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Posted on: Wed, 06/23/1999 - 5:03am
SteveW's picture
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Joined: 04/08/1999 - 09:00

Our pediatrician has been very good about our son's peanut allergy. His first reaction was very mild - he threw up and had hives on his face that disappeared so quickly that we weren't sure we ever saw them (he was also sick at the time and had thrown-up the night before). We decided not to give him peanut butter again and talked to the pediatrician about this at his next checkup (a week later). The pediatrician was surprised that he had had a reaction the first time he ate peanut butter (he was probably sensitized through nursing), but did recommend that he not eat peanuts again until he was at least three.
His second reaction was at day care where he was accidentlly fed peanut butter. This time he threw up again and had severe facial swelling (you couldn't tell what color his eyes were because the area around them was so swollen). Luckily, he had no trouble with his breathing. When my wife called the pediatrician's office, she spoke to the nurse whose daughter has a walnut allergy and was very understanding and very helpful. Because she couldn't see the reaction, she had day care call the office and talk to the nurse she had spoken to and the pediatrician also came to the phone. Since he wasn't having breathing trouble, they asked me to bring him to the office as soon as we could get him there. They observed him for almost two hours. The pediatrician ordered a CAP-RAST (done later the same day) and said he would refer us to an allergist depending on the results. When the results came back we had a prescription for Epi-pens and a referral to an allergist.
The allergist told us at the first appointment that this would go more quickly than usual because the pediatrician had taken care of the preliminaries for us. The only difference they had was that the allergist
read the RAST test differently with respect to eggs. The pediatrician thought the eggs were a false positive and the allergist wants our son to strictly avoid them as a precaution.

Posted on: Wed, 06/23/1999 - 6:30am
brenda's picture
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Joined: 01/22/1999 - 09:00

As many of you, I too have been bothered by the lack of allergy knowledge that most peds have and have wondered why they are not more informed. The explaination to this came up at the Stamford FAN conference. Dr. Sampson said peds get very little or no allergy training during their whole medical training (at most they get 1- 2 hours)!!!! Dr. Sampson said the only way to change this is through a public outcry to the boards (ie, write letters to the exam and pediatric boards). It is terrible that peds have no training for allergies during med. school, BUT it is still no excuse for them not to at least educate themselves thru medical journals, internet, and FAN about such an important and common childrens' health issue (just as we have all educated ourselves). The well informed peds that some of you write about are probably the ones who have done this. It certainly explains why there is such different handling of the allergy amongst all our peds.

Posted on: Wed, 06/23/1999 - 6:31am
brenda's picture
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Joined: 01/22/1999 - 09:00

[This message has been edited by brenda (edited June 23, 1999).]

Posted on: Wed, 06/23/1999 - 8:33am
SteveW's picture
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Joined: 04/08/1999 - 09:00

There are two distinct topics being addressed on this thread. First, the pediatricians level of knowledge once someone has a reaction. This varies greatly. From my very unscientific sample, the younger ones appear to have greater knowledge of food allergies.
Second, the guidance in the "What To Expect" books are just that. I'll probably take some major heat for this but, I find it extremely unproductive to make statements such as "I think somebody somewhere should be held accountable for failing to warn parents about the possibility of a fatal disease as a result of food eaten by mother or child."
1. There is no definitive proof (although suspected) that early exposure will increase the probability of having a reaction.
2. There is no definitive causal link between mothers eating peanuts during pregnancy and an increased probability of developing PA. This link has only VERY recently (British Medical Journal, June 27th, 1998 published a letter entitled "Women warned to avoid peanuts during pregnancy and lactation.") been suspected. People at high risk should certainly avoid it (my wife certainly will). Some researchers feel that in utero sensitization may actually reduce the body's rejection of pn proteins (as happens with transplants). Indirect data suggest that lactation is a more likely route of primary sensitization, but this point remains to be established.
That said, I think there should be greater awareness of the possible PA links so that expectant mothers (especially high risk ones) can make informed decisions.

