What Questions to Ask Allergist?

Posted on: Fri, 09/22/2000 - 4:55pm
Anonymous's picture
Anonymous (not verified)

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.

Posted on: Sat, 09/23/2000 - 2:40am
amy2's picture
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Joined: 09/02/2000 - 09:00

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.

Posted on: Sat, 09/23/2000 - 3:31am
booandbrimom's picture
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Joined: 08/23/2000 - 09:00

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.

Posted on: Sat, 09/23/2000 - 6:50am
Anonymous's picture
Anonymous (not verified)

[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).]

Posted on: Sat, 09/23/2000 - 7:00am
mkruby's picture
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Joined: 05/01/2000 - 09:00

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

Posted on: Sat, 09/23/2000 - 7:04am
booandbrimom's picture
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Joined: 08/23/2000 - 09:00

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.

Posted on: Sat, 09/23/2000 - 7:06am
PattyR's picture
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Joined: 04/12/2002 - 09:00

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.

Posted on: Sat, 09/23/2000 - 7:38am
Anonymous's picture
Anonymous (not verified)

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).]

Posted on: Sat, 09/23/2000 - 10:10am
care's picture
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Joined: 09/21/2000 - 09:00

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.

Posted on: Sat, 09/23/2000 - 11:40am
KarenT's picture
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Joined: 10/30/1999 - 09:00

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.
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Karalot

Posted on: Sat, 09/23/2000 - 9:31pm
Teresa1's picture
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Joined: 09/19/2000 - 09:00

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.

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