peanut skin test

Kari,
Thanks for the note. You share some good information (not just because I happen to agree with you [img]http://client.ibboards.com/peanutallergy/smile.gif[/img] )
My daughter's school nurse and principal kept pushing for more information on our five year old daughter's peanut allergy. They wanted to avoid any changes at school and showed NO caring or compassion. Prior to the school being willing to provide any kind of accommadations, they insisted on knowing what kind of a reaction our daughter would have based on the amount of exposure: a speck of peanut butter VS two specks VS a dot, VS a bite, etc. I spent way too much time providing them info from FAN, the internet, doctor's and the blood test, trying to convince them that no one knows how much it will take and that each exposure can be different.
This went on for months. I even took our daughter out of school for almost four months because they were doing everything they could to avoid helping us keep our daughter safe at school.
I would never let anyone do a skin test on our daughter - she blisters when peanut products even touch her.
A few weeks ago, a little girl friend came over to our house to play with our daughter. Before she went home she kissed our daughter good-bye on the lips. We did not know that this little girl had eaten a peanut butter sandwich six hours earlier at school. Within minutes of the kiss, our daughter had extreme sadness, diahrea, vomiting and a rash. I think this is a good example as to why you can never know how much a peanut allergic person can be exposed to prior to anaphylaxis.
Anyway, thanks for the wise advice and welcome.
Sue in sunny Arizona

Your thoughts?

We met w Dr. Rosen of FAAn today and he is planning to do a skin test on our son - he feels there is no risk.

I am never sure where this idea that skin prick tests are incredibly dangerous comes from.
My son has had about 3 lots of skin tests with blood tests combined.
A drop of diluted peanut solution is placed on arm, then a small lance pricks the skin.
Perhaps someone knows of a few links which give us an idea of the risk of such tests.
I have always been lead to believe ( my doc is Doc Gideon Lack of St Marys hos pad , london UK)that there is a extremely low risk for these tests. However all of these skin prick tests and food challenges are carried out in hospital with easy access to any help that may be needed.
interesting thread, but when you conisder that skin prick tests have been used since the 1960's there isnt much around about the rate of deaths or severe reactions to these tests in print that I have heard/seen.
So my opinon is that these tests are low risk and worth doing.
sarah

Why if you know your child is allergic to peanuts do they have to do the skin test. Isn't the blood test enough? I would like others opinions on this as well. My dd is touch/airborne/cross contamination reactive and I definately wouldn't do the skin test. Her reactions were enough to convince me of that.

When my son went to see his immunologist , his whole medical background was noted, the allergic disease in the family , and his previous reactions and the state of his skin and chest,( his weight and height noted).
He had blood tests and the skin prick tests, and the results were considered together.
He was about 2 at this time, and there was some question over the fact that he may grow out of some of his allergies. ( he is now 8 and will be always be severely allergic to peanuts and beans)
With out the regular skin prick tests , not just for peanut but for egg ( and you must question yourselves here about the supposed risk of JUST peanut being unsafe for skin prick testing, when other common foods cause anaphylaxis ) my son would still be avoiding all egg. Since his food challenges he can now eat foods with cooked egg. I have been able to give him higher calorie foods as a result, which is very useful as he is under weight.
There is also the reasoning that if I hadnt gone for testing he would have spent the whole of his life avoiding egg for no reason.
We are dealing with a long list of allergies, and beleive me the joy of crossing one off ( even when adding others ) was worth it!
As a point , i must stress that all food challenges MUST be done within a hospital setting, not at home or in a doctors office.It doesnt matter if the doc has 30 epis in his desk drawer, epi's are there just to get you to a hospital, oh, and none of this camping outside hospitals before you shove a teaspoon of food in your childs mouth, all very risky IMO.
When I read others statements that their children have reactions to touch/contact/ airbourne etc. I often wonder if they mean life threateing ?
My son has had whole body hives ( huge ones) to coming in to contact with peanut dust. However I do NOT consider this symptom on its own to be life threatening. Painful , and to be avoided, but mainly in case of accidental injestion.
Contact reactions are again a low risk arm swelling and hives are painful, but I wouldnt give my son an epi for those symptoms.
I would simply wash affected skin and give him antihistamine, and wait for further symptoms.
This is again the result of having seen a immunologist who has assessed my child and given me a decent care plan to follow. Something that wouldnt have been acheived if he hadnt had testing.
Perhaps william has avoided constant trips to hospital because of this.
As for airbourne, for those with asthma , that must be a risk, however the situations where peanut dust is in the air must be fairly rare. The worst type of peanut product to cause asthma must be the dreaded dry roasted peanut as the particles are light and can carry up in the air.
However, my son is not asthmatic and has only had asthma type reactions to tree pollen and dog. We do have inhalers for this purpose only.
I have seen severe asthama attacks in my family , and one child ( I was her nanny many years ago!) had a nebuliser and a varity of different inhalers during the day.
So at least I have seen and lived with others with asthma and can recognise it.
As parents we can be over protective of our children , when they have food allergy to a certain extent this over protectiveness is needed. But we have to always condsider the future and work towards making our childrens adult lives as easy as possible.
sometimes that means not listeing to your friends and extended family, but researching for yourselves and making your own opinions.
sarah