Posted on: Thu, 06/24/1999 - 3:55am
EILEEN's picture
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Joined: 04/06/1999 - 09:00

Steve W.
I think the British government may be taking the view that it can't do any harm for women to avoid peanut while pregnant and that it may help to curb what they perceive to be a growing epidemic.
As I've said on these boards before the rest of the world was putting babies to sleep on their backs to reduce the risk of SIDS (sudden infant death syndrome or cot-deaths) long before it was adopted in the US (and how many lives would have be saved iif it had been introduced earlier?). We can't easily dismiss what the rest of the world is doing.
Could you please post citations to the work you describe about researches thinking that in utero sensitization could reduce the body's reactions to peanuts. I have not come across this in any of my literature searches. Also immunological responses are very much affected by the nature of the antigen. These are very different in transplant rejection (the foreign antigen is on the cell-surface) and to peanut ( a soluble protein) and I am not sure the same events take place to produce "tolerance".
If you haven't seen them already, you may find these limks of interest, I had previously posted them under research.
"Reduced exposure might increases allergic sensitisation" BMJ 1996;313:300
[url="http://www.bmj.com/cgi/content/full/313/7052/300"]www.bmj.com/cgi/content/full/313/7052/300[/url]
and
Selective expansion of T cells expressing V beta 2 in peanut allergy. Pediatr Allergy Immunol, 1995; 6: 95. T
[url="http://www.ncbi.nlm.nih.go/htbin-post/Entrez/query?uid=7581727&form=6&db=m&Dopt=b"]www.ncbi.nlm.nih.go/htbin-post/Entrez/query?uid=7581727&form=6&db=m&Dopt=b[/url]
[This message has been edited by EILEEN (edited June 24, 1999).]

Posted on: Fri, 06/25/1999 - 2:23pm
tracy's picture
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Joined: 02/03/1999 - 09:00

Steve W.,
Our son had a very similar reaction to your son's... he also threw up and had some hives, in addition to some mild swelling in his face. When we gave him Benadryl, it all went away quickly. We took him to an allergist as soon as we could and the allergist told us that our son's reaction was not mild -- it was anaphylactic. When I said I thought it was a good sign that our son threw up (because I thought he was getting rid of the peanuts), the allergist said he threw up because of the amount of histamine his system produced in reaction to the peanut cookie he ate -- his stomach couldn't tolerate it.
Anyway, I originally thought our son's reaction was mild (because he didn't have breathing problems either), but the allergist's explanation of his reaction has made me much more concerned.
Eileen understands the terminology better than I do, so she can correct me if I'm wrong in any of my explanations here. (Thanks Eileen.)
--Tracy

Posted on: Mon, 06/28/1999 - 8:48pm
Ilene Clayman's picture
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Joined: 06/19/1999 - 09:00

My son has multiple food allergies including nuts and peanuts. I feel that pediatricians are not properly trained about food allergies. Yesterday my friend's daughter ate peanuts and had what appears to be a reaction (hives all over). She called the doctor and got a nurse practitioner on the phone. The nurse told her it could be an allergic reaction. The nurse said you could either take her to the allergist soon or wait a month and and give her a small amount of peanuts by herself and have benadryl in case of a reaction. Things like this infuriate me. As you all know the next reaction could require epinephrine and without it the child could be in very bad shape. My friend is going to stay away from peanuts until she gets to an allergist.

Posted on: Tue, 06/29/1999 - 11:42am
Kelly Morse's picture
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Joined: 03/13/1999 - 09:00

Hi everyone! I don't think it is only pediatricians who have a lack of knowledge in this area. Our allergist refused to listen to Spencers chest, check his ears or throat (wanted us to see the pediatrican for that). He was much more interested in taking notes concerning the last two reactions. Unfortunately had he taken an interest in what was happening yesterday we may have avoid the ER this morning! Needless to say we are immediately switching allergist.
------------------
Kelly M
Another Mom in Michigan

Posted on: Wed, 06/30/1999 - 8:01am
MaryLynn's picture
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Joined: 06/25/1999 - 09:00

My first pediatrician who was suposed to also have a specialty in allergies told me that a 2 yearold can't have allergies, the throwing up after tasting and spitting out the peanut butter candy was an intolerance and to keep reintroducing it every month or so. He did not even suggest Benadryl! At three, when I had daughter try again, again she spit out the candy and then threw up. This time he suggested that I "might want to start watching what she eats". Luckily for all of us I had been watching what she had been eating carefully, because the second ped I took her to immeciately sent her for RAST testing and personally called me to inform me that she scored 46,000 well over the category 6. The ped also asked for my pharmacy phone number, so she could call in an Epi-pen prescription and referred us to an allergist who specailizes in food allergies. We have since been to the ER twice, but these doctors have worked with us and continue to do so. I am glad to say there a few really good ones out there. You just have to look hard!

