reliability of testing

Posted on: Fri, 10/15/1999 - 11:34am
CVB in CA's picture
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Joined: 10/15/1999 - 09:00

My son has a peanut allergy. The pediatrician
has prescribed Benadryl and epi-pen. We have not used the epi yet.
My son is 4 and been exposed several times, but only ingested 2X (snickers and Nutter
Butter Cap'n Crunch cereal).
My pediatrician will not refer him to allergist for testing. He continues to say
my son is clearly allergic to peanuts, and
severly so. Testing would not show any
different.
The pediatrician says that testing in very young children- in his opinion below 6 years
is not really reliable.
I am worried about related allergies. He is undersized and scrawny compared to his sister. I have been told that this can be allergy related, inhibits physical growth.

Any comments on whether testing has been accurate in your small children?

Posted on: Fri, 10/15/1999 - 10:27pm
Christine's picture
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Joined: 02/03/1999 - 09:00

After my son's first reaction to peanut butter at age 8 months, my pediatrician referred me to an allergist. He admitted that allergies were not his area of expertise and felt that they should be handled by a specialist (but SOME pediatricians can/do take a special interest in allergies). My allergist tested my son (at about 10 months) and he clearly showed a reaction to peanuts as well as eggs (which we were unaware of). I think your doctor might be incorrect in stating that testing is unreliable. The only real problem with testing a very young child is that not all their allergies have had a chance to develop so the test you have at age 2 could be very different than the test you get at age 5 or 6. When my son was tested for the first 2 years he showed no reactions to environmental allergens (dust mites, pollen, etc.) but at age 3 1/2 they started to surface. The egg and peanut reactions have remained the same throughout our 4 years of testing, no better, no worse.
Christine

Posted on: Sat, 10/16/1999 - 5:23am
Ilene Clayman's picture
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Joined: 06/19/1999 - 09:00

My son is also 4 years old and allergic to peanuts, nuts, mustard, sesame, kiwi and fish. His only reaction to peanuts was at 18 months. My pediatrician recommended an allergist and his allergy was confirmed with a blood test and skin test. Subsequent to that all his food allergies were confirmed by an allergist. I would insist that your pediatrician refer him to an allergist and that your son be tested. Tell him or her that there would be no harm if he saw an allergist and perhaps it would be a benefit as the allergist may be able to uncover undetected allergies.

Posted on: Sat, 10/16/1999 - 1:41pm
Donnamarie's picture
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Joined: 11/16/1999 - 09:00

I had a similar experience with several of my doctors. They all agreed that my son has analphylaxis to peanuts, and several other foods, but would not refer him to an allergist. In the meantime, he kept experiencing other seemingly non-related problems such as ASTHMA, lack of growth, stomach disorders and gastrointestinal reflux. After finally changing to a pediatrician who referred us to an allergist, we learned that all these problems were caused by food allergies. Remember, this is your child! You know he's allergic to peanuts, he could be allergic to something else. Also, you could learn how and when to use the epi-pen, and what symptoms you should look for when trying new foods. Many pediatricians (in my opinion) do not give food allergies the respect they deserve. These doctors may also be pressured by insurance companies to not give referrals. But insist on at least an initial "second opinion" by an allergist.

Posted on: Sat, 10/16/1999 - 1:43pm
Donnamarie's picture
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Joined: 11/16/1999 - 09:00

Sorry for the second posting. Although your child's allergies may change between the ages of 2 and 5, you should consider that you need to feed your child based on your current situation. Also, if your child had a severe reaction to peanuts, please insist on a RAST test. Our son had a terrible reaction to the skin prick test for peanuts... it was awful to watch. And RAST tests are much safer.

Posted on: Mon, 10/18/1999 - 5:18am
EILEEN's picture
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Joined: 04/06/1999 - 09:00

In May 1994, UK government's Chief Medical Officier issued guidelines to general practictioners (the equivalent of your kid's/family doctor)
"All patients suffering from peanut allergy should be referred to a specialist clinic."
Although this CMO Update covered peanut allergy specifically, the need for specialist medical advice was shown to be jsut as important for whatever foods trigger anaphylaxis.
I would find an allergist AND an new pediatrican.
[This message has been edited by EILEEN (edited October 18, 1999).]

