What Questions to Ask Allergist?

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Both of my children have their 1st allergist appt. at the end of October. I already know without testing that my son is PA and has environment allergies. He is nearly 5. My daughter, just turned 3, is being tested mainly because of the PA before she enters school. What are the important questions to ask when we see the allergist? I am assuming that the testing will only involve skin testing not the oral challenge for the PA. Is that even correct? Then, because I know my son is definitely PA can I avoid having him tested for that? I had wanted to confirm his environmental allergies and see if he had any other food allergies? Also, will a skin test give me a RAST score? Any suggestions would be greatly appreciated as I can remember what I asked when I had mine re-tested 20 years ago! Best wishes.

On Sep 23, 2000

Cindy, I would definitely get your son the RAST test so you will know a definitive answer about his PA. I have learned from these boards that a peanut skin test is dangerous, and should be avoided. I would have your daughter tested as well. My son was diagnosed at 10 months with PA with a RAST and he had a scratch test of other environmental allergies when he was 14 months. He has many environmental allergies as well. And be sure to get instructed about the epi pen jr. and how it is used. Hope this helps. And read these boards a lot. Every day I learn something new. Just today I learned that when using the epi pen, you are supposed to leave it in for 10 seconds, and I didn't know that. Take care.

On Sep 23, 2000

Actually, Scott Sicherer, one of the leading researchers in this field, said that they've never had a case of severe anaphylaxis that resulted from a scratch test. He seemed to think that these were pretty safe but mentioned that they will do a RAST if the mom seems uneasy with the concept.

Questions we have asked:

1. Under what circumstances should we give an Epi? Where does our child fall with regard to severity of the allergy? What other medications can/should we give?

2. Do EMTs in this area carry epinephrine or should we carry extra Epi-Pens? (Make sure you get a prescription for as many as you need - count one for you, one for home, one for school and possibly more depending on your situation.)

3. Under what conditions should we call you (the doctor)? How often do you want to see our child?

4. Are there support services in the area you can recommend?

We also asked our doctor to review our school plan and provide a letter confirming the allergy for school officials. If you like, you can ask questions about how allergies occur, etc., but they usually don't have time for this stuff. The question "will my child outgrow the allergy" always generates the "we'll have to wait and see" response no matter how many doctors we ask, so I wouldn't waste time with this one. Same with "is the allergy life-threatening."

Hope this helps - good luck.

On Sep 23, 2000

[img]http://uumor.pair.com/nutalle2/peanutallergy/confused.gif[/img] I'm really confused. What is the difference between the skin test and the test that will give me a RAST score? From reading this board, it seems like the RAST score is something that is really important for people to know. I know that Jesse's PA is extremely severe so I've never felt the need to know a score for it. He's actually being tested simply because I'm taking his sister in to see if she is PA and I wanted to see if he had any other food allergies that I wasn't aware of. That probably doesn't make sense to most of you because everyone seems to have had their child tested. I have 3 Epi-pens - 2 for him at school and 1 for us at home/with me at all times. If anyone can help me by telling me the difference between the skin test and what would give me a RAST score, that would be great. I'll probably post after my visit regardless whether my daughter is PA or not. Thanks and best wishes.

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[This message has been edited by Cindy Spowart Cook (edited September 23, 2000).]

On Sep 23, 2000

WELCOME BACK CINDY!!!!! WE'VE MISSED YOU!

On Sep 23, 2000

I can only tell you what the speaker at the last FAN conference, Scott Sicherer, said...which is that skin tests are very reliable for negative results, but have a rate of 50% false positives. However, a combination of a positive plus history (reported by the parent) is diagnostic of a food allergy. (Incidently, there is a "score" to a skin test as well depending on how quickly the child reacts and how big the wheal is.)

Skin tests are much cheaper than RAST tests, which is why doctors do them first. I do not know if a RAST test is more predictive of allergy - I do know though that the number has no relevance whatsoever to the severity of the allergic symptoms. You hear a lot of numbers thrown around on this board, but they're essentially meaningless except to confirm that a child has an allergy. If a score is in a "maybe" area, doctors will retest.