Posted on: Sun, 07/04/1999 - 10:19pm
SquirrellyMom's picture
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Joined: 06/29/1999 - 09:00

This is so interesting. I have been very concerned about the lack of knowledge our family doctor seemed to have about food allergies!!
Like most of the others who have posted, I read everything I could find about introducing foods to a young child. I read a lot about the dangers of giving a child under 1 year honey - BUT, never have I read anything about peanut products!!!!
My 3rd child - now 9 years old - was given his 1st taste of peanut butter when he was 9 - 10 months old - We gave him a peanut butter cookie. He would throw-up & he became quite lethargic. This went on - off & on - for weeks!!!!! He would eat a cookie & become very sick. I took this child to our family practitioner EVERY OTHER DAY for almost 2 weeks. She could not figure out what was wrong!!!!! We never discussed possible food allergy! Josh was dehydrating & a nurse in our Dr.'s office actually told me that they were very worried because THEY THOUGHT THEY WERE GOING TO LOSE HIM and they didn't know what was making him so sick!
This doctor consulted with a partner in the same office & after he looked at Josh we were advised that he had "possibly" had some kind of allergy and that we should visit an ear, nose & throat specialist to see if he was experiencing "sinus problems". Lucky for us, the ENT Dr. said that something was causing an allergic reaction & that we should see an allergist and have tests done. I still am quite concerned with the "lack of information" I receive. At about 1 year of age, Josh was given the RAST test. He showed up mildly allergic to peas and eggs and VERY allergic to peanuts. The allergist did not advise me to carry an epi or even what reactions I could expect if Josh came in contact with peanuts! Our family doctor just "laughingly" told me to "keep him away from peanuts.
For the next 2 years Josh was exposed to peanut butter (usually in a cookie) and would throw-up and act very sick for a number of hours (sometimes a day or two). My DOCTORS, including the allergist, never even told me to give him benedryl!!!!
His worst reaction came when he was 3-1/2 and my mother accidentally gave him a mini snickers bar. She totally forgot that he had a problem with peanuts because we didn't realize how severe it COULD be. Josh threw-up & started swelling. His eyes were glassey & he had some difficulty breathing. I called the allergist because I became very scared when I looked at his reaction. The allergist told me to give him benedryl & to watch him for a while. I told him that Josh was throwing-up a lot - and the allergist said, "that's good, at least he's getting it out of his system".
Our next scare was when he was 6 and he ate some nuts from a bowl of mixed nuts when we were at a school play. He actually came and told me that he "thought" he had eaten a peanut & that nothing was happening so he was sure he wasn't allergic anymore. I took one look at him & I could see the hives beginning to come out. I threw him in the car & drove to the nearest emergency room (about a 20 min drive away) By the time I got there he was throwing-up & told me his throat felt like it had a plate in it. The emergency room staff were not helpful & made us wait in the waiting room area for over 30-45 minutes. The hives grew worse & worse and my son rolled in the floor and cried the entire time. I almost left to go to a drug store to get benedryl to try and help him - but I was afraid because it seemed to be getting worse & worse and I didn't want to leave the "safety" of the hospital. Finally a Dr. saw us & gave him the adrenalin shot with immediate relief for Josh. I shook for the rest of the night and I vowed to never go through that experience again. I've been through febral convulsions with another child & this was worse!!!!
Anyway, I made an appt. with another allergist & he not only had him skin tested for other allergies (Dust & Dogs came out very high) but he gave me a letter to carry with me about his peanut allergy & what to do if he was exposed to peanuts, he also told me to always carry an epi pen & he explained to me the seriousness of the peanut allergy (SOMETHING NO OTHER DOCTOR HAD EVER DONE!!!DUH?) After that episode, I have read up on the peanut allergy & I now pay special attention to everything in the media about it. I still don't think some of our relatives take it serious enough!! The really frightening thing for me was that it started out with throwing-up & has now moved to throwing-up, severe hives & swelling & difficulty breathing. I don't want there to be another episode!!!! BUT, with tests, doctor visits, even an allergist, NOT ONE of these made an impression on me as to how serious a food allergy could be. I have had to see it for myself, educate myself & look for a doctor I could trust. Our new allergist even told me that I should not put up with any delay in an emergency room. He was quite upset at the length of time we had to wait when we had our last reaction. He told me to always carry my letter, benedry & epi with me & to demand that they call him if I had to go in again and I was told to "wait". It makes me wonder how many people have life threatening reactions to foods & it is unrecognized!!! I trusted my doctors to know about these things - AND BELIEVE ME - THEY DID'NT!!!!!!!!!!!

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