I think maybe if you suspect (or are aware of ) multiple food allergies it would make a difference in the decision to do a skin test. My son had an anaphylactic reaction to peanuts, had never had any other allergic reactions, and his RAST (or CapRast) showed only an allergy to peanuts. In his case it seemed like an unnecessary exposure to do a skin test.
However, if he had (or was suspected of) multiple food allergies, I would consider the skin test, as it seems to be much more accurate.
Kelly

My son - at the time of his first skin test was aound 14 months old- we had already had a horrible reaction to peanuts. But he was having other reactions also- so we needed to get him tested. -- As the Allergist went to put the stuff on his back - had not touched his back yet - just approaching - he (my son) started breaking out in hives all over the back of his body. He has not had a skin prick test- I think the airborne contact was enough. I will not have this child ever have a skin prick test.
Now- I don't know what I am going to do with my younger son who is obviously allergic to something - but we know it isn't peanuts or nuts - because he doesn't get them- and he is almost 2 so he isn't around a school environment or a day care to be exposed to nuts. I'm trying to post pone any testing as long as I can.

If you are allergic to one food, you are more likely to have another.
For instance peanut and egg allergies are a common combination, so is peanut and tree nuts.
To find this out skin and blood tests are needed.
The children that only have the one food allergy often have other common allergies, such as asthma and ezcema, hay fever, tree pollen and mold allergies.
So for them its is of greater importance to have there asthama under control so that if accidental contact with peanut will not result in either a quicker or more severe reaction.
I have been told by my sons immunologist, DR Gideon Lack, that of all the skin prick tests, peanut is one of the most accurate.
Williams reactions to peanut skin test have risen over the years. Lacks opinon of William being a mildly allergic child with a small/low potenital when younger , has now changed to a more serious reaction and that william has a high risk of full blown anaphylaxis. ( I think as parents we guessed this well before he told us, but anyway its documented and we are prepared )
Childrens immume systems are changing as they grow and develop, and just because a child was unable to have a skin prick test as a baby, it doenst mean that he/she's allergy will remain at that high level.
Its vital to have a good indication and medical opinon from a immuneologist so that as parents we can adjust our children's lives accordingly.
For instance, if your child is air bourne allergic when younger, but when older is less sensitive, but does not have testing, it could result in a life more restricted than needed.
I am constantly amazed that my son is growing out of his egg allergy, when he was 2 he stood behind me in the kitchen when I was frying a egg, and he broke out in hives all over his face , neck and hands.
We banned egg as well as peanuts from the house for years.
With skin and blood testing combined we were persuaded to have a egg challenge.
William can now eat egg, and have a slightly less restricted food choice as a result.
Always with allergic children and with life in general its worth haveing an open mind, and listen to others opinons carefully before making your choice.
sarah