Does this help? If not, I'll pull out my stuff from the conference and retype anything applicable here.

On Sep 23, 2000

The skin test is when they actually scratch the skin and then put the allergen onto the site to see how it reacts. If there is an allergic reaction, a hive will develop at the site. The bigger the hive, the more severe the allergy. You get the results immediately. The RAST is a blood test so the child never actually comes into contact with the allergen. You will have to wait for the lab results. I recently had my son retested via a skin test and he was one of the few to have an anaphylactic reaction. Not severe I suppose but he had a large hive at the site and tightness in the throat that was getting worse. They had to treat him with epinephrine. I was concerned before the test so the dilluted the protein 100 parts water to one part peanut and he still reacted. I am in favor of the RAST as you might expect.

On Sep 23, 2000

Thank-you everyone. Actually, MK Ruby, I would have been very interested in your input re this question. I'm going to call the allergist on Monday and see if they do skin or RAST tests or both. I think from what I've read so far that I would also prefer a RAST test. I know that when my allergy testing was done as a child and again as a mid-twenties adult, it was a skin test and I had a severe allergy to dust that the allergist actually brought other doctors out to see because of the size of the hive on my arm. See, I know Jesse is PA - he has an anaphylactic reaction to peanut products so why have him tested for that simply to get some kind of score? As far as environmental allergies, I think I would feel comfortable with the skin test but I'm going to check on Monday to see if they can do RAST tests on both children. I also think that I'm going to have Jesse excluded from PA testing because I already know and it's not important to me what his score is, especially if that does not indicate the severity and I certainly don't want to risk an anaphylactic reaction in either child! Thanks so much for the clarification. I'll post after I call on Monday to get further advice if it turns out they only do skin testing. See, this is what is so fabulous about this board - when you have a question or concern you can get the input from other PA parents or PA people and be better prepared for dealing with certain things. I would not have known the difference between the two tests and I had assumed that they would both be having skin prick tests. I would have come out of there, either with Jesse having experienced an anaphylactic reaction or my daughter having experienced one should she be allergic and as severely as her brother and then we would have had to go for the RAST testing at a later date. I would have been totally pissed (pardon me). I simply know that Jesse has environmental allergies but would like to confirm to what exactly (I suspect the same as me) which I control with Claritin (I'm against immunization therapy simply from my experience with it). My daughter doesn't appear to have environmental allergies, or, if she does, they aren't as pronounced as Jesse's and again, my main reason for them seeing an allergist was to have Ember tested for PA before entering the school system. I am so pleased that I was able to get back online and post my question and receive such wonderful responses. Thank-you and best wishes. [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img] And, MK Ruby, for the wonderful post that you put in, there are probably ten people to each one that is pleased to see me back on the board currently shriekly at my reappearance because of my long windedness. Ah, what the hay! LOL!

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[This message has been edited by Cindy Spowart Cook (edited September 23, 2000).]

On Sep 23, 2000

My son just had his skin test this week and he tested positive. The hive on his back was about the size of a large mosquito bite. The Dr and the nurse who ran the test told me that you cannot tell from a skin test how severe a child is.(Are we all being given different information?) Each time a PA child has a reaction it can vary and every time they come in contact with peanut butter the reaction can get worse,according to our DR. We live in Ontario,Canada and apparently the RAST test is not available here but somehow others know what level their child is, with a 4 being the highest score.I am going to call the Drs office (He specializes in Paediatric allergies and works out of The Hospital for Sick Children in Toronto)and ask about levels and further tests. I have also been told that there is no such thing as a mild peanut allergy as (as I said before) each reaction can be different and worse each time.

On Sep 23, 2000

care I also live in Ontario. We are going to the doctor next week to have the Rast test done. It will cost us $20 per allergin that we test our daughter for , but I think it will be worth it. Just wanted to let you know that it is available in Canada.