Posted on: Mon, 10/18/1999 - 7:33am
Susan K's picture
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Joined: 08/13/1999 - 09:00

Something else to consider: allergists help maintain a reaction-free patient with meds and helpful hints. You mentioned your son was underweight. My allergist recommended a dietary conselor that specializes in food allergies. My son is allergic to pn, wheat, eggs, and milk. He was underweight and she gave me ideas to supplement his diet and add fat and calories.

Posted on: Mon, 10/18/1999 - 7:59am
CVB in CA's picture
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Joined: 10/15/1999 - 09:00

Thank you for your replies. I will try this again more forcefully. How expensive is a RAST test? Is there any info on incidence of "false positives"? Would skin tests for wheat and dairy be ok, or should I insist on RAST for all the typical foods?
I am currently in HMO, but was PPO up till this July. I don't think the doctor is caving to pressure from insurance on this one. His answer has always been the same no matter which insurance company it has been. Although I did not notice it when I selected this Dr.- who has a rep as very good diagnostician and has good bedside manner, he is about 5 ft. + (to be generous) 4 inches. The kids really relate to him. When I tried to discuss the growth thing with him, Dr. said "he's just going to be short and incredibly brillian like his doctor". Very funny- not!
Regarding other symptoms, my son does not have athsma or bowel problems. He rarely, but has once or twice said his stomach hurts after a meal. Either related to illness or MANGO. He had a sip of a mango smoothie once and vomited in under 3 seconds and had cramps for hours. I thought he had e. coli or something for a few hours. Later he had a piece of mango at a party and turned red as a lobster.
My son would not eat meat until he was 3 years old. He just never puts on any weight. He had a bad start after the hospital- below six pounds after 1rst week, and then lost 5% of his body weight with a rotavirus infection at 2 yrs. He was always at 10th percentile or below and is now the same weight 27 lbs. as his 2 year old sister. I still think something is holding him back from more growth even though he doesn't have any other symptons.

Posted on: Mon, 10/18/1999 - 11:58am
dhumphries's picture
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Joined: 02/02/1999 - 09:00

Hi,
I would like to comment on your son's being undersized. My son just turned three last week, and is also undersized compared to most three year olds. He weighs 28 pounds. He is also much less socially mature than many three year olds, and I am having trouble with potty training him also. I wouldn't say that he is less intelligent, as he can count to 20 and say his ABC's, but he just seems to be socially immature. Does anyone else with p.a. children find them to be a little behind their peers in social development?

Posted on: Mon, 10/18/1999 - 1:23pm
ElizabethsMom's picture
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Joined: 04/17/1999 - 09:00

Hi
It sounds like you have a history with this pediatrician....consider the value of going through the diagnosis and education process with this ped before you switch. If you want to see an allergist, don't ask DEMAND. Find out your rights under the HMOs by-laws and bring a highlighted copy in to the next meeting with your physician. Perhaps even schedule a visit without the kids to specifically discuss this issue (make it at the end of the day so he doesn't have to hurry off to another child). In my years of experience as a patient (many many years) and a parent, I've found it is easiest to work out the flaws with a ped you generally like rather than break in a new one.
Be prepared that the allergist may choose not to re-test your child. Our pediatrician RAST tested our daughter, another allergist gave her a skin-prick test and our current allergist believed that those tests were valid and did not re-test for peanut butter. He did, however, test for a few other food allergies such as shell-fish and eggs. Interestingly enough he also put a lot of faith in our account of her reaction to peanut butter. I found it very refreshing to talk with a doc who really regarded my experience. Like your ped, he seems to believe that an actual reaction is the best indication of an allergy.
Both dhumphries and CVB - As far as heights, weights and social maturity goes - my daughter is 22 months, weighs 29 lbs at 30 inches tall (she's a chunk) and is more social than most children. I attribute her social nature to two days a week at a great day care, a once-a-week play group, a rowdy gymnastics class and two extroverted parents. Her day care and play group are tremendously supportive of her PA status which allows us to be more involved socially than lots of PA toddlers. I've often wondered if the social inhibitions discussed by many parents are indirect effects of the difficulties in creatin a secure environment for PA children. What is your opinion?
------------------
Kristin

Posted on: Mon, 10/18/1999 - 2:22pm
Anonymous's picture
Anonymous (not verified)

CVB in CA- Is your son allergic to tree nuts in addition to peanut? My daughter is tree nut allergic and we strictly avoid Mango. Mango comes from the same family as pistachios. It is not uncommon for tree nut allergic people to have problems with Mango.

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