just *non-detectable* in the blood(it would depend on the sensetivity of the test).
About skin hives and not any other reaction. I think my dd has her most pronounced reactions on her skin. I do not know if she would ever have an anaphylactic reaction, but all her reactions to anything have involved her skin and eyes itching, and hives. She had some eczema as a baby, but really has excellent skin, now, though sensetive to a random little hive here or there, generally around her mouth, and I really doubt it is cross contact, with the care we take, but you never know!
I often wonder if it is entirely possible to have only skin reactions. Of course, that is not your son's history, though. I would worry that his reactions might become increasingly worse again. I would not consider this a "passed challenge". Did the doctor think it was?
I hope your son does not have any increased sensetivity after this challenge, and does fully outgrow this! becca

Posted on: Tue, 10/29/2002 - 1:44am
austin2001's picture
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Joined: 05/03/2002 - 09:00

What a horrible experience! Is he better now? I have talked to some people who say their kid's RAST is negative, but have still had reactions--with a 4++ reaction to skin! My child's reaction was 3+ but tested class 4 on the RAST to peanut. So far, (fingers crossed), we've only had 1 reaction, but not sure if it was due to ingestion or contact (happened at daycare)...and it was anaphylactic. My son doent have asthma, but has eczema....and I rate his reaction as Pretty Bad!
If your son is Asthmatic, there is a better chance of an involved reaction. have you noticed on the RAST test, that the negative value is not zero, but <0.35 Ku/l...how does the doctor know it is not .34??
just something to think about....hope your child feels better soon!
allison

Posted on: Tue, 10/29/2002 - 2:06am
BS312's picture
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Joined: 09/05/2001 - 09:00

So sorry this happened! Unfortunately, the numbers are not always helpful. My DD's peanut cap-rast was less than 0.35 (the lowest it could be, class zero) and she ALMOST DIED during her challenge. I think you need a new allergist.

Posted on: Tue, 10/29/2002 - 2:09am
smack's picture
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Joined: 11/14/2001 - 09:00

NaomiR,
OMG the allergist sounds like a quack! Doesn't consider hives an indicator of a reaction?
Where did he/she get their diploma?
Search for another allergist.
I really trust your son's reaction means that he is still allergic. If you doubt this, get another CapRast now(especially after this exposure)...then let's see what the score is.

Posted on: Tue, 10/29/2002 - 10:33am
cathlina's picture
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Joined: 06/29/2001 - 09:00

Get a new allergist!!!!!!!!!!!!

Posted on: Wed, 10/30/2002 - 12:11pm
Anonymous's picture
Anonymous (not verified)

Thank you for your replies. He is doing much better...thanks for asking.
No, she told us to consider him failing the reaction and we would try again next year. I think I will continue to have him RAST tested for 3 more years and if they continually are negative then we may challenge again.
I do not know where she received her diploma.
This is the ONLY group of allergists our insurance will cover so it is not easy to change to another....I am planning to contact another one that I saw prior to this and inquire what his opinion of this is.
I am just glad that he did not swallow any amount over a dime. It could have turned out MUCH worse.

Posted on: Sat, 11/02/2002 - 2:55am
solarflare's picture
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Joined: 02/07/2002 - 09:00

I agree with the rest, find a new allergist.
RAST isn't 100%. Jason tested out class 6 to milk on the RAST... he has absolutely no reaction when he ingests it.
------------------
Cheryl, mom to Jason (5) and Joey (3)

Posted on: Sat, 11/02/2002 - 3:29am
williamsmummy's picture
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Joined: 03/26/2002 - 09:00

could you please give us some more information ? how old is your son? was the test conducted in a safe environment? ie hospital, was the test conducted on blood tests and skin prick tests etc ?
skin , that is sensitive such as those children with ezcema can react with hives , but I have to admit it does sound like a allergic reaction.
It is possible that your son can be only tree nut allergic, as my son is only allergic to peanut /legume food family, but not tree nuts. We still avoid them due to cross contamination.
food challanges are one of the most stressful things for a family to face. My son was totally cool about having his blood drawn etc , but the thought of having egg any where near him made him shake with fear.
sarah.

Posted on: Sat, 11/02/2002 - 9:47am
Carefulmom's picture
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Joined: 01/03/2002 - 09:00

I`d get a new allergist also. I understand your point about your insurance only letting you go to a certain one. Maybe if you picked an allergist in a different city, even if you had to drive a long way, so that insurance would cover another opinion---you probably won`t be going to the allergist that often anyhow, and it seems worth it to get the correct management of something so important. What city are you in? Maybe someone here can recommend one.

Posted on: Sat, 11/02/2002 - 12:50pm
Anonymous's picture
Anonymous (not verified)

I had to contact the allergist again on Thursday to inquire into a CT scan that was performed on Monday evening and found out that they performed a CAP RAST test not a RAST but I am still unclear on the difference.
She did mention that her and two other allergists discussed my son's situation and they decided they wanted to do another skin test on him in 2 or 3 months. I am completely against this as he had a reaction the last time he was skin tested. I would assume they would want to test him with the CAP RAST to see if the results may differ. I am planning to contact them again on Monday.
Williamsmummy-
Jacob is six years old. He has been skin tested twice (once in 2000 and once in 2001) and had the blood test this past July. The challenge was done in their office. His skin is not as sensitive as others on this board are. He does not have nor ever had excema. The reason I believe it to be a reaction was because he was not 'clawing' at his face as she said and because there were hives on his eye and his wrist. I know it is possible to only be tree nut allergic but he has reacted severly to peanuts before. His past skin tests revealed a wheal 17 mm in diameter. My son was so calm during the blood test...not a whimper. They were so impressed but when he had to eat pb he completely lost control. I expected this from him but how does anyone go through a food challenge when their children are so frightened?
Carefulmom-
You said, "I understand your point about your insurance only letting you go to a certain one. Maybe if you picked an allergist in a different city...you probably won`t be going to the allergist that often anyhow." Unfortunately we do see the allergist often as Jacob has asthma and it seems to be out of control every couple of months. His asthma is worsening each year and anywhere from October to June we are at the allergists. We live in Chattanooga, TN, there are five allergists in this one particular practice and they have four offices within an hour from us.

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