------------------ Karalot

On Sep 24, 2000

My daughter's allergist also told us that the size of the wheal didn't mean anything. The thing I didn't like was that he treats her as a mild case because she didn't have a severe reaction her first and only time. Now that I've been to this board, I have a lot of questions to call him with.

On Sep 24, 2000

Thanks KarenT for the info, thats great I will definately be calling the Dr on Monday. I think that I am in a small state of denial as I keep thinking that he only has a mild case (No-one has told me this) but I don't feel overwhelmed by the diagnosis or terrified to let him go anywhere. We do have a neice and nephew with severe PA so I am used to this situation and he has not had a reaction in two years even though he has been around peanut butter, maybe this is why I am not as stressed out at this diagnosis as others?? BUT at the same time I am wondering what to do about the epi-pen when he is outside playing, should it be on his person at all times?We live on a court(cul de sac) alongside another court and the boys often go from one house to the next. My neighbours are now all aware of his allergy but I can't leave an epi-pen at each house!

On Sep 24, 2000

Care, my son carries his Epi-pen in a fanny pack when he is at school. Perhaps that would work for your child too. Okay, so since the RAST tests cost $20 per allergen in Ontario where I am, what should I do if I can't afford it? Do the skin tests first? As I indicated earlier, I don't need to have Jesse tested for PA, I wanted to confirm his environmental allergies and see if he had any other food allergies. So, would skin testing be okay for him? Then, with my daughter, RAST test for the PA and skin test for everything else? What do you think? I really can't afford $20.00 for each allergen and as I noted above, I have only had skin tests myself when I've been tested. What does everyone think? Thanks!

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On Sep 24, 2000

Cindy, I would think that your daughter would need the skin test first and then if that is positive you could ask for the RAST test. Also maybe you only need to do the RAST test for the peanut butter for now and do the others later as PB is the most serious.Maybe the RAST test could be a write-off on our taxes?- I know that doesn't help now and I'm only guessing but as I said before I will be looking into it. My son only showed positive for PB when he had the skin test but was also tested for walnuts,pecans, almonds and a few others. We will still keep him away from all nuts though just in case. I have a friend who developed PA at the age of 29 so I think that if your'e allergic to one type of nut stay away from the rest as you never know! Carolyn

On Sep 24, 2000

Care, thank-you for the great advice. I know that I immediately omitted all nuts from our home and diet as soon as I found out Jesse was PA because of the greater chance of cross-contamination. Although I miss the occasional pesto, we've managed fine, I think! For me, even if his tests for tree nuts came back negative, I would still avoid them for that reason. But, thank-you for your advice, that does help. And yes, the $20.00 you pay is part of Medical Expenses for the year and tax deductible (not the lump sum of $20.00, there's a whole formula to do with medical expenses and you have to spend quite a bit on prescriptions and other medical expenses to have it come out to any kind of deduction, but this would be something included in that. For example, I had to pay for both children to have their chicken pox vaccines and that's tax deductible under the Medical Expenses part). No, I just didn't want to go in and have them tested for quite a few things and ring up a lot of cash unnecessarily. Thanks for your advice and best wishes!

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On Sep 25, 2000

Hi Cindy. Welcome back. Here in Ontario RAST and CapRAST testing is not OHIP covered. It can be done but you must pay for each substance that you want tested. It gets very expensive, very quickly. If you want to do it then the blood is drawn at a local laboratory then sent to a laboratory in London, Ontario that will test and report the results. RAST testing is rarely done here in Ontario and if you want it then you will have to push for it. My ds and my brother have never had it, only skin tests. It does not really offer any additional help when dealing with this on a day to day basis--either the child is allergic or not. IMHO.

On Sep 25, 2000

Kathyrn, what is the difference between RAST and Cap RAST testing? So, I think that if I do skin tests for everything except the PA for my daughter in case she does have a severe reaction, that I'll be okay? The posts on this board, not this thread in particular, but the board in general have made me feel extremely guilty that I haven't had my children allergy tested. It seems like everyone's children have been through a litany of tests and everyone knows certain scores and everything. All I know is that Jesse has an anaphylactic reaction to peanut products. To me, his reaction is severe enough that I felt he didn't need tested. And again, the main reason we're going is to simply have Ember tested for PA before entering school. Then, I thought since we were going I might as well have their environmental allergies confirmed while we're there. Does this make any sense? As you say though, you're either allergic or not and as far as the PA, that's basically what I want to know about Ember, whether she's PA or not. Thanks for your thoughts and also for your kind welcome back. Best wishes!

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[This message has been edited by Cindy Spowart Cook (edited September 25, 2000).]

On Sep 25, 2000

I just got off the phone with my sons allergist. He also is involved with the Division of Immunology and Allergy at Sick Kids so I feel that he does know what he is talking about!! According to him you can only find out whethar or not your child is PA from a skin test or RAST test not the level of allergy. He said that they used to use it to give a level but have since found that it doesn't matter how big the reaction is, anyone can have a severe reaction if they are positive. That is not to say that everyone is severe but just that they don't know who is--except that asthmatics tend to have worse reactions because of the breathing difficulties.A CAP-RAST is a guideline test and they use it on people who have displayed a mild reaction and they think that they are losing the allergy. Now they have found that some people do loose the allergy if they were only mild to begin with. What he said that any and all peanut allergies are to be treated as severe as even if you had a mild reaction one time the next could be severe. A RAST test(been around since 1968) doesn't give you any further info than the skin test. ---Carolyn

On Sep 25, 2000

I have my child scheduled with an allergist for next month. I found out that she was PA last week when she was exposed to peanut butter. Her doctor gave her the Rx for the epi-pen jr and I keep Benadryl on hand at all times. Why am I taking her to the Allergist if they cannot determine the severity of the allergy to peanut products by the test that they run?

On Sep 25, 2000

LGHC, When they do the skin test they for peanuts they will also test for a few other nuts.(walnuts,almonds,pecans) A friends daughter had a reaction with hives etc and they blamed it on the peanut butter sandwich that she had eaten,when they did the testing they found that she wasn't allergic to peanuts and the DR said that she must have had some virus that coincided with the ingestion of the peanut butter. Sounds wierd I know but now she eats peanut butter safely.

On Sep 26, 2000

LGHC, see, I thought the same as you do, if we know are child is PA why do we have to have them tested? From all of the wonderful posts I've seen here, I've basically decided to just have them skin tested and with Jesse I will ask that they DO NOT test for the PA. I already know he has an anaphylactic reaction to peanut products. My whole reason for them going to an allergist is that I wanted to see if my daughter was PA or not before she enters the school system. She has never been exposed to peanut product. Then, I thought, since I was taking her, I might as well have Jesse tested for other food allergies and to confirm what environmental allergies he has. Otherwise, I thought his PA was handled well by his family doctor (i.e., prescribed the Epi-pen, fills out the school forms), so why go to an allergist? But I'm really pleased I posed the ? on this forum because now I know the difference between the types of test and also feel fairly comfortable simply having them skin tested. Best wishes!

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On Sep 26, 2000

To all you Canadians...I have been trying to read the Canadian thread and can only get the first page, is anyone else having any difficulty with this? I emailed the website contact but haven't heard anything.

On Sep 26, 2000

Care, to get to the other pages of the Canadians thread - if you pull up the thread, it will say something about this thread is 1 2 3 pages long with each of the numbers underlined. This is at the top left hand of the thread. When you 1st pull it up, you'll see that you have page 1 with it underlined. Then, just click on the page that you want to get into. Hopefully that made sense. Let us know if it didn't. Best wishes.

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On Sep 26, 2000

Thanks Cindy for the reply but I have already tried that. When I pull up the Canadians thread it says that it is 3 pges long but only shows page 1 it doesn't have 2 or 3 underlined

On Sep 26, 2000

Care, I checked the thread after I gave you the instructions and it worked okay for me. When you go into the thread from the Main Discussion Group it will automatically pull up page 1 for you but if you look in the upper left hand corner once the thread has been pulled up it will show that you're on page 1 and it indicates there are pages 2 and 3 and they're underlined. When you want to go to them you go to the top of the page and click on the number 2 that is underlined and it will bring 2 up. And the same for page 3. I did try it without any problems but if you try it again after reading this and still have problems I know that I'm not very good at explaining computer stuff or maybe it does have something to do with either your computer or the website. Also, once you click on the page that you want, say page 2, it does take what seems like a couple of minutes for it to appear. Good luck trying. Maybe someone else will come into this thread that can explain it better than I have. Best wishes!

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On Sep 26, 2000

Hi Care - I'm also Canadian, my name is also Carolyn and my nickname is also Care! Pleased to meet you! There is spot on the top of the page to press to send the page through email. I noticed you don't have your email posted or I would have sent you the pages already. If you don't want to post your email address on the board, you can ask [email]Chris@PeanutAllergy.com[/email] to send you the pages you can't access. If you want to email me with your address I can send them to you email or snail mail, whichever you prefer. My email is [email]mcarolynblack@hotmail.com[/email]

Whereabouts in Canada are you located? No particular reason - just being nosy! Take care.

Cindy - welcome back! I live about 45 minutes or so from you. You should email me and maybe we can get together for coffee sometime. I'd like to meet the web-famous author of the PA article! Take care, Cindy.

[This message has been edited by Cayley's Mom (edited September 26, 2000).]

On Sep 26, 2000

Cindy - I wanted to comment or your statement about the reasons for allergy testing. Both or my kids have been RAST tested, so I know what their food allergies are. (I also know from their reactions) I am in the process of looking for a new allergist, mostly because of the problems my kids have had with asthma. I was in the ER last week with my daughter, and was asking the opinion of the ER Dr. on this. The new allergists I was looking into all wanted to automatically skin test my kids. I just didn't want to put them through that, since I know what to avoid, and they are not having any symptoms that are a mystery. Anyway, The ER Dr. agreed. He said that you would treat them the same way whether they had the skin testing or not. He said, "What does it matter what tree you are allergic to?" So, I hope this isn't too confusing, just trying to agree with your initial opinion of why you didn't have your kids tested yet. (But I do understand your reasons for having them tested now.)

On Sep 26, 2000

Thanks Cindy and Carolyn. I know exactly what you mean Cindy but my computer is not showing those other two page numbers--it did once a day or two ago but I went to page 2 and not page three and since then I have had no luck! Carolyn(Care!) I have now entered my email address so if you don't mind I would appreciate you emailing me the pages--Thanks. We live in Brampton,Ontario. I have 3 daughters and a son(PA). Thanks again.....Carolyn

On Sep 26, 2000

Cindy-

My daughter has never been tested for PA but I know she is. She had been tested for tree nuts three years ago and showed no difficulty to peanut then so we didn't test. She ate it fine ( but only rarely and only in candy) until this last spring. She started having a rash, hives, minor facial swelling and repetitive coughing after eating some Easter candy. This happened around the time we were scheduled to see the allergist anyway. He said by history alone we could determine her PA and it would be pointless to test because regardless of the actual results he would recommend she avoid peanut anyhow.

The number results from testing mean absolutely nothing. Many numbers vary depending on the type of test you do and the manufacturer of the test your allergist purchases. At the FAN conference they gave this example: two people have a rast result of 50, both are exposed to peanut one goes into full anlphylaxis the other gets a rash, well the very next time their reactions could be reversed. They also said someone with a 50 could get a hive and someone with a 2 could go into full on anaphlyaxis. You just never know what will happen.

Linda

On Sep 26, 2000

Cayley's Mom, it would be really good to meet you IF THIS 41 YEAR OLD WOMAN KNEW HOW TO DRIVE!!!! [img]http://uumor.pair.com/nutalle2/peanutallergy/redface.gif[/img] I am literally "stuck in Stayner" due to some misguided belief people that were born and raised in Toronto have that they don't need to learn how to drive! As far as the article, I, again, truly believe that any one of us could have written it and am becoming even more embarrassed because it was a draft. I think I am going to use it as Jesse's introduction letter for the next School Council meeting though since the issue of PA was overtaken by the issue of [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img] head lice (I posted all this under Schools). And, Care, I'm sorry that I couldn't simply say what Carolyn did to you - give me your e-mail address. Duh! Best wishes!

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On Sep 26, 2000

Please bear with me but I have a question that you all have probably answered already on this page. My 3 year old was diagnosed 3 weeks ago with PA after breaking out in massive hives and facial swelling. I brought her to the doctor and they did a rast test which was positive to peanuts..Do I need to have her skin tested? Does a skin test show her reaction if she touched peanuts? I hope i don't sound too stupid. I'm still in that confused overwelmed stage! I'm learning so much from all of you..but its a lot to take in...Do you know what I mean? I also wanted to know what you guys thought of this...My daughter is in a preschool 2X week for half days..but there is no nurse at this school. I gave instructions to the teachers on the epi pen..do you think I should look into changing her school. I'm just so worried about her. Thanks!

------------------ Sue

On Sep 27, 2000

I don't think you have to switch schools for your child due to not having a nurse. I would however also train the director of her school and anyone else who may come in contact with her on using the epipen and what to look for. THere is a great web site and someone here posted it somewhere that was created specifically to train teachers/school personnel in how to use an epi, and signs to watch for. Very simple and user friendly, I hope this is the right address: [url="http://www.parsons.umaryland.edu/epipen/index.html"]www.parsons.umaryland.edu/epipen/index.html[/url]

My daughter goes to a private school in NYC that has no nurse and I met with all her teachers, (her two class teachers, her art teacher, gym teacher, music, etc.) A few people that worked in the office, the director and others to give a demonstration on how to use the epipen, how to spot a reaction, etc. I also left about 5 epi-pens there, they are located all over the school so they are easily accesible depending on where she is (they move around a lot for kindergarteners!). ANyway, just because someone is a school nurse wouldn't automatically give them much experience in PA or epi-pens. Just my opinion. At first its overwhelming but you really do adjust, most days I don't even think about it. She is pretty aware of her allergies now and has accepted that she cannot eat a lot of candies that other kids eat (which is just fine anyway but of course the potato chip habit she has is out of this world LOL) Halloween is coming up again and I buy a lot of stuff w/out nuts and after she goes trick or treating we go through it and switch whatever is questionable. I used to do that anyway before I was sure of her allergy, like get rid of any chokable type candies when she was really young, etc.

On Oct 23, 2000

My appointment is less than a week away for both kids. Do you think I have it covered "properly"? Skin test both for everything except peanuts. No peanut test at all for Jesse because it's obvious. RAST test for Ember for peanuts. Any additional thoughts? I'm getting more nervous as the time approaches, not because of the results I may get but simply because it has to be done. I've also decided to have my daughter done first as she is younger (3) and then her Grandmother can console her, if need be, while Jesse is done next. Does that make sense? Thanks all. Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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On Oct 24, 2000

Hi cindy, I had my son tested at 1 year and my daughter at 5. My son was excellent through the entire thing. Naturally we knew he was going to react to the peanut. The doctor told us he would test the nut up higher just because he was assuming the reaction would happen. sure enough he reacted so quickly that the doctor wiped the test right off. He say there is that answer. the only problem is he also reacted to every nut except for walnut. He had very small reactiont to this. The pistachio was very bad. We had him tested to everything. Naturally they will be uncomfortable,but it is something they get over quickly. We had him done again before kindergarten and same results. He did fine. We bought some new toys and wrapped them and let him open them after unless he got cranky during this we would have given them to him during the test. Then they don't know what is going on. It was amazing how the little trinkets worked. My daughter was tested to cats and things like this. she was 5 and never made a peep. It wasn't comfortable but she was fine. With her it was the McDonalds she was getting after. Let me know how you do. Claire

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