To Challenge or Not to Challenge . . . Need Advice!

Posted on: Fri, 02/16/2007 - 2:01am
Rebecca's picture
Joined: 08/23/2001 - 09:00

My 6 year old DD just tested negative on her blood test for PA-- exciting, but scary! Her allergist now wants to skin test and, if that is negative, then challenge test her. I am concerned because he is planning to challenge test in his office with a PB & J sandwich. I thought challenge tests were done in hospital with 1/200th of a peanut to start, etc. As that is a traumatic sounding procedure (IV, etc) I wasn't planning on challenge testing until she was 10 or 12. Are office challenges normal? Are they safe? I don't know what sorts of precautions they take in office. He just seemed rather cavalier about it, although we have felt very safe with him until now. He says if both tests are negative, it is 95% sure she is not allergic. Has anyone else challenged after both skin and blood tests were negative? What were the results of the challenge? Her history is this--reacted with blood in stool as an infant due to exposure in breastmilk. Skin tested positive to Peanut and Egg at 6 months. Later read that skin tests at that age are not accurate so we changed doctors. Outgrew egg allergy at 4 years. We have been very vigilant to keep her away from any peanut exposure; she has never directly eaten peanut (besides BM exposure). She has not been retested since the initial skin test, until now. I didn't expect her to have a negative result, just wanted to see where she fell on the scale. I love the thought of living a normal life, but I am scared to death to challenge test her!!

[This message has been edited by Rebecca (edited February 16, 2007).]

Posted on: Fri, 02/16/2007 - 2:41am
NicoleinNH's picture
Joined: 06/21/2003 - 09:00

[This message has been edited by NicoleinNH (edited June 10, 2007).]

Posted on: Fri, 02/16/2007 - 4:20am
turtle's picture
Joined: 12/10/2004 - 09:00

I have no advice for you, but I am in a similiar situation. My ds is almost 5. Diagnosed by skin test at 2. (Husband admits he fed him a reeces peanut butter cup prior to this with no reaction.) Negative rast at 3, positive skin test at 3 1/2 and another positive skin test just last week. His wheal was 5 mm this year, 10 mm last year, so getting smaller. Our Allergist suggests a food challenge. If the skin test was negative they would do it in the office. Since the skin test is still positive, he wants to do it at the hospital. There is a 6 month wait.
My son is a very anxious drama queen and picky eater. I asked the doctor how I should discuss it with him prior to the challenge. He said tell him he is going to eat a little peanut butter to see if he is allergic. He might get itchy or a rash.
He says they will do the challenge in a part of the hospital that is well staffed with people and equipment.
Part of me would be thrilled for him to outgrow it, but I am NOT looking forward to the challenge. His doctor does not feel it necessary to do any additional blood or skin testing.
The thought of the whole thing makes me nervous! My husband is thrilled and thinks he never really had an allergy. We shall see.
Good luck and let me know how it is goes.

Posted on: Fri, 02/16/2007 - 4:44am
BS312's picture
Joined: 09/05/2001 - 09:00

My 4 yo DD was challenged with peanut butter in the allergist's office after a RAST test was negative...not low, but negative. There was no skin test done at that time. They gave her 1/4 tsp of rxn. Then they gave her ONE TEASPOON of PB and she ALMOST DIED. (Sorry for shouting, but this is still upsetting five years later.) She required five shots of epinephrine for full-blown anaphylaxis. We later found out from our new allegist (we fired the incompetent and dangerous one) that the lab had been "having problems" and it was most likely a false negative RAST.
Just our horrible experience. I would consider waiting a few months and repeating the RAST to be sure it is truly low enough to challenge safely. Of, course, a negative skin test will be reassuring.

Posted on: Sat, 02/17/2007 - 2:29am
lj's picture
Joined: 01/26/2006 - 09:00

Our dr has several different office locations. However, he will ONLY do food challenges at his office that is attached to a hospital. That is just their policy and I have to say it sounds like a good one to me.

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