negative skin and blood test... on to oral challenge?

Posted on: Fri, 12/12/2003 - 11:28am
AmyR's picture
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Joined: 09/26/2000 - 09:00

Hi everyone,

I have not been on this board for a very long time. I have been reading a lot of the threads this week to catch up a bit.

To give you a little history to those who do not know (or remember) me. My son had his first and only reaction when he turned one. We served peanut butter and jelly sandwiches at his one year birthday party and he had a reaction. His reaction was not severe but resulted in large white welts all over his neck and two on his face. We gave him benydryl which stopped the reaction. Since then we have been very careful to avoid peanuts and have been extremely lucky with no other reactions. His original blood test was 5.46 (class III) and had a positive skin test when it was done at a later age.

When my son was re-tested 1 1/2 years ago, his skin test was negative so it was repeated immediately and came out positive. I questioned the results and then had a blood test done which came back at the "lowest level detectable" (whatever that means). A few months ago my son asked me if he could be re-tested to see if he is still allergic. He just turned 6 a week ago. I made an appointment with the allergist which was today. Last week at his check up, our pediatrician did a blood test which came back negative. Today we had a skin test which also came out negative. We are now faced with the decision of whether we should do an oral challenge. The doctor said we could continue how we have and assume he is still allergic and wait to test him when he is a bit older (even though we know the test results) or do the challenge. The allergist told us that the challenge would be very safe for us since both tests were negative.

Has anyone had a challenge after having both the skin test and blood test be negative? What was your experience? For those who have passed the oral challenge, does your child eat peanuts now? Has anyone's PA come back? I do believe that my son has outgrown the allergy and I'd love to be able to give him "may contain" foods and not worry about birthday parties and things like that. It's just that I'm not sure I could actually give him a peanut butter and jelly sandwich. I asked my son this morning if he would want a PB&J sandwich if he was no longer PA. I expected his answer to be a definite no but his response was, "well, I'd have to try it".

Any experiences to share would be appreciated.

Amy

Posted on: Sat, 12/13/2003 - 6:48am
anonymous's picture
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Joined: 05/28/2009 - 16:42

Congratulations Amy. My daughter passed her oral challenge November 2002. You may be interested in the two threads I have re-raised on the issue for you.
It's been 13 months now, and she's doing great.
Good luck to you in your decision and let me know if you have any questions.

Posted on: Sat, 12/13/2003 - 10:04am
AmyR's picture
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Joined: 09/26/2000 - 09:00

Kami's Mom - I'm so glad you responded to my posting. I read your threads a few days ago and wanted to get in touch with you. I didn't see an a-mail address and was hoping you would see my posting.
I'm so glad to hear things are still going well for you. Does your daughter actually eat peanut butter? If so, was that a hard decision for you to make? Does she eat peanut products often? Also, can you tell me if your daughter had both a negative skin test and blood test before her oral challenge?

Posted on: Sat, 12/13/2003 - 2:29pm
nikky's picture
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Joined: 11/14/2000 - 09:00

Kami's mom:
Do you still feed your dd peanuts on a regular weekly basis? Is this something that you need to do for life to keep the body used to them? Please let us know some more details...yours is a very interesting story. How wonderful for you and your family!!! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Sun, 12/14/2003 - 6:15am
anonymous's picture
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Joined: 05/28/2009 - 16:42

Hey Nikky and Amy,
Here's the update and what's happened since Kami's food challenge:
After she passed, her allergist told us that some kids have been known to get their allergy back. So my gut reaction was just to continue avoiding peanuts as before. However, as the NEJM article suggests (that I re-raised), researchers believe that regularly eating peanuts helps to avoid this (at least in the small sample size that they have studied). Kami's allergist concurs with this view.
So it was with a lot of fear that I began giving her PB&J once a week at home under my very watchful eye. Her allergist believed that if she were to get her allergy back, it would be within the first 10 exposures.
Several months went by with no problem. However, there were a few instances where Kami would start scratching herself while eating and even remarked "peanut butter always makes me itch." Right after she said that, we stopped giving her PB and had her CAP-RAST level checked. It had risen from <.35 to .8, which her allergist said is not necessarily significant. So we gave her a blind oral challenge as well, which she passed.
I am still giving her pb on a regular basis, but still don't allow her to eat any outside the home. The strange thing is that she rubs her nose about 50% of the time when she has pb (but when she doesn't know she's eating it, she's fine). So it seems that there's definitely a psychological component to this (although part of me still worries that her nose scratching is meaningful).
While it's nice that she can enjoy a pb&j sandwich, the best part is not worrying about cross-contamination or having to provide a "special" snack for her every time she goes out.
Kami is also part of a study at Johns Hopkins looking at children who have outgrown their peanut allergy. I believe that the results of this latest study will be published later next year. Because of Kami's participation, we will be informed of the results before publication and I'll be sure to post them here.
Amy, you asked about the skin and blood tests before the challenge: Kami only had a CAP-RAST done which was <.35. Her allergist did not perform a skin test because he said that skin tests will often remain positive long after the allergy is outgrown, and therefore they are not reliable in this instance.
For me, I did not hesitate to do the food challenge on Kami for the following reasons: (1) her CAP-RAST score was as low as it could be; (2) she never had an anaphylactic reaction; (3) being exposed to pb would not effect her changes of outgrowing the allergy -- her allergist said if she hadn't outgrown it by that point, she never would; (4) in the event of a problem, we were in a hospital where emergency care was seconds away; (5) she was to begin kindergarten in 2003, and I so wanted to have some peace of mind about her allergy.
All of our children are different and we all have different risk tolerances -- only you know what's best for you and your child. But I hope that this helps you in making your decision.
Again, if you have any questions, I'd be happy to answer them.

Posted on: Sun, 12/14/2003 - 10:42am
AmyR's picture
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Joined: 09/26/2000 - 09:00

Thanks for the info. Kami's Mom. I am going to call the allergist tomorrow to see how long it will take to get an appointment for an oral challenge. I've thought a lot about it this weekend, and go back and forth as to whether or not I will feel comfortable giving my DS peanut butter if he passes the challenge. I'm sure it will become clearer to me after the test is performed. If I decide to give him peanut butter, like you, I think I will not let him have it out of the house. Thanks again.

Posted on: Sun, 12/14/2003 - 12:39pm
Naer74's picture
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Joined: 11/03/2003 - 09:00

AmyR,
Please trust your instincts. I don't have much time to post, but if you do a search you will find my story about my son's food challenge. He also tested negative via CAP-RAST. However, he reacted to the challenge and has had two reactions since then. One was because of a relative who did not read the label on something while I was in the bathroom and one was due to cross-contamination. Just be careful!

Posted on: Sun, 12/14/2003 - 1:03pm
AmyR's picture
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Joined: 09/26/2000 - 09:00

Hi Naer74 - could you please point me to where your posting is regarding your DS's food challenge? I did a search on your username but couldn't seem to find it. Also, did your DS also have a negative skin test along with the negative blood test?

Posted on: Mon, 12/15/2003 - 2:04am
Naer74's picture
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Joined: 11/03/2003 - 09:00

AmyR
I bumped the thread up for you-it is titled Need Opinion-Food Challenge Yesterday